Deck 20: Somatic Symptom and Dissociative Disorders

Question 1

A nurse is reviewing progress notes on a newly admitted client. One progress note reveals that the client purposefully inserted a contaminated catheter into the urethra, leading to a urinary tract infection. The nurse recognizes this behavior as characteristic of which mental disorder?

A) Illness anxiety disorder
B) Factitious disorder
C) Functional neurological symptom disorder
D) Depersonalization-derealization disorder

Answer 1

Factitious disorder

Question 2

A client is exhibiting symptoms of generalized amnesia. Which of the following questions should the nurse ask to confirm this diagnosis?

A) "Have you taken any new medications recently?"
B) "Have you recently traveled away from home?"
C) "Have you recently experienced any traumatic event?"
D) "Have you ever felt detached from your environment?"
E) "Have you had any history of memory problems?"

Answer 2

"Have you taken any new medications recently?"
"Have you recently experienced any traumatic event?"
"Have you had any history of memory problems?"

Question 3

According to the DSM-5 diagnostic criteria for dissociative amnesia (DA), what symptom would be essential to meet the criteria for the subcategory of dissociative fugue?

A) An inability to recall important autobiographical information
B) Clinically significant distress in social and occupational functioning
C) Sudden unexpected travel or bewildered wandering
D) "Blackouts" related to alcohol toxicity

Answer 3

Sudden unexpected travel or bewildered wandering

Question 4

An inpatient client is newly diagnosed with dissociative identity disorder (DID) stemming from severe childhood sexual abuse. Which nursing intervention takes priority?

A) Encourage exploration of sexual abuse.
B) Encourage guided imagery.
C) Establish trust and rapport.
D) Administer antianxiety medications.

Question 5

The DSM-5 diagnosis of functional neurological symptom disorder can also be identified as ____________________ disorder.

Question 6

A client is diagnosed with IAD. Which of the following symptoms is the client most likely to exhibit?

A) Obsessive-compulsive behaviors
B) Pseudocyesis
C) Anxiety
D) Flat affect
E) Depression

Question 7

A client is diagnosed with functional neurological symptom disorder (FNSD). Which of the following symptoms is the client most likely to exhibit?

A) Anosmia
B) Anhedonia
C) Akinesia
D) Aphonia
E) Amnesia

Question 8

A nursing instructor is teaching about the etiology of IAD from a psychodynamic perspective. What student statement about clients diagnosed with this disorder indicates that learning has occurred?

A) "They tend to have a familial predisposition to this disorder."
B) "When the sick role relieves them from stressful situations, their physical symptoms are reinforced."
C) "They misinterpret and cognitively distort their physical symptoms."
D) "They express personal worthlessness through physical symptoms, because physical problems are more acceptable than psychological problems."

Question 9

Which are examples of primary and secondary gains that clients diagnosed with SSD: predominately pain, may experience?

A) Primary: chooses to seek a new doctor; Secondary: euphoric feeling from new medications
B) Primary: euphoric feeling from new medications; Secondary: chooses to seek a new doctor
C) Primary: receives get-well cards; Secondary: pain prevents attending stressful family reunion
D) Primary: pain prevents attending stressful family reunion; Secondary: receives get-well cards

Question 10

A client diagnosed with DID switches personalities when confronted with destructive behavior. The nurse recognizes that this dissociation serves which function?

A) It is a means to attain secondary gain.
B) It is a means to explore feelings of excessive and inappropriate guilt.
C) It serves to isolate painful events so that the primary self is protected.
D) It serves to establish personality boundaries and limit inappropriate impulses.

Question 11

Which combination of diagnoses and appropriate pharmacological treatments are correctly matched?

A) SSD: predominantly pain; treated with venlafaxine (Effexor)
B) IAD; treated with cefadroxil (Duricef)
C) Conversion disorder; treated with cyclobenzaprine (Flexeril)
D) Depersonalization-derealization disorder; treated with mometasone (Elocom)

Question 12

Neurological tests have ruled out pathology in a client's sudden lower-extremity paralysis. Which nursing care should be included for this client?

A) Deal with physical symptoms in a detached manner.
B) Challenge the validity of physical symptoms.
C) Meet dependency needs until the physical limitations subside.
D) Encourage a discussion of feelings about the lower-extremity problem.

Question 13

Which would be considered an appropriate outcome when planning care for an inpatient client diagnosed with SSD?

A) The client will admit to fabricating physical symptoms to gain benefits by day three.
B) The client will list three potential adaptive coping strategies to deal with stress by day two.
C) The client will comply with medical treatments for physical symptoms by day three.
D) The client will openly discuss physical symptoms with staff by day four.

Question 14

A nursing instructor is teaching about the DSM-5 diagnosis of depersonalization-derealization disorder (D-DD). Which student statement indicates a need for further instruction?

A) "Clients with this disorder can experience emotional and/or physical numbing and a distorted sense of time."
B) "Clients with this disorder can experience unreality or detachment with respect to their surroundings."
C) "During the course of this disorder, individuals or objects are experienced as dreamlike, foggy, lifeless, or visually distorted."
D) "During the course of this disorder, the client is out of touch with reality and is impaired in social, occupational, or other areas of functioning."

Question 15

Which situation is an example of selective amnesia?

A) A client cannot relate any lifetime memories.
B) A client can describe driving to Ohio but cannot remember the car accident that occurred.
C) A client often wanders aimlessly after sunset.
D) A client cannot provide personal demographic information during admission assessment.

Question 16

A client diagnosed with somatic symptom disorder (SSD) is most likely to exhibit which personality disorder characteristics?

A) Experiences intense and chaotic relationships with fluctuating attitudes toward others
B) Socially irresponsible, exploitative, guiltless, and disregards rights of others
C) Self-dramatizing, attention seeking, overly gregarious, and seductive
D) Uncomfortable in social situations, perceived as timid, withdrawn, cold, and strange

Question 17

A client is diagnosed with DID. What is the primary goal of therapy for this client?

A) To recover memories and improve thinking patterns
B) To prevent social isolation
C) To decrease anxiety and need for secondary gain
D) To collaborate among sub-personalities to improve functioning

Question 18

A nurse is working with a client diagnosed with SSD. What criteria would differentiate this diagnosis from illness anxiety disorder (IAD)?

A) The client diagnosed with SSD experiences physical symptoms in various body systems, and the client diagnosed with IAD does not.
B) The client diagnosed with SSD experiences a change in the quality of self-awareness, and the client diagnosed with IAD does not.
C) The client diagnosed with SSD disorder has a perceived disturbance in body image or appearance, and the client diagnosed with IAD does not.
D) The client diagnosed with SSD only experiences anxiety about the possibility of illness, and the client diagnosed with IAD does not.