Chapter 17 - Somatic Symptom Disorders

What precipitating emotional factor has been associated with an increased incidence of cancers? Select all that apply. a. Anxiety b. Job-related stress c. Acute grief d. Feelings of hopelessness and despair from depression e. Prolonged, intense stress

d. Feelings of hopelessness and despair from depression e. Prolonged, intense stress

Living comfortable and materialistic lives in Western societies seems to have altered the original hierarchy proposed by Maslow in that: a. Once lower level needs are satisfied, no further growth feels necessary b. Self-actualization is easier to achieve with financial stability c. Esteem is more highly valued than safety d. Focusing on materialism reduces interests in love, belonging, and family

d. Focusing on materialism reduces interests in love, belonging, and family

Melanie is a 38-year-old female admitted to the hospital to rule out a neurological disorder. The testing was negative, yet she is reluctant to be discharged. Today she has added lower back pain and a stabbing sensation in her abdomen. The nurse suspects a factitious disorder in which Melanie may: a. Consciously be trying to maintain her role of a sick patient b. Not recognize her unmet needs to be cared for c. Protect her child from illness d. Recognize physical symptoms as a coping mechanism

a. Consciously be trying to maintain her role of a sick patient

What class of medications is commonly prescribed for somatic disorders? mood stabilizers. anxiolytics. antidepressants. antipsychotics.

anxiolytics.

What statement by a client would indicate that goals for treatment for a somatization disorder are being achieved? "I take my medications just as the physician prescribed." "I feel less anxiety than before." "My memory is better than it was a month ago." "I don't think about my symptoms all the time as I used to be."

"I don't think about my symptoms all the time as I used to be."

Which statement made by a client would support the diagnosis of Illness anxiety disorder? "I know I have cancer, but the doctors just cannot find it." "I feel as though I'm outside my body watching what is happening." "I woke up one morning, and my left leg was paralyzed from the knee down." "I feel confused and disoriented."

"I know I have cancer, but the doctors just cannot find it."

Which client is most likely to initially demonstrate behaviors suggesting a somatic disorder? 43-year-old female 33-year-old male 13-year-old male 23-year-old female

23-year-old female

A 23 years old is admitted with reports of abdominal pain, dizziness, and headache. When told that all the results of a physical workup have been negative, the client shares, "Now I am having back pain." Which notation in the client's medical record may alert the nurse to the possibility of malingering? A) A court date this week for drunk driving B) Was adopted at the age of 5 years C) A history of oppositional-defiant disorder D) A history of physical abuse by his stepfather

A) A court date this week for drunk driving

It is most important for the nurse to employ which holistic strategy when managing clients diagnosed with a somatization disorder? A) Considering all dimensions of the patient, including biological, psychological, and sociocultural B) Incorporating spirituality and religion into treatment C) Involving every member of the family as well as the patient in treatment D) Utilizing many different therapeutic strategies or modalities for enhanced coping

A) Considering all dimensions of the patient, including biological, psychological, and sociocultural

A client asks the nurse what kind of therapy will help. Based on current knowledge, what form of therapy is most appropriate for a client diagnosed with a conversion disorder? A) "Modeling will be used; as you see desired behaviors modeled by the therapist you will be able to also achieve the expected outcome." B) "Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders." C) "A combination of antianxiety and antidepressant therapy is the most effective therapy." D) "Aversion therapy is often used because in effect you are punishing yourself by not being able to walk."

B) "Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders."

Conversion disorder is described as an absence if a neurological diagnosis that manifests in neurological symptoms. Channeling of emotions, conflicts, and stressors into physical symptoms is thought to be the cause of conversion disorder. Which statement is true? A) People with conversion disorder are extremly upset about often dramatic symptoms B) Abnormal patterns of cerebral activation have been found in individuals with conversion disorder C) An organic cause is usually found in most cases of conversion disorder D) Symptoms can be turned off and on depending on the patients choice

B) Abnormal patterns of cerebral activation have been found in individuals with conversion disorder

The care plan for a patient diagnosed with somatic disorder included the nursing diagnosis impaired coping. Which patient behavior demonstrates a successful outcome for that ND? A) Showers and dresses in clean clothes daily B) Calls a friend to talk when feeling lonely C) Spends more time talking about pain in her abdomen D) Maintains focus and concentration

B) Calls a friend to talk when feeling lonely

Ever since participating in a village raid where explosives were used, a military veteran has been unable to walk. After all diagnostic testing were negative for any physical abnormalities, the client was diagnosed with conversion disorder. What is the nurse's best response when asked by the client, "Why can't I walk?" A) "Your legs don't work because your brain is screwed up." B) "You are overly anxious about having a severe illness." C) "Your emotional distress is being expressed as a physical symptom." D) "You are making up your symptoms as a cry for help."

C) "Your emotional distress is being expressed as a physical symptom."

You are caring for Yolanda, a 67 year old patient who has been receiving hemodialysis for 3 months. Yolanda reports that she is feeling angry whenever it is time for her dialysis treatment. You attribute this it A) Organic changes in her brain B) A flaw in her personality C) A normal response to grief and loss D) Denial of the reality of a poor prognosis

C) A normal response to grief and loss

What would be an appropriate expected outcome of the treatment plan for a client diagnosed with a conversion disorder that interferes with the ability to walk effective? A) Client will walk unassisted within 1 week. B)Client will return to a pre-illness level of functioning within 2 weeks. C) Client will be able to state two new effective coping skills within 2 weeks. D) Client will assume full self-care within 3 weeks.

C) Client will be able to state two new effective coping skills within 2 weeks.

Studies have shown a correlation between mental disorders and which medical condition? Chronic renal failure Psoriasis Asthma Cardiovascular disease

Cardiovascular disease

Which statement about somatoform disorders is true? No relation exists between these disorders and early childhood loss or trauma. Clients lack awareness of the relations among symptoms, anxiety, and conflicts. Nurses perceive clients with these disorders as easy to care for. An organic basis exists for each group of disorders.

Clients lack awareness of the relations among symptoms, anxiety, and conflicts.

Which mental health disorder is an example of a somatoform disorder? Conversion disorder Depersonalization Dissociative identity disorder Dissociative fugue

Conversion disorder

What therapeutic intervention should be prescribed for a client diagnosed with a somatoform disorder? Conveying an interest in the client rather than in the symptoms Encouraging the client to use benzodiazepines liberally Encouraging the client to rely on the nurse to meet the client's needs Steering conversation away from the client's feelings

Conveying an interest in the client rather than in the symptoms

Which patient is at greatest risk for developing a stress induced myocardial infraction? A) A patient who lost a child in an accidental shooting 24 hours ago B) A woman who has begin experiencing early signs of menopause C) A patient who has spent years trying to sustain a successful business D) A patient who was diagnosed with chronic major depression 10 years ago

D) A patient who was diagnosed with chronic major depression 10 years ago

You are caring for Aaron, a 38-year old patient diagnosed with somatic symptom disorder. When interacting with you, Aaron continues to focus on his severe headache. In planning care for Aaron, which of the following interventions would be appropriate? A) Call for a family meeting with Aaron in attendance to confront Aaron regarding his diagnosis B) Educate Aaron on alternative therapies to deal with the pain C) Improve reality testing by telling Aaron that you do not believe that the headache is real D) After a limited discussion of physical concerns, shift focus to feelings and effective coping skills

D) After a limited discussion of physical concerns, shift focus to feelings and effective coping skills

Which item of data should be routinely gathered during assessment of a client with a somatoform disorder? Potential for violence Dependence on medication Level of confusion Personal identity disturbance

Dependence on medication

The primary difference between a factitious disorder and other somatic disorders is described in which statement? Factitious disorders have a symptomatology that is actually controlled by the client. Factitious disorders are always self-directed. Factitious disorders have their origins in depression and anxiety. Factitious disorders respond well to confrontation as a primary therapeutic technique.

Factitious disorders have a symptomatology that is actually controlled by the client.

A primary health provider describes a client as "malingering." The nurse knows this means that the client is demonstrating which behavior? Experiencing symptoms that cannot be explained medically. Falsely claiming to have symptoms. Experiencing symptoms that have a physiological basis. Seeking medication to ease pain of psychological origin.

Falsely claiming to have symptoms.

Which disorder is characterized by the client's misinterpretation of physical sensations or feelings? Somatic disorder Conversion disorder Factitious disorder Illness anxiety disorder

Illness anxiety disorder

Which nursing diagnosis should be investigated for clients with somatoform disorders? Self-care deficit Deficient fluid volume Ineffective coping Delayed growth and development

Ineffective coping

A woman suddenly finds she cannot see but seems unconcerned about her symptom and tells her husband, "Don't worry, dear. Things will all work out." Her attitude is an example of what process? La belle indifference Depersonalization Dissociative amnesia Regression

La belle indifference

Providing care to a client diagnosed with a somatization disorder can be frustrating owing to the client's lack of an organic illness. In order to best manage this barrier to care the staff should implement which personal intervention? Attend in-services that focus on the various aspects of somatic disorders. Provide a unified approach to the client's behavior so as to manage and lessen the barrier itself. Rotate care of the client among the entire nursing department staff to minimize the frustration. Regularly discuss their feelings about the client during the unit's interprofessional care meetings.

Regularly discuss their feelings about the client during the unit's interprofessional care meetings.

When discussing somatic disorders from a cultural perspective, which statement is true? Somatic disorders are rarely observed in males. Secondary gain is seldom a factor in somatic disorders. Underdeveloped countries rarely tolerate somatic disorders. Somatic symptoms vary widely from culture to culture.

Somatic symptoms vary widely from culture to culture.

Lucas is a nurse on a medical floor caring for Kelly, a 48-year-old patient with newly diagnosed type 2 diabetes. He realizes that depression is a complicating factor in the patient's adjustment to her new diagnosis. What problem has the most potential to arise? a. Development of agoraphobia b. Treatment nonadherence c. Frequent hypoglycemic reactions d. Sleeping rather than checking blood sugar

b. Treatment nonadherence

Diane, a 63-year-old mother of three, was brought to the community psychiatric clinic. Diane and her son had a bitter fight over finances. Ever since Diane has been complaining of "a severe pain in my neck." She has seen several doctors who cannot find a physical basis for the pain. The nurse knows that: a. Showing concern for Diane's pain will increase her obsessional thinking. b. Diane's symptoms are manipulative and under conscious control. c. Diane believes there is a physical cause for the pain and will resist a psychological explanation. d. Diane is trying to make her son feel bad about the argument.

c. Diane believes there is a physical cause for the pain and will resist a psychological explanation.