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A patient with a diagnosis of somatic symptom disorder is being assessed. What assessment questions are appropriate and therapeutic in nature?
- A. "Would you consider yourself to be mentally ill?"
- B. "Do you have periods of depression or extreme sadness thinking?""
- C. "Have you ever been told that your symptoms are not real?"
- D. "Are you able to care for yourself and meet your own basic needs?"
- E. "How do the members of your immediate family react to your illness?"
Correct Answer: B,D,E
Rationale: The assessment should address possible comorbid conditions like depression, the ability for a patient to be able to self-feed their basic needs independently, and the dynamics of feeding himself to the existence. The remaining options are likely to cause increased stress and foster anger, either of which would not be therapeutic.
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A patient says, "I know I have a brain tumor despite the results of the magnetic resonance image (MRI). The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day." Which response by the nurse fosters cognitive restructuring?
- A. "You do not have a brain tumor. The more you talk about it, the more it reinforces your illogical thinking."
- B. "Let's see whether any other explanations for your vomiting are possible."
- C. "You seem so worried. Let's talk about how you're feeling."
- D. "We should talk about something else."
Correct Answer: B
Rationale: Questioning the evidence is a cognitive restructuring technique. Identifying causes other than the feared disease can be helpful in changing distorted perceptions. Distraction by changing the subject will not be effective.
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.
To assist a patient diagnosed with a somatic system disorder, which nursing intervention is of highest priority?
- A. Implying that somatic symptoms are not real
- B. Helping the patient suppress feelings of anger
- C. Shifting the focus from somatic symptoms to feelings
- D. Investigating each physical symptom as soon as it is reported
Correct Answer: C
Rationale: Shifting the focus from somatic symptoms to feelings or to neutral topics conveys an interest in the patient as a person rather than as a condition. The need to gain attention with the use of symptoms is reduced over the long term. A desired outcome is that the patient expresses feelings, including anger, if it is present. Once physical symptoms have been investigated, they do not need to be reinvestigated each time the patient reports them.
For a patient diagnosed with somatic symptom disorder, what statement would effectively complete the long-term outcome of "Within 4 weeks, the patient will demonstrate an ability to?
- A. Functioning independently on a basic level.
- B. Verbalizing feelings of physical and emotional safety.
- C. Regularly attending prescribed diversional activity groups.
- D. Identifying personal coping patterns that are proving to be ineffective.
Correct Answer: D
Rationale: The ability to identify and recognize as relevant the ineffective coping patterns that contribute to the somatic symptoms is an appropriate outcome. A patient may verbalize feeling safe, to function independently on a basic level, and to attend diversional activities without addressing the factors significant to resolving somatic symptom disorders.