psych CH 32 somatic symptoms
A client has a somatization disorder. Which statement by the client would indicate a need for additional client teaching? "Drinking strong coffee really helps me combat my fatigue." "Nicotine makes my heart race, so I need to stop smoking." "I have learned that my family can be a support system." "I will let my therapist know if I think suicidal thoughts."
"Drinking strong coffee really helps me combat my fatigue." Explanation: Clients who somatize often have sleep pattern disturbances, lack basic nutrition, and get no exercise. In addition, they may take multiple prescriptions for pain or other complaints. Educating the client about the importance of limiting caffeine, nicotine, and other CNS stimulants is important since these substances can increase physical symptoms of anxiety (rapid heart rate, jitteriness) that may cue other somatic concerns. This statement indicates a need for more teaching. The remaining options are all positive thoughts or actions for a client.
Which statement by the client indicates an understanding of somatic symptom disorder? "As soon as my symptoms go away, I'll be my old self again." "How I handle stress and emotions can affect my physical health." "Taking medication won't help my pain since it's caused by stress." "I have to avoid stress all my life to avoid getting sick again."
"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.
The family members of a client with somatic symptom illness report to the nurse that every time they invite the client to join in an activity the client declines, saying things like, "I wish I could, but I feel so terrible." Which approach should the nurse suggest to encourage activity? "I'll let you rest. Let me know when you feel better." "What does your pain feel like right now?" "You are fine, the doctor said so. Let's go." "I know this is difficult, but exercise is important. It will be a short walk."
"I know this is difficult, but exercise is important. It will be a short walk." Explanation: The nurse must help the client and family learn how to establish a daily routine that includes improved health behaviors. Family members should expect resistance, including protests from the client that she or he does not feel well enough to do these things. The challenge is to validate the client's feelings while encouraging her or him to participate in activities. The nurse should not focus on the client's pain. Deferring to "doctor's orders" does not provide the client with information that could motivate him or her. The nurse should attempt to have the client participate and should address the client's reluctance.
A client is seeking relief for undiagnosed pain. There is no history of significant physical illness. The history reveals that the client was laid off 4 months ago from a job. The nurses assessment is unremarkable. Which statement made by the client would most strongly suggest a somatoform disorder? "I'm sure they will figure out what is wrong with me." "I probably just overexerted myself working around the house. It's hard to slow down." "I seem to have more pain now that I got laid off." "I have been having a hard time lately. It's hard not working like I'm used to."
"I seem to have more pain now that I got laid off." Explanation: The correlation between the client's stressors and pain suggests a somatoform disorder. The client's statements about having a "hard time," "overexerting myself" and hoping that the care team finds out what is wrong do not suggest a pathologic response to a stressor.
A family member of a client diagnosed with functional neurologic symptom disorder asks the nurse, "What is this disorder?" Which of the following is the best response by the nurse? "It is a preoccupation with an imagined or exaggerated defect in physical appearance." "It involves unexplained, usually sudden deficits in sensory or motor function." "It is a preoccupation with the fear that one has a serious disease." "It is characterized by multiple physical symptoms."
"It involves unexplained, usually sudden deficits in sensory or motor function." Explanation: Clients with functional neurologic symptom disorder have neurologic symptoms that include impaired coordination or balance, paralysis, aphonia (inability to produce sound), difficulty swallowing or a sensation of a lump in the throat, and urinary retention. They also may have loss of touch, vision problems, blindness, deafness, and hallucinations. In some instances, they may have seizures.
The spouse of a client with a somatic symptom illness asks the nurse why the doctors cannot find anything wrong. Which would be the appropriate explanation for the nurse to offer? "There is no physical cause. Mental distress is causing the symptoms, even though you are not aware of it." "You control the symptoms when you are not feeling much stress. It is hard to diagnose when the symptoms are intermittent." "You are not really experiencing the symptoms. You are making them up to get attention." "There is a physical cause. It just has not been detected yet."
"There is no physical cause. Mental distress is causing the symptoms, even though you are not aware of it." Explanation: Clients are convinced they harbor serious physical problems despite negative results during diagnostic testing. They actually experience these physical symptoms as well as the accompanying pain, distress, and functional limitations such symptoms induce. Clients do not willfully control the physical symptoms. Nurses must remember that these clients really experience the symptoms they describe and cannot voluntarily control them.
The spouse of a client with hypochondriasis has accompanied the client to the follow-up doctor's visit. While waiting for the doctor, the spouse expresses to the nurse frustration with the client's obsession about illness. The spouse asks the nurse, "What can I do?" What would be the best response by the nurse? "Try to give the client some sort of reward when the client resists complaining about the client's illnesses." "Try finding an activity you enjoy doing together to help the client feel better overall." "Try ignoring the client's complaints, and they should subside." "Try to be the client and understand that the client is worried that the client is sick."
"Try finding an activity you enjoy doing together to help the client feel better overall." Explanation: Building a trusting relationship with the client, providing empathy and support, and being sensitive to rather than dismissive of complaints are skills that the nurse can use in any setting where clients are seeking assistance. Encouraging clients to find pleasurable activities or hobbies may help to meet their needs for attention and security. Ignoring the complaints is likely to exacerbate the situation. Providing rewards for participating does not address the root causes of this phenomenon. Telling the husband to just "understand" his wife's worries is simplistic because this does not give him any tools to address this challenging situation.
The nurse is seeing a Chinese client who reports chronic pain that radiates to the lower back. The client reports the pain has been unresolved with analgesia, physical therapy and therapeutic massage. The client's diagnostic imaging reports are all unremarkable. Which statement by the nurse would be the most supportive response to this client? "You must be so frustrated with this unexplained pain. Do you have other stresses in your life too? "Is it common in your culture to talk about psychological distress like it is physical pain?" "It would be best for your to see a specialist until the underlying issue is properly diagnosed." "The treatment that was recommended to you has worked for many clients. It is supported by research."
"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.
A client diagnosed with hypochondriasis reports to the nurse that others doubt the seriousness of the client's illness. The client is angry, frustrated, and anxious. Which nursing intervention takes priority? Discuss with client's family ways to avoid secondary gains associated with physical complaints. Acknowledge the client's frustrations without fostering continued focus on physical illness. Remind the client that lab tests showed no evidence of physiological problems. Document the client's unwillingness to accept anxiety as the source of the illness.
Acknowledge the client's frustrations without fostering continued focus on physical illness. Explanation: Clients with hypochondriasis are convinced they harbor serious physical problems despite negative results during diagnostic testing. They actually experience these physical symptoms as well as the accompanying pain, distress, and functional limitations such symptoms induce. Clients do not willfully control the physical symptoms. Although their illnesses are psychiatric in nature, many clients do not seek help from mental health professionals. Clients diagnosed with hypochondriasis are so convinced that their symptoms are related to organic pathology that they adamantly reject, and are often angry and frustrated by anyone doubting their illness. Empathizing with the client about anger and frustration assists in building a therapeutic relationship. The nurse-client relationship is the foundation for all other interventions and takes priority at this time.
A nurse is preparing a presentation for a local community group about somatic symptom disorder. When describing the factors associated with the increased incidence of somatization in women, which belief would the nurse most likely include? Select all that apply. Women more often receive treatment for psychiatric disorders with strong somatic components such as depression. Women seek medical treatment more often than men, and it is more socially acceptable for them to do so. Childhood sexual abuse, which is related to somatization, happens more frequently to girls. Boys in the United States are taught to be stoic and to "take it like a man," causing them to offer fewer physical complaints as adults. Unexplained female pains result from migration of the uterus throughout the woman's body.
Boys in the United States are taught to be stoic and to "take it like a man," causing them to offer fewer physical complaints as adults. Women seek medical treatment more often than men, and it is more socially acceptable for them to do so. Childhood sexual abuse, which is related to somatization, happens more frequently to girls. Women more often receive treatment for psychiatric disorders with strong somatic components such as depression. Explanation: Somatization is associated most often with women, as evidenced by the old term hysteria (Greek for "wandering uterus";). Ancient theorists believed that unexplained female pains resulted from migration of the uterus throughout the woman's body. Psychosocial theorists posit that increased incidence of somatization in women may be related to various factors: Boys in the United States are taught to be stoic and to "take it like a man,"causing them to offer fewer physical complaints as adults.\ Women seek medical treatment more often than men, and it is more socially acceptable for them to do so. Childhood sexual abuse, which is related to somatization, happens more frequently to girls. Women more often receive treatment for psychiatric disorders with strong somatic components such as depression.
The client has a somatic symptom illness. During individual therapy, the client yells at the nurse, "You are all quacks! Can't you see I am sick?" Which knowledge statement would help the nurse to work most effectively with this client? Client progress is expected to be very slow. Physical illness is the root of the client's problems. The nurse has done everything possible to treat the client. The client will never be free of somatic symptoms.
Client progress is expected to be very slow. Explanation: Clients who cope through physical symptoms can be frustrating for the nurse. Initially, they are unwilling to consider that anything other than major physical illness is the root of all their problems. The client's progress is slow and painstaking, if any change happens at all. The nurse should be realistic about the small successes that can be achieved in any given period. To enhance the ongoing relationship, the nurse must be able to accept the client and his or her continued complaints and criticisms while remaining nonjudgmental. Psychological factors are the root of the illness. The nurse can never know if he or she has done all that can be done for the client and the nurse should not "write off" the client as untreatable.
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. Clients find it difficult to go to a clinic setting. Clients are often embarrassed about the number and extent of their physical complaints. There are no known successful treatments for this 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 Mood stabilizers to manage the symptoms Multiple provider evaluations Electroconvulsive therapy
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.
In planning care for clients with a somatic symptom disorder, an appropriate long-term outcome for treatment would be that the client will ... Develop alternative coping mechanisms Resume home maintenance activities Assume responsibility for self-care activities Learn new diversional recreation patterns
Develop alternative coping mechanisms Explanation: The development of alternative coping mechanisms is the outcome that will decrease the client's somatic way of coping.
Assessment of a client reveals that the client has been inflicting illness on her daughter to gain the attention of medical personnel. The nurse identifies this as which of the following? Conversion disorder Factitious disorder Functional neurologic symptom disorder Factitious disorder imposed on another
Factitious disorder imposed on another Explanation: Factitious disorder imposed on another (previously factitious disorder by proxy or Münchausen's by proxy), 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. Conversion disorder or functional neurologic symptom disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms.
A client is prescribed phenelzine. The nurse is educating the client on avoiding foods containing tyramine to prevent which of the following? Oversedation Hypoglycemia Hypertensive crisis Seizures
Hypertensive crisis Explanation: Phenelzine is a monoamine oxidase inhibitor (MAOI). If the client consumes foods containing tyramine, the client is at high risk for developing hypertensive crisis. Seizures, hypoglycemia, or oversedation are not the result of combining phenelzine with foods containing tyramine.
A client is seen in the primary care clinic reporting headaches. The client appears extremely distressed and insists that the client must have a brain tumor. Which mental health diagnosis is most probable for this client? Brain cancer Illness anxiety disorder Conversion disorder Pain disorder
Illness anxiety disorder Explanation: Illness anxiety disorder is preoccupation with the fear that one has a serious disease (disease conviction) or will get a serious disease (disease phobia). It is thought that clients with this disorder misinterpret bodily sensations or functions. Conversion disorder, sometimes called conversion reaction, involves unexplained, usually sudden deficits in sensory or motor function. Pain disorder has the primary physical symptom of pain, which generally is unrelieved by analgesics and greatly affected by psychological factors in terms of onset, severity, exacerbation, and maintenance.
Which accurately describes how somatic symptoms are distinguished from factitious disorders and malingering? In malingering or factitious disorders, people willfully control the symptoms, and in somatic symptom illnesses, clients do not voluntarily control their physical symptoms. Munchausen's syndrome cannot be controlled by persons who have it. Persons who experience somatic disorders intentionally produce symptoms for some external purpose or gain. People who experience somatic symptom illnesses can stop the physical symptoms as soon as they have gained what they wanted.
In malingering or factitious disorders, people willfully control the symptoms, and in somatic symptom illnesses, clients do not voluntarily control their physical symptoms. Explanation: In malingering or factitious disorders, people willfully control the symptoms, and in somatic symptom illnesses, clients do not voluntarily control their physical symptoms. Munchausen's disorder is the common term for factitious disorder, which is imposed on self and occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention. People with factitious disorders may even inflict injury on themselves to receive attention. Persons who experience somatic disorders are unable to control their symptoms. People who experience somatic symptom illnesses cannot stop their physical symptoms. However, people who malinger can stop the physical symptoms as soon as they have gained what they wanted.
When describing the major difference between somatic symptom disorder and factitious disorders, which would the nurse include? In somatic symptom disorder, clients consciously seek attention. In factitious disorders, clients are unaware that their symptoms are not real. In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints. Factitious disorders respond much more readily to psychopharmacologic treatment than does somatic symptom disorder.
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.
Psychosocial theorists propose that somatic symptom illnesses are an indirect expression of stress and anxiety through physical symptoms. Which is the primary defense mechanism used in somatoform disorders? Repression Identification Somatization Internalization
Internalization Explanation: Psychosocial theorists believe that people with somatic symptom illnesses keep stress, anxiety, or frustration inside rather than expressing them outwardly. This is called internalization. Clients express these internalized feelings and stress through physical symptoms (somatization). In this conceptualization of the illness, the client's internalization is the primary defense mechanism that causes somatization. Identification is trying to ease distress by emulating others whom one admires and repression is the unconscious exclusion of distressing situations from one's memory; neither process is included in the major psychosocial theories of somatic symptom illnesses.
A nurse is conducting an inservice presentation for a group of newly hired mental health nurses. Which would the nurse most likely include when describing conversion disorder (functional neurologic symptom disorder)? Laboratory and diagnostic test results are usually negative. The client's complaints are not real. Symptoms expressed reflect a neurologic illness. The symptoms follow a typical neurologic pattern.
Laboratory and diagnostic test results are usually negative. Explanation: Functional neurologic symptom disorder (or conversion disorder) is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms (APA, 2013). Clients with conversion disorder have neurologic symptoms that include impaired coordination or balance, paralysis, aphonia (inability to produce sound), difficulty swallowing, a sensation of a lump in the throat, and urinary retention. They also may have loss of touch, vision problems, blindness, deafness, and hallucinations. In some instances, they may have seizures (Nielsen, Stone, & Edwards, 2013). However, laboratory, electroencephalographic, and neurologic test results are typically negative. The symptoms, different than those with an organic basis, do not follow a neurologic course but rather follow the person's own perceived conceptualization of the problem.
The nurse is caring for a client who was in a motorcycle accident 2 months ago. The client says he still has terrible neck pain, but he will be better once he gets "a big insurance settlement." The nurse suspects that the client is Malingering A hypochondriac Having a conversion reaction Exhibiting somatization disorder
Malingering Explanation: Malingering is suspected when the client is exaggerating physical complaints for some type of material gain. Hypochondriasis is a preoccupation with the fear that one has a serious disease. A somatization disorder is characterized by multiple physical symptoms in a variety of bodily systems that have no organic or medical basis. A conversion reaction involves unexplained, usually sudden, deficits in sensory or motor function related to an emotional conflict the client experiences but does not handle directly.
A middle-aged client goes to the physician reporting hip pain. The friend that brought the client to the office tells the nurse that the client's intention is to fake chronic hip pain to apply for disability benefits from the government. Which best reflects the client's potential diagnosis? Illness anxiety disorder Malingering Factitious disorder imposed on another Factitious disorder
Malingering Explanation: Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms; it is motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining financial compensation, or obtaining drugs. Illness anxiety disorder is preoccupation with the fear that one has a serious disease (disease conviction) or will get a serious disease (disease phobia). Factitious disorder occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention. Factitious disorder imposed on another occurs when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a "hero" for saving the victim.
Which occurs when an individual intentionally produces illness symptoms to avoid work? Conversion disorder Alexithymia Malingering Illness anxiety disorder
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? Factitious disorder Factitious disorder imposed on another Malingering Functional neurologic symptom disorder
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? Symptoms that cannot be substantiated by physicians Psychological origin of illness that is not real Manifestation of physical symptoms from psychological distress Physical symptoms that are all in one's head
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.
Factitious disorder imposed on another is commonly inflicted by which family member upon a child? Father Mother Grandparent Sibling
Mother Explanation: A rare but dramatic disorder, factitious disorder imposed on another (previously factitious disorder by proxy or Münchausen's by proxy), 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 a health care provider through her child's injuries. These actions include inducing seizures, poisoning, or smothering. This most severe form of child abuse is usually identified in the emergency department. The mother rarely admits injuring the child and thus is not amenable to treatment; the child is removed from the mother's care.
The most severe form of factitious disorder includes which of the following? Munchausen's syndrome Hypochondriasis Alexithymia Malingering
Munchausen's syndrome Explanation: In 1951, the term Munchausen's syndrome was used to describe the most severe form of factitious disorder, which was characterized by fabricating a physical illness, having recurrent hospitalizations, and going from one medical provider to another. Malingering occurs when an individual intentionally produces illness symptoms that are motivated by another specific self-serving goal, such as being classified as disabled or avoiding work. Alexithymia and hypochondriasis are not factitious disorders.
A mother rushes her infant to the emergency department and states "Help, my baby is unresponsive!" Which term is applicable when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a "hero" for saving the victim? Induced illness Factitious disorder Malingering Munchausen's syndrome by proxy
Munchausen's syndrome by proxy Explanation: A variation of factitious disorder, imposed on others, is commonly called Munchausen's syndrome by proxy and occurs when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a "hero" for saving the victim. Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms; it is motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining financial compensation, or obtaining drugs. Factitious disorder, imposed on self, occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention. Induced illness is another name for factitious disorder.
The nurse obtains a psychosocial history from a client who may have psychological factors affecting the medical condition. Which should the nurse recognize as pertinent to this diagnosis? The client is able to articulate the cause of psychological distress. No physiologic cause has been found for the client's symptoms. The client's symptoms subside with appropriate medical treatment. The client's symptoms are related to conscious motives.
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.
After educating a group of nursing students on somatic symptom disorder, the instructor determines that the education was successful when the group identifies which of the following as the most common problem? Pain Paresthesias in the extremities Nausea Muscle weakness
Pain Explanation: Pain is the most common problem in people with somatic symptom disorder. Because pain is usually related to symptoms of all the major body systems, it is unlikely that somatic intervention (such as an analgesic) will be effective on a long-term basis. Nausea, muscle weakness, and paresthesias in the extremities are not the most common problems associated with somatic symptom disorder.
A client with a somatic symptom illness asks what is causing the physical symptoms. Which would be the appropriate explanation for the nurse to offer? Physical symptoms are deliberately expressed in order to benefit in some way. Physical symptoms can be attributed to an organic cause. Physical symptoms are independent of the amount of the client's psychic distress. Physical symptoms are an involuntary way of dealing with psychic conflict.
Physical symptoms are an involuntary way of dealing with psychic conflict. Explanation: The three central features of somatic symptom are as follows: physical complaints suggest major medical illness, but have no demonstrable organic basis; psychological factors and conflicts seem important in initiating, exacerbating, and maintaining the symptoms; and symptoms or magnified health concerns are not under the client's conscious control. The severity of symptoms corresponds to the severity of psychic conflict.
A client diagnosed with factitious disorder tells the nurse about how he overcame a tremendous disability. Based on the client's history, the nurse knows that the story is not all true. The client is exhibiting which of the following? Hypochondriasis Pseudologia fantastica Malingering Alexithymia
Pseudologia fantastica Explanation: With factitious disorder, clients are extremely creative in simulating illnesses, and they tell fascinating but false stories of personal triumph. These tales are referred to as pseudologia fantastica and are a core symptom of the disorder. Pseudologia fantastica are stories that are not entirely improbable and often contain a matrix of truth and falsehood. Malingering involves an individual who intentionally produces illness symptoms but is motivated by as 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. Hypochondriasis is seen in individuals who are fearful of developing a serious illness based on their misinterpretation of body sensations.
Which is possible with somatization? Select all that apply. Unrelated symptoms can occur. Real symptoms can begin. Real symptoms can worsen. Clients can control these symptoms. Real symptoms can continue.
Real symptoms can begin. Real symptoms can continue. Real symptoms can worsen. Unrelated symptoms can occur. Explanation: The term somatization is used to convey the connection between the mind and the body in states of health and illness. Essentially, the mind can cause the body to create physical symptoms or to worsen physical illnesses. Real symptoms can begin, continue, or be worsened as a result of emotional factors. Examples include diabetes, hypertension, and colitis, all of which are medical illnesses influenced by stress and emotions. In addition, stress can cause physical symptoms unrelated to a diagnosed medical illness. Clients do not willfully control the physical symptoms.
A client is diagnosed with somatic symptom disorder. Which would the nurse expect to assess as the major clinical finding? Loss of voluntary motor or sensory functioning Definitive medical finding with a history of "doctor shopping" The client's inability to focus on emotional content Report of symptoms with no demonstrable pathology on testing or examination
Report of symptoms with no demonstrable pathology on testing or examination Explanation: There are no positive lab or diagnostic tests indicating an organic cause of the physical symptom. The cause is psychological, which does not show on diagnostic testing. Although the client may "provider shop," there is no evidence or definitive finding to support the symptoms.
When assessing a client with somatic symptom disorder, which would the nurse most likely note? The client willfully controls the physical symptoms. Reports of physical symptoms do not have a demonstrable organic basis to fully account for them. Denial and repression are the chief defense mechanisms used. The client's symptoms are under the conscious control of the client.
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.
A client is diagnosed with somatic symptom disorder (SSD) with anxiety. Based on the nurse's understanding of this disorder, which medication classification would the nurse identify as being effective in some cases? Antibiotics SSRIs Antipsychotics Antimanic agents
SSRIs Explanation: Clients with anxiety are treated pharmacologically, similar to those with depression. The first line of treatment for all anxiety disorders is with a selective serotonin reuptake inhibitor (SSRI). Doses for SSD are usually higher than those prescribed for depression to relieve and manage the symptoms of the anxiety disorders, including panic, social phobia, generalized anxiety, OCD, and posttraumatic stress disorder. Phenelzine (Nardil) is one of the monoamine oxidase inhibitors (MAOIs) that has been effective in treating not just depression but also the chronic pain and headaches common in people with SSD.
A client has been diagnosed with conversion disorder. Which medication classification has been shown to be effective in some cases of somatoform disorders? Antimanics Antibiotics SSRIs Antipsychotics
SSRIs Explanation: SSRIs have been shown to be effective in some cases of somatoform disorders.
A client with somatic symptom disorder (SSD) which involves chronic headaches is prescribed medication therapy. Which medication would the nurse expect to be prescribed? Antipsychotics Antimanics SSRIs Monoamine oxidase inhibitors (MAOIs)
SSRIs Explanation: Clients with anxiety are treated pharmacologically, similar to those with depression. The first line of treatment for all anxiety disorders is with a selective serotonin reuptake inhibitor (SSRI). Doses for SSD are usually higher than those prescribed for depression to relieve and manage the symptoms of the anxiety disorders, including panic, social phobia, generalized anxiety, OCD, and posttraumatic stress disorder. Any additional signs and symptoms of the disorder, such as headache, should be treated with medication that has the least potential for dependence or abuse. Therefore, an NSAID would be a favorable choice over narcotic analgesics.
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? Mood stabilizers Selective serotonin reuptake inhibitors (SSRIs) Antipsychotics Tricyclic antidepressants
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.
Somatic symptom disorder is characterized by what? Severe physical symptoms unexplainable by any organic or physical pathology Self-inflicted injuries Self-induced disease states or faked symptoms to garner attention Physical symptoms coupled with extreme focus on emotional state
Severe physical symptoms unexplainable by any organic or physical pathology 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.
Which term describes the conversion of unexpressed emotions into physical symptoms? Hysteria Somatization La belle indifference Psychosomatic
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.
A client is diagnosed with functional neurologic symptom disorder after extensive evaluation. The client developed blindness after witnessing the death of her twin sister in a car accident. When teaching the client's mother about her daughter's illness, which of the following would the nurse include? Her blindness requires a conscious effort to maintain the feigned symptom. Her blindness will gradually disappear if proper ophthalmologic care is provided. The blindness is a reaction to the trauma of losing her sister and has no physiologic basis. Her blindness results in increased anxiety and attention from family and friends.
The blindness is a reaction to the trauma of losing her sister and has no physiologic basis. Explanation: With functional neurologic symptom disorder, disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms. In this case, the blindness is the physical symptom manifested due to the extreme emotional stress. There is no physiologic basis for the condition. Itis an unconscious process; it will not disappear with ophthalmologic care. The symptom is unconsciously designed to reduce anxiety,
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 believes that his/her condition is catastrophic and disabling. The client believes he/she has a serious illness. The client usually thinks anxiety is behind the symptoms. The client embraces the "sick role."
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.
The client has severe headaches that are debilitating. The nurse has encouraged the client with a somatic symptom illness to keep a journal. Which treatment outcomes might be met by journaling? The nurse will assess the onset of physical symptoms. The client will express emotions privately. The nurse will control external stressors that trigger the client's physical symptoms. The client will identify the occurrence of physical symptoms when stressed.
The client will identify the occurrence of physical symptoms when stressed. Explanation: Teaching about the relationship between stress and physical symptoms is a useful way to help clients begin to see the mind-body relationship. This involves the expression of emotions, but the primary purposes is identifying a link between the two phenomena. Journaling is not suggested as a means for the nurse to control the client's stressors or to assess symptoms; the client is the focus of the exercise.
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. The client readily discusses feelings and expresses needs verbally. The client will often minimize the medical history. The client avoids playing the sick role and resists medical attention.
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.
The nurse is seeing a an adolescent client who has attended the clinic frequently with vague reports of abdominal pain. Despite normal blood values, stool tests, and diagnotic imaging of the abdomen, the client continues to report symptoms. Which psychological factor may be contributing to the client's problem? The client recently received a low mark on an exam. The client is fearful of needles. The client is the head of the school debate team. The client's parents are considering getting divorced.
The client's parents are considering getting divorced. Explanation: Somatization has been explained as a form of social or emotional communication, meaning that the bodily symptoms express an emotion that cannot be verbalized by the individual. An adolescent who experiences extreme abdominal pain after her parents argue is one example. In the case of this client, the stress in the home over the parents considering a divorce may be a signal that the client's unfounded abdominal pain is linked to ongoing stress in the home. Receiving a low mark on an exam may be a stressful experience for the client. Although some somatic manifestations may arise from the stress of the low grade, it would not be likely to persist over time as in this client's case. A client who is fearful of needles would likely avoid seeking medical investigation of a problem for this reason. A client on the school debate team is more likely to have a healthier sense of self and something to attach a sense of value. This may act as a protective factor against somatization.
Which of the following statements about somatic symptom disorder is most accurate? Symptoms of the disorder in children usually involve joint pain. The disorder is usually diagnosed during middle age. The disorder manifests differently in different populations. The disorder is rare among most populations.
The disorder manifests differently in different populations. Explanation: Somatic symptom disorder is found in most populations and cultures, even though its expression may vary from population to population. In cultures that highly stigmatize mental illness, somatic symptoms are more likely to occur. The disorder is usually diagnosed during adolescence. The most common symptoms in children are frequent abdominal pain, headache, fatigue, and nausea.
Which statement about the etiology of somatic symptom disorder is accurate? The disorder is more common in adults with a history of child abuse. Most clients with somatic symptom disorder also suffer from schizophrenia. The exact etiology is unknown. The disorder is associated with substance abuse.
The exact etiology is unknown. Explanation: The cause of somatic symptom disorder is unknown. There is general agreement that somatization has a biopsychosocial basis with the possibility of biological dysfunction common in depression and chronic fatigue syndrome. Child abuse, substance abuse, and schizophrenia are not linked to somatic symptom disorder.
The nurse is providing care to a client with somatic symptoms disorder. The client has been prescribed escitalopram one week ago. The client reports experiencing nausea after starting the medication and describes it as "worse than what the average person would have." Which intervention should the nurse recommend for this client? To monitor the nausea using a daily journal for one week To consume a balanced diet To stop taking the medication immediately To see physician specialized in gastric disorders
To monitor the nausea using a daily journal for one week Explanation: In order to reduce a client's anxiety about their illness, the nurse should ask the client to monitor any side effects related to the medication using a daily journal and report back in a follow up visit with the nurse. This validates the clients concerns and helps with problems solving in the next visit. The nurse should not tell the client to stop taking the medication as nausea is a common side effects of escitalopram. Such side effects tend to last 1-2 weeks after commencing the medication and subside as the primary purpose of the medication manifests. Telling the client to consume a balanced diet does not acknowledge the client's problem, thus will not help to alleviate the client's fears of anxiety. Referring the client to another health care provider communicates that the problem is not within the client's control and fosters a dependence on health care providers rather than reinforcing the notion of self efficacy.
A client with recurrent headaches has been told by the physician that the cause is likely psychosomatic. The client reports this conversation to the nurse and says, "That just can't be true! My head hurts so bad sometimes that it makes me sick to my stomach." Which is the nurse's best response? To give the client some privacy and time to calm down To say "well, that's not what your doctor thinks." To say nothing and sit quietly with the client To say "the pain in your head is very real."
To say "the pain in your head is very real." Explanation: When the nurse says, "The pain in your head is very real," the nurse is validating the client's pain as real. The client is asking for some type of validation. In the situation presented, the client's headaches are very real to him or her. The client needs to talk out the feelings regarding what the physician has told him or her. It would be inappropriate for the nurse to say nothing. Leaving to give the client privacy does not engage the client or validate his or her circumstances. Saying "Well, that's not what your doctor thinks," would put the client on the defensive.
A client is prescribed phenelzine for treatment of somatic symptom disorder. The nurse would instruct the client to avoid foods high in which of the following to avoid hypertensive crisis? Potassium Tyramine Magnesium Calcium
Tyramine Explanation: Phenelzine is a monoamine oxidase inhibitor (MAOI). While taking MAOIs, clients should avoid foods high in tyramine (e.g., aged cheese, sausage, smoked fish, beer) and certain medications for colds and coughs. Foods high in calcium, potassium, and magnesium do not interact with MAOIs.
The client presented to the emergency department with a report of chest pain. The nurse performs a thorough physical examination for this client, who has a history of a somatic symptom illness. Which is the best rationale for the physical exam? Physical disorders underlie somatic disorders. Ease the client's mind that the nurse is looking for physical illness. Physical exams are reimbursed by third-party payers. Underlying pathology should be ruled out.
Underlying pathology should be ruled out. Explanation: The nurse must investigate physical health status thoroughly to ensure that there is no underlying organic pathology requiring treatment. When a client has been diagnosed with a somatic symptom illness, it is important not to dismiss all future complaints because at any time the client could develop a physical condition that would require medical attention. Financial factors do not drive the nurse's plan for assessments and it would be inappropriate to perform assessment for the sole purpose of easing the client's mind. Psychological, not physical, problems underlie somatic disorders.
A client reports severe pain during intercourse since being sexually assaulted three years ago. Which is the first step in confirming the diagnosis of a pain disorder? assessing the client for posttraumatic stress disorder asking the client to keep a journal of her feelings regarding the assault ruling out a physical cause of pain evaluating the client's understanding of a pain disorder
ruling out a physical cause of pain Explanation: Pain disorder has the primary physical symptom of pain, which generally is unrelieved by analgesics and greatly affected by psychological factors in terms of onset, severity, exacerbation, and maintenance. Initially the presence of a physical cause of the pain must be ruled out. The assessment of the client's understanding of the disorder or recording the feelings regarding the trauma are not priorities until a diagnosis of pain disorder is made.
