Deck 11: Somatoform, Factitious, and Dissociative Disorders

Question 1

A nurse interviews a 17-year-old patient and notes these assessment data: excessive grooming,checking in the mirror,and preoccupation with perceived physical imperfections.The nurse suspects:

A) Hypochondriasis
B) Factitious disorder
C) Somatoform disorder
D) Body dysmorphic disorder

Answer 1

Body dysmorphic disorder

Question 2

Which adult patient is most likely a candidate for the diagnosis of factitious disorder?

A) An educated African immigrant
B) A health care facility employee
C) A cognitively challenged female
D) A middle-aged American male

Answer 2

A health care facility employee

Question 3

A patient is diagnosed with body dysmorphic disorder.Which question assesses for the presence of a common co-morbid mental disorder?

A) "Do you every have suicidal thoughts?"
B) "Do you worry about being terminally ill?"
C) "Do you see yourself as having problems controlling your anger?"
D) "Do you engage in repetitive, ritualistic behaviors to help control anxiety?"

Answer 3

"Do you every have suicidal thoughts?"

Question 4

Which nursing assessment finding would support a diagnosis of somatoform disorder?

A) Patient reports a family history of depression
B) The onset of symptoms beginning at age 38
C) An abnormality of the patient's left heart ventricle
D) Complaints of diarrhea and an erratic menstrual cycle

Question 5

A family member asks the nurse about possible medications to treat somatization disorders.Which statement by the nurse shows an understanding of the recognized medication therapy for this disorder?

A) "Hypnotics, taken appropriately will help with your major complaints."
B) "Lithium will require regular monitoring to assure therapeutic blood levels."
C) "Antidepressant therapy may take several weeks to bring about symptom relief."
D) "Anticonvulsants are often used to treat the side effects of these type of disorders"

Question 6

A patient is being treated for somatoform disorder with psychotherapy and medication therapy.Which interventions are appropriate for the patient's plan of care? Select all that apply.

A) Instructing the patient in use of imagery to distract themselves when feeling anxious
B) Educating the patient on the identification of side effects related to anxiolytic therapy
C) Monitoring the patient's vital signs to assess for the side effects of benzodiazepine administration
D) Discussing the need for long-term cognitive therapy in order to eliminate the symptoms of the disorder
E) Asking the patient to explain the role serotonin selective reuptake inhibitors (SSRIs) play in the management of his symptoms.

Question 7

To differentiate between somatoform and conversion disorders,the nurse will direct the assessment to determine the presence of the critical defining factor associated with conversion disorder.Which is true about a conversion reaction?

A) Symptoms are generally associated with pain or sexual function.
B) Symptoms are not accounted for by a medical condition.
C) Symptoms are precipitated by psychological factors.
D) Symptoms are under the patient's voluntary control.

Question 8

A patient has a somatization disorder.Which statement by the patient would indicate a need for additional patient teaching?

A) "I have learned that my family can be a support system."
B) "I will let my therapist know if I think suicidal thoughts."
C) "Drinking strong coffee really helps me combat my fatigue."
D) "Nicotine makes my heart race, so I need to stop smoking."

Question 9

What discharge criteria would be appropriate for a patient with a somatization disorder? Select all that apply.

A) Increased willingness to relinquish the "sick role"
B) Decreased anxiety related to possible health issues
C) Increased caloric intake and demonstrated weight gain
D) Decrease the use of laxatives, sleeping pills, and diuretics
E) Experiencing decreased frequency of auditory hallucinations

Question 10

A diagnosis of dissociative identity disturbance has been identified for a patient who has stated that he is unable to distinguish between himself and his surroundings.What is an appropriate outcome for this patient?

A) Refers to himself as "the patient"
B) Identifies the onset of increasing anxiety
C) Uses manipulative behaviors to meet needs
D) Displays ability to suppress feelings of dissatisfaction

Question 11

Which question would the nurse performing an admission interview for a patient with suspected dissociative amnesia disorder identify as a priority?

A) "What help would you like us to give you?"
B) "Are you experiencing a high level of anxiety?"
C) "Do you find rituals make you feel more comfortable?"
D) "How would you describe your childhood memories?"

Question 12

A patient comes to the ED stating that he suddenly became deaf.It is determined that his wife has recently asked for a divorce.What is the basis for the possibility that this patient is experiencing a conversion disorder?

A) Inventing the symptom helps in diverting attention from the marital problems.
B) Such a traumatic life change is likely to result in some form of mental illness.
C) The loss is a protective mechanism to help deal with overwhelming anxiety.
D) Men often exhibit this disorder since it is more accepted than showing sadness.

Question 13

The nurse is evaluating a patient diagnosed with a dissociative disorder for discharge criteria.Which statements made by the patient indicate that discharge criteria have been met? Select all that apply.

A) "I've learned to identify my personal stressors."
B) "Meditation is a wonderful support in managing my stress."
C) "It's getting better; I'm sleeping about 5 hours most nights."
D) "I know I have to rely on myself to get this problem under control."
E) "I'll talk with my doctor before making any changes to my medicines."

Question 14

The ED nurse is caring for a patient with a dissociative fugue.Which assessment finding would support this diagnosis?

A) Reports of pain in both legs and abdomen
B) An inability to recall how and when he arrived in this city
C) Change in voice and attitude suggesting two distinct personality states
D) Inability to see since witnessing an accident that resulted in two deaths

Question 15

A patient experiencing the sudden onset of blindness is diagnosed with a conversion disorder.Which nursing intervention would be most therapeutic?

A) Suggesting to the patient that this is possibly malingering
B) Assisting him to make an appointment with an ophthalmologist
C) Providing nursing care in a supportive but matter-of-fact manner
D) Providing an occupational therapy consult to address the needs of a blind person

Question 16

A patient reports severe pain during intercourse since being sexually assaulted three years ago.What is the first step in confirming the diagnosis of a pain disorder?

A) Evaluating the patient's understanding of the emotional effects of the assault
B) Asking the patient to keep a journal of her feelings regarding the assault
C) Assessing the patient for posttraumatic stress disorder
D) Ruling out a physical cause of the pain

Question 17

A patient who inaccurately believes he has stomach cancer is recommended cognitive theory to help address this false believe.Which intervention is most consistent with a cognitive theory approach?

A) Continuing to challenge the patient about the rationality of his belief
B) Assisting him to reinterpret the meaning of the sensations his body is creating
C) Urging him to have a 'second opinion' consult with another medical specialist
D) Rewarding him with praise and acceptance when he states, "I do not have cancer."

Question 18

A patient has developed an acute loss of hearing and is diagnosed with a conversion disorder.Which nursing diagnosis would be most appropriate?

A) Hearing impairment
B) Panic-level anxiety
C) Disturbed sensory perception
D) Denial due to a medical condition

Question 19

A patient is being evaluated for the diagnosis of hypochondriasis.Which assessment observation of the patient would serve to confirm this diagnosis?

A) Reports, "Pain in my back is certainly from a spinal tumor."
B) Patient expresses no concern over her sudden loss of hearing.
C) Patient shows insight into the role stress plays in the illness.
D) Reports, "I don't like doctors and so I haven't been to one in years."

Question 20

The nurse reinforces the recommendation of group therapy for a patient with a somatization disorder.What knowledge is this recommendation based upon?

A) Group therapy is the one therapy of choice for this anxiety disorder.
B) Group therapy is therapist driven and managed to eliminate stress on the patients.
C) The group will support the patient in all complaints of physical illness as well as emotional distress.
D) This therapy allows the patient to learn what has successfully worked for other patients with the disorder.