Chapter 20: dissociative and somatic disorders

A psychiatric client looks at cotton swabs on the nursing table and says, "These cotton swabs are as big as clouds." Which condition might be present in this client? 1. Factitious disorder 2. Derealization disorder 3. Illness anxiety disorder 4. Functional neurological symptom disorder

2. derealization disorder

After a traumatic event a client reports paralysis in his left arm. The laboratory reports of the client indicate that there is no underlying organic pathology. Which disorder might the nurse suspect in this client? 1. Factious disorder 2. Conversion disorder 3. Illness anxiety disorder 4. Somatic symptom disorder

2. conversion disorder

What are the symptoms that can be observed in the client diagnosed with depersonalization? 1. Unreality, detachment, and distorted sense of time 2. Altered behavior, consciousness, and memory 3. Inability to recall important autobiographical information 4. Falsification of physical or psychological signs or symptoms

1. unreality, detachment, and distorted sense of time

A client who recently had a hysterectomy says, "I can feel my baby is moving around inside my womb." What does this behavior of the client indicate? 1. Abreaction 2. Integration 3. Pseudocyesis 4. Dissociative fugue

3. pseudocyesis

The RN is taking care of a client with a conversion disorder. The client presents with an unusual inability to produce a voice. Which of the following describes this symptom? 1. Anosmia 2. Aphonia 3. Psychogenic seizure 4. Pseudocyesis

2. aphonia

Which therapy helps to free a client who has depersonalization-derealization disorder from distorted thoughts? 1. Group therapy 2. Cognitive-behavior psychotherapy(CBT) 3. Intensive, long-term psychotherapy 4. Analytical oriented insight psychotherapy

2. cognitive-behavior psychotherapy

The RN is caring for a client who has been diagnosed with dissociative identity disorder. Which of the following are treatment goals for this disorder? 1. Achievement of integration 2. Removal of the individual from the stressful situation 3. Use of techniques of persuasion and free association 4. Provision of analytically-oriented insight therapy

1. achievement of integration

What are the predisposing factors of somatic symptom disorder? Select all that apply. 1. Decreased levels of serotonin 2. Increased levels of endorphins 3. Increased levels of norepinephrine 4. Impaired information processing center of brain 5. Presence of somatic symptom disorder in first-degree relatives of the client

1. decreased levels of serotonin 4. impaired information processing center of brain 5. presence of somatic symptom disorder in first-degree relatives of the client

The nurse is caring for a client who has somatic symptom disorder. The primary health-care provider plans a treatment to attain tertiary gain. Which procedure would the nurse expect to be performed in the client? 1. Explaining the process and stages of grieving to the client 2. Hypnotizing the client to help in regaining the memory 3. Shifting the focus from family discord to concern for the client 4. Helping the subpersonalities understand that integration would unify them all into one

3. shifting the focus from family discord to concern for the client

What is the purpose of prescribing amobarbital to a client with dissociative identity disorder? 1. This medication helps the client remember forgotten events. 2. This medication helps the client to sleep. 3. This medication helps the client control anxiety. 4. This medication helps the client obtain relief from seizures.

1. this medication helps the client remember forgotten events

The nurse is caring for a client who is scheduled for hypnosis therapy. Which drug would facilitate this therapy? 1. Sertraline 2. Venlafaxine 3. Desipramine 4. Sodium amobarbital

4. sodium amobarbital

Which action of the client makes the nurse suspect factitious disorder in the client? 1. Self-induction of injury 2. Impressionistic thought and speech 3. Repeated checks of his or her body for signs of illness 4. High level of anxiety about health or symptoms

1. self-induction of injury

Which characteristic applies to a client with dissociative fugue? 1. Discontinuity in the sense of self 2. Unexpected travel or bewildered wandering to another location 3. Existence of two or more personalities 4. Detachment with body or surroundings

2. unexpected travel or bewildered wandering to another location

A client is diagnosed with disturbed personal identity in which one of the personalities is suicidal. Which nursing intervention would protect the client from self-harm? 1. Seeking assistance from a strong-willed personality 2. Helping the client to understand the existence of subpersonalities 3. Helping the client to identify stressful situations 4. Assisting the subpersonalities to understand that their existence will not be destroyed

1. seeking assistance from a strong-willed personality

What are the diagnostic criteria of a client with functional neurological symptom disorder? Select all that apply. 1. Seizures 2. Paralysis 3. Blindness 4. Seductiveness 5. Impressionistic speech

1. seizures 2. paralysis 3. blindness

A client who is having heartburn is experiencing a fear of having heart attack. Which medication would the nurse expect to be beneficial in this client? 1. Duloxetine 2. Amobarbital 3. Phenytoin 4. Clonazepam

1. Duloxetine

Which statement of the client is compatible with illness anxiety disorder? 1. "I have a sore on my arm. I think I have skin cancer." 2. "I don't remember anything about the accident." 3. "I don't know why I am taken to a psychiatric unit. I am mentally alright." 4. "I cannot do anything by myself. I always need someone's help."

1. I have a sore on my arm. I think I have skin cancer

What is intensive, long-term psychotherapy directed toward in a client with dissociative identity disorder? 1. Ability to integrate all the feelings, experiences, memories, and skills that were previously in command of all the various personalities 2. Ability to confront all distorted thoughts 3. Ability to re-experience the abuse with feeling 4. Ability to interpret bodily sensations correctly

1. ability to integrate all the feelings, experiences, memories, and skills that were previously in command of all the various personalities

While collecting data on a client who is a victim of childhood sexual abuse, the nurse finds that the client has various personalities dominating at different points of time. What would be the primary nursing intervention in this client? 1. Developing a trusting relationship with the original personality 2. Helping the client to understand the existence of other subpersonalities 3. Helping subpersonalities understand that their being would not be destroyed 4. Helping the client to identify stressful situations that precipitate transition of personalities

1. developing a trusting relationship with the original personality

The wife of a client complains that her husband has been found wandering far from home and sometimes he is unable to recall information about himself. What would the nurse suspect as a diagnosis for this client? 1. Dissociative fugue 2. Conversion disorder 3. Somatic symptom disorder 4. Dissociative identity disorder

1. dissociative fatigue

What is the goal of behavior therapy? 1. Establishing self-sufficiency and independence in the client 2. Providing social support and interaction to the client 3. Achieving practical solutions for the client's difficulties 4. Challenging feelings of unreality in the client

1. establishing self-sufficiency and independence in the client

hich disorders are categorized as somatic symptom disorders? Select all that apply. 1. Factitious disorder 2. Conversion disorder 3. Dissociative amnesia 4. Illness anxiety disorder 5. Depersonalization-derealization disorder

1. factitious disorder 2. conversion disorder 4. illness anxiety disorder

Which nursing intervention will the nurse provide to neutralize the anxiety and maladaptive behavior of a client with somatic symptom disorder? 1. Fulfills the client's most urgent dependency needs 2. Helps the client to identify the ways to achieve recognition from others 3. Provides pain medication to the client as prescribed 4. Accepts that the physical complaint is real, even though it is inaccurate

1. fulfills the clients most urgent dependency needs

A client with disturbed personal identity shows symptoms of depression, unresolved grief, and self-blame. Which nursing intervention will help to ensure safety of this client? 1. Guarding the client against self-harm 2. Helping client to identify stressors 3. Exposing the client to past experiences 4. Helping the client to understand the existence of subpersonalities

1. guarding the client against self-harm

Which therapy helps the alter personalities to emerge in the client with dissociation identity disorder? 1. Hypnotherapy 2. Psychotherapy 3. Behavior therapy 4. Integration therapy

1. hypnotherapy

The nurse is reviewing the nursing care plan prepared for a client with illness anxiety disorder. Which intervention by the nurse will help to prevent anxiety and fear in the client during future stressful events? 1. Including role-play in the client's plan for dealing with anxiety 2. Decreasing the time spent on discussing the physical concerns 3. Conveying empathy to the client's physical concerns 4. Identifying the secondary gains provided by the physical symptoms

1. including role-play in the client's plan for dealing with anxiety

Which statement made by the client's family may indicate the client of having dissociative amnesia with dissociative fugue? 1. "My son assumed a new identity after the accident." 2. "My son is intentionally harming himself." 3. "My son is disoriented and detached from the environment." 4. "My son developed negative feelings about his capabilities."

1. my son assumed a new identity after the accident

What outcome would the nurse expect after providing an appropriate intervention to a client with somatic symptom disorder? 1. The client demonstrates full recovery from the previous loss of physical function. 2. The client verbalizes the existence of multiple personalities within himself or herself. 3. The client is able to perceive stimuli correctly and maintains a sense of reality during stressful situations. 4. The client verbalizes the correlation between stressful situations and the onset of depersonalization behaviors.

1. the client demonstrates full recovery from the previous loss of physical function

A client is diagnosed with somatic symptom disorder. Which outcome indicates the effectiveness of treatment? 1. The client verbalizes relief from pain. 2. The client is free of from complaints of physical disability. 3. The client interprets bodily sensations rationally. 4. The client is able to recall events associated with traumatic situations.

1. the client verbalizes relief from pain

A client whose husband died 10 years ago due to myocardial infarction has a preoccupation with having heart attack and often thinks she is having one. What would be the major goal of the treatment for this client? 1. The client will interpret bodily sensations correctly. 2. The client will verbalize that fears associated with bodily tensions are irrational. 3. The client will demonstrate recovery of altered functions. 4. The client will be able to intervene before the exacerbation of physical symptoms.

1. the client will interpret bodily sensation correctly

What is the goal of group psychotherapy in a client with dissociative amnesia? 1. To assist the client in integrating memories into his or her conscious state 2. To help the client confront distorted thoughts 3. To help the client learn to interpret bodily sensations correctly 4. To help the client challenge the feelings of reality

1. to assist the client in integrating memories into his or her conscious state

A client is diagnosed with dissociative identity disorder. What initial information should the nurse provide to the spouse of the client? 1. "Your husband may frequently check his body for signs of illness." 2. "Your husband may not remember some of the events during the change in personality." 3. "Your husband may have difficulty in expressing his feelings." 4. "Your husband may not feel comfortable with individuals of opposite gender."

2. "your husband may not remember some of the events during the change in personality"

A client with somatic symptom disorder is able to understand the correlation between physical symptoms and psychological problems. Which nursing intervention would have brought this change in the client? 1. Providing pain medication 2. Explaining medical assessment data 3. Encouraging the client to verbalize fears and anxieties 4. Helping the client to identify ways to achieve recognition from others

2. explaining medical assessment data

What is a probable cause for dissociative identity disorder in a client? 1. Alcohol abuse 2. History of abuse as a child 3. Drug abuse and overmedication 4. Detachment with respect to surroundings

2. history of abuse as a child

What would the nurse expect in a client with anosmia? 1. Inability to produce voice 2. Inability to perceive smell 3. Inability to recall the past 4. Inability to interpret bodily sensations correctly

2. inability to perceive smell

The RN has a client suffering from amnesia; the client is unable to remember years of abuse as a child. Which type of amnesia is described in this scenario? 1. Selective amnesia 2. Localized amnesia 3. Generalized amnesia 4. Dissociative fugue

2. localized amnesia

The client is encouraged to participate in group psychotherapy. Which of the following benefits will they receive from this type of treatment? 1. Frequent physical exams 2. Sharing the experiences of illness 3. Establishment of an intimate trusting relationship 4. Opportunity to confront distorted thoughts

2. sharing the experience of illness

Which behavior of the client indicates the presence of factitious disorder? 1. The client will avoid interaction with the primary health-care providers. 2. The client inflicts painful injuries on himself or herself. 3. The client seeks relief from disorder through over-the-counter medication. 4. The client is suspicious of the presence of an undiagnosed medical illness.

2. the client inflicts painful injuries on himself or herself

A client with dissociative identity disorder (DID) is scheduled for intensive, long-term psychotherapy. Which action of the client indicates the completion of abreaction? 1. The client is blending all the personalities into one. 2. The client is crying, screaming, and feeling the pain. 3. The client is confronting the distorted thoughts. 4. The client is maintaining a sense of reality during stressful conditions.

2. the client is crying, screaming, and feeling the pain

Which statement indicates an effective outcome of the nursing care provided for a client with illness anxiety disorder? 1. The client recalls events associated with the trauma. 2. The client realizes that his or her fear of falling ill is unreasonable and irrational. 3. The client verbalizes the anxiety, which has precipitated the dissociation. 4. The client starts to cope effectively during stressful situations without resorting to physical symptoms.

2. the client realized that his or her fear of falling ill is unreasonable and irrational

While caring for a client who has unrealistic interpretation of bodily signs and sensations, the nurse allows the client to discuss his or her feelings in a nonthreatening environment. What is the rationale behind this nursing intervention? 1. To resolve anxiety 2. To resolve disturbing emotions 3. To provide direction for planning client care 4. To promote a therapeutic nurse-client relationship

2. to resolve disturbing emotions

The registered nurse is teaching a group of nurses about psychological trauma. Which statement should the registered nurse include in the lesson? 1. "Dissociative amnesia may be related to neurological amnesia." 2. "Traumatic experiences overcome the capacity to cope by any means other than dissociation." 3. "Repressing distressed mental contents from conscious awareness may lead to dissociative behaviors." 4. "Genetic factors of pathological and nonpathological dissociative capacity may be associated with dissociative identity disorder."

2. traumatic experiences overcome the capacity to cope by any means other than dissociation

The clinician encourages the RN to monitor a 5-year-old client and the client's mother, as there is suspicion that the mother is fabricating the child's symptoms for emotional gain. Which dissociative syndrome is being described in this scenario? 1. Hypochondriasis 2. Dissociative identity disorder 3. Munchausen syndrome 4. Dissociative amnesia

3. Munchausen syndrome

A client is diagnosed with illness anxiety disorder. Which nursing action would help yield information about maladaptive behavior present in the client? 1. Allowing the client to discuss physical concerns 2. Monitoring laboratory reports of the client 3. Assessing the function that the client's excessive concern is fulfilling for him or her 4. Determining the extent to which physical complaints correlate with times of increased anxiety

3. assessing the function that the clients excessive concern is fulfilling for him or her

The RN meets with a client that expresses his/her frustration with being on a psychiatric unit when he/she feels his/her symptoms are physical. Which is a likely a nursing diagnosis of this client? 1. Ineffective coping 2. Deficient knowledge 3. Impaired memory 4. Disturbed sensory perception

3. deficient knowledge

A client reports being extremely conscious of his bodily sensations saying, "My heart rate is racing and I think it's probably heart disease." What condition would the nurse suspect in the client? 1. Factious disorder 2. Conversion disorder 3. Illness anxiety disorder 4. Somatic symptom disorder

3. illness anxiety disorder

A client is diagnosed with depersonalization-derealization disorder. Which outcome would the nurse expect while planning care for this client? 1. The client can recall all events of his life. 2. The client verbalizes understanding regarding the existence of multiple personalities. 3. The client can demonstrate more adaptive coping strategies to avert dissociative behaviors. 4. The client effectively uses adaptive coping strategies during stressful situations without resorting to physical symptoms.

3. the client can demonstrate more adaptive coping strategies to avert dissociative behavior

What would the nurse expect in the client diagnosed with dissociative localized amnesia? 1. The client has amnesia due to a skull injury. 2. The client has amnesia for his or her identity and total life history. 3. The client is unable to recall all incidents associated with stressful events. 4. The client can only recall certain incidents associated with a stressful event.

3. the client is unable to recall all incidents associated with stressful events

The nurse is caring for a client who has a history of requesting care from multiple health-care providers. Which outcome indicates the effectiveness of the nursing care plan in this client? 1. The client will recover deficits in his or her memory. 2. The client will demonstrate the recovery of lost or altered function. 3. The client will interpret bodily sensations correctly. 4. The client will verbalize psychological factors affecting his or her physical condition.

3. the client will interpret bodily sensations correctly

Which outcome in the client diagnosed with dissociative identity disorder (DID) would indicate the effectiveness of psychotherapy? 1. The client will retrieve all the past memories of his or her life. 2. The client will verbalize adaptive ways for coping with stress. 3. The client will optimize the level of functioning and potential. 4. The client will learn how to confront distorted thoughts and challenge his or her feelings.

3. the client will optimize the level of functioning and potential

The mother of a client says, "My child fears that he has any disease he reads about." Which nursing intervention would provide insight into reasons for this child's behavior? 1. Conveying empathy to the client 2. Identifying primary and secondary gains 3. Helping the client determine the techniques that help to cope with fear and anxiety 4. Assessing the function that is being fulfilled in the client's excessive concern for minor symptoms

4. assessing the function that is being fulfilled in the clients excessive concern for minor symptoms

What does the psychodynamic theory of conversion disorder propose? 1. Increased incidence is seen in first degree relatives 2. Increased incoming sensory stimuli produce a deficiency of endorphins. 3. Aberrant behaviors associated with the disorder may be due to impairment in information processing. 4. Emotions related to a traumatic event that are not expressed due to moral unacceptability are converted into physical symptoms.

4. emotions related to a traumatic event that are not expressed due to moral unacceptability are converted into physical symptoms

The nurse is caring for a client with disturbed sensory perception. Which nursing intervention is the first step in the process of behavioral change? 1. Resolving the conflicts produced by the painful experiences 2. Providing support and encouragement during times of depersonalization 3. Teaching assertive and relaxing techniques to cope with fear and anxiety 4. Explaining the relationship between severe anxiety and depersonalization behavior

4. explaining the relationship between severe anxiety and depersonalization

Which behavior could the nurse most likely see in the client who is diagnosed with ineffective coping? 1. Denying emotional problems 2. An unhygienic condition 3. Verbalizing frustration due to lack of control 4. Feigning of physical symptoms to gain attention

4. feigning of physical symptoms to gain attention

The nurse is caring for a client with disturbed personal identity. Which nursing intervention will help to eliminate fear and defensiveness in this client? 1. Provide support during disclosure of painful experiences. 2. Guard the client against self-harm. 3. Help to identify stressful situations. 4. Help the subpersonalities to understand that their "being" will not be destroyed.

4. help the subpersonalities to understand that their "being" will not be destroyed

Which nursing intervention helps the client become aware of the psychological implications of conversion disorder? 1. Encouraging the client to be as dependent as possible 2. Maintaining a judgmental attitude when providing assistance to the client 3. Quickly withdrawing attention if the client continues to focus on physical limitations 4. Helping the client to identify physical symptoms as coping mechanisms used in times of stress

4. helping the client to identify physical symptoms as coping mechanisms used in times of stress

The registered nurse is evaluating a student nurse who is caring for a client with deficient knowledge and a high level of anxiety. Which intervention implemented by the student nurse needs correction? 1. Reassuring and staying with the client 2. Encouraging the client to verbalize fears 3. Discussing the purpose of laboratory tests 4. Helping the client to perform relaxation techniques

4. helping the client to perform relaxation techniques

A client is diagnosed with disturbed personal identity. Which nursing intervention would be the first step in the integration process? 1. Developing a trusting relationship with the personalities 2. Providing support during disclosure of the painful experiences 3. Helping the subpersonalities understand that they will not be destroyed 4. Helping the client understand the existence of subpersonalities

4. helping the client understand the existence of subpersonalities

The nurse is caring for a client with dissociative identity disorder. What variable might help the nurse to determine the client's response to the disease? 1. Feeling of detachment from surroundings 2. Change in quality of self-awareness. 3. Inability to recall information of a traumatic event 4. Recurrent gaps in the recalling of everyday events

4. recurrent gaps in the recalling of everyday events

While caring for a client with illness anxiety disorder, the nurse gives positive reinforcement for the client's involvement in physical activities and for the use of assertive techniques. Which outcome does the nurse expect out of this nursing action? 1. The client recognizes the factors that are resulting in altered sensory perception. 2. The client identifies the stressors that result in a personality transition. 3. The client verbalizes the fears and anxieties in an appropriate manner. 4. The client copes with stress using mechanisms other than preoccupation with physical symptoms.

4. the client copes with stress using mechanisms other than preoccupation with physical symptoms

hich outcome indicates the effectiveness of therapy for depersonalization-derealization disorder? 1. The client interprets bodily sensations rationally. 2. The client understands the existence of multiple personalities. 3. The client is able to recall the events associated with trauma. 4. The client is able to maintain a sense of reality during stressful situations.

4. the client is able to maintain a sense of reality during stressful situations

Which client condition is a positive outcome for the intervention of explaining the relationship between severe anxiety and dissociative behavior? 1. The client is prepared to face stressful situations. 2. The client feels secure when fears and anxiety are manifested. 3. The client has a decreased need for the dissociative response to anxiety. 4. The client is aware that the occurrence of depersonalization behaviors is associated with severe anxiety.

4. the client is aware that the occurrence of depersonalization behaviors is associated with severe anxiety

The registered nurse is teaching students about caring for a client with impaired memory. Which statement made by the student needs correction? 1. "The client should be encouraged to discuss stressful situations." 2. "The client should be helped to identify specific conflicts that remain unresolved." 3. "The client should be engaged in activities that provide additional stimulation." 4. "The client should be reminded of all the events of past life at once, to simulate life experiences."

4. the client should be reminded of all the events of past life at once, to simulate life experiences

Which outcome would indicate the effectiveness of the nursing care for a 28-year-old client with somatic symptom disorder? 1. The client will be free of physical liability. 2. The client will interpret bodily sensations rationally. 3. The client will verbalize the extreme anxiety that precipitated the dissociation. 4. The client will effectively use adaptive coping strategies during stressful situations without resorting to physical symptoms.

4. the client will effectively use adaptive coping strategies during stressful situations without resorting to physical symptoms

Which outcome in the client receiving nursing care for depersonalization-derealization disorder would evaluate the effectiveness of the nursing care? 1. The client will retrieve the memories of the past life. 2. The client will demonstrate recovery of lost or altered function. 3. The client will cooperate with the plan for teaching provided by the nurse. 4. The client will learn to confront distorted thoughts and challenge feelings of unreality.

4. the client will learn to confront distorted thoughts and challenge feelings of unreality

which outcome in the client receiving nursing care for depersonalization-derealization disorder would evaluate the effectiveness of the nursing care? 1. The client will retrieve the memories of the past life. 2. The client will demonstrate recovery of lost or altered function. 3. The client will cooperate with the plan for teaching provided by the nurse. 4. The client will learn to confront distorted thoughts and challenge feelings of unreality.

4. the client will learn to confront distorted thoughts and challenge feelings of unreality

When is a client with the somatic symptom disorder said to have tertiary gain according to the learning theory? 1. When the client postpones unwelcome challenges 2. When the client learns that he or she may avoid stressful obligations 3. When the client becomes the prominent focus of attention because of the illness 4. When the client came comes to know that the concern towards him or her has relieved the conflict within the family

4. when the client came comes to know that the concern towards him or her has relieved the conflict within the family