Deck 12: Somatoform Disorders and Dissociative Disorders

Question 1

A patient says,"I feel detached and weird all the time,like I'm looking at life through a cloudy window.Everything seems unreal.These feelings really interfere with my work and study." Which term should the nurse use to document this complaint?

A)Depersonalization
B)Hypochondriasis
C)Dissociation
D)Malingering

Answer 1

Depersonalization

Question 2

A patient reports fears of having cervical cancer and says to the nurse,"I've had Pap smears by six different doctors.The results are normal,but I'm sure that's because of errors in the laboratory." Which disorder would the nurse suspect?

A)Functional neurologic (conversion)disorder
B)Prominent health anxiety (hypochondriasis)
C)Predominant (pain)disorder
D)Dissociative fugue

Answer 2

Prominent health anxiety (hypochondriasis)

Question 3

To plan effective care for patients with somatic system 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.

Answer 3

Provide relief from health anxiety.

Question 4

A nurse counsels a patient diagnosed with body dysmorphic disorder.Which nursing diagnosis would be a priority for the plan of care?

A)Anxiety
B)Risk for suicide
C)Disturbed body image
D)Ineffective role performance

Question 5

For a patient with dissociative amnesia,complete this outcome: Within 4 weeks,the patient will demonstrate an ability to execute complex mental processes by:

A)functioning independently."
B)verbalizing feelings of safety."
C)regularly attending diversional activities."
D)describing previously forgotten experiences."

Question 6

A patient has blindness related to a functional neurological (conversion)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 him- or herself after explaining the arrangement of the food on the tray.
C)direct the patient to locate items on the tray independently and feed self unassisted.
D)address the needs of other patients in the dining room,and then feed this patient.

Question 7

A patient has blindness related to a functional neurological (conversion)disorder but is unconcerned about this problem.Which understanding should guide the nurse's planning for this patient? The patient is:

A)suppressing accurate feelings regarding the problem.
B)relieving anxiety through the physical symptom.
C)meeting needs through hospitalization.
D)refusing to disclose genuine fears.

Question 8

Select the correct etiology to complete this nursing diagnosis for a patient with dissociative identity disorder.Disturbed personal identity,related to:

A)obsessive fears of harming self or others.
B)poor impulse control and lack of self-confidence.
C)depressed mood secondary to nightmares and intrusive thoughts.
D)cognitive distortions associated with unresolved childhood abuse issues.

Question 9

A medical-surgical nurse works with a patient diagnosed with a somatic system 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.

Question 10

A person comes to the clinic reporting,"I wear a scarf across my lower face when I go out but because of my ugly appearance." Assessment reveals an average appearance with no actual disfigurement.Which problem is most likely?

A)Dissociative identity disorder
B)Body dysmorphic disorder
C)Pseudocyesis
D)Malingering

Question 11

A patient who fears serious heart disease was referred to the mental health center by a cardiologist after extensive diagnostic evaluation showed no physical illness.The patient says,"I have tightness in my chest and my heart misses beats.I'm frequently absent from work.I don't go out much because I need to rest." Which health problem is most likely?

A)Dysthymic disorder
B)Antisocial personality disorder
C)Simple somatic symptom disorder
D)Prominent health anxiety (hypochondriasis)

Question 12

A woman is 5'7" tall,weighs 160 pounds,and wears a size 8 shoe.She says,"My feet are huge.I've asked three orthopedists to surgically reduce my feet." The patient tries to buy shoes to make her feet look smaller,and in social settings conceals both feet under a table or chair.Which health problem is likely?

A)Dissociative fugue
B)Prominent pain disorder
C)Body dysmorphic disorder
D)Depersonalization disorder

Question 13

A patient with blindness related to a functional neurological (conversion)disorder says,"All the doctors and nurses in this hospital stop by often to check on me.Too bad people outside the hospital don't find me interesting." Which nursing diagnosis is most relevant?

A)Social isolation
B)Chronic low self-esteem
C)Interrupted family processes
D)Ineffective health maintenance

Question 14

A nurse counseling a patient with a dissociative identity disorder should understand that the assessment of highest priority is:

A)Risk for self-harm
B)Cognitive functioning
C)Identification of drug abuse
D)Readiness to reestablish identity or memory

Question 15

A nurse assesses a patient diagnosed with functional neurological (conversion)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."

Question 16

A nurse assessing a patient with a somatic system disorder is most likely to note that the patient:

A)Readily sees a relationship between symptoms and interpersonal conflicts.
B)Rarely derives personal benefit from the symptoms.
C)Has little difficulty communicating emotional needs.
D)Has altered comfort and activity needs.

Question 17

Which assessment finding best supports dissociative fugue? The patient states:

A)"I cannot recall why I'm living in this town."
B)"I feel as if I'm living in a fuzzy dream state."
C)"I feel like different parts of my body are at war."
D)"I feel very anxious and worried about my problems."

Question 18

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 the other family members.
B)Demonstrate a resumption of former roles and tasks.
C)Focus energy on problems occurring in the family.
D)Rely on family members to meet his or her personal needs.

Question 19

To assist a patient with a somatic system disorder,a nursing intervention of high priority is to:

A)imply that somatic symptoms are not real.
B)help the patient suppress feelings of anger.
C)shift the focus from somatic symptoms to feelings.
D)investigate each physical symptom as it is offered.

Question 20

A college student observes a roommate going out wearing uncharacteristically seductive clothing,returning 12 to 24 hours later and sleeping for 8 to 12 hours.At other times,the roommate sits on the floor speaking like a young child.Which health problem should be considered?

A)Functional neurological (conversion)disorder
B)Dissociative identity disorder
C)Depersonalization disorder
D)Body dysmorphic disorder

Question 21

A patient's roommate has observed the patient behaving in uncharacteristic ways,but the patient cannot remember the episodes.A dissociative identity disorder is suspected.Which questions are most relevant to the assessment of this patient? Select all that apply.

A)"Are you sexually promiscuous?"
B)"Do you think you need an antidepressant medication?"
C)"Have you ever found yourself someplace and did not know how you got there?"
D)"Are your memories of childhood clear and complete,or do you have blank spots?"
E)"Have you ever found new things in your belongings that you can't remember buying?"

Question 22

A patient with predominant pain 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 23

A patient with predominant pain 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

Question 24

The causes of somatic system disorders may be related to:

A)faulty perceptions of body sensations.
B)traumatic childhood events.
C)culture-bound phenomena.
D)depressive equivalents.

Question 25

A patient with predominant pain 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)unsuccessful.
B)minimally successful.
C)partially successful.
D)totally achieved.

Question 26

An essential difference between somatic system disorders and dissociative disorders is:

A)Somatic system disorders are under voluntary control,whereas dissociative disorders are unconscious and automatic.
B)Dissociative disorders are precipitated by psychologic factors,whereas somatic system disorders are related to stress.
C)Dissociative disorders are individually determined and related to childhood sexual abuse,whereas somatic system disorders are culture bound.
D)Dissociative disorders entail stress-related disruptions of memory,consciousness,or identity,whereas somatic system disorders involve the expression of psychologic stress through somatic symptoms.

Question 27

A nurse assesses a patient suspected to have complex somatic system disorder.Which findings support the diagnosis? Select all that apply.

A)Patient is a woman.
B)Patient reports frequent syncope.
C)Patient complains of heavy menstrual bleeding.
D)Patient was first diagnosed with psoriasis at 12 years of age.
E)Patient reports back pain,painful urination,frequent diarrhea,and hemorrhoids.

Question 28

A patient with depersonalization disorder tells the nurse,"It's starting again.I feel as though I'm going to float away." The nurse should help the patient by:

A)encouraging meditation.
B)administering an anxiolytic medication.
C)helping the patient visualize a pleasant scene.
D)helping the patient focus on the here and now.

Question 29

A patient says,"I know I have a brain tumor despite the results of the magnetic resonance image (MRI).The radiologist is wrong.People who have brain tumors vomit,and yesterday I vomited all day." Which response by the nurse fosters cognitive restructuring?

A)"You do not have a brain tumor.The more you talk about it,the more it reinforces your illogical thinking."
B)"Let's see whether any other explanations for your vomiting are possible."
C)"You seem so worried.Let's talk about how you're feeling."
D)"We'll talk about something else."

Question 30

Which treatment modality should a nurse recommend to help a patient with pain disorder cope more effectively?

A)Flooding
B)Relaxation
C)Response prevention
D)Systematic desensitization