Deck 23: Somatic Symptom Disorders and Dissociative Disorders

Question 1

A medical-surgical nurse works with a patient diagnosed with a somatic symptom disorder. Care planning is facilitated by understanding which of the following?

A) The patient will probably readily seek psychiatric counselling.
B) The patient will probably be resistant to accepting psychiatric help.
C) The patient will probably attend psychotherapy sessions without encouragement.
D) The patient will probably be eager to discover the true reasons for physical symptoms.

Answer 1

The patient will probably be resistant to accepting psychiatric help.

Question 2

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 which of the following?

A) Marginally successful
B) Minimally successful
C) Partially successful
D) Totally achieved

Answer 2

Partially successful

Question 3

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?"

Answer 3

"What are you unable to do now but were previously able to do?"

Question 4

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

Question 5

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.

Question 6

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 the patient. An appropriate outcome is that the patient will do which of the following?

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

Question 7

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 underlying depression
C) Long-term use of benzodiazepines to support coping with anxiety
D) Conventional antipsychotic medications to correct cognitive distortions

Question 8

To assist patients diagnosed with somatic symptom disorders, nursing interventions of high priority do which of the following?

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

Question 9

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 which of the following?

A) Mood
B) Cognitive style
C) Secondary gains
D) Identity and memory

Question 10

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

Question 11

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 would be most therapeutic?

A) "I'm wondering if you're 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 bell so frequently. It is a problem."
D) "You frustrate the staff by calling them so often. Why are you doing that?"

Question 12

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

Question 13

A patient with fears of serious heart disease was referred to the mental health centre 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)

Question 14

A patient has blindness related to conversion (functional neurological) disorder. Which of the following should the nurse do to help the patient eat?

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 plate
C) Direct the patient to locate items on the tray independently and feed self
D) Address needs of other patients in the dining room, and then feed this patient

Question 15

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.

Question 16

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."

Question 17

A nurse assessing a patient diagnosed with a somatic symptom disorder is most likely to note which of the following?

A) The patient sees a relationship between symptoms and interpersonal conflicts.
B) The patient has little difficulty communicating emotional needs to others.
C) The patient rarely derives personal benefit from the symptoms.
D) The patient has altered comfort and activity needs.

Question 18

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

Question 19

To plan effective care for patients diagnosed with somatic symptom disorders, the nurse should understand that patients have difficulty giving up the symptoms because of which of the following?

A) The symptoms are generally chronic.
B) The symptoms have a physiological basis.
C) The symptoms can be voluntarily controlled.
D) The symptoms provide relief from health anxiety.

Question 20

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 I'm asleep so I can avoid it. I think it's starting to cause problems with my marriage."
D) "I choke very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus."

Question 21

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

Question 22

A nurse's neighbour 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 which of the following? Select all that apply.

A) Cancer
B) Hip fractures
C) Hypertension
D) Immune disorders
E) Cardiovascular disease

Question 23

A patient diagnosed with a factitious 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

Question 24

Which presentations suggest the possibility of a factitious disorder, self-directed 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 of illness to obtain financial benefit or other incentive
E) Difficulty describing symptoms