Question 1

A medical-surgical nurse works with a patient diagnosed with a somatic symptom disorder. Care planning is facilitated by understanding which of the following?

Accepted Answer

Patients with somatic symptom disorders go from one health care provider to another trying to establish a physical cause for their symptoms, referred to as "doctor shopping." When a psychological basis is suggested and a referral for counselling offered, these patients reject both.

Question 2

A patient diagnosed with a somatic symptom disorder has been in treatment for 4 weeks. The patient says, "Although I'm still having pain, I notice it less and am able to perform more activities." The nurse should evaluate the treatment plan as which of the following?

Accepted Answer

Decreased preoccupation with symptoms and increased ability to perform activities of daily living suggest partial success of the treatment plan. Total success is rare because of patient resistance.

Question 3

Which assessment question could a nurse ask to help identify secondary gains associated with a somatic symptom disorder?

Accepted Answer

Secondary gains should be assessed. Secondary gains reinforce maladaptive behaviour. The patient's dependency needs may be evident through losses of abilities. When secondary gains are prominent, the patient is more resistant to giving up the symptom. There may be a history of abuse or doctor shopping, but the question does not assess the associated gains.

Question 4

Which treatment modality should a nurse recommend to help a patient diagnosed with a somatic symptom disorder to cope more effectively?

Accepted Answer

Somatic symptom disorders are commonly associated with complicated reactions to stress. These reactions are accompanied by muscle tension and pain. Relaxation can diminish the patient's perceptions of pain and reduce muscle tension. The distracters are modalities useful in treating selected anxiety disorders.

Question 5

What is an essential difference between somatic symptom disorders and factitious disorders?

Accepted Answer

Factitious disorders are under voluntary control, whereas somatic symptom disorders involve expression of psychological stress through somatization is the only fully accurate statement. Somatic symptom disorders involve expression of stress through bodily symptoms and are not under voluntary control or culture bound. Factitious disorders are under voluntary control. See relationship to audience response question.

Question 6

A patient with a somatic symptom disorder has the nursing diagnosis Interrupted family processes related to patient's disabling symptoms as evidenced by spouse and children assuming roles and tasks that previously belonged to the patient. An appropriate outcome is that the patient will do which of the following?

Accepted Answer

The patient with a somatic symptom disorder has typically adopted a sick role in the family, characterized by dependence. Increasing independence and resumption of former roles are necessary to change this pattern. An appropriate outcome is that the patient will resume performance of work, family, and social role behaviours. The distracters are inappropriate outcomes.

Question 7

Which prescription medication would the nurse expect to be prescribed for a patient diagnosed with a somatic symptom disorder?

Accepted Answer

Various types of antidepressants may be helpful in somatic disorders directly by reducing depressive symptoms and hence somatic responses, but also indirectly by affecting nerve circuits that affect not only mood, but fatigue, pain perception, GI distress, and other somatic symptoms. Patients may benefit from short-term use of antianxiety medication (benzodiazepines) but require careful monitoring because of risks of dependence. Conventional antipsychotic medications would not be used, although selected atypical antipsychotics may be useful. Narcotic analgesics are not indicated.

Question 8

To assist patients diagnosed with somatic symptom disorders, nursing interventions of high priority do which of the following?

Accepted Answer

Shifting the focus from somatic symptoms to feelings or to neutral topics conveys interest in the patient as a person rather than as a condition. The need to gain attention with the use of symptoms is reduced over the long term. A desired outcome would be that the patient would express feelings, including anger if it is present. Once physical symptoms are investigated, they do not need to be reinvestigated each time the patient reports them.

Question 9

A patient diagnosed with a somatic symptom disorder says, "My pain is from an undiagnosed injury. I can't take care of myself. I need pain medicine six or seven times a day. I feel like a baby because my family has to help me so much." It is important for the nurse to assess which of the following?

Accepted Answer

Secondary gains should be assessed. The patient's dependency needs may be met through care from the family. When secondary gains are prominent, the patient is more resistant to giving up the symptom. The scenario does not allude to a problem of mood. Cognitive style and identity and memory assessment are of lesser concern because the patient's diagnosis has been established.

Question 10

Which assessment data would help the health care team distinguish symptoms of conversion (functional neurological) disorder from symptoms of illness anxiety disorder (hypochondriasis)?

Accepted Answer

Patients with illness anxiety disorder (hypochondriasis) tend to be more anxious about their concerns and display more obsessive attention to detail, whereas patients with conversion (functional neurological) disorder often exhibit less concern with the symptom they are presenting than would be expected. Neither disorder involves voluntary control of the symptoms. Results of diagnostic testing for both would be negative (i.e., no physiological basis would be found for the symptoms). Secondary gains can occur in both disorders but are not necessary to either.

Question 11

A patient who experienced a myocardial infarction was transferred from critical care to a step-down unit. The patient then used the call bell every 15 minutes for minor requests and complaints. Staff nurses reported feeling inadequate and unable to satisfy the patient's needs. When the nurse manager intervenes directly with this patient, which comment would be most therapeutic?

Accepted Answer

This patient is experiencing anxiety associated with a serious medical condition. Verbalization is an effective outlet for anxiety. "I'm wondering if you're anxious . . ." focuses on the emotions underlying the behaviour rather than the behaviour itself. This opening conveys the nurse's willingness to listen to the patient's feelings and an understanding of the commonly seen concern about not having a nurse always nearby as in the critical care unit. The other options focus on the behaviour or its impact on nursing and do not help the patient with her emotional needs.

Question 12

A patient reports fears of having cervical cancer and says to the nurse, "I've had Pap smears by six different doctors. The results were normal, but I'm sure that's because of errors in the laboratory." Which disorder would the nurse suspect?

Accepted Answer

Patients with illness anxiety disorder have fears of serious medical problems, such as cancer or heart disease. These fears persist despite medical evaluations and interfere with daily functioning. There are no complaints of pain. There is no evidence of factitious or conversion disorder.

Question 13

A patient with fears of serious heart disease was referred to the mental health centre by a cardiologist. Extensive diagnostic evaluation showed no physical illness. The patient says, "My chest is tight, and my heart misses beats. I'm often absent from work. I don't go out much because I need to rest." Which health problem is most likely?

Accepted Answer

Illness anxiety disorder (hypochondriasis) involves preoccupation with fears of having a serious disease even when evidence to the contrary is available. The preoccupation causes impairment in social or occupational functioning. Somatic symptom disorder involves fewer symptoms. Dysthymic disorder is a disorder of lowered mood. Antisocial disorder applies to a personality disorder in which the individual has little regard for the rights of others. See relationship to audience response question.

Question 14

A patient has blindness related to conversion (functional neurological) disorder. Which of the following should the nurse do to help the patient eat?

Accepted Answer

The patient is expected to maintain some level of independence by feeding self, while the nurse is supportive in a matter-of-fact way. The patient experiencing blindness can be told at what numbers on an imaginary clock the food is located on the plate. The distracters support dependency or offer too little support.

Question 15

A patient has blindness related to conversion (functional neurological) disorder but is unconcerned about this problem. Which understanding should guide the nurse's planning for this patient?

Accepted Answer

Psychoanalytical theory suggests conversion reduces anxiety through production of a physical symptom symbolically linked to an underlying conflict. Conversion, not suppression, is the operative defence mechanism in this disorder. While some MRI studies suggest that patients with conversion disorder have an abnormal pattern of cerebral activation, there is no actual alternation of nerve transmission. The other distracters oversimplify the dynamics, suggesting that only dependency needs are of concern, or suggesting conscious motivation (conversion operates unconsciously).

Question 16

A patient says, "I know I have a brain tumor despite the results of the MRI. The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day." Which response by the nurse fosters cognitive reframing?

Accepted Answer

Questioning the evidence is a cognitive reframing technique. Reattribution treatment, which can help the patient identify causes other than the feared disease, can be helpful in changing distorted perceptions. Distraction by changing the subject will not be effective.

Question 17

A nurse assessing a patient diagnosed with a somatic symptom disorder is most likely to note which of the following?

Accepted Answer

The patient frequently has altered comfort and activity needs associated with the symptoms displayed (fatigue, insomnia, weakness, tension, pain). In addition, hygiene, safety, and security needs may also be compromised. The patient is rarely able to see a relation between symptoms and events in his or her life, which is readily discernible to health professionals. Patients with somatic symptom disorders often derive secondary gain from their symptoms and/or have considerable difficulty identifying feelings and conveying emotional needs to others.

Question 18

A patient with blindness related to conversion (functional neurological) disorder says, "All the doctors and nurses in the hospital stop by often to check on me. Too bad people outside the hospital don't find me as interesting." Which nursing diagnosis is most relevant?

Accepted Answer

The patient mentions that the symptoms make people more interested. This indicates that the patient feels uninteresting and unpopular without the symptoms, thus supporting the nursing diagnosis of chronic low self-esteem. Defining characteristics for the other nursing diagnoses are not present in the scenario.

Question 19

To plan effective care for patients diagnosed with somatic symptom disorders, the nurse should understand that patients have difficulty giving up the symptoms because of which of the following?

Accepted Answer

At the unconscious level, the patient's primary gain from the symptoms is anxiety relief. Considering that the symptoms actually make the patient more psychologically comfortable and may also provide secondary gain, patients frequently fiercely cling to the symptoms. The symptoms tend to be chronic, but that does not explain why they are difficult to give up. The symptoms are not under voluntary control; nor are they physiologically based.

Question 20

A nurse assesses a patient diagnosed with conversion (functional neurological) disorder. Which comment is most likely from this patient?

Accepted Answer

Patients with conversion (functional neurological) disorder demonstrate a lack of concern regarding the seriousness of symptoms. This lack of concern is termed "la belle indifférence." There is also a specific, identifiable cause for the development of the symptoms; in this instance, the death of a parent would have precipitated stress. The distracters relate to sexual dysfunction and illness anxiety disorder.

Quiz 23: Somatic Symptom Disorders and Dissociative Disorders