Psych Nursing Quiz 8

A nurse interviews a client diagnosed with conversion disorder, or functional neurobiological symptom disorder. Which comment is most likely from this client? 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. "Since getting a divorce, I've had crushing chest pain, but I don't think it really means anything." Rationale Conversion disorder, also called functional neurobiological symptom disorder, presents with one or more symptoms of impaired motor or sensory function. Findings are incompatible with or an exaggeration of recognized neurological conditions, and are not better explained by another mental or medical disorder. The symptoms are not voluntarily controlled or created. Clients may be highly distressed or show a lack of emotional concern. The other statement options are suggestive of illness anxiety disorder.

The nurse is caring for a client diagnosed with a somatic symptom disorder. About what type of medication does the nurse need to teach the client and the family? 1. Antianxiety medication 2. Antidiabetic medication 3. Medications for cardiac diseases 4. Medications for brain hemorrhage

1. Antianxiety medication Rationale The client may benefit from the short-term use of antianxiety medication, which may be used in certain cases under strict monitoring because of the risk of dependence. Even if the medicines are not prescribed, the nurse should teach the client and the family of the medicines as a treatment option. Medications for diabetes, cardiac diseases, or brain hemorrhage are not indicated for somatic symptom disorder unless the client is diagnosed with some comorbidities that require these medications.

Which classes of medications have been shown to be most helpful in treating somatic symptom disorders? Select all that apply. 1. Anxiolytics 2. Antipsychotics 3. Antidepressants 4. Mood stabilizers 5. Benzodiazepines

1. Anxiolytics 3. Antidepressants 5. Benzodiazepines Rationale Antidepressants, anxiolytics, and benzodiazepines, which are a type of anxiolytic, have been shown to be helpful in clients with somatic symptom disorders. Antipsychotics and mood stabilizers are not commonly used for the treatment of these disorders.

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

1. Assess suicidal ideation in the client. Rationale Assessing suicidal ideation is important to take necessary precautions to protect the client from self-harm. It can be done through hospitalization, providing appropriate outpatient treatment, and administering medications. Developing a relationship with the client will help to develop a behavior therapy plan for the client. Encouraging the client to identify anxiety will help manage the client's distress and promote self-care behavior. Counseling the client about sharing or expressing feelings will help in reducing stress and form a supportive environment.

Which statements concerning somatic symptom disorders are true? Select all that apply. 1. Clients typically experience high levels of functional impairment. 2. Chest pain, dizziness, and headache are commonly reported symptoms. 3. Incidences of the disorder are diagnosed equally between males and females. 4. Medical and psychosocial histories are vital to achieving an accurate diagnosis. 5. The health care provider's perception of the client is a factor in the diagnosis process.

1. Clients typically experience high levels of functional impairment. 2. Chest pain, dizziness, and headache are commonly reported symptoms. 4. Medical and psychosocial histories are vital to achieving an accurate diagnosis. 5. The health care provider's perception of the client is a factor in the diagnosis process. Rationale Somatic symptom disorder is characterized by a combination of distressing symptoms and an excessive or maladaptive response or associated health concerns without significant physical findings and medical diagnosis. Clients' suffering is authentic, and they typically experience a high level of functional impairment. The most common symptoms for visits to primary health care providers are chest pain, fatigue, dizziness, headache, swelling, back pain, shortness of breath, insomnia, abdominal pain, and numbness. Somatic symptom disorder is difficult to distinguish from physical disorders with organic causes, and the client's history is extremely important for accurate diagnosis. Studies show that the strongest predictor of misdiagnosing somatic disorders is the primary health care provider's dissatisfaction with the clinical encounter. The predominance of women with somatization is significant.

For which characteristics will the nurse look when assessing a client suspected of having antisocial personality disorder? 1. Deceitfulness, impulsiveness, and lack of empathy 2. Perfectionism, preoccupation with detail, and verbosity 3. Avoidance of interpersonal contact and preoccupation with being criticized 4. A need for others to assume responsibility for decision-making and nurture-seeking

1. Deceitfulness, impulsiveness, and lack of empathy Rationale Clients with antisocial personality disorder lack conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others. Perfectionism and related traits are associated with obsessive-compulsive disorder. Avoidance of interpersonal contact is associated with avoidant personality disorder. A need for others to assume responsibility is associated with dependent personality disorder.

A client is diagnosed with disturbed personal identity. What signs and symptoms does the nurse expect to find in the client? Select all that apply. 1. Feelings of unreality 2. Substance abuse 3. Amnesia 4. Disorganization 5. Ineffective coping

1. Feelings of unreality 3. Amnesia Rationale The signs and symptoms of disturbed personal identity are feelings of unreality and amnesia of the traumatic event. These clients usually assume different identities to escape from the reality of the traumatic event. Substance abuse and disorganization are symptoms of ineffective role performance. Ineffective coping is a symptom of anxiety.

A nurse is assessing a client who complains of chronic pain. The client has negative thoughts and feels unwanted by family and peers. Which nursing diagnoses does the nurse consider? Select all that apply. 1. Powerlessness 2. Chronic low self-esteem 3. Interrupted family processes 4. Ineffective role performance 5. Risk for self-directed violence

1. Powerlessness 2. Chronic low self-esteem 5. Risk for self-directed violence Rationale Powerlessness is observed when a client feels useless and has a negative self-evaluation. Chronic low self- esteem is also considered since the client expresses a feeling of being unwanted. Risk for self-directed violence is considered because the client has chronic pain and feels useless and unwanted. Interrupted family processes may be related to the client's inability to meet social relations due to symptoms. Ineffective role performance is observed when the client is unable to cope and meet family needs.

In caring for a client diagnosed with a somatic symptom disorder, the nurse tries to build an effective relationship with the client. How does this action support the treatment process? 1. Reduces the client's tendency toward defensiveness 2. Decreases the need for medical tests and procedures 3. Encourages the client's beliefs about the origin of the symptoms 4. Helps the client to derive secondary gains through illness behaviors

1. Reduces the client's tendency toward defensiveness Rationale The therapeutic relationship is vital to treatment success given the tendency toward defensiveness in these clients. Broaching a nonmedical or psychiatric etiology to the client's symptoms is threatening. The nurse keeps a good medical record of all the visits and the treatment procedures. The record can be transferred to other primary health care providers to reduce medical tests and procedures. The nurse helps the client to get needs met. The nurse should not encourage the client's beliefs. The client has a resistance to understanding that there is no physical cause for the symptoms. Though the nurse may help by caring for the client, he or she does not help the client to derive secondary benefits through illness behaviors.

Which statement is correct regarding somatic symptom disorders from a cultural perspective? 1. Somatic symptoms vary widely from culture to culture. 2. Somatic symptom disorders are rarely observed in males. 3. Secondary gain is seldom a factor in somatic symptom disorders. 4. Non-Western countries rarely tolerate somatic symptom disorders.

1. Somatic symptoms vary widely from culture to culture. Rationale The type and frequency of somatic symptoms vary across cultures. Somatic symptom disorders are observed in males as often as females. Secondary gain is a common factor is these disorders. Non-Western countries also have populations of people experiencing somatic symptom disorders.

A health care provider describes a client as "malingering." What does the nurse understand this term to mean? 1. The client is falsely claiming to have symptoms. 2. The client is experiencing symptoms that have a physiological basis. 3. The client is seeking medication to ease pain of psychological origin. 4. The client is experiencing symptoms that cannot be explained medically.

1. The client is falsely claiming to have symptoms. Rationale Malingering is a consciously motivated act to falsely claim to have symptoms, usually based on the desire for material gain. Malingering does not mean that the symptoms have no physiological basis or that the client is seeking medication for psychological pain. It also does not mean the client is experiencing symptoms that cannot be explained medically.

Which statements about secondary gains are true? Select all that apply. 1. They are benefits the client receives from demonstrating symptoms. 2. Clients are usually able to fulfill social but not employment obligations. 3. Therapy involves learning ways to communicate needs more effectively. 4. Receiving extra attention from family members is an example of a secondary gain. 5. Because they provide emotional support, it may be difficult to give up the symptoms.

1. They are benefits the client receives from demonstrating symptoms. 3. Therapy involves learning ways to communicate needs more effectively. 4. Receiving extra attention from family members is an example of a secondary gain. 5. Because they provide emotional support, it may be difficult to give up the symptoms. Rationale Secondary gains are those benefits derived from the symptoms alone. The health care provider works with the client to achieve the same benefits through healthier avenues, such as learning to communicate more adaptively and connect with others. Examples include the client not being able to perform the usual family, work, and social functions and receives extra attention from loved ones. IN a client derives a personal benefit from the symptoms, giving up the symptoms is more difficult. Clients benefiting from secondary gains are typically no more or less able to fulfill social or employment obligations.

Which statement is descriptive of clients diagnosed with personality disorders? 1. They are resistant to behavioral change. 2. They have an ability to tolerate frustration and pain. 3. They usually seek help to change maladaptive behaviors. 4. They are able to form satisfying and intimate relationships.

1. They are resistant to behavioral change. Rationale Personality disorders are deeply ingrained and pervasive. Clients diagnosed with personality disorders find it very difficult, if not impossible, to change. Because they are so resistant to change, these clients do not often seek help. This makes a client easily frustrated and intolerant of pain. They have difficulty establishing and maintaining intimate relationships that are satisfying.

In a psychiatric unit, a nurse cares for clients diagnosed with various somatic symptom disorders. Why do these clients often present with illness? 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. To obtain financial benefit 2. To seek attention from others 5. To gain benefit in interpersonal relationships Rationale Behaviorists suggest that people with somatic disorders want to demonstrate that they are helpless and manipulate others to care for them. By showing that they are ill, the clients try to obtain financial benefit or attention from others. They also do it to avoid activities that they dislike or to gain some advantage in interpersonal relationships. Such clients do not want to help others; rather they want care from others. They want to show that they are incapable of doing any activities.

A nurse in an outpatient medical clinic talks with a client with a long history of malingering and "doctor shopping." The client continues to express complaints of multiple problems. Select the nurse's best comment to the client. 1. "The treatment team believes you should see a mental health professional." 2. "The treatment team carefully discussed your case. We'd like to begin a special case management program for you." 3. "Because you take so many different medications, it would be safer to have them all filled at the same pharmacy." 4. "Diagnostic testing has shown no medical problems, and you are using more than your fair share of health care services."

2. "The treatment team carefully discussed your case. We'd like to begin a special case management program for you." Rationale It is important for the nurse to carefully convey compassion and support to the client to avoid reinforcing the symptoms. Case management can help limit health care costs. Seeing the client at regular intervals can instill security and avoid frantic and frequent demands. The client who establishes a relationship with the case manager often feels less anxiety because he or she has an advocate and feels someone is managing and aware of his or her care. Telling the client that he or she should see a mental health professional or suggesting the client is using more health services than he or she is entitled to use may increase the client's defensiveness. Suggesting support for the number of medications the client uses may reinforce his or her symptoms.

Which interventions are used to care for clients with somatic symptom disorders? Select all that apply. 1. Reality testing 2. Assertiveness training 3. Self-esteem enhancement 4. Family involvement promotion 5. Professional skill enhancement

2. Assertiveness training 3. Self-esteem enhancement 4. Family involvement promotion Rationale Assertive communication can help in developing positive ways to meet needs and reducing the need for manipulation or a feeling of helplessness. Self-esteem enhancement reduces dependency and the need to use illness for secondary gains. Family involvement is encouraged so that the risk of loneliness can be overcome. Reality testing to let the client verify that the symptoms are not real is not needed. Clients suffering from somatic symptom disorders do not need professional skill development training. Rather, the nurses who care for clients with these disorders need to develop professional skills to be able to care for such clients.

Which personality disorder is considered a Cluster B personality disorder? 1. Avoidant personality disorder 2. Borderline personality disorder 3. Paranoid personality disorder 4. Schizotypal personality disorder

2. Borderline personality disorder Rationale Borderline personality disorder is considered a CIuster B personality disorder. Avoidant personality disorder is one of the disorders in Cluster C. Paranoid and schizotypal personality disorders are Cluster A personality disorders.

Which diagnoses are included among the somatic symptom disorders? Select all that apply. 1. Gender dysphoria 2. Conversion disorder 3. Illness anxiety disorder 4. Obsessive-compulsive disorder 5. Factitious disorder imposed on self

2. Conversion disorder 3. Illness anxiety disorder 5. Factitious disorder imposed on self Rationale Conversion disorder (also called functional neurobiological symptom disorder), illness anxiety disorder, and Factitious disorder imposed on selfcare examples of somatic symptom disorders. Gender dysphoria is characterized by feelings of unease about one's maleness or femaleness and is not a somatic symptom disorder. Obsessive-compulsive disorder is classified as an anxiety disorder.

A client suddenly develops paralysis in the bilateral lower extremities. The neurologist finds no neurological disorder. With which disorder does the nurse expect the client to be diagnosed? 1. Factitious disorder 2. Conversion disorder 3. IIIness anxiety disorder 4. Derealization disorder

2. Conversion disorder Rationale The client has paralysis of the lower limbs. This deficit in the voluntary motor function is a neurological symptom. There is, however, no neurological diagnosis to explain the neurological symptom. The nurse, therefore, suspects the client of having conversion disorder. Factitious disorder is a deliberate act of pretending to be ill. Clients with such disorders consciously fabricate symptoms or cause self-inflicted injuries. Illness anxiety disorder is obsessive thought about illness. Such clients interpret even normal bodily changes as signs and symptoms of serious illnesses. In derealization disorder, the client has repeated periods of feeling unreal, detached, outside of the body, numb, dreamlike, or a distorted sense of time or visual perception.

The nurse is assessing a client diagnosed with narcissistic personality disorder. Which behavior is the nurse most likely to find in this client? 1. Aggression toward others 2. Exploitation of others 3. Hypervigilance of others 4. Submission to others

2. Exploitation of others Rationale People diagnosed with narcissistic personality disorder are arrogant and need constant admiration. They lack social empathy and may exploit others for their own benefit. People diagnosed with borderline personality disorder and antisocial personality disorder are often aggressive toward others. People diagnosed with paranoid personality disorder view others with suspicion and may be hypervigilant of them. People diagnosed with dependent personality disorders feel insecure and may be submissive to others.

Which abnormalities in brain structure and function have been found to be associated with borderline personality disorder? Select all that apply. 1. Gray matter size 2. Hippocampus size 3. Frontal lobe function 4. Amygdala size 5. Prefrontal lobe function

2. Hippocampus size 3. Frontal lobe function 4. Amygdala size Rationale In people with borderline personality disorder, abnormal brain structure and function have been found. Findings include abnormalities in the size of the hippocampus, in the size and functioning of the amygdala, and in the functioning of the frontal lobes. Individuals with antisocial personality disorder have shown altered metabolism in the prefrontal regions of the brain. An image study identified reduced prefrontal gray matter within areas of the brain implicated in empathic processing, moral reasoning, and the processing of emotions such as guilt and embarrassment.

A nurse is assessing a client diagnosed with a somatic symptom disorder. Which diagnosis does the nurse consider when the client is unable to meet daily responsibilities? 1. Powerlessness 2. Ineffective coping 3. Impaired social interaction 4. Risk for self-directed violence

2. Ineffective coping Rationale Ineffective coping is observed when the client is unable to manage and meet daily needs. Powerlessness is seen when a client feels useless and has a negative self-evaluation. Impaired social interaction is related to the inability to participate in usual community activities or friendships because of psychogenic symptoms. Risk of self-directed violence is considered if the client has chronic pain and feels useless and unwanted. It is not an appropriate diagnosis when the client is unable to meet daily responsibilities.

A client complains of severe headache and seeing blinding lights. The client's history shows numerous hospitalizations and diagnostic tests for neurological problems. All tests were normal and revealed no physical pathophysiology. What is the priority nursing diagnosis for this client? 1. Powerlessness 2. Ineffective coping 3. Disturbed body image 4. Ineffective role performance

2. Ineffective coping Rationale Some clients use somatization as a way of coping with anxiety; therefore, the priority nursing diagnosis is ineffective coping. Powerlessness, ineffective role performance, and disturbed body image also may apply, but the primary issue relates to the client's coping problem.

Research has indicated that an individual diagnosed with an antisocial personality may present with which characteristic? 1. Social isolation 2. Lack of remorse 3. Learning difficulties 4. Difficulty with reality testing

2. Lack of remorse Rationale Individuals with an antisocial personality exhibit a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior toward others. Social isolation, learning difficulties, and difficulty with reality generally are not associated with antisocial personality disorder.

When providing care for a client diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with which characteristic behavior in the client? 1. Grief, anger, and social isolation 2. Mood shifts, impulsivity, and splitting 3. Altered sensory perceptions and suspicion 4. Perfectionism and preoccupation with detail

2. Mood shifts, impulsivity, and splitting Rationale Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Individuals diagnosed with borderline personality disorder desperately seek relationships to avoid feeling abandoned. They often drive others away with excessive demands, impulsive behavior, or uncontrolled anger. Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings. Grief, anger, and social isolation; altered sensory perceptions and suspicious; and perfectionism are more characteristic of other personality disorders.

Which statement appropriately describes somatic symptoms? 1. Physical symptoms of a physical illness 2. Physical symptoms of a psychological illness 3. Psychological symptoms of a physical illness 4. Psychological symptoms of a psychological illness

2. Physical symptoms of a psychological illness Rationale Somatic symptoms refer to the physical symptoms associated with a psychological illness; these symptoms do not have an organic cause. The physical symptoms of a physical illness are referred to as the signs of the illness; these have an organic cause that can be diagnosed. Somatic symptoms do not include psychological symptoms of a physical illness or the psychological symptoms of a psychological illness.

What action should the nurse take when helping a client who is displaying manipulative behaviors? 1. Maintain client confidentiality from other staff members. 2. Set boundaries and enforce consequences. 3. Self-disclose relevant personal information. 4. Offer to do special favors for the client.

2. Set boundaries and enforce consequences. Rationale When helping clients who display manipulative behaviors, it is important for the nurse to set boundaries and enforce consequences. Clients will test boundaries. Once they understand these limits are solid, clients can work on other ways to meet their needs. The nurse should avoid keeping secrets from other staff members, discussing him- or herself, and doing special favors for the client. This kind of behavior by the nurse can further the client's manipulation.

A nurse is caring for a client diagnosed with illness anxiety disorder. Which interventions will the nurse include in the plan of care for this client? Select all that apply. 1. Allow dependency needs. 2. Show concern for the client. 3. Teach assertive communication. 4. Teach stress reduction techniques. 5. Calm the client by saying the symptoms are not real.

2. Show concern for the client. 3. Teach assertive communication. 4. Teach stress reduction techniques. Rationale Showing concern for the client indicates respect and acknowledgment of the client's feelings. Assertive communication can help in developing positive ways for meeting needs and reducing the need for manipulation or feeling of helplessness. Stress reduction techniques like relaxation, exercise, or meditation help in coping and reducing the need for medication. Promotion of dependency needs will be avoided to reduce illness-related secondary gains. The nurse should not communicate to the client that the symptoms are not real because the client firmly believes they are. Contradicting the client's beliefs may block the communication between the client and the nurse.

What term is used to identify the inability to view both positive and negative aspects of others as part of a whole? 1. Devaluation 2. Splitting 3. Impulsiveness 4. Social ineffectiveness

2. Splitting Rationale Splitting is the inability to integrate both the positive and the negative qualities of an individual into a whole. The individual using this defense tends to think in extremes. Devaluation, impulsiveness, and social ineffectiveness do not accurately identify the behavior described.

The nurse is caring for a client diagnosed with borderline personality disorder. Which behavior does the nurse expect find in the client? 1. The client is always calm and depressed. 2. The client shows extreme fluctuating emotions. 3. The client abuses peers and hospital staff 4. The client feels uncomfortable with the nurse's attention.

2. The client shows extreme fluctuating emotions. Rationale Clients diagnosed with borderline personality disorder have unstable moods. Such clients exhibit rapid emotional shifts. They may be extremely aggressive and suddenly become extremely calm. While this client may have calm or depressed periods, he or she will not remain that way. A diagnosed with borderline personality disorder will not necessarily be abusive to other clients or staff A client diagnosed with borderline personality disorder craves attention and would not be uncomfortable with it.

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

3. "I don't think about my symptoms all the time as I used to." Rationale "I don't think about my symptoms all the time as I used to" indicates that the client's preoccupation with the physical symptoms has decreased, a highly desirable outcome. Feeling less anxiety, having improved memory, and taking medications as prescribed are positive outcomes but may not be directly related to somatic symptom disorders.

A nurse assesses a client diagnosed with conversion disorder (functional neurobiological symptom disorder). Which comment is most likely from this client? 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 demonic forces 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. "Since losing my job last week, I've been unable to maintain my balance and coordination. It's probably just a little nerve irritation." Rationale Clients with conversion disorder channel emotional distress into physical symptoms of a neurological nature. Many clients show a lack of emotional concern about the symptoms (la belle indifférence). In this scenario, the client describes symptoms of a neurological disorder that began after a significant stressor, but then discounts the symptoms. Illness anxiety disorder results in the misinterpretation of physical sensations as evidence of a serious illness, such as concluding that abdominal bloating is a symptom of colon cancer. Believing that demonic forces are causing physical sensations is culturally specific. Somatic symptom disorder has a chronic and relapsing course, such as gastrointestinal sensitivity over the course of one's life.

Which scenario demonstrates a secondary gain? 1. A couple refrains from sexual intercourse for 6 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. A husband hires a housekeeper to clean and provide childcare while his wife is having abdominal distress. Rationale 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 wide to avoid childcare and home maintenance responsibilities. Remaining from sexual intercourse after a hysterectomy shows compliance with discharge instructions. Rewarding children for good report cards demonstrates positive reinforcement. Feeling lonely and devalued is an understandable emotional reaction.

Which personality disorder is characterized by persistent disregard for and violation of the rights of others with an absence of remorse for hurting others? 1. Borderline 2. Schizotypal 3. Antisocial 4. Narcissistic

3. Antisocial Rationale Antisocial personality disorder is characterized by persistent disregard for and violation of the rights of others with an absence of remorse for hurting others. Borderline personality disorder is characterized by unstable and intense relationships and unstable and frequent mood changes. Schizotypal personality disorder is characterized by peculiar behavior, odd speech, and the presence of cognitive perceptual distortions in the absence of psychosis. Narcissistic personality disorder is characterized by a person's grandiose sense of personal achievements.

Which is an example of a somatic symptom disorder? 1. Depersonalization 2. Dissociative fugue 3. Conversion disorder 4. Dissociative identity disorder Rationale Conversion disorder is an example of a somatic symptom disorder. Depersonalization, dissociative fugue, and dissociative identity disorder are examples of dissociative disorders.

3. Conversion disorder

What therapeutic intervention is most appropriate for a client diagnosed with a somatic symptom disorder? 1. Steer conversation away from the client's feelings. 2. Encourage the client to use benzodiazepines as needed. 3. Convey an interest in the client rather than in the symptoms. 4. Encourage the client to not hesitate to rely on the nurse to meet the client's needs

3. Convey an interest in the client rather than in the symptoms. Rationale The nurse should focus on and express interest in the client rather than the symptoms to enhance the client's self-worth and coping skills and avoid rewarding illness-related behaviors. The nurse should encourage the client to express his or her feelings. The nurse should encourage conservative use of benzodiazepines in order to reduce the risk of medication dependence. Encouraging the client to rely on the nurse to meet the client's needs reinforces the illness behavior and should be avoided.

A client who is dramatic, charming, and seductive has traits of which personality disorder? 1. Narcissistic 2. Antisocial 3. Histrionic 4. Borderline

3. Histrionic Rationale Individuals with histrionic personality disorder are dramatic, charming, and seductive. They are excessively emotional and always the center of attention. Individuals with narcissistic personality disorder have a grandiose sense of their personal achievements. Individuals with antisocial personality disorder are callous, deceitful, and impulsive. Individuals with borderline personality disorder are emotionally unstable and impulsive and have feelings of emptiness.

A nurse notices that a client behaves in a melodramatic way and acts flirtatiously. With which personality disorder does the nurse expect the client to be diagnosed? 1. Paranoid personality disorder 2. Schizoid personality disorder 3. Histrionic personality disorder 4. Narcissistic personality disorder

3. Histrionic personality disorder Rationale People diagnosed with histrionic personality disorder have emotional, attention-seeking behaviors. They are often melodramatic and act flirtatiously. People diagnosed with paranoid personality disorder are extremely suspicious and often believe others will harm them. People diagnosed with schizoid personality disorder exhibit emotional detachment and are viewed as loners. People diagnosed with narcissistic personality disorder are arrogant and need constant admiration.

A nurse is assessing a client who complains of body pain. The client seems to be anxious about the possibility of a serious medical illness. With what does the nurse expect the client will be diagnosed? 1. Factitious disorder 2. Conversion disorder 3. Illness anxiety disorder 4. Functional neurobiological symptom disorder

3. Illness anxiety disorder Rationale Illness anxiety disorder is seen when the client obsessively misinterprets that a physical sensation is due to a serious medical illness. In factitious disorder, the person pretends to be ill in order to seek attention and get emotional needs met. Conversion disorder presents with neurological symptoms when a neurological diagnosis is absent. Functional neurobiological symptom disorder is another name for conversion disorder.

Which disorder is characterized by the client's misinterpretation of physical sensations or feelings? 1. Factitious disorder 2. Conversion disorder 3. Illness anxiety disorder 4. Functional neurobiological symptom disorder

3. Illness anxiety disorder Rationale Previously known as hypochondriasis, illness anxiety disorder results in the misinterpretation of physical sensations as evidence of a serious illness. Illness anxiety can be quite obsessive, because thoughts about illness may be intrusive and difficult to dismiss, even when the client recognizes that his or her fears are unrealistic. Factitious disorder is the deliberate fabrication of symptoms. Conversion disorder is another name for functional neurobiological symptom disorder. Functional neurobiological symptom disorder is characterized by one or more symptoms of impaired motor or sensory function.

The spouse of a client diagnosed with a somatic symptom disorder confides to the nurse, "I've been overwhelmed by the shifting of my role from sexual partner to caregiver." Which nursing diagnosis is most applicable? 1. Chronic low self-esteem 2. Ineffective sexuality pattern 3. Risk for caregiver role strain 4. Interrupted family processes

3. Risk for caregiver role strain Rationale The spouse's statement of being overwhelmed by the sudden changing of role to caregiver from sexual partner best indicates the nursing diagnosis of risk for caregiver role strain. Although chronic low self-esteem, ineffective sexuality patterns, and interrupted family processes may indeed be at play in this situation, the risk for caregiver role strain is the best nursing diagnosis due to the wife's feelings of being overwhelmed.

What is the primary difference between Factitious disorder and somatic symptom disorder? 1. Factitious disorder has its origins in depression and anxiety. 2. The symptoms associated with Factitious disorder are always self-directed. 3. The symptomology of factitious disorder is actually controlled by the client. 4. Factitious disorder responds well to confrontation as a primary therapeutic technique.

3. The symptomology of factitious disorder is actually controlled by the client. Rationale Factitious disorder, in contrast to other somatic symptom disorders, is under the conscious control of the client. Depression and anxiety may be associated with all somatic symptom disorders. Factitious disorder may be imposed on the self or on another. Confrontation is not a beneficial therapeutic technique.

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

4. "Your emotional distress is being expressed as physical symptoms." Rationale Conversion disorder, or functional neurobiological symptom disorder, is attributed to the channeling of emotional conflicts or stressors into physical symptoms. Symptoms of conversion disorder are not within the client's voluntary control. Telling the client his or her brain is "confused" is unprofessional and does not provide useful education. Being overly anxious about having a severe illness describes illness anxiety disorder.

Which activity will the nursing director of a neighborhood clinic implement to best address a facility's evidence-based practice needs? 1. Educating the community to the long-term effects of childhood abuse and trauma 2. Including information regarding the characteristics of somatic disorders as a part of new nursing staff orientation 3. Asking clients who have identified themselves as being victims of childhood abuse to be interviewed for a research project 4. Advocating for the admission interviews of clients with somatic symptoms to contain questions concerning childhood traumas

4. Advocating for the admission interviews of clients with somatic symptoms to contain questions concerning childhood traumas Rationale Clients in general medical settings with high levels of somatic symptoms may have been victims of childhood abuse. An awareness of this association will facilitate more mental health assessments within the general physical examination and history. Although educating the community about the long-term effects of childhood abuse and trauma, including information regarding the characteristics of somatic disorders, and asking clients who have identified themselves as being victims of childhood abuse to be interviewed may be appropriate, they are not generally focused on the suggested implications for nursing practice.

A client says to the nurse, "Sometimes I feel like I'm floating above my body, watching it from the outside." When documenting this observation, which term applies? 1. Fugue 2. Amnesia 3. Dissociation 4. Depersonalization

4. Depersonalization Rationale Depersonalization is an uncomfortable feeling of being an observer of one's own body or mental processes. Fugue refers to a memory loss associated with travel away from home. Amnesia refers to the loss of memory. Dissociative identity disorder is marked by the existence of two or more separate personalities.

The nurse is assessing a client who casually says, "I woke up this morning and couldn't move my arm." There is no confirmed diagnosis of physical pathophysiology. With which disorder does the nurse expect the client to be diagnosed? 1. Factitious disorder 2. IIIness anxiety disorder 3. Somatic symptom disorder 4. Functional neurological disorder

4. Functional neurological disorder Rationale In conversion disorder, also called functional neurological disorder, the severity of the symptoms reported may be conveyed in a very casual, matter-of-fact manner. In factitious disorder cases, the client uses proper medical terminology and describes the symptoms very convincingly. In illness anxiety disorder and somatic symptom disorder, the client describes the symptoms, exaggerating them to a level that cannot be explained by the assessment findings. The client uses metaphors and gives colorful descriptions to report a symptom.

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

4. Intentional Rationale Clients with factitious disorder intentionally fabricate symptoms or self-inflicted injury, with the goal of assuming a sick role and getting emotional needs met. Factitious and somatic symptom disorders may involve pain. Symptoms are authentically experienced for clients with somatic symptom disorders, but not those with Factitious disorder. Dependent refers to a physical or psychological need to rely on or trust in somebody or something for help or support. Dependency may be involved in both factitious and somatic symptom disorders.

A nurse is evaluating the effects of treatment for a client with dissociative identity disorder. Which factor would indicate success of the treatment? 1. The client is nervous. 2. The client has increased appetite. 3. The client no longer daydreams. 4. The client has integrated past events.

4. The client has integrated past events. Rationale Dissociative identity disorder is characterized by the presence of two or more distinct personality states that recurrently take control of the client's behavior. Integration of past events or fragmented memories is a positive sign of successful treatment. For the treatment to be successful the client's nervousness should be reduced. The appetite is not affected by dissociative identity disorder. Dissociative identity disorder should not be thought of as daydreaming, and the absence of daydreaming would not indicate a measure of successful treatment.

Which is the most appropriate expected outcome for a client diagnosed with a somatic disorder that has resulted in leg paralysis? 1. The client will walk unassisted within 1 week. 2. The client will assume full self-care within 3 weeks. 3. The client will return to a pre-illness level of functioning within 2 weeks. 4. The client will be able to state two new effective coping skills within 2 weeks.

4. The client will be able to state two new effective coping skills within 2 weeks. Rationale An appropriate outcome for somatic symptom disorders is to be aware of negative coping strategies and to learn new, effective skills for coping within a realistic time frame. Expecting the client to walk unassisted within a week, expecting the client to assume full self-care within 3 weeks, and expecting the client to return to pre-illness level functioning within 2 weeks are less realistic.

A combat veteran from two tours of the war in Afghanistan tells the nurse, "Some others in my unit have posttraumatic stress disorder, but I never had any problems other than my hearing is not as good as it once was." Which explanation for this comment should the nurse consider? 1. The veteran wants to demonstrate toughness and strength. 2. The veteran shows indicators of derealization/depersonalization. 3. The veteran may be rationalizing this reaction to memories of combat. 4. The veteran may have amnesia associated with the combat experience.

4. The veteran may have amnesia associated with the combat experience. Rationale The veteran may have amnesia, or an inability to recall information or feelings after a traumatic event or period of time. Since the veteran references others having posttraumatic stress disorder (PTSD), it is likely that the veteran went through the same traumatic experiences. An assumption that the veteran is trying to look strong is not fully supported by the veteran's statement nor does it assist the nurse in helping the client. The veteran's response is not indicative of derealization/depersonalization, a disorder characterized by recurrent periods of feelings such as detachment, numbness, and distortion of sense of time. The veteran's response does not exhibit rationalization, because no action is being justified.