Nokea
A medical-surgical nurse works with a patient diagnosed with a somatic system disorder. Care planning is facilitated by understanding that the patient will probably present what behavior?
- A. Readily seek psychiatric counseling.
- B. Being resistant to accepting psychiatric help.
- C. Attending psychotherapy sessions without encouragement.
- D. Being eager to discover the true reasons for physical symptoms.
Correct Answer: B
Rationale: Patients with somatic system disorders go from physician to physician trying to establish a physical cause for their symptoms. When a psychological basis is suggested and a referral for counseling is offered, these patients reject both.
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A patient reports fears of having cervical cancer and says to the nurse, "I've had Pap smears by six different doctors. The results are normal, but I'm sure that's because of errors in the laboratory." Which disorder would the nurse suspect?
- A. Functional neurological (conversion) disorder
- B. Illness anxiety disorder (hypochondriasis)
- C. Derealization disorder
- D. Dissociative amnesia with fugue
Correct Answer: B
Rationale: Patients with illness anxiety disorder (hypochondriasis) have fears of serious medical problems such as cancer or heart disease. These fears persist, despite medical evaluations, and interfere with daily functioning. No complaints of pain are made, and no evidence of dissociation or conversion exists. Derealization disorder involves recurrent periods of feeling unreal, detached, outside of the body, numb, dreamlike, or a distorted sense of time or visual perception.
A patient with a diagnosis of somatic symptom disorder is being assessed. What assessment questions are appropriate and therapeutic in nature?
- A. "Would you consider yourself to be mentally ill?"
- B. "Do you have periods of depression or extreme sadness thinking?""
- C. "Have you ever been told that your symptoms are not real?"
- D. "Are you able to care for yourself and meet your own basic needs?"
- E. "How do the members of your immediate family react to your illness?"
Correct Answer: B,D,E
Rationale: The assessment should address possible comorbid conditions like depression, the ability for a patient to be able to self-feed their basic needs independently, and the dynamics of feeding himself to the existence. The remaining options are likely to cause increased stress and foster anger, either of which would not be therapeutic.
Which medication would the nurse expect to be prescribed for a patient diagnosed with a somatic symptom disorder?
- A. Narcotic analgesics for use as needed for acute pain
- B. Antidepressant medications to treat underlying depression
- C. Long-term use of benzodiazepines to support coping with anxiety
- D. Conventional antipsychotic medications to correct cognitive distortions
Correct Answer: B
Rationale: 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 also fatigue, pain perception, GI distress, and other somatic symptoms. Patients may benefit from short-term use of anti-anxiety 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.
Which patient statement best supports the diagnosis of somatic disorders?
- A. "I can't do much because of the severe pain."
- B. "I feel as if I'm living in a fuzzy dream state."
- C. "I feel like different parts of my body are at war."
- D. "I feel very anxious and worried about my problems."
Correct Answer: A
Rationale: The patient diagnosed with somatic disorders is preoccupied and disabled as a result of somatic pain or some other disability. The distractors are more consistent with depersonalization, generalized anxiety disorder, or dissociative identity disorder.
A patient diagnosed with a somatic symptom disorder has the nursing diagnosis: Interrupted family processes, related to patient's disabling symptoms as evidenced by the spouse and children assuming roles and tasks that previously belonged to patient. What is an appropriate outcome for this patient?
- A. Assumes roles and functions of the other family members.
- B. Demonstrate a resumption of former roles and tasks.
- C. Focuses energy on problems occurring in the family.
- D. Relies on family members to meet personal needs.
Correct Answer: B
Rationale: The patient with a somatic symptom disorder has typically adopted a sick role in the family, characterized by dependence. Increasing independence and the resumption of former roles are necessary to change this pattern. The distractors are inappropriate outcomes.