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A patient with blindness related to a functional neurological (conversion) disorder states, "All the doctors and nurses in this hospital stop by often to check on me. Too bad people outside the hospital don't find me interesting." Which nursing diagnosis is most relevant?
- A. Social isolation
- B. Chronic low self-esteem
- C. Interrupted family processes
- D. Ineffective health maintenance
Correct Answer: B
Rationale: The patient mentions that the symptoms make people more interested, which indicates that the patient believes he or she is uninteresting and unpopular without the symptoms, thus supporting the nursing diagnosis of chronic low self-esteem. Defining characteristics for the other nursing diagnoses are not present in this scenario.
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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, "Why has God chosen me to be sick all the time and unable to provide for my family? The burden on my family is worse than the pain I bear." Which nursing diagnoses apply to this patient?
- A. Spiritual distress
- B. Decisional conflict
- C. Adult failure to thrive
- D. Impaired social interaction
- E. Ineffective role performance
Correct Answer: A,E
Rationale: The patient's verbalization is consistent with spiritual distress. Moreover, the patient's description of being unable to provide for and burdening the family suggests ineffective role performance. No data support diagnoses of adult failure to thrive, impaired social interaction, or decisional conflict.
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 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 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.