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A nurse is working with a client diagnosed with complex somatic symptom disorder. Which of the following would the nurse identify as the most difficult aspect of providing care to this client?
- A. Managing the client?s pain.
- B. Relieving the client?s anxiety.
- C. Developing the therapeutic relationship.
- D. Monitoring the client?s treatment program.
Correct Answer: C
Rationale: Developing a therapeutic relationship (C) is the most challenging in CSSD due to mistrust and symptom preoccupation. Managing pain (A), relieving anxiety (B), and monitoring treatment (D) are secondary to establishing trust.
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A client is admitted to the mental health unit with a diagnosis of factitious disorder. When reviewing the client?s history, which of the following would the nurse most likely find?
- A. Intentional self-injurious behavior
- B. Pain to achieve a self-serving goal
- C. Malingering to avoid work
- D. Parents who were restrictive
Correct Answer: B
Rationale: Factitious disorder involves fabricating symptoms, like pain, for psychological gain, such as attention (B). Self-injury (A) is more typical of borderline personality disorder, malingering (C) seeks external gain, and restrictive parents (D) are not specific.
A client is being assessed for complex somatic symptom disorder. Which client statement would the nurse interpret as most likely supporting this diagnosis?
- A. It?s like my foot is asleep all the time; I can?t feel anything that touches my foot.
- B. I?m losing weight no matter what or how much I eat.
- C. I am always in pain; there is nothing I can do to relieve it.
- D. It seems like I am always having diarrhea at the most inconvenient times.
Correct Answer: C
Rationale: Chronic, unrelieved pain (C) strongly supports a CSSD diagnosis due to its persistent and distressing nature. Numbness (A) suggests functional neurologic symptoms, weight loss (B) aligns with eating disorders, and diarrhea (D) is less specific to CSSD.
The nurse is caring for a client with complex somatic symptom disorder. When assessing this client, the nurse would be especially alert for symptoms of which of the following?
- A. Depression
- B. Avoidant personality disorder
- C. Delirium
- D. Bipolar disorder
Correct Answer: A
Rationale: Complex somatic symptom disorder (CSSD) is frequently comorbid with depression (A) due to chronic distress from somatic symptoms. Avoidant personality disorder (B) is less common, delirium (C) involves acute cognitive changes unrelated to CSSD, and bipolar disorder (D) is not typically associated.
A client with complex somatic symptom disorder also has anxiety. Which of the following would the nurse expect to be prescribed?
- A. Monoamine oxidase inhibitor (MAOI)
- B. Selective serotonin reuptake inhibitor (SSRI)
- C. Tricyclic antidepressant (TCA)
- D. Atypical antipsychotic
Correct Answer: B
Rationale: SSRIs (B) are commonly prescribed for CSSD with anxiety due to their efficacy in managing both somatic and anxiety symptoms. MAOIs (A) and TCAs (C) are less preferred due to side effects, and atypical antipsychotics (D) are not first-line.
A nurse is providing care for a client who has complex somatic symptom disorder and is exhibiting anxiety about having a severe illness. Which of the following would be appropriate for the nurse to do? Select all that apply.
- A. Listening closely to the client?s report of symptoms
- B. Discouraging the client from talking about fears
- C. Acknowledging that what the client is saying may be real
- D. Encouraging the client to write down symptoms in a journal
- E. Reviewing symptom pattern with the client
Correct Answer: A,C,D,E
Rationale: Appropriate interventions for CSSD with anxiety include listening closely (A), acknowledging the reality of symptoms (C), journaling symptoms (D), and reviewing patterns (E) to validate and manage distress. Discouraging fear discussion (B) is non-therapeutic.