Nokea
A patient's blindness is related to a functional neurological (conversion) disorder. To help the patient eat, the nurse should implement what intervention?
- A. Establishing a "buddy" system with other patients who can feed the patient at each meal
- B. Expecting the patient to self-feed after explaining the arrangement of the food on the tray
- C. Directing the patient to locate items on the tray independently with feeding being unassisted
- D. Addressing the needs of other patients in the dining room, and then feeding this patient
Correct Answer: B
Rationale: The patient is expected to maintain some level of independence by feeding himself or herself, whereas the nurse is supportive in a matter-of-fact way. The distractors support dependency or offer little support.
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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.
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.
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 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.