Deck 16: Psychophysiological Responses and Somatoform and Sleep Disorders

Question 1

Which patient is most likely exhibiting a conversion disorder?

A) A toddler with frequent ear infections
B) An athlete with exercise-induced asthma
C) A night guard who suddenly goes blind
D) An older adult whose fractured foot is not healing well

Answer 1

A night guard who suddenly goes blind

Question 2

A patient diagnosed with hypochondriasis says,"No one believes I have a brain tumor! I have terrible headaches and episodes of blurred vision.I'm going to die." Which nursing approach fosters cognitive restructuring?

A) "Tell me about your relationships with the significant people in your life."
B) "You must be very worried about your condition. Let's discuss these feelings."
C) "Let's look at the evidence that suggests you have a brain tumor and consider the possible explanations for the symptoms."
D) "Your concern is unfounded. The more you talk about it, the more real your false idea seems. Let's talk about something else."

Answer 2

"Let's look at the evidence that suggests you have a brain tumor and consider the possible explanations for the symptoms."

Question 3

A staff nurse decides to ignore an unfavorable evaluation from the nurse manager but now complains about getting little satisfaction from work,feels tired all the time,and can't wait for the shift to end.The nurse's behavior is characteristic of which stage of the general adaptation syndrome?

A) Alarm
B) Resistance
C) Exhaustion
D) Resolution

Answer 3

Resistance

Question 4

Which patient is most likely exhibiting a somatization disorder?

A) A person with chronic pain in the right ankle after a skiing injury
B) A person who experiences occasional chest pain after a myocardial infarction
C) A college graduate who cannot maintain steady employment because of multiple vague complaints
D) A person who dislikes going out to social events with large groups because of embarrassment about facial acne

Question 5

A business executive is in the cardiac care unit (CCU) after a myocardial infarction.When the patient is told that it is not possible to have a telephone in the room,the patient angrily berates the nurse and demands to see a physician.Which response by the nurse would be the most therapeutic?

A) "I'll call your physician."
B) "I'll arrange for you to have a telephone."
C) "I can see that being ill is difficult for you."
D) "You are just too ill to make business calls."

Question 6

Which patient would be at greatest risk of encountering the exhaustion phase of the general adaptation syndrome?

A) A patient who is scheduled for knee replacement surgery
B) A patient who has high self-efficacy and has recently accepted a job promotion
C) A patient who has had elective rhinoplasty to correct a prominent hump in the bridge of the nose
D) A person who has severe osteoarthritis and was admitted to a nursing home after the death of a caretaker spouse 2 months ago

Question 7

Which expected outcome would be appropriate for a patient with a somatoform disorder?

A) Patient's anxiety level will decrease from severe to moderate.
B) Patient will demonstrate compliance with antianxiety medication regimen.
C) Patient will be able to cope with stress without being preoccupied with physical symptoms.
D) Patient will express feelings verbally rather than through the development of physical symptoms.

Question 8

A patient has had two rhinoplasties but continues to seek further surgery.The patient has been told repeatedly that further surgery is not indicated.The patient tells a nurse,"My life will be ruined unless my appearance can be improved." The patient's thinking suggests:

A) hypochondriasis.
B) conversion disorder.
C) somatization disorder.
D) body dysmorphic disorder.

Question 9

Which intervention should a nurse select to help a patient cope more effectively with chronic pain disorder?

A) Mild opioids
B) Benzodiazepines
C) Relaxation techniques
D) Response prevention

Question 10

A nurse is working with a patient exhibiting psychophysiological symptoms.It is important that the nurse understand that the patient's symptoms are:

A) feigned.
B) psychosomatic.
C) serious and require treatment.
D) only serious if associated with actual pathology.

Question 11

A patient has been instructed to use crutches in order to rest an injured foot.At a follow-up appointment,the patient admits to beginning a walking program.A nurse can assess this behavior as evidence the patient is employing:

A) projection.
B) regression.
C) rationalization.
D) compensation.

Question 12

"Doctor shopping," which is common among patients with somatoform disorders,suggests to a nurse that a patient:

A) is denying the psychological component of the illness.
B) cannot be successfully treated on an outpatient basis.
C) uses rationalization to cope with anxiety aroused by the physical symptoms.
D) has chosen to display symptoms of a physical illness to avoid responsibilities.

Question 13

Which type of treatment is likely to be effective for a patient diagnosed with body dysmorphic disorder whose nose is the focus of concern?

A) Short-term benzodiazepine use to reduce anxiety
B) Biofeedback to control physical responses to anxiety
C) Antidepressant therapy to increase self-esteem, self-confidence, and outlook
D) Cognitive behavioral therapy to challenge distorted thinking and interrupt self-critical thoughts

Question 14

A patient is diagnosed with conversion disorder that is evidenced by paralysis of the right hand.Which nursing intervention should be implemented?

A) Focus discussions on the patient's inability to fulfill usual roles.
B) Focus discussions on the patient's unusual and unexplainable physical symptom.
C) Spend time with the patient to give recognition for positive qualities and strengths.
D) Spend time with the patient when the patient is helpless to perform self-care activities because of paralysis.

Question 15

A nurse plans care for a patient at risk for development of a psychophysiological disorder associated with multiple stressors.In the assessment of the patient's coping resources,which factor would the nurse consider initially?

A) The social support available to the patient
B) Whether there has been sustained grief over a recent loss
C) Whether the patient is overworked with too many commitments
D) Strain associated with the patient's parenting duties

Question 16

A nurse planning care for a patient who has somatoform disorder needs to be aware that these patients often have relationship problems associated with:

A) anger.
B) dependency.
C) detachment.
D) misplaced objectivity.

Question 17

A patient says,"Although numerous assessments and diagnostic tests over the past year have shown no evidence of organic disease I'm still anxious and sure something is wrong." The nurse should suspect the presence of:

A) hypochondriasis.
B) chronic pain disorder.
C) chronic major depression.
D) body dysmorphic disorder.

Question 18

A patient diagnosed with body dysmorphic disorder says,"I'm seriously dissatisfied with the appearance of my nose.It's ruining my life." A possible nursing diagnosis to consider for this patient is:

A) anxiety.
B) disturbed body image.
C) ineffective coping skills.
D) ineffective role performance.

Question 19

A patient diagnosed with essential hypertension reports feeling pressured by the demands made by family,friends,and an employer.Which role-play situation,as part of a patient education plan for coping with stress,would most likely help the patient develop effective stress-reduction skills?

A) Patient offering to help a friend organize a church group activity
B) Patient saying "no" to a request made by the employer to work overtime
C) Patient accepting a verbal demonstration of caring and concern from spouse
D) Patient asking a work subordinate to be prepared to come to work on time

Question 20

A nurse is working with a patient who has been diagnosed with a somatoform disorder.The patient asks,"My last tests didn't show anything.When will I have more diagnostic testing?" Which nursing response would be most therapeutic?

A) "You are resisting the idea that you do not have a physical illness."
B) "No more tests will be ordered. Your health maintenance organization (HMO) won't pay for repeating any tests."
C) "We think you need a rest from all the testing. We'll consider more tests at a later time."
D) "Since the tests were all negative, we will focus next on evaluating the role of stress in your life."

Question 21

A patient admitted with conversion disorder was prematurely forced to acknowledge the psychological nature of what was thought to be paralysis.The morning after,the patient called a nurse and reports,"I am blind." This set of circumstances is evidence of the _____ disorder.

A) unpredictability of the
B) defensive nature of the
C) intentional nature of the
D) manipulative tendencies of patients with conversion

Question 22

A patient with a history of insomnia has been taking 15 mg of chlordiazepoxide (Librium) at bedtime for the past year.The patient reports having difficulty falling asleep and wakes up frequently during the night.The most appropriate nursing diagnosis to consider is:

A) disturbed sleep pattern related to anxiety.
B) moderate anxiety related to disturbed sleep pattern.
C) insomnia related to tolerance to chlordiazepoxide (Librium).
D) thought disorder related to intolerance of chlordiazepoxide (Librium).

Question 23

Which strategy would be most therapeutic when helping a patient with a psychophysiological disorder to develop insight?

A) Spend time with the patient to identify strengths.
B) Identify dysfunctional coping mechanisms for the patient.
C) Suggest that the patient's use of denial is interfering with developing insight.
D) Help the patient become aware of feelings when physical symptoms are present.

Question 24

A nurse is caring for a patient diagnosed with extreme stress.The nurse is focusing interventions on the promotion of adaptive psychophysiological patient responses.Which intervention is included in the plan of care?

A) Monitoring the patient's medication
B) Monitoring the patient's physical health
C) Shifting the patient's attention away from the symptoms
D) Providing education to promote change in the patient's health practices

Question 25

Which nursing actions would enhance the development of a therapeutic relationship with a patient diagnosed with a psychophysiological disorder? (Select all that apply.)

A) Assure the patient that the problem is easily treated since it is imagined.
B) Approach the patient with the understanding that the symptoms are real.
C) Encourage the patient to identify triggers that make the symptoms worse.
D) Encourage the patient to identify situations that make the symptoms better.
E) Provide the patient with a list of behaviors that are the focus of the problem.