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Patients with illness anxiety disorder have fears of serious medical problems, such as cancer or heart disease. These fears persist despite medical evaluations and interfere with daily functioning. There are no complaints of pain. There is no evidence of factitious or conversion disorder.

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

REF: Pages 17-6, 7

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment eBay: testbanks_and_xanax

16. A patient diagnosed with a somatic symptom disorder says, “My pain is from an undiagnosed injury. I can’t take care of myself. I need pain medicine six or seven times a day. I feel like a baby because my family has to help me so much.” It is important for the nurse to assess a. mood. b. cognitive style. c. secondary gains. d. identity and memory.

ANS: C

Secondary gains should be assessed. The patient’s dependency needs may be met through care from the family. When secondary gains are prominent, the patient is more resistant to giving up the symptom. The scenario does not allude to a problem of mood. Cognitive style and identity and memory assessment are of lesser concern because the patient’s diagnosis has been established.

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

REF: Pages 17-21, 58 (Table 17-3) | Pages 17-28, 60 (Table 17-4)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity a. Somatic symptom disorders are under voluntary control, whereas factitious disorders are unconscious and automatic. b. Factitious disorders are precipitated by psychological factors, whereas somatic symptom disorders are related to stress. c. Factitious disorders are individually determined and related to childhood sexual abuse, whereas somatic symptom disorders are culture bound. d. Factitious disorders are under voluntary control, whereas somatic symptom disorders involve expression of psychological stress through somatization.

17. What is an essential difference between somatic symptom disorders and factitious disorders?

ANS: D

The key is the only fully accurate statement. Somatic symptom disorders involve expression of stress through bodily symptoms and are not under voluntary control or culture bound. Factitious disorders are under voluntary control. See relationship to audience response question.

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

REF: Pages 17-19, 31, 32

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment a. “You do not have a brain tumor. The more you talk about it, the more it reinforces your belief.” b. “Let’s see if there are any other possible explanations for your vomiting.” c. “You seem so worried. Let’s talk about how you’re feeling.” d. “We need to talk about something else.”

18. A patient says, “I know I have a brain tumor despite the results of the MRI. The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day.” Which response by the nurse fosters cognitive reframing?

ANS: B

Questioning the evidence is a cognitive reframing technique. Identifying causes other than the feared disease can be helpful in changing distorted perceptions. Distraction by changing the subject will not be effective.

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

REF: Pages 17-25, 30 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Flooding b. Response prevention c. Relaxation techniques d. Systematic desensitization

19. Which treatment modality should a nurse recommend to help a patient diagnosed with a somatic symptom disorder to cope more effectively?

ANS: C

Somatic symptom disorders are commonly associated with complicated reactions to stress. These reactions are accompanied by muscle tension and pain. Relaxation can diminish the patient’s perceptions of pain and reduce muscle tension. The distracters are modalities useful in treating selected anxiety disorders.

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

REF: Pages 17-25 to 27, 60 (Table 17-4) TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity a. “What are you unable to do now but were previously able to do?” b. “How many doctors have you seen in the last year?” c. “Who do you talk to when you’re upset?” d. “Did you experience abuse as a child?”

20. Which assessment question could a nurse ask to help identify secondary gains associated with a somatic symptom disorder?

ANS: A

Secondary gains should be assessed. Secondary gains reinforce maladaptive behavior. The patient’s dependency needs may be evident through losses of abilities. When secondary gains are prominent, the patient is more resistant to giving up the symptom. There may be a history of abuse or doctor shopping, but the question does not assess the associated gains.

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

REF: Page 17-21 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

21. A patient diagnosed with a somatic symptom disorder has been in treatment for 4 weeks. The patient says, “Although I’m still having pain, I notice it less and am able to perform more activities.” The nurse should evaluate the treatment plan as a. marginally successful. b. minimally successful. c. partially successful. d. totally achieved.

ANS: C

Decreased preoccupation with symptoms and increased ability to perform activities of daily living suggest partial success of the treatment plan. Total success is rare because of patient resistance.

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

REF: Pages 17-23, 24, 31 TOP: Nursing Process: Evaluation

MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. A child has a history of multiple hospitalizations for recurrent systemic infections. The child is not improving in the hospital, despite aggressive treatment. Factitious disorder imposed on another is suspected. Which nursing interventions are appropriate? (Select all that apply.)

a. Increase private visiting time for the parents to improve bonding.

b. Keep careful, detailed records of visitation and untoward events.

c. Place mittens on the child to reduce access to ports and incisions.

d. Encourage family members to visit in groups of two or three.

e. Interact with the patient frequently during visiting hours.

ANS: B, D, E

Factitious disorder imposed on another is a condition wherein a person intentionally causes or perpetuates the illness of a loved one (e.g., by periodically contaminating IV solutions with fecal material). When this disorder is suspected, the child’s life could be at risk. Depending on the evidence supporting this suspicion, interventions could range from minimizing unsupervised visitation to blocking visitation altogether. Frequently checking on the child during visitation and minimizing unobserved access to the child (by encouraging small group visits) reduces the opportunity to take harmful action and increases the collection of data that can help determine whether this disorder is at the root of the child’s illness. Detailed tracking of visitation and untoward events helps identify any patterns there might be between select visitors and the course of the child’s illness. Increasing private visitation provides more opportunity for harm. Educating visitors about aseptic techniques would not be of help if the infections are intentional, and preventing inadvertent contamination by the child himself would not affect factitious disorder by proxy.

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

REF: Pages 17-34, 35

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. History of multiple hospitalizations without findings of physical illness b. History of multiple medical procedures or exploratory surgeries c. Going from one doctor to another seeking the desired response d. Claims illness to obtain financial benefit or other incentive e. Difficulty describing symptoms

2. Which assessment findings suggest the possibility of a factitious disorder, imposed on self-type? (Select all that apply.)

ANS: A, B

Persons with factitious disorders, imposed on self-type, typically have a history of multiple hospitalizations and medical workups, with negative findings from workups. Sometimes they have even had multiple surgeries seeking the origin of the physical complaints. If they do not receive the desired response from a hospitalization, they may elope or accuse staff of incompetence. Such persons usually seek treatment through a consistent health care provider rather than doctor shopping, are not motivated by financial gain or other external incentives, and present symptoms in a very detailed, plausible manner indicating considerable understanding of the disorder or presentation they are mimicking. See relationship to audience response question.

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

REF: Page 17-32 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Spiritual distress b. Decisional conflict c. Adult failure to thrive d. Impaired social interaction e. Ineffective role performance

3. A patient diagnosed with a somatic symptom disorder says, “Why has God chosen me to be sick all the time and unable to provide for my family? The burden on my family is worse than the pain I bear.” Which nursing diagnoses apply to this patient? (Select all that apply.)

ANS: A, E

The patient’s verbalization is consistent with spiritual distress. The patient’s description of being unable to provide for and burdening the family indicates ineffective role performance. No data support diagnoses of adult failure to thrive, impaired social interaction, or decisional conflict.

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

REF: Pages 17-23, 24, 58 (Table 17-3) TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Psychosocial Integrity a. Female b. Reports frequent syncope c. Rates pain as “1” on a scale of “10” d. First diagnosed with psoriasis at age 12 e. Reports insomnia often results from back pain

4. A nurse assesses a patient suspected of having somatic symptom disorder. Which assessment findings regarding this patient support the suspected diagnosis? (Select all that apply.)

ANS: A, B, E

There is no chronic disease to explain the symptoms for patients with somatic symptom disorder. Patients report multiple symptoms; gastrointestinal and pseudoneurological symptoms are common. This disorder is more common in women than in men. Patients with conversion disorder would have a tendency to underrate pain.

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

REF: Pages 17-2 to 4 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity eBay: testbanks_and_xanax

5. A nurse’s neighbor says, “I saw a news story about a man without any known illness who died suddenly after his ex-wife committed suicide. Was that a coincidence, or can emotional shock be fatal?” The nurse should respond by noting that some serious medical conditions may be complicated by emotional stress, including (Select all that apply) a. cancer. b. hip fractures c. hypertension. d. immune disorders e. cardiovascular disease.

ANS: A, C, D, E

A number of diseases can be worsened or brought to awareness by intense emotional stress. Immune disorders can be complicated associated with detrimental effects of stress on the immune system. Others can be brought about indirectly, such as cardiovascular disease due to acute or chronic hypertension. Hip fractures are not in this group.

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

REF: Pages 17-9 to 12, 51 (Table 17-1)

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation

Chapter 18: Eating and Feeding Disorders

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

Multiple Choice

1. Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely?

a. Binge eating b. Bulimia nervosa c. Anorexia nervosa d. Eating disorder not otherwise specified

ANS: C

Overly controlled eating behaviors, extreme weight loss, preoccupation with food, and wearing several layers of loose clothing to appear larger are part of the clinical picture of an individual with anorexia nervosa. The individual with bulimia usually is near normal weight. The binge eater is often overweight. The patient with eating disorder not otherwise specified may be obese.

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

REF: Page 18-67 (Box 18-1) TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity a. Weight, muscle, and fat congruence with height, frame, age, and sex b. Calorie intake is within required parameters of treatment plan c. Weight reaches established normal range for the patient d. Patient expresses satisfaction with body appearance

2. Disturbed body image is a nursing diagnosis established for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor?

ANS: D

Body image disturbances are considered improved or resolved when the patient is consistently satisfied with his or her own appearance and body function. This is a subjective consideration. The other indicators are more objective but less related to the nursing diagnosis.

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

REF: Pages 18-13, 58 (Table 18-3) TOP: Nursing Process: Outcomes Identification

MSC: Client Needs: Psychosocial Integrity

3. A patient referred to the eating disorders clinic has lost 35 pounds during the past 3 months. To assess eating patterns, the nurse should ask the patient: a. “Do you often feel fat?” b. “Who plans the family meals?” c. “What do you eat in a typical day?” d. “What do you think about your present weight?”

ANS: C

Although all the questions might be appropriate to ask, only “What do you eat in a typical day?” focuses on the eating patterns. Asking if the patient often feels fat focuses on distortions in body image. Questions about family meal planning are unrelated to eating patterns. Asking for the patient’s thoughts on present weight explores the patient’s feelings about weight.

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

REF: Pages 18-12, 19 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity a. “I am fat and ugly.” b. “What I think about myself is my business.” c. “I’m grossly underweight, but that’s what I want.” d. “I’m a few pounds’ overweight, but I can live with it.”

4. A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and lost 25% of body weight. A nurse asks, “Describe what you think about your present weight and how you look.” Which response by the patient is most consistent with the diagnosis?

ANS: A

Untreated patients with anorexia nervosa do not recognize their thinness. They perceive themselves to be overweight and unattractive. The patient with anorexia will usually tell people perceptions of self. The patient with anorexia does not recognize his or her thinness and will persist in trying to lose more weight.

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

REF: Pages 18-12, 19 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity a. Adult failure to thrive related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss b. Disturbed energy field related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia c. Ineffective health maintenance related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia d. Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia

5. A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is currently 2.7 mg/dL. Which nursing diagnosis applies?

ANS: D

The patient’s history and lab result support the nursing diagnosis Imbalanced nutrition: less than body requirements. Data are not present that the patient uses laxatives, induces vomiting, or exercises excessively. The patient has hypokalemia rather than hyperkalemia.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)