NUR210CH22

  1. Which nursing diagnosis should be investigated for clients with somatoform disorders?

    A. Deficient fluid volume
    B. Self-care deficit
    C. Disturbed personal identity
    D. Delayed growth and development
    B. Self-care deficit

    Clients with somatoform disorders may be unable to meet certain self-care needs because of pain, paralysis, weakness, and fatigue. Text page: 510
  2. Use of dissociation most closely resembles

    A. sitting in a lecture and "tuning out."
    B. developing a headache to avoid an unpleasant task.
    C. feeling angry with a co-worker who shirks work.
    D. finding a socially acceptable reason to meet a need.
    A. sitting in a lecture and "tuning out."

    Dissociation involves having one's thoughts or feelings out of conscious awareness and is similar to, but more drastic than, inattention to a lecture. Text page: 515
  3. A physician describes a client as "malingering." The nurse knows this means the client

    A. is falsely claiming to have the symptoms.
    B. experiences symptoms that cannot be explained medically.
    C. experiences symptoms that have a physiological basis.
    D. is seeking medication to ease pain of psychological origin.
    A. is falsely claiming to have the symptoms.

    Malingering is a conscious effort to deceive others by pretending to have certain incapacitating physical symptoms. The goal of malingering can often be financial gain. Text page: 514
  4. What symptom characterizes body dysmorphic disorder?

    A. Severe pain with psychological origins
    B. Fear of having a life-threatening illness
    C. Multiple physical symptoms spanning many years
    D. Preoccupation with an imagined defect in appearance
    D. Preoccupation with an imagined defect in appearance

    The primary symptom of body dysmorphic disorder is preoccupation and loathing of a defect in one's physical appearance. Text page: 505
  5. Which neurotransmitter has been implicated as a possible causative factor in both pain disorder and body dysmorphic disorder?

    A. Dopamine
    B. Serotonin
    C. Norepinephrine
    D. Acetylcholine
    B. Serotonin

    Serotonin is implicated primarily because clients with pain disorder and body dysmorphic disorder have responded to selective serotonin reuptake inhibitors. Text page: 507
  6. Dissociative identity disorder is characterized by

    A. the inability to recall important information.
    B. sudden unexpected travel away from home and inability to remember the past.
    C. the existence of two or more subpersonalities, each with its own patterns of thinking.
    D. recurring feelings of detachment from one's body or mental processes.
    C. the existence of two or more subpersonalities, each with its own patterns of thinking.

    In dissociative identity disorder, aspects of the self may emerge as distinct personalities, with the individual losing sense of who he or she is. Dissociative identity disorder was previously referred to as multiple personality disorder. Text page: 517
  7. An example of a somatoform disorder is

    A. depersonalization.
    B. dissociative fugue.
    C. conversion disorder.
    D. dissociative identity disorder.
    C. conversion disorder.

    A somatoform disorder has physical symptoms. Conversion disorder is the only option in which the client would display somatic symptoms. The other options are examples of dissociative disorders. Text page: 506
  8. Therapeutic intervention for a client with a somatoform disorder would include

    A. steering conversation away from client feelings.
    B. conveying interest in the client rather than in symptoms.
    C. encouraging the client in liberal use of benzodiazepines.
    D. encouraging the client to refer to the nurse for meeting client needs.
    B. conveying interest in the client rather than in symptoms.

    Clients with somatoform disorders often have poor self-esteem. They expect to receive attention for their symptoms rather than for themselves. Shifting emphasis from the symptom to the person raises self-esteem and does not reinforce reliance on the symptom as a way of getting emotional needs met. Text page: 511
  9. What information should the nurse give to the family of a client who has had a dissociative episode?

    A. Dissociation is a method for coping with severe stress.
    B. Dissociation suggests the possibility of early dementia.
    C. Alert family that brief periods of psychotic behavior may occur.
    D. How to intervene to prevent self-mutilation and suicide attempts.
    A. Dissociation is a method for coping with severe stress.

    This explanation helps families see the disorder as less "weird" and helps them understand that treatment will be aimed at identifying and developing alternative coping strategies. Text page: 515
  10. For a client with pain disorder, the etiology statement most consistent with current theory would be "related to

    A. difficulty expressing emotions."
    B. altered perceptions of pain stimuli."
    C. lack of coping skills."
    D. unmet dependency needs."
    B. altered perceptions of pain stimuli."

    Current research suggests that clients with pain disorder have altered perceptions of pain stimuli, perhaps caused by serotonin and endorphin deficiency. Text page: 507
  11. Which statement about somatoform and dissociative disorders is true?

    A. An organic basis exists for each group of disorders.
    B. Nurses perceive clients with these disorders as easy to care for.
    C. No relation exists between these disorders and early childhood loss or trauma.
    D. Clients lack awareness of the relations among symptoms, anxiety, and conflicts.
    D. Clients lack awareness of the relations among symptoms, anxiety, and conflicts.

    Option 4 is the only true statement. Text page: 507
  12. Which item of data should be routinely gathered during assessment of a client with a somatoform disorder?

    A. Potential for violence
    B. Level of confusion
    C. Dependence on medication
    D. Personal identity disturbance
    C. Dependence on medication

    Many clients with somatoform disorder have received prescription medication for anxiety or pain relief and may have developed dependence. Assess not only for what the client has taken, but also for amounts and length of time over which the drugs have been prescribed. Text page: 509
  13. Which item of data routinely gathered during assessment of a client with dissociative disorder would be of least relevance to planning?

    A. Voluntary control of symptoms
    B. Ability to remember
    C. Level of anxiety
    D. Evidence of confusion and disorientation
    A. Voluntary control of symptoms

    Clients with dissociative disorders do not have voluntary control of symptoms. Voluntary control of symptoms has greater relevance when the nurse is assessing clients with somatoform disorders. Text page: 507
  14. Which behavior by a client would not support a diagnosis of somatoform disorder?

    A. Attention seeking from significant others
    B. Acquiring financial gain from a disability plan
    C. Avoidance of certain unpleasant activities
    D. Performing activities of daily living unassisted
    D. Performing activities of daily living unassisted

    Somatic symptoms are reinforced by situations in which there is some sort of "payoff" for the client: attention, financial gain, avoidance of unpleasant situations, or getting dependent needs met. Performing activities of daily living unassisted would have no payoff of the sort mentioned. Text page: 512
  15. During which client assessment interview should the nurse be particularly alert for the possibility of coexisting substance abuse disorder?

    A. Mrs. R, who has hypochondriasis
    B. Mrs. S, who has body dysmorphic disorder
    C. Mr. U, who has somatoform pain disorder
    D. Mr. V, who has been diagnosed as malingering
    C. Mr. U, who has somatoform pain disorder

    Clients with pain disorder may use alcohol or other central nervous system depressants or anxiolytic drugs to self-medicate. Text page: 503
  16. The symptom the nurse can expect a client with depersonalization disorder to manifest is

    A. aimless wandering with confusion and disorientation.
    B. a feeling of detachment from one's body or mental processes.
    C. existence of two or more personalities that take control of behavior.
    D. worry about having a serious disease based on symptom misinterpretation.
    B. a feeling of detachment from one's body or mental processes.

    Depersonalization is characterized by a sense of unreality or self-estrangement. Text page: 516
  17. The nurse would expect the chief complaint of the client with hypochondriasis to be

    A. "I feel confused and disoriented."
    B. "I feel spaced out, as though I'm outside my body watching what is happening."
    C. "I know I have cancer, but the doctors just cannot find it."
    D. "I woke up one morning and my left leg was paralyzed from the knee down."
    C. "I know I have cancer, but the doctors just cannot find it."

    Hypochondriasis is characterized by the persistent belief that one has a serious medical condition despite lack of evidence to prove this. Text page: 503
  18. A woman has to take her real estate examination tomorrow but suddenly finds she cannot see. She seems unconcerned about her symptom and tells her husband "Don't worry, dear. Things will all work out." Her attitude is an example of

    A. regression.
    B. depersonalization.
    C. la belle indifference.
    D. dissociative amnesia.
    C. la belle indifference.

    La belle indifference is an attitude of unconcern about a symptom that is unconsciously used to lower anxiety. Text page: 506
  19. What statement by a client would indicate that goals for treatment of her somatization disorder are being achieved?

    A. "I feel less anxiety that before."
    B. "My memory is better than it was a month ago."
    C. "I take my medications just as the physician prescribed."
    D. "I don't find myself thinking about my symptoms all the time as I used to."
    D. "I don't find myself thinking about my symptoms all the time as I used to."

    This statement indicates that the client's preoccupation with the physical symptom has decreased, a highly desirable outcome. Text page: 503
  20. A client has had hypochondriasis for 2 years. His wife tells the nurse "It is so difficult! Whenever we make plans to get together with another couple or go on vacation or do anything pleasant, my husband throws a monkey wrench in the works, saying he is too ill, or he needs to make a doctor's appointment. I don't know how much longer I can take it." On the basis of this report, the nurse may wish to explore the nursing diagnosis of

    A. interrupted family processes.
    B. decisional conflict.
    C. risk for caregiver role strain.
    D. impaired home maintenance.
    C. risk for caregiver role strain.

    Caregiver role strain is defined as caregiver's felt or expressed difficulty in performing the family caregiver role. The statements "It is so difficult" and "I don't know how much longer I can take it" are the clues. Text page: 510
  21. A patient states she has been ill for several months with stomach pain, headache, and
    dizziness. A review of records shows that she has been tested repeatedly for various conditions, yet no clinical diagnosis has been found. She states her pain is “10 out of 10” on a scale of 1 to
    10. She has been treated in the past for anxiety and depression. Which condition should the nurse anticipate?




    C. Somatization

    Somatization is characterized by a certain number of symptoms accompanied by significant functional impairment. Pain, gastrointestinal concerns, and psychoneurological symptoms are hallmarks of this condition. Complaints are dramatic and sometimes difficult to clarify. Hypochondriasis results in the misinterpretation of innocent physical sensations as evidence of a serious illness. Conversion disorder is marked by the presence of deficits in voluntary motor or sensory functions, including paralysis, blindness, movement disorder, gait disorder, numbness, paresthesia, loss of vision or hearing, or episodes resembling epilepsy. Body dysmorphic disorder is characterized by a preoccupation with an imagined defective body part, resulting in obsessional thinking and compulsive behavior such as mirror checking and camouflaging.
  22. A patient presents to the emergency department with a sudden onset of lower paralysis. Although the patient’s wife is hysterical, the patient himself is calm and unemotional. All organic causes for the paralysis have been ruled out. Which condition should the nurse anticipate?




    B. Conversion disorder
  23. A patient has been diagnosed with Munchausen’s syndrome. Which behavior should the nurse anticipate?

    A. Tendency to frequent the same caregiver and use the emergency department at night
    B. Exaggeration of symptoms with the intent of becoming eligible for disability
    compensation
    C. Inability to recall important information related to a recent rape attempt
    D. Attempts to make oneself ill and going from one hospital to another to call attention to oneself
    D. Attempts to make oneself ill and going from one hospital to another to call attention to oneself

    The tendency to frequent the same caregiver and use the emergency department at night is associated with common factitious disorder. Exaggeration of symptoms with the intent of becoming eligible for disability compensation is associated with malingering. Inability to recall important information related to a traumatic or stressful event is called dissociative amnesia. Attempts to make oneself ill and going from one hospital to another to call attention to oneself is associated with Munchausen’s syndrome.
  24. The nurse is planning care for a patient with a somatoform disorder. Which intervention(s)
    would be appropriate? Select all that apply.

    1. Have patient direct requests to varying nurses so they will become familiar with the
    patient’s needs.
    2. Objectively explain that the patient’s symptoms are not real.
    3. Teach assertive communication.
    4. Shift focus from somatic concerns to feelings.
    5. Spend time with patient only when summoned.
    3, 4

    • Teaching assertive communication provides the patient with a positive means of getting needs met while reducing feelings of helplessness and the need for manipulation. Shifting focus from somatic concerns to feelings conveys an interest in the patient as a person rather than in the patient’s symptoms, which reduces the need to gain attention via symptoms. The patient
    • should be taught to direct all requests to the case manager to reduce manipulation. The nurse should not imply that the symptoms are not real, because this may alienate the patient who feels that his or her symptoms truly are real. Spending time with the patient outside of being summoned rewards non-illness-related behaviors and encourages repetition of the desired behavior.
  25. Somatization Disorder
    Type of Somatoform Disorder

    1. History of many physical complaints beginning before 30 years of age, occurring over a period of years and resulting in impairment in social, occupational, or other important areas of functioning.

    • 2. Complaints must include all of the following:
    • • History of pain in at least four different sites or functions
    • • History of at least two gastrointestinal symptoms other than pain
    • • History of at least one sexual or reproduction symptom
    • • History of at least one symptom defined as or suggesting a neurological disorder
  26. Conversion Disorder
    Type of Somatoform Disorder

    Voluntary motor or sensory function, so paralysis possible as well as blindness, etc.

    1. Development of one or more symptoms or deficits suggesting a neurological disorder (blindness, deafness, loss of touch) or general medical condition.

    2. Psychological factors are associated with the symptom or deficit because the symptom is initiated or exacerbated by psychological stressors.

    3. Not due to malingering or factitious disorder and not culturally sanctioned.

    4. Cannot be explained by general medical condition or effects of a substance.

    5. Causes impairment in social or occupational functioning, causes marked distress, or requires medical attention.
  27. Hypochondriasis
    Type of Somatoform Disorder

    For at least 6 months:

    1. Preoccupation with fears of having, or the idea that one has, a serious disease.

    2. Preoccupation persists despite appropriate medical tests and reassurances.

    3. Other disorders are ruled out (e.g. Somatic delusional disorders).

    4. Preoccupation causes significant impairment in social or occupational functioning or causes marked distress.
  28. Pain Disorder
    Type of Somatoform Disorder

    1. Pain in one or more anatomical sites is a major part of the clinical picture.

    2. Causes significant impairment in occupational or social functioning or causes marked distress.

    3. Psychological factors thought to cause onset, severity, or exacerbation. Pain associated with psychological factors.

    4. Symptoms not intentionally produced or feigned. If medical condition present, it plays minor role in accounting for pain.

    5. Pain may be associated with a psychological and/or medical condition. Both factors are judged to be important in onset, severity, exacerbation, and maintenance of pain.
  29. Body Dysmorphic Disorder (BDD)
    Type of Somatoform Disorder

    Often Pt keeps the disorder secret for many years and does not respond to reassurance. It is chronic and response to treatment is limited.

    1. Preoccupation with some imagined defect in appearance. If the defect is present, concern is excessive.

    2. Preoccupation causes significant impairment in social or occupational functioning or causes marked distress.

    3. Preoccupation not better accounted for by another mental disorder.
  30. la belle indifference?
    Conversion disorder pts. with a lack of emotional concern about their very real and physically limiting symptoms, e.g. blindness.
Author
TomWruble
ID
202044
Card Set
NUR210CH22
Description
Somatoform, Factitious, and Dissociative Disorders
Updated