Exam 22: Somatoform, Factitious, and Dissociative Disorders

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 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:

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

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?

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

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

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 __________.

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:

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 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 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 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:

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

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 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 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?

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

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 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?

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