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PTS: 1

DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 17-18, 24

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning

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. b. be resistant to accepting psychiatric help. c. attend psychotherapy sessions without encouragement. d. be eager to discover the true reasons for physical symptoms.

ANS: B

Patients with somatic symptom disorders go from one health care provider to another trying to establish a physical cause for their symptoms. When a psychological basis is suggested and a referral for counseling offered, these patients reject both.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 17-29, 30

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning a. The patient is suppressing accurate feelings regarding the problem. b. The patient’s anxiety is relieved through the physical symptom. c. The patient’s optic nerve transmission has been impaired. d. The patient will not disclose genuine fears.

4. A patient has blindness related to conversion (functional neurological) disorder but is unconcerned about this problem. Which understanding should guide the nurse’s planning for this patient?

ANS: B

Psychoanalytical theory suggests conversion reduces anxiety through production of a physical symptom symbolically linked to an underlying conflict. Conversion, not suppression, is the operative defense mechanism in this disorder. While some MRI studies suggest that patients with conversion disorder have an abnormal pattern of cerebral activation, there is no actual alternation of nerve transmission. The other distracters oversimplify the dynamics, suggesting that only dependency needs are of concern, or suggest conscious motivation (conversion operates unconsciously).

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 17-8, 9

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning

5. A patient has blindness related to conversion (functional neurological) disorder. To help the patient eat, the nurse should a. establish a “buddy” system with other patients who can feed the patient at each meal. b. expect the patient to feed self after explaining arrangement of the food on the tray. c. direct the patient to locate items on the tray independently and feed self. d. address needs of other patients in the dining room, then feed this patient.

ANS: B

The patient is expected to maintain some level of independence by feeding self, while the nurse is supportive in a matter-of-fact way. The distracters support dependency or offer little support.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 17-27, 28

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation a. Social isolation b. Chronic low self-esteem c. Interrupted family processes d. Ineffective health maintenance

6. A patient with blindness related to conversion (functional neurological) disorder says, “All the doctors and nurses in the hospital stop by often to check on me. Too bad people outside the hospital don’t find me as interesting.” Which nursing diagnosis is most relevant?

ANS: B

The patient mentions that the symptoms make people more interested. This indicates that the patient feels uninteresting and unpopular without the symptoms, thus supporting the nursing diagnosis of chronic low self-esteem. Defining characteristics for the other nursing diagnoses are not present in the scenario.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 17-23, 28, 58 (Table 17-3) TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Psychosocial Integrity

7. To assist patients diagnosed with somatic symptom disorders, nursing interventions of high priority a. explain the pathophysiology of symptoms. b. help these patients suppress feelings of anger. c. shift focus from somatic symptoms to feelings. d. investigate each physical symptom as it is reported.

ANS: C

Shifting the focus from somatic symptoms to feelings or to neutral topics conveys interest in the patient as a person rather than as a condition. The need to gain attention with the use of symptoms is reduced over the long term. A desired outcome would be that the patient would express feelings, including anger if it is present. Once physical symptoms are investigated, they do not need to be reinvestigated each time the patient reports them.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 17-28, 60 (Table 17-4) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Dysthymic disorder b. Somatic symptom disorder c. Antisocial personality disorder d. Illness anxiety disorder (hypochondriasis)

8. A patient with fears of serious heart disease was referred to the mental health center by a cardiologist. Extensive diagnostic evaluation showed no physical illness. The patient says, “My chest is tight, and my heart misses beats. I’m often absent from work. I don’t go out much because I need to rest.” Which health problem is most likely?

ANS: D

Illness anxiety disorder (hypochondriasis) involves preoccupation with fears of having a serious disease even when evidence to the contrary is available. The preoccupation causes impairment in social or occupational functioning. Somatic symptom disorder involves fewer symptoms. Dysthymic disorder is a disorder of lowered mood. Antisocial disorder applies to a personality disorder in which the individual has little regard for the rights of others. See relationship to audience response question.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 17-6, 7 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

9. A nurse assessing a patient diagnosed with a somatic symptom disorder is most likely to note that the patient a. sees a relationship between symptoms and interpersonal conflicts. b. has little difficulty communicating emotional needs to others. c. rarely derives personal benefit from the symptoms. d. has altered comfort and activity needs.

ANS: D

The patient frequently has altered comfort and activity needs associated with the symptoms displayed (fatigue, insomnia, weakness, tension, pain, etc.). In addition, hygiene, safety, and security needs may also be compromised. The patient is rarely able to see a relation between symptoms and events in his or her life, which is readily discernible to health professionals. Patients with somatic symptom disorders often derive secondary gain from their symptoms and/or have considerable difficulty identifying feelings and conveying emotional needs to others.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 17-18, 19, 36 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

10. To plan effective care for patients diagnosed with somatic symptom disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms a. are generally chronic. b. have a physiological basis. c. can be voluntarily controlled. d. provide relief from health anxiety.

ANS: D

At the unconscious level, the patient's primary gain from the symptoms is anxiety relief. Considering that the symptoms actually make the patient more psychologically comfortable and may also provide secondary gain, patients frequently fiercely cling to the symptoms. The symptoms tend to be chronic, but that does not explain why they are difficult to give up. The symptoms are not under voluntary control or physiologically based.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 17-18, 19, 36 (Case Study and Nursing Care Plan) TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

11. A patient with a somatic symptom disorder has the nursing diagnosis Interrupted family processes related to patient’s disabling symptoms as evidenced by spouse and children assuming roles and tasks that previously belonged to patient. An appropriate outcome is that the patient will a. assume roles and functions of other family members. b. demonstrate performance of former roles and tasks. c. focus energy on problems occurring in the family. d. rely on family members to meet personal needs.

ANS: B

The patient with a somatic symptom disorder has typically adopted a sick role in the family, characterized by dependence. Increasing independence and resumption of former roles are necessary to change this pattern. The distracters are inappropriate outcomes.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 17-23, 24, 36 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Outcomes Identification

MSC: Client Needs: Psychosocial Integrity a. “My employer should have paid for a health club membership for me.” b. “My family will see me through this. It won’t be easy, but I will never be alone.” c. “My heart attack was no fun, but it showed me up the importance of a good diet and more exercise.” d. “I accept that I have heart disease. Now I need to decide if I will be able to continue my work daily.”

12. Which comment by a patient who recently experienced a myocardial infarction indicates use of maladaptive, ineffective coping strategies?

ANS: A

Blaming someone else and rationalizing one’s failure to exercise are not adaptive coping strategies. Seeing the glass as half full, using social and religious supports, and confronting one’s situation are seen as more effective strategies. The distracters demonstrate effective coping associated with a serious medical condition.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 17-9 to 12

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment a. “Since my father died, I’ve been short of breath and had sharp pains that go down my left arm, but I think it’s just indigestion.” b. “I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry, and I think I’m getting seriously dehydrated.” c. “Sexual intercourse is painful. I pretend as if I’m asleep so I can avoid it. I think it’s starting to cause problems with my marriage.” d. “I get choked very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus.”

13. A nurse assesses a patient diagnosed with conversion (functional neurological) disorder. Which comment is most likely from this patient?

ANS: A

Patients with conversion (functional neurological) disorder demonstrate a lack of concern regarding the seriousness of symptoms. This lack of concern is termed la belle indifférence. There is also a specific, identifiable cause for the development of the symptoms; in this instance, the death of a parent would precipitate stress. The distracters relate to sexual dysfunction and illness anxiety disorder.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 17-8, 9

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment a. “I’m wondering if you are feeling anxious about your illness and being left alone.” b. “The staff are concerned that you are not satisfied with the care you are receiving.” c. “Let’s talk about why you use your call light so frequently. It is a problem.” d. “You frustrate the staff by calling them so often. Why are you doing that?”

14. A patient who experienced a myocardial infarction was transferred from critical care to a step-down unit. The patient then used the call bell every 15 minutes for minor requests and complaints. Staff nurses reported feeling inadequate and unable to satisfy the patient’s needs. When the nurse manager intervenes directly with this patient, which comment is most therapeutic?

ANS: A

This patient is experiencing anxiety associated with a serious medical condition. Verbalization is an effective outlet for anxiety. “I’m wondering if you are anxious …” focuses on the emotions underlying the behavior rather than the behavior itself. This opening conveys the nurse’s willingness to listen to the patient’s feelings and an understanding of the commonly seen concern about not having a nurse always nearby as in the intensive care unit. The other options focus on the behavior or its impact on nursing and do not help the patient with her emotional needs.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 17-9 to 12

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation a. Conversion (functional neurological) disorder b. Illness anxiety disorder (hypochondriasis) c. Somatic symptom disorder d. Factitious disorder

15. A patient reports fears of having cervical cancer and says to the nurse, “I’ve had Pap smears by six different doctors. The results were normal, but I’m sure that’s because of errors in the laboratory.” Which disorder would the nurse suspect?

ANS: B