Mental: Ch 21 Somatic Symptom Disorders

Which statement by the client indicates an understanding of somatic symptom disorder? A) "Taking medication won't help my pain since it's caused by stress." B) "How I handle stress and emotions can affect my physical health." C) "I have to avoid stress all my life to avoid getting sick again." D) "As soon as my symptoms go away, I'll be my old self again."

B) "How I handle stress and emotions can affect my physical health."

A client is admitted to a mental health unit because the client was found trying to inject diluted feces into the client's hospitalized child's intravenous line. The client has a history of similar attempts of harming the child. The nurse would most likely suspect what? A) Borderline personality disorder B) Functional neurologic symptoms C) Factitious disorder imposed on another D) Schizoid personality traits

C) Factitious disorder imposed on another

While assessing a client thought to have a factitious disorder, a nurse asks the client to describe when the client felt nurtured as a child. Which response would the nurse interpret as supporting the client's diagnosis? A) "The only time I felt loved and appreciated was when I made the honor roll at school." B) "I felt loved and accepted when my father apologized for spanking me so hard." C) "I never felt nurtured or loved when I was growing up." D) "The only time I ever felt loved was when I was sick enough to miss school."

D) "The only time I ever felt loved was when I was sick enough to miss school."

With treatment, conversion disorder often remits in a few weeks but recurs in approximately which percentage of clients? A) 10% B) 35% C) 50% D) 25%

D) 25%

what is the focus of treatment of somatic symptom disorder?

managing symptoms improving QOL

a factitious disorder where the person intentionally causes injury or physical symptoms to self to gain attention and sympathy from health-care providers, family, and others

munchausen

when a person inflicts illness or injury on someone else to gain attention of medical personnel or to be a "hero" for "saving" the victim

munchausen by proxy

the primary symptom of pain, which generally is unrelieved by analgesics and greatly affected by psychological factors in terms of onset, severity, exacerbation and maintenance

pain disorder

A nurse is working with a client diagnosed with somatic symptom disorder who is experiencing pain. Which would be an important focus of care? Select all that apply. A) Identifying strategies to relieve pain B) Administering opioid analgesics as neeeded C) Suggesting the use of complementary and alternative treatments. D) Addressing nonpharmacologic measures for symptom relief E) Examining stressors in the client's life

A) Identifying strategies to relieve pain C) Suggesting the use of complementary and alternative treatments. D) Addressing nonpharmacologic measures for symptom relief E) Examining stressors in the client's life

A client's family member asks the nurse, "What is a conversion disorder?" Which is the best response by the nurse? A) It involves unexplained, usually sudden, deficits in sensory or motor function. B) It is characterized by multiple physical symptoms. C) It is a preoccupation with an imagined or exaggerated defect in physical appearance. D) It is a preoccupation with the fear that one has a serious disease.

A) It involves unexplained, usually sudden, deficits in sensory or motor function.

Which best describes the concept of somatization? A) Manifestation of physical symptoms from psychological distress B) Psychological origin of illness that is not real C) Physical symptoms that are all in one's head D) Symptoms that cannot be substantiated by physicians

A) Manifestation of physical symptoms from psychological distress

Which best describes the concept of somatization? A) Manifestation of physical symptoms from psychological distress B) Psychological origin of illness that is not real C) Symptoms that cannot be substantiated by physicians D) Physical symptoms that are all in one's head

A) Manifestation of physical symptoms from psychological distress

After teaching a group of nursing students about somatic symptom disorder (SSD), the instructor determines that additional education is necessary when the group identifies which statement as true? A) The condition is an acute short-term condition. B) The age of onset is usually before age 30 years. C) The condition is characterized by multiple physical symptoms. D) The disorder includes a combination of pain and gastrointestinal, sexual, and pseudoneurologic symptoms.

A) The condition is an acute short-term condition.

The nurse is seeing a Chinese client who reports chronic pain that radiates to the lower back. The client reports the pain has been unresolved with analgesia, physical therapy and therapeutic massage. The client's diagnostic imaging reports are all unremarkable. Which statement by the nurse would be the most supportive response to this client? A) "It would be best for your to see a specialist until the underlying issue is properly diagnosed." B) "You must be so frustrated with this unexplained pain. Do you have other stresses in your life too? C) "Is it common in your culture to talk about psychological distress like it is physical pain?" D) "The treatment that was recommended to you has worked for many clients. It is supported by research."

B) "You must be so frustrated with this unexplained pain. Do you have other stresses in your life too?

Which is a significant obstacle in providing psychiatric care for clients who have somatic symptom illnesses? A) There are no known successful treatments for these disorders. B) Clients are often unrecognized because clients receive treatment in different primary care offices, and care is often fragmented. C) Clients with these disorders find it difficult to go to a clinic setting. D) Clients are often embarrassed about the number and extent of their physical complaints.

B) Clients are often unrecognized because clients receive treatment in different primary care offices, and care is often fragmented.

When describing the major difference between somatic symptom disorder and factitious disorders, which would the nurse include? A) In somatic symptom disorder, clients consciously seek attention. B) In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints. C) Factitious disorders respond much more readily to psychopharmacologic treatment than does somatic symptom disorder. D) In factitious disorders, clients are unaware that their symptoms are not real.

B) In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints.

Following a long history of multiple visits to community clinics and emergency departments, a client has been diagnosed with hypochondriasis. During this current visit to the emergency department, the client has just been informed that diagnostic testing and assessment reveal no severe illness. Despite this, the client persists in verbalizing physical complaints. How should the nurse respond to this? A) Facilitate a repeat of the previous diagnostic testing in order to appease the client. B) Set limits with the client about the complaints. C) Have a different member of the care team present the test and assessment results to the client. D) Feign an assessment of the client in order to calm the client's anxiety.

B) Set limits with the client about the complaints.

A nurse was placed in charge of the pediatric care unit. Over a period of time it was discovered that most of the children on the unit experienced sudden cardiac arrest. Although the nurse went to great lengths to revive the children, most of these children died. On further investigation, it was found that the nurse had been injecting high doses of digoxin drug in the children, which caused the cardiac arrest. The nurse was arrested and found guilty. What would have been the most likely cause of the nurse's behavior? A) The nurse might have conversion disorder. B) The nurse might have Munchausen's syndrome by proxy. C) The nurse might have somatic symptom disorder. D) The nurse might have Munchausen's syndrome.

B) The nurse might have Munchausen's syndrome by proxy.

When describing somatic symptom disorder to a group of nurses, which would the nurse include as a significant obstacle in providing psychiatric care for clients with that disorder? A) Clients are often embarrassed about the number and extent of their physical complaints. B) There are no known successful treatments for this disorder. C) Clients are often unrecognized because clients seek out multiple care providers and care is often fragmented. D) Clients find it difficult to go to a clinic setting.

C) Clients are often unrecognized because clients seek out multiple care providers and care is often fragmented.

The nurse has concluded the assessment of a client recently diagnosed with somatic symptom disorder. The client states the client's most significant source of stress is that "No one believes how sick I am." The client's physical complaints include fatigue, loss of appetite, and frequent urination. Based on these data, the most appropriate nursing diagnosis is what? A) Hopelessness related to chronicity of symptoms as evidenced by dependency B) Risk for spiritual distress related to feelings of isolation C) Ineffective coping related to unresolved psychological issues as evidenced by inability to express feelings verbally D) Chronic low self-esteem related to physical symptoms that inhibit the client's daily functioning

C) Ineffective coping related to unresolved psychological issues as evidenced by inability to express feelings verbally

When assessing a client with somatic symptom disorder, which would the nurse most likely note? A) Denial and repression are the chief defense mechanisms used. B) The client willfully controls the physical symptoms. C) Reports of physical symptoms do not have a demonstrable organic basis to fully account for them. D) The client's symptoms are under the conscious control of the client.

C) Reports of physical symptoms do not have a demonstrable organic basis to fully account for them.

The nurse is seeing a an adolescent client who has attended the clinic frequently with vague reports of abdominal pain. Despite normal blood values, stool tests, and diagnotic imaging of the abdomen, the client continues to report symptoms. Which psychological factor may be contributing to the client's problem? A) The client is the head of the school debate team. B) The client is fearful of needles. C) The client's parents are considering getting divorced. D) The client recently received a low mark on an exam.

C) The client's parents are considering getting divorced.

A parent brings a teenaged child, who is complaining of having a severe headache, to the clinic. The teenager is groaning with pain. During assessment, the client asks the nurse for a note to excuse the absence from school. After further assessment, the nurse suspects that the client is malingering. What leads the nurse to come to this conclusion? Choose the best answer. A) The client reported having signs related to raised intracranial pressure, such as nausea. B) The client's symptoms may have been a result of stress caused by studying all night for an exam. C) The client's symptoms disappeared after getting the medical note. D) The client was not found to have any underlying cause of headache on assessment.

C) The client's symptoms disappeared after getting the medical note.

The nurse is teaching basic physical exercises and meditation techniques to a client recently diagnosed with conversion disorder. What outcome does the nurse expect from teaching the client these exercises? Choose the best answer. A) The exercises may help the client understand the conflict underlying the disorder B) The exercises may distract the client from the physical disability C) The exercises may help the client manage stress underlying the disorder D) The exercises may help the client express feelings of fear, anger, guilt, or inadequacy

C) The exercises may help the client manage stress underlying the disorder

The nurse is providing care to a client with somatic symptom disorder (SSD). Which would the nurse expect to be included in the client's plan of care? A) Multiple provider evaluations B) Electroconvulsive therapy C) Mood stabilizers to manage the symptoms D) Cognitive behavior therapy

D) Cognitive behavior therapy

Which characteristic differentiates conversion disorder from malingering disorder? A) Conversion disorder is normally permanent, while malingering disorder is transient in response to stress. B) Conversion disorder has no pathophysiological cause, while malingering disorder has a neurological or endocrine basis. C) Conversion disorder produces reward, while malingering disorder normally results in punishment or difficulty. D) Conversion disorder is an unconscious process, while malingering disorder is a deliberate fabrication of symptoms.

D) Conversion disorder is an unconscious process, while malingering disorder is a deliberate fabrication of symptoms.

Which would be most important for a nurse to do when caring for a client with somatic symptom disorder? A) Assist in developing a daily routine B) Administer prescribed pharmacotherapy C) Ensure adherence to counseling D) Develop a sound, positive nurse-client relationship

D) Develop a sound, positive nurse-client relationship

The nurse is educating the spouse of a client with a somatic symptom disorder about how to best help the client. Which strategy should the nurse suggest? A) Ignore the client's complaints about physical discomfort and help the client focus on feelings instead. B) Encourage the client to acknowledge the spouse's frustration and helplessness. C) Keep a log of the client's physical symptoms to track improvement. D) Empathize about physical discomfort but encourage independence.

D) Empathize about physical discomfort but encourage independence.

The nurse is educating the spouse of a client with a somatic symptom disorder about how to best help the client. Which strategy should the nurse suggest? A) Keep a log of the client's physical symptoms to track improvement. B) Ignore the client's complaints about physical discomfort and help the client focus on feelings instead. C) Encourage the client to acknowledge the spouse's frustration and helplessness. D) Empathize about physical discomfort but encourage independence.

D) Empathize about physical discomfort but encourage independence.

A group of nursing students is reviewing information about somatic symptom and related mental health disorders. The students demonstrate understanding of the information when they identify which disorder as involving physical or psychological symptoms (or both) fabricated to assume the sick role? A) Alexithymia B) Conversion disorder C) Illness anxiety disorder D) Factitious disorder

D) Factitious disorder

In which disorder is the individual motivated solely by the desire to become a health care client? A) Conversion disorder B) Illness related disorder C) Somatic symptom disorder D) Factitious disorder

D) Factitious disorder

Which mental health disorder is characterized by a fear of developing a serious illness based on a misinterpretation of body sensation? A) Alexithymia B) Body dysmorphic disorder C) Conversion disorder D) Hypochondriasis

D) Hypochondriasis

A client who has been having difficulty functioning in daily life comes to the nurse and states, "I'm really afraid. I've had these funny feelings in my stomach. I'm scared that I might have cancer." The client has been seen by numerous health care professionals and no evidence of cancer has been demonstrated. The nurse suspects what? A) Conversion disorder B) Factitious disorder C) Functional neurologic symptom disorder D) Illness anxiety disorder

D) Illness anxiety disorder

Which medication classification has been shown to be effective in some cases of somatoform disorders? A) Antibiotics B) Antipsychotics C) Antimanics D) Serotonin reuptake inhibitors (SSRIs)

D) Serotonin reuptake inhibitors (SSRIs)

Which term describes the conversion of unexpressed emotions into physical symptoms? A) Psychosomatic B) Hysteria C) La belle indifference D) Somatization

D) Somatization

The primary reason for considering cultural issues when caring for the client with somatization disorders is what? A) Somatization disorders differ in type and frequency of symptoms and depend on the culture in which they are expressed. B) Somatization disorders usually only occur in the United States. C) Somatization disorders are only seen in a few cultures. D) Somatization disorders are characterized by middle-class, Caucasian value expressions.

A) Somatization disorders differ in type and frequency of symptoms and depend on the culture in which they are expressed.

A client reports a headache. On further assessment, the nurse finds that the client has been spending long hours on a difficult project at work. What should the nurse conclude from the assessment? A) The client may be stressed from work. B) The client may be lying about pain. C) The client may have conversion disorder. D) The client may be a hypochondriac.

A) The client may be stressed from work.

A client complains of severe low back pain that began shortly after the death of the client's mother 2 years ago. No physical cause has been found to account for the pain. The client has been largely responsible for the care of four younger siblings because the client's father spends much of the week out of town on work-related business. Based on the client's symptoms, which nursing diagnosis is most appropriate for the client at this time? A) Somatic complaints due to anxiety related to life stressors B) Ineffective parenting due to poor coping C) Depression exhibited by repressed rage D) Altered comfort exhibited by poor school grades

A) Somatic complaints due to anxiety related to life stressors

The nurse obtains a psychosocial history from a client who may have psychological factors affecting the medical condition. Which should the nurse recognize as pertinent to this diagnosis? A) No physiologic cause has been found for the client's symptoms. B) The client's symptoms are related to conscious motives. C) The client is able to articulate the cause of psychological distress. D) The client's symptoms subside with appropriate medical treatment.

A) No physiologic cause has been found for the client's symptoms.

A nurse is preparing to interview a client diagnosed with somatic symptom disorder. The nurse anticipates that the client will most likely exhibit what? A) Rapidly changing moods during the interview B) Altered mental status C) Intermittent nodding and glancing at the clock on the wall D) No facial expression during the interview

A) Rapidly changing moods during the interview

Somatic symptom illness disorders are characterized by what? A) Severe physical symptoms that cannot be explained by any organic or physical pathology B) Self-inflicted injuries C) Self-induced disease states or faked symptoms to garner attention D) Physical symptoms coupled with extreme focus on emotional state

A) Severe physical symptoms that cannot be explained by any organic or physical pathology

Clients from which continent or country may have symptoms of somatization disorder that include the nondelusional sensation of worms in the head or ants under the skin? A) Africa B) China C) North America D) Greece

A) Africa

A nurse is reviewing the medical history of a client diagnosed with somatic symptom disorder. Which would the nurse expect to find as a comorbid condition? A) Depression B) Thought disorder C) Sleep disorder D) `Bipolar disorder

A) Depression

A nurse is preparing a plan of care for a client diagnosed with body dysmorphic disorder. Which nursing diagnosis would the nurse likely identify as the priority? A) Disturbed body image B) Ineffective coping C) Low self-esteem D) Risk for other-directed violence

A) Disturbed body image

A nursing instructor is describing complex somatic symptom disorder to a group of nursing students. The instructor determines that the teaching was successful when the students state what? A) The first symptom usually appears during adolescence. B) Highly educated individuals often develop this disorder. C) The disorder typically is diagnosed in men. D) The disorder commonly occurs with substance abuse.

A) The first symptom usually appears during adolescence.

Which statement about the etiology of somatic symptom disorder is accurate? A) The disorder is associated with substance abuse. B) The exact etiology is unknown. C) The disorder is more common in adults with a history of child abuse. D) Most clients with somatic symptom disorder also suffer from schizophrenia.

B) The exact etiology is unknown.

The nurse is assessing a client who reports severe chest pain. The client appears worried and frightened. Further assessment and laboratory testing does not reveal any abnormalities. The nurse observes that in the absence of any medical personnel, the client watches TV, is relaxed, and speaks to a friend on the phone in a normal tone of voice. What should the nurse suspect in this case? A) The client may have Munchausen's syndrome. B) The client may have silent angina. C) The client may be a hypochondriac. D) The client may be malingering.

D) The client may be malingering.

what antidepressants are most commonly used to treat somatic symptom disorder?

SSRI's

involves unexplained, usually sudden deficits in sensory or motor function related to an emotional conflict the client experiences but does not handle directly

conversion disorder

characterized by physical symptoms that are feigned or inflicted on one's self (or another) for sole purpose of gaining attention other emotional benefits

fabricated/induced illness

preoccupation with the fear that one has a serious disease or will get a serious disease

hypochondriasis

characterized by multiple, recurrent physical symptoms in a variety of bodily systems that have no organic or medical basis

hysteria

the intentional production of false or grossly exaggerated physical or psychological symptoms

malingering

the relief of anxiety achieved by performing the specific anxiety-driven behavior or the direct external benefits that being sick provides, such as relief of anxiety, conflict, or distress

primary gain

the internal or personal benefits received from others because one is sick, such as attention from family members, comfort measures and being excused from usual responsibilities or tasks

secondary gain

A client developed conversion blindness after witnessing the death of the client's twin in a car accident. When teaching the client's parent about the client's illness, the nurse explains what? A) The client's blindness is a reaction to the trauma of losing the twin and has no physiologic basis. B) The clients blindness will gradually disappear if proper ophthalmologic care is provided. C) The client's blindness results in increased anxiety and attention from family and friends. D) The client's blindness requires a conscious effort to maintain the feigned symptom

A) The client's blindness is a reaction to the trauma of losing the twin and has no physiologic basis.

A client is admitted to a mental health unit with a diagnosis of factitious disorder. When reviewing the client's history, which would a nurse most likely find? A) Parents who were restrictive B) Malingering to avoid work C) Pain to achieve a self-serving goal D) Intentional self-injurious behavior

D) Intentional self-injurious behavior

Which mental health disorder is characterized by a fear of developing a serious illness based on a misinterpretation of body sensation? A) Alexithymia B) Hypochondriasis C) Conversion disorder D) Body dysmorphic disorder

B) Hypochondriasis

The la belle indifference occurs in which somatoform disorder? A) Somatization disorder B) Hypochondriasis C) Body dysmorphic disorder D) Conversion disorder

D) Conversion disorder

A client has been diagnosed with somatic symptom disorder. The client's assessment reveals high levels of anxiety. Which would the nurse expect to be prescribed? A) Antipsychotics B) Tricyclic antidepressants C) Mood stabilizers D) Selective serotonin reuptake inhibitors (SSRIs)

D) Selective serotonin reuptake inhibitors (SSRIs)

All of the following disease processes are caused by stress except which one? A) Diabetes B) Hypertension C) Colitis D) Deep vein thrombosis

D) Deep vein thrombosis

Somatic symptom illness disorders are characterized by what? A) Self-inflicted injuries B) Self-induced disease states or faked symptoms to garner attention P C) Physical symptoms coupled with extreme focus on emotional state D) Severe physical symptoms that cannot be explained by any organic or physical pathology

D) Severe physical symptoms that cannot be explained by any organic or physical pathology

What is the major clinical finding in somatic symptom disorder? A) The client's inability to focus on emotional content B) Loss of voluntary motor or sensory functioning C) Pain with a history of "doctor shopping" D) The report of symptoms with no demonstrable pathology on testing or examination

D) The report of symptoms with no demonstrable pathology on testing or examination

Over the past 5 years, a client has had two exploratory surgeries and numerous examinations for severe abdominal pain. All diagnostic and laboratory results have been negative for organic problems. The client has had vague descriptions of periods of anxiety and depression and has continued to seek medical assistance for the abdominal pain and various other physical problems. The nurse would assess this client as using which defense mechanism? A) Displacement B) Repression C) Somatization D) Dissociation

C) Somatization

In somatic symptom disorders, all except which are true? A) The client believes he/she has a serious illness. B) The client believes that his/her condition is catastrophic and disabling. C) The client usually believes he/she has some sort of anxiety disorder. D) The client embraces the "sick role."

C) The client usually believes he/she has some sort of anxiety disorder.

When describing the major difference between somatic symptom disorder and factitious disorders, which would the nurse include? A) Factitious disorders respond much more readily to psychopharmacologic treatment than does somatic symptom disorder. B) In somatic symptom disorder, clients consciously seek attention. C) In factitious disorders, clients are unaware that their symptoms are not real. D) In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints.

D) In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints.

During a client interview, the nurse determines that the client has a fear of developing a serious illness based on a misinterpretation of body sensation. The nurse identifies this as being characteristic of what? A) Conversion disorder B) Factitious disorder C) Alexithymia D) Illness anxiety disorder

D) Illness anxiety disorder

Assessment reveals that a client has been intentionally injuring the self so that the client can receive long-term disability and not have to work. The nurse interprets this behavior as suggesting which condition? A) Factitious disorder B) Functional neurologic symptom disorder C) Factitious disorder imposed on another D) Malingering

D) Malingering

Which is the name given to a direct external benefit that being sick provides, such as relief from anxiety? A) La belle indifference B) Secondary gain C) Malingering D) Primary gain

D) Primary gain