Question 1

A client is diagnosed with functional neurological symptom disorder (FNSD).Which of the following symptoms is the client most likely to exhibit? (Select all that apply.)

Accepted Answer

Rationale: FNSD can also be termed conversion disorder.Conversion symptoms affect voluntary motor or sensory functioning suggestive of neurological disease.Examples include paralysis,aphonia,seizures,coordination disturbance,difficulty swallowing,urinary retention,akinesia,blindness,deafness,double vision,anosmia,loss of pain sensation,and hallucinations.

Question 2

A client diagnosed with DID switches personalities when confronted with destructive behavior.The nurse recognizes that this dissociation serves which function?

Accepted Answer

Rationale: The nurse should anticipate that a client who switches personalities when confronted with destructive behavior is dissociating in order to isolate painful events so that the primary self is protected.The transition between personalities is usually sudden,dramatic,and precipitated by stress.

Question 3

Which combination of diagnoses and appropriate pharmacological treatments are correctly matched?

Accepted Answer

Rationale: The nurse should anticipate that the diagnosis of SSD: predominantly pain can be effectively treated with venlafaxine.Antidepressants are often used with somatic symptom disorder when the predominant symptom is pain.They have been shown to be effective in relieving pain,independent of influences on mood.

Question 4

The DSM-5 diagnosis of functional neurological symptom disorder can also be identified as ____________________ disorder.

Accepted Answer

Rationale: The DSM-5 diagnosis of functional neurological symptom disorder can also be identified as conversion disorder.Conversion disorder is a loss of or change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism.There is most likely a psychological component involved in the initiation,exacerbation,or perpetuation of the symptom,although it may or may not be obvious or identifiable.

Question 5

Which are examples of primary and secondary gains that clients diagnosed with SSD: predominately pain,may experience?

Accepted Answer

Rationale: The nurse should identify that primary gains are those that allow the client to avoid an unpleasant activity (stressful family reunion)and that secondary gains are those in which the client receives emotional support or attention (get-well cards).

Question 6

An inpatient client is newly diagnosed with dissociative identity disorder (DID)stemming from severe childhood sexual abuse.Which nursing intervention takes priority?

Accepted Answer

Rationale: The nurse should prioritize establishing trust and rapport when beginning to work with a client diagnosed with DID.DID was formerly called multiple personality disorder.Trust is the basis of every therapeutic relationship.Each personality views itself as a separate entity and must be treated as such to establish rapport.

Question 7

According to the DSM-5 diagnostic criteria for dissociative amnesia (DA),what symptom would be essential to meet the criteria for the subcategory of dissociative fugue?

Accepted Answer

Rationale: An inability to recall important autobiographical information and clinically significant distress in social and occupational functioning are basic criteria for the diagnosis of DA.A specific subtype of dissociative amnesia is with dissociative fugue.Dissociative fugue is characterized by a sudden,unexpected travel away from customary place of daily activities,or by bewildered wandering,with the inability to recall some or all of one's past.The DSM-5 also states that symptoms cannot be attributable to the direct physiological effects of a substance (e.g.,alcohol,a drug of abuse,a medication).

Question 8

Neurological tests have ruled out pathology in a client's sudden lower-extremity paralysis.Which nursing care should be included for this client?

Accepted Answer

Rationale: The nurse should assist the client in dealing with physical symptoms in a detached manner.This client should be diagnosed with a conversion disorder in which symptoms affect voluntary motor or sensory functioning with or without apparent impairment of consciousness.Examples include paralysis,aphonia,seizures,coordination disturbance,difficulty swallowing,urinary retention,akinesia,blindness,deafness,double vision,anosmia,and hallucinations.

Question 9

Which would be considered an appropriate outcome when planning care for an inpatient client diagnosed with SSD?

Accepted Answer

Rationale: The nurse should determine that an appropriate outcome for a client diagnosed with SSD would be for the client to list three potential adaptive coping strategies to deal with stress by day two.Because the symptoms of SSD are associated with psychosocial distress,increased coping skills may help the client reduce symptoms.

Question 10

A client diagnosed with somatic symptom disorder (SSD)is most likely to exhibit which personality disorder characteristics?

Accepted Answer

Rationale: The nurse should anticipate that a client diagnosed with SSD would be self-dramatizing,attention seeking,and overly gregarious.It has been suggested that,in somatic symptom disorder,there may be some overlapping of personality characteristics and features associated with histrionic personality disorder.These symptoms include heightened emotionality,impressionistic thought and speech,seductiveness,strong dependency needs,and a preoccupation with symptoms and oneself.

Question 11

A nursing instructor is teaching about the etiology of IAD from a psychoanalytical perspective.What student statement about clients diagnosed with this disorder indicates that learning has occurred?

Accepted Answer

Rationale: The nurse should understand that from a psychoanalytical perspective,IAD occurs because physical problems are more acceptable than psychological problems.Psychodynamicists view IAD as a defense mechanism.

Question 12

A nurse is working with a client diagnosed with SSD.What criteria would differentiate this diagnosis from illness anxiety disorder (IAD)?

Accepted Answer

Rationale: Individuals experiencing somatic symptoms without corroborating pathology are considered to have SSD,and those with minimal or no somatic symptoms would be diagnosed with IAD,a diagnosis new to the DSM-5.Clients diagnosed with IAD have minimal or no somatic complaints,but present with intense anxiety and suspiciousness of the presence of an undiagnosed,serious medical illness.

Question 13

A client is diagnosed with DID.What is the primary goal of therapy for this client?

Accepted Answer

Rationale: The nurse should anticipate that the primary therapeutic goal for a client diagnosed with DID is to collaborate among sub-personalities to improve functioning.Some clients choose to pursue a lengthy therapeutic regimen to achieve integration,a blending of all the personalities into one.The goal is to optimize the client's functioning and potential.

Question 14

A client is diagnosed with IAD.Which of the following symptoms is the client most likely to exhibit? (Select all that apply.)

Accepted Answer

Rationale: The nurse should expect that a client diagnosed with IAD would exhibit obsessive-compulsive behaviors,anxiety,and depression.Hypochondriasis involves an unrealistic or inaccurate interpretation of physical symptoms or sensations that can lead to preoccupation and fear of having a serious disease.

Question 15

A nursing instructor is teaching about the DSM-5 diagnosis of depersonalization-derealization disorder (D-DD).Which student statement indicates a need for further instruction?

Accepted Answer

Rationale: D-DD is characterized by a temporary change in the quality of self-awareness,which often takes the form of feelings of unreality,changes in body image,feelings of detachment from the environment,or a sense of observing oneself from outside the body.Depersonalization (a disturbance in the perception of oneself)is differentiated from derealization,which describes an alteration in the perception of the external environment.The DSM-5 states that during the depersonalization and/or derealization experiences,reality testing remains intact.This student statement indicates a need for further instruction.

Question 16

A client is exhibiting symptoms of generalized amnesia.Which of the following questions should the nurse ask to confirm this diagnosis? (Select all that apply.)

Accepted Answer

Rationale: The nurse should assess the client for possible causes of amnesia,which may include side effects of new medications,experiencing a traumatic event,or having a history of memory problems.Three types of disturbance in recall are identified in the DSM-5: localized,selective,and generalized.In the generalized type,the individual has amnesia for his or her identity and total life history.

Question 17

Which situation is an example of selective amnesia?

Accepted Answer

Rationale: Three types of disturbance in recall are identified in the DSM-5: localized,selective,and generalized.Localized and selective amnesia are related to a specific stressful event that has occurred.In selective amnesia,the individual can recall only certain incidents associated with a stressful event for a specific period after the event.In the generalized type,the individual has amnesia for his or her identity and total life history.

Question 18

A nurse is reviewing progress notes on a newly admitted client.One progress note reveals that the client purposefully inserted a contaminated catheter into urethra,leading to a urinary tract infection.The nurse recognizes this behavior as characteristic of which mental disorder?

Accepted Answer

Rationale: Factitious disorders involve conscious,intentional feigning of physical or psychological symptoms.Individuals with factitious disorder pretend to be ill in order to receive emotional care and support commonly associated with the role of "patient." Individuals become very inventive in their quest to produce symptoms.Examples include self-inflicted wounds,injection or insertion of contaminated substances,manipulating a thermometer to feign a fever,urinary tract manipulation,and surreptitious use of medications.

Quiz 20: Somatic Symptom and Dissociative Disorders

A client is diagnosed with functional neurological symptom disorder (FNSD) .Which of the following symptoms is the client most likely to exhibit? (Select all that apply.)