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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.
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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.
A nurse physically assessing a patient diagnosed with somatic disorder should understand that which intervention is the priority?
- A. Provide a thorough physical examination.
- B. Avoid detailed discussion of the reported complaints.
- C. Avoid suggesting the appropriateness of any medical testing.
- D. Focus on both prescribed and OTC medications the client is taking.
Correct Answer: A
Rationale: It is always important to ensure that an underlying medical condition has been eliminated from the differential diagnosis and so it is vital that the assessment be thorough. This understanding makes the other options incomplete or inappropriate.
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).
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.
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.