Chapter 21: Somatic Symptom Illnesses (COMBINED)

In whicThe nurse provides care to a client who is diagnosed with somatic symptom disorder (SSD) and who presents with anxiety and depression in addition to physical symptoms that affect the gastrointestinal (GI) system. Which is the priority question from the nurse when conducting the interview portion of the assessment process?h disorder is the individual motivated solely by the desire to become a health care client?

"How long have you been experiencing the GI symptoms?" Explanation: Encourage and allow clients who are diagnosed with SSD to discuss their physical problems before focusing on psychosocial issues. Based on this information, the priority question from the nurse is "How long have you been experiencing GI symptoms?" because this question focuses on the client's physical problems. The questions related to the client's depression and anxiety are psychosocial issues.

The nurse suspects that a client is experiencing somatic symptom disorder (SSD). Which question should the nurse include in the assessment process to determine specific gastrointestinal (GI) symptoms?

"How many episodes of diarrhea do you have each week?" Explanation: Somatic symptom disorder (SSD) is one of the most difficult disorders to manage because its symptoms tend to change, are diffuse and complex, and vary and move from one body system to another. Although all these assessment questions focus on SSD symptoms, it is only the question "How many episodes of diarrhea do you have each week?" that addresses GI symptoms. Headache is a neurologic symptom, aching legs is a musculoskeletal symptom, and pain with intercourse is a sexual issue.

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?

"The only time I ever felt loved was when I was sick enough to miss school." Explanation: Individuals who are diagnosed with factitious disorders are thought to have often been abused as children and to have received nurturance only during times of illness. As a result, they try to recreate illness or injury in a desperate attempt to receive love and attention.

The nurse is seeing a 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? Explanation: Whereas some evidence suggests that somatization is a result of abnormally high levels of physiologic response, other evidence supports the idea that somatization is the physical expression of personal problems or the internalization and expression of stress through physical symptoms. The nurse should use an approach that helps to establish trust through acknowledgment and validation. The therapeutic relationship is key. Telling the client the recommended treatment approach is supported by research may elicit a defensive reaction in the client, hindering the therapeutic relationship. Talking about culturally specific behaviors indicates the nurse is using stereotyping, a culturally incompetent approach. Encouraging the client to continue to seek multiple health care providers is ineffective and feeds into the client's beliefs about the illness. The client should be encouraged to be consistent with one, primary health care provider.

With treatment, conversion disorder often remits in a few weeks but recurs in approximately which percentage of clients?

25% Explanation: With treatment, conversion disorder often remits in a few weeks but recurs in 25% of clients.

Which is the nurse's priority on the first meeting with a client who is diagnosed with somatic symptom disorder (SSD)?

Develop a therapeutic relationship. Explanation: Developing a therapeutic relationship promotes trust and can minimize the client's need to search for a health care professional who believes their symptoms and suffering; therefore, this is the nurse's priority. Initiating a health history interview, conducting a physical examination, and collecting a current list of medications are all important actions but not the priority based on the client's diagnosis.

A nurse is caring for a client with somatic symptom illness. The health care provider has prescribed sertraline, 80 mg, to the client. What should the nurse monitor the client for after administering the drug? Select all that apply.

Diarrhea Insomnia Explanation: Sertraline is an antidepressant drug used to treat underlying depression in a client with somatic illness. Headache, diarrhea, and insomnia are side effects associated with this drug. The nurse should monitor for these signs after administering this drug. Unlike fluoxetine, rashes are not a side effect related to sertraline. Unlike paroxetine, dry mouth is not a side effect associated with sertraline.

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?

Empathize about physical discomfort but encourage independence. Explanation: The results of a family assessment often reveal that families of these individuals need education about the disorder, helpful strategies for dealing with the multiple complaints of the client, and usually help in developing more effective communication patterns. Empathizing with clients about physical discomfort is important while simultaneously encouraging family members to assist the client in becoming more independent.

The nurse plans to care for a teenage male client experiencing conversion disorder after a bullying incident. The client has stated, "It does not matter if my legs do not work. I will not need them anyway." What is the priority nursing action for this client?

Evaluate the client's risk for suicide. Explanation: In this scenario, the nurse must fully investigate any negative thoughts, feelings, or behaviors that place the client at risk of suicide. The statement, "I won't need them anyway," could indicate that the client has suicidal ideations and has decided that using the limbs is unnecessary since they will be deceased. Journaling and talk therapy that addresses the bullying incident are all important nursing care plan items but come below safety and security in order of priority. Clients with conversion disorder have difficulty understanding that their symptoms are part of a coping/disease process and often take on the attitude of "la belle indifférence."

When assessing a client diagnosed with hypochondriasis, the most serious risk factor to be identified for this client is what?

Extensive use of over-the-counter medications Explanation: When assessing a client diagnosed with hypochondriasis, the most serious risk factor to be identified is the extensive use of over-the-counter medications. Many clients with hypochondriasis overuse medication and can become dependent as a result. For example, the nurse should identify if a client has developed laxative dependence as a result of anxiety regarding bowel patterns.

In which disorder is the individual motivated solely by the desire to become a health care client?

Factitious disorder Explanation: Persons with factitious disorders intentionally cause an illness or injury to receive the attention of health care workers. These individuals are motivated solely by the desire to become a client and develop a dependent relationship with a health care provider. Somatic symptom disorder, conversion disorder, and illness-related disorder are not disorders in which the client is motivated by the desire to become a client.

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 Explanation: When individuals are fearful of developing a serious illness based on their misinterpretation of body sensations, the classification of illness anxiety disorder can be used to describe this preoccupation. The fear of having an illness continues despite medical reassurance, and this interferes with psychosocial functioning. The individual spends time and money on repeated examinations looking for feared illnesses. With factitious disorder, the illness or injury is intentionally caused to gain attention of health care workers. Functional neurologic symptom disorder or conversion disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms.

Which occurs when an individual intentionally produces illness symptoms to avoid work?

Malingering Explanation: Malingering occurs when an individual intentionally produces illness symptoms, motivated by another specific self-serving goal, such as being classified as disabled or avoiding work. Individuals with alexithymia have difficulty identifying and expressing their emotions. They have a preoccupation with external events and are described as concrete, externally oriented thinkers. Conversion disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms. Illness anxiety disorder occurs when an individual is fearful of developing a serious illness based on a misinterpretation of body sensations.

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 Explanation: Malingering refers to the situation in which an individual intentionally produces illness symptoms because the motivation is another specific self-serving goal, such as being classified as disabled or avoiding work. Clients with factitious disorder injure themselves covertly. The illnesses are produced in such a manner that the health care provider is tricked into believing that a true physical or psychiatric disorder is present. Factitious disorder imposed on another involves a person who inflicts injury on another person. It is commonly a mother, who inflicts injuries on her child to gain the attention of the health care provider through her child's injuries. Functional neurologic symptom disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms.

Which best describes the concept of somatization?

Manifestation of physical symptoms from psychological distress Explanation: The concept of somatization acknowledges and respects that bodily sensations and functional changes are expressions of health and illness, and even though they may be unexplained, they are not imaginary or "all in the head." Somatization (from soma, meaning body) is the manifestation of psychological distress as physical symptoms, which may result in functional changes, somatic descriptions, or both. The terms hysteria and hysterical were used to describe physical or emotional symptoms that could not be substantiated by physicians.

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. Explanation: One of the important factors regarding the diagnosis of psychological factors affecting medical conditions is that there is no physiologic basis for these symptoms. They are often based on psychological conditions. These symptoms do not usually subside easily, clients cannot often talk about the cause of their distress, and the symptoms are always related to unconscious processes.

Which is the name given to a direct internal benefit that being sick provides, such as relief from anxiety?

Primary gain Explanation: Primary gains are the direct internal benefits that being sick provides. Secondary gains are the external benefits received from others because one is sick. Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms. The la belle indifference is a seeming lack of concern or distress for sudden deficits in sensory or motor function, as seen in conversion disorder.

When assessing a client with somatic symptom disorder, which would the nurse most likely note?

Reports of physical symptoms do not have a demonstrable organic basis to fully account for them. Explanation: A central feature of somatic symptom disorder is a report of physical symptoms without a demonstrable organic basis to fully account for the symptoms. Symptoms or magnified health concerns are not under the client's conscious control. Denial and repression are not chief defense mechanisms used. Clients do not willfully control the physical symptoms.

Which drug classification has been shown to be effective in treating somatization disorders?

Selective serotonin reuptake inhibitors Explanation: Selective serotonin reuptake inhibitors have been shown to be effective in treating somatization disorders.

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) Explanation: Clients with anxiety are treated pharmacologically, similar to those with depression. The first line of treatment for all anxiety disorders is with an SSRI. Doses for somatic symptom disorder are usually higher than those prescribed for depression to relieve and manage the symptoms of the anxiety disorders.

Medications have been tried for somatic symptom disorder. Which drugs have been shown to be effective in some cases?

Selective serotonin reuptake inhibitors (SSRIs) Explanation: SSRIs, given in sequential trials of one or more medications, have been found to be the drugs of choice for somatoform disorders; they are cost effective and helpful.

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?

Set limits with the client about the complaints. Explanation: If a client with the diagnosis of hypochondriasis has been told that the client has no life-threatening or severe illnesses, but the client continues to verbalize clinical symptoms, limit-setting is used. A "false" assessment is unethical, and repeating diagnostic testing reinforces the client's behavior. Having diagnostic results presented by another member of the care team is unlikely to eliminate the client's concerns.

Somatic symptom illness disorders are characterized by what?

Severe physical symptoms that cannot be explained by any organic or physical pathology Explanation: Clients with somatoform disorders experience physical symptoms despite no underlying medical explanation for them. They complain of severe symptoms with no organic or physical basis.

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 Explanation: The client is experiencing stress related to the client's current life situation and reacting by somatization to deal with the client's feelings. Therefore, "somatic complaints due to anxiety related to life stressors" would be the correct nursing diagnosis. The other choices are not appropriate.

Which term describes the conversion of unexpressed emotions into physical symptoms?

Somatization Explanation: Somatization is a term used to describe the conversion of unexpressed emotions into physical symptoms. The la belle indifference is a seeming lack of concern or distress for deficits seen in conversion disorder. Hysteria refers to multiple physical complaints with no organic basis. The term psychosomatic is used to convey the connection between the mind and the body in states of health and illness.

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 be attempting to block the witnessed event to reduce anxiety. Explanation: The client is most likely experiencing conversion disorder after witnessing a violent act. In this case, the client may be trying to protect the self, either consciously or unconsciously, from the fear or anxiety from the event. The assessment and subsequent testing did not reveal any other cause of speech impairment, which indicates the client does not have vocal cord paralysis or any dysfunction related to the brain's speech center.

In somatic symptom disorders, all except which are true?

The client usually believes he/she has some sort of anxiety disorder. Explanation: Somatoform disorders are often mistaken for physical disorders because the person is not aware that the source of the symptoms is underlying psychic conflict. The somatization of anxiety decreases the level of stress the person perceives.

After teaching a group of nursing students about somatic symptom disorder, the instructor determines that additional education is needed when the students identify which as true?

The client usually thinks anxiety is behind the symptoms. Explanation: Individuals with somatic symptom disorder perceive themselves as being "sicker than the sick" and report all aspects of their health as poor. Many eventually become disabled and cannot work. They typically visit health care providers multiple times per month and quickly become frustrated because their primary health care providers do not appreciate their level of suffering and are unable to validate that a particular problem accounts for their extreme discomfort. Clients do not have insight to identify anxiety as a problem.

When describing the course of illness associated with somatic symptom disorder, which would the nurse include?

The client will report going to many different providers without satisfaction. Explanation: Clients living with a somatic symptom disorder usually present exaggerated, inconsistent, yet complicated medical histories. They often seek treatment from multiple health care providers when their physical complaints are not addressed to their satisfaction.

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. Explanation: Conversion blindness is an unconscious process; it will not disappear with ophthalmologic care. Conversion symptoms are unconsciously designed to reduce anxiety, so "the client's blindness is a reaction to the trauma of losing the twin and has no physiologic basis" is appropriate.

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?

The client's experience of pain is real. Explanation: Even though there is no medical explanation for the pain, the client's pain is real and has serious psychosocial implications. Aggressive pharmacologic treatment of the symptoms must be avoided. Nonpharmacologic strategies, including complementary and alternative treatments, should be used to assist in pain relief. Outcomes developed need to avoid focusing on the biologic aspects of the disorder and instead help the client overcome the pain through biopsychosocial approaches.

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's symptoms disappeared after getting the medical note. Explanation: A malingerer is a person who intentionally produces false or grossly exaggerated physical or psychological symptoms. This behavior is motivated by external motives, and once the motives have been met, the client's symptoms will disappear. If the client had studied all night for an exam, the client may have been suffering from a tension headache and the symptoms would have remained after the client received the medical note. If a client doesn't have any underlying cause of headache on assessment, it could be concluded that the client either is a malingerer or has a somatic symptom illness. However, clients do not have voluntary control over somatic symptoms. If the client reports having signs related to raised intracranial pressure, such as nausea, which are not consistent with the assessment findings, then the client may have Munchausen's syndrome. In this condition the client inflicts illness or injury on oneself in order to gain attention.

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 manage stress underlying the disorder Explanation: Physical exercise and meditation may help the client relieve and manage stress in a healthy manner. If the client is able to build stress management skills while in treatment, he or she may be able to build on these strategies in the future. Conversation about other topics and avoiding any discussion about the client's symptoms might help distract the client from the disability but may not provide useful tools for lessening possible future occurrences. Talking about various coping methods used by the client in the past may help the client understand and cope with the conflict underlying the disability. Talking about the problems that the client faces is useful to the client for identifying and expressing feelings of fear and guilt.

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 Munchausen's syndrome by proxy. Explanation: Munchausen's syndrome by proxy is a condition in which a person inflicts illness or injury on someone else in order to gain attention from becoming a "hero" for saving the victim. In this case, the nurse tried to kill the children and then went to great lengths to revive them. This indicates that the nurse had Munchausen's syndrome by proxy. In conversion disorder, the client has sudden deficits in sensory or motor function due to an unexplained cause. In somatic symptom disorder, the client reports having one or more than one physical symptom without any underlying cause. In Munchausen's syndrome the client inflicts illness or injury on oneself in order to gain attention.

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 learn if the client has any conflicts with family or friends. Explanation: Conversion disorders are usually related to interpersonal conflict arising among family or friends. The nurse asks the client about family and friends in order to find out whether any conflicts have caused the disorder in the client. Conversion disorder is not inherited, thus the nurse is not trying to find out if similar symptoms are evident in the family. Asking about family and friends would divert the client's attention from the disability, but this is not the nurse's chief intention here. Asking about family and friends would be useful to decrease the chances of secondary gain, but this again is not the nurse's chief intention in this scenario.

Which client does the nurse identity as having the greatest risk for developing somatic symptom disorder (SSD)?

a female of African descent who works two minimum wage jobs Explanation: Epidemiologic studies have reported that SSD occurs primarily in nonwhite, less educated women, particularly those with a lower socioeconomic status and high emotional distress. Men are less likely to be diagnosed with SSD, partly because of stereotypic male traits, such as a disinclination to admit discomfort or seek help for their symptoms. Based on this information, the client who is at greatest risk for SSD is the female of African descent who works two minimum wage jobs because there are three risk factors (ethnicity, gender, and low socioeconomic status). The white male, the white female, and the male client of African descent each have one risk factor for SSD.

A nurse is caring for a young adult female client with a somatoform disorder. Which statement by the client would indicate effective coping?

"Even though my body hurts, I have made a goal to exercise four times per week." Explanation: Clients with a somatoform disorder need ongoing support, care, and validation of their feelings. Clients that minimize their disorder by stating it will "Go away" or "It's not real" limit their ability to practice effective coping techniques and understand their mind-body relationship. Asking for additional testing indicates that the client is not yet able to obtain relief in a non-chemical, non-medical way. Incorporating routines such as exercise and relaxation can help the client increase their mental and physical well-being and diminish their reliance on psychosomatic symptoms to cope with stress.

Which statement by the client indicates an understanding of somatic symptom disorder?

"How I handle stress and emotions can affect my physical health." Explanation: Clients who come to understand that how they cope with stress affects their physical health demonstrate an understanding of somatic symptom disorder. Clients with somatic symptom disorder eventually may be treated in mental health settings. It is unrealistic to avoid all stress in one's life.

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 Explanation: Pseudoneurologic symptoms of somatization disorder in Africa and South Asia include burning hands and feet and the nondelusional sensation of worms in the head or ants under the skin.

A nurse tells a 22-year-old male client on an inpatient psychiatric floor that it is time to attend group therapy. The client states, "I do not want to go." The nurse insists that the client attends as part of the client's prescribed care. The client states they feel like they might have a seizure and drops to the floor, but the nurse suspects the client has fallen in an attempt to further delay therapy. Select the most appropriate nursing response.

After assessing the client's safety, calmly wait until the client stops the behavior to speak with them again. Explanation: With malingering, clients often feign physical symptoms to gain attention or avoid non-preferred activities. After assessing for safety, withdrawing attention from the client's physical symptoms minimizes secondary gain. It is important not to draw more attention to the symptom by arguing with the client or yelling at others. It is also important to expect the client to participate in therapy and to not grant special privileges after exhibiting malingering behavior.

The nurse plans care for a client in the primary care setting who is diagnosed with somatic symptom disorder (SSD). Which intervention does the nurse include in the client's plan of care?

Ask the client if there is a history of trauma. Explanation: The cornerstones of management are trust and believing. The provider should assess for any stressors, life changes, and/or a history of trauma that has been linked to the excessive expression of somatic symptoms. Ideally, the client should see only one health care provider at regularly scheduled visits. During each primary care visit, the provider should conduct a holistic assessment including a partial physical examination of the organ system, focusing on the areas where the client reports issues. Physical symptoms are treated conservatively using the least intrusive approach. In the mental health setting, the use of cognitive behavior therapy (CBT) can be effective; however, this client is seeking care in the primary care setting.

Which is a significant obstacle in providing psychiatric care for clients who have somatic symptom illnesses?

Clients are often unrecognized because clients receive treatment in different primary care offices, and care is often fragmented. Explanation: Clients focus on physical symptoms as the primary problem. When physicians are unable to diagnose the cause, clients are often referred to other physicians for further physical assessment.

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?

Clients are often unrecognized because clients seek out multiple care providers and care is often fragmented. Explanation: Clients focus on physical symptoms as the primary problem. When physicians are unable to diagnose the cause, clients are often referred to other physicians for further physical assessment or clients seek out other providers (i.e., "provider shop").

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 Explanation: The cornerstone of management is trust and believing. Ideally, the client should see only one health care provider at regularly scheduled visits. During each primary care visit, the provider should conduct a partial physical examination of the organ system in which the client has complaints. Physical symptoms are treated conservatively using the least intrusive approach. In the mental health setting, the use of cognitive behavior therapy is effective. Medications may be used, such as monoamine oxidase inhibitors or selective serotonin reuptake inhibitors, but not mood stabilizers. Electroconvulsive therapy is not typically used.

Which disorder is characterized by unexplained, sudden deficits in sensory or motor function?

Conversion disorder Explanation: Conversion disorder involves unexplained, usually sudden, deficits in sensory or motor function. Body dysmorphic disorder is preoccupation with an imagined or exaggerated defect in physical appearance, such as thinking one's nose is too large or teeth are crooked and unattractive. Hypochondriasis is preoccupation with the fear that one has a serious disease (disease conviction) or will get a serious disease (disease phobia). Somatization disorder is characterized by multiple physical symptoms.

The la belle indifference occurs in which somatoform disorder?

Conversion disorder Explanation: La belle indifference occurs in clients diagnosed with conversion disorder.

Which characteristic differentiates conversion disorder from malingering disorder?

Conversion disorder is an unconscious process, while malingering disorder is a deliberate fabrication of symptoms. Explanation: In conversion disorder, anxiety-provoking impulses are converted unconsciously into functional symptoms. Malingering disorder is characterized by the voluntary production of false or grossly exaggerated physical or psychological symptoms. Both produce rewards, and neither has any pathophysiological cause. Neither disorder is considered a permanent or untreatable condition.

A nurse is reviewing the medical history of a client diagnosed with somatic symptom disorder (SSD). Which would the nurse expect to find as a comorbid condition?

Depression Explanation: Somatic symptom disorder frequently coexists with other psychiatric disorders, most commonly depression and anxiety. Others include panic disorder, mania, social phobia, obsessive-compulsive disorder, psychotic disorders, and personality disorders. Older adults are particularly high risk for comorbid depression.

Which would be most important for a nurse to do when caring for a client with somatic symptom disorder?

Develop a sound, positive nurse-client relationship Explanation: Although administering prescribed pharmacotherapy, counseling, and assisting in developing a daily routine are important, the most crucial part of the plan of care is developing a sound, positive nurse-client relationship. Without the relationship, the nurse is just one more provider who fails to meet the client's expectations.

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 Explanation: The obvious nursing diagnosis is disturbed body image. Nursing care should focus on building a therapeutic relationship and supporting the client's positive physical aspects.

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 Explanation: SSD is one of the most difficult disorders to manage because the symptoms tend to change, are diffuse and complex, and vary and move from one body system to another. The physical symptoms may last for 6 to 9 months.

When assessing a client with somatic symptom disorder (SSD), the nurse would be alert for which comorbidity as most common? Select all that apply.

Explanation: Although social phobia, panic disorder, and personality disorder are other comorbidities with SSD, it frequently coexists with other psychiatric disorders, most commonly depression and anxiety.

Which mental health disorder is characterized by a fear of developing a serious illness based on a misinterpretation of body sensation?

Hypochondriasis Explanation: When individuals are fearful of developing a serious illness based on their misinterpretation of body sensation, the term hypochondriasis is used to describe the preoccupation. Individuals with alexithymia have difficulty identifying and expressing their emotions. Conversion disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms. Patients with body dysmorphic disorder focus on real (but slight) or imagined defects in appearance, such as a large nose or thinning hair. Preoccupation with the defect causes significant distress and interferes with their ability to function socially.

When describing the major difference between somatic symptom disorder and factitious disorders, which would the nurse include?

In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints. Explanation: Clients with somatic symptom disorder do not intentionally cause, and have no conscious or voluntary control over, their symptoms. Lack of voluntary control is in contrast to factitious disorder and malingering. In factitious disorder, clients deliberately make up or inflict symptoms.

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. Explanation: A conversion disorder involves an unexplained, usually sudden, deficit in sensory or motor function.

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?

Munchausen's syndrome by proxy Explanation: The client who attempts to injure someone else, usually a child, to gain the attention of the health care provider most likely has factitious disorder by proxy, or Munchausen's syndrome by proxy. Typically, this disorder affects mothers. The client's history does not reflect manifestations of schizoid personality traits or borderline personality disorder. Functional neurologic symptoms involve severe emotional distress or unconscious conflict expressed through physical symptoms.

Somatic symptom disorder is characterized by what?

Severe physical symptoms unexplainable by any organic or physical pathology Explanation: The diagnostic criteria for somatic symptom disorder were updated in the DSM-5 and include one or more symptoms that cause persistent distress or significant disruption in daily lives for at least 6 months, as well as excessive thoughts about the seriousness of the symptoms, feelings (such as anxiety about the symptoms or health) or behaviors related to the symptoms, or health concerns (such as spending excessive time and energy focusing on these symptoms or health). These symptoms cannot be explained or unexplained by medical evidence.

The nurse provides care for an older adult client who is newly diagnosed with somatic symptom disorder (SSD). Which psychiatric disorder is the priority to assess this client for based on the current diagnosis of SSD?

depression disorder Explanation: SSD frequently coexists with other psychiatric disorders, most commonly anxiety and depression. Others include OCD, PTSD, panic disorder, personality disorders, psychotic disorders, and social phobia. Older adults are at particularly high risk for comorbid depression; therefore, depression disorder is assessed on priority based on the SSD diagnosis.

The nurse plans care for a client who experiences pain due to somatic symptom disorder (SSD). Which complementary and alternative medicine (CAM) intervention does the nurse include in the client's plan of care to address pain?

relaxation techniques Explanation: In pain management, a single approach rarely works. Pain is a primary issue and was previously considered a separate disorder. Nursing care focuses on helping clients identify strategies to relieve pain and to examine stressors in their lives. After a careful assessment of the pain, nonpharmacologic strategies should be developed to reduce it. One nonpharmacologic strategy is the implementation of CAM with an appropriate intervention being the introduction of relaxation techniques. Daily exercise and a physical therapy referral are appropriate for back pain but are not considered CAM interventions. Modification of eating habits is appropriate for frequent gastrointestinal pain; however, this is not considered a CAM intervention.