Chapter 17 Evolve Resources

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

a Deficient fluid volume

b Self-care deficit

c Ineffective coping

d Delayed growth and development

C

Soma is the Greek word for "body," and somatization is the expression of psychological stress through physical symptoms.

REF: 324, 333

A physician describes a client as "malingering." The nurse knows this means that the client

a is falsely claiming to have 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

Soma is the Greek word for "body," and somatization is the expression of psychological stress through physical symptoms.

REF: 324, 333

An example of a somatoform disorder is

a depersonalization.

b dissociative fugue.

c conversion disorder.

d dissociative identity disorder.

C

Somatic disorders include conversion disorders that are functional neurological disorders.

REF: 325-326

Therapeutic intervention for a client with a somatoform disorder would include

a steering conversation away from the client's feelings.

b conveying an interest in the client rather than in the symptoms.

c encouraging the client to use benzodiazepines liberally.

d encouraging the client to rely on the nurse to meet the client's needs.

B

When the nurse focuses on the client rather than on the symptoms, the client's self-worth and coping skills are enhanced.

REF: 337; Table 17-4

The most likely client to initially demonstrate behaviors suggesting a somatic disorder is a

a 13-year-old male

b 23-year-old female

c 33-year-old male

d 43-year-old female

B

The predominance of women with somatization is significant. It has been proposed that women are more aware of their bodily sensations, have different health-seeking behaviors when faced with physical and psychological distress, and use more health care services than men. In particular, young women aged 16 to 25 are more likely to receive a somatic diagnosis than men or older individuals.

REF: 325

Which disorder is characterized by the client's misinterpretation of physical sensations or feelings?

a Somatic disorder

b Factitious disorder

c Illness anxiety disorder

d Conversion disorder

C

Previously known as hypochondriasis, illness anxiety disorder results in the misinterpretation of physical sensations as evidence of a serious illness. Illness anxiety can be quite obsessive, because thoughts about illness may be intrusive and difficult to dismiss, even when the patient recognizes that his or her fears are unrealistic.

REF: 325

Studies have shown a correlation between mental disorders and medical conditions such as

a psoriasis.

b asthma.

c renal failure.

d cancer.

D

Studies in recent years have contributed to the growing body of evidence indicating a link between mental disorders and medical conditions such as cardiovascular disease and cancer.

REF: 326

When discussing somatic disorders from a cultural perspective, it is true that

a somatic disorders are rarely observed in males.

b somatic symptoms vary widely from culture to culture.

c underdeveloped countries rarely tolerate somatic disorders.

d secondary gain is seldom a factor in somatic disorders.

B

The type and frequency of somatic symptoms vary across cultures.

REF: 328

A class of medications commonly prescribed for somatic disorders is

a mood stabilizers.

b antidepressants.

c anxiolytics.

d antipsychotics.

C

Primary care providers prescribe anxiolytic agents for patients who seem highly anxious and concerned about their symptoms. Individuals experiencing many somatic complaints often become dependent on medication to relieve pain or anxiety or to induce sleep.

REF: 333

When caring for a client demonstrating the inability to provide effective self-care, the nurse

a identifies the level of self-care the client is willing to perform and sets expectations accordingly.

b initially sets only minimal self-care expectations for the client.

c attends to all self-care needs until the client indicates a willingness to perform care independently.

d identifies the client's highest level of self-care and states reasonable expectations to the client.

D

In general, interventions involve the use of a matter-of-fact approach to support the highest level of self-care the client can perform. For clients manifesting paralysis, blindness, or severe fatigue, an effective nursing approach is to support the client while expecting the individual to feed, bathe, or groom himself or herself.

REF: 335

Which statement about somatoform 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

Somatization disorders are believed to be responses to psychosocial stress, although the patient often shows no insight into the potential stressors.

REF: Page 339-340

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

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.

REF: Page 336

Providing care to a client diagnosed with a somatization disorder can be frustrating owing to the client's lack of an organic illness. In order to best manage this barrier to care the staff will

A regularly discuss their feelings about the client during the unit's interprofessional care meetings.

B be required to attend in-services that focus on the various aspects of somatic disorders.

C rotate care of the client among the entire nursing department staff to minimize the frustration.

D provide a unified approach to the client's behavior so as to manage and lessen the barrier itself.

A

It is helpful for health care workers, no matter the setting, to discuss responses to these patients in conferences with other health care members to allow for expression of feelings and, ultimately, to provide for consistent care.

REF: Page 331-332

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

Somatic symptoms are reinforced by situations in which there is some sort of "payoff" for the client, such as 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.

REF: Page 328

Which disorder places the client at highest risk for developing a coexisting substance abuse disorder?

A Conversion disorder

B Factitious disorder

C Somatoform pain disorder

D Illness anxiety disorder

C

Clients with pain disorder may use alcohol or other central nervous system depressants or anxiolytic drugs to self-medicate.

REF: Page 16-17

The primary difference between a factitious disorder and other somatic disorders is that factitious disorders

A respond well to confrontation as a primary therapeutic technique.

B have a symptomatology that is actually controlled by the client.

C have their origins in depression and anxiety.

D are always self-directed.

B

Factitious disorders, in contrast to other somatic disorders, are under conscious control.

REF: Page 331-332

Which statement made by a client would support the diagnosis of hypochondriasis?

A "I feel confused and disoriented."

B "I feel 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

Hypochondriasis is characterized by the persistent belief that one has a serious medical condition despite lack of evidence to prove this.

REF: Page 325

A woman 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 is an attitude of unconcern about a symptom that is unconsciously used to lower anxiety.

REF: Page 325-326

What statement by a client would indicate that goals for treatment for a somatization disorder are being achieved?

A "I feel less anxiety than 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 think about my symptoms all the time as I used to."

D

his statement indicates that the client's preoccupation with the physical symptom has decreased, a highly desirable outcome.

REF: Page 329 (Considering culture box)

The wife of a client diagnosed with hypochondriasis tells the nurse, "It is so difficult! Whenever we make plans my husband says he is too ill to go. 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

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.

REF: Page 333 (Table 17-3)

In somatization disorders, it is important for the nurse to employ holistic strategies. This can be defined as:

A utilizing many different therapeutic strategies or modalities for enhanced coping.

B involving every member of the family as well as the patient in treatment.

C incorporating spirituality and religion into treatment.

D considering all dimensions of the patient, including biological, psychological, and sociocultural.

D

It is important to use a holistic approach in nursing care so that we may address the multidimensional interplay of biological, psychological, and sociocultural needs and its effects on the somatization process. All nurses need to be aware of the influence of environment, stress, individual lifestyle, and coping skills of each patient. The other options do not explain the concept of holistic care.

Cognitive Level: Understand (Comprehension)

Nursing Process: Planning

NCLEX: Psychosocial Integrity

Text page: 325

Emily is a veteran returning from Iraq. Ever since Emily participated in a village raid where explosives were used, she has been unable to walk. All diagnostic testing has been negative for any physical abnormalities, and she was diagnosed with conversion disorder. She asks you what that means. Your best response would be:

A "Your legs don't work because your brain is screwed up."

B "Your emotional distress is being expressed as a physical symptom."

C "You are making up your symptoms as a cry for help."

D "You are overly anxious about having a severe illness."

B

Conversion disorder is attributed to channeling of emotional conflicts or stressors into physical symptoms. Telling the patient her brain is "screwed up" is unprofessional and does not give any useful education. Symptoms of conversion disorder are not within the patient's voluntary control. Being overly anxious about having a severe illness describes illness anxiety disorder.

Cognitive Level: Apply (Application)

Nursing Process: Implementation

NCLEX: Psychosocial Integrity

Text page: 325-326

What would be an appropriate expected outcome of Emily's treatment plan?

A Emily will walk unassisted within 1 week.

B Emily will return to a pre-illness level of functioning within 2 weeks.

C Emily will be able to state two new effective coping skills within 2 weeks.

D Emily will assume full self-care within 3 weeks.

C

An appropriate outcome for somatization disorders is to be aware of negative coping strategies and learn new, effective skills for coping within a realistic timeframe. In the other options, the time frames of these outcomes are unrealistic.

Cognitive Level: Apply (Application)

Nursing Process: Outcome Identification

NCLEX: Psychosocial Integrity

Text page: 331

Emily asks you what kind of therapy will help her. Your best response, based on current knowledge, is:

A "A combination of antianxiety and antidepressant therapy is the most effective therapy."

B "Aversion therapy is often used because in effect you are punishing yourself by not being able to walk."

C "Modeling will be used; as you see desired behaviors modeled by the therapist you will be able to also achieve the expected outcome."

D "Cognitive behavioral therapy has been shown to consistently provide the best outcome for these types of disorders."

D

Cognitive behavioral therapy (CBT) is the most consistently supported treatment for the full spectrum of somatic disorders. All the other options are incorrect and do not describe the most used and effective therapy for this disorder.

Cognitive Level: Analyze (Analysis)

Nursing Process: Planning

NCLEX: Psychosocial Integrity

Text page: 336

Shane, aged 23 years, is admitted to your medical-surgical unit with complaints of abdominal pain, dizziness, and headaches. Results of a physical workup have been negative so far. Today Shane tells you, "Now I am having back pain." Which of the following in Shane's medical record may alert you to the possibility of malingering? (select all that apply):

A Shane has a court date this week for drunk driving.

B Shane was adopted at the age of 5 years.

C Shane has a history of physical abuse by his stepfather.

D Shane has a history of oppositional-defiant disorder.

E Shane was raised primarily by his mother.

AC

Malingering is a process of fabricating an illness or exaggerating symptoms to gain a desired benefit or avoid something undesired, such as to obtain prescription medications, evade military service, or evade legal action. It is more common in men, those who have been neglected or abused in childhood, and those who have had frequent childhood hospitalizations. Adoption is not known to be a causative factor in malingering. A history of oppositional-defiant disorder is not known to a causative factor in malingering. Being raised in a single parent home or by a primarily female influence is not known to be a causative factor in malingering.

Cognitive Level: Analyze (Analysis)

Nursing Process: Diagnosis

NCLEX: Psychosocial Integrity

Text page: 337