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
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(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
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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.
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PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 17-6 to 9 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
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2. Which prescription medication would the nurse expect to be prescribed for a patient
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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
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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.
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