Nokea
A patient diagnosed with 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 using what phrase:
- A. unsuccessful.
- B. minimally successful.
- C. partially successful.
- D. totally achieved.
Correct Answer: C
Rationale: Decreased preoccupation with symptoms and an increased ability to perform activities of daily living suggest partial success of the treatment plan. Total success is rare because of patient resistance.
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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 college student reports that, "My vision is too blurry to read effectively, especially when it's time to be studying for a test." Which health problem should be considered initially?
- A. Malingering
- B. Illness anxiety
- C. Factitious disorder
- D. Functional neurological disorder
Correct Answer: A
Rationale: Malingering is intentionally faking or exaggerating symptoms for an obvious benefit such as money, housing, medications, avoiding work, or criminal prosecution. Functional neurological disorder (FND) involves chronic or brief symptoms of altered voluntary motor or sensory function that cause substantial distress or psychosocial impairment. Individuals with illness anxiety disorder are preoccupied with having or eventually developing a serious illness. The essential feature of factitious disorder is intentionally faking symptoms in order to assume the sick role, that is, to be a patient.
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.
A patient who fears serious heart disease was referred to the mental health center by a cardiologist after diagnostic evaluation showed no physical illness. The patient says, "My heart misses beats. I'm frequently absent from work. I don't go out much because I need to rest." Which health problem is most likely?
- A. Depersonalization disorder
- B. Antisocial personality disorder
- C. Illness anxiety disorder
- D. Persistent depressive disorder
Correct Answer: C
Rationale: Illness anxiety disorder (hypochondriasis) involves a preoccupation with fears of having a serious disease, even when evidence to the contrary is available. The preoccupation causes impairment in social or occupational functioning. Depersonalization disorder involves recurrent periods of feeling unreal, detached, outside of the body, numb, dreamlike, or a distorted sense of time or visual perception. Persistent depressive disorder (dysthymia) is a disorder of lowered mood. Antisocial disorder applies to a personality disorder in which the individual has little regard for the rights of others.
A patient diagnosed with somatic symptom disorder tells the nurse, "It's starting again. I feel as though my heart is beating out of my chest and I can't breathe." The nurse should provide what response to best address the patient's symptoms?
- A. "I'll call your health care provider and see if I can give you a sedative."
- B. "Do you think you will feel better with some oxygen?"
- C. "We've talked about how being dramatic is helpful."
- D. "Has something happened to make you anxious?"
Correct Answer: D
Rationale: Patients with somatic symptom disorders have difficulty communicating their emotional needs. As children, their family communication style may have neglected the appropriate expression of anger, depression, fear, and other emotions, and thus they do not recognize feelings nor understand how to relate to them. The feeling of anxiety may cause tightness in the stomach, nausea, rapid heartbeat, shortness of breath, dizziness, sweating, and tensing of muscles such as the hands or jaw. If a person is taught to consider the relationship of emotions to physical symptoms, the person will likely identify that he or she is anxious. Offering medical interventions are not addressing the likely trigger for the symptoms. Accusing the patient of being dramatic will likely serve to only increase the anxiety already being experienced.