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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.
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To plan effective care for patients diagnosed with somatic system disorders, the nurse should understand that patients have difficulty giving up the symptoms because of what characteristic?
- A. They are generally chronic in nature.
- B. They have a physiological basis.
- C. They can be voluntarily controlled.
- D. They provide relief from health anxiety.
Correct Answer: D
Rationale: At the unconscious level, the patient's primary gain from the symptoms is anxiety relief. Considering that the symptoms actually make the patient more psychologically comfortable and may also provide a secondary gain, patients frequently and fiercely cling to the symptoms. The symptoms tend to be chronic; however, this does not explain why they are difficult to give up. The symptoms are not under voluntary control or physiologically based.
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.
What is the primary difference between somatic system disorders and dissociative disorders?
- A. They are under voluntary control
- B. They are related to resolved stress.
- C. They are generally strongly cultural bound.
- D. They are psychological stress expressed through somatic symptoms.
Correct Answer: D
Rationale: Somatic symptom disorders are expressions of unresolved emotional trauma characterized by the presence of one or more physical symptoms without a known organic source that causes substantial distress and psychosocial impairment with or without a known general medical disease. Somatic system disorders are neither under voluntary control nor are they cultural bound.
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 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.