Chapter 17 Somatic Symptom Disorders PDF

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VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Chapter 17: Somatic Symptom Disorders Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition MULTIPLE CHOICE 1. 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 ANS: B

Patients with illness anxiety disorder (hypochondriasis) tend to be more anxious about their concerns and display more obsessive attention to detail, whereas the patients with conversion (functional neurological) disorder often exhibit less concern with the symptom they are presenting than would be expected. Neither disorder involves voluntary control of the symptoms. Results of diagnostic testing for both would be negative (i.e., no physiological basis would be found for the symptoms). Secondary gains can occur in both disorders but are not necessary to either. See relationship to audience response question. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 17-6 to 9 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity NURSINGTB.COM 2. 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 co-morbid depression c. Long-term use of benzodiazepines to support coping with anxiety d. Conventional antipsychotic medications to correct cognitive distortions ANS: B

Various types of antidepressants may be helpful in somatic disorders not only directly by reducing depressive symptoms and hence somatic responses, but also indirectly by affecting nerve circuits that affect not only mood but also fatigue, pain perception, GI distress, and other somatic symptoms. Patients may benefit from short-term use of antianxiety medication (benzodiazepines) but require careful monitoring because of risks of dependence. Conventional antipsychotic medications would not be used, although selected atypical antipsychotics may be useful. Narcotic analgesics are not indicated. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 17-18, 24 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 3. A medical-surgical nurse works with a patient diagnosed with a somatic symptom disorder.

Care planning is facilitated by understanding that the patient will probably a. readily seek psychiatric counseling.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

b. be resistant to accepting psychiatric help. c. attend psychotherapy sessions without encouragement. d. be eager to discover the true reasons for physical symptoms. ANS: B

Patients with somatic symptom disorders go from one health care provider to another trying to establish a physical cause for their symptoms. When a psychological basis is suggested and a referral for counseling offered, these patients reject both. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 17-29, 30 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 4. 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. ANS: B

Psychoanalytical theory suggests conversion reduces anxiety through production of a physical symptom symbolically linked to an underlying conflict. Conversion, not suppression, is the operative defense mechanism in this disorder. While some MRI studies suggest that patients with conversion disorder have an abnormal pattern of cerebral activation, there is no actual alternation of nerve transmission. The other distracters oversimplify the dynamics, suggesting that only dependency needs are ofNURSINGTB.COM concern, or suggest conscious motivation (conversion operates unconsciously). PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 17-8, 9 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 5. A patient has blindness related to conversion (functional neurological) 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 self after explaining arrangement of the food on the tray. c. direct the patient to locate items on the tray independently and feed self. d. address needs of other patients in the dining room, then feed this patient. ANS: B

The patient is expected to maintain some level of independence by feeding self, while the nurse is supportive in a matter-of-fact way. The distracters support dependency or offer little support. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 17-27, 28 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

6. 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 ANS: B

The patient mentions that the symptoms make people more interested. This indicates that the patient feels uninteresting and unpopular without the symptoms, thus supporting the nursing diagnosis of chronic low self-esteem. Defining characteristics for the other nursing diagnoses are not present in the scenario. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 17-23, 28, 58 (Table 17-3) TOP: Nursing Process: Diagnosis/Analysis MSC: Client Needs: Psychosocial Integrity 7. To assist patients diagnosed with somatic symptom disorders, nursing interventions of high

priority 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. ANS: C

Shifting the focus from somatic symptoms to feelings or to neutral topics conveys interest in the patient as a person rather than NURSINGTB.COM as a condition. The need to gain attention with the use of symptoms is reduced over the long term. A desired outcome would be that the patient would express feelings, including anger if it is present. Once physical symptoms are investigated, they do not need to be reinvestigated each time the patient reports them. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 17-28, 60 (Table 17-4) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 8. A patient with fears of serious heart disease was referred to the mental health center 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) ANS: D

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Illness anxiety disorder (hypochondriasis) involves preoccupation with fears of having a serious disease even when evidence to the contrary is available. The preoccupation causes impairment in social or occupational functioning. Somatic symptom disorder involves fewer symptoms. Dysthymic disorder is a disorder of lowered mood. Antisocial disorder applies to a personality disorder in which the individual has little regard for the rights of others. See relationship to audience response question. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 17-6, 7 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 9. A nurse assessing a patient diagnosed with a somatic symptom disorder is most likely to note

that the patient a. sees a relationship between symptoms and interpersonal conflicts. b. has little difficulty communicating emotional needs to others. c. rarely derives personal benefit from the symptoms. d. has altered comfort and activity needs. ANS: D

The patient frequently has altered comfort and activity needs associated with the symptoms displayed (fatigue, insomnia, weakness, tension, pain, etc.). In addition, hygiene, safety, and security needs may also be compromised. The patient is rarely able to see a relation between symptoms and events in his or her life, which is readily discernible to health professionals. Patients with somatic symptom disorders often derive secondary gain from their symptoms and/or have considerable difficulty identifying feelings and conveying emotional needs to others. NURSINGTB.COM

PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 17-18, 19, 36 (Case Study and Nursing Care Plan) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 10. To plan effective care for patients diagnosed with somatic symptom 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. ANS: D

At the unconscious level, the patient's primary gain from the symptoms is anxiety relief. Considering that the symptoms actually make the patient more psychologically comfortable and may also provide secondary gain, patients frequently fiercely cling to the symptoms. The symptoms tend to be chronic, but that does not explain why they are difficult to give up. The symptoms are not under voluntary control or physiologically based. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 17-18, 19, 36 (Case Study and Nursing Care Plan) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

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11. 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 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. ANS: B

The patient with a somatic symptom disorder has typically adopted a sick role in the family, characterized by dependence. Increasing independence and resumption of former roles are necessary to change this pattern. The distracters are inappropriate outcomes. PTS: REF: TOP: MSC:

1 DIF: Cognitive Level: Apply (Application) Pages 17-23, 24, 36 (Case Study and Nursing Care Plan) Nursing Process: Outcomes Identification Client Needs: Psychosocial Integrity

12. Which comment by a patient who recently experienced a myocardial infarction indicates use

of maladaptive, ineffective coping strategies? a. “My employer should have paid for a health club membership for me.” b. “My family will see me through this. It won’t be easy, but I will never be alone.” c. “My heart attack was no fun, but it showed me up the importance of a good diet

and more exercise.” d. “I accept that I have heart disease. Now I need to decide if I will be able to

continue my work daily.”

NURSINGTB.COM

ANS: A

Blaming someone else and rationalizing one’s failure to exercise are not adaptive coping strategies. Seeing the glass as half full, using social and religious supports, and confronting one’s situation are seen as more effective strategies. The distracters demonstrate effective coping associated with a serious medical condition. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 17-9 to 12 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 13. 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 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.” ANS: A

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Patients with conversion (functional neurological) disorder demonstrate a lack of concern regarding the seriousness of symptoms. This lack of concern is termed la belle indifférence. There is also a specific, identifiable cause for the development of the symptoms; in this instance, the death of a parent would precipitate stress. The distracters relate to sexual dysfunction and illness anxiety disorder. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 17-8, 9 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 14. 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 is most therapeutic? a. “I’m wondering if you are 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 light so frequently. It is a problem.” d. “You frustrate the staff by calling them so often. Why are you doing that?” ANS: A

This patient is experiencing anxiety associated with a serious medical condition. Verbalization is an effective outlet for anxiety. “I’m wondering if you are anxious …” focuses on the emotions underlying the behavior rather than the behavior itself. This opening conveys the nurse’s willingness to listen to the patient’s feelings and an understanding of the commonly seen concern about not having a nurse always nearby as in the intensive care unit. The other options focus on the behavior or its impact on nursing and do not help the patient with her NURSINGTB.COM emotional needs. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 17-9 to 12 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 15. 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 ANS: B

Patients with illness anxiety disorder have fears of serious medical problems, such as cancer or heart disease. These fears persist despite medical evaluations and interfere with daily functioning. There are no complaints of pain. There is no evidence of factitious or conversion disorder. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 17-6, 7 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

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16. 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 a. mood. b. cognitive style. c. secondary gains. d. identity and memory. ANS: C

Secondary gains should be assessed. The patient’s dependency needs may be met through care from the family. When secondary gains are prominent, the patient is more resistant to giving up the symptom. The scenario does not allude to a problem of mood. Cognitive style and identity and memory assessment are of lesser concern because the patient’s diagnosis has been established. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 17-21, 58 (Table 17-3) | Pages 17-28, 60 (Table 17-4) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 17. 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 NURSINGTB.COM voluntary control, whereas somatic symptom disorders involve expression of psychological stress through somatization. ANS: D

The key is the only fully accurate statement. Somatic symptom disorders involve expression of stress through bodily symptoms and are not under voluntary control or culture bound. Factitious disorders are under voluntary control. See relationship to audience response question. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 17-19, 31, 32 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 18. 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.” ANS: B

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Questioning the evidence is a cognitive reframing technique. Identifying causes other than the feared disease can be helpful in changing distorted perceptions. Distraction by changing the subject will not be effective. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 17-25, 30 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 19. 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 ANS: C

Somatic symptom disorders are commonly associated with complicated reactions to stress. These reactions are accompanied by muscle tension and pain. Relaxation can diminish the patien...