chapter 17

A nurse is assessing a group of patients suffering from stress-related medical conditions. Which condition does the nurse consider to be most associated with a feeling of hopelessness? 1. Cancer 2. Peptic ulcer 3. Essential hypertension 4. Coronary heart disease

1

The nurse is caring for a patient with a somatic symptom disorder. What pharmacologic medicine does the nurse need to teach the patient and the family about? 1.Antianxiety medication 2. Antidiabetic medication 3. Medications for cardiac diseases 4. Medications for brain hemorrhage

1

A health care provider describes a patient as "malingering." The nurse knows this means that the patient 1. Is falsely claiming to have symptoms 2 Experiences symptoms that cannot be explained medically 3 Experiences symptoms that have a physiological basis 4 Is seeking medication to ease pain of psychological origin

1 Malingering is a consciously motivated act to deceive based on the desire for material gain.

Which somatization disorder should the nurse consider highly treatment-resistant? 1. Factitious disorder 2. Conversion disorder 3. Illness anxiety disorder 4. Somatic symptom disorder

1 Factitious disorder is highly treatment-resistant. This is because the patient is consciously pretending or exaggerating illness for material gains. Due to pretense, it is highly treatment-resistant as the symptoms are deliberately fabricated. Conversion disorder usually has an acute onset and may resolve quickly. The course of illness anxiety disorder is chronic. It is also marked by relapses. Fifty percent of the patients suffering from illness anxiety disorder improve. The course of somatic symptom disorder can be chronic and relapsing in nature. It is not treatment-resistant though.

The nurse practices cognitive behavioral therapy (CBT) while caring for a patient with somatization disorders. What is the advantage of using CBT for such patients? 1. Helps to reframe the patient's thoughts and gain control of the situation 2. Provides a consistent supported treatment by a general medical nurse 3. Builds a self-fulfilling cycle of pain, despair, and health-seeking behaviors 4. Initiates psychiatric consultation without need for the primary health care provider

1 In cognitive behavioral therapy (CBT), the nurse helps the patient to reframe his or her thoughts of exaggeration of symptoms and health-seeking behaviors. This helps the patient to gain control of the situation and break the cycle of pain, despair, and health-seeking behaviors. CBT is a consistent supported treatment method that cannot be managed by general medical nurses. An advanced practice psychiatric nurse provides CBT. An advanced practice nurse works with the patient, keeping the primary health care provider in the loop. An advanced practice nurse initiates the psychiatric consultation if needed.

The nurse is caring for a patient with illness anxiety disorder. What are the key interventions for an effective treatment and relationship with the patient? Select all that apply. 1. Provide continuity of care 2. Set reasonable therapeutic goals 3. Refrain from conducting a physical exam 4. Avoid unnecessary tests and procedures 5. Explain that the symptoms are all baseless 6. Provide frequent, brief office visits

1, 2, 4, 6

In a psychiatric unit, a nurse is caring for patients with somatic disorders. Why do patients with somatic disorder often show that they are ill? Select all that apply. 1. To obtain financial benefit 2. To seek attention from others 3. To show that they care for others 4. To show a special interest in an activity 5. To gain benefit in interpersonal relationships

1, 2, 5

A nurse is caring for patients with somatic symptoms. Which strategies does the nurse incorporate in the plan of care to facilitate effective recovery? Select all that apply. 1. provide continuity of care 2. avoid physical exam 3. set reasonable treatment goals 4. conduct labratory investigations r/t to each symptom 5. conduct physical examination each time

1, 3, 5

How does a nurse help a patient with holistic nursing techniques? Select all that apply. 1. Teach effective coping skills 2. Arrange for financial support 3. Refer the patient to the community support groups 4. Encourage the patient to undergo tests and medical procedures 5. Provide information regarding specific treatments

1, 3, 5

A nurse is assessing a patient who complains of a headache. Which behaviors of the patient will make the nurse suspect factitious disorder? Select all that apply. 1. he patient demands specific treatments. 2. The patient cooperates with the heath care team. 3. The patient feels better with negative test results. 4. The patient describes his complaints dramatically. 5. The patient is unwilling to interact with the family.

1, 4, 5

Which holistic therapy can be added to the care plan for a patient diagnosed with stress-induced essential hypertension? 1. Yoga 2. Biofeedback 3. Psychotherapy 4. Behavioral therapy

1.

A patient diagnosed with a somatic disorder asks what kind of psychotherapy will be prescribed. What is the nurse's response? 1. "A combination of antianxiety and antidepressant therapy is the most effective therapy." 2. "Aversion therapy often is used because in effect you are punishing yourself by not being able to walk." 3. "As you see desired behaviors modeled by the therapist, you also will be able to achieve the expected outcome." 4. "Cognitive behavioral therapy has been shown to consistently provide the best outcome for these types of disorders."

1. Cognitive behavioral therapy (CBT) is the most consistently supported treatment for the full spectrum of somatic disorders. A combination of antianxiety and antidepressant therapy, aversion therapy, and emulating desired behaviors are incorrect and do not describe the most used and effective therapy for this disorder.

A nurse interviews a patient diagnosed with conversion disorder. Which comment is most likely from this patient? 1. "Since getting a divorce, I've had crushing chest pain, but I don't think it really means anything." 2. "I have daily problems with nausea and vomiting. I think I'm getting seriously dehydrated." 3. "Sexual intercourse is so painful that I avoid it. I'm afraid that's going to destroy my marriage." 4. "I get big lumps in my throat and can't swallow when I eat. I'm afraid I might have cancer."

1. In conversion disorder, the individual may be expressing a forbidden thought or wish by converting it into physical symptoms that are more appropriate and acceptable, and which also provide sympathy, care, and attention from others. Individuals exhibit one or more symptoms that affect voluntary motor or sensory function. These symptoms appear to be related to a neurologic or general medical condition but are not caused by a general medical condition, or the direct effects of a substance, or a culturally sanctioned behavior or experience. The symptom is not intentionally produced and is not limited to pain or sexual dysfunction. The conversion symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Common symptoms are blindness, paralysis, deafness, seizures, anesthesia, or abnormal motor movements

A nurse counsels a patient diagnosed with a somaticization disorder. The patient says, "I've been sick for so long, my friends and family no longer help me. I guess I'm on my own now." Which nursing diagnosis best applies to this scenario? 1. Anxiety 2. Loneliness 3. Body image disturbance 4. Impaired social interaction

2

A nurse is caring for a young widow and suggests community resources available to help her cope with the loss. Why is this intervention important? 1To identify anxiety 2. To identify a support system 3. To assess suicidal tendency 4. To build a relationship with the patient

2

A nurse is planning care for a patient with illness anxiety disorder. Which intervention does the nurse perform to prevent the patient from self-harm? 1. Develop a relationship with the patient. 2. Assess suicidal ideation in the patient. 3. Encourage the patient to identify anxiety. 4. Counsel the patient about sharing feelings.

2

When discussing somatic disorders from a cultural perspective, it is true that 1. Somatic disorders rarely are observed in males 2. Somatic symptoms vary widely from culture to culture 3. Underdeveloped countries rarely tolerate somatic disorders 4. Secondary gain is seldom a factor in somatic disorders

2

A veteran returning from Iraq is diagnosed with a conversion disorder when all diagnostic testing has been negative for any physical abnormalities. When asked what this means, what is the nurse's best response? 1. "Your legs don't work because your brain is confused." 2. "Your emotional distress is being expressed as a physical symptom." 3. "You are making up your symptoms as a cry for help." 4. "You are overly anxious about having a severe illness."

2 Conversion disorder is attributed to the channeling of emotional conflicts or stressors into physical symptoms. Telling the patient his or her brain is "confused" is unprofessional and does not give any useful education. Symptoms of conversion disorder are not within the patient's voluntary control. Being overly anxious about having a severe illness describes illness anxiety disorder.

A nurse is caring for a patient with illness anxiety disorder. Which interventions does the nurse perform while managing this patient? Select all that apply. 1. Promote dependency needs 2. Show concern for the patient 3. Teach assertive communication 4. Teach stress reduction techniques 5. Communicate that the symptoms are not real

2, 3, 4

Therapeutic intervention for a patient with a somatoform disorder would include 1. Steering conversation away from the patient's feelings 2. Conveying an interest in the patient rather than in the symptoms 3. Encouraging the patient to use benzodiazepines liberally 4. Encouraging the patient to rely on the nurse to meet the patient's needs

2.

A member of the military service prepares for discharge. Just before the exit physical examination, this person consumes large amounts of caffeine to increase blood pressure in an effort to qualify for disability benefits. Which term is most applicable to this individual's behavior? 1. Resilience 2. Malingering 3. Somatization 4. Hypochondriasis

2. Malingering is a consciously motivated act to deceive based on the desire for material gain. It involves fabricating an illness or exaggerating symptoms to become eligible for disability compensation, commit fraud against insurance companies, obtain prescription medications, evade military service, or receive a reduced prison sentence. Resilience refers to the capacity to adapt to and cope with severe stress. Somatization refers to the expression of psychological stress through physical symptoms. Hypochondriasis is an older term for illness anxiety disorder.

The most likely patient to initially demonstrate behaviors suggesting a somatic disorder is a 1. 13 yr. M 2. 23 yr. F 3. 33 yr. M 4. 43 yr. F

2. seen more in young women aged 16-25

he primary difference between a factitious disorder and other somatic disorders is that factitious disorders 1. Respond well to confrontation as a primary therapeutic technique 2. Have a symptomology that actually is controlled by the patient 3. Have their origins in depression and anxiety 4. Are always self-directed

2. Factitious disorders, in contrast to other somatic disorders, are under conscious control.

A patient complains of severe headache and seeing blinding lights. The patient's history shows numerous hospitalizations and diagnostic tests for neurological problems. All tests were normal and revealed no pathophysiology. What is the most appropriate nursing diagnosis for this patient? 1. sorrow 2. Ineffective denial 3. Ineffective coping 4. Deficient knowledge

3

What would be an appropriate expected outcome for a patient diagnosed with a somatic disorder that has resulted in leg paralysis? 1. Patient will walk unassisted within one week. 2. Patient will return to a preillness level of functioning within two weeks. 3. Patient will be able to state two new effective coping skills within two weeks. 4. Patient will assume full self-care within three weeks.

3

Which nursing diagnosis should be investigated for patients with somatoform disorders? 1. Deficient fluid volume 2. Self-care deficit 3. Ineffective coping 4. Delayed growth and development

3

Why is self-assessment necessary for the nurse who is working with patients with somatization disorders? 1. To assess the objectivity of the nursing plan 2. To check whether a correct nursing plan has been followed 3. To eradicate resentment toward the patient 4. To check capability to handle such a difficult patient

3

An anxious patient has frequent abdominal cramps and believes it is because of some underlying serious illness. What is the possible diagnosis for this condition? 1. Factitious disorder 2. Conversion disorder 3. Illness anxiety disorder 4. Somatic symptom disorder

3 Illness anxiety disorder is an exaggeration of a negligible health symptom. The minor changes experienced physically by the patient at a stressful time are magnified into a serious illness. In the case of a factitious disorder, the patient consciously pretends that he or she is in need of medical help. The patient does this to gain something or to attain the status of a "patient." Patients with conversion disorder have symptoms of neurological disorders, but examination by a neurologist often does not reveal any neurological diagnosis. In cases of somatic symptom disorder, the distressing symptoms and health concerns that the patient experiences are baseless, with no physical findings or medical diagnosis.

The nurse includes stress management interventions when developing a plan of care for a patient with which disorder? 1. Factitious disorder 2. Conversion disorder 3. Illness anxiety disorder 4. Somatic symptom disorder

3 Patients with Illness anxiety disorder experience stress or extreme worry and fear about the possibility of having a disease. Hence, with stress management the fear and worry is brought under control. Factitious disorder can be resistant to treatment and may require management rather than cure or legal interventions. Conversion disorder can be managed with behavior therapy, hypnosis, or antianxiety drugs. Somatic symptom disorder can be managed with cognitive behavioral therapy.

A nurse assesses a patient diagnosed with conversion (functional neurological) disorder. Which comment is most likely from this patient? 1. "I have severe abdominal bloating. I think I might have colon cancer." 2. "I have the sensation of needles sticking in my feet. I think there are demon forces that are causing it." 3. "Since losing my job last week, I've been unable to maintain my balance and coordination. It's probably just a little nerve irritation." 4. "For most of my life, I've had a sensitive gastrointestinal tract. Sometimes it's very bad but it usually gets better without seeing a doctor."

3 Patients with conversion disorder channel emotional distress into physical symptoms of a neurological nature. Many patients show a lack of emotional concern about the symptoms (la belle indifférence). In this scenario, the patient describes symptoms of a neurological disorder that began after a significant stressor, but then discounts the symptoms. Somatic symptom disorder has a chronic and relapsing course. Illness anxiety disorder (hypochondriasis) results in the misinterpretation of physical sensations as evidence of a serious illness.

Which disorder places the patient at highest risk for developing a coexisting substance abuse disorder? 1. conversion disorder 2. factitious disorder 3. somatoform pain disorder 4. illness anxiety disorder

3 Patients with pain disorder may use alcohol or other central nervous system depressants or anxiolytic drugs to self-medicate.

what class of medication is common prescribed for somatic disorders? 1. mood stabilizers 2. antidepressants 3. anxiolytics 4. antipsychotics

3 Primary care providers prescribe anxiolytic agents for patients who seem highly anxious and concerned about their symptoms. Individuals experiencing many somatic complaints often become dependent on medication to relieve pain or anxiety or to induce sleep.

Which scenario demonstrates a secondary gain? 1. A couple refrains from sexual intercourse for six weeks after the woman has a hysterectomy. 2. Parents reward their children for good school reports with an afternoon at the park and an ice cream treat. 3. A husband hires a housekeeper to clean and provide childcare while his wife is having abdominal distress. 4. Grandparents complain of loneliness and feeling devalued because they rarely have visits from their children and grandchildren.

3 Secondary gains are benefits derived from the symptoms alone, such as receiving extra attention from loved ones or avoiding usual responsibilities. In this scenario, a housekeeper permits the wife to avoid childcare and home maintenance responsibilities. Refraining from sexual intercourse after a hysterectomy, rewarding children for good report cards, and feeling lonely and devalued show compliance with discharge instructions, positive reinforcement, or emotional reactions.

A woman suddenly finds she cannot see. She seems unconcerned about her symptom and tells her husband, "Don't worry, dear. Things will all work out." Her attitude is an example of 1. Regression 2. Depersonalization 3. La belle indifference 4. Dissociative amnesia

3. La belle indifference is an attitude of unconcern about a symptom that is unconsciously used to lower anxiety.

an example of somatoform disorder is 1. depersonalization 2. dissociative fugue 3. conversion disorder 4. dissociative identity disorder

3. Somatic disorders include conversion disorders that are functional neurological disorders.

Studies have shown a correlation between mental disorders and medical conditions such as 1. Psoriasis 2. Asthma 3. Renal failure 4. Cancer

4

What statement by a patient would indicate that goals for treatment for a somatization disorder are being achieved? 1. "I feel less anxiety than before." 2. "My memory is better than it was a month ago." 3. "I take my medications just as the health care provider prescribed." 4. "I don't think about my symptoms all the time as I used to.

4

When caring for patients with somatic symptom disorders, what cultural considerations does the nurse keep in mind? 1. Men in the United States are commonly seen to have somatization disorders. 2. West Indians (Caribbean) attribute somatic symptoms to suppressed anger or rage. 3. People in North America sense worms in the head more often than people in Africa. 4. People in southern Asia feel ants under the skin more often than those in North America.

4

Which adjective applies specifically to factitious disorders rather than somatic symptoms disorders? 1. Painful 2. Authentic 3. Dependent 4. Intentional

4

Which statement about somatoform disorders is true? 1. An organic basis exists for each group of disorders. 2. Nurses perceive patients with these disorders as easy to care for. 3. No relation exists between these disorders and early childhood loss or trauma. 4. Patients lack awareness of the relations among symptoms, anxiety, and conflicts

4 Somatization disorders are believed to be responses to psychosocial stress, although the patient often shows no insight into the potential stressors.

hen a pregnant woman is brought in to a health care facility with a suspected ruptured amniotic sac, the nurse suspects Munchausen by proxy. What is the most appropriate statement about the disorder? 1. The patient has ruptured the sac with her fingernails. 2. The family has ruptured the sac to receive insurance money. 3. The agony will be less if legal intervention is avoided. 4. The disorder may lead to harmful medical procedures.

4 Munchausen by proxy disorder results in unnecessary medical visits. It may sometimes cause serious complications or sepsis that leads to harmful medical procedures. The patient does not cause harm to self. The harm is caused by a caregiver to the vulnerable and dependent patient r. The family does not feign illness of the patient to receive insurance money or other rewards. They do it to attract attention and cause excitement. The caregiver may also do this so that the dependent remains a "patient" and the relationship of the dependent with the primary health care providers is maintained. Legal interventions may be necessary depending on the severity of the cases because some cases may become fatal due to such feigning.

A patient is admitted to the inpatient unit with conversion disorder. Which factor related to the conversion disorder does the nurse keep in mind? 1. The patient has a definite psychiatric disorder. 2. The patient has a definite neurological disorder. 3. The patient does not have associated psychiatric conditions. 4. The patient may show neurological symptoms.

4 Patients with conversion disorder show neurological symptoms in the absence of an organic cause. A patient with conversion disorder does not have a psychiatric or neurological disorder, as the patient is channeling emotional conflicts into physical symptoms. He or she may have associated psychiatric conditions like anxiety, depression, or posttraumatic stress disorder that may exaggerate the condition.

Which behavior by a patient would not support a diagnosis of somatoform disorder? 1. Attention-seeking from significant others 2. Acquiring financial gain from a disability plan 3. Avoidance of certain unpleasant activities 4. Performing activities of daily living unassisted

4 Somatic symptoms are reinforced by situations in which there is some sort of "payoff" for the patient: attention, financial gain, avoidance of unpleasant situations, or getting dependent needs met. Performing activities of daily living unassisted would have no payoff of the sort mentioned.

Two nurses talk privately at the end of a shift change report on a medical-surgical unit. One nurse makes this statement regarding a patient diagnosed with a somatic symptom disorder, "That patient is just taking up a bed that should go to a patient with a real problem." What is the nurse colleague's best response? 1. "The insurance company approved that patient's hospitalization, so it must be justified." 2. "You are being judgmental. Maybe you should ask to be assigned to a different patient tomorrow." 3. "I find caring for that patient very frustrating also. The patient should have been sent to the psychiatric unit." 4. "The symptoms and distress are real to the patient. As nurses, we have an obligation to provide compassionate care."

4 The symptoms patients with somatic symptom disorders experience feel real, even though objective data may not support a physiological basis for it. It is important for caregivers not to convey their own frustration. In addition, collegiality warrants providing constructive criticism.

Which statement best defines the phrase "holistic approach"? 1. Using many different therapeutic strategies or modalities for enhanced coping. 2. Involving every member of the family as well as the patient in treatment. 3. Incorporating spirituality and religion into treatment. 4. Considering all dimensions of the patient, including biological, psychological, and sociocultural.

4.

During an assessment the nurse notices that a patient has a "crisscrossed" abdomen. In which illness or disorder is a crisscrossed abdomen commonly seen? 1. Diarrhea 2. Constipation 3. Anorexia disorder 4. Factitious disorder

4. A crisscrossed or "railroad-track" abdomen is commonly seen in a patient with factitious disorder. This happens due to scars from numerous exploratory surgeries. Patients with factitious disorder often have several invasive investigations done to investigate a proper cause of the symptoms they experience. Diarrhea, constipation, and anorexia are common symptoms often reported by patients with somatization disorders, but they do not have any physical causes behind them.

Which item of data should routinely be gathered during assessment of a patient with a somatoform disorder? 1. Potential for violence 2. Level of confusion 3. Dependence on medication 4. Personal identity disturbance

Many patients with somatoform disorder have received prescription medication for anxiety or pain relief and may have developed dependence. Assess not only for what the patient has taken, but also for amounts and length of time over which the drugs have been prescribed.