Deck 12: Somatic Symptom Disorders and Dissociative Disorders

Question 1

A college student observes a roommate going out wearing uncharacteristically seductive clothing, returning 12 to 24 hours later, and then 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) Dissociative amnesia
D) Derealization disorder

Answer 1

Dissociative identity disorder

Question 2

An adult diagnosed with conversion (functional neurobiological symptom) disorder says, "Our family has gotten along over the years by working together. My partner cooks and the children clean house." Nursing interventions should recognize that the patient likely:

A) receives secondary gains from the symptoms.
B) has problems with sexual identity and satisfaction.
C) will be resistant to developing a trusting relationship.
D) will benefit from confrontation about physical complaints.

Answer 2

receives secondary gains from the symptoms.

Question 3

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 3

Depersonalization

Question 4

A patient is hospitalized with blindness of sudden onset. According to the spouse, the patient entered a room and found the spouse in a romantic embrace with a neighbor. The patient is unconcerned about the blindness and says, "I'm sure things will turn out all right." Which term best describes this reaction? A person comes to the clinic reporting, "I wear a scarf across my lower face when I go out because of my ugly appearance." Assessment reveals an average appearance with no actual disfigurement. Which problem is most likely?

A) La belle indifference
B) Agoraphobia
C) Dissociation
D) Fugue

Question 5

To plan effective care for patients diagnosed with somatic system disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms:

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

Question 6

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 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

A patient diagnosed with a somatic symptom disorder has the nursing diagnosis: interrupted family processes, related to patient's disabling symptoms as evidenced by the 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 9

Which assessment finding best supports the diagnosis of dissociative amnesia with 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 10

To assist a patient diagnosed 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 soon as it is reported.

Question 11

A nurse assessing a patient diagnosed 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 unmet needs related to comfort and activity.

Question 12

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 13

A nurse counseling a patient diagnosed with dissociative identity disorder (DID) 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 14

Select the correct etiology to complete this nursing diagnosis for a patient diagnosed 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 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

For a patient diagnosed 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 17

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) Illness anxiety disorder (hypochondriasis)
C) Derealization disorder
D) Dissociative amnesia with fugue

Question 18

A patient who fears serious heart disease was referred to the mental health center by a cardiologist after diagnostic evaluation showed no physical illness. The patient says, "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) Depersonalization disorder
B) Antisocial personality disorder
C) Illness anxiety disorder (hypochondriasis)
D) Persistent depressive disorder (dysthymia)

Question 19

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 20

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 himself 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 himself or herself unassisted.
D) address the needs of other patients in the dining room, and then feed this patient.

Question 21

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

Question 22

What is the primary difference between somatic system disorders and dissociative disorders?

A) Somatic system disorders are under voluntary control, whereas dissociative disorders are unconscious and automatic.
B) Dissociative disorders are precipitated by psychological 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 psychological stress through somatic symptoms.

Question 23

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 should talk about something else."

Question 24

A patient diagnosed with 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

Question 25

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

A) Female
B) Reports frequent syncope
C) Complains of heavy menstrual bleeding
D) First diagnosed with psoriasis at 12 years of age
E) Reports of back pain, painful urination, frequent diarrhea, and hemorrhoids

Question 26

A patient diagnosed 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 27

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

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

Question 28

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) mood instability.

Question 29

A patient diagnosed with somatic symptom disorder says, "I have pain 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 30

A patient's roommate has observed the patient behaving in uncharacteristic ways, but the patient cannot remember the episodes. Dissociative identity disorder (DID) 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?"