Ch. 21 Somatic Symptom Disorders PrepU M.C.
A client is prescribed sertraline for treatment of a somatoform disorder. The nurse would instruct the client to be alert to which side effect? Vomiting Headache Increased appetite Constipation
Headache
Which statement by the client indicates an understanding of somatic symptom disorder? "Taking medication won't help my pain since it's caused by stress." "How I handle stress and emotions can affect my physical health." "I have to avoid stress all my life to avoid getting sick again." "As soon as my symptoms go away, I'll be my old self again."
"How I handle stress and emotions can affect my physical health."
A client with somatic symptom disorder has been attending group therapy. Which of the following statements indicates that therapy is having a positive outcome for this client? "I feel better physically just from getting a chance to talk" "I haven't said much, but I get a lot from listening to others" "I shouldn't complain too much; my problems aren't as bad as others" "The other people in this group have emotional problems"
"I feel better physically just from getting a chance to talk"
Which of the following statements would indicate that teaching about somatic symptom disorder has been effective? "The doctor believes I am faking my symptoms." "If I try harder to control my symptoms, I will feel better." "I will feel better when I begin handling stress more effectively." "Nothing will help me feel better physically."
"I will feel better when I begin handling stress more effectively"
A nurse is assessing a client with conversion disorder. The client complains that the client's left side is paralyzed. Which statement made by the client would indicate "la belle indifférence"? "Please do something to cure me. I am a burden to everybody." "My paralysis doesn't bother me. I have accepted my disability." "I am sure I will get well soon. This problem won't persist for long." "I am not able to walk or do anything at all. I am totally dependent on my mom."
"My paralysis doesn't bother me. I have accepted my disability."
The nurse is working with a client who has been coming to the clinic regularly with a report of abdominal pain and fatigue. The nurse consults with another health care provider, who states, "she is just psychosomatic, we can't do anything to help her." What is the nurse's best response to the health care provider? "That word perpetuates stigma and does not validate the client's distress." "Even clients who are attention seeking deserve the attention of their health care providers." "I agree, the client's problems are purely psychological. She should address the mental illness first." "We can offer the client a placebo medication to keep trust in the relationship."
"That word perpetuates stigma and does not validate the client's distress."
With treatment, conversion disorder often remits in a few weeks but recurs in approximately which percentage of clients? 50% 25% 35% 10%
25%
After reviewing the epidemiology of somatic symptom disorder, the nurse should correctly identify which of the following clients is most likely to be diagnosed with this condition? A male client who was born in North America, works as a truck driver, and experienced verbal abuse as a child A female client who recently migrated from China, works as a consultant, and recently married A female client who recently migrated from South America, works as a housekeeper, and had a parent pass away recently A male client who is migrated from South America, works as an office manager, and has an estranged spouse
A female client who recently migrated from South America, works as a housekeeper, and had a parent pass away recently
Which scenario best exemplifies the psychosocial theory of the development of somatic symptom disorders? A person's family of origin models ineffective coping and conflict-based interactions. An individual consciously develops fictitious complaints in order to distract himself or herself from stressors. An individual's neuroendocrine system is overstimulated and the person becomes accustomed to this condition. A person unconsciously realizes that a particular physiological response produces a reward.
A person unconsciously realizes that a particular physiological response produces a reward.
Which is the primary gain associated with developing physical symptoms in response to stress? Accept dependency Decrease anxiety Experience attention Suppress anger
Accept dependency
A student nurse asks the mental health nurse about when somatic symptom disorder (SSD) usually begins. The nurse responds by saying that the first symptoms often appear during which time? Adolescence Early 20s After age 40 years Mid 30s
Adolescence
A client yells at the nurse, "You are all quacks! Can't you see I am sick?" Which knowledge would help the nurse to work most effectively with this client? Client progress is expected to be very slow. Physical illness is the root of the client's problems. The client will never be free of somatic symptoms. The nurse has done everything possible to treat the client.
Client progress is expected to be very slow
Which is a significant obstacle in providing psychiatric care for clients who have somatic symptom illnesses? Clients with these disorders find it difficult to go to a clinic setting. Clients are often embarrassed about the number and extent of their physical complaints. Clients are often unrecognized because clients receive treatment in different primary care offices, and care is often fragmented. There are no known successful treatments for these disorders.
Clients are often unrecognized because clients receive treatment in different primary care offices, and care is often fragmented.v
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? Depression Bipolar disorder Thought disorder Sleep disorder
Depression
The nurse is caring for a client with somatic symptom disorder. When assessing this client, the nurse would be especially alert for symptoms of what? Depression Avoidant personality disorder Delirium Bipolar disorder
Depression
Which would be most important for a nurse to do when caring for a client with somatic symptom disorder? Administer prescribed pharmacotherapy Ensure adherence to counseling Develop a sound, positive nurse-client relationship Assist in developing a daily routine
Develop a sound, positive nurse-client relationship
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? Disturbed body image Ineffective coping Low self-esteem Risk for other-directed violence
Disturbed body image
After teaching a group of nursing students about somatic symptom disorder (SSD), the instructor determines the need for additional education when the students identify which as a characteristic of the disorder? Easily manageable with treatment Symptoms that move from one body system to another Symptoms tend to change Symptoms that can last from 6 to 9 months
Easily manageable with treatment
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? Keep a log of the client's physical symptoms to track improvement. Empathize about physical discomfort but encourage independence. Encourage the client to acknowledge the spouse's frustration and helplessness. Ignore the client's complaints about physical discomfort and help the client focus on feelings instead.
Empathize about physical discomfort but encourage independence.
When assessing a client diagnosed with hypochondriasis, the most serious risk factor to be identified for this client is what? Aggressive behavior Ruminating thoughts Extensive use of over-the-counter medications Denial of emotional problems
Extensive use of over-the-counter medications
The nurse is caring for a client with conversion disorder. The client reports having paralysis of the right side of the body. Which action by the nurse would constitute a secondary gain? Talking about family and friends with the client Feeding the client during mealtime Teaching the client techniques of meditation and relaxation Discussing coping strategies that the client used in the past
Feeding the client during mealtime
Clients with a somatization disorder typically do what? Discuss feelings and express needs verbally Minimize their medical history Have a history of going to many different providers without satisfaction Avoid playing the sick role and resist attention from health care providers
Have a history of going to many different providers without satisfaction
A nurse is describing the social network of clients diagnosed with somatic symptom disorder when conducting a class for a group of staff nurses. The nurse determines that the class was successful when the group identifies which network as the primary network for this population? Peers Coworkers Health care providers Siblings
Health care providers
A client is seen in the primary care clinic complaining of headaches. The client appears extremely distressed and insists that she must have a brain tumor. Which diagnosis is most probable for this client? Conversion disorder Pain disorder Brain cancer Hypochondriasis
Hypochondriasis
A client is seeking relief for undiagnosed pain. There is no history of significant physical illness. The history reveals that the client was laid off 4 months ago from her job. Which statement made by the client would most strongly suggest a somatoform disorder? I have been having a hard time lately. It's hard not working like I'm used to. I seem to have more pain now that I got laid off. I probably just overexerted myself working around the house. It's hard to slow down. I'm sure they will figure out what is wrong with me.
I seem to have more pain now that I got laid off.
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? Illness anxiety disorder Conversion disorder Factitious disorder Functional neurologic symptom disorder
Illness anxiety disorder
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? Factitious disorder Alexithymia Conversion disorder Illness anxiety disorder
Illness anxiety disorder
The nurse anticipates which nursing diagnosis is the most likely to contribute to co-morbid depression in a client with somatic symptoms disorder? Impaired social interaction Disturbed thought processes Ineffective airway clearance Disturbed sensory perception
Impaired social interaction
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? Ineffective coping related to unresolved psychological issues as evidenced by inability to express feelings verbally Chronic low self-esteem related to physical symptoms that inhibit the client's daily functioning Risk for spiritual distress related to feelings of isolation Hopelessness related to chronicity of symptoms as evidenced by dependency
Ineffective coping related to unresolved psychological issues as evidenced by inability to express feelings verbally
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? Pain to achieve a self-serving goal Intentional self-injurious behavior Parents who were restrictive Malingering to avoid work
Intentional self-injurious behavior
Psychosocial theorists propose that somatic symptom illnesses are an indirect expression of stress and anxiety through physical symptoms. Which is the primary defense mechanism used in somatoform disorders? Somatization Identification Internalization Repression
Internalization
The client asks the nurse, What does having psychosomatic symptoms mean? What should the nurse reply? It means you're not physically sick. It means that stress and/or emotions are causing your symptoms. It means that you'll be well when you get your life in order. It means that your symptoms are a product of your imagination.
It means that stress and/or emotions are causing your symptoms
When assessing the mood of a client with somatic symptom disorder, which mood would the nurse expect to find? Consistently elevated Labile Within normal limits Consistently depressed
Labile
A nurse is conducting an in-service presentation for a group of newly hired mental health nurses. Which would the nurse most likely include when describing conversion disorder (functional neurologic symptom disorder)? Symptoms expressed reflect a neurologic illness. Laboratory and diagnostic test results are usually negative. The symptoms follow a typical neurologic pattern. The client's complaints are not real.
Laboratory and diagnostic test results are usually negative.
A middle-aged client goes to the physician falsely complaining of hip pain. The client's intention is to fake chronic hip pain to apply for disability benefits from the government. Which best reflects the client's potential diagnosis? Malingering Hypochondriasis Factitious disorder Munchausen's syndrome by proxy
Malingering
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? Malingering Factitious disorder Factitious disorder imposed on another Functional neurologic symptom disorder
Malingering
A client is admitted to the 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? Schizoid personality traits Munchausen's syndrome by proxy Functional neurologic symptoms Borderline personality disorder
Munchausen's syndrome by proxy
Which of the following terms are applicable when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a "hero" for saving the victim? Malingering Factitious disorder Munchausen's syndrome by proxy Induced illness
Munchausen's syndrome by proxy
Which is an inaccurate statement regarding malingering? It is motivated by external incentives. People who malinger usually do not stop the physical symptoms when given a reward. It is the intentional production of false or grossly exaggerated physical or psychological symptoms. People who malinger have no real physical symptoms.
People who malinger usually do not stop the physical symptoms when given a reward.
A client with a somatic symptom illness asks what is causing her physical symptoms. Which would be the appropriate explanation for the nurse to offer? Physical symptoms can be attributed to an organic cause. Physical symptoms are deliberately expressed in order to benefit in some way. Physical symptoms are independent of the amount of the client's psychic distress. Physical symptoms are an involuntary way of dealing with psychic conflict.
Physical symptoms are an involuntary way of dealing with psychic conflict.
A nurse is preparing to interview a client diagnosed with somatic symptom disorder. The nurse anticipates that the client will most likely exhibit what? No facial expression during the interview Intermittent nodding and glancing at the clock on the wall Altered mental status Rapidly changing moods during the interview
Rapidly changing moods during the interview
A client has been admitted to a hospital with the inability to move the client's right arm. The client has a diagnosis of conversion reaction. Which consequence of this condition would be an example of primary gain? Attention from the client's spouse and children Medical leave from the client's high-stress job Relief from anxiety Avoidance of jury duty
Relief from anxiety
Which is the primary gain for a client with conversion disorder? Relief from emotional conflict Identification of anxious feelings Emotional detachment Emotional support from family
Relief from emotional conflict
A client is diagnosed with somatic symptom disorder. Which would the nurse expect to assess as the major clinical finding? The client's inability to focus on emotional content Definitive medical finding with a history of "doctor shopping" Report of symptoms with no demonstrable pathology on testing or examination Loss of voluntary motor or sensory functioning
Report of symptoms with no demonstrable pathology on testing or examination
When assessing a client with somatic symptom disorder, which would the nurse most likely note? The client's symptoms are under the conscious control of the client. Denial and repression are the chief defense mechanisms used. Reports of physical symptoms do not have a demonstrable organic basis to fully account for them. The client willfully controls the physical symptoms.
Reports of physical symptoms do not have a demonstrable organic basis to fully account for them.
A client with somatic symptom illness tells the nurse that she is sick so often that her husband and children take over most of the household duties, such as cooking, cleaning, doing laundry, and so forth. Which is this evidence of? Dysfunctional family unit Primary gain Role reversal Secondary gain
Secondary gain
The personal benefit derived from blocking psychological conflict from conscious awareness is called what? Primary gain La belle indifference Secondary gain Sick role reward
Secondary gain
Which drug classification has been shown to be effective in treating somatization disorders? Selective serotonin reuptake inhibitors Antipsychotics Antimanics Antianxiety medications
Selective serotonin reuptake inhibitors
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? Selective serotonin reuptake inhibitors (SSRIs) Antipsychotics Tricyclic antidepressants Mood stabilizers
Selective serotonin reuptake inhibitors (SSRIs)
Somatic symptom disorder is characterized by what? Severe physical symptoms unexplainable by any organic or physical pathology Self-inflicted injuries Self-induced disease states or faked symptoms to garner attention Physical symptoms coupled with extreme focus on emotional state
Severe physical symptoms unexplainable by any organic or physical pathology
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? Somatic complaints due to anxiety related to life stressors Depression exhibited by repressed rage Altered comfort exhibited by poor school grades Ineffective parenting due to poor coping
Somatic complaints due to anxiety related to life stressors
The primary factor that differentiates somatization disorders from conversion disorders is what? Somatization disorders affect multiple organ systems, whereas conversion disorders usually involve only one system. Somatization disorders are conscious, whereas conversion disorders are unconscious. Conversion disorders are always targeted at the respiratory system. Somatization disorders usually affect the cardiac system, whereas conversion disorders do not.
Somatization disorders affect multiple organ systems, whereas conversion disorders usually involve only one system.
The primary reason for considering cultural issues when caring for the client with somatization disorders is what? Somatization disorders differ in type and frequency of symptoms and depend on the culture in which they are expressed. Somatization disorders usually only occur in the United States. Somatization disorders are only seen in a few cultures. Somatization disorders are characterized by middle-class, Caucasian value expressions.
Somatization disorders differ in type and frequency of symptoms and depend on the culture in which they are expressed.
The nurse is seeing a male client who reports multiple somatic symptoms including back pain, nausea, and headache. The client has reported the same symptoms on multiple visits and a detailed physical examination including lab values and diagnostic imaging tests have been unremarkable. Which assessment tool should the nurse include in this visit with the client? The CAGE questionnaire The St. Louis University Mental Status assessment The Hamilton Rating Scale for Depression The Mini Mental Status Examination
The CAGE questionnaire
The nurse is assessing a client who has been unable to speak after witnessing a murder. The assessment and subsequent testing reveal no physical abnormality that may cause speech impairment. What is the most likely cause of this speech impairment in the client? The client may have vocal cord paralysis. The client may not want to speak. The client may be attempting to block the witnessed event to reduce anxiety. The client may have dysfunction of the speech center of the brain.
The client may be attempting to block the witnessed event to reduce anxiety.
The nurse is providing care to a client with somatic symptoms disorder. The client has been prescribed escitalopram one week ago. The client reports experiencing nausea after starting the medication and describes it as "worse than what the average person would have." Which intervention should the nurse recommend for this client? To monitor the nausea using a daily journal for one week To stop taking the medication immediately To consume a balanced diet To see physician specialized in gastric disorders
To monitor the nausea using a daily journal for one week
A client who developed numbness in the right hand could not play the piano at a scheduled recital. The consequence of the symptom, not having to perform, is best described as emotion-focused coping phobia primary gain secondary gain
primary gain
Which of the following is true about clients with illness anxiety disorder? They may interpret normal body sensations as signs of disease They often exaggerate or fabricate physical symptoms for attention They do not show signs of distress about their physical symptoms All the above
they may interpret normal body sensations as signs of disease
In which disorder is the individual motivated solely by the desire to become a health care client? Factitious disorder Somatic symptom disorder Conversion disorder Illness related disorder
Factitious disorder
In which mental health disorder are physical or psychological symptoms (or both) fabricated to assume the sick role? Factitious disorder Conversion disorder Hypochondriasis Factitious disorder by proxy
Factitious disorder
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? "I never felt nurtured or loved when I was growing up." "The only time I felt loved and appreciated was when I made the honor roll at school." "The only time I ever felt loved was when I was sick enough to miss school." "I felt loved and accepted when my father apologized for spanking me so hard."
"The only time I ever felt loved was when I was sick enough to miss school."
The nurse is studying the medical record of a client who reports blindness. The record indicates there is no ocular abnormality. The client doesn't seem upset by the blindness. What is the client's most likely diagnosis? Hypochondriasis Conversion disorder Somatic symptom disorder Optic nerve dysfunction
Conversion disorder
A client with pain who has been diagnosed with somatic symptom disorder and depression is prescribed medication therapy to treat both the pain and the symptoms of depression. When educating the client about the medication, which would the nurse emphasize? Limiting of the amount of water ingested Use of sunscreen when exposed to bright sunlight Alcohol should be avoided Stopping the medication if there is no change after 1 week
Alcohol should be avoided
Which characteristic differentiates conversion disorder from malingering disorder? Conversion disorder is normally permanent, while malingering disorder is transient in response to stress. Conversion disorder is an unconscious process, while malingering disorder is a deliberate fabrication of symptoms. Conversion disorder produces reward, while malingering disorder normally results in punishment or difficulty. Conversion disorder has no pathophysiological cause, while malingering disorder has a neurological or endocrine basis.
Conversion disorder is an unconscious process, while malingering disorder is a deliberate fabrication of symptoms.
The nurse is working with the client to develop emotion-focused coping strategies. Which should the nurse include as an emotion-focused coping strategy? Problem solving Assertiveness techniques Role-playing Deep breathing techniques
Deep breathing techniques
All of the following disease processes are caused by stress except which one? Diabetes Hypertension Colitis Deep vein thrombosis
Deep vein thrombosis
A client's family member asks the nurse, "What is a conversion disorder?" Which is the best response by the nurse? It involves unexplained, usually sudden, deficits in sensory or motor function. It is characterized by multiple physical symptoms. It is a preoccupation with the fear that one has a serious disease. It is a preoccupation with an imagined or exaggerated defect in physical appearance.
It involves unexplained, usually sudden, deficits in sensory or motor function.
Which statement best reflects the pharmacologic treatment of somatic symptom disorder? No medications have been specifically recommended for somatic symptom disorder. Selective serotonin reuptake inhibitors are especially helpful for clients experiencing pain. Monoamine oxidase inhibitors are effective in treating comorbid anxiety disorders. Pharmacologic therapy is the primary mode of treatment.
No medications have been specifically recommended for somatic symptom disorder.
A nurse is assessing a client who is suspected of having somatic symptom disorder (SSD). Which would the nurse expect to report as the most common report? Nausea Dizziness Pain Cough
Pain
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? The client may be a hypochondriac. The client may be malingering. The client may have silent angina. The client may have Munchausen's syndrome.
The client may be malingering.
The nurse is seeing a client who is suspected of having the personality trait called alexithymia. Which characteristic about the client is consistent with this psychological explanation for somatization? The client talks in detail about childhood experiences The client experiences angry outbursts The client talks a great deal about external events The client is often tearful during clinic visits
The client talks a great deal about external events
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? The nurse might have conversion disorder. The nurse might have somatic symptom disorder. The nurse might have Munchausen's syndrome. The nurse might have Munchausen's syndrome by proxy.
The nurse might have Munchausen's syndrome by proxy.
The nurse performs a thorough physical examination for a client being admitted for a somatic symptom illness. Which of the following is the best rationale for the physical exam? Ease the client's mind that the nurse is looking for physical illness. Physical disorders underlie somatic disorders. Physical exams are reimbursed by third-party payers. Underlying pathology should be ruled out.
Underlying pathology should be ruled out.
The client's family asks the nurse, "What is illness anxiety disorder?" The best response by the nurse is, "Illness anxiety disorder is A persistent preoccupation with getting a serious disease An illness not fully explained by a diagnosed medication condition Characterized by a variety of symptoms over a number of years The eventual result of excessive worrying about diseases
a persistent preoccupation with getting a serious disease"
Emotion-focused coping strategies are designed to accomplish which of the following outcomes? Helping the client manage difficult situations more effectively Helping the client manage the intensity of symptoms Teaching the client the relationship between stress and physical symptoms Relieving the client's physical symptoms
helping the client manage the intensity of symptoms
The nurse is caring for a client with a conversion disorder. Which of the following assessments will the nurse expect to see? extreme distress over the physical symptom indifference about the physical symptom labile mood multiple physical complaints
indifferent about the physical symptom
The mental health nurse providing care for a client exhibiting symptoms of hypochondriasis is prepared to observe the client performing ritualistic, repetitive actions. treating a cognitively impaired client aggressively. producing grossly exaggerated physical symptoms to have needs met. seldom engaging in milieu activities
performing ritualistic, repetitive actions.
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? "You must be so frustrated with this unexplained pain. Do you have other stresses in your life too? "The treatment that was recommended to you has worked for many clients. It is supported by research." "Is it common in your culture to talk about psychological distress like it is physical pain?" "It would be best for your to see a specialist until the underlying issue is properly diagnosed."
"You must be so frustrated with this unexplained pain. Do you have other stresses in your life too?
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? Africa China North America Greece
Africa
The nurse has encouraged the client with a somatic symptom illness to keep a journal. Which treatment outcome might be met by journaling? The nurse will control external stressors that trigger the patient's physical symptoms. The nurse will assess the onset of physical symptoms. The client will express emotions privately. The client will identify the occurrence of physical symptoms when stressed.
The client will identify the occurrence of physical symptoms when stressed.
The family members of a client with somatic symptom illness report to the nurse that every time they invite the client to join in an activity the client declines, saying things like, I wish I could, but I feel so terrible. Which of the following approaches should the nurse suggest to encourage activity? What does your pain feel like right now? You are fine, the doctor said so. Let's go. I know this is difficult, but exercise is important. It will be a short walk. I'll let you rest. Let me know when you feel better
I know this is difficult, but exercise is important. It will be a short walk.
The client states, I can't go to group today. I have a very upset stomach this morning. Which would be the nurse's most appropriate response? You have to go to group. The doctor has ordered it. Okay, you can miss this time. I know you don't feel well, but it's important for you to participate in therapy. You aren't really feeling nauseous. It is part of your illness.
I know you don't feel well, but it's important for you to participate in therapy.
The spouse of a client diagnosed with complex somatic symptom disorder asks the nurse, "What causes this condition?" Which response by the nurse would be most accurate? "There is definitely an underlying genetic link for this disorder." "Your spouse is experiencing chronic stress that causes hypoarousal." "The symptoms reflect an internal preoccupation with events." "The symptoms reflect an emotion that your spouse cannot verbalize."
"The symptoms reflect an emotion that your spouse cannot verbalize."
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? The disorder includes a combination of pain and gastrointestinal, sexual, and pseudoneurologic symptoms. The condition is an acute short-term condition. The condition is characterized by multiple physical symptoms. The age of onset is usually before age 30 years.
The condition is an acute short-term condition.
Which statement about the etiology of somatic symptom disorder is accurate? The exact etiology is unknown. The disorder is more common in adults with a history of child abuse. The disorder is associated with substance abuse. Most clients with somatic symptom disorder also suffer from schizophrenia.
The exact etiology is unknown.
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. The exercises may help the client understand the conflict underlying the disorder The exercises may help the client express feelings of fear, anger, guilt, or inadequacy The exercises may help the client manage stress underlying the disorder The exercises may distract the client from the physical disability
The exercises may help the client manage stress underlying the disorder
Which disorder is characterized by unexplained, sudden deficits in sensory or motor function? Hypochondriasis Conversion disorder Body dysmorphic disorder Somatization disorder
Conversion disorder
Which would the nurse expect to assess in a client diagnosed with functional neurologic symptom disorder? Headache Pain Gastrointestinal upset Imbalance
Imbalance
The major difference between somatoform disorders and factitious disorders is what? In somatoform disorders, clients are not consciously aware that they are meeting needs through physical complaints. In factitious disorders, clients are unaware that their symptoms are not real. In somatoform disorders, clients consciously seek attention. Factitious disorders respond much more readily to psychopharmacologic treatment than do somatoform disorders.
In somatoform disorders, clients are not consciously aware that they are meeting needs through physical complaints.
One of the most important goals of treatment for clients with somatoform disorders is which of the following? Managing the client's use of medical services Restricting the client's use of medical services Resolving the physical symptoms Having the client accept that the physical symptoms are related to stress
Managing the client's use of medical services
Which best describes the concept of somatization? Manifestation of physical symptoms from psychological distress Psychological origin of illness that is not real Symptoms that cannot be substantiated by physicians Physical symptoms that are all in one's head
Manifestation of physical symptoms from psychological distress
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? Feign an assessment of the client in order to calm the client's anxiety. Have a different member of the care team present the test and assessment results to the client. Facilitate a repeat of the previous diagnostic testing in order to appease the client. Set limits with the client about the complaints.
Set limits with the client about the complaints.
An adolescent experiencing severe abdominal pain after the client's parents' argument is an example of what? Bipolar disorder Schizophrenia Somatization Depression
Somatization
Which term describes the conversion of unexpressed emotions into physical symptoms? La belle indifference Psychosomatic Hysteria Somatization
Somatization
In somatic symptom disorders, all except which are true? The client believes he/she has a serious illness. The client believes that his/her condition is catastrophic and disabling. The client embraces the "sick role." The client usually believes he/she has some sort of anxiety disorder.
The client usually believes he/she has some sort of anxiety disorder.
What is the major clinical finding in somatic symptom disorder? The client's inability to focus on emotional content Loss of voluntary motor or sensory functioning Pain with a history of "doctor shopping" The report of symptoms with no demonstrable pathology on testing or examination
The report of symptoms with no demonstrable pathology on testing or examination
The husband of a client with hypochondriasis has accompanied his wife to the follow-up doctor's visit. While waiting for the doctor, the husband expresses to the nurse his frustration with his wife's obsession about illness. He asks the nurse, What can I do? The best response by the nurse would be Try ignoring her complaints, and they should subside. Try finding an activity you enjoy doing together to help her feel better overall. Try to be the client and understand that she is worried that she is sick. Try to give her some sort of reward when she resists complaining about her illnesses.
Try finding an activity you enjoy doing together to help her feel better overall.
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? Schizoid personality traits Factitious disorder imposed on another Functional neurologic symptoms Borderline personality disorder
Factitious disorder imposed on another
The nurse is planning care for a client with somatic symptom illness disorder. Which should the nurse plan to reassess on a daily basis? Sensory deficits experienced by the client Character of pain reported by the client Frequency of generalized somatic complaints Signs of possible neurologic disorders
Frequency of generalized somatic complaints
Which mental health disorder is characterized by a fear of developing a serious illness based on a misinterpretation of body sensation? Hypochondriasis Alexithymia Conversion disorder Body dysmorphic disorder
Hypochondriasis
The nurse is caring for a client who was in a motorcycle accident 2 months ago. The client says he still has terrible neck pain, but he will be better once he gets "a big insurance settlement." What condition might the nurse suspect? Hypochondriasis La belle indifference Conversion reaction Malingering
Malingering
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? Repression Somatization Displacement Dissociation
Somatization
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? Cognitive behavior therapy Multiple provider evaluations Mood stabilizers to manage the symptoms Electroconvulsive therapy
Cognitive behavior therapy
An actor has prepared extensively for his first stage production. On the morning of the opening of the play, the actor awakens with laryngitis. From which disorder is the actor most likely suffering? Acute upper respiratory infection Conversion disorder Hysteria Somatization disorder
Conversion disorder
The la belle indifference occurs in which somatoform disorder? Somatization disorder Hypochondriasis Conversion disorder Body dysmorphic disorder
Conversion disorder
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? No physiologic cause has been found for the client's symptoms. The client's symptoms subside with appropriate medical treatment. The client is able to articulate the cause of psychological distress. The client's symptoms are related to conscious motives.
No physiologic cause has been found for the client's symptoms.
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? The client may be stressed from work. The client may be lying about pain. The client may have conversion disorder. The client may be a hypochondriac.
The client may be stressed from work.
The nurse is studying the medical records of an Indian male client. The nurse finds that the client has dhat syndrome. What should the nurse infer from this? The client may have concerns regarding loss of semen. The client may have concerns about having dizziness, headache, pain, and sleep disturbance. The client may have concerns about having insomnia, fatigue, and indigestion. The client may have concerns about his penis shrinking.
The client may have concerns regarding loss of semen.
The nurse is identifying outcomes for a client with a somatic symptom illness. Which is an appropriate outcome to include in the plan of care? The client will verbally express his or her emotions. The client will be free from stress. The client will demonstrate alternative ways to avoid stressful situations. The client will verbalize acceptance of physical symptoms.
The client will verbally express his or her emotions.
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? The client's blindness is a reaction to the trauma of losing the twin and has no physiologic basis. The clients blindness will gradually disappear if proper ophthalmologic care is provided. The client's blindness results in increased anxiety and attention from family and friends. The client's blindness requires a conscious effort to maintain the feigned symptom
The client's blindness is a reaction to the trauma of losing the twin and has no physiologic basis.
A client with complex somatic symptom disorder is complaining of significant pain in the joints. When providing care to this client, which would be most important for the nurse to keep in mind? Opioid analgesics are the primary mode of therapy. Opioid analgesics are the primary mode of therapy. Complementary therapies are usually of little benefit. Outcomes need to reflect the biologic aspects of the pain.
The client's experience of pain is real.
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 diagnostic imaging of the abdomen, the client continues to report symptoms. Which psychological factor may be contributing to the client's problem? The client's parents are considering getting divorced. The client recently received a low mark on an exam. The client is fearful of needles. The client is the head of the school debate team.
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. The client reported having signs related to raised intracranial pressure, such as nausea. The client's symptoms may have been a result of stress caused by studying all night for an exam. The client's symptoms disappeared after getting the medical note. The client was not found to have any underlying cause of headache on assessment.
The client's symptoms disappeared after getting the medical note.
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? The first symptom usually appears during adolescence. The disorder typically is diagnosed in men. Highly educated individuals often develop this disorder. The disorder commonly occurs with substance abuse.
The first symptom usually appears during adolescence.
A nursing instructor is describing somatic symptom disorder to a group of nursing students. The instructor determines that the education was successful when the students state what? The disorder typically is diagnosed in men. The first symptom usually appears during adolescence. The disorder commonly occurs with substance abuse. Highly educated individuals often develop this disorder.
The first symptom usually appears during adolescence.
The nurse is caring for a client with conversion disorder. The nurse asks the client about the client's relationships with family and friends. What is the nurse trying to determine with this question? Choose the best answer. The nurse wants to divert the client's attention from the illness. The nurse wants to find out if similar symptoms are evident in the family. The nurse wants to learn if the client has any conflicts with family or friends. The nurse wants to minimize the chances of secondary gain.
The nurse wants to learn if the client has any conflicts with family or friends.
A client with recurrent headaches has been told by the physician that the cause is likely psychosomatic. The client reports this conversation to the nurse and says, That just can't be true! My head hurts so bad sometimes that it makes me sick to my stomach. Which is the nurse's best response? To give the client some privacy and time to calm down To say nothing and sit quietly with the client The pain in your head is very real. Well, that's not what your doctor thinks.
The pain in your head is very real.
The husband of a woman with a somatic symptom illness asks the nurse why the doctors cannot find anything wrong with her. Which would be the appropriate explanation for the nurse to offer? She is not really experiencing the symptoms. She is making them up to get attention. There is no physical cause. Mental distress is causing the symptoms, even though she is not aware of it. She controls the symptoms when she isn't feeling much stress. It is hard to diagnose when the symptoms are intermittent. There is a physical cause. It just has not been detected yet.
There is no physical cause. Mental distress is causing the symptoms, even though she is not aware of it.
Regularly scheduled therapy sessions are integral to the treatment plans for all clients requiring psychiatric-mental health care. The nurse understands that this is important for clients with somatic symptom disorder for which reason? To monitor the client's physical health To prevent the client from relapsing To monitor for suicidal ideation To ensure a therapeutic relationship with the client
To ensure a therapeutic relationship with the client
