Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Differentiate among somatoform disorders, factitious disorders, and malingering.

Question 14

Type: MCSA

The nurse cares for several clients with somatoform disorders, regularly reassessing their status. The nurse is aware that it is:

1. Easy to be kind, nonjudgmental, and understanding.

2. Challenging because of the psychobiologic factors involved.

3. Best to include objective information only.

4. Best to include subjective information only.

Correct Answer: 2

Rationale 1: It can be difficult to assess the client because of the psychobiologic factors involved. It is not always easy to be kind, nonjudgmental, and understanding with this group of clients. Both objective and subjective information should be included in the assessment.

Rationale 2: It can be difficult to assess the client because of the psychobiologic factors involved. It is not always easy to be kind, nonjudgmental, and understanding with this group of clients. Both objective and subjective information should be included in the assessment.

Rationale 3: It can be difficult to assess the client because of the psychobiologic factors involved. It is not always easy to be kind, nonjudgmental, and understanding with this group of clients. Both objective and subjective information should be included in the assessment.

Rationale 4: It can be difficult to assess the client because of the psychobiologic factors involved. It is not always easy to be kind, nonjudgmental, and understanding with this group of clients. Both objective and subjective information should be included in the assessment.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Perform a thorough and comprehensive assessment of clients with dissociative, somatoform, and factitious disorders.

Question 15

Type: MCSA

A client presents to the community clinic describing abdominal pain, refuses to complete informational forms, and dismisses the nurses assessment attempts while demanding to be seen immediately by a doctor. Which approach would be best for the nurse to use when assessing for somatoform disorders?

1. Realize client judgment is intact.

2. Avoid personalizing the behavior by recognizing that somatization is part of the illness.

3. Have sympathy for the psychopathology of the disorder.

4. Expect the client to respond appropriately to the nurses need to complete the assessment.

Correct Answer: 2

Rationale 1: The best approach is to avoid personalizing the behavior by recognizing that somatization is part of the illness. The nurse should have empathy, not sympathy for the psychopathology of the disorder. Given the self-absorption common to this disorder, it may be unrealistic to expect the client to respond appropriately to the nurses need to complete the assessment. With this disorder, client judgment is impaired.

Rationale 2: The best approach is to avoid personalizing the behavior by recognizing that somatization is part of the illness. The nurse should have empathy, not sympathy for the psychopathology of the disorder. Given the self-absorption common to this disorder, it maybe unrealistic to expect the client to respond appropriately to the nurses need to complete the assessment. With this disorder, client judgment is impaired.

Rationale 3: The best approach is to avoid personalizing the behavior by recognizing that somatization is part of the illness. The nurse should have empathy, not sympathy for the psychopathology of the disorder. Given the self-absorption common to this disorder, it maybe unrealistic to expect the client to respond appropriately to the nurses need to complete the assessment. With this disorder, client judgment is impaired.

Rationale 4: The best approach is to avoid personalizing the behavior by recognizing that somatization is part of the illness. The nurse should have empathy, not sympathy for the psychopathology of the disorder. Given the self-absorption common to this disorder, it maybe unrealistic to expect the client to respond appropriately to the nurses need to complete the assessment. With this disorder, client judgment is impaired.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Perform a thorough and comprehensive assessment of clients with dissociative, somatoform, and factitious disorders.

Question 16

Type: MCMA

The nurse knows that performing an assessment on a client with dissociative disorder can be challenging. The nurse knows it is important to include which of the following in the assessment?

Standard Text: Select all that apply.

1. Memory

2. Identity

3. Consciousness

4. Clients spouse

5. Awareness of time

Correct Answer: 1,2,3,5

Rationale 1: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Rationale 2: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Rationale 3: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Rationale 4: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Rationale 5: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Perform a thorough and comprehensive assessment of clients with dissociative, somatoform, and factitious disorders.

Question 17

Type: MCMA

The nurse is working with a client who has been diagnosed with a somatoform disorder. The nurse knows it is important to include which of the following interventions in the clients plan of care?

Standard Text: Select all that apply.

1. Encourage verbalization of feelings.

2. Encourage the client to write in a journal

3. Establish a weekly routine

4. Establish a trusting relationship.

5. Encourage the discussion of physical symptoms

Correct Answer: 1,2,4

Rationale 1: Encourage verbalization of feelings: Verbalization is healthier than somatization.

Rationale 2: Encourage the client to write in a journal: Increases personal insight.

Rationale 3: Establish a weekly routine: A daily routine, not weekly, should be encouraged for this client as it will decrease the clients anxiety.

Rationale 4: Establish a trusting relationship: Promotes clients psychologic safety.

Rationale 5: Encourage the discussion of physical symptoms: The patient should be discouraged from discussing physical symptoms because it frees up time for problem-solving activities and decreases the reinforcement of secondary gain.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate an understanding of therapeutic interventions for clients experiencing selected dissociative, somatoform, and factitious disorders into their plan of care.

Question 18

Type: MCSA

The nurse is caring for a client who has been diagnosed with dissociative disorder. The nurse knows that an appropriate intervention to promote effective role performance is to:

1. Encourage the client to have no contact with friends and family.

2. Ignore the clients other personalities.

3. Help the client alienate family members who do not believe the client is sick.

4. Include family members is therapy.

Correct Answer: 4

Rationale 1: It is important to work with the clients family in order to help everyone in the family unit to adjust to role performance alterations. Including family members in a therapeutic counseling relationship helps them learn new ways of dealing with the client. As stated earlier, considerable secondary gain is often associated with dissociative behavior: some clients mayuse the illness to escape responsibility and get special treatment. Families often need support in learning to avoid reinforcing dissociative behavior by acting as the source of secondary gain.

Rationale 2: It is important to work with the clients family in order to help everyone in the family unit to adjust to role performance alterations. Including family members in a therapeutic counseling relationship helps them learn new ways of dealing with the client. As stated earlier, considerable secondary gain is often associated with dissociative behavior: some clients mayuse the illness to escape responsibility and get special treatment. Families often need support in learning to avoid reinforcing dissociative behavior by acting as the source of secondary gain.

Rationale 3: It is important to work with the clients family in order to help everyone in the family unit to adjust to role performance alterations. Including family members in a therapeutic counseling relationship helps them learn new ways of dealing with the client. As stated earlier, considerable secondary gain is often associated with dissociative behavior: some clients mayuse the illness to escape responsibility and get special treatment. Families often need support in learning to avoid reinforcing dissociative behavior by acting as the source of secondary gain.

Rationale 4: It is important to work with the clients family in order to help everyone in the family unit to adjust to role performance alterations. Including family members in a therapeutic counseling relationship helps them learn new ways of dealing with the client. As stated earlier, considerable secondary gain is often associated with dissociative behavior: some clients may use the illness to escape responsibility and get special treatment. Families often need support in learning to avoid reinforcing dissociative behavior by acting as the source of secondary gain.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate an understanding of therapeutic interventions for clients experiencing selected dissociative, somatoform, and factitious disorders into their plan of care.

Question 19

Type: MCSA

When working with clients with somatoform disorders, the nurse knows the priority intervention is to:

1. Encourage clients to participate in group therapy to receive feedback about the effect of their behavior on others.

2. Tone down clients characteristic extravagance.

3. Establish a trusting relationship.

4. Express respectful skepticism regarding clients oversimplifications and overdramatizations.

Correct Answer: 3

Rationale 1: A trusting relationship is essential to effective therapy. To tone down clients characteristic extravagance, express respectful skepticism regarding their oversimplifications and overdramatizations, and encourage participation in group therapy to receive feedback about the effect of their behavior on others are appropriate interventions, but they are not priorities.

Rationale 2: A trusting relationship is essential to effective therapy. To tone down clients characteristic extravagance, express respectful skepticism regarding their oversimplifications and overdramatizations, and encourage participation in group therapy to receive feedback about the effect of their behavior on others are appropriate interventions, but they are not priorities.

Rationale 3: A trusting relationship is essential to effective therapy. To tone down clients characteristic extravagance, express respectful skepticism regarding their oversimplifications and overdramatizations, and encourage participation in group therapy to receive feedback about the effect of their behavior on others are appropriate interventions, but they are not priorities.

Rationale 4: A trusting relationship is essential to effective therapy. To tone down clients characteristic extravagance, express respectful skepticism regarding their oversimplifications and overdramatizations, and encourage participation in group therapy to receive feedback about the effect of their behavior on others are appropriate interventions, but they are not priorities.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate an understanding of therapeutic interventions for clients experiencing selected dissociative, somatoform, and factitious disorders into their plan of care.

Question 20

Type: MCSA

To intervene effectively with clients with somatoform disorders, it is essential that the nurse:

1. Help the client express a decreased degree of comfort regarding physical symptoms.

2. Encourage the clients expression of feelings symbolically through physical symptoms.

3. Address client anxiety at a later time.

4. Recognize and understand the clients self-perception as demonstrating an inability to cope.

Correct Answer: 4

Rationale 1: Recognize and understand the clients self-perception as an inability to cope and as part of the disorder. Do not encourage expression of feelings symbolically through physical symptoms. Client anxiety should be addressed at the present time, not at a later date. The client should express an increased degree of comfort regarding physical symptoms.

Rationale 2: Recognize and understand the clients self-perception as an inability to cope and as part of the disorder. Do not encourage expression of feelings symbolically through physical symptoms. Client anxiety should be addressed at the present time, not at a later date. The client should express an increased degree of comfort regarding physical symptoms.

Rationale 3: Recognize and understand the clients self-perception as an inability to cope and as part of the disorder. Do not encourage expression of feelings symbolically through physical symptoms. Client anxiety should be addressed at the present time, not at a later date. The client should express an increased degree of comfort regarding physical symptoms.

Rationale 4: Recognize and understand the clients self-perception as an inability to cope and as part of the disorder. Do not encourage expression of feelings symbolically through physical symptoms. Client anxiety should be addressed at the present time, not at a later date. The client should express an increased degree of comfort regarding physical symptoms.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity