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An adult diagnosed with conversion (functional neurobiological symptom) disorder says, "Our family has gotten along over the years by working together. My partner cooks and the children clean house." Understanding of this disorder will provide what rationalization for this statement?
- A. Patient is receiving secondary gains from the symptoms.
- B. Patient has problems with sexual identity and satisfaction.
- C. Patient will be resistant to developing a trusting relationship.
- D. Patient will benefit from confrontation about physical complaints.
Correct Answer: A
Rationale: Being able to avoid traditional family role responsibilities by adopting a sick role can be seen as a "payoff." Receiving a payoff is another way of saying that the individual receives secondary gain from the symptoms. Data are not present to permit choice of the incorrect options.
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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.
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.
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.
Which treatment modality should a nurse recommend to help a patient diagnosed with somatic symptom disorder cope more effectively?
- A. Flooding
- B. Relaxation
- C. Response prevention
- D. Systematic desensitization
Correct Answer: B
Rationale: Pain, a common complaint in patients diagnosed with somatic symptom disorder, increases when the patient has muscle tension. Relaxation can diminish the patient's perceptions of the intensity of pain. The distractors are modalities useful in treating selected anxiety disorders.
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.