Ch 21 Somatic Symptom illnesses

A client is prescribed sertraline for treatment of a somatoform disorder. The nurse would instruct the client to be alert to which side effect? Vomiting Headache Increased appetite Constipation

Headache Explanation: Side effects of sertraline include loss of appetite, diarrhea, nausea, and headache.

Which statement by the client indicates an understanding of somatic symptom disorder? "How I handle stress and emotions can affect my physical health." "As soon as my symptoms go away, I'll be my old self again." "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.

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." "Please do something to cure me. I am a burden to everybody." "I am sure I will get well soon. This problem won't persist for long." "I am not able to walk or do anything at all. I am totally dependent on my mom."

"My paralysis doesn't bother me. I have accepted my disability." Explanation: A client with conversion disorder shows a seeming lack of concern or distress about the functional loss. This behavior is referred to as "la belle indifférence." The statement that the client wants to be cured indicates that the client is worried about the condition, which is not characteristic of conversion disorder. The statement that the client will get well soon indicates that the client is hopeful about getting rid of the illness soon. This attitude is not seen in clients with conversion disorder. The statement that the client is dependent on others indicates that the client is very concerned about the illness; this is not an indication of conversion disorder.

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 only time I felt loved and appreciated was when I made the honor roll at school." "I felt loved and accepted when my father apologized for spanking me so hard." "I never felt nurtured or loved when I was growing up."

"The only time I ever felt loved was when I was sick enough to miss school." Explanation: Individuals who are diagnosed with factitious disorders are thought to have often been abused as children and to have received nurturance only during times of illness. As a result, they try to recreate illness or injury in a desperate attempt to receive love and attention.

The spouse of a client diagnosed with complex somatic symptom disorder asks the nurse, "What causes this condition?" Which response by the nurse would be most accurate? "Your spouse is experiencing chronic stress that causes hypoarousal." "There is definitely an underlying genetic link for this disorder." "The symptoms reflect an emotion that your spouse cannot verbalize." "The symptoms reflect an internal preoccupation with events."

"The symptoms reflect an emotion that your spouse cannot verbalize." Explanation: Complex somatic symptom disorder has been explained as a form of social or emotional communication, meaning that the body symptoms express an emotion that cannot be verbalized by the individual. Although there is some evidence to support a genetic component, the exact transmission mechanism is unclear. In individuals with this disorder, chronic activation of the hypothalamic-pituitary-adrenal axis indicates a hyperarousal condition from chronic stress. Additionally, the personality trait alexithymia is associated with somatic symptoms. These individuals have difficulty identifying and expressing their emotions, have a preoccupation with external events, and are described as concrete thinkers.

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? "It would be best for your to see a specialist until the underlying issue is properly diagnosed." "You must be so frustrated with this unexplained pain. Do you have other stresses in your life too? "The treatment that was recommended to you has worked for many clients. It is supported by research." "Is it common in your culture to talk about psychological distress like it is physical pain?"

"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.

With treatment, conversion disorder often remits in a few weeks but recurs in approximately which percentage of clients? 35% 50% 25% 10%

25% Explanation: With treatment, conversion disorder often remits in a few weeks but recurs in 25% of clients.

Which scenario best exemplifies the psychosocial theory of the development of somatic symptom disorders? A person unconsciously realizes that a particular physiological response produces a reward. A person's family of origin models ineffective coping and conflict-based interactions. An individual's neuroendocrine system is overstimulated and the person becomes accustomed to this condition. An individual consciously develops fictitious complaints in order to distract himself or herself from stressors.

A person unconsciously realizes that a particular physiological response produces a reward. Explanation: According to the learning theory, a person learns to produce a physiologic response (somatization) to achieve a reward, attention, or some other reinforcement. This process is unconscious rather than conscious. Learning theory does not emphasize the roles of family modeling, and a neuroendocrine etiology would rule out a diagnosis of somatoform disorder.

A student nurse asks the mental health nurse about when somatic symptom disorder (SSD) usually begins. The nurse responds by saying that the first symptoms often appear during which time? Early 20s After age 40 years Mid 30s Adolescence

Adolescence Explanation: SSD usually begins before the age of 30 years with the first symptoms often appearing during adolescence; however, it is rarely diagnosed until several years later.

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? North America Greece China Africa

Africa Explanation: Pseudoneurologic symptoms of somatization disorder in Africa and South Asia include burning hands and feet and the nondelusional sensation of worms in the head or ants under the skin.

A client with pain who has been diagnosed with somatic symptom disorder and depression is prescribed medication therapy to treat both the pain and the symptoms of depression. When educating the client about the medication, which would the nurse emphasize? Limiting of the amount of water ingested Use of sunscreen when exposed to bright sunlight Alcohol should be avoided Stopping the medication if there is no change after 1 week

Alcohol should be avoided Explanation: The client will likely be prescribed a nonsteroidal analgesic and selective serotonin reuptake inhibitor medication. In both cases, the client should be reminded to avoid consuming alcohol as this can increase the sedative effects of the antidepressants and increase dehydration leading to dysfunctional metabolism of the medications. Photosensitivity is not associated with the use of monoamine oxidase inhibitors. Water intake needs to be monitored when lithium is used. Clients should also be encouraged to give the medications enough time to be effective because many medications require up to 6 weeks before the client has a response or a relief of symptoms.

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 embarrassed about the number and extent of their physical complaints. Clients find it difficult to go to a clinic setting. Clients are often unrecognized because clients seek out multiple care providers and care is often fragmented. 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 Electroconvulsive therapy Multiple provider evaluations

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.

Which disorder is characterized by unexplained, sudden deficits in sensory or motor function? Conversion disorder Somatization disorder Body dysmorphic disorder Hypochondriasis

Conversion disorder Explanation: Conversion disorder involves unexplained, usually sudden, deficits in sensory or motor function. Body dysmorphic disorder is preoccupation with an imagined or exaggerated defect in physical appearance, such as thinking one's nose is too large or teeth are crooked and unattractive. Hypochondriasis is preoccupation with the fear that one has a serious disease (disease conviction) or will get a serious disease (disease phobia). Somatization disorder is characterized by multiple physical symptoms.

The la belle indifference occurs in which somatoform disorder? Conversion disorder Body dysmorphic disorder Hypochondriasis Somatization disorder

Conversion disorder Explanation: La belle indifference occurs in clients diagnosed with conversion disorder.

The nurse is studying the medical record of a client who reports blindness. The record indicates there is no ocular abnormality. The client doesn't seem upset by the blindness. What is the client's most likely diagnosis? Conversion disorder Optic nerve dysfunction Hypochondriasis Somatic symptom disorder

Conversion disorder Explanation: The client has no ocular abnormality and isn't distressed by the situation. These findings indicate that the client may have conversion disorder. This involves unexplained, usually sudden deficits in sensory or motor function, such as blindness. Hypochondriasis is condition in which a client is preoccupied with possibly having a disorder or contracting a serious illness. Because all tests for blindness were negative, the client does not have any somatic dysfunction, such as optic nerve dysfunction. Somatic symptom disorder is a condition characterized by one or more physical symptoms that have no organic basis.

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? Avoidant personality disorder Bipolar disorder Deliriuim Depression

Depression Explanation: Somatic symptom disorder frequently coexists with other psychiatric disorders, most commonly depression and anxiety. Other less common comorbidities include panic disorder, mania, social phobia, obsessive-compulsive disorder, psychotic disorders, and personality disorders.

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

Depression Anxiety Explanation: Although social phobia, panic disorder, and personality disorder are other comorbidities with SSD, it frequently coexists with other psychiatric disorders, most commonly depression and anxiety.

Which would be most important for a nurse to do when caring for a client with somatic symptom disorder? Ensure adherence to counseling Assist in developing a daily routine Administer prescribed pharmacotherapy Develop a sound, positive nurse-client relationship

Develop a sound, positive nurse-client relationship Explanation: Although administering prescribed pharmacotherapy, counseling, and assisting in developing a daily routine are important, the most crucial part of the plan of care is developing a sound, positive nurse-client relationship. Without the relationship, the nurse is just one more provider who fails to meet the client's expectations.

Which disease process is influenced by stress and emotions? Diabetes Hypotension Influenza Bipolar disorder

Diabetes Explanation: Diabetes can be influenced by stress and emotions, as can other conditions such as hypertension and colitis. Influenza, bipolar disorder, and hypotension are not psychosomatic conditions.

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. Sweating Dry mouth Diarrhea Rashes Insomnia

Diarrhea Insomnia Explanation: Sertraline is an antidepressant drug used to treat underlying depression in a client with somatic illness. Headache, diarrhea, and insomnia are side effects associated with this drug. The nurse should monitor for these signs after administering this drug. Unlike fluoxetine, rashes are not a side effect related to sertraline. Unlike paroxetine, dry mouth is not a side effect associated with sertraline.

Based on the psychosocial theory associated with somatic symptom illnesses, the mental health nurse suspects that a client who frequently fails to meet deadlines at work claiming reoccurring "stomach problems" is what? Select all that apply. Likely to give up the behavior when it is identified as a mental health issue Displaying somatizing behavior Not consciously causing the "stomach problems" Not experiencing any negative repercussions at work Being rewarded for this behavior

Displaying somatizing behavior Being rewarded for this behavior Not consciously causing the "stomach problems" Explanation: According to the learning theory, a person learns to produce a physiologic response (somatization) to achieve a reward, attention, or some other reinforcement. Therefore, the client who frequently fails to meet deadlines at work claiming reoccurring "stomach problems" is likely displaying somatizing behavior, being rewarded for the behavior, and is not consciously causing the stomach problems.

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? Ineffective coping Disturbed body image Low self-esteem Risk for other-directed violence

Disturbed body image Explanation: The obvious nursing diagnosis is disturbed body image. Nursing care should focus on building a therapeutic relationship and supporting the client's positive physical aspects.

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? Ignore the client's complaints about physical discomfort and help the client focus on feelings instead. Empathize about physical discomfort but encourage independence. Keep a log of the client's physical symptoms to track improvement. Encourage the client to acknowledge the spouse's frustration and helplessness.

Empathize about physical discomfort but encourage independence. Explanation: The results of a family assessment often reveal that families of these individuals need education about the disorder, helpful strategies for dealing with the multiple complaints of the client, and usually help in developing more effective communication patterns. Empathizing with clients about physical discomfort is important while simultaneously encouraging family members to assist the client in becoming more independent.

When assessing a client diagnosed with hypochondriasis, the most serious risk factor to be identified for this client is what? Aggressive behavior Denial of emotional problems Ruminating thoughts Extensive use of over-the-counter medications

Extensive use of over-the-counter medications Explanation: When assessing a client diagnosed with hypochondriasis, the most serious risk factor to be identified is the extensive use of over-the-counter medications. Many clients with hypochondriasis overuse medication and can become dependent as a result. For example, the nurse should identify if a client has developed laxative dependence as a result of anxiety regarding bowel patterns.

In which mental health disorder are physical or psychological symptoms (or both) fabricated to assume the sick role? Conversion disorder Hypochondriasis Factitious disorder Factitious disorder by proxy

Factitious disorder Explanation: In factitious disorder, physical or psychological symptoms (or both) are fabricated to assume the sick role. In factitious disorder by proxy, the intentional production of symptoms is in others, usually children. Hypochondriasis occurs when individuals are fearful of developing a serious illness based on their misinterpretation of body sensations. Conversion disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms.

In which disorder is the individual motivated solely by the desire to become a client? Body dysmorphic disorder (BDD) Conversion disorder Factitious disorder Complex somatic symptom disorder (CSSD)

Factitious disorder Explanation: Persons with factitious disorders intentionally cause an illness or injury to receive the attention of health care workers. These individuals are motivated solely by the desire to become a client and develop a dependent relationship with a health care provider. BDD, conversion disorder, and CSSD are not disorders in which the client is motivated by the desire to become a client.

In which disorder is the individual motivated solely by the desire to become a health care client? Somatic symptom disorder Factitious disorder Conversion disorder Illness related disorder

Factitious disorder Explanation: Persons with factitious disorders intentionally cause an illness or injury to receive the attention of health care workers. These individuals are motivated solely by the desire to become a client and develop a dependent relationship with a health care provider. Somatic symptom disorder, conversion disorder, and illness-related disorder are not disorders in which the client is motivated by the desire to become a client.

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? Functional neurologic symptoms Borderline personality disorder Factitious disorder imposed on another Schizoid personality traits

Factitious disorder imposed on another Explanation: A rare but dramatic disorder, factitious disorder imposed on another (previously called 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 a child to gain the attention of a health care provider through her child's injuries. The client's history does not reflect manifestations of schizoid personality traits or borderline personality disorder. Functional neurologic symptoms involve severe emotional distress or unconscious conflict expressed through physical symptoms.

The nurse is caring for a client with conversion disorder. The client reports having paralysis of the right side of the body. Which action by the nurse would constitute a secondary gain? Feeding the client during mealtime Teaching the client techniques of meditation and relaxation Talking about family and friends with the client Discussing coping strategies that the client used in the past

Feeding the client during mealtime Explanation: Secondary gains refer to the personal benefits that the client experiences from being considered sick. In this case, being fed is considered the secondary gain. Discussion about family and friends with the client is a treatment strategy that may help the client develop insight into the cause of the condition. Teaching the client techniques of meditation and relaxation is a treatment strategy that may help the client relieve stress. Discussing the coping strategies that the client used in the past may help the client identify and integrate those coping strategies in the future.

A nurse is describing the social network of clients diagnosed with somatic symptom disorder when conducting a class for a group of staff nurses. The nurse determines that the class was successful when the group identifes which network as the primary network for this population? Health care providers Coworkers Peers Siblings

Health care providers Explanation: Because they believe themselves to be very sick, those with somatic symptom disorder also believe that they are disabled and cannot work. Because their symptoms are often inconsistent with any identifiable medical diagnosis, these individuals are rarely satisfied with health care providers, who can find nothing wrong. However, their social network often consists of a series of providers, rather than peers or family members, who can also become weary of the individual's constant complaints of physical problems.

Which mental health disorder is characterized by a fear of developing a serious illness based on a misinterpretation of body sensation? Alexithymia Conversion disorder Hypochondriasis Body dysmorphic disorder

Hypochondriasis Explanation: When individuals are fearful of developing a serious illness based on their misinterpretation of body sensation, the term hypochondriasis is used to describe the preoccupation. Individuals with alexithymia have difficulty identifying and expressing their emotions. Conversion disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms. Patients with body dysmorphic disorder focus on real (but slight) or imagined defects in appearance, such as a large nose or thinning hair. Preoccupation with the defect causes significant distress and interferes with their ability to function socially.

A nurse is working with a client diagnosed with somatic symptom disorder who is experiencing pain. Which would be an important focus of care? Select all that apply. Suggesting the use of complementary and alternative treatments. Addressing nonpharmacologic measures for symptom relief Examining stressors in the client's life Identifying strategies to relieve pain Administering opioid analgesics as neeeded

Identifying strategies to relieve pain Examining stressors in the client's life Addressing nonpharmacologic measures for symptom relief Suggesting the use of complementary and alternative treatments. Explanation: Pain is a primary issue and was once considered a separate disorder. Nursing care focuses on helping clients identify strategies to relieve pain and to examine stressors in their lives. After a careful assessment of the pain, nonpharmacologic strategies should be developed to reduce it. Additionally, complementary and alternative therapies may be useful.

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 Alexithymia Conversion disorder Factitious disorder

Illness anxiety disorder Explanation: When individuals are fearful of developing a serious illness based on their misinterpretation of body sensation, the diagnosis of illness anxiety disorder can be used to describe the preoccupation. Individuals with alexithymia have difficulty identifying and expressing their emotions. Conversion disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms. Persons with factitious disorders intentionally cause an illness or injury to receive the attention of health care workers. These individuals are motivated solely by the desire to become a client and develop a dependent relationship with a health care provider.

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? Factitious disorder Illness anxiety disorder Functional neurologic symptom disorder Conversion disorder

Illness anxiety disorder Explanation: When individuals are fearful of developing a serious illness based on their misinterpretation of body sensations, the classification of illness anxiety disorder can be used to describe this preoccupation. The fear of having an illness continues despite medical reassurance, and this interferes with psychosocial functioning. The individual spends time and money on repeated examinations looking for feared illnesses. With factitious disorder, the illness or injury is intentionally caused to gain attention of health care workers. Functional neurologic symptom disorder or conversion disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms.

Which would the nurse expect to assess in a client diagnosed with functional neurologic symptom disorder? Imbalance Pain Headache Gastrointestinal upset

Imbalance Explanation: Clients with conversion 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. Headache, pain, and gastrointestinal upset would be more common in clients with somatic symptom disorder.

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. In factitious disorders, clients are unaware that their symptoms are not real. In somatic symptom disorder, clients consciously seek attention. 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.

A client's family member asks the nurse, "What is a conversion disorder?" Which is the best response by the nurse? It is a preoccupation with an imagined or exaggerated defect in physical appearance. 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.

It involves unexplained, usually sudden, deficits in sensory or motor function. Explanation: A conversion disorder involves an unexplained, usually sudden, deficit in sensory or motor function.

The nurse has concluded the assessment of a client recently diagnosed with somatic symptom disorder. The client states the client's most significant source of stress is that "No one believes how sick I am." The client's physical complaints include fatigue, loss of appetite, and frequent urination. Based on these data, the most appropriate nursing diagnosis is what? Hopelessness related to chronicity of symptoms as evidenced by dependency Chronic low self-esteem related to physical symptoms that inhibit the client's daily functioning Risk for spiritual distress related to feelings of isolation Ineffective coping related to unresolved psychological issues as evidenced by inability to express feelings verbally

Ineffective coping related to unresolved psychological issues as evidenced by inability to express feelings verbally Explanation: Nursing diagnoses for clients with somatic system disorders focus on identifying the causes of dysfunctional coping and issues related to the family and psychosocial interaction.

A client is admitted to a mental health unit with a diagnosis of factitious disorder. When reviewing the client's history, which would a nurse most likely find? Intentional self-injurious behavior Pain to achieve a self-serving goal Malingering to avoid work Parents who were restrictive

Intentional self-injurious behavior Explanation: Clients with factitious disorder intentionally cause an illness or injury to receive the attention of health care professionals. Pain for a self-serving goal, malingering, or restrictive parents are not associated with factitious disorder.

When assessing the mood of a client with somatic symptom disorder, which mood would the nurse expect to find? Labile Consistently elevated Consistently depressed Within normal limits

Labile Explanation: The individual's mood is usually labile, often shifting from extremely excited or anxious to being depressed and hopeless. Cognition is usually not impaired.

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)? The client's complaints are not real. The symptoms follow a typical neurologic pattern. Symptoms expressed reflect a neurologic illness. Laboratory and diagnostic test results are usually negative.

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.

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? Assisting with problem solving Educating the client about positive health care practices Maintaining a therapeutic relationship Discussing results of diagnostic tests

Maintaining a therapeutic relationship Explanation: Although discussing the results of diagnostic tests, assisting with problem solving, and teaching the client about health are important interventions addressing the psychological domain, the most difficult aspect is developing a sound, positive nurse-client relationship. This relationship is crucial.

Which occurs when an individual intentionally produces illness symptoms to avoid work? Malingering Conversion disorder Alexithymia 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 imposed on another Factitious disorder Functional neurologic symptom disorder Malingering

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.

A nurse is assessing a client who is suspected of having somatic symptom disorder (SSD). Which would the nurse expect to report as the most common report? Dizziness Cough Pain Nausea

Pain Explanation: Although any symptom may be reported, pain is the most common problem in clients with this disorder.

Which best describes the concept of somatization? Physical symptoms that are all in one's head Manifestation of physical symptoms from psychological distress Psychological origin of illness that is not real Symptoms that cannot be substantiated by physicians

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.

Which statement best reflects the pharmacologic treatment of somatic symptom disorder? No medications have been specifically recommended for somatic symptom disorder. Pharmacologic therapy is the primary mode of treatment. Monoamine oxidase inhibitors are effective in treating comorbid anxiety disorders. Selective serotonin reuptake inhibitors are especially helpful for clients experiencing pain.

No medications have been specifically recommended for somatic symptom disorder. Explanation: No medication is specifically recommended for clients with somatic symptom disorder; however, psychiatric symptoms of comorbid disorders, such as depression and anxiety, are treated pharmacologically as appropriate. Phenelzine is one of the monoamine oxidase inhibitors that has been effective in treating not just depression but also the chronic pain and headaches common in people with somatic symptom disorder. 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.

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. The client's symptoms are related to conscious motives. The client is able to articulate the cause of psychological distress. The client's symptoms subside with appropriate medical treatment.

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.

Which is an inaccurate statement regarding malingering? People who malinger usually do not stop the physical symptoms when given a reward. People who malinger have no real physical symptoms. It is the intentional production of false or grossly exaggerated physical or psychological symptoms. It is motivated by external incentives.

People who malinger usually do not stop the physical symptoms when given a reward. Explanation: The purpose noted in people who malinger is some external incentive or outcome that they view as important and results directly from illness.

Based on the nurse's knowledge of common problems associated with somatic symptom disorder, the nurse would ensure that which areas are assessed? Select all that apply. Urinary function Polypharmacy Activity level Sleep patterns Fluid intake

Polypharmacy Sleep patterns Activity level Explanation: Although a complete review of systems is important, certain areas require a close examination because the actual physical functioning of these individuals is often marginal. They usually have problems with sleep, fatigue, and physical activity. The client may also be taking multiple medications related to the numerous physical complaints and fragmented health provision. Assessment of these areas generates data to be used in establishing a nursing diagnosis.

Which is the name given to a direct internal benefit that being sick provides, such as relief from anxiety? La belle indifference Primary gain Malingering Secondary gain

Primary gain Explanation: Primary gains are the direct internal benefits that being sick provides. Secondary gains are the external benefits received from others because one is sick. Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms. The la belle indifference is a seeming lack of concern or distress for sudden deficits in sensory or motor function, as seen in conversion disorder.

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 Intermittent nodding and glancing at the clock on the wall No facial expression during the interview Altered mental status

Rapidly changing moods during the interview Explanation: The individual's mood is usually labile, often shifting from extremely excited or anxious to being depressed and hopeless. Response to physical symptoms is usually magnified. The client's mental status is usually normal, and cognition is not impaired but may be distorted.

A client has been admitted to a hospital with the inability to move the client's right arm. The client has a diagnosis of conversion reaction. Which consequence of this condition would be an example of primary gain? Medical leave from the client's high-stress job Attention from the client's spouse and children Avoidance of jury duty Relief from anxiety

Relief from anxiety Explanation: Primary gain is the immediate gain by the client to remove himself or herself from an overwhelming situation. In this case, relief from anxiety would be an example of primary gain. The other three answers reflect secondary gain, or mechanisms to remove the client from stress and provide an opportunity to meet dependency needs.

When assessing a client with somatic symptom disorder, which would the nurse most likely note? 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. The client willfully controls the physical symptoms. Denial and repression are the chief defense mechanisms used.

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.

The personal benefit derived from blocking psychological conflict from conscious awareness is called what? Primary gain Secondary gain Sick role reward La belle indifference

Secondary gain Explanation: Secondary gains are the internal or personal benefits received from others because one is sick, such as attention from family members and comfort measures.

Which drug classification has been shown to be effective in treating somatization disorders? Antianxiety medications Antipsychotics Antimanics Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors Explanation: Selective serotonin reuptake inhibitors have been shown to be effective in treating somatization disorders.

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) Mood stabilizers Tricyclic antidepressants Antipsychotics

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.

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) Hypnotics Monoamine oxidase inhibitors (MAOIs) Benzodiazepines

Selective serotonin reuptake inhibitors (SSRIs) Explanation: SSRIs are used in the treatment of somatic symptom disorder. Benzodiazepines may be occasionally indicated but are not an appropriate form of primary treatment due to the potential for dependence and difficult withdrawal. MAOIs and hypnotics are not commonly used in the treatment of the disorder.

Medications have been tried for somatic symptom disorder. Which drugs have been shown to be effective in some cases? Antipsychotics Selective serotonin reuptake inhibitors (SSRIs) Antihypertensive drugs Antianxiety agents

Selective serotonin reuptake inhibitors (SSRIs) Explanation: SSRIs, given in sequential trials of one or more medications, have been found to be the drugs of choice for somatoform disorders; they are cost effective and helpful.

Which medication classification has been shown to be effective in some cases of somatoform disorders? Antibiotics Antimanics Antipsychotics Serotonin reuptake inhibitors (SSRIs)

Serotonin reuptake inhibitors (SSRIs) Explanation: SSRIs have been shown to be effective in some cases of somatoform disorders.

Following a long history of multiple visits to community clinics and emergency departments, a client has been diagnosed with hypochondriasis. During this current visit to the emergency department, the client has just been informed that diagnostic testing and assessment reveal no severe illness. Despite this, the client persists in verbalizing physical complaints. How should the nurse respond to this? Facilitate a repeat of the previous diagnostic testing in order to appease the client. Have a different member of the care team present the test and assessment results to the client. Feign an assessment of the client in order to calm the client's anxiety. Set limits with the client about the complaints.

Set limits with the client about the complaints. Explanation: If a client with the diagnosis of hypochondriasis has been told that the client has no life-threatening or severe illnesses, but the client continues to verbalize clinical symptoms, limit-setting is used. A "false" assessment is unethical, and repeating diagnostic testing reinforces the client's behavior. Having diagnostic results presented by another member of the care team is unlikely to eliminate the client's concerns.

Somatic symptom illness disorders are characterized by what? Self-induced disease states or faked symptoms to garner attention Self-inflicted injuries Severe physical symptoms that cannot be explained by any organic or physical pathology Physical symptoms coupled with extreme focus on emotional state

Severe physical symptoms that cannot be explained by any organic or physical pathology Explanation: Clients with somatoform disorders experience physical symptoms despite no underlying medical explanation for them. They complain of severe symptoms with no organic or physical basis.

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 Altered comfort exhibited by poor school grades Depression exhibited by repressed rage Ineffective parenting due to poor coping

Somatic complaints due to anxiety related to life stressors Explanation: The client is experiencing stress related to the client's current life situation and reacting by somatization to deal with the client's feelings. Therefore, "somatic complaints due to anxiety related to life stressors" would be the correct nursing diagnosis. The other choices are not appropriate.

Which term describes the conversion of unexpressed emotions into physical symptoms? Hysteria La belle indifference Psychosomatic Somatization

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.

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? Dissociation Somatization Repression Displacement

Somatization Explanation: This client is using somatization. The physical symptoms are a method of reducing anxiety. Dissociation is a disturbance in integrated personal functions. Thoughts and feelings are split into different mental compartments. Displacement is the transfer of emotional reactions from one person or object to another. Repression is the defense mechanism in which experiences are blocked from the conscious mind.

The primary reason for considering cultural issues when caring for the client with somatization disorders is what? Somatization disorders are only seen in a few cultures. Somatization disorders differ in type and frequency of symptoms and depend on the culture in which they are expressed. Somatization disorders are characterized by middle-class, Caucasian value expressions. Somatization disorders usually only occur in the United States.

Somatization disorders differ in type and frequency of symptoms and depend on the culture in which they are expressed. Explanation: The type and frequency of symptoms in somatization disorders differ depending on the culture in which they are expressed. For example, there is a higher reported frequency of somatization disorder in Greek and Puerto Rican men than in men in the United States. Therefore, the symptom reviews must be adjusted to the culture.x

A nurse is assessing a client with hypochondriasis. Which signs could the nurse expect to find in the client? Select all that apply. The client does not believe in the use of over-the-counter medications. The client is preoccupied with the self. The client reports having visited many physicians or hospitals. The client will discuss many emotional problems. The client is reluctant to participate in psychiatric treatment programs.

The client is preoccupied with the self. The client reports having visited many physicians or hospitals. The client is reluctant to participate in psychiatric treatment programs. Explanation: Clients with hypochondriasis are extremely preoccupied with themselves, especially with their physical functioning. They are most likely to visit many physicians and hospitals for their complaints. Such clients do not believe that their illness is due to an underlying psychiatric cause, thus they are reluctant to participate in psychiatric treatment programs. Such clients deny having emotional problems and are not expressive. Hypochondriac clients would extensively use over-the-counter medications for relieving their physical illnesses.

The nurse is assessing a client who has been unable to speak after witnessing a murder. The assessment and subsequent testing reveal no physical abnormality that may cause speech impairment. What is the most likely cause of this speech impairment in the client? The client may have vocal cord paralysis. The client may be attempting to block the witnessed event to reduce anxiety. The client may have dysfunction of the speech center of the brain. The client may not want to speak.

The client may be attempting to block the witnessed event to reduce anxiety. Explanation: The client is most likely experiencing conversion disorder after witnessing a violent act. In this case, the client may be trying to protect the self, either consciously or unconsciously, from the fear or anxiety from the event. The assessment and subsequent testing did not reveal any other cause of speech impairment, which indicates the client does not have vocal cord paralysis or any dysfunction related to the brain's speech center.

The nurse is assessing a client who reports severe chest pain. The client appears worried and frightened. Further assessment and laboratory testing does not reveal any abnormalities. The nurse observes that in the absence of any medical personnel, the client watches TV, is relaxed, and speaks to a friend on the phone in a normal tone of voice. What should the nurse suspect in this case? The client may have silent angina. The client may be a hypochondriac. The client may be malingering. The client may have Munchausen's syndrome.

The client may be malingering. Explanation: Malingering refers to the intentional production of false or grossly exaggerated physical or psychological symptoms. These people do not have any real physical symptoms, or they grossly exaggerate relatively minor symptoms. This behavior is motivated by external motives and the client's symptoms end when the desired outcome has been achieved. Hypochondriasis is a condition in which a client is preoccupied with possibly having a disorder or contracting a serious illness. In silent angina, the client has no physical discomfort. In Munchausen's syndrome, a person intentionally produces physical or psychological symptoms solely to gain attention.

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 a hypochondriac. The client may be stressed from work. The client may have conversion disorder. The client may be lying about pain.

The client may be stressed from work. Explanation: The client may have a tension headache as a result of work-related stress. Hypochondriasis is a preoccupation with the fear that one will get a serious illness. These findings do not indicate that the client is a hypochondriac. There is nothing in assessment that indicates the client may be lying about being in pain. Conversion disorder involves sudden deficits in sensory or motor function due to an unexplained cause. These findings do not indicate that the client has a conversion disorder.

The nurse is studying the medical records of an Indian male client. The nurse finds that the client has dhat syndrome. What should the nurse infer from this? The client may have concerns about having dizziness, headache, pain, and sleep disturbance. The client may have concerns regarding loss of semen. The client may have concerns about his penis shrinking. The client may have concerns about having insomnia, fatigue, and indigestion.

The client may have concerns regarding loss of semen. Explanation: Dhat syndrome is a hypochondriachal syndrome seen in India, in which the client has concerns regarding loss of semen. Koro is a culture-bound somatic syndrome seen in Southeast Asia in which the client believes that the penis is shrinking and will collapse into the abdomen. Hwa-byung is a culture-bound somatic syndrome in Korea in which a client has insomnia, fatigue, and indigestion, believed to result from suppressed anger. Shenjing shuariuo is a syndrome that occurs in China. It manifests as physical and mental fatigue, dizziness, headache, pain, and sleep disturbance.

A client with conversion disorder talks at length about a loss of vision. The nurse talks to the client about good hygiene practices and encourages the client to talk about any topic of interest. What is the nurse's intention for this intervention? Choose the best answer. The client should pay less attention to the physical problem. The client should feel comfortable with the nurse. The client should express the physical problem to the nurse. The client should adopt good hygienic practices.

The client should pay less attention to the physical problem. Explanation: By discussing good hygiene practices and encouraging the client to speak on any topic of interest, the nurse is trying to avoid discussing the client's physical symptom. The client with conversion disorder may have good hygiene habits; the nurse is not trying to teach the client about good hygiene habits. The nurse's intervention is not aimed at making the client feel comfortable with the nurse or to make the client express the physical problems. The purpose of the nurse's intervention is to help minimize secondary gain and decrease the client's focus on the symptom.

In somatic symptom disorders, all except which are true? The client believes that his/her condition is catastrophic and disabling. The client usually believes he/she has some sort of anxiety disorder. The client embraces the "sick role." The client believes he/she has a serious illness.

The client usually believes he/she has some sort of anxiety disorder. Explanation: Somatoform disorders are often mistaken for physical disorders because the person is not aware that the source of the symptoms is underlying psychic conflict. The somatization of anxiety decreases the level of stress the person perceives.

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 he/she has a serious illness. The client believes that his/her condition is catastrophic and disabling. The client embraces the "sick role." The client usually thinks anxiety is behind the symptoms.

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.

When describing the course of illness associated with somatic symptom disorder, which would the nurse include? The client readily discusses feelings and expresses needs verbally. The client avoids playing the sick role and resists medical attention. The client will often minimize the medical history. The client will report going to many different providers without satisfaction.

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.

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? Outcomes need to reflect the biologic aspects of the pain. Opioid analgesics are the primary mode of therapy. The client's experience of pain is real. Complementary therapies are usually of little benefit.

The client's experience of pain is real. Explanation: Even though there is no medical explanation for the pain, the client's pain is real and has serious psychosocial implications. Aggressive pharmacologic treatment of the symptoms must be avoided. Nonpharmacologic strategies, including complementary and alternative treatments, should be used to assist in pain relief. Outcomes developed need to avoid focusing on the biologic aspects of the disorder and instead help the client overcome the pain through biopsychosocial approaches.

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. Opioid analgesics are the primary mode of therapy. Complementary therapies are usually of little benefit. Outcomes need to reflect the biologic aspects of the pain.

The client's experience of pain is real. Explanation: Even though there is no medical explanation for the pain, the client's pain is real and has serious psychosocial implications. Aggressive pharmacologic treatment of the symptoms must be avoided. Nonpharmacologic strategies, including complementary and alternative treatments, should be used to assist in pain relief. Outcomes developed need to avoid focusing on the biologic aspects of the disorder and instead help the client overcome the pain through biopsychosocial approaches.

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 reported having signs related to raised intracranial pressure, such as nausea. The client was not found to have any underlying cause of headache on assessment. The client's symptoms may have been a result of stress caused by studying all night for an exam. The client's symptoms disappeared after getting the medical note.

The client's symptoms disappeared after getting the medical note. Explanation: A malingerer is a person who intentionally produces false or grossly exaggerated physical or psychological symptoms. This behavior is motivated by external motives, and once the motives have been met, the client's symptoms will disappear. If the client had studied all night for an exam, the client may have been suffering from a tension headache and the symptoms would have remained after the client received the medical note. If a client doesn't have any underlying cause of headache on assessment, it could be concluded that the client either is a malingerer or has a somatic symptom illness. However, clients do not have voluntary control over somatic symptoms. If the client reports having signs related to raised intracranial pressure, such as nausea, which are not consistent with the assessment findings, then the client may have Munchausen's syndrome. In this condition the client inflicts illness or injury on oneself in order to gain attention.

After teaching a group of nursing students about somatic symptom disorder (SSD), the instructor determines that additional education is necessary when the group identifies which statement as true? The disorder includes a combination of pain and gastrointestinal, sexual, and pseudoneurologic symptoms. The condition is an acute short-term condition. The age of onset is usually before age 30 years. The condition is characterized by multiple physical symptoms.

The condition is an acute short-term condition. Explanation: The disorder is not acute. SSD is one of the most difficult disorders to manage because the symptoms tend to change, are diffuse and complex, and vary and move from one body system to another. For example, initially there may be gastrointestinal (nausea, vomiting, diarrhea) and neurologic (headache, backache) symptoms that change to musculoskeletal (aching legs) and sexual issues (pain in the abdomen, pain during intercourse). The physical symptoms may last for 6 to 9 months.

The nurse is teaching basic physical exercises and meditation techniques to a client recently diagnosed with conversion disorder. What outcome does the nurse expect from teaching the client these exercises? Choose the best answer. The exercises may help the client manage stress underlying the disorder The exercises may distract the client from the physical disability The exercises may help the client understand the conflict underlying the disorder The exercises may help the client express feelings of fear, anger, guilt, or inadequacy

The exercises may help the client manage stress underlying the disorder Explanation: Physical exercise and meditation may help the client relieve and manage stress in a healthy manner. If the client is able to build stress management skills while in treatment, he or she may be able to build on these strategies in the future. Conversation about other topics and avoiding any discussion about the client's symptoms might help distract the client from the disability but may not provide useful tools for lessening possible future occurrences. Talking about various coping methods used by the client in the past may help the client understand and cope with the conflict underlying the disability. Talking about the problems that the client faces is useful to the client for identifying and expressing feelings of fear and guilt.

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 disorder typically is diagnosed in men. Highly educated individuals often develop this disorder. The disorder commonly occurs with substance abuse. The first symptom usually appears during adolescence.

The first symptom usually appears during adolescence. Explanation: Complex somatic symptom disorder typically has an onset before age 30 years, with the first symptom often appearing during adolescence. The disorder is diagnosed more often in women and occurs most often with depression and anxiety. Epidemiologic studies reveal that the disorder occurs primarily in nonwhite, less educated women, particularly those with lower socioeconomic status and high emotional stress.

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 might have Munchausen's syndrome. The nurse might have somatic symptom disorder. The nurse might have conversion disorder.

The nurse might have Munchausen's syndrome by proxy. Explanation: Munchausen's syndrome by proxy is a condition in which a person inflicts illness or injury on someone else in order to gain attention from becoming a "hero" for saving the victim. In this case, the nurse tried to kill the children and then went to great lengths to revive them. This indicates that the nurse had Munchausen's syndrome by proxy. In conversion disorder, the client has sudden deficits in sensory or motor function due to an unexplained cause. In somatic symptom disorder, the client reports having one or more than one physical symptom without any underlying cause. In Munchausen's syndrome the client inflicts illness or injury on oneself in order to gain attention.

The nurse is caring for a client with conversion disorder. The nurse asks the client about the client's relationships with family and friends. What is the nurse trying to determine with this question? Choose the best answer. The nurse wants to learn if the client has any conflicts with family or friends. The nurse wants to divert the client's attention from the illness. The nurse wants to find out if similar symptoms are evident in the family. The nurse wants to minimize the chances of secondary gain.

The nurse wants to learn if the client has any conflicts with family or friends. Explanation: Conversion disorders are usually related to interpersonal conflict arising among family or friends. The nurse asks the client about family and friends in order to find out whether any conflicts have caused the disorder in the client. Conversion disorder is not inherited, thus the nurse is not trying to find out if similar symptoms are evident in the family. Asking about family and friends would divert the client's attention from the disability, but this is not the nurse's chief intention here. Asking about family and friends would be useful to decrease the chances of secondary gain, but this again is not the nurse's chief intention in this scenario.

Regularly scheduled therapy sessions are integral to the treatment plans for all clients requiring psychiatric-mental health care. The nurse understands that this is important for clients with somatic symptom disorder for which reason? To ensure a therapeutic relationship with the client To monitor for suicidal ideation To prevent the client from relapsing To monitor the client's physical health

To ensure a therapeutic relationship with the client Explanation: The most important and ongoing intervention for a client with somatic symptom disorder is the maintenance of a therapeutic relationship.The care coordinator works with the client over time and establishes and maintains a regular schedule of therapy sessions. The care coordinator does so to build a trusting, therapeutic relationship with the client with the eventual goal of having the client express thoughts and feelings related to stress and conflict, rather than communicate through somatic complaints.

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 prevent any danger to other clients and medical personnel To help the client cope with interpersonal conflicts To help the client identify the cause of the physical illness To help the client express emotions freely To administer narcotic analgesics to reduce the somatic illness

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 Explanation: Clients with somatic symptom illness may have difficulty expressing emotions and feelings. It may be extremely difficult for them to deal with their interpersonal conflicts. These clients may be unable to perceive the real cause of their illness. In order to resolve these issues, the nurse should help such clients express their emotions freely, cope with interpersonal conflicts, and identify the cause of their physical illness. Clients with somatic symptom illness do not pose any danger to other clients or medical personnel. The nurse should not administer narcotic analgesics to these clients because of the risk for dependence or abuse. Nonsteroidal antiinflammatory agents may be prescribed and administered for pain.

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 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

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 nurse is completing a history for a client who recently suffered emotional stress over the death of a family member. What would the nurse expect the client who is diagnosed with conversion disorder to reveal? Select all that apply. nausea and vomiting tremors and difficulty walking double vision significant drop in hemoglobin and hematocrit difficulty swallowing or feeling "a lump in the throat"

difficulty swallowing or feeling "a lump in the throat" double vision tremors and difficulty walking Explanation: Conversion disorder is part of a group of illnesses called Somatoform disorders, in which there is no physical or laboratory evidence to support the physical manifestations that the client presents. Symptoms can affect body movement and function and the senses. Signs and symptoms that affect body movement and function may include: weakness or paralysis, abnormal movement, such as tremors or difficulty walking, loss of balance, difficulty swallowing or feeling "a lump in the throat," seizures or episodes of shaking and apparent loss of consciousness, and episodes of unresponsiveness. Signs and symptoms that affect the senses include: numbness or loss of the touch sensation, speech problems, such as inability to speak or slurred speech, double vision or blindness, and hearing problems or deafness. Significant drop in hemoglobin and hematocrit, and nausea and vomiting are not included in the signs and symptoms of conversion disorder.

The mental health nurse providing care for a client exhibiting symptoms of hypochondriasis is prepared to observe the client ... treating a cognitively impaired client aggressively. producing grossly exaggerated physical symptoms to have needs met. seldom engaging in milieu activities. performing ritualistic, repetitive actions.

performing ritualistic, repetitive actions. Explanation: The mental health nurse providing care for a client exhibiting symptoms of hypochondriasis is prepared to observe the client performing ritualistic, repetitive actions.