Varcarolis 17: Somatic Symptom Disorders
In the case of a ___ 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."
factitious
___ ___ disorder is an exaggeration of a negligible health symptom.
illness anxiety
In cases of ___ ___ disorder, the distressing symptoms and health concerns that the patient experiences are baseless, with no physical findings or medical diagnosis.
somatic symptom
A nurse assesses a patient diagnosed with conversion (functional neurological) disorder. Which comment is most likely from this patient? a. "Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion." b. "I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry, and I think I'm getting seriously dehydrated." c. "Sexual intercourse is painful. I pretend as if I'm asleep so I can avoid it. I think it's starting to cause problems with my marriage." d. "I get choked very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus."
a
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? a. Cancer b. Peptic ulcer c. Essential hypertension d. Coronary heart disease
a
Which assessment findings suggest the possibility of a factitious disorder, imposed on self-type? (Select all that apply.) a. History of multiple hospitalizations without findings of physical illness b. History of multiple medical procedures or exploratory surgeries c. Going from one doctor to another seeking the desired response d. Claims illness to obtain financial benefit or other incentive e. Difficulty describing symptoms
ab
A patient who experienced a myocardial infarction was transferred from critical care to a step-down unit. The patient then used the call bell every 15 minutes for minor requests and complaints. Staff nurses reported feeling inadequate and unable to satisfy the patient's needs. When the nurse manager intervenes directly with this patient, which comment is most therapeutic? a. "I'm wondering if you are feeling anxious about your illness and being left alone." b. "The staff are concerned that you are not satisfied with the care you are receiving." c. "Let's talk about why you use your call light so frequently. It is a problem." d. "You frustrate the staff by calling them so often. Why are you doing that?"
a
A nurse assesses a patient suspected of having somatic symptom disorder. Which assessment findings regarding this patient support the suspected diagnosis? (Select all that apply.) a. Female b. Reports frequent syncope c. Rates pain as "1" on a scale of "10" d. First diagnosed with psoriasis at age 12 e. Reports insomnia often results from back pain
abe
The nurse is assessing four patients. Based on the statements made by the patients, which patient most likely has somatic symptom disorder? a. "I've spent months dealing with the headaches and stomachaches that I get from my stress." b. "I am always worried that I will get cancer, so I get blood tests and imaging tests done as often as I can." c. "I've had to go from one doctor to another because none of them believe me when I tell them that I'm sick." d. "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."
a
Which assessment question could a nurse ask to help identify secondary gains associated with a somatic symptom disorder? a. "What are you unable to do now but were previously able to do?" b. "How many doctors have you seen in the last year?" c. "Who do you talk to when you're upset?" d. "Did you experience abuse as a child?"
a
Which comment by a patient who recently experienced a myocardial infarction indicates use of maladaptive, ineffective coping strategies? a. "My employer should have paid for a health club membership for me." b. "My family will see me through this. It won't be easy, but I will never be alone." c. "My heart attack was no fun, but it showed me up the importance of a good diet and more exercise." d. "I accept that I have heart disease. Now I need to decide if I will be able to continue my work daily."
a
Which somatization disorder should the nurse consider highly treatment-resistant? a. Factitious disorder b. Conversion disorder c. Illness anxiety disorder d. Somatic symptom disorder
a
A nurse's neighbor says, "I saw a news story about a man without any known illness who died suddenly after his ex-wife committed suicide. Was that a coincidence, or can emotional shock be fatal?" The nurse should respond by noting that some serious medical conditions may be complicated by emotional stress, including (Select all that apply) a. cancer. b. hip fractures. c. hypertension. d. immune disorders. e. cardiovascular disease.
acde
A patient diagnosed with a somatic symptom disorder says, "Why has God chosen me to be sick all the time and unable to provide for my family? The burden on my family is worse than the pain I bear." Which nursing diagnoses apply to this patient? (Select all that apply.) a. Spiritual distress b. Decisional conflict c. Adult failure to thrive d. Impaired social interaction e. Ineffective role performance
ae
A medical-surgical nurse works with a patient diagnosed with a somatic symptom disorder. Care planning is facilitated by understanding that the patient will probably a. readily seek psychiatric counseling. b. be resistant to accepting psychiatric help. c. attend psychotherapy sessions without encouragement. d. be eager to discover the true reasons for physical symptoms.
b
A nurse interviews a patient diagnosed with conversion disorder. Which comment is most likely from this patient? a. "I get big lumps in my throat and can't swallow when I eat. I'm afraid I might have cancer." b. "Since getting a divorce, I've had crushing chest pain, but I don't think it really means anything." c. "Sexual intercourse is so painful that I avoid it. I'm afraid that's going to destroy my marriage." d. "I have daily problems with nausea and vomiting. I think I'm getting seriously dehydrated."
b
A patient has blindness related to conversion (functional neurological) disorder but is unconcerned about this problem. Which understanding should guide the nurse's planning for this patient? a. The patient is suppressing accurate feelings regarding the problem. b. The patient's anxiety is relieved through the physical symptom. c. The patient's optic nerve transmission has been impaired. d. The patient will not disclose genuine fears.
b
A patient has blindness related to conversion (functional neurological) disorder. To help the patient eat, the nurse should a. establish a "buddy" system with other patients who can feed the patient at each meal. b. expect the patient to feed self after explaining arrangement of the food on the tray. c. direct the patient to locate items on the tray independently and feed self. d. address needs of other patients in the dining room, then feed this patient
b
A patient reports fears of having cervical cancer and says to the nurse, "I've had Pap smears by six different doctors. The results were normal, but I'm sure that's because of errors in the laboratory." Which disorder would the nurse suspect? a. Conversion (functional neurological) disorder b. Illness anxiety disorder (hypochondriasis) c. Somatic symptom disorder d. Factitious disorder
b
A patient says, "I know I have a brain tumor despite the results of the MRI. The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day." Which response by the nurse fosters cognitive reframing? a. "You do not have a brain tumor. The more you talk about it, the more it reinforces your belief." b. "Let's see if there are any other possible explanations for your vomiting." c. "You seem so worried. Let's talk about how you're feeling." d. "We need to talk about something else."
b
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? a. Factitious disorder b. Conversion disorder c. Illness anxiety disorder d. Somatic symptom disorder
b
A patient with a somatic symptom disorder has the nursing diagnosis Interrupted family processes related to patient's disabling symptoms as evidenced by spouse and children assuming roles and tasks that previously belonged to patient. An appropriate outcome is that the patient will a. assume roles and functions of other family members. b. demonstrate performance of former roles and tasks. c. focus energy on problems occurring in the family. d. rely on family members to meet personal needs.
b
A patient with blindness related to conversion (functional neurological) disorder says, "All the doctors and nurses in the hospital stop by often to check on me. Too bad people outside the hospital don't find me as interesting." Which nursing diagnosis is most relevant? a. Social isolation b. Chronic low self-esteem c. Interrupted family processes d. Ineffective health maintenance
b
Studies have shown a correlation between mental disorders and which medical conditions? a. Asthma b. Cancer c. Psoriasis d. Renal failure
b
Which assessment data would help the health care team distinguish symptoms of conversion (functional neurological) disorder from symptoms of illness anxiety disorder (hypochondriasis)? a. Voluntary control of symptoms b. Patient's style of presentation c. Results of diagnostic testing d. The role of secondary gains
b
Which patient is most likely to initially demonstrate behaviors suggesting a somatic disorder? a. 13-year-old male b. 23-year-old female c. 33-year-old male d. 43-year-old female
b
Which prescription medication would the nurse expect to be prescribed for a patient diagnosed with a somatic symptom disorder? a. Narcotic analgesics for use as needed for acute pain b. Antidepressant medications to treat co-morbid depression c. Long-term use of benzodiazepines to support coping with anxiety d. Conventional antipsychotic medications to correct cognitive distortions
b
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. a. Biofeedback b. Visualization c. Massage therapy d. Type A modification e. Psychological counseling
bce
A child has a history of multiple hospitalizations for recurrent systemic infections. The child is not improving in the hospital, despite aggressive treatment. Factitious disorder imposed on another is suspected. Which nursing interventions are appropriate? (Select all that apply.) a. Increase private visiting time for the parents to improve bonding. b. Keep careful, detailed records of visitation and untoward events. c. Place mittens on the child to reduce access to ports and incisions. d. Encourage family members to visit in groups of two or three. e. Interact with the patient frequently during visiting hours.
bde
Which diagnoses are included among the somatic disorders? Select all that apply. a. Gender dysphoria b. Factitious disorder c. Frotteuristic disorder d. Somatic symptom disorder (SSD) e. Illness anxiety disorder (hypochondriasis) f. Psychological factors affecting medical condition g. Conversion disorder (functional neurological disorder)
bdefg
A nurse is assessing a patient who complains of body pain. The patient seems to be anxious about the presence of a serious medical illness. What should the nurse suspect the patient is suffering from? a. Factitious disorder b. Conversion disorder c. Illness anxiety disorder d. Somatic symptom disorder
c
A patient diagnosed with a somatic symptom disorder has been in treatment for 4 weeks. The patient says, "Although I'm still having pain, I notice it less and am able to perform more activities." The nurse should evaluate the treatment plan as a. marginally successful. b. minimally successful. c. partially successful. d. totally achieved.
c
A patient diagnosed with a somatic symptom disorder says, "My pain is from an undiagnosed injury. I can't take care of myself. I need pain medicine six or seven times a day. I feel like a baby because my family has to help me so much." It is important for the nurse to assess a. mood. b. cognitive style. c. secondary gains. d. identity and memory.
c
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? a. Factitious disorder b. Conversion disorder c. Illness anxiety disorder d. Somatic symptom disorder
c
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? a. Decreases the medical tests and procedures for the illness b. Encourages the patient's beliefs about the origin of the symptoms c. Reduces the patient's tendency to go from one caregiver to another d. Helps the patient to derive secondary gains through illness behaviors
c
The nurse includes stress management interventions when developing a plan of care for a patient with which disorder? a. Factitious disorder b. Conversion disorder c. Illness anxiety disorder d. Somatic symptom disorder
c
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? a. "Pharmacologic interventions are not effective." b. "There are several medications that can be used to treat somatic symptom disorder." c. "Some medications can be used off-label to help manage the symptoms of the disorder." d. "Benzodiazepines can be used to help with anxiety, and these are self-administered."
c
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? a. "The stomachache is not real; it is all in your head." b. "I can call the healthcare provider in here to reassess your stomach." c. "I understand that your stomach may be hurting; it must be frustrating to have that sensation." d. "For right now, try to imagine that your stomach does not hurt so that you can finish eating your breakfast."
c
To assist patients diagnosed with somatic symptom disorders, nursing interventions of high priority a. explain the pathophysiology of symptoms. b. help these patients suppress feelings of anger. c. shift focus from somatic symptoms to feelings. d. investigate each physical symptom as it is reported.
c
What data should be gathered routinely during assessment of a patient with a somatoform disorder? a. Level of confusion b. Potential for violence c. Dependence on medication d. Personal identity disturbance
c
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? a. The patient has ruptured the sac with her fingernails. b. The agony will be less if legal intervention is avoided. c. The disorder may lead to harmful medical procedures. d. The family has ruptured the sac to receive insurance money.
c
Which therapeutic intervention is included for a patient with a somatoform disorder? a. Encouraging the patient to use benzodiazepines liberally b. Steering the conversation away from the patient's feelings c. Conveying an interest in the patient rather than in the symptoms d. Encouraging the patient to rely on the nurse to meet the patient's needs
c
Which treatment modality should a nurse recommend to help a patient diagnosed with a somatic symptom disorder to cope more effectively? a. Flooding b. Response prevention c. Relaxation techniques d. Systematic desensitization
c
Patients with ___ disorder have symptoms of neurological disorders, but examination by a neurologist often does not reveal any neurological diagnosis.
conversion
A nurse assessing a patient diagnosed with a somatic symptom disorder is most likely to note that the patient a. sees a relationship between symptoms and interpersonal conflicts. b. has little difficulty communicating emotional needs to others. c. rarely derives personal benefit from the symptoms. d. has altered comfort and activity needs.
d
A patient with fears of serious heart disease was referred to the mental health center by a cardiologist. Extensive diagnostic evaluation showed no physical illness. The patient says, "My chest is tight, and my heart misses beats. I'm often absent from work. I don't go out much because I need to rest." Which health problem is most likely? a. Dysthymic disorder b. Somatic symptom disorder c. Antisocial personality disorder d. Illness anxiety disorder (hypochondriasis)
d
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? a. "Your legs don't work because your brain is confused." b. "You are making up your symptoms as a cry for help." c. "You are overly anxious about having a severe illness." d. "Your emotional distress is being expressed as a physical symptom."
d
During an assessment the nurse notes that a patient has a "crisscrossed" abdomen due to scars from numerous exploratory surgeries. In which illness or disorder is a crisscrossed abdomen commonly seen? a. Diarrhea b. Constipation c. Anorexia disorder d. Factitious disorder
d
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? a. Powerlessness b. Risk of suicide c. Risk of loneliness d. Ineffective coping
d
To plan effective care for patients diagnosed with somatic symptom disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms a. are generally chronic. b. have a physiological basis. c. can be voluntarily controlled. d. provide relief from health anxiety.
d
What is an essential difference between somatic symptom disorders and factitious disorders? a. Somatic symptom disorders are under voluntary control, whereas factitious disorders are unconscious and automatic. b. Factitious disorders are precipitated by psychological factors, whereas somatic symptom disorders are related to stress. c. Factitious disorders are individually determined and related to childhood sexual abuse, whereas somatic symptom disorders are culture bound. d. Factitious disorders are under voluntary control, whereas somatic symptom disorders involve expression of psychological stress through somatization.
d
Which disorder places the patient at highest risk for developing a coexisting substance abuse disorder? a. Factitious disorder b. Conversion disorder c. Illness anxiety disorder d. Somatoform pain disorder
d
Which statement about somatoform disorders is true? a. An organic basis exists for each group of disorders. b. Nurses perceive patients with these disorders as easy to care for. c. No relation exists between these disorders and early childhood loss or trauma. d. Patients lack awareness of the relations among symptoms, anxiety, and conflicts.
d
