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Which patient statement best supports the diagnosis of somatic disorders?
- A. "I can't do much because of the severe pain."
- B. "I feel as if I'm living in a fuzzy dream state."
- C. "I feel like different parts of my body are at war."
- D. "I feel very anxious and worried about my problems."
Correct Answer: A
Rationale: The patient diagnosed with somatic disorders is preoccupied and disabled as a result of somatic pain or some other disability. The distractors are more consistent with depersonalization, generalized anxiety disorder, or dissociative identity disorder.
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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 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.
What is the primary difference between somatic system disorders and dissociative disorders?
- A. They are under voluntary control
- B. They are related to resolved stress.
- C. They are generally strongly cultural bound.
- D. They are psychological stress expressed through somatic symptoms.
Correct Answer: D
Rationale: Somatic symptom disorders are expressions of unresolved emotional trauma characterized by the presence of one or more physical symptoms without a known organic source that causes substantial distress and psychosocial impairment with or without a known general medical disease. Somatic system disorders are neither under voluntary control nor are they cultural bound.
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.
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.