Chapter 33: Somatic Symptom and Dissociative Disorders: Nursing Care of Persons with Somatization

Format: Multiple Choice

Client Needs: Psychosocial Integrity

Cognitive Level: Understand

Integrated Process: Nursing Process

Objective: 10

Page and Header: 648, Factitious Disorders

1. A client is admitted to a mental health unit with a diagnosis of factitious disorder. When reviewing the client’s history, which assessment would a nurse find?

A) Intentional self-injurious behavior

B) Pain to achieve a self-serving goal

C) Malingering to avoid work

D) Parents who were restrictive

Page and Header: 648, Factitious Disorders

2. While assessing a client thought to have a factitious disorder, a nurse asks the client to describe when the client 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.”

Page and Header: 650, Factitious Disorder Imposed on Another

3. A client attempted to inject diluted feces into his or her child’s intravenous line. The client has a history of similar attempts of harming the child and has now been admitted to a mental health unit. The nurse would most likely suspect which diagnosis?

A) Schizoid personality traits

B) Factitious disorder imposed on another

C) Functional neurologic symptoms

D) Borderline personality disorder

Page and Header: 633, Somatic Symptom Disorder

4. After educating a group of nurses about somatic symptom disorder (SSD), an instructor determines that the education was successful when the group identifies which characteristic?

A) Symptoms that remain relatively static

B) Manifestations highly variable

C) Symptoms that are easily manageable

D) Reports of overall health as good

Page and Header: 636, Review of Systems

5. A client diagnosed with somatic symptom disorder (SSD) is reporting significant pain in the joints. When providing care to this client, which factor would be most important for a 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.

Page and Header: 633, Somatic Symptom Disorder

6. A client has made multiple visits to the clinic. A nurse suspects that the client may be experiencing somatic symptom disorder (SSD) based on which assessment finding?

A) Expressions of concern about psychological problems

B) Indications that the parents were always in good health

C) Reports of symptoms changing to different body systems

D) Evidence of a need for social support from friends

Page and Header: 640, Psychosocial Assessment

7. A nurse is reviewing the medical history of a client diagnosed with somatic symptom disorder (SSD). Which would the nurse expect to find as a comorbid condition?

A) Depression

B) Bipolar disorder

C) Thought disorder

D) Sleep disorder

Page and Header: 642, Pain Management

8. A nurse is assessing a client for somatic symptom disorder (SSD). 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.”

Page and Header: 640, Psychosocial Assessment

9. The nurse is caring for a client diagnosed with somatic symptom disorder (SSD). When assessing this client, the nurse would be especially alert for which comorbidity?

A) Depression

B) Avoidant personality disorder

C) Delirium

D) Bipolar disorder

Page and Header: 634, Children and Adolescents

10. A nursing instructor is describing somatic symptom disorder (SSD) to a group of nursing students. The instructor determines that the education was successful when the students make which statement?

A) The disorder typically is diagnosed in men.

B) The first symptom usually appears during adolescence.

C) The disorder commonly occurs with substance abuse.

D) Highly educated individuals often develop this disorder.

Page and Header: 635, Psychological Theories

11. The spouse of a client diagnosed with somatic symptom disorder (SSD) asks the nurse, “What causes this condition?” Which response by the nurse would be most accurate?

A) “There is definitely an underlying genetic link for this disorder.”

B) “Your wife is experiencing chronic stress that causes hypoarousal.”

C) “The symptoms reflect an emotion that your wife cannot verbalize.”

D) “The symptoms reflect an internal preoccupation with events.”

Page and Header: 646, Promoting Safety

12. A nurse is preparing to interview a client diagnosed with somatic symptom disorder (SSD). The nurse anticipates that the client will most likely exhibit which response?

A) No facial expression during the interview

B) Intermittent nodding and glancing at the clock on the wall

C) Altered mental status

D) Rapidly changing moods during the interview

Page and Header: 640, Substance Use

13. After teaching a client who is prescribed phenelzine for treatment of somatic symptom disorder (SSD), the nurse determines that additional education is needed when the client states which of the following?

A) “I can take an over-the-counter medicine for my hay fever.”

B) “I should avoid alcohol when I take this drug.”

C) “I should not stop taking the drug abruptly.”

D) “I need to report any panic attacks or irritability.”

Page and Header: 646, Evaluation and Treatment Outcomes

14. A nurse is evaluating the outcomes for a client diagnosed with somatic symptom disorder (SSD). Which finding would the nurse most likely identify as interfering with achievement?

A) Outcomes were stated in realistic terms.

B) Outcomes addressed overall issues.

C) Outcomes indicated small successes.

D) Outcomes identified specific behaviors.

Page and Header: 642, Therapeutic Relationship

15. A nurse is working with a client diagnosed with somatic symptom disorder (SSD). 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

Page and Header: 646, Group Interventions

16. The nurse is assisting in planning a series of group therapy sessions with several clients diagnosed with somatic symptom disorder (SSD). The nurse plans to focus the sessions on which priority?

A) Causes of medical illnesses

B) Positive self-talk

C) Side effects of medications

D) Assertiveness skills

Page and Header: 645, Therapeutic Interactions

17. The nurse is providing care to a client diagnosed with somatic symptoms disorder (SSD). The client has been prescribed escitalopram 1 week ago. The client reports experiencing nausea after starting the medication and describes it as worse than what the average person would have. Which intervention should the nurse recommend for this client?

A) To monitor the nausea using a daily journal for 1 week

B) To stop taking the medication immediately

C) To consume a balanced diet

D) To see physician specialized in gastric disorders

Page and Header: 632, Key Concept

18. The nurse is seeing a client who reports chronic pain that radiates to the lower back. The client reports the pain has been unresolved with analgesia, physical therapy, and therapeutic massage. The client’s diagnostic imaging reports are all unremarkable. Which statement by the nurse would be the most supportive response to this client?

A) “You must be so frustrated with this unexplained pain. Do you have other stresses in your life too?

B) “The treatment that was recommended to you has worked for many clients. It is supported by research.”

C) “Is it common in your culture to talk about psychological distress like it is physical pain?”

D) “It would be best for you to see a specialist until the underlying issue is properly diagnosed.”

Page and Header: 648, Conversion Disorder (Functional Neurologic Symptom Disorder)

19. A psychiatric–mental health clinical nurse specialist is preparing a class about functional neurologic symptoms. Which assessment finding would the nurse most likely include? Select all that apply.

A) Difficulty swallowing

B) Spasticity

C) Urinary frequency

D) Aphonia

E) Blindness

Page and Header: 642, Physical Health Interventions

20. A nurse is providing care for a client who has been diagnosed with somatic symptom disorder (SSD) and is exhibiting anxiety about having a severe illness. Which action would be appropriate for the nurse to take? Select all that apply.

A) Listen closely to the client’s report of symptoms.

B) Ignore the client’s report of symptoms and make a professional nursing assessment.

C) Acknowledge that what the client is saying may be real.

D) Encourage the client to write down symptoms in a journal.

E) Review the symptom pattern with the client.