Chapter 29: Somatic Symptom and Dissociative Disorders

Which student statement indicates an understanding regarding dissociative identity disorder (DID)?

1. "I suspect my client inherited this disease from his parent."

2. "It is unlikely my client had a diagnosis of schizophrenia before DID, since the two do not go hand in hand."

3. "My client experiences periods of blackouts, or lost time where he doesn't know what happened during that time frame."

4. "I assume my client has other personalities because he doesn't want to deal with real life."

3

The nurse is working with a client diagnosed with somatic symptom disorder. Which predominant symptoms would the nurse expect to assess?

1. Disproportionate and persistent thoughts about the seriousness of one's symptoms

2. Amnestic episodes in which the client is pain free

3. Excessive time spent discussing psychosocial stressors

4. Lack of physical symptoms

1

Which outcome is appropriate when planning care for an inpatient client diagnosed with somatic symptom disorder?

1. The client will admit to fabricating physical symptoms to gain benefits by day 3.

2. The client will list three potential adaptive coping strategies to deal with stress by day 2.

3. The client will comply with medical treatments for physical symptoms by day 3.

4. The client will openly discuss physical symptoms with staff by day 4.

2

A client has been diagnosed with somatic symptom disorder. As the nurse is talking with this client and her family, which statement suggests primary or secondary gains that the physical symptoms are providing for the client?

1. The family agrees that the client began having physical symptoms after she lost her job.

2. The client states that even though medical tests have not found anything wrong, she is convinced her headaches are indicative of a brain tumor.

3. The client's mother reports that someone from the family stays with her each night because the physical symptoms are incapacitating.

4. The client states she noticed feeling hotter than usual the last time she had a headache.

3

Which student statement about clients diagnosed with this disorder indicates that learning has occurred regarding the etiology of dissociative disorders from a psychoanalytical perspective?

1. "Dissociative behaviors occur when individuals repress distressing mental information from their conscious awareness."

2. "When their physical symptoms relieve them from stressful situations, their amnesia is reinforced.

3. "People with dissociative disorders typically have strong egos."

4. "There is clear and convincing evidence of a familial predisposition to this disorder."

1

An inpatient client is newly diagnosed with DID stemming from severe childhood sexual abuse. Which nursing intervention is the priority?

1. Encourage exploration of sexual abuse.

2. Encourage guided imagery.

3. Establish trust and rapport.

4. Administer antianxiety medications.

3

A client diagnosed with DID switches personalities when confronted with destructive

behavior. The nurse recognizes that this dissociation serves which function?

1. It is a means to attain secondary gain.

2. It is a means to explore feelings of excessive and inappropriate guilt.

3. It serves to isolate painful events so that the primary self is protected.

4. It serves to establish personality boundaries and limit inappropriate impulses.

3

A client is diagnosed with DID. Which statement describes the primary goal of therapy for this client?

1. To recover memories and improve thinking patterns

2. To prevent social isolation

3. To decrease anxiety and the need for secondary gain

4. To collaborate among subpersonalities to improve functioning

4

Which statement accurately describes dissociative fugue?

1. Dissociative fugue is not precipitated by stressful events.

2. Dissociative fugue is characterized by sudden, unexpected travel or bewildered wandering with inability to recall some or all of one's past.

3. Dissociative amnesia and dissociative fugue are completely different types of disorders.

4. Dissociative fugue is characterized by a sense of observing oneself from outside the body.

2

Which would the nurse recognize as an example of localized amnesia?

1. A client cannot relate any lifetime memories, including personal identity.

2. A client can relate family memories but has no recollection of a particular brother.

3. A client cannot remember events surrounding a fatal car accident.

4. A client whose home was destroyed by a tornado only remembers waking up in the hospital.

3

Neurological tests have ruled out pathology in a client's sudden lower-extremity paralysis. Which nursing care would be included for this client?

1. Deal with physical symptoms in a detached manner.

2. Challenge the validity of physical symptoms.

3. Meet dependency needs until the physical limitations subside.

4. Encourage a discussion of feelings about the lower-extremity problem.

1

The family of a client diagnosed with conversion disorder asks the nurse, "Will his paralysis ever go away?" Which response by the nurse is evidence based?1. "Most symptoms of conversion disorder resolve within a few weeks."

2. "Typically, people who have conversion disorder symptoms that include paralysis will be paralyzed for the rest of their lives."

3. "The only people who recover are those who develop conversion disorder symptoms without a precipitating stressful event."

4. "Technically, he could walk now since he is intentionally feigning paralysis."

1

The nurse is educating a client diagnosed with Munchausen syndrome. Which statement made by the nurse is correct?

1. "A characteristic of your disorder is that you fabricate signs and symptoms of illness."

2. "Having your condition means that you hear voices that guide your actions."

3. "Your condition causes you to experience a change in body function that cannot be explained."

4. "Your symptom of memory loss is very common in your condition."

1

The nurse documents assessment findings of a client who is unable to recall all specifics related to compound childhood traumas. Which disorder is the client experiencing?

1. Localized amnesia

2. Selective amnesia

3. Generalized amnesia

4. Retrograde amnesia

1

The nurse is caring for a client diagnosed with conversion disorder. Which statement made by the nurse is most therapeutic for this client?

1. "I think you could get over this condition if you tried hard enough. A positive outlook can change everything."

2. "I'm so sorry that your back hurts so much. Yes, I'm happy to get you a wheelchair so you don't have to walk to meals."

3. "I think that your symptoms are just in your head. Therapy can help you get rid of them."

4. "I am pleased to hear you say that you recognize that your anxiety may be the cause of your swallowing difficulties.'

4

A healthy adolescent client with no history of substance abuse presents to the mental health clinic. This client tells the nurse that she has experienced several episodes where she feels like she is watching a movie of herself where she is floating above and watching herself as an outside observer. She asks the nurse what is wrong with her. Which statement made by the nurse is most

appropriate?

1. "You have derealization disorder and must be treated for this immediately."

2. "These may be symptoms of depersonalization disorder, but I'm going to suggest you meet with the psychiatrist for a diagnosis."

3. "You must be schizophrenic. I'm going to ask the psychiatrist to run some tests on you."

4. "I wouldn't worry about these symptoms. These are typical for female teenagers who are experiencing hormonal changes."

2

Which scenario best describes Munchausen by proxy?

1. A wife makes her husband ill so she can be seen as the hero when bringing him to the emergency department.

2. A client uses three personalities to block out the trauma of sexual abuse experienced as a child.

3. A former soldier thinks back to an experience and sees himself observing from a distance and wonders what he would do in that situation.

4. A client has a strong desire to be pregnant and has morning sickness and symptoms associated with pregnancy but has a negative pregnancy test.

1

A client is diagnosed with illness anxiety disorder. Which symptoms is the client most likely to exhibit? Select all that apply.

1. Obsessive-compulsive traits

2. Pseudocyesis

3. Disabling fear of having a serious illness

4. Multiple pronounced physical symptoms

5. Depression

1, 3, 5

A client is exhibiting symptoms of generalized amnesia. Which questions would the nurse ask to confirm this diagnosis? Select all that apply.

1. "Can you tell me your name and where you live?"

2. "Have you ever traveled suddenly or unexpectedly away from home?"

3. "Have you recently experienced any traumatic event?"

4. "Have you ever felt detached from your environment?"

5. "Have you had any history of memory problems?"

1, 5

A client diagnosed with DID has likely been diagnosed with which disorders in the past? Select all that apply.

1. Attention deficit-hyperactivity disorder

2. Depression

3. Bipolar Disorder

4. Epilepsy

5. Oppositional Defiant Disorder

6. Schizophrenia

2, 3, 4, 6

A client is diagnosed with somatic symptom disorder. Which question will help the nurse develop nursing diagnoses for this client's plan of care? Select all that apply.

1. "Have you had thoughts of self-harm?"

2. "How many physicians have you seen in the past 6 months?"

3. "Do you take medication for anxiety as prescribed?"

4. "When did you last feel detached from your environment?"

5. "How long have you had these memory problems?"

1, 2, 3

A 56-year-old is brought to the emergency department by the police because she was found wandering confusedly in a busy shopping center several miles from her home. The nurse assesses the client and finds that she has been the victim of domestic violence for 32 years and has recently been beaten by her spouse. Her recollection of current events is hazy and she is not able to give the nurse a detailed account of the abuse. Which of the client's symptoms cause the nurse to suspect that she is suffering from dissociative fugue? Select all that apply.

1. Her trip to a shopping center several miles from her home

2. The client's confused wandering

3. Her ability to stay with an abuser all these years

4. The client's inability to offer details about the domestic abuse

1, 2, 4

A client is diagnosed with a dissociative disorder. Which actions would the nurse take when teaching the client about her disorder? Select all that apply.

1. The nurse should determine if the client is anxious.

2. The nurse should explore the client's fears.

3. The nurse should ask the physician to explain test results to the client.

4. The nurse should ask the family to engage in role-play.

1, 2