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A nurse assesses a patient suspected to have somatic system disorder. Which findings support the diagnosis?
- A. Female
- B. Reports frequent dizziness
- C. Complains of heavy menstrual bleeding
- D. First diagnosed with psoriasis at 12 years of age
- E. Reports of back pain, painful urination and frequent diarrhea
Correct Answer: A,B,C,E
Rationale: No chronic disease explains the symptoms for patients with somatic system disorder. Patients report multiple symptoms; gastrointestinal, sexual, and pseudoneurological symptoms are common. This disorder is more common in women than in men.
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To assist a patient diagnosed with a somatic system disorder, which nursing intervention is of highest priority?
- A. Implying that somatic symptoms are not real
- B. Helping the patient suppress feelings of anger
- C. Shifting the focus from somatic symptoms to feelings
- D. Investigating each physical symptom as soon as it is reported
Correct Answer: C
Rationale: Shifting the focus from somatic symptoms to feelings or to neutral topics conveys an 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 is that the patient expresses feelings, including anger, if it is present. Once physical symptoms have been investigated, they do not need to be reinvestigated each time the patient reports them.
What are the causes of somatic system disorders generally related to?
- A. Faulty perceptions of body sensations
- B. Traumatic childhood events
- C. Culture-bound phenomena
- D. Mood instability
Correct Answer: A
Rationale: Structural or functional abnormalities of the brain have been suggested to lead to the somatic system disorders, resulting in disturbed processes of perception and interpretation of bodily sensations. Furthermore, cognitive theorists believe patients misinterpret the meaning of certain bodily sensations and then become excessively alarmed by them. Traumatic childhood events are related to the dissociative disorders. Culture-bound phenomena may explain the prevalence of some symptoms but cannot explain the cause. Somatic system disorders are not a facet of mood instability; however, depression may coexist with a somatic system disorder.
A patient reporting stomach pain says, "I have seen 10 different health care providers but all of them tell me I don't have stomach cancer." Which term might be appropriate in describing this report?
- A. Somatic symptom disorder
- B. Factitious disorder
- C. Illness anxiety
- D. Malingering
Correct Answer: C
Rationale: Individuals with illness anxiety disorder are preoccupied with having or eventually developing a serious illness. The patient is apprehensive of a particular illness despite continuous negative medical evaluations and assurances. Malingering is intentionally faking or exaggerating symptoms for an obvious benefit such as money, housing, medications, avoiding work, or criminal prosecution. Malingering is a behavior and not a psychiatric disorder. "Somatization," defined as a process by which psychological distress is expressed as physical symptoms without a known organic source, causes substantial distress and psychosocial impairment with or without a known general medical disease. The essential feature of factitious disorder is intentionally faking symptoms in order to assume the sick role, that is, to be a patient. In addition, there are no obvious external benefits such as financial gain or avoiding work or criminal prosecution.
A nurse assesses a patient diagnosed with functional neurological (conversion) disorder. Which comment best supports this diagnosis?
- 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."
Correct Answer: A
Rationale: Patients with functional neurological (conversion) disorder often demonstrate a lack of concern regarding the seriousness of symptoms. In addition, a specific cause for the development of the symptoms is identifiable; in this instance, the death of a parent precipitates the stress. The incorrect options suggest other types of somatic symptom disorders.
A nurse assessing a patient diagnosed with a somatic system disorder is most likely to note what patient characteristic?
- A. Readily sees a relationship between symptoms and interpersonal conflicts.
- B. Rarely derives personal benefit from the symptoms.
- C. Has little difficulty communicating emotional needs.
- D. Has unmet needs related to comfort and activity.
Correct Answer: D
Rationale: The patient diagnosed with a somatic system disorder frequently has altered comfort and activity needs. 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 system disorders often derive secondary gain from their symptoms and/or have considerable difficulty identifying feelings and conveying emotional needs to others.