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While assessing a client thought to have a factitious disorder, the nurse asks the client to describe when she felt nurtured as a child. Which response would the nurse interpret as supporting the client?s diagnosis?
- A. I never felt nurtured or loved when I was growing up.
- B. The only time I felt loved and appreciated was when I made the honor roll at school.
- C. The only time I ever felt loved was when I was sick enough to miss school.
- D. I felt loved and accepted when my father apologized for spanking me so hard.
Correct Answer: C
Rationale: Feeling nurtured only when sick (C) supports factitious disorder, as it suggests a pattern of seeking attention through illness. Lack of nurturing (A), academic achievement (B), or parental apologies (D) are less specific to this disorder.
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A nurse is working with a client diagnosed with complex somatic symptom disorder. Which of the following would the nurse identify as the most difficult aspect of providing care to this client?
- A. Managing the client?s pain.
- B. Relieving the client?s anxiety.
- C. Developing the therapeutic relationship.
- D. Monitoring the client?s treatment program.
Correct Answer: C
Rationale: Developing a therapeutic relationship (C) is the most challenging in CSSD due to mistrust and symptom preoccupation. Managing pain (A), relieving anxiety (B), and monitoring treatment (D) are secondary to establishing trust.
The nurse is assisting in planning a series of group therapy sessions with several female clients diagnosed with complex somatic symptom disorder. The nurse plans to focus the sessions on which of the following as a priority?
- A. Causes of medical illnesses
- B. Positive self-talk
- C. Side effects of medications
- D. Assertiveness skills
Correct Answer: B
Rationale: Positive self-talk (B) is a priority in group therapy for CSSD to reframe negative symptom-focused thoughts, promoting coping. Medical causes (A) may reinforce preoccupation, medication side effects (C) are secondary, and assertiveness (D) is less relevant.
A nurse is providing care for a client who has complex somatic symptom disorder and is exhibiting anxiety about having a severe illness. Which of the following would be appropriate for the nurse to do? Select all that apply.
- A. Listening closely to the client?s report of symptoms
- B. Discouraging the client from talking about fears
- C. Acknowledging that what the client is saying may be real
- D. Encouraging the client to write down symptoms in a journal
- E. Reviewing symptom pattern with the client
Correct Answer: A,C,D,E
Rationale: Appropriate interventions for CSSD with anxiety include listening closely (A), acknowledging the reality of symptoms (C), journaling symptoms (D), and reviewing patterns (E) to validate and manage distress. Discouraging fear discussion (B) is non-therapeutic.
A client is being assessed for complex somatic symptom disorder. Which client statement would the nurse interpret as most likely supporting this diagnosis?
- A. It?s like my foot is asleep all the time; I can?t feel anything that touches my foot.
- B. I?m losing weight no matter what or how much I eat.
- C. I am always in pain; there is nothing I can do to relieve it.
- D. It seems like I am always having diarrhea at the most inconvenient times.
Correct Answer: C
Rationale: Chronic, unrelieved pain (C) strongly supports a CSSD diagnosis due to its persistent and distressing nature. Numbness (A) suggests functional neurologic symptoms, weight loss (B) aligns with eating disorders, and diarrhea (D) is less specific to CSSD.
A client with complex somatic symptom disorder is complaining of significant pain in the joints. When providing care to this client, which of the following would be most important for the nurse to keep in mind?
- A. Opioid analgesics are the primary mode of therapy.
- B. The client?s experience of pain is real.
- C. Complementary therapies are usually of little benefit.
- D. Outcomes need to reflect the biologic aspects of the pain.
Correct Answer: B
Rationale: The client?s pain experience in CSSD is real (B), requiring validation to build trust and support treatment. Opioids (A) are not primary due to dependency risks, complementary therapies (C) can be beneficial, and biologic outcomes (D) are secondary to psychological focus.