Question 1

The nurse understands that the patient with somatic symptom disorder may have an increased sensitivity to pain. This explanation of the patient's symptoms is based in which domain?

Accepted Answer

2. Holistically, in nursing, there are five domains of wellness: biological, psychological, sociological, cultural, and spiritual. Research has shown that patients with somatic symptom disorder and its related disorders express symptoms such as pain and other somatic experiences through their body. This heightened sense of pain and other normal body sensations occurs in the biological domain.

Question 2

The nurse in a clinic is caring for a patient whom she suspects has a somatic symptom or related disorder. Which risk factors will the nurse include in the assessment? Select all that apply.

Accepted Answer

3. Within the sociological domain, patients suffering from somatic symptoms and related disorders are generally female, older, and/or of lower socioeconomic status. Patients with somatic symptom disorders feel that no one understands the physical symptoms and therefore will not help. They are unable to take part in hobbies or interests with others, so they are more likely to experience frequent unemployment than be high achieving. Divorce itself is not a risk factor for a somatic symptom or related disorder.

Question 3

The nurse knows that which types of complementary and alternative therapy may be helpful for patients with dissociative identity disorder (DID)? Select all that apply.

Accepted Answer

1. Hypnosis is an effective modality for patients with DID, helping with affective regulation, modulating anxiety, and promoting self-soothing. Additional therapies for dissociative disorders are art, music, and dance therapies; these therapies help the patient to improve concentration, work through affective material, and enhance problem-solving skills. Acupuncture is not commonly used in the treatment of DIDs.
2. Hypnosis is an effective modality for patients with DID, helping with affective regulation, modulating anxiety, and promoting self-soothing. Additional therapies for dissociative disorders are art, music, and dance therapies; these therapies help the patient to improve concentration, work through affective material, and enhance problem-solving skills. Acupuncture is not commonly used in the treatment of DIDs.
3. Hypnosis is an effective modality for patients with DID, helping with affective regulation, modulating anxiety, and promoting self-soothing. Additional therapies for dissociative disorders are art, music, and dance therapies; these therapies help the patient to improve concentration, work through affective material, and enhance problem-solving skills. Acupuncture is not commonly used in the treatment of DIDs.
4. Hypnosis is an effective modality for patients with DID, helping with affective regulation, modulating anxiety, and promoting self-soothing. Additional therapies for dissociative disorders are art, music, and dance therapies; these therapies help the patient to improve concentration, work through affective material, and enhance problem-solving skills. Acupuncture is not commonly used in the treatment of DIDs.

Question 4

The nurse is caring for a patient who is morbidly obese and who has been diagnosed with somatic symptom disorder. The patient history reveals that the patient's mother suffered from alcohol use disorder. Which domain does the nurse recognize as the most useful in explaining the patient's condition?

Accepted Answer

4. Research into the emotional responses of individuals in their relation to their physical state lies within the psychological domain. Early childhood distress is associated with adult obesity and other physical illnesses. In the cultural domain somatic concerns vary depending on the culture or the country. In the spiritual domain, individuals may seek meaning and/or solace in their symptoms, or they may feel spiritually and emotionally disengaged. In the biological domain body sensations become the individual's focus and concern.

Question 5

The nurse is caring for a patient diagnosed with dissociative identity disorder (DID). Which statements by the patient best describes the manifestations of this disorder? Select all that apply.

Accepted Answer

1. Dissociative disorders are characterized by a combination of fragmented memories (which may result in fragmented personalities), difficulties with memory recall, and dissociative behavior patterns. Depersonalization, a manifestation of dissociative disorders, is the experience of unreality or detachment from the individual's mind, sense of self, and/or physical body. Dissociations are unwelcome intrusions that occur with losses of continuity of time, changes in ability to relate to others, and amnesia, or the inability to recall what the person was doing during the dissociation. The client stating physical pain, not psychological suffering, is manifesting a somatic symptom. Difficulty describing or discussing feelings is seen in somatic symptom and related disorders.
4. Dissociative disorders are characterized by a combination of fragmented memories (which may result in fragmented personalities), difficulties with memory recall, and dissociative behavior patterns. Depersonalization, a manifestation of dissociative disorders, is the experience of unreality or detachment from the individual's mind, sense of self, and/or physical body. Dissociations are unwelcome intrusions that occur with losses of continuity of time, changes in ability to relate to others, and amnesia, or the inability to recall what the person was doing during the dissociation. The client stating physical pain, not psychological suffering, is manifesting a somatic symptom. Difficulty describing or discussing feelings is seen in somatic symptom and related disorders.
5. Dissociative disorders are characterized by a combination of fragmented memories (which may result in fragmented personalities), difficulties with memory recall, and dissociative behavior patterns. Depersonalization, a manifestation of dissociative disorders, is the experience of unreality or detachment from the individual's mind, sense of self, and/or physical body. Dissociations are unwelcome intrusions that occur with losses of continuity of time, changes in ability to relate to others, and amnesia, or the inability to recall what the person was doing during the dissociation. The client stating physical pain, not psychological suffering, is manifesting a somatic symptom. Difficulty describing or discussing feelings is seen in somatic symptom and related disorders.

Question 6

The nurse is caring for a patient with somatic symptom disorder. What information is most important for the nurse to include in the report to the staff on the next shift?

Accepted Answer

3. Patients with somatic symptom disorder exhibit excessive focus on their physical symptoms. It is essential the staff on the next shift know how much time the patient talks about physical complaints in order to evaluate whether the patient meets the goal of decreasing that time spent on talking about the physical complaints. While the other information may be helpful to other staff members, it is not as important as how much time the patient has spent focusing on physical complaints.

Question 7

The nurse is caring for a 40-year-old patient suspected of having a somatic symptom or related disorder. Which symptoms within the psychological domain would suggest that the patient does not have a somatic symptom or related disorder? Select all that apply.

Accepted Answer

2. Individuals with somatic symptom and related disorders may exhibit the following psychological symptoms: dissociation; hallucinations; crying; decreased interest; decreased productivity; depression; difficulty concentrating; feelings of apprehension, helplessness, worthlessness; focusing on the past; hypercritical; irritability; persistent worrying preoccupation with negatives; and withdrawal. Flashbacks are associated with dissociative disorders and posttraumatic stress disorder (PTSD). Compulsions are associated with obsessive-compulsive disorder (OCD).
3. Individuals with somatic symptom and related disorders may exhibit the following psychological symptoms: dissociation; hallucinations; crying; decreased interest; decreased productivity; depression; difficulty concentrating; feelings of apprehension, helplessness, worthlessness; focusing on the past; hypercritical; irritability; persistent worrying preoccupation with negatives; and withdrawal. Flashbacks are associated with dissociative disorders and posttraumatic stress disorder (PTSD). Compulsions are associated with obsessive-compulsive disorder (OCD).

Question 8

Which nursing intervention helps promote stress reduction and healthy coping in a patient diagnosed with a dissociative disorder?

Accepted Answer

1. Performing safety checks at each health care interaction helps ensure patient safety and provides an opportunity to discuss triggers and promote healthy coping mechanisms. Discussing activities to reduce the need for safety provisions, teaching nonpharmacologic methods of reducing pain, and reviewing the patient's daily journal to assess appetite are appropriate interventions for somatic symptom disorders.

Question 9

The nurse is caring for a patient who has been diagnosed with a dissociative disorder after being missing for two weeks and returning home, not knowing any time had passed. The nurse recognizes the patient is experiencing which condition associated with dissociative disorders?

Accepted Answer

1. Individuals with dissociative fugue wander, usually far from home and for days, perhaps even weeks or months, at a time. During this period, patients completely forget their past life and associations, but unlike people with amnesia, they are unaware of having forgotten anything. Individuals do not recall the fugue period when they return to consciousness. Alexithymia is the inability to label feelings with words. Derealization is the experience of unreality or detachment from the individual's surroundings.

Question 10

The nurse suspects that the patient who was brought to the emergency department (ED) because of what the family describes as "a sudden case of Alzheimer disease" may have general amnesia. Which characteristics make the nurse suspect general amnesia? Select all that apply.

Accepted Answer

1. General amnesia typically occurs rapidly and causes disorientation and wandering. It results in a complete loss of memory of the individual's life history. Localized amnesia is when an individual cannot recall specific events, selective amnesia is when the individual can recall some, but not all events during a specified period of time. Depersonalization is the experience of unreality or detachment from mind, self, and/or physical body. Derealization is the experience of unreality or detachment from the person's surroundings. Multiple personality states do not emerge with general amnesia.
2. General amnesia typically occurs rapidly and causes disorientation and wandering. It results in a complete loss of memory of the individual's life history. Localized amnesia is when an individual cannot recall specific events, selective amnesia is when the individual can recall some, but not all events during a specified period of time. Depersonalization is the experience of unreality or detachment from mind, self, and/or physical body. Derealization is the experience of unreality or detachment from the person's surroundings. Multiple personality states do not emerge with general amnesia.

Question 11

The nurse caring for a patient admitted with somatic symptom disorder questions the health care provider about which orders? Select all that apply.

Accepted Answer

1. Medication is not advised for individuals with somatic symptom and related disorders. The most effective ways of treating this disorder are cognitive-behavioral therapy and complementary/alternative therapies.
2. Medication is not advised for individuals with somatic symptom and related disorders. The most effective ways of treating this disorder are cognitive-behavioral therapy and complementary/alternative therapies.

Question 12

The nurse is taking care of patient admitted with a diagnosis of dissociative identity disorder. The nurse knows that which symptoms differentiate dissociative disorders from somatic symptom disorder? Select all that apply.

Accepted Answer

1. Individuals with dissociative disorders exhibit symptoms of alterations in sensory or motor functioning; alterations in memory; changes in consciousness; inability to recall autobiographical information; self-mutilation; flashbacks; and functional neurologic symptoms. These symptoms are not seen in somatic symptom disorder. Dissociation, struggling with faith, and lack of connectedness may be seen in individuals suffering from either disorder.
2. Individuals with dissociative disorders exhibit symptoms of alterations in sensory or motor functioning; alterations in memory; changes in consciousness; inability to recall autobiographical information; self-mutilation; flashbacks; and functional neurologic symptoms. These symptoms are not seen in somatic symptom disorder. Dissociation, struggling with faith, and lack of connectedness may be seen in individuals suffering from either disorder.

Question 13

A patient suffering from dissociative identity disorder complains of intrusive thoughts. The anticipates an order for which medication?

Accepted Answer

3. Guidelines by the International Society for the Study of Trauma and Dissociation suggest that medications used in the treatment of patients with dissociative disorders should target the symptoms that are disturbing to the patient. SSRIs and beta-blockers are used to treat hyperarousal and intrusive thoughts, depressive symptoms, obsessive-compulsive thoughts and behaviors, and sleep disturbances. Benzodiazepines should not be used as they increase the risk of further dissociation; epinephrine is a catecholamine, and insulin is a hormone.

Question 14

A patient diagnosed with dissociative identity disorder is in the emergency department after attempting suicide. After a thorough assessment the nurse determines the attempted suicide was in response to which event?

Accepted Answer

2. Patients with dissociative identity disorder have sustained horrific physical and psychological abuse over time. These events lead to the patient experiencing multiple ego states that help the patient survive the trauma. Suicidal ideation is common among patients with this disorder. The other answer choices are not indicative of dissociative identity disorder.

Question 15

The nurse is caring for a patient with dissociative identity disorder who has been admitted to the hospital for dehydration. Which question is the priority for including in the assessment?

Accepted Answer

3. Patients with dissociative disorders have a high risk for suicide. It is important to ask these patients direct questions about risk for suicide and self-harm. The other questions may be appropriate, but they are not the priority. Assessing for safety always takes priority.

Question 16

The nurse taking care of a patient recently diagnosed with somatic symptom disorder knows that which biological symptoms are related to this disorder? Select all that apply.

Accepted Answer

1. Patients with somatic symptom disorder have symptoms that are physical in nature and cause significant distress and inability to function in activities of daily living. These may include pain, gastrointestinal distress, paralysis, or blindness. Psychological symptoms of somatic symptom disorder include persistent anxiety about symptoms and disproportionate and persistent thoughts about symptoms that result in disruption of daily living.
3. Patients with somatic symptom disorder have symptoms that are physical in nature and cause significant distress and inability to function in activities of daily living. These may include pain, gastrointestinal distress, paralysis, or blindness. Psychological symptoms of somatic symptom disorder include persistent anxiety about symptoms and disproportionate and persistent thoughts about symptoms that result in disruption of daily living.
4. Patients with somatic symptom disorder have symptoms that are physical in nature and cause significant distress and inability to function in activities of daily living. These may include pain, gastrointestinal distress, paralysis, or blindness. Psychological symptoms of somatic symptom disorder include persistent anxiety about symptoms and disproportionate and persistent thoughts about symptoms that result in disruption of daily living.
5. Patients with somatic symptom disorder have symptoms that are physical in nature and cause significant distress and inability to function in activities of daily living. These may include pain, gastrointestinal distress, paralysis, or blindness. Psychological symptoms of somatic symptom disorder include persistent anxiety about symptoms and disproportionate and persistent thoughts about symptoms that result in disruption of daily living.

Question 17

A patient has had what appeared to be an epileptic seizure; however, the patient's MRI and EEG results that do not show seizure activity. After a thorough assessment and appropriate tests by the patient's health care professional, the nurse begins to suspect which psychological disorder?

Accepted Answer

2. Patients who have symptoms of conversion disorder experience one or more changes in voluntary motor or sensory function, changes that are not recognized as neurologic or medical in origin. Some patients may experience symptoms that mimic seizure. Factitious disorder is characterized by patients falsifying an illness. Somatic symptom disorder refers to emotional distress that exhibits through somatic or physiological symptoms. Illness anxiety disorder refers to patients who experience preoccupation with having an illness, though there are typically no physical symptoms.

Question 18

A 29-year-old patient is admitted with nausea and diarrhea. She has not eaten anything since she learned her dog was hit by a car three days ago. She complains of "a migraine." The patient has a flat affect and her family says she "has not shed a tear." The patient is exhibiting which personality trait?

Accepted Answer

4. Individuals with somatic symptom and related disorders complain of biological disorders focusing on those complaints to the extent of risking functional impairment in other domains. An individual with alexithymia is unable to identify or define feelings into words. Alexithymia has been linked to PTSD and migraine headaches. Negative affectivity is an independent risk factor for having multiple somatic symptoms; hypochondriasis refers to illness anxiety disorder; and dysthymia is a chronic depression.

Question 19

When assessing patients with dissociative disorders, the nurse knows that which assessments are most important?

Accepted Answer

3. When assessing patients with dissociative symptom disorders, it is important to assess patient safety, level of consciousness, and anxiety level. The other choices are more appropriate for assessing the patient with a somatic symptom or related disorder.

Question 20

The nurse knows that which modality is the best for patients with dissociative disorders?

Accepted Answer

3. Patients with dissociative disorders require long-term therapy. The best modality for this type patient is individual psychotherapy. Group therapy, support groups, and dialectical behavior therapy are not typically recommended for patients with dissociative disorders.

Quiz 14: Somatic Symptom Disorders and Dissociative Disorders