Chapter 17 - Somatic (Psych) EAQ's

The nurse is assessing four patients. Based on the statements made by the patients, which patient most likely has somatic symptom disorder? 1 "I've spent months dealing with the headaches and stomachaches that I get from my stress." 2 "I am always worried that I will get cancer, so I get blood tests and imaging tests done as often as I can." 3 "I've had to go from one doctor to another because none of them believe me when I tell them that I'm sick." 4 "Sometimes I feel like my body goes numb, and it's hard for me to move when I'm really stressed. My vision starts to get blurred, too."

1 "I've spent months dealing with the headaches and stomachaches that I get from my stress." When patients have somatic symptom disorder, they experience symptoms that cause distress and disrupt daily life. They also may spend an excessive amount of time and energy devoted to dealing with the symptoms that they need to manage, caused by the stress. Spending months dealing with headaches and stomachaches tells the nurse that the patient may have somatic stress disorder. The patient who is afraid of getting an illness more likely has illness anxiety disorder. The patient who experiences numbness or paralysis in the body with blurred vision more likely has conversion disorder. The patient who goes from one doctor to another because no one believes the patient is ill may have factitious disorder. Text Reference - p. 316

Which intervention should the case manager implement for a patient demonstrating somatization-associated behaviors? Select all that apply. 1 Being a contact resource for the patient 2 Liaising between patient and primary health care provider 3 Educating the patient to the cost of unnecessary diagnostic testing 4 Identifying for the primary health care provider which diagnostics are necessary 5 Acting as the patient's advocate so that the patient feels that someone is "in charge"

1 Being a contact resource for the patient 2 Liaising between patient and primary health care provider 5 Acting as the patient's advocate so that the patient feels that someone is "in charge" "Doctor shopping" is common among patients with somatization disorders, who hope to establish a physical basis for their distress. Repeated computed tomographic scans, magnetic resonance images, and other diagnostic tests often are documented in the medical record. Case management can help limit health care costs associated with such visits. The case manager can recommend to the primary health care provider that the patient be scheduled for brief appointments every four to six weeks at set times, rather than on demand, and that laboratory tests be avoided unless they are absolutely necessary. The patient who establishes a relationship with the case manager often feels less anxiety because the patient has someone to contact and knows that someone is "in charge." It is not the case manager's role to determine which diagnostics are necessary. Patient education regarding the condition is not a focus of the nurse manager. Text Reference - p. 326

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

1 Cancer Cancer is related to long-standing stress and the diagnosis can be related to feelings of hopelessness. Peptic ulcers are more related to increased social pressure and grief. Essential hypertension can be seen in traumatic life situations or a stressful job. Coronary heart disease is more related to sudden stress and often precipitated by long periods of frustration and disappointment. Text Reference - p. 318, Table 17.1

A patient has had on-and-off stomach pain and a feeling of weakness for the last two days. The patient suspects colon cancer and gives an exaggerated description of the symptoms. Extensive investigation does not show any serious illness. What challenges does the nurse face when caring for this patient? Select all that apply. 1 Care of this patient takes a lot of time and effort. 2 Organic changes often play a role in the disorder. 3 Absence of a diagnosis makes the treatment difficult. 4 The patient may feel that the treatment is inadequate. 5 Misdiagnosis is common when a patient has such complaints.

1 Care of this patient takes a lot of time and effort. 4 The patient may feel that the treatment is inadequate. 5 Misdiagnosis is common when a patient has such complaints. Patients with somatic disorders fear the worst about their health. They come with many reported symptoms, but the biological causes are detected in only 26 percent of the patients. As the primary health care provider is unable to provide a clear diagnosis, the patients may feel the assessment and treatment are inadequate. Patients with such somatic disorders have longer visits than patients with straightforward symptoms. The primary health care provider is often dissatisfied with the clinical encounter and may misdiagnose somatic disorders. This makes it difficult to care for the patient. The symptoms are not based on any physical cause, and there are no physical or organic changes in the body in most of the cases. The assessment and planning procedure for somatic disorder is different from that of straightforward illnesses. There are guidelines to follow for taking care of such patients though these may be different from treatment of patients with a clear diagnosis. Text Reference - pp. 316-317

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

1 Factitious disorder Factitious disorder is highly treatment-resistant. This is because the patient is consciously pretending or exaggerating illness for material gains. Due to pretense, it is highly treatment-resistant as the symptoms are deliberately fabricated. Conversion disorder usually has an acute onset and may resolve quickly. The course of illness anxiety disorder is chronic. It is also marked by relapses. Fifty percent of the patients suffering from illness anxiety disorder improve. The course of somatic symptom disorder can be chronic and relapsing in nature. It is not treatment-resistant though. Text Reference - p. 327

Which statement concerning somatic symptom disorder is true? Select all that apply. 1 Patients typically experience high levels of functional impairment. 2 Chest pain, dizziness, and headache commonly are 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 patient is a factor in the diagnosis process.

1 Patients typically experience high levels of functional impairment. 2 Chest pain, dizziness, and headache commonly are reported symptoms. 4 Medical and psychosocial histories are vital to achieving an accurate diagnosis. 5 The health care provider's perception of the patient is a factor in the diagnosis process. 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. Patients' suffering is authentic and they typically experience a high level of functional impairment. Somatic symptom disorder is difficult to distinguish from physical disorders with organic causes, and the patient's history is extremely important for accurate diagnosis. 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. 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. Text Reference - pp. 316-317

A nurse is caring for patients with somatic symptoms. Which strategies does the nurse incorporate in the plan of care to facilitate effective recovery? Select all that apply. 1 Provide continuity of care. 2 Avoid physical examination. 3 Set reasonable treatment goals. 4 Conduct a physical examination each time. 5 Conduct laboratory investigations related to each symptom.

1 Provide continuity of care. 3 Set reasonable treatment goals. 4 Conduct a physical examination each time. Providing continuity of care is essential for ensuring effective patient relationships and treatment. Setting reasonable treatment goals in spite of ongoing symptoms helps the patient to be positive about treatment and recovery. Physical examination should always be conducted to evaluate the symptoms and for patient satisfaction. Laboratory tests and procedures should be ordered only when necessary. Text Reference - p. 325

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

1 The patient demands specific treatments. 4 The patient describes the complaints dramatically. 5 The patient is unwilling to interact with the family. A patient with factitious disorder can be demanding about specific treatments and procedures. To gain more attention, the complaints are exaggerated and described dramatically by the patient. As the illness is factitious, the patient is often not willing to interact with the nurse or the family members. The patient is often demanding and may get angry if the demands are not met; hence it is not likely that the patient cooperates with the health care team. The patient may often feel worse after negative test results, and new complaints may appear as the patient has the goal of assuming a sick role in factitious disorder. Text Reference - p. 327

The nurse is caring for a 45-year-old patient who presents with nonassertive behavior and speaks poorly about him- or herself. When discussing the patient's background and health history, the patient consistently seeks the nurse's reassurance. Based on the nurse's nursing diagnosis as "chronic low self-esteem," what is the best outcome the nurse should plan for this patient? 1 Verbalizes positive sense of self; maintains strong decision-making abilities 2 Displays ability to stand up for one's self; finds more positive coping patterns 3 Finds more positive social system to support sense of self; describes self as successful 4 Identifies support system to assist with self-esteem issues; recognizes ways of being more successful

1 Verbalizes positive sense of self; maintains strong decision-making abilities For the patient with nonassertive behavior who displays negative self-talk and has a nursing diagnosis of chronic low self-esteem, the best outcome is for the patient to verbalize a positive sense of self and maintain strong decision-making abilities. Identifying a support system, recognizing ways of being successful, finding more positive social systems, describing self as successful, displaying the ability to stand up for oneself, and finding more positive coping patterns are outcomes that can be planned once the patient has first achieved a positive sense of self and strong decision-making. Text Reference - p. 324

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

2 "Since getting a divorce, I've had crushing chest pain, but I don't think it really means anything." In conversion disorder, the individual may be expressing a forbidden thought or wish by converting it into physical symptoms that are more appropriate and acceptable, and which also provide sympathy, care, and attention from others. Individuals exhibit one or more symptoms that affect voluntary motor or sensory function. These symptoms appear to be related to a neurologic or general medical condition but are not caused by a general medical condition, or the direct effects of a substance, or a culturally sanctioned behavior or experience. The symptom is not intentionally produced and is not limited to pain or sexual dysfunction. The conversion symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Common symptoms are blindness, paralysis, deafness, seizures, anesthesia, or abnormal motor movements Text Reference - p. 317

Which patient is most likely to initially demonstrate behaviors suggesting a somatic disorder? 1 13-year-old male 2 23-year-old female 3 33-year-old male 4 43-year-old female

2 23-year-old female The predominance of women with somatization is significant. It has been proposed that women are more aware of their bodily sensations, have different health-seeking behaviors when faced with physical and psychological distress, and use more health care services than men. In particular, young women aged 16 to 25 are more likely to receive a somatic diagnosis than men or older individuals. Text Reference - p. 317

What techniques are offered by the Nursing Interventions Classification (NIC) to care for patients with somatization 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 The Nursing Interventions Classification (NIC) offers effective coping strategies to help the overall functioning of a patient with somatization disorder. 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. This reduces 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 patient verify that the symptoms are not real is not needed. The strategies are developed to address the root psychiatric problem so that the symptoms do not exist at all. Patients suffering from somatization disorders do not need professional skill development training. Rather, the nurses who care for patients with somatization disorders need to develop professional skills to be able to care for such patients. Text Reference - p. 325

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

2 Cancer Studies in recent years have contributed to the growing body of evidence indicating a link between mental disorders and medical conditions, such as cardiovascular disease and cancer. Text Reference - pp. 317-318

A patient suddenly develops paralysis in the bilateral lower extremities. The neurologist finds no neurological disorder. What does the nurse suspect the patient to be suffering from? 1 Factitious disorder 2 Conversion disorder 3 Illness anxiety disorder 4 Somatic symptom disorder

2 Conversion disorder The patient 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 patient of having conversion disorder. Factitious disorder is a deliberate act of pretending to be ill. Patients with such disorders consciously fabricate symptoms or cause self-inflicted injuries in order to be treated as a "patient." Illness anxiety disorder is obsessive thought about illness. Such patients interpret even normal bodily changes as signs and symptoms of serious illnesses. In somatic symptom disorder, the patient's suffering is real. The patient actually experiences a high level of functional impairment and may complain of chest pain, shortness of breath, back pain, insomnia, and abdominal pain. Biological causes of these symptoms are identified only in a few patients.

Which diagnoses are included among the somatic disorders? Select all that apply. 1 Gender dysphoria 2 Factitious disorder 3 Frotteuristic disorder 4 Somatic symptom disorder (SSD) 5 Illness anxiety disorder (hypochondriasis) 6 Psychological factors affecting medical condition 7 Conversion disorder (functional neurological disorder)

2 Factitious disorder 4 Somatic symptom disorder (SSD) 5 Illness anxiety disorder (hypochondriasis) 6 Psychological factors affecting medical condition 7 Conversion disorder (functional neurological disorder) The somatic disorders include SSD, illness anxiety disorder (previously hypochondriasis), conversion disorder (functional neurological disorder), psychological factors affecting medical condition, and factitious disorder. Gender dysphoria is a problem characterized by feelings of unease about one's maleness or femaleness. Rubbing or touching a nonconsenting person characterizes frotteuristic disorder, which is one of the paraphilic disorders. Text Reference - p. 316

Which interventions does the nurse use when caring for a patient demonstrating the inability to provide effective self-care? 1 Initially sets only minimal self-care expectations for the patient 2 Identifies the patient's highest level of self-care and states reasonable expectations to the patient 3 Identifies the level of self-care the patient is willing to perform and sets expectations accordingly 4 Attends to all self-care needs until the patient indicates a willingness to perform care independently

2 Identifies the patient's highest level of self-care and states reasonable expectations to the patient In general, interventions involve the use of a matter-of-fact approach to support the highest level of self-care the patient can perform. Setting only minimal self care expectations, attending to the needs of the patient for them, or only performing up to the expectations the patient is willing to do is not supporting a positive outcome for the patient. Text Reference - p. 325

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

2 Loneliness The patient's chronic symptoms have alienated family and friends, resulting in loneliness. Anxiety, body image disturbance, and impaired social interaction also may apply to this patient, but the focal issue is loneliness. Text Reference - p. 323

Which statement concerning conversion disorder is true? Select all that apply. 1 A commonly reported symptom is chronic diarrhea. 2 Patients tend to experience symptom remission as they age. 3 Childhood abuse plays a role in the development of the disorder. 4 Comorbid conditions include posttraumatic stress disorder (PTSD). 5 Conversion disorders can be the exaggeration of existing medical conditions.

2 Patients tend to experience symptom remission as they age. 3 Childhood abuse plays a role in the development of the disorder. 4 Comorbid conditions include posttraumatic stress disorder (PTSD). 5 Conversion disorders can be the exaggeration of existing medical conditions. Childhood physical or sexual abuse is common in patients with conversion disorder, and comorbid psychiatric conditions include depression, anxiety, posttraumatic stress disorder, other somatic disorders, and personality disorders. There are also cases in which a comorbid medical or neurologic condition exists, and the conversion disorder is an exaggeration of the original problem. Conversion disorder is marked by the presence of deficits in voluntary motor or sensory functions. Chronic diarrhea is not a characteristic sign of this disorder. Text Reference - p. 317

The nurse is caring for a patient from Africa with a somatic symptom disorder. Which finding does the nurse expect from this patient? 1 Denying having any symptoms 2 Reporting the sensation of ants under the skin 3 Telling the nurse that the symptoms are food-related 4 Explaining that the symptoms are related to a spell that was cast on the patient

2 Reporting the sensation of ants under the skin It is important to understand cultural implications for patients with somatic symptom disorders. Burning hands and feet or the sensation of ants under the skin or worms in the head are common in patients with somatic symptom disorders who are from Africa and southern Asia. The nurse knows that it is less likely that this patient will deny having any symptoms, say the symptoms are food-related, or attribute the symptoms to a spell. Text Reference - p. 320

A nurse assesses a patient suspected to have somatic symptom disorder. Which findings support the diagnosis? Select all that apply. 1 The patient is currently 55 years old. 2 The patient says, "None of my doctors listen to me." 3 The patient names six current health care providers providing care. 4 The patient complains of abdominal pain and swollen lymph nodes. 5 The patient complains of being unable to care for children because of headaches.

2 The patient says, "None of my doctors listen to me." 3 The patient names six current health care providers providing care. 4 The patient complains of abdominal pain and swollen lymph nodes. 5 The patient complains of being unable to care for children because of headaches. 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. The predominance of women is significant, particularly younger women. There may be a high level of medical care use, which rarely alleviates the patient's concerns. The most common symptoms are chest pain, fatigue, dizziness, headache, swelling, back pain, shortness of breath, insomnia, abdominal pain, and numbness. Some patients feel that their medical assessment and treatment have been inadequate, leaving them feeling discounted or misunderstood. Text Reference - pp. 316-317

What is the primary difference between a factitious disorder and other somatic disorders? 1 Factitious disorders are always self-directed. 2 Factitious disorders have their origins in depression and anxiety. 3 Factitious disorders have a symptomology that actually is controlled by the patient. 4 Factitious disorders respond well to confrontation as a primary therapeutic technique.

3 Factitious disorders have a symptomology that actually is controlled by the patient. Factitious disorders, in contrast to other somatic disorders, are under conscious control. Text Reference - p. 327

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

3 Illness anxiety disorder Patients with illness anxiety disorder experience stress or extreme worry and fear about the possibility of having a disease. Hence, with stress management the fear and worry is brought under control. Factitious disorder can be resistant to treatment and may require management rather than cure or legal interventions. Conversion disorder can be managed with behavior therapy, hypnosis, or antianxiety drugs. Somatic symptom disorder can be managed with cognitive behavioral therapy. Text Reference - p. 327, Table 17.5

Which disorder is characterized by the patient's misinterpretation of physical sensations or feelings? 1 Somatic disorder 2 Factitious disorder 3 Illness anxiety disorder 4 Conversion disorder

3 Illness anxiety disorder 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 patient recognizes that his or her fears are unrealistic. Text Reference - p. 317

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

3 Ineffective coping Some patients use somatization as a way of coping with anxiety; therefore, the most appropriate nursing diagnosis is ineffective coping. Chronic sorrow, ineffective denial, and deficient knowledge also may apply, but the primary issue relates to the patient's coping problem. Text Reference - p. 324, Table 17.3

During the care of a patient with somatic symptom disorder, the nurse tries to build an effective relationship with the patient. How does this help in the treatment process? 1 Decreases the medical tests and procedures for the illness 2 Encourages the patient's beliefs about the origin of the symptoms 3 Reduces the patient's tendency to go from one caregiver to another 4 Helps the patient to derive secondary gains through illness behaviors

3 Reduces the patient's tendency to go from one caregiver to another A good therapeutic relationship between the nurse and the patient reduces the patient's tendency to go from one caregiver to another. This helps in the success of the plan of care. 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 the patient has met with. This can reduce medical tests and procedures. The nurse helps the patient to get needs met so that the patient does not need to behave ill. The nurse should not encourage the patient's beliefs. The patient has a resistance to understanding that there is no physical cause for the symptoms. A good therapeutic relationship with the nurse helps in reducing this resistance. Though the nurse may help by caring for the patient, he or she does not help the patient to derive secondary benefits through illness behaviors. Text Reference - pp. 323-324

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

3 The disorder may lead to harmful medical procedures. Munchausen by proxy disorder results in unnecessary medical visits. It may sometimes cause serious complications or sepsis that leads to harmful medical procedures. The patient does not cause harm to self. The harm is caused by a caregiver to the vulnerable and dependent patient. The family does not feign illness of the patient to receive insurance money or other rewards. They do it to attract attention and cause excitement. The caregiver may also do this so that the dependent remains a "patient" and the relationship of the dependent with the primary health care providers is maintained. Legal interventions may be necessary depending on the severity of the cases because some cases may become fatal due to such feigning. Text Reference - pp. 327-328

Which statement best defines somatization? 1 The holistic approach to managing stress 2 The psychological and behavioral response to stress 3 The expression of stress through physical symptoms 4 The conversion of stress into a physical and emotional form

3 The expression of stress through physical symptoms Somatization is the expression of stress through physical symptoms. Conversion disorder describes the conversion of stress into both a physical and emotional form. Somatization is not just psychological and behavioral; it has a physical component. There are holistic approaches to managing stress, but this is not the definition of somatization. Text Reference - p. 316

After reviewing the following information, which activity will the nursing director of a neighborhood clinic implement to best address the facility's evidence-based practice needs? 1 Educating the community about 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 patients who have identified themselves as being victims of childhood abuse to be interviewed for a research project. 4 Advocating for the admission interviews of patients reporting somatic symptoms to contain questions concerning childhood traumas, including abuse.

4 Advocating for the admission interviews of patients reporting somatic symptoms to contain questions concerning childhood traumas, including abuse. Text Reference - pp. 319-320

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

4 Factitious disorder A crisscrossed or "railroad-track" abdomen is commonly seen in a patient with factitious disorder. This happens due to scars from numerous exploratory surgeries. Patients with factitious disorder often have several invasive investigations done to investigate a proper cause of the symptoms they experience. Diarrhea, constipation, and anorexia are common symptoms often reported by patients with somatization disorders, but they do not have any physical causes behind them. Text Reference - p. 327

A nurse is assessing a patient with a somatic disorder. Which diagnosis does the nurse consider when the patient is unable to meet family responsibilities? 1 Powerlessness 2 Risk for suicide 3 Risk of loneliness 4 Ineffective coping

4 Ineffective coping Ineffective coping is observed as the patient is unable to manage and meet the family's needs. Powerlessness is seen when a patient feels useless and has a negative self-evaluation. Risk of suicide is considered if the patient has chronic pain and feels useless and unwanted. It is not an appropriate diagnosis when the patient is unable to meet family responsibilities. Risk of loneliness is seen when the patient lacks support from family or friends. Text Reference - p. 324, Table 17.3

The nurse is caring for a patient with somatic disorder. While assessing the patient, the nurse finds that the patient is not able to meet occupational, family, or social responsibilities due to somatic symptoms. What is the most appropriate nursing diagnosis in such a case? 1 Powerlessness 2 Risk of suicide 3 Risk of loneliness 4 Ineffective coping

4 Ineffective coping The nursing diagnosis is ineffective coping as the patient is unable to manage and meet his or her occupational, family, or social needs. Powerlessness is seen when a patient feels helpless and expresses frustration over his or her inability to live a normal life. Such a patient often has a negative self-evaluation. Risk of suicide is considered if the patient has chronic pain and feels useless and unwanted to such an extent that the patient has no desire to live. Risk of loneliness is seen when the patient lacks support from family or friends. Text Reference - p. 324, Table 17.3

Which intervention demonstrates an understanding of the recommendations when working with patients exhibiting somatic disorder behaviors? Select all that apply. 1 Scheduling the patient for short visits every five weeks. 2 Arranging for uninterrupted therapy when the patient relocates. 3 Recognizing that the patient's symptoms are real to him or her. 4 Minimizing reinforcement of the patient's fears by avoiding routine physicals. 5 Evaluating the patient's plan of care frequently for the reasonable goals directed towards maintaining function.

1 Scheduling the patient for short visits every five weeks. 2 Arranging for uninterrupted therapy when the patient relocates. 3 Recognizing that the patient's symptoms are real to him or her. 5 Evaluating the patient's plan of care frequently for the reasonable goals directed towards maintaining function. General recommendations for health care providers in working with patients with somatic symptoms include: provide continuity of care, avoid unnecessary tests and procedures, provide frequent, brief, and regular office visits, always conduct a physical examination, avoid making disparaging comments such as "your symptoms are all in your head," and set reasonable therapeutic goals, such as maintaining function despite ongoing pain. Text Reference - p. 325

What does the mental health nurse identify as a symptom of illness anxiety disorder? Select all that apply. 1 Seeking frequent plastic surgeries for imagined defects 2 Reporting a vague pain to obtain prescription medication 3 Fainting attack and sweating after fasting throughout the day 4 Nausea and vomiting within 24 hours prior to each class test 5 Reporting symptoms of multiple illnesses and bodily complaints 6 Hemiparesis of the right arm and left leg after a fight with spouse

1 Seeking frequent plastic surgeries for imagined defects 4 Nausea and vomiting within 24 hours prior to each class test Patients with illness anxiety disorder are often obsessed with the idea that they have a serious illness. The patient seeks frequent plastic surgeries for nonexistent defects because the patient is quite obsessed with thoughts about illness. The symptoms of illness anxiety disorder are augmented during times of stress. The patient having nausea and vomiting prior to a class test indicates that the symptoms have increased at a time of stress. Hemiparesis is a neurological symptom. If it has resulted following a fight with the spouse but cannot be explained by a neurological diagnosis, it is a conversion disorder. By fasting throughout the day, the patient causes self-inflicted hypoglycemia, which may result in fainting attack and sweating. This is a factitious disorder. Reporting a vague pain to obtain benefit is a conscious act to deceive and is identified as an act of malingering. Reporting symptoms of multiple illnesses and bodily or somatic symptoms is a characteristic feature of somatic symptom disorder. Text Reference - p. 317

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

1 The patient may show neurologic symptoms. Patients with conversion disorder show neurologic symptoms in the absence of an organic cause. A patient with conversion disorder does not have a psychiatric or neurologic disorder, as the patient is channeling emotional conflicts into physical symptoms. He or she may have associated psychiatric conditions like anxiety, depression, or posttraumatic stress disorder that may exaggerate the condition. Text Reference - p. 317

A patient describes the nature of recurrent headache pain. Which comment is most likely if the patient is experiencing tension headaches? 1 "I have more headaches when I eat chocolate." 2 "The pain almost always starts around supper time." 3 "I have more headaches in the spring and fall seasons." 4 "I see flashing lights above my head just before the headache starts."

2 "The pain almost always starts around supper time." Tension headache occurs in 80% of population when under stress and usually begins at end of workday or early evening. Headaches when eating chocolate, in the spring and fall seasons, and seeing flashing lights before a headache are more related to migraine or cluster headaches. Text Reference - p. 318, Table 17.1

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

2 Ineffective coping Ineffective coping is a priority in this population. Other potential nursing diagnoses include anxiety, risk for loneliness, powerlessness, hopelessness, social isolation, pain, altered family processes, and risk for suicide. Self-care deficit, deficient fluid volume, and delayed growth and development are not appropriate nursing diagnoses for somatoform disorders. Text Reference - p. 323

A nurse is developing a care plan for a patient with cancer. Which holistic therapies does the nurse apply to support medical management? Select all that apply. 1 Biofeedback 2 Visualization 3 Massage therapy 4 Type A modification 5 Psychological counseling

2 Visualization 3 Massage therapy 5 Psychological counseling Visualization helps cancer patients relax and create positivity about treatment and cure. Massage therapy helps in relieving anxiety and depression and reducing physical and mental stress. Psychological counseling helps in opening up the mind and reducing anxiety and stress. Biofeedback helps to alter gastric acidity and is more appropriate for managing peptic ulcers, not cancer. Type A modification helps to reduce stress in type A personalities and is more helpful in managing coronary heart disease, not cancer patients. Text Reference - p. 318, Table 17

The nurse is caring for an adult patient with somatic symptom disorder who reports frequent headaches and stomachaches. Although the health provider's physical assessment of the patient did not reveal any gastrointestinal issues, the patient is convinced the doctor is wrong. Which is the best response by the nurse? 1 "The stomachache is not real; it is all in your head." 2 "I can call the healthcare provider in here to reassess your stomach." 3 "I understand that your stomach may be hurting; it must be frustrating to have that sensation." 4 "For right now, try to imagine that your stomach does not hurt so that you can finish eating your breakfast."

3 "I understand that your stomach may be hurting; it must be frustrating to have that sensation." Patients with somatic symptom disorder may report physical symptoms, such as stomachaches, and may believe that there is something wrong with them, even if physical assessments prove otherwise. Although it can be frustrating for the nurse, the nurse must always believe that the patient's symptoms are real and treat the patient as such. Therefore, empathizing with the patient is the best response by the nurse. It is not appropriate or therapeutic to tell the patient that the symptoms are not real. It is not necessary to call the healthcare provider for another assessment. It is unrealistic to push the patient to eat when he or she is experiencing pain. Text Reference - p. 322

The nurse is caring for a patient who was recently diagnosed with somatic symptom disorder. The patient asks the nurse about possible pharmacological interventions. Which is the best response by the nurse? 1 "Pharmacologic interventions are not effective." 2 "There are several medications that can be used to treat somatic symptom disorder." 3 "Some medications can be used off-label to help manage the symptoms of the disorder." 4 "Benzodiazepines can be used to help with anxiety, and these are self-administered."

3 "Some medications can be used off-label to help manage the symptoms of the disorder." There is still no evidence that specifies that medications are beneficial and effective specifically for treating somatic symptom disorder, but some medications are used off-label to help manage the symptoms. It is incorrect to tell the patient that there are several medications to treat the disorder. It is incorrect to say that pharmacologic interventions are not effective, as some can be effective for managing symptoms. Some benzodiazepines are self-administered, but oftentimes the nurse will administer them as well. Text Reference - p. 325

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

3 Conveying an interest in the patient rather than in the symptoms When the nurse focuses on the patient rather than on the symptoms, the patient's self-worth and coping skills are enhanced. Text Reference - p. 324

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

3 Dependence on medication Many patients with somatoform disorder have received prescription medication for anxiety or pain relief and may have developed dependence. The nurse should assess not only for what the patient has taken, but also for amounts and length of time over which the drugs have been prescribed. Text Reference - p. 321

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

3 Illness anxiety disorder Illness anxiety disorder is an exaggeration of a negligible health symptom. The minor changes experienced physically by the patient at a stressful time are magnified into a serious illness. In the case of a factitious disorder, the patient consciously pretends that he or she is in need of medical help. The patient does this to gain something or to attain the status of a "patient." Patients with conversion disorder have symptoms of neurological disorders, but examination by a neurologist often does not reveal any neurological diagnosis. In cases of somatic symptom disorder, the distressing symptoms and health concerns that the patient experiences are baseless, with no physical findings or medical diagnosis. Text Reference - p. 317

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

4 "Cognitive behavioral therapy has been shown to consistently provide the best outcome for these types of disorders." Cognitive behavioral therapy (CBT) is the most consistently supported treatment for the full spectrum of somatic disorders. A combination of antianxiety and antidepressant therapy, aversion therapy, and emulating desired behaviors are incorrect and do not describe the most used and effective therapy for this disorder. Text Reference - p. 326

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

4 "Your emotional distress is being expressed as a physical symptom." Conversion disorder is attributed to the channeling of emotional conflicts or stressors into physical symptoms. Telling the patient his or her brain is "confused" is unprofessional and does not give any useful education. Symptoms of conversion disorder are not within the patient's voluntary control. Being overly anxious about having a severe illness describes illness anxiety disorder. Text Reference - p. 317

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

4 People in southern Asia feel ants under the skin more often than those in North America. The type and frequency of somatic symptoms may be different in different cultures. People in southern Asia and Africa may complain of a sensation of ants under their skin more often than those in North America. Men in the United States are rarely seen to have somatization disorders. It is more common in Greek and Puerto Rican men. West Indians (Caribbean) believe somatic symptoms are due to chronic overwork and irregular lifestyles rather than due to suppressed anger or rage. People in Africa express a sensation of worms in the head more often than people in North America. Text Reference - p. 320

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

4 Performing activities of daily living unassisted Somatic symptoms are reinforced by situations in which there is some sort of "payoff" for the patient: attention, financial gain, avoidance of unpleasant situations, or getting dependent needs met. Performing activities of daily living unassisted would have no payoff of the sort mentioned. Text Reference - p. 316

Which disorder places the patient at highest risk for developing a coexisting substance abuse disorder? 1 Factitious disorder 2 Conversion disorder 3 Illness anxiety disorder 4 Somatoform pain disorder

4 Somatoform pain disorder Patients with pain disorder may use alcohol or other central nervous system depressants or anxiolytic drugs to self-medicate. Text Reference - p. 316