Chapter 12: Somatic Symptom Disorders (Exam 2)

A patient with blindness related to a functional neurological (conversion) disorder states, "All the doctors and nurses in this hospital stop by often to check on me. Too bad people outside the hospital don't find me interesting." Which nursing diagnosis is most relevant? A. Social isolation B. Chronic low self-esteem C. Interrupted family processes D. Ineffective health maintenance

B. Chronic low self-esteem The patient mentions that the symptoms make people more interested, which indicates that the patient believes he or she is uninteresting and unpopular without the symptoms, thus supporting the nursing diagnosis of chronic low self-esteem. Defining characteristics for the other nursing diagnoses are not present in this scenario.

A patient diagnosed with a somatic symptom disorder has the nursing diagnosis: Interrupted family processes, related to patient's disabling symptoms as evidenced by the spouse and children assuming roles and tasks that previously belonged to patient. What is an appropriate outcome for this patient? A. Assumes roles and functions of the other family members. B. Demonstrate a resumption of former roles and tasks. C. Focuses energy on problems occurring in the family. D. Relies on family members to meet personal needs.

B. Demonstrate a resumption of former roles and tasks. The patient with a somatic symptom disorder has typically adopted a sick role in the family, characterized by dependence. Increasing independence and the resumption of former roles are necessary to change this pattern. The distractors are inappropriate outcomes.

A patient's blindness is related to a functional neurological (conversion) disorder. To help the patient eat, the nurse should implement what intervention? A. Establishing a "buddy" system with other patients who can feed the patient at each meal B. Expecting the patient to self-feed after explaining the arrangement of the food on the tray C. Directing the patient to locate items on the tray independently with feeding being unassisted D. Addressing the needs of other patients in the dining room, and then feeding this patient

B. Expecting the patient to self-feed after explaining the arrangement of the food on the tray The patient is expected to maintain some level of independence by feeding himself or herself, whereas the nurse is supportive in a matter-of-fact way. The distractors support dependency or offer little support.

A patient reports fears of having cervical cancer and says to the nurse, "I've had Pap smears by six different doctors. The results are normal, but I'm sure that's because of errors in the laboratory." Which disorder would the nurse suspect? A. Functional neurological (conversion) disorder B. Illness anxiety disorder (hypochondriasis) C. Derealization disorder D. Dissociative amnesia with fugue

B. Illness anxiety disorder (hypochondriasis) Patients with illness anxiety disorder (hypochondriasis) have fears of serious medical problems such as cancer or heart disease. These fears persist, despite medical evaluations, and interfere with daily functioning. No complaints of pain are made, and no evidence of dissociation or conversion exists. Derealization disorder involves recurrent periods of feeling unreal, detached, outside of the body, numb, dreamlike, or a distorted sense of time or visual perception.

Which treatment modality should a nurse recommend to help a patient diagnosed with somatic symptom disorder cope more effectively? A. Flooding B. Relaxation C. Response prevention D. Systematic desensitization

B. Relaxation Pain, a common complaint in patients diagnosed with somatic symptom disorder, increases when the patient has muscle tension. Relaxation can diminish the patient's perceptions of the intensity of pain. The distractors are modalities useful in treating selected anxiety disorders.

A patient reporting stomach pain says, "I have seen 10 different health care providers but all of them tell me I don't have stomach cancer." Which term might be appropriate in describing this report? A. Somatic symptom disorder B. Factitious disorder C. Illness anxiety D. Malingering

C. Illness anxiety Individuals with illness anxiety disorder are preoccupied with having or eventually developing a serious illness. The patient is apprehensive of a particular illness despite continuous negative medical evaluations and assurances. Malingering is intentionally faking or exaggerating symptoms for an obvious benefit such as money, housing, medications, avoiding work, or criminal prosecution. Malingering is a behavior and not a psychiatric disorder. "Somatization," defined as a process by which psychological distress is expressed as physical symptoms without a known organic source, causes substantial distress and psychosocial impairment with or without a known general medical disease. The essential feature of factitious disorder is intentionally faking symptoms in order to assume the sick role, that is, to be a patient. In addition, there are no obvious external benefits such as financial gain or avoiding work or criminal prosecution.

A patient who fears serious heart disease was referred to the mental health center by a cardiologist after diagnostic evaluation showed no physical illness. The patient says, "My heart misses beats. I'm frequently absent from work. I don't go out much because I need to rest." Which health problem is most likely? A. Depersonalization disorder B. Antisocial personality disorder C. Illness anxiety disorder D. Persistent depressive disorder

C. Illness anxiety disorder Illness anxiety disorder (hypochondriasis) involves a preoccupation with fears of having a serious disease, even when evidence to the contrary is available. The preoccupation causes impairment in social or occupational functioning. Depersonalization disorder involves recurrent periods of feeling unreal, detached, outside of the body, numb, dreamlike, or a distorted sense of time or visual perception. Persistent depressive disorder (dysthymia) is a disorder of lowered mood. Antisocial disorder applies to a personality disorder in which the individual has little regard for the rights of others.

A patient diagnosed with somatic symptom disorder says, "I have pain from an undiagnosed injury. I can't take care of myself. I need pain medicine six or seven times a day. I feel like a baby because my family has to help me so much." It is important for the nurse to conduct what focused assessment? A. Mood B. Cognitive style C. Secondary gains D. Identity and memory

C. Secondary gains Secondary gains should be assessed. The patient's dependency needs may be met through care from the family. When secondary gains are prominent, the patient is more resistant to giving up the symptom. The scenario does not allude to a problem of mood. Cognitive style and identity and memory assessment are of lesser concern because the patient's diagnosis has been established.

To assist a patient diagnosed with a somatic system disorder, which nursing intervention is of highest priority? A. Implying that somatic symptoms are not real B. Helping the patient suppress feelings of anger C. Shifting the focus from somatic symptoms to feelings D. Investigating each physical symptom as soon as it is reported

C. Shifting the focus from somatic symptoms to feelings Shifting the focus from somatic symptoms to feelings or to neutral topics conveys an interest in the patient as a person rather than as a condition. The need to gain attention with the use of symptoms is reduced over the long term. A desired outcome is that the patient expresses feelings, including anger, if it is present. Once physical symptoms have been investigated, they do not need to be reinvestigated each time the patient reports them.

A patient diagnosed with somatic symptom disorder has been in treatment for 4 weeks. The patient says, "Although I'm still having pain, I notice it less and am able to perform more activities." The nurse should evaluate the treatment plan using what phrase: A. unsuccessful. B. minimally successful. C. partially successful. D. totally achieved.

C. partially successful. Decreased preoccupation with symptoms and an increased ability to perform activities of daily living suggest partial success of the treatment plan. Total success is rare because of patient resistance.

A patient diagnosed with somatic symptom disorder tells the nurse, "It's starting again. I feel as though my heart is beating out of my chest and I can't breathe." The nurse should provide what response to best address the patient's symptoms? A. "I'll call your health care provider and see if I can give you a sedative." B. "Do you think you will feel better with some oxygen?" C. "We've talked about how being dramatic is helpful." D. "Has something happened to make you anxious?"

D. "Has something happened to make you anxious?" Patients with somatic symptom disorders have difficulty communicating their emotional needs. As children, their family communication style may have neglected the appropriate expression of anger, depression, fear, and other emotions, and thus they do not recognize feelings nor understand how to relate to them. The feeling of anxiety may cause tightness in the stomach, nausea, rapid heartbeat, shortness of breath, dizziness, sweating, and tensing of muscles such as the hands or jaw. If a person is taught to consider the relationship of emotions to physical symptoms, the person will likely identify that he or she is anxious. Offering medical interventions are not addressing the likely trigger for the symptoms. Accusing the patient of being dramatic will likely serve to only increase the anxiety already being experienced.

Which patient statement best supports the diagnosis of somatic disorders? A. "I can't do much because of the severe pain." B. "I feel as if I'm living in a fuzzy dream state." C. "I feel like different parts of my body are at war." D. "I feel very anxious and worried about my problems."

A. "I can't do much because of the severe pain." The patient diagnosed with somatic disorders is preoccupated and disabled as a result of somatic pain or some other disability. The distractors are more consistent with depersonalization, generalized anxiety disorder, or dissociative identity disorder.

A nurse assesses a patient diagnosed with functional neurological (conversion) disorder. Which comment best supports this diagnosis? A. "Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion." B. "I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry and I think I'm getting seriously dehydrated." C. "Sexual intercourse is painful. I pretend as if I'm asleep so I can avoid it. I think it's starting to cause problems with my marriage." D. "I get choked very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus."

A. "Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion." Patients with functional neurological (conversion) disorder often demonstrate a lack of concern regarding the seriousness of symptoms. In addition, a specific cause for the development of the symptoms is identifiable; in this instance, the death of a parent precipitates the stress. The incorrect options suggest other types of somatic symptom disorders.

A patient has been diagnosed with a somatic symptoms disorder after various testing has failed to confirm a physiological cause for the patient's reports of back pain. What intervention by the nurse demonstrates the appropriate response when the patient continues to monopolize the group discussion with about back pain? A. Acknowledge the presence of pain but then redirect to another topic. B. Offer to discuss the back pain with the patient after the group session is over. C. In a matter-of-fact manner tell the patient that their pain is somatic in nature. D. Offer to discuss additional pain medication with the patient's health care provider.

A. Acknowledge the presence of pain but then redirect to another topic. After physical complaints have been investigated and a somatic symptom diagnosis is made, avoid further reinforcement of the somatic complaints by directing focus away from physical symptoms. The presence of the pain should not be denied but reinforcing or rewarding such behavior should not be engaged in.

What are the causes of somatic system disorders generally related to? A. Faulty perceptions of body sensations B. Traumatic childhood events C. Culture-bound phenomena D. Mood instability

A. Faulty perceptions of body sensations Structural or functional abnormalities of the brain have been suggested to lead to the somatic system disorders, resulting in disturbed processes of perception and interpretation of bodily sensations. Furthermore, cognitive theorists believe patients misinterpret the meaning of certain bodily sensations and then become excessively alarmed by them. Traumatic childhood events are related to the dissociative disorders. Culture-bound phenomena may explain the prevalence of some symptoms but cannot explain the cause. Somatic system disorders are not a facet of mood instability; however, depression may coexist with a somatic system disorder.

A college student reports that, "My vision is too blurry to read effectively, especially when it's time to be studying for a test." Which health problem should be considered initially? A. Malingering B. Illness anxiety C. Factitious disorder D. Functional neurological disorder

A. Malingering Malingering is intentionally faking or exaggerating symptoms for an obvious benefit such as money, housing, medications, avoiding work, or criminal prosecution. Functional neurological disorder (FND) involves chronic or brief symptoms of altered voluntary motor or sensory function that cause substantial distress or psychosocial impairment. Individuals with illness anxiety disorder are preoccupied with having or eventually developing a serious illness. The essential feature of factitious disorder is intentionally faking symptoms in order to assume the sick role, that is, to be a patient.

An adult diagnosed with conversion (functional neurobiological symptom) disorder says, "Our family has gotten along over the years by working together. My partner cooks and the children clean house." Understanding of this disorder will provide what rationalization for this statement? A. Patient is receiving secondary gains from the symptoms. B. Patient has problems with sexual identity and satisfaction. C. Patient will be resistant to developing a trusting relationship. D. Patient will benefit from confrontation about physical complaints.

A. Patient is receiving secondary gains from the symptoms. Being able to avoid traditional family role responsibilities by adopting a sick role can be seen as a "payoff." Receiving a payoff is another way of saying that the individual receives secondary gain from the symptoms. Data are not present to permit choice of the incorrect options.

A nurse physically assessing a patient diagnosed with somatic disorder should understand that which intervention is the priority? A. Provide a thorough physical examination. B. Avoid detailed discussion of the reported complaints. C. Avoid suggesting the appropriateness of any medical testing. D. Focus on both prescribed and OTC medications the client is taking.

A. Provide a thorough physical examination. It is always important to ensure that an underlying medical condition has been eliminated from the differential diagnosis and so it is vital that the assessment be thorough. This understanding makes the other options incomplete or inappropriate.

A nurse assessing a patient diagnosed with a somatic system disorder is most likely to note what patient characteristic? A. Readily sees a relationship between symptoms and interpersonal conflicts. B. Rarely derives personal benefit from the symptoms. C. Has little difficulty communicating emotional needs. D. Has unmet needs related to comfort and activity.

D. Has unmet needs related to comfort and activity. The patient diagnosed with a somatic system disorder frequently has altered comfort and activity needs. In addition, hygiene, safety, and security needs may also be compromised. The patient is rarely able to see a relation between symptoms and events in his or her life, which is readily discernible to health professionals. Patients with somatic system disorders often derive secondary gain from their symptoms and/or have considerable difficulty identifying feelings and conveying emotional needs to others.

For a patient diagnosed with somatic symptom disorder, what statement would effectively complete the long-term outcome of "Within 4 weeks, the patient will demonstrate an ability to? A. Functioning independently on a basic level." B. Verbalizing feelings of physical and emotional safety." C. Regularly attending prescribed diversional activity groups." D. Identifying personal coping patterns that are proving to be ineffective."

D. Identifying personal coping patterns that are proving to be ineffective." The ability to identify and recognize as relevant the ineffective coping patterns that contribute to the somatic symptoms is an appropriate outcome. A patient may verbalize feeling safe, to function independently on a basic level, and to attend diversional activities without addressing the factors significant to resolving somatic symptom disorders.

Instructions concerning what stress management technique should be included in the care plan of a patient diagnosed with a somatic symptom disorder? A. Mindful awareness B. Positive self-talk C. Take a time out D. Meditation

D. Meditation Meditation has been shown to be effective in managing stress associated with somatic symptom disorders. Mindful awareness and positive self-talk are associated with anxiety management while the concept of a time out helps manage anger.

What is the primary difference between somatic system disorders and dissociative disorders? A. They are under voluntary control B. They are related to resolved stress. C. They are generally strongly cultural bound. D. They are psychological stress expressed through somatic symptoms.

D. They are psychological stress expressed through somatic symptoms. Somatic symptom disorders are expressions of unresolved emotional trauma characterized by the presence of one or more physical symptoms without a known organic source that causes substantial distress and psychosocial impairment with or without a known general medical disease. Somatic system disorders are neither under voluntary control nor are they cultural bound.

To plan effective care for patients diagnosed with somatic system disorders, the nurse should understand that patients have difficulty giving up the symptoms because of what characteristic? A. They are generally chronic in nature. B. They have a physiological basis. C. They can be voluntarily controlled. D. They provide relief from health anxiety.

D. They provide relief from health anxiety. At the unconscious level, the patient's primary gain from the symptoms is anxiety relief. Considering that the symptoms actually make the patient more psychologically comfortable and may also provide a secondary gain, patients frequently and fiercely cling to the symptoms. The symptoms tend to be chronic; however, this does not explain why they are difficult to give up. The symptoms are not under voluntary control or physiologically based.

A nurse assesses a patient suspected to have somatic system disorder. Which findings support the diagnosis? (Select all that apply.) A. Female B. Reports frequent dizziness C. Complains of heavy menstrual bleeding D. First diagnosed with psoriasis at 12 years of age E. Reports of back pain, painful urination and frequent diarrhea

ANS: A, B, C, E A. Female B. Reports frequent dizziness C. Complains of heavy menstrual bleeding E. Reports of back pain, painful urination and frequent diarrhea No chronic disease explains the symptoms for patients with somatic system disorder. Patients report multiple symptoms; gastrointestinal, sexual, and pseudoneurological symptoms are common. This disorder is more common in women than in men.

A patient diagnosed with somatic symptom disorder says, "Why has God chosen me to be sick all the time and unable to provide for my family? The burden on my family is worse than the pain I bear." Which nursing diagnoses apply to this patient? (Select all that apply.) A. Spiritual distress B. Decisional conflict C. Adult failure to thrive D. Impaired social interaction E. Ineffective role performance

ANS: A,E A. Spiritual distress E. Ineffective role performance The patient's verbalization is consistent with spiritual distress. Moreover, the patient's description of being unable t o provide for and burdening the family suggests ineffective role performance. No data support diagnoses of adult failure to thrive, impaired social interaction, or decisional conflict.

A patient with a diagnosis of somatic symptom disorder is being assessed. What assessment questions are appropriate and therapeutic in nature? (Select all that apply.) A. "Would you consider yourself to be mentally ill?" B. "Do you have periods of depression or extreme sadness?" C. "Have you ever been told that your symptoms are not real?" D. "Are you able to care for yourself and meet your own basic needs?" E. "How do the members of your immediate family react to your illness?"

ANS: B, D, E B. "Do you have periods of depression or extreme sadness?" D. "Are you able to care for yourself and meet your own basic needs?" E. "How do the members of your immediate family react to your illness?" The assessment should address possible comorbid conditions like depression, the patient's ability to meet their basic needs independently, and the dynamics of the family regarding the existence of the sick role and secondary benefits. The remaining options are likely to increase the patient's stress and foster anger, either of which are therapeutic.

A patient says, "I know I have a brain tumor despite the results of the magnetic resonance image (MRI). The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day." Which response by the nurse fosters cognitive restructuring? A. "You do not have a brain tumor. The more you talk about it, the more it reinforces your illogical thinking." B. "Let's see whether any other explanations for your vomiting are possible." C. "You seem so worried. Let's talk about how you're feeling." D. "We should talk about something else."

B. "Let's see whether any other explanations for your vomiting are possible." Questioning the evidence is a cognitive restructuring technique. Identifying causes other than the feared disease can be helpful in changing distorted perceptions. Distraction by changing the subject will not be effective.

Which medication would the nurse expect to be prescribed for a patient diagnosed with a somatic symptom disorder? A. Narcotic analgesics for use as needed for acute pain B. Antidepressant medications to treat underlying depression C. Long-term use of benzodiazepines to support coping with anxiety D. Conventional antipsychotic medications to correct cognitive distortions

B. Antidepressant medications to treat underlying depression Various types of antidepressants may be helpful in somatic disorders directly by reducing depressive symptoms and hence somatic responses, but also indirectly by affecting nerve circuits that affect not only mood, but also fatigue, pain perception, GI distress, and other somatic symptoms. Patients may benefit from short-term use of anti-anxiety medication (benzodiazepines) but require careful monitoring because of risks of dependence. Conventional antipsychotic medications would not be used, although selected atypical antipsychotics may be useful. Narcotic analgesics are not indicated.

A patient whose blindness is related to a functional neurological (conversion) disorder appears to be unconcerned about this problem. Which understanding should guide the nurse's planning for this patient? A. Suppressing accurate feelings regarding the problem. B. Anxiety is relieved through the physical symptom. C. Emotional needs are met through hospitalization. D. The patient refuses to disclose genuine fears.

B. Anxiety is relieved through the physical symptom. Psychoanalytic theory suggests conversion reduces anxiety through the production of a physical symptom that is symbolically linked to an underlying conflict. Conversion, not suppression, is the operative defense mechanism in this disorder. The other distractors oversimplify the dynamics, suggesting that only dependency needs are of concern, or suggest conscious motivation (conversion operates unconsciously).

A medical-surgical nurse works with a patient diagnosed with a somatic system disorder. Care planning is facilitated by understanding that the patient will probably present what behavior? A. Readily seek psychiatric counseling. B. Being resistant to accepting psychiatric help. C. Attending psychotherapy sessions without encouragement. D. Being eager to discover the true reasons for physical symptoms.

B. Being resistant to accepting psychiatric help. Patients with somatic system disorders go from physician to physician trying to establish a physical cause for their symptoms. When a psychological basis is suggested and a referral for counseling is offered, these patients reject both.