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:

Accepted Answer

These symptoms are indicative of a body dysmorphic disorder.

Question 2

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

Accepted Answer

The adult patients diagnosed with factitious disorder are often knowledgeable regarding medical terminology,and many work in the health care.The other options are not commonly associated with the disorder.

Question 3

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

Accepted Answer

Anxiety and depression are common comorbid mental health conditions seen in patients diagnosed with body dysmorphic disorder due to their constant dissatisfaction with their appearance.Obsessive-compulsive disorder,poor impulse control,and somatization disorders are not generally seen in such patients.

Question 4

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

Accepted Answer

The diagnosis of somatization disorder requires that symptoms indicate there is involvement of multiple organ systems (e.g.,gastrointestinal,reproductive,neurologic).Structural anomalies would indicate a medical problem exists.An early onset of symptoms (prior to age 30)is not recognized as a criterion for the diagnosis.A family history of depression is not a criterion for the diagnosis.

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?

Accepted Answer

Pharmacologic therapy for somatization disorders commonly include antidepressants,which can take weeks of administration before positive effects are noted.The remaining classifications are not generally used to treat somatization 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.

Accepted Answer

Pharmacologic interventions are symptom oriented and include anxiolytics for associated anxiety,antidepressants for associated depression,and short-term benzodiazepine therapy.Monitoring for orthostatic hypotension is recommended when benzodiazepines are prescribed.Instructing the patient to perform visual imagery (guided imagery)will reduce anxiety by distracting his or her focus on somatic concerns.When used,cognitive therapy is implemented short term.

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?

Accepted Answer

Symbolic psychological factors are identified as being related to the onset or exacerbation of a conversion symptom.An absence of a medical cause is present in both the case of conversion and somatization disorders.The conversion symptom is not limited to pain or sexual function nor is not under voluntary control.

Question 8

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

Accepted Answer

Educating the patient about the importance of limiting caffeine,nicotine,and other central nervous system stimulants is important since these substances can increase physical symptoms of anxiety (e.g.,rapid heart rate,jitteriness)that may cue other somatic concerns.Drinking strong coffee each day may cause physical symptoms that could cue other somatic concerns; this statement indicates a need for more teaching.The remaining options are all positive thoughts or actions for a patient.

Question 9

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

Accepted Answer

Minimization of the use of sickness to gain control and decreased anxiety related to health and wellness are the outcomes that relates specifically to somatization disorder.The remaining options are not typically associated with this disorder.

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?

Accepted Answer

Dissociative identity disturbance is exacerbated when the patient's anxiety escalates.Identification of increasing anxiety permits the patient to exercise anxiety-management strategies and prevent dissociation.The patient should be expressing such feelings to others.The patient should refer to himself in the first person.Use of manipulative behavior is not desirable in this or any other patient.

Question 11

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

Accepted Answer

Due to a recent increase in reported cases of dissociative amnesia involving previously forgotten early childhood memories,assessing such memories would have priority with this patient.Obsessive-compulsive disorder is not generally viewed as a co-morbid disorder of dissociative amnesia.The remaining options would not provide much specific information for this patient's condition.

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?

Accepted Answer

The scenario suggests that the patient is experiencing symptoms of conversion disorder,an anxiety disorder in which the symptom affects voluntary sensory or motor function and mimics a neurological disorder as a result of extreme anxiety,such as learning of his wife's desire to divorce him.There is no organic basis for the hearing loss but it is not under the patient's voluntary control.Most traumas are not dealt with by developing a mental illness but by rather coping effectively.Males are as likely as females to display conversion disorder symptoms.

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.

Accepted Answer

Discharge criteria would include behaviors and attitudes that show insight and some control over the disorder.Compliance with medication therapy,identification of stressors and using learned stress-reducing strategies such as mindfulness meditation are examples of such behaviors.There is a need for more nightly sleep and a willingness to seek help and support are important unmet criteria with this patient.

Question 14

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

Accepted Answer

The inability to recall the past is indicative of a fugue disorder.The remaining options are not characteristics of dissociative fugue.

Question 15

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

Accepted Answer

Interacting in a supportive but matter-of-fact way reduces the potential for any secondary reward on the part of the patient.The patient is not feigning illness,so is not a malingerer.An appointment with an eye doctor is not needed since the source of the blindness is not physical.The person is not permanently blind,so occupational therapy at this point is not a priority.

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?

Accepted Answer

While psychological factors have an important role in the onset,severity,exacerbation,or maintenance of the pain,initially the presence of a physical cause of the pain must be ruled out.The assessment of the patient's understanding of the disorder or recording of feelings regarding the trauma are not priorities until a diagnosis of pain disorder is made.Posttraumatic stress disorder is not generally characterized with reports of sustained 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?

Accepted Answer

Cognitive theorists believe that patients with somatic symptoms misinterpret the meaning of body functions and sensations and become overly alarmed by them and so help patients to reinterpret the meaning of body sensations.Continuing to challenge the patient regarding the belief is not therapeutic and should be avoided.Reinterpretation of thoughts is an appropriate cognitive approach.Rewarding appropriate behavior is a behavioral technique.Encouraging a second opinion is not helpful at this point since it is not likely to change his belief.

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?

Accepted Answer

The diagnosis of conversion disorder in this case results in a disruption of the patient's ability to perceive sensations,not a true loss or impairment of hearing.There is no evidence to support panic-level anxiety or a medical condition causing denial.

Question 19

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

Accepted Answer

With this disorder,the individual focuses on fears of having or the idea of having a serious medical disorder on the basis of his or her misinterpretation of bodily symptoms such as assuming pain is the result of a tumor.La belle indifference,showing little or no concern,occurs with conversion disorders.Individuals with hypochondriasis make multiple visits to physicians with health concerns.Showing insight into the condition would not be displayed at the time of diagnosis,since such improvement is a result of appropriate treatment.

Question 20

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

Accepted Answer

An advantage of group therapy is that it is an opportunity for the patient to learn from the successes and failures of others with similar symptoms.The group therapist will not allow members to support dysfunctional verbalizations.This disorder is treated with a variety of treatment modalities.This therapy is done with cooperation between therapist and patients.

Quiz 11: Somatoform, Factitious, and Dissociative Disorders