375 Overview of Somatic Symptom and Related Disorders

Question 2 of 6 When assessing the current physical health of a patient who is being evaluated for a somatic illness, which questions would the nurse ask the patient? Select all that apply. "Have you had any recent falls or injuries?" "How satisfied are you with your life on a daily basis?" "How many hours of uninterrupted sleep do you get each night?" "When did you first notice that your headaches were becoming problematic?" "How much liquid do you drink daily, excluding caffeinated or alcoholic beverages?"

"Have you had any recent falls or injuries?" "How many hours of uninterrupted sleep do you get each night?" " "How much liquid do you drink daily, excluding caffeinated or alcoholic beverages?"

Question 3 of 13 Which statements of a homeless person in the ED best meets the criteria for psychiatric inpatient admission? Select all that apply. "I'm hungry. Can I have something to eat?" "I got crucified today. Nothing can kill me now." "There's a devil in me, and I have to starve him out." "You have no right to keep me here. You'd better let me go!" "I ran out of my meds. I keep thinking that if I run in front of a car it would be over fast."

"I got crucified today. Nothing can kill me now." "There's a devil in me, and I have to starve him out." "I ran out of my meds. I keep thinking that if I run in front of a car it would be over fast."

Question 12 of 14 A patient was admitted to an inpatient psychiatric unit for acute mania. The patient has since stabilized and is preparing for discharge with his treatment team who has recommended he enter psychotherapy. The patient asks his nurse why psychotherapy is necessary. Which is the best response by the nurse? "Psychotherapy will give you someone to talk to." "Psychotherapy will show your doctor you are invested in treatment." "Psychotherapy will eventually replace your medication." "Psychotherapy will help you cope with stressors that present after discharge."

"Psychotherapy will help you cope with stressors that present after discharge." When the patient is not experiencing acute mania, psychotherapy may be used to help the patient cope more positively to stressors in the environment and decrease the risk of relapse

Question 3 of 6 Which statement made by the instructor to a class of nursing students best describes the role of trauma to development of a somatic symptom disorder later in life? "A history of physical trauma is a risk factor for the development of a somatic symptom disorder." "History of childhood trauma is difficult to obtain and relies on anecdotal information from family members." "There is a direct relationship between degree of childhood trauma experienced and the likelihood of developing somatic symptomology." "Experiences of trauma early in life have not been shown to be a risk factor in the development of a somatic symptom disorder later in life."

"There is a direct relationship between degree of childhood trauma experienced and the likelihood of developing somatic symptomology." The more trauma experienced during childhood, the more likely the person is to have physical manifestations related to the trauma, resulting in some form of somatic disorder. This statement accurately describes the role of trauma in development of somatic symptom disorder.

Question 5 of 14 The hospital unit's psychiatrist has ordered a mood stabilizer and antipsychotic for a patient with bipolar disorder. The nurse is now administering medications and recognizes the patient has not been educated on the newly ordered medications. Which would be the appropriate education to provide this patient? "Valproate will help make you happier, and risperidone will help control the side effects of valporate." "Valproate will help to control your mood while risperidone will help your mind to think clearly." "Risperidone will give you more energy during the day while valproate will speed your thoughts." "Valproate and risperidone are common medications for bipolar disorder. You should notice improvement in a few weeks."

"Valproate will help to control your mood while risperidone will help your mind to think clearly." This response accurately identifies the effect of valproate, a mood stabilizer, and risperidone, an atypical antipsychotic.

Question 1 of 6 Which statements made by an individual diagnosed with factitious disorder demonstrate a motivation for secondary gain? Select all that apply. "When I have headaches, I call in sick to work and my boss calls later to check on me." "I love having my sister here to take care of me. Since she moved, I hardly ever see her." "I feel bad that I can't do the laundry when I don't feel well, but my family understands." "The nurses at my provider's office are always so sweet. They make sure I'm seen right away." "I'm worried I might have a brain tumor. I've had difficulty concentrating at work recently, and that's one of the symptoms."

"When I have headaches, I call in sick to work and my boss calls later to check on me." "I love having my sister here to take care of me. Since she moved, I hardly ever see her." "The nurses at my provider's office are always so sweet. They make sure I'm seen right away."

Question 1 of 14 The onset of bipolar II is typically around what age? 18 25 30 35

25 The onset of bipolar II is typically in the mid-20s.

Question 2 of 13 Which patient admitted to the emergency department is most likely to be admitted to the inpatient psychiatric unit? An anxious patient who cannot sleep A depressed patient who lacks motivation A medicated patient with bipolar disorder who occasionally hallucinates A paranoid patient with schizophrenia who is aggressive toward the ED nurse

A paranoid patient with schizophrenia who is aggressive toward the ED nurse A paranoid patient with schizophrenia who is aggressive toward the ED nurse is dangerous and requires inpatient care.

Question 7 of 13 Which patients are well suited for referral to PHP? Select all that apply. A homeless patient An acutely suicidal patient A patient who needs help improving coping skills A patient who needs more structure than day treatment A patient being discharged from an inpatient unit after a lengthy hospitalization

A patient who needs help improving coping skills A patient who needs more structure than day treatment A patient being discharged from an inpatient unit after a lengthy hospitalization

Question 1 of 6 When discussing somatic symptom illness in class, which example would the instructor provide to aid in the students' understanding of these disorders? A patient who was in a motor vehicle accident a year ago is being seen for chronic lower back pain. A patient who is being seen by the primary care provider for insomnia describes being out of work for 6 months. A patient, having recently lost their spouse, is seen for acute abdominal pain but has an otherwise normal examination. A patient who schedules an appointment with the primary care provider to discuss issues with excessive worry over family finances.

A patient, having recently lost their spouse, is seen for acute abdominal pain but has an otherwise normal examination. This patient has a significant reason for an acute emotional reaction but does not associate the abdominal pain with the emotional responses to the loss of a spouse. This is an example of somatic symptom disorder behavior.

Question 12 of 14 During the implementation phase of providing nursing care to a depressed patient, what is the primary goal of the nurse? Develop a discharge plan. Provide for patient safety. Eliminate negative thoughts. Encourage patient participation in support groups.

Provide for patient safety. The nurse's main goal in providing patient care during the implementation phase is to provide for patient safety.

Question 9 of 14 An older adult patient whose husband recently died has experienced insomnia and significant weight loss for the past six months. Which techniques should the nurse use when communicating with this patient? Select all that apply. Provide spiritual referrals. Explore the patient's childhood. Encourage supportive relationships. Encourage activities that can raise self-esteem. Encourage the patient to rest as much as possible.

Provide spiritual referrals. Encourage supportive relationships. Encourage activities that can raise self-esteem.

Question 5 of 6 Which examples of patient behavior would the nursing instructor present to a class of students when teaching about factitious disorder? Select all that apply. Reporting a sudden inability to speak without any other physical concerns Refusing to let one provider see the records from, or contact, a previous provider Undergoing three abdominal surgeries in 6 months for undiagnosed abdominal pain Excessively researching lung cancer on the Internet because of an occasional cough in the winter months Demanding specific diagnostic tests for symptoms within an hour of being seen in the emergency department

Refusing to let one provider see the records from, or contact, a previous provider Undergoing three abdominal surgeries in 6 months for undiagnosed abdominal pain Demanding specific diagnostic tests for symptoms within an hour of being seen in the emergency department

Question 13 of 14 A patient diagnosed with bipolar disorder presents for his medication evaluation with the outpatient psychiatric nurse. The patient states that he has significantly decompensated since his last appointment, now endorsing fatigue, anhedonia, insomnia, and suicidal ideation. He also admits to smoking more cigarettes to help him try to relax. Which nursing diagnoses apply to this patient? Select all that apply. Risk for injury Sleep deprivation Ineffective coping Interrupted family processes Impaired verbal communication

Risk for injury Sleep deprivation Ineffective coping

Question 13 of 14 The nurse uses the depressive patient's statement, "I don't want to be around anyone right now. I want to be alone," to help formulate which nursing diagnosis? Hopelessness Self-care deficit Low self-esteem Risk for loneliness

Risk for loneliness The depressive patient's social isolation puts him or her at risk for loneliness.

Question 5 of 14 Which tool is an example of collaborative care of the patient with a depressive disorder? Safety plan Face-to-face checks No restraints policy Electroconvulsive therapy (ECT) consent

Safety plan The safety plan includes resources and coping strategies for patient to use, including relaxation exercises, physical activities to reduce stress, and how to access support from family, significant others, and the therapist. The patient identifies at one or more reasons for living

Question 4 of 13 What is the role of the psychiatric liaison who works in the ED? Implements the plan of care Determines patient disposition Evaluates patient odd behaviors Secures an inpatient psychiatric bed

Secures an inpatient psychiatric bed The psychiatric liaison secures an inpatient psychiatric bed at a local facility for the patient.

Question 10 of 13 Which treatment strategies are often used in dual diagnosis/co-occurring disorders programs? Select all that apply. ACT Self-help groups Psychiatric home care Relapse prevention plans Couples and family therapy NOT SURE

Self-help groups Relapse prevention plans Couples and family therapy

Question 14 of 14 A patient is prescribed a tricyclic antidepressant (TCA) for feelings of hopelessness due to severe insomnia. What should the nurse teach the patient about this medication? A potential toxic effect of TCA use is stroke. The patient may experience constipation when taking a TCA. TCAs work by flooding the brain with serotonin and dopamine. The patient will take a high loading dose of the TCA in the beginning and then will be given a lower daily dose.

The patient may experience constipation when taking a TCA. Reactions to TCAs are similar to those for anticholinergic drugs: dry mouth, blurred vision, tachycardia, constipation, urinary retention, and esophageal reflux.

Question 6 of 14 A patient has just been started on lithium. The patient reports to the nurse that she has been experiencing increased urination, nausea, and a slight tremor. How should the nurse respond to the patient? "Those are typical side effects of lithium. We will continue to monitor you." "Those are signs of lithium toxicity. If you skip tonight's dose of lithium, the symptoms should subside. You should be able to continue with your regular lithium dose in the morning." "We need to alert your doctor immediately." "Let's check your lithium level before continuing with this medication."

Those are typical side effects of lithium. We will continue to monitor you." This response accurately identifies the expected side effects of lithium and identifies that in a non-emergent, non-toxic state, the patient should continue to be monitored.

Question 9 of 14 A patient has just been put into seclusion. Which information should the nurse include in her documentation of the event? Select all that apply. Type of behavior exhibited by the patient What items have been permitted in the seclusion room with the patient Time patient entered seclusion Time when patient is planned to be released Less restrictive interventions used first

Type of behavior exhibited by the patient Time patient entered seclusion Less restrictive interventions used first

Question 1 of 13 When does disposition begin for psychiatric patients admitted to the emergency department (ED)? Upon entry to ED At discharge from ED Upon placement to a crisis house At acceptance to a day treatment program

Upon entry to ED Disposition for psychiatric patients begins upon entry to the ED and includes placing the patient at a lower level of care.

Question 5 of 6 Which action would a nurse take if they felt a negative bias toward a patient in their care who is being treated for a somatic symptom or related disorder? Ask to be assigned to a different patient. Avoid lengthy interactions with the patient. Provide the care needed, ignoring the negative feelings. Work with the nursing supervisor to understand the source of the negative feeling.

Work with the nursing supervisor to understand the source of the negative feeling. Understanding the source of the bias and learning how to overcome it by working with a trusted colleague will allow the nurse to provide the full spectrum of care needed.

Question 11 of 14 The nurse is caring for a withdrawn patient diagnosed with a depressive disorder. Which statements made by the nurse exemplify appropriate nursing interventions for this patient? Select all that apply. "Would you like to go for a walk or watch a movie?" "You are very sweet and kind to everyone on the unit." "I know you're not much of a runner, but you should go for a jog." "You seem overwhelmed, so I will give you some alone time." "You're in a tough spot now, but you're doing the work to pull yourself through."

Would you like to go for a walk or watch a movie?" "You are very sweet and kind to everyone on the unit." "You're in a tough spot now, but you're doing the work to pull yourself through."

Question 9 of 13 Which is the major treatment challenge associated with community mental health? Access to health care Lack of adequate resources Availability of psychotherapy Adherence to medication regimen

Adherence to medication regimen Even though community mental health patients have access to medication monitoring, many patients do not feel the need to continue with medication now that "normal life" has resumed outside of the hospital.

Question 6 of 13 At which point in PHP care is an aftercare treatment plan developed? At the end of PHP At the beginning of PHP When medication is decreased or discontinued After 90 consecutive days of PHP participation

At the end of PHP A referral to outpatient care or a day treatment program is planned upon completion of PHP to assist the patient to cope in a less structured setting

uestion 7 of 14 Which medication should the nurse anticipate will be ordered for a manic patient who is highly agitated? Clonazepam Citalopram Clozapine Clonidine

Clonazepam Clonazepam, which is a benzodiazepine, is useful in controlling agitated behavior.

Question 6 of 6 Which intervention would be provided by the case manager involved in the care of a patient diagnosed with a somatic symptom or related disorder? Assess vital signs with each patient encounter. Schedule a diagnostic x-ray requested by the provider. Develop a schedule of routine follow-up care office visits. Facilitate a group working on assertive communication skills.

Develop a schedule of routine follow-up care office visits. The case manager would develop and maintain an appointment schedule to minimize excessive office visits.

Question 4 of 6 Which strategies would the nurse employ to develop and maintain an empathetic relationship with a patient diagnosed with a somatic symptom or related disorder? Select all that apply. Allow the patient one office visit per month. Develop patient goals that are reasonable and attainable. Encourage the patient to continue with the same provider consistently. Encourage the patient to seek a second opinion if symptoms do not improve. Remind the patient that their symptoms are in their head and not a cause for worry.

Develop patient goals that are reasonable and attainable. Encourage the patient to continue with the same provider consistently.

Question 7 of 14 Which medical procedure does the nurse anticipate that the health care provider to order for the patient who experiences catatonia due to depression? Deep brain stimulation (DBS) Vagal nerve stimulation (VNS) Electroconvulsive therapy (ECT) Transcranial magnetic stimulation (TMS)

Electroconvulsive therapy (ECT) ECT is used in depressive patients who have marked agitation, marked vegetative symptoms, or catatonia.

Question 11 of 14 A patient has been exhibiting significant and worsening mania. He has developed paranoia that has advanced to the point that the patient is not eating because he believes food is poison. The treatment team wants to choose a treatment that will act quickly. What would be an appropriate option considering the patient's state? Lamotrigine Mirtazepine Electroconvulsive therapy (ECT) Phototherapy

Electroconvulsive therapy (ECT) Electroconvulsive therapy (ECT) is sometimes used to reduce severe manic behavior. It can be especially useful in decreasing severe depression, catatonia, paranoid-destructive symptoms, and treatment-resistant depression.

Question 2 of 14 Which is a characteristic of bipolar II? Clang associations Decreased social function Continuous, accelerated speech Excessive involvement in pleasurable activities

Excessive involvement in pleasurable activities Bipolar II is characterized by excessive involvement in pleasurable activities that have a potential for painful consequences.

Question 14 of 14 A patient diagnosed with bipolar disorder is seen by the outpatient psychiatric nurse for the medication evaluation. The patient states, "I just can't see things getting better in the future. Why am I even here anymore?" Which nursing diagnosis is most appropriate for this patient? Hopelessness Risk for injury Ineffective coping Self-care deficit

Hopelessness Based on the statement made by the patient, he describes a lack of hope for the future.

Question 3 of 6 When focusing on individual strengths or weaknesses, which characteristics would the nurse explore when assessing a patient with a somatic illness? How frequently the individual seeks medical care Concurrent mental health diagnoses the individual has How the individual has dealt with past stressors or problems Enjoyment of the attention received related to physical symptoms

How the individual has dealt with past stressors or problems Understanding an individual's coping skills and how they deal with adversity is an important aspect of the assessment for individual strengths and weaknesses.

Question 3 of 14 Which are characteristics of hypomania associated with bipolar I? Select all that apply. Impulsivity Distractibility Risky behavior Poor global functioning Resistance to somatic treatments

Impulsivity Distractibility Risky behavior

Question 5 of 13 Treatment in PHP is characterized by which factor? ACT Aftercare Psychiatric home care Intensive outpatient therapy

Intensive outpatient therapy PHP is one level below inpatient hospitalization and provides intensive outpatient therapy.

Question 10 of 14 A patient presents to a psychiatric outpatient office and reports a history of bipolar disorder and epilepsy. Which medication would present a high risk for treatment for this patient? Lithium Carbamazepine Valproate Lamotrigine

Lithium Lithium can cause seizures when serum level exceeds therapeutic range.

Question 12 of 13 A psychiatric nurse assesses which factors during a psychiatric home visit? Select all that apply. Medical illness Family dynamics Transportation issues Medication compliance Distance to community health center

Medical illness Family dynamics Medication compliance

Question 8 of 13 Which are components of PHP aftercare? Select all that apply. Inpatient follow-up Outpatient therapy Psychiatric home care Day treatment program Medication management

Outpatient therapy Day treatment program Medication management

Question 10 of 14 The nurse develops a plan of care for a patient with major depressive disorder (MDD). Which nursing outcomes are appropriate for this patient? Select all that apply. Patient will report any presence of suicidal ideation. Patient will verbalize two resources of emotional support. Patient will report decreased crying spells during day shift. Patient will report ability to sleep soundly for 18 hours a day. Patient will remain without self-harm during hospitalization.

Patient will verbalize two resources of emotional support. Patient will report decreased crying spells during day shift. Patient will remain without self-harm during hospitalization.

Question 13 of 13 Which group is the focus of ACT services? Patients who are in PHP Patients who are homeless Patients who are chronically ill Patients who are acutely suicidal

Patients who are chronically ill ACT case manages chronically ill psychiatric patients who would otherwise use the ED to address their mental health needs.

Question 2 of 6 Which statements regarding somatic symptom disorders are accurate? Select all that apply. Patients with somatic symptom disorders often have seen many different providers. Somatic symptom disorders are rooted in psychologically buried and unrecognized phobias. Lack of insight on the patient's part into the psychological aspect of their symptoms is common. Organic physical conditions must be ruled out before a diagnosis of somatic symptom disorder can be made. Once a patient with a somatic symptom disorder accepts the etiology of their symptoms, treatment is often successful.

Patients with somatic symptom disorders often have seen many different providers. Lack of insight on the patient's part into the psychological aspect of their symptoms is common. Organic physical conditions must be ruled out before a diagnosis of somatic symptom disorder can be made.

Question 2 of 14 Which statement is true regarding the diathesis-stress model of depression? Depression symptoms result from the feelings of helplessness and unworthiness. Depression symptoms occur as a result of cultural and ethnic perspectives. People predisposed to depression can develop depression that is triggered by hormonal changes. People predisposed to depression can develop depression that is triggered by a stressful life event.

People predisposed to depression can develop depression that is triggered by a stressful life event. The diathesis-stress model of depression purports that some people may be born with a predisposition toward depression that can be triggered by a stressful life event.

Question 4 of 14 Difficulty making decisions is a symptom of which depressive disorder? Schizophrenia disorder Premenstrual dysphoric disorder Persistent depressive disorder (PDD) Disruptive mood dysregulation disorder

Persistent depressive disorder (PDD) Patients with PDD experience symptoms for long periods of time, which can impact cognitive processes. The patient with impaired cognition may have difficulty making decisions

Question 8 of 14 An ICU nurse has just been assigned to a patient transferred for treatment of lithium toxicity. Which treatments should the nurse expect to be ordered for this patient? Select all that apply. Gastric lavage Mannitol LFT monitoring Urea Aminophylline Haloperidol

Gastric lavage Mannitol Urea Aminophylline

Question 4 of 14 Which are thought to be the causes of bipolar disorder? Select all that apply. Genetics Hypothyroidism Immune response Neurotransmitter disorders Hyperactive pituitary gland

Genetics Hypothyroidism Neurotransmitter disorders

Question 8 of 14 Which collaborative team member would be the most appropriate team lead for a depressed patient who has recently left priesthood? Pharmacist Social worker Patient's family Spiritual counselor

Spiritual counselor The spiritual counselor provides emotional and spiritual support to the patient and provides information about the community and facility spiritual resources.

Question 1 of 14 Which type of statements may indicate the presence of depression? Statements about chronic medical illnesses Statements that reflect negative thoughts about self Statements that reflect negative thoughts about others Statements about the presence of interpersonal stressors

Statements that reflect negative thoughts about self Negative thoughts about self can aid in the development of depression

Question 11 of 13 Assertive Community Treatment (ACT) addresses which issues for patients with chronic mental illness? Select all that apply. Family therapy instituted with patient permission. Intensive therapy sessions Structured case management After hours and weekend problem-solving Medication management to avoid an ED visit

Structured case management After hours and weekend problem-solving Medication management to avoid an ED visit

Question 3 of 14 Inappropriate guilt is which type of depressive symptom? Primary Objective Subjective Secondary

Subjective Feelings of inappropriate guilt are a subjective symptom of depressive disorders.

Question 6 of 14 A patient reports unpleasant side effects from antidepressant therapy. Which nonpharmacological options might the nurse recommend to the patient for treating depression? Select all that apply. Suggest the patient enroll in art therapy. Encourage the patient to undergo acupuncture. Refer the patient to a cognitive behavioral therapist. Ask the health care provider to change the patient's antidepressant dosage. Ask the health care provider to change the patient's antidepressant to a mood stabilizer.

Suggest the patient enroll in art therapy. Encourage the patient to undergo acupuncture. Refer the patient to a cognitive behavioral therapist.

Question 6 of 6 Which benefit is a patient diagnosed with factitious disorder imposed by another seeking? Medical care for their own physical symptoms The best possible care for their sick dependent The attention that comes from being a dedicated caretaker Time away from other responsibilities and life expectations

The attention that comes from being a dedicated caretaker In factitious disorder imposed by another, the person (often a parent) is motivated by the attention they get for their role in the care of the "sick" dependent.