Deck 22: Somatoform, Factitious, and Dissociative Disorders

Question 1

A patient with blindness related to conversion disorder tells the nurse,"Lots of doctors and nurses stop by to check on my blindness,and the other patients are really interested in it,too.Too bad people didn't think I was interesting before I became blind." Which nursing diagnosis is most suggested by this comment?

A) Social isolation
B) Chronic low self-esteem
C) Interrupted family processes
D) Ineffective health maintenance

Answer 1

Chronic low self-esteem

Question 2

A patient with somatoform pain disorder reveals to the nurse that he has begun to question why God has made him an invalid who is unable to provide for his family.He states that he believes the burden placed on his spouse and his children may be even greater than the burden he must bear.He blames God for punishing his "innocent family." Which nursing diagnosis should be the priority diagnosis?

A) Spiritual distress
B) Self-care deficit
C) Decisional conflict
D) Ineffective role performance

Answer 2

Ineffective role performance

Question 3

A patient has blindness related to conversion disorder.Which response would be most appropriate for ensuring adequate nutrition?

A) Ask other patients to volunteer to feed the patient at each meal.
B) Direct her to locate items on the tray and feed herself unassisted.
C) Assign staff to sit with and take turns feeding the patient at each meal.
D) Explain where the foods and utensils are on the tray so she can self-feed.

Answer 3

Explain where the foods and utensils are on the tray so she can self-feed.

Question 4

A patient who is concerned that she may have serious heart disease seeks help at the mental health center after her internist examined her and told her that she has no physical illness.She wants staff to tell her internist it's not all in her head.The patient reports she has had tightness in her chest and the sensation of her heart missing a beat.Her concern over her symptoms has caused her to miss much time from work over the past 2 years,and her social life has been severely restricted because she believes she must rest each evening.This presentation most suggests:

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

Question 5

A patient states,"I feel detached and weird all the time.It's as though I'm looking at life through a cloudy window.Everything seems unreal.It really messes up things at work and school." This presentation is most consistent with the DSM-IV-TR criteria for:

A) depersonalization disorder.
B) body dysmorphic disorder.
C) dissociative amnesia.
D) malingering.

Question 6

The nurse who is counseling a patient with dissociative identity disorder should understand that the assessment of highest priority is:

A) risk for self-harm.
B) cognitive functioning.
C) memory impairment.
D) treatment motivation.

Question 7

A patient who is 5 feet 9 inches tall and weighs 160 pounds believes that her size-9 feet are enormous compared with the rest of her body.She has visited orthopedic surgeons to see if surgery could reduce the length of her feet,and she spends hours trying to buy shoes that make her feet look smaller.In social situations,she sits with her feet concealed under a table or wears long skirts to hide them.The nurse can assess that the patient's symptoms are consistent with:

A) hypochondriasis.
B) somatoform pain disorder.
C) body dysmorphic disorder.
D) depersonalization disorder.

Question 8

A medical inpatient who is being counseled for somatoform pain disorder states he believes his pain is the result of an undiagnosed injury.He adds that he is unable to adhere to his plan for care,which involves performing his own activities of daily living,walking 20 minutes daily,and using pain medication only at bedtime.Which behavior,as charted by staff,would most suggest that he is responding to interventions?

A) "Patient bathed himself and did not seek analgesics this shift."
B) "Up ad lib,complains of minor pain but 'trying to do without' pain meds."
C) "Patient agrees to try acetaminophen (Tylenol)in place of narcotics."
D) "Patient states he is feeling better and is ready to leave the hospital."

Question 9

The husband of a patient who has been diagnosed with severe dissociative disorder asks the nurse if he is in any way at fault for his wife's illness.He states their relationship is mutually supportive,and no trauma has recently occurred.Which response would be most therapeutic and best illustrates our current understanding of the etiology of such disorders?

A) "We think the disorder is caused by trauma or abuse early in life.You seem very concerned about your wife;we could talk about your concerns if you like."
B) "I doubt there is anything you could have done that made it worse or could do to make it better,because we think it is primarily a genetic disorder you are born with."
C) "These disorders arise from within the person;they are just something the rest of us have to be supportive about until they get better on their own."
D) "These conditions are understandably frustrating;it's hard to imagine why a person would put their loved ones through what they do."

Question 10

The nurse assessing a patient with a somatoform disorder is most likely to note that the patient:

A) rarely derives any personal benefit from the physical symptoms.
B) readily sees a connection between symptoms and unresolved conflicts.
C) usually is able to talk readily about feelings and emotional needs.
D) has alterations in comfort and activities related to physical complaints.

Question 11

A patient has been diagnosed as having blindness related to conversion disorder.She displays indifference regarding the conversion symptom.The nurse states,"I can't understand why the patient doesn't seem more anxious about her symptom." Which explanation from the Clinical Nurse Specialist would enable the nurse to understand the patient's behavior?

A) The patient is suppressing her true feelings.She is upset but is not showing it.
B) The blindness is actually helping the patient by reducing her anxiety.
C) Her needs are met during hospitalization,so she has no need to be anxious.
D) She is controlling her own anxiety through partial denial of the blindness.

Question 12

To plan effective care for patients with somatoform disorders,the nurse must understand that the patients may have difficulty giving up the symptoms because they:

A) have impaired interpersonal skills.
B) can be voluntarily controlled.
C) provide relief of anxiety.
D) have a physiological basis.

Question 13

A fellow nurse reports a strange experience: She was riding with her carpool partner after working her second double shift in a row when she looked down at her hands on her lap and did not immediately recognize them as her own.They seemed "small and far away" to her.She felt "like I wasn't myself" for several minutes,after which she gradually returned to normal.This happened several weeks ago,and she has never had a similar experience otherwise.She is worried she is losing her mind or suffering from a brain tumor.Which response most accurately reflects what the friend probably experienced?

A) Not accepting part of one's body as one's own is an indication of body dysmorphic disorder;this is a psychiatric disorder and prompt treatment is needed.
B) The long hours of work with little recovery time led her to have a transient episode of depersonalization;these are common,stress-related,and not a sign of major illness.
C) The friend had a mini-fugue experience,which suggests deeper underlying conflicts or past trauma that has not resolved;it could progress and merits counseling.
D) Such feelings of unreality could be early symptoms of dissociative identity disorder;she might not have recognized her own body because an alter personality was taking control.

Question 14

A patient with somatization has an established nursing diagnosis of Interrupted family processes related to patient's symptoms.The patient's spouse and children assume roles and tasks that previously belonged to the patient.Which is an appropriate outcome for the patient? The patient will __________.

A) demonstrate resumption of former roles and tasks.
B) assume roles and functions of other family members.
C) focus energy on problems occurring in the family.
D) rely on family members to meet all patient needs.

Question 15

The medical-surgical nurse working with patients who has a somatoform disorder will find planning is facilitated by the understanding that the patients will probably:

A) be resistant to seeking psychiatric help.
B) be interested in seeing the consulting psychiatrist.
C) attend psychotherapy sessions without encouragement.
D) be eager to discover the true reasons for their physical symptoms.

Question 16

The nursing assistant remarks to the nurse,"The patient with amnesia looks together,but when I talk to her,she seems rather vague.What should I be doing for her?" The best reply would be:

A) "Provide more info about her past to reduce the unknowns that cause her anxiety."
B) "Use short,simple sentences and keep her environment calm and protective."
C) "Spend as much time with her as you can,and ask questions about her recent life."
D) "Structure her time with lots of activities to keep her busy and stimulated."

Question 17

Which assessment data most suggests that the patient is experiencing a fugue state?

A) After being caught in an affair,a man disappeared only to reappear months later without memory of what had occurred while he was missing.
B) A woman reports that when she feels tired or stressed,it seems like her body isn't real and is somehow growing smaller,which seems "crazy" to her.
C) A man is extremely anxious about his problems and sometimes "zones out," finding that several minutes have passed without conscious awareness of them.
D) A woman finds unfamiliar clothes in her closet,is recognized when she walks into restaurants she's never been to,and complains of "blackouts" despite not drinking.

Question 18

Establishing a therapeutic relationship with a patient with a dissociative disorder may be more difficult for the nurse than establishing a relationship with a psychotic patient because the patient with a dissociative disorder:

A) is more reluctant to engage with others.
B) has symptoms that may seem contrived.
C) seems so needy that it overwhelms the nurse.
D) is seeking large amounts of secondary gains.

Question 19

The patient lives with her roommate in a condominium.The roommate has observed her leaving the condo wearing seductive clothing quite different from her usual wardrobe and returning 12 to 24 hours later,after which she sleeps for 8 to 12 hours.Episodes have also occurred in which the patient and her roommate have argued about household matters,and the patient has gone to sit on the floor in the corner of the kitchen.While seated there,she has spoken like a young child.The patient's problem can be assessed as being consistent with DSM-IV-TR criteria for:

A) dissociative fugue state.
B) dissociative identity disorder.
C) body dysmorphic disorder.
D) depersonalization disorder.

Question 20

To best assist a patient with a conversion disorder,which nursing intervention would be most effective?

A) "Everyone has been focused on your blindness,but I would like to talk about your feelings and what emotions you were experiencing before this began."
B) "I have looked at your test results and spoken with your doctor,and it appears that although your blindness seems real to you,it isn't."
C) "Letting one's anger out all at once can be frightening,and that could make your blindness worse.Let's focus on some other topics instead."
D) "Tell me more about your blindness: What exactly is it like for you,how does it affect you,and what is it like being blind all of a sudden?"

Question 21

A patient who is being counseled for somatoform pain disorder states he believes his pain is the result of an undiagnosed injury.He adds that he cannot adhere to his plan for care involving performing his own activities of daily living,walking 20 minutes daily,and using pain medication only at bedtime.He states he feels "like a baby" because his wife and children must provide so much care for him.The nurse understands that it is most important to assess:

A) mood.
B) cognitive style.
C) secondary gains.
D) identity and memory.

Question 22

You are caring for a child with a history of multiple admissions for recurrent systemic infections,and the child is not improving in the hospital,despite aggressive treatment.A doctor mentions "factitious disorder by proxy." What nursing interventions would be appropriate when this disorder is suspected? Select all that apply.

A) Provide more private visiting time for the parents to increase bonding.
B) Stop by the patient's room frequently during visiting hours.
C) Encourage family members to visit in groups of two or three.
D) Keep careful,detailed records of visitation and untoward events.
E) Educate visitors about the importance of strict hand washing.

Question 23

Which assessment data would help the health care team distinguish symptoms of conversion from symptoms of hypochondriasis?

A) Results of diagnostic testing
B) Voluntary control of symptoms
C) Patient's style of presentation
D) The role of secondary gains

Question 24

A college senior comes to the mental health clinic with the chief complaint that "My face is so ugly I can't go out in public." Assessment reveals she has no actual disfigurement and is of average attractiveness.She tells the nurse that she goes to class wearing a scarf draped across her lower face but is concerned that she will be unable to interview for positions after graduation because of her ugly appearance.The patient's symptoms are consistent with the clinical picture of:

A) dissociative identity disorder.
B) body dysmorphic disorder.
C) hypochondriasis.
D) malingering.

Question 25

Which presentations suggest the possibility of a factitious disorder? Select all that apply.

A) Doctor shops,that is,goes from one doctor to another seeking the desired response
B) Has a history of multiple hospitalizations without findings of physical illness
C) If the desired response is not received,accuses staff of incompetence
D) Claims illness to obtain financial benefit or other external incentive
E) Has had multiple workups or even multiple exploratory surgeries

Question 26

A patient with depersonalization disorder tells the nurse,"It's starting again.I feel as though I'm going to float away." Which intervention would be most appropriate at this point?

A) Advise her to begin meditation by slowing her breathing.
B) Administer an as-needed antianxiety or sedative medication.
C) Use guided imagery to help her visualize a pleasant scene.
D) Engage her in a concrete,here-and-now activity such as singing.

Question 27

To assess patients effectively,the nurse must understand that the essential difference between somatoform disorders and dissociative disorders is that somatoform disorders:

A) involve the expression of anxiety through bodily sensation or function,and dissociative disorders alter consciousness,recall,and awareness of self.
B) follow a particularly traumatic event,whereas dissociative disorders are responses to the accumulation of distress from multiple stressors.
C) usually affect persons older than age 40,whereas dissociative disorders are primarily disorders of persons younger than age 40.
D) involve the patient being unaware that they have a psychological problem,whereas persons with dissociative disorders are fully aware they are troubled.

Question 28

Which physician orders would be most likely for a patient with chronic pain?

A) Vitals signs every four hours,PRN narcotic analgesics.
B) Relaxation techniques and antidepressant medications.
C) Respond thoroughly and supportively to pain complaints.
D) Provide respite from daily demands to reduce anxiety.