Ch 21 Mental Health

A group of nursing students is reviewing information about somatic symptom and related mental health disorders. The students demonstrate understanding of the information when they identify which disorder as involving physical or psychological symptoms (or both) fabricated to assume the sick role?

Factitious disorder

A client has been diagnosed with somatic symptom disorder. The client's assessment reveals high levels of anxiety. Which would the nurse expect to be prescribed?

Selective serotonin reuptake inhibitors (SSRIs)

In the care of a client with somatic symptom disorder, the nurse should anticipate that drug treatment will prioritize which class in order to treat the disorder?

Selective serotonin reuptake inhibitors (SSRIs)

A client complains of severe low back pain that began shortly after the death of the client's mother 2 years ago. No physical cause has been found to account for the pain. The client has been largely responsible for the care of four younger siblings because the client's father spends much of the week out of town on work-related business. Based on the client's symptoms, which nursing diagnosis is most appropriate for the client at this time?

Somatic complaints due to anxiety related to life stressors

Over the past 5 years, a client has had two exploratory surgeries and numerous examinations for severe abdominal pain. All diagnostic and laboratory results have been negative for organic problems. The client has had vague descriptions of periods of anxiety and depression and has continued to seek medical assistance for the abdominal pain and various other physical problems. The nurse would assess this client as using which defense mechanism?

Somatization

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

Selective serotonin reuptake inhibitors

Which characteristic differentiates conversion disorder from malingering disorder?

Conversion disorder is an unconscious process, while malingering disorder is a deliberate fabrication of symptoms.

A client is admitted to a mental health unit because the client was found trying to inject diluted feces into the client's hospitalized child's intravenous line. The client has a history of similar attempts of harming the child. The nurse would most likely suspect what?

Factitious disorder imposed on another

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

Factitious disorder

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

"How I handle stress and emotions can affect my physical health."

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

Factitious disorder

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

Clients are often unrecognized because clients receive treatment in different primary care offices, and care is often fragmented.

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.

The client asks the nurse, "What does having psychosomatic symptoms mean?" What is the nurse's best reply?

"It means that stress and/or emotions are causing your symptoms."

A nurse is assessing a client with conversion disorder. The client complains that the client's left side is paralyzed. Which statement made by the client would indicate "la belle indifférence"?

"My paralysis doesn't bother me. I have accepted my disability."

While assessing a client thought to have a factitious disorder, a nurse asks the client to describe when the client felt nurtured as a child. Which response would the nurse interpret as supporting the client's diagnosis?

"The only time I ever felt loved was when I was sick enough to miss school."

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?

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

Characteristics of a conversion disorder include what? Select all that apply.

A lack of stress over the physical loss Production of both a primary and secondary gain for the client Physical symptoms that are worse in the presence of the stressor

Clients from which continent or country may have symptoms of somatization disorder that include the nondelusional sensation of worms in the head or ants under the skin?

Africa

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

Conversion disorder

All of the following disease processes are caused by stress except which one?

Deep vein thrombosis

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

Depression

The nurse is caring for a client with somatic symptom disorder. When assessing this client, the nurse would be especially alert for symptoms of what?

Depression

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

Headache Diarrhea Insomnia

A client's family member asks the nurse, "What is a conversion disorder?" Which is the best response by the nurse?

It involves unexplained, usually sudden, deficits in sensory or motor function

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.

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

Primary gain

A nurse is preparing to interview a client diagnosed with somatic symptom disorder. The nurse anticipates that the client will most likely exhibit what?

Rapidly changing moods during the interview

A client is diagnosed with somatic symptom disorder. Which would the nurse expect to assess as the major clinical finding?

Report of symptoms with no demonstrable pathology on testing or examination

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

Reports of physical symptoms do not have a demonstrable organic basis to fully account for them.

Somatic symptom illness disorders are characterized by what?

Severe physical symptoms that cannot be explained by any organic or physical pathology

Somatic symptom disorder is characterized by what?

Severe physical symptoms unexplainable by any organic or physical pathology

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

Somatization

A client reports a headache. On further assessment, the nurse finds that the client has been spending long hours on a difficult project at work. What should the nurse conclude from the assessment?

The client may be stressed from work.

In somatic symptom disorders, all except which are true?

The client usually believes he/she has some sort of anxiety disorder.

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.

A parent brings a teenaged child, who is complaining of having a severe headache, to the clinic. The teenager is groaning with pain. During assessment, the client asks the nurse for a note to excuse the absence from school. After further assessment, the nurse suspects that the client is malingering. What leads the nurse to come to this conclusion? Choose the best answer.

The client's symptoms disappeared after getting the medical note.

Which statement about the etiology of somatic symptom disorder is accurate?

The exact etiology is unknown.

A nursing instructor is describing somatic symptom disorder to a group of nursing students. The instructor determines that the education was successful when the students state what?

The first symptom usually appears during adolescence.

What is the major clinical finding in somatic symptom disorder?

The report of symptoms with no demonstrable pathology on testing or examination

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

Develop a sound, positive nurse-client relationship

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

Hypochondriasis

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

In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints.

When developing the plan of care for a client with somatic symptom disorder, which would be the most important yet most difficult intervention for the nurse to implement?

Maintaining a therapeutic relationship

The nurse obtains a psychosocial history from a client who may have psychological factors affecting the medical condition. Which should the nurse recognize as pertinent to this diagnosis?

No physiologic cause has been found for the client's symptoms.

A client with complex somatic symptom disorder is complaining of significant pain in the joints. When providing care to this client, which would be most important for the nurse to keep in mind?

The client's experience of pain is real.

A client with somatic symptom disorder is complaining of significant pain in the joints. When providing care to this client, which would be most important for a nurse to keep in mind?

The client's experience of pain is real.

A nurse was placed in charge of the pediatric care unit. Over a period of time it was discovered that most of the children on the unit experienced sudden cardiac arrest. Although the nurse went to great lengths to revive the children, most of these children died. On further investigation, it was found that the nurse had been injecting high doses of digoxin drug in the children, which caused the cardiac arrest. The nurse was arrested and found guilty. What would have been the most likely cause of the nurse's behavior?

The nurse might have Munchausen's syndrome by proxy.

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

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

Depression Anxiety

A nurse is preparing a plan of care for a client diagnosed with body dysmorphic disorder. Which nursing diagnosis would the nurse likely identify as the priority?

Disturbed body image

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

The client usually thinks anxiety is behind the symptoms.

A client who has been having difficulty functioning in daily life comes to the nurse and states, "I'm really afraid. I've had these funny feelings in my stomach. I'm scared that I might have cancer." The client has been seen by numerous health care professionals and no evidence of cancer has been demonstrated. The nurse suspects what?

Illness anxiety disorder

During a client interview, the nurse determines that the client has a fear of developing a serious illness based on a misinterpretation of body sensation. The nurse identifies this as being characteristic of what?

Illness anxiety disorder

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

Malingering

Which best describes the concept of somatization?

Manifestation of physical symptoms from psychological distress

The nurse is planning care for a client with a somatic symptom illness. What should the nurse's goals be while formulating the plan to treat the client? Select all that apply.

To help the client express emotions freely To help the client cope with interpersonal conflicts To help the client identify the cause of the physical illness

The primary factor that differentiates somatization disorders from conversion disorders is what?

Somatization disorders affect multiple organ systems, whereas conversion disorders usually involve only one system.

The nurse is educating the spouse of a client with a somatic symptom disorder about how to best help the client. Which strategy should the nurse suggest?

Empathize about physical discomfort but encourage independence.