Question 1

A client is admitted to a mental health unit with a diagnosis of factitious disorder. When reviewing the client's history, which assessment would a nurse find?

Accepted Answer

Clients with factitious disorder intentionally cause an illness or injury to receive the attention of health care professionals. Pain for a self-serving goal, malingering, or restrictive parents are not associated with factitious disorder.

Question 2

While assessing a client thought to have a factitious disorder, a nurse asks the client to describe when the client felt nurtured as a child. Which response would the nurse interpret as supporting the client's diagnosis?

Accepted Answer

Individuals who are diagnosed with factitious disorders are thought to have often been abused as children and to have received nurturance only during times of illness. As a result, they try to recreate illness or injury in a desperate attempt to receive love and attention.

Question 3

A client attempted to inject diluted feces into his or her child's intravenous line. The client has a history of similar attempts of harming the child and has now been admitted to a mental health unit. The nurse would most likely suspect which diagnosis?

Accepted Answer

A rare but dramatic disorder, factitious disorder imposed on another (previously called factitious disorder by proxy or Münchausen's by proxy), involves a person who inflicts injury on another person. It is commonly a mother who inflicts injuries on a child to gain the attention of a health care provider through her child's injuries. The client's history does not reflect manifestations of schizoid personality traits or borderline personality disorder. Functional neurologic symptoms involve severe emotional distress or unconscious conflict expressed through physical symptoms.

Question 4

After educating a group of nurses about somatic symptom disorder (SSD), an instructor determines that the education was successful when the group identifies which characteristic?

Accepted Answer

SSD is one of the most difficult disorders to manage because the symptoms tend to change, are diffuse and complex, and vary/move from one body system to another. For example, initially there may be gastrointestinal (nausea, vomiting, diarrhea) and neurologic (headache, backache) symptoms that change to musculoskeletal (aching legs) and sexual issues (pain in the abdomen, pain during intercourse). The physical symptoms may last for 6-9 months. Individuals with SSD perceive themselves as being "sicker than the sick" and report all aspects of their health as poor.

Question 5

A client diagnosed with somatic symptom disorder (SSD) is reporting significant pain in the joints. When providing care to this client, which factor would be most important for a nurse to keep in mind?

Accepted Answer

Even though there is no medical explanation for the pain, the client's pain is real and has serious psychosocial implications. Aggressive pharmacologic treatment of the symptoms must be avoided. Nonpharmacologic strategies, including complementary and alternative treatments, should be used to assist in pain relief. Outcomes developed need to avoid focusing on the biologic aspects of the disorder and instead help the client overcome the pain through biopsychosocial approaches.

Question 6

A client has made multiple visits to the clinic. A nurse suspects that the client may be experiencing somatic symptom disorder (SSD) based on which assessment finding?

Accepted Answer

SSD is one of the most difficult disorders to manage because the symptoms tend to change, are diffuse and complex, and vary/move from one body system to another. For example, initially there may be gastrointestinal (nausea, vomiting, diarrhea) and neurologic (headache, backache) symptoms that change to musculoskeletal (aching legs) and sexual issues (pain in the abdomen, pain during intercourse). The physical symptoms may last for 6-9 months. Individuals with SSD perceive themselves as being sicker than the sick and report all aspects of their health as poor. Many eventually become disabled and cannot work. They typically visit health care providers multiple times per month and quickly become frustrated because their primary health care providers do not appreciate their level of suffering and are unable to validate that a particular problem accounts for their extreme discomfort.

Question 7

A nurse is reviewing the medical history of a client diagnosed with somatic symptom disorder (SSD). Which would the nurse expect to find as a comorbid condition?

Accepted Answer

Somatic symptom disorder frequently coexists with other psychiatric disorders, most commonly depression and anxiety. Others include panic disorder, mania, social phobia, obsessive-compulsive disorder, psychotic disorders, and personality disorders. Older adults are particularly high risk for comorbid depression.

Question 8

A nurse is assessing a client for somatic symptom disorder (SSD). Which client statement would the nurse interpret as most likely supporting this diagnosis?

Accepted Answer

With somatic symptom disorder, the client may complain of various symptoms. However, pain is the most common complaint.

Question 9

The nurse is caring for a client diagnosed with somatic symptom disorder (SSD). When assessing this client, the nurse would be especially alert for which comorbidity?

Accepted Answer

Somatic symptom disorder frequently coexists with other psychiatric disorders, most commonly depression and anxiety. Other less common comorbidities include panic disorder, mania, social phobia, obsessive-compulsive disorder, psychotic disorders, and personality disorders.

Question 10

A nursing instructor is describing somatic symptom disorder (SSD) to a group of nursing students. The instructor determines that the education was successful when the students make which statement?

Accepted Answer

Complex somatic symptom disorder typically has an onset before age 30 years, with the first symptom often appearing during adolescence. The disorder is diagnosed more often in women and occurs most often with depression and anxiety. Epidemiologic studies reveal that the disorder occurs primarily in nonwhite, less educated women, particularly those with lower socioeconomic status and high emotional stress.

Question 11

The spouse of a client diagnosed with somatic symptom disorder (SSD) asks the nurse, "What causes this condition?" Which response by the nurse would be most accurate?

Accepted Answer

Somatic symptom disorder has been explained as a form of social or emotional communication, meaning that the body symptoms express an emotion that cannot be verbalized by the individual. Although there is some evidence to support a genetic component, the exact transmission mechanism is unclear. In individuals with this disorder, chronic activation of the hypothalamic-pituitary-adrenal axis indicates a hyperarousal condition from chronic stress. Additionally, the personality trait alexithymia is associated with somatic symptoms. These individuals have difficulty identifying and expressing their emotions, have a preoccupation with external events, and are described as concrete thinkers.

Question 12

A nurse is preparing to interview a client diagnosed with somatic symptom disorder (SSD). The nurse anticipates that the client will most likely exhibit which response?

Accepted Answer

The individual's mood is usually labile, often shifting from extremely excited or anxious to being depressed and hopeless. Response to physical symptoms is usually magnified. The client's mental status is usually normal, and cognition is not impaired but may be distorted.

Question 13

After teaching a client who is prescribed phenelzine for treatment of somatic symptom disorder (SSD), the nurse determines that additional education is needed when the client states which of the following?

Accepted Answer

Phenelzine is a monoamine oxidase inhibitor. Clients prescribed this drug should avoid alcohol, sleep-inducing drugs, and over-the-counter drugs such as cold and hay fever medications and appetite suppressants, all of which may cause serious or life-threatening problems. The client should take the drug exactly as prescribed and not stop taking it abruptly. Signs such as anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation should be reported to the client's prescriber, especially if they are severe, abrupt in onset, or were not part of the client's presenting symptoms.

Question 14

A nurse is evaluating the outcomes for a client diagnosed with somatic symptom disorder (SSD). Which finding would the nurse most likely identify as interfering with achievement?

Accepted Answer

Recovery outcomes for clients with somatic symptom disorder should be realistic. Because this is a lifelong disorder, small successes should be expected. Specific outcomes also should be identified, so that the small successes can be measured, such as gradually increasing social contact. Over time, there should be a gradual reduction in the number of health care providers the individual contacts, and a slight improvement in the ability to cope with stresses.

Question 15

A nurse is working with a client diagnosed with somatic symptom disorder (SSD). Which of the following would the nurse identify as the most difficult aspect of providing care to this client?

Accepted Answer

Although managing the client's symptoms can be challenging, and anxiety may be present to add to the challenges, the most difficult aspect is developing a sound, positive nurse-client relationship. This relationship is crucial, however, for without it, the nurse is just one more provider who fails to meet the client's expectations. Developing this relationship requires time and patience.

Question 16

The nurse is assisting in planning a series of group therapy sessions with several clients diagnosed with somatic symptom disorder (SSD). The nurse plans to focus the sessions on which priority?

Accepted Answer

Because most of the clients are women, participation in groups that address feminist issues should be encouraged to strengthen their assertiveness skills and improve their generally low self-esteem. Group sessions focusing on the causes of medical illnesses and on positive self-talk would be inappropriate. Medication therapy is not specifically recommended for people with this disorder unless they have comorbid disorders such as depression or anxiety.

Question 17

The nurse is providing care to a client diagnosed with somatic symptoms disorder (SSD). The client has been prescribed escitalopram 1 week ago. The client reports experiencing nausea after starting the medication and describes it as worse than what the average person would have. Which intervention should the nurse recommend for this client?

Accepted Answer

In order to reduce a client's anxiety about an illness, the nurse should ask the client to monitor any side effects related to the medication using a daily journal and report back in a follow-up visit with the nurse. This validates the client's concerns and helps with problem solving in the next visit. The nurse should not tell the client to stop taking the medication as nausea is a common side effect of escitalopram. Such side effects tend to last 1-2 weeks after commencing the medication and subside as the primary purpose of the medication manifests. Telling the client to consume a balanced diet does not acknowledge the client's problem, thus will not help to alleviate the client's fears of anxiety. Referring the client to another health care provider communicates that the problem is not within the client's control and fosters a dependence on health care providers rather than reinforcing the notion of self-efficacy.

Question 18

The nurse is seeing a client who reports chronic pain that radiates to the lower back. The client reports the pain has been unresolved with analgesia, physical therapy, and therapeutic massage. The client's diagnostic imaging reports are all unremarkable. Which statement by the nurse would be the most supportive response to this client?

Accepted Answer

Whereas some evidence suggests that somatization is a result of abnormally high levels of physiologic response, other evidence supports the idea that somatization is the physical expression of personal problems or the internalization and expression of stress through physical symptoms. The nurse should use an approach that helps to establish trust through acknowledgment and validation. The therapeutic relationship is a key. Telling the client the recommended treatment approach is supported by research may elicit a defensive reaction in the client, hindering the therapeutic relationship. Talking about culturally specific behaviors indicates the nurse is using stereotyping, a culturally incompetent approach. Encouraging the client to continue to seek multiple health care providers is ineffective and feeds into the client's beliefs about the illness. The client should be encouraged to be consistent with one, primary health care provider.

Question 19

A psychiatric-mental health clinical nurse specialist is preparing a class about functional neurologic symptoms. Which assessment finding would the nurse most likely include? Select all that apply.

Accepted Answer

Clients with functional neurologic symptoms (conversion disorder) have neurologic symptoms including impaired coordination or balance, paralysis, aphonia (inability to produce sound), difficulty swallowing or a sensation of a lump in the throat, and urinary retention. They also may have loss of touch, vision problems, blindness, deafness, and hallucinations.

Question 20

A nurse is providing care for a client who has been diagnosed with somatic symptom disorder (SSD) and is exhibiting anxiety about having a severe illness. Which action would be appropriate for the nurse to take? Select all that apply.

Accepted Answer

Nursing management should include listening to the client's report of symptoms and fears, validating it by acknowledging that the fears may be real, asking the client to monitor symptoms in a journal, and encouraging the client to bring the journal to the next visit. By actually seeing the symptom pattern, it is possible to continue to educate the client and assess for significant symptoms.

Quiz 33: Somatic Symptom and Dissociative Disorders: Nursing Care of Persons With Somatization

A client is admitted to a mental health unit with a diagnosis of factitious disorder. When reviewing the client's history, which assessment would a nurse find?

While assessing a client thought to have a factitious disorder, a nurse asks the client to describe when the client felt nurtured as a child. Which response would the nurse interpret as supporting the client's diagnosis?

A client attempted to inject diluted feces into his or her child's intravenous line. The client has a history of similar attempts of harming the child and has now been admitted to a mental health unit. The nurse would most likely suspect which diagnosis?

After educating a group of nurses about somatic symptom disorder (SSD) , an instructor determines that the education was successful when the group identifies which characteristic?

A client diagnosed with somatic symptom disorder (SSD) is reporting significant pain in the joints. When providing care to this client, which factor would be most important for a nurse to keep in mind?

A client has made multiple visits to the clinic. A nurse suspects that the client may be experiencing somatic symptom disorder (SSD) based on which assessment finding?

A nurse is reviewing the medical history of a client diagnosed with somatic symptom disorder (SSD) . Which would the nurse expect to find as a comorbid condition?

A nurse is assessing a client for somatic symptom disorder (SSD) . Which client statement would the nurse interpret as most likely supporting this diagnosis?

The nurse is caring for a client diagnosed with somatic symptom disorder (SSD) . When assessing this client, the nurse would be especially alert for which comorbidity?

A nursing instructor is describing somatic symptom disorder (SSD) to a group of nursing students. The instructor determines that the education was successful when the students make which statement?

The spouse of a client diagnosed with somatic symptom disorder (SSD) asks the nurse, "What causes this condition?" Which response by the nurse would be most accurate?

A nurse is preparing to interview a client diagnosed with somatic symptom disorder (SSD) . The nurse anticipates that the client will most likely exhibit which response?

After teaching a client who is prescribed phenelzine for treatment of somatic symptom disorder (SSD) , the nurse determines that additional education is needed when the client states which of the following?

A nurse is evaluating the outcomes for a client diagnosed with somatic symptom disorder (SSD) . Which finding would the nurse most likely identify as interfering with achievement?

A nurse is working with a client diagnosed with somatic symptom disorder (SSD) . Which of the following would the nurse identify as the most difficult aspect of providing care to this client?

The nurse is assisting in planning a series of group therapy sessions with several clients diagnosed with somatic symptom disorder (SSD) . The nurse plans to focus the sessions on which priority?

A psychiatric-mental health clinical nurse specialist is preparing a class about functional neurologic symptoms. Which assessment finding would the nurse most likely include? Select all that apply.

A nurse is providing care for a client who has been diagnosed with somatic symptom disorder (SSD) and is exhibiting anxiety about having a severe illness. Which action would be appropriate for the nurse to take? Select all that apply.