Question 1

Which assessment findings suggest the possibility of a factitious disorder, imposed on self-type? (Select all that apply.)

Accepted Answer

A)   History of multiple hospitalizations without findings of physical illness
B)   History of multiple medical procedures or exploratory surgeries
C)   Going from one doctor to another seeking the desired response
D)   Claims illness to obtain financial benefit or other incentive
E)   Difficulty describing symptoms A, B

Question 2

Which comment by a patient who recently experienced a myocardial infarction indicates use of maladaptive, ineffective coping strategies?

Accepted Answer

A)   "My employer should have paid for a health club membership for me."
B)   "My family will see me through this. It won't be easy, but I will never be alone."
C)   "My heart attack was no fun, but it showed me up the importance of a good diet and more exercise."
D)   "I accept that I have heart disease. Now I need to decide if I will be able to continue my work daily." A

Question 3

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

Accepted Answer

A)   Narcotic analgesics for use as needed for acute pain
B)   Antidepressant medications to treat co-morbid depression
C)   Long-term use of benzodiazepines to support coping with anxiety
D)   Conventional antipsychotic medications to correct cognitive distortions B

Question 4

A patient has blindness related to conversion (functional neurological) disorder. To help the patient eat, the nurse should

Accepted Answer

A)   establish a "buddy" system with other patients who can feed the patient at each meal.
B)   expect the patient to feed self after explaining arrangement of the food on the tray.
C)   direct the patient to locate items on the tray independently and feed self.
D)   address needs of other patients in the dining room, then feed this patient.

Question 5

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

Accepted Answer

A)   "What are you unable to do now but were previously able to do?"
B)   "How many doctors have you seen in the last year?"
C)   "Who do you talk to when you're upset?"
D)   "Did you experience abuse as a child?"

Question 6

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

A)   "You do not have a brain tumor. The more you talk about it, the more it reinforces your belief."
B)   "Let's see if there are any other possible explanations for your vomiting."
C)   "You seem so worried. Let's talk about how you're feeling."
D)   "We need to talk about something else."

Question 7

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 patient. An appropriate outcome is that the patient will

Accepted Answer

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

Question 8

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

Accepted Answer

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

Question 9

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

Accepted Answer

A)   Somatic symptom disorders are under voluntary control, whereas factitious disorders are unconscious and automatic.
B)   Factitious disorders are precipitated by psychological factors, whereas somatic symptom disorders are related to stress.
C)   Factitious disorders are individually determined and related to childhood sexual abuse, whereas somatic symptom disorders are culture bound.
D)   Factitious disorders are under voluntary control, whereas somatic symptom disorders involve expression of psychological stress through somatization.

Question 10

A patient with fears of serious heart disease was referred to the mental health center 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

A)   Dysthymic disorder
B)   Somatic symptom disorder
C)   Antisocial personality disorder
D)   Illness anxiety disorder (hypochondriasis)

Question 11

A nurse's neighbor says, "I saw a news story about a man without any known illness who died suddenly after his ex-wife committed suicide. Was that a coincidence, or can emotional shock be fatal?" The nurse should respond by noting that some serious medical conditions may be complicated by emotional stress, including (Select all that apply)

Accepted Answer

A)   cancer.
B)   hip fractures.
C)   hypertension.
D)   immune disorders.
E)   cardiovascular disease.

Question 12

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

A)   The patient is suppressing accurate feelings regarding the problem.
B)   The patient's anxiety is relieved through the physical symptom.
C)   The patient's optic nerve transmission has been impaired.
D)   The patient will not disclose genuine fears.

Question 13

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

A)   Conversion (functional neurological)  disorder
B)   Illness anxiety disorder (hypochondriasis) 
C)   Somatic symptom disorder
D)   Factitious disorder

Question 14

A child has a history of multiple hospitalizations for recurrent systemic infections. The child is not improving in the hospital, despite aggressive treatment. Factitious disorder imposed on another is suspected. Which nursing interventions are appropriate? (Select all that apply.)

Accepted Answer

A)   Increase private visiting time for the parents to improve bonding.
B)   Keep careful, detailed records of visitation and untoward events.
C)   Place mittens on the child to reduce access to ports and incisions.
D)   Encourage family members to visit in groups of two or three.
E)   Interact with the patient frequently during visiting hours.

Question 15

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

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

Question 16

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

Accepted Answer

A)   "Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion."
B)   "I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry, and I think I'm getting seriously dehydrated."
C)   "Sexual intercourse is painful. I pretend as if I'm asleep so I can avoid it. I think it's starting to cause problems with my marriage."
D)   "I get choked very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus."

Question 17

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

Accepted Answer

A)   marginally successful.
B)   minimally successful.
C)   partially successful.
D)   totally achieved.

Question 18

A nurse assessing a patient diagnosed with a somatic symptom disorder is most likely to note that the patient

Accepted Answer

A)   sees a relationship between symptoms and interpersonal conflicts.
B)   has little difficulty communicating emotional needs to others.
C)   rarely derives personal benefit from the symptoms.
D)   has altered comfort and activity needs.

Question 19

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

Accepted Answer

A)   Flooding
B)   Response prevention
C)   Relaxation techniques
D)   Systematic desensitization

Question 20

A medical-surgical nurse works with a patient diagnosed with a somatic symptom disorder. Care planning is facilitated by understanding that the patient will probably

Accepted Answer

A)   readily seek psychiatric counseling.
B)   be resistant to accepting psychiatric help.
C)   attend psychotherapy sessions without encouragement.
D)   be eager to discover the true reasons for physical symptoms.

Exam 17: Somatic Symptom Disorders