Nokea
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.
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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.
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 patient diagnosed with somatic symptom disorder says, "I have pain 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 conduct what focused assessment?
- A. Mood
- B. Cognitive style
- C. Secondary gains
- D. Identity and memory
Correct Answer: C
Rationale: Secondary gains should be assessed. The patient's dependency needs may be met through care from the family. When secondary gains are prominent, the patient is more resistant to giving up the symptom. The scenario does not allude to a problem of mood. Cognitive style and identity and memory assessment are of lesser concern because the patient's diagnosis has been established.
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.
A patient has been diagnosed with a somatic symptoms disorder after various testing has failed to confirm a physiological cause for the patient's reports of back pain. What intervention by the nurse demonstrates the appropriate response when the patient continues to monopolize the group discussion with about back pain?
- A. Acknowledge the presence of pain but then redirect to another topic.
- B. Offer to discuss the back pain with the patient after the group session is over.
- C. In a matter-of-fact manner tell the patient that their pain is somatic in nature.
- D. Offer to discuss additional pain medication with the patient's health care provider.
Correct Answer: A
Rationale: After physical complaints have been investigated and a somatic symptom diagnosis is made, avoid further reinforcement of the somatic complaints by directing focus away from physical symptoms. The presence of the pain should not be denied but reinforcing or rewarding such behavior should not be engaged in.