Varcarolis- Chapter 17 Somatic Symptom Disorders

A 23 years old is admitted with reports of abdominal pain, dizziness, and headache. When told that all the results of a physical workup have been negative, the client shares, "Now I am having back pain." Which notation in the client's medical record may alert the nurse to the possibility of malingering? A. A court date this week for drunk driving B.Was adopted at the age of 5 years C. A history of physical abuse by his stepfather D. A history of oppositional-defiant disorder E. Raised primarily in a single parent household

A. A court date this week for drunk driving Malingering is a process of fabricating an illness or exaggerating symptoms to gain a desired benefit or avoid something undesired, such as to obtain prescription medications, evade military service, or evade legal action. It is more common in men, those who have been neglected or abused in childhood, and those who have had frequent childhood hospitalizations. Adoption is not known to be a causative factor in malingering. A history of oppositional-defiant disorder is not known to a causative factor in malingering. Being raised in a single parent home is not known to be a causative factor in malingering.DIF: Cognitive Level: Analyze (Analysis)REF: page 36TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity

Melanie is a 38-year-old female admitted to the hospital to rule out a neurological disorder. The testing was negative, yet she is reluctant to be discharged. Today she has added lower back pain and a stabbing sensation in her abdomen. The nurse suspects a factitious disorder in which Melanie may : A. Consciously be trying to maintain her role of a sick patient B. Not recognize her unmet needs to be cared for C. Protect her child from illness D. Recognize physical symptoms as a coping mechanism

A. Consciously be trying to maintain her role of a sick patient

Conversion disorder is described as an absence of a neurological diagnosis that manifests in neurological symptoms. Channeling of emotions, conflicts, and stressors into physical symptoms is thought to be the cause in conversion disorder. Which statement is true? A. People with conversion disorder are extremely upset about often dramatic symptoms. B. Abnormal patterns of cerebral activation have been found in individuals with conversion disorder. C. An organic cause is usually found in most cases of conversion disorder. D. Symptoms can be turned on and off depending on the patient's choice

B. Abnormal patterns of cerebral activation have been found in individuals with conversion disorder.

Lucas is a nurse on a medical floor caring for Kelly, a 48-year-old patient with newly diagnosed type 2 diabetes. He realizes that depression is a complicating factor in the patient's adjustment to her new diagnosis. What problem has the most potential to arise? A. Development of agoraphobia B. Treatment nonadherence C. Frequent hypoglycemic reactions D. Sleeping rather than checking blood sugar

B. Treatment nonadherence

You are caring for a 67-year-old patient who has been receiving hemodialysis for three months. Yolanda reports that she feels angry whenever it is time for her dialysis treatment. You attribute this to: A. Organic changes in Yolanda's brain B. A flaw in Yolanda's personality C. A normal response to grief and loss D. Denial of the reality of a poor prognosis

C. A normal response to grief and loss

Ever since participating in a village raid where explosives were used, a military veteran has been unable to walk. After all diagnostic testing were negative for any physical abnormalities, the client was diagnosed with conversion disorder. What is the nurse's best response when asked by the client, "Why can't I walk?" A. "Your legs don't work because your brain is screwed up." B."Your emotional distress is being expressed as a physical symptom." C. "You are making up your symptoms as a cry for help." D. "You are overly anxious about having a severe illness."

B."Your emotional distress is being expressed as a physical symptom." Conversion disorder is attributed to channeling of emotional conflicts or stressors into physical symptoms. Telling the patient her brain is "screwed up" 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

Diane, a 63 year-old mother of three, was brought to the community psychiatric clinic. Diane and her son had a bitter fight over finances. Ever since Diane has been complaining of a "severe pain in my neck." She has seen several doctors who cannot find a physical basis for the pain. The nurse knows that: A. Showing for concern for Diane's pain will increase her obsessional thinking. B. Diane's symptoms are manipulative and under conscious control. C. Diane believes there is a physical cause for the pain and will resist a psychological explanation. D. Diane is trying to make her son feel bad about the argument.

C. Diane believes there is a physical cause for the pain and will resist a psychological explanation.

What would be an appropriate expected outcome of the treatment plan for a client diagnosed with a conversion disorder that interferes with the ability to walk effective? A. Client will walk unassisted within 1 week. B. Client will return to a pre-illness level of functioning within 2 weeks. C. Client will be able to state two new effective coping skills within 2 weeks. D. Client will assume full self-care within 3 weeks.

Client will be able to state two new effective coping skills within 2 weeks. An appropriate outcome for somatization disorders is to be aware of negative coping strategies and learn new, effective skills for coping within a realistic timeframe. In the other options, the time frames of these outcomes are unrealistic

Emily asks you what kind of therapy will help her. Based on current knowledge, what form of therapy is most appropriate for a client diagnosed with a conversion disorder? A. "A combination of antianxiety and antidepressant therapy is the most effective therapy." B. "Aversion therapy is often used because in effect you are punishing yourself by not being able to walk." C. "Modeling will be used; as you see desired behaviors modeled by the therapist you will be able to also achieve the expected outcome." D. "Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders."

D. CBT is the most consistently supported treatment for the full spectrum of somatic disorders. All the other options are incorrect and do not describe the most used and effective therapy for this disorder.

Which patient is at greatest risk for developing a stress induced myocardial infarction? A. A patient who lost a child in an accidental shooting 24 hours ago B. A woman who has begun experiencing early signs of menopause C. A patient who has spent years trying to sustain a successful business D. A patient who was diagnosed with chronic depression 10 years ago

D. A patient who was diagnosed with chronic depression 10 years ago

You are caring for Aaron, a 38 year-old patient diagnosed with somatic disorder. When interacting with you, Aaron continues to focus on his severe headaches. In planning care for Aaron, which of the following interventions would be appropriate? A. Call for a family meeting with Aaron in attendance to confront Aaron regarding his diagnosis B. Educate Aaron on alternative therapies to deal with pain. C. Improve reality testing by telling Aaron that you do not believe the headaches are real D. After a limited discussion of physical concerns, shift focus to feelings and effective coping skills.

D. After a limited discussion of physical concerns, shift focus to feelings and effective coping skills

It is most important for the nurse to employ which holistic strategy when managing clients diagnosed with a somatization disorder? A. Utilizing many different therapeutic strategies or modalities for enhanced coping B. Involving every member of the family as well as the patient in treatment C. Incorporating spirituality and religion into treatment D. Considering all dimensions of the patient, including biological, psychological, and sociocultural

D. Considering all dimensions of the patient, including biological, psychological, and sociocultural It is important to use a holistic approach in nursing care so that we may address the multidimensional interplay of biological, psychological, and sociocultural needs and its effects on the somatization process. All nurses need to be aware of the influence of environment, stress, individual lifestyle, and coping skills of each patient. The other options do not explain the concept of holistic care.

What precipitating emotional factor has been associated with an increased incidence of cancers? select all that apply A. Anxiety B. Job related stress C. Acute grief D. Feelings of hopelessness and despair from depression E. Prolonged, intense stress

D. Feelings of hopelessness and despair from depression E. Prolonged, intense stress

Living comfortable and materialistic lives in Western societies seems to have altered the original hierarchy proposed by Maslow in that: A. Once lower level needs are satisfied, no further growth feels necessary B. Self-actualization is easier to achieve with financial stability C. Esteem is more highly valued than safety. D. Focusing on materialism reduces interests in love, belonging, and family

D. Focusing on materialism reduces interests in love, belonging, and family

The care plan for a patient diagnosed with a somatic disorder includes the nursing diagnosis Ineffective Coping. Which nursing diagnosis demonstrates a successful outcome for that diagnosis? A. Showers and dresses in clean clothes daily. B. Calls a friend to talk when feeling lonely C. Spends more time talking about pain in her abdomen D. Maintains focus and concentration

b. Calls a friend to talk when feeling lonely