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A patient whose blindness is related to a functional neurological (conversion) disorder appears to be unconcerned about this problem. Which understanding should guide the nurse's planning for this patient?
- A. Suppressing accurate feelings regarding the problem.
- B. Anxiety is relieved through the physical symptom.
- C. Emotional needs are met through hospitalization.
- D. The patient refuses to disclose genuine fears.
Correct Answer: B
Rationale: Psychoanalytic theory suggests conversion reduces anxiety through the production of a physical symptom that is symbolically linked to an underlying conflict. Conversion, not suppression, is the operative defense mechanism in this disorder. The other distractors oversimplify the dynamics, suggesting that only dependency needs are of concern, or suggest conscious motivation (conversion operates unconsciously).
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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.
Instructions concerning what stress management technique should be included in the care plan of a patient diagnosed with a somatic symptom disorder?
- A. Mindful awareness
- B. Positive self-talk
- C. Take a time out
- D. Meditation
Correct Answer: D
Rationale: Meditation has been shown to be effective in managing stress associated with somatic symptom disorders. Mindful awareness and positive self-talk are associated with anxiety management while the concept of a time out helps manage anger.
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 medical-surgical nurse works with a patient diagnosed with a somatic system disorder. Care planning is facilitated by understanding that the patient will probably present what behavior?
- A. Readily seek psychiatric counseling.
- B. Being resistant to accepting psychiatric help.
- C. Attending psychotherapy sessions without encouragement.
- D. Being eager to discover the true reasons for physical symptoms.
Correct Answer: B
Rationale: Patients with somatic system disorders go from physician to physician trying to establish a physical cause for their symptoms. When a psychological basis is suggested and a referral for counseling is offered, these patients reject both.
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.