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. Which statement made by a client being treated for a somatic disorder, supports the nurse's evaluation that the client has developed the skills necessary to achieve full recovery?
A. “I really want to get better and I will do whatever it takes to have that happen.”
B. “I've learned how to cope with the stress that triggered my past physical problems.”
C. “I won't ask for any diagnostic testing unless I'm really sure the pain isn't in my head.”
D. “I've learned that my illness causes me to exaggerate the pain I'm experiencing.”
Answer: B
Rationale: The overall goal for the client with a somatic disorder is to reduce health anxiety and the behaviors related to the symptoms, rather than eliminating the symptoms entirely. Goals related to improving occupational and interpersonal functioning are important.
The client will need to address the unrecognized anxiety before the somatic symptoms are resolved. Recognition of the cause of their symptoms is an ongoing and time-consuming process, so goals need to be realistic in terms of the time it will take to achieve them. Focusing on the somatic symptoms as an outcome should be avoided as the symptoms provide distraction from the underlying cause of the disorder. Evaluation focuses on the client's ability to recognize the underlying psychological stress and anxiety that are contributing to the physical symptoms. Determining whether the client has developed an awareness of increased anxiety and initiated more effective coping mechanisms to deal with the stress level is vital because once the client can look realistically at the connection between repressed emotional turmoil and the somatic symptoms, a decrease in concerns or full recovery from the previous level of altered physical functioning or pain is anticipated. While a desire to recover is important, that alone will not facilitate recovery. Expressing an understanding of the origin of the pain and the characteristic display of the symptoms suggest some understanding of the disorder but don't necessarily support recovery.
An interview with a client reveals that a client is receiving significant attention from family members as a result of the client's somatic symptoms. The client states, “My children have been so attentive. They've gone out and gotten me all sorts of pain relief devices. They even come over every day and cook for me.” The nurse identifies the client’s statements as reflecting which concept?
A. Displacement
B. Primary gain
C. Secondary gain
D. Repression
Answer: C
Rationale: The somatic symptoms provide a psychological or primary gain as the anxiety is relieved and focus is diverted to the physical problem. Secondary gain comes from the subsequent attention the person receives from a provider or a family member. Other mechanisms that are used by people with a somatic symptom disorder include repression of trauma or conflict, denial that psychological factors exist, and displacement of anxiety and conflict to body symptoms.
When reviewing the history, the nurse notes that the client stated, “I spend so much of my time and money on provider visits and they still doesn't know what is causing my pain. But I know there is something seriously wrong.” The nurse interprets this statement as reflecting which condition?
A. Conversion disorder
B. Illness anxiety disorder
C. Factitious disorder
D. Somatic symptom disorder
Answer: D
Rationale: Somatic disorders are a significant issue for the health care system due to the fact that clients with these symptoms tend to overuse health care provider services and resources. They have exaggerated fears concerning the severity of illness that is not supported by the existing symptoms. This fear monopolizes their lives and causes major personal disruptions. A conversion disorder involves a sensory or neurologic impairment that is not supported by diagnostic testing. Illness anxiety disorder is characterized by health care provider shopping, visiting many different health care provider. This client appears to be seeing only one health care provider Factitious disorders involve the falsification of physical or mental symptoms primarily to assume the sick role. There is no evidence to support this suspicion regarding this client.
A client is suspected of having somatic symptom disorder. When interviewing the client, which client statement would the nurse identify as supporting this suspicion?
A. “I can't understand why you think there is a connection between my bad head pain and a mental disorder.”
B. “Just because that test didn't find the cause of my pain doesn't mean I don't need more testing.”
C. “The pain these headaches cause is certainly an indicator that I'm horribly sick with a brain tumor.”
D. “I'll never be able to have a decent job until these headaches stop and the pain they cause goes away.”
Answer: C
Rationale: The disproportionate distress caused by the abnormal thoughts, feelings, or behaviors related to the somatic symptoms is the primary factor in diagnosis of this condition. The client's assumption that the head pain is certainly confirmation of a brain tumor is an example of such distorted thinking. It is not uncommon for a client to lack the understanding of the relationship between the symptoms of their illness and the existence of a mental illness. Clients experiencing chronic pain originating from a variety of sources will often disregard the results of negative tests and seek additional tests to confirm a problem. The existence of a secondary gain such as not being employed is common among disorders that result in physical limitations.
The spouse of a female client diagnosed with a somatic symptom disorder shares that, “I don't really believe the pain is so great that she can't go to work; the kids and I need to tell her to go back to work.” The nurse should educate the spouse concerning the possibility of the client to threaten to which situation?
A. Accuse spouse of physical abuse.
B. Prevent spouse from seeing the children.
C. Commit suicide.
D. Divorce the spouse.
Answer: C
Rationale: Individuals with somatic symptom disorder become extremely dependent on both health care provider–client and personal relationships with an increasing demand for attention and emotional support, often getting upset when they feel their needs are not being met. In an attempt to manipulate others, the demand for attention may, in some instances, result in threats or attempts to commit suicide. The other threats are not typical and would not have the same manipulative affect.
A 9-year-old child experiencing hearing loss has been diagnosed with a conversion disorder. Which question would be appropriate for the nurse to ask when attempting to determine the underlying cause of the child's symptoms?
A. “How have you been treated since you lost your hearing?”
B. “Do you like going to see your doctor?”
C. “Are you worried about not being able to hear?”
D. “Do you think your mother and father yell too much?”
Answer: D
Rationale: Family stress and physical or sexual abuse are thought to be the most common causes of conversion disorders in children and adolescents. The child's anxiety and lack of coping skills may be the cause of the hearing loss. The presence of a secondary gain, degree of concern over the loss, or the child's attitude about going to the doctor's would not be as relevant to identifying the cause of the condition.
A client diagnosed with a somatic symptom disorder threatens to “kill myself” if the nurse does not arrange for a sophisticated diagnostic test. Which outcome would be most appropriate for the nurse to add to the client's plan of care to help the client deal with the safety issues related to this behavior?
A. Expresses feelings of anxiety and effective means of dealing with the illness
B. Demonstrates reduced use of manipulative behavior to secure attention
C. Expresses positive feelings about self
D. Acknowledges understanding and perception of present illness
Answer: B
Rationale: This example of manipulative behavior is a characteristic behavior to secure attention. To minimize the risk associated with this threat, the goal to utilize nonmanipulative behaviors is most appropriate. While the other goals are fitting for this disorder, they are not as associated with the root of this particular threat as is the correct option.
A client is diagnosed with a somatic symptom disorder. Which client statement demonstrates an understanding of the disorder that will be most effective in preventing a relapse of the symptoms?
A. “I know I have control over these symptoms.”
B. “If I take my medication, this problem will go away.”
C. “I understand that I must manage my stress daily.”
D. “It's my anxiety that causes me to have this disorder.”
Answer: C
Rationale: Evaluation of implemented nursing actions focuses on the client's ability to recognize the underlying psychological stress and anxiety that are contributing to the physical symptoms. The client will need to address the unrecognized anxiety before the somatic symptoms are resolved. Recognition of the cause of their symptoms is an ongoing and time-consuming process, so goals need to be realistic in terms of the time it will take to achieve them. Because these disorders tend to reoccur, it is important to recognize that the symptoms can reappear if psychological defenses and coping strategies such as stress management fail. While the other options demonstrate varying degrees of understanding, they are not as insightful. Knowing that the process is controllable, and a result of anxiety, does not indicate understanding of how to best manage the condition. Medication alone will not prevent the reappearance of the symptoms.
When gathering the health history of a client newly diagnosed with a somatic symptom disorder, which information would the nurse identify as having the greatest significance?
A. Any familial diseases
B. Any genetic diseases
C. Any recent surgical procedures
D. Any pattern of repeatedly reported symptoms
Answer: D
Rationale: Elicit any pattern of repeatedly reported symptoms by taking a history of current and past health status. While information in all answers needs to be noted, it is most important in these clients to elicit information on a pattern of repeatedly reported symptoms.
A hospitalized client is diagnosed with a somatic symptom disorder. The nurse should expect the client to achieve which outcome prior to discharge?
A. Client demonstrates no manipulative behaviors as a means to secure attention
B. Client states that sleep-related problems have disappeared
C. Client verbalizes a realistic perception of minor body defects and related feelings
D. Client participates in development of an effective symptom management plan
Answer: D
Rationale: The only appropriate outcome to be achieved before discharge is to actively participate in the plan of care. While appropriate, the remaining options are more long term and will be the focus of treatment after discharge.
A nurse is assisting with the development of a plan of care for a client diagnosed with a somatic symptom disorder. Which intervention would be the initial priority?
A. Responding to the client with patience and understanding
B. Providing a comfortable environment
C. Identifying positive feelings that the client may have
D. Helping the client face responsibilities
Answer: A
Rationale: Establishing a trusting relationship with clients experiencing a somatic symptom disorder is the first step in helping them overcome a low self-concept. A safe and supportive environment will also help lower their anxiety to a level that allows the expression of underlying feelings. It is important to identify and come to terms with any anger or negative feelings that the nurse may have related to clients with this disorder. Remember that the clients are not consciously trying to be sick or avoid responsibilities.
When evaluating the nursing interventions used with a client exhibiting psychophysiologic behaviors, which should be the nurse's initial focus regarding the client's abilities?
A. Recognize the underlying stress and anxiety.
B. Decrease the manipulative behavior.
C. Perform self-care activities independently.
D. Verbalize the physical deficits.
Answer: A
Rationale: The overall goal for the client with a somatic disorder is to reduce health anxiety and the behaviors related to the symptoms, rather than eliminating the symptoms entirely.
The client will need to address the unrecognized anxiety before the somatic symptoms are resolved. Recognition of the cause of their symptoms is an ongoing and time-consuming process, so goals need to be realistic in terms of the time it will take to achieve them. The nurse would not focus on the client's ability to decrease the manipulative behavior, to perform self-care activities, or to verbalize the physical deficits until this basic ability to understand the illness is achieved.
A client is diagnosed with a conversion disorder related to the loss of feeling in the client's right hand. When talking with the client, the nurse observes the client's lack of concern over the symptoms. Which term would the nurse use to describe this?
A. Hysteria
B. Munchausen syndrome
C. La belle indifference
D. Primary gain
Answer: C
Rationale: People with conversion disorder may exhibit an attitude of la belle indifference, that is, they demonstrate little anxiety or concern over the implications of the symptoms. Hysteria is a nervous disorder marked by ineffective emotional control. Munchausen syndrome is the deliberate falsification of an illness in another for attention of assuming the sick role. Primary gain is the psychological relief that is felt when anxiety is converted into physical symptoms of a disorder.
An adolescent has been diagnosed with conversion disorder that involves the loss of vision. The client's parent asks the nurse about the prognosis for this disorder. Which response by the nurse would be best?
A. “Unfortunately, this disorder tends to recur in times of severe stress.”
B. “With effective treatment, most recover in 2 to 4 weeks without reoccurrence.”
C. “Recovery generally requires 8 to 12 weeks of intensive therapy.”
D. “It’s difficult to say because your adolescent’s vision is affected.”
Answer: B
Rationale: Conversion disorder tends to be of short-term duration, with most clients recovering in 2 to 4 weeks without reoccurrence.
When assessing a client with a somatic symptoms disorder, the nurse is gathering data about secondary gain. The nurse would focus questions on which topic?
A. Type and amount of medications the client is taking
B. Any pattern of repeatedly reported symptoms
C. Previous work or activities client is no longer able to perform
D. Description of physical symptoms
Answer: C
Rationale: Secondary gains may be assessed by asking questions concerning any previous work or activity the client used to be able to do that the client is unable to perform as a result of the symptoms. The nurse can also ask in what way the client's life has been altered by the symptoms. Medications taken, repeatedly reported symptoms or physical symptoms do not reflect secondary gain, the subsequent attention the person receives from a health care provider or family member.
A client reports chronic pain that health care providers believe to be somatic in nature. What is the nurse's primary safety concern regarding the client's self-management of this pain?
A. The client will develop a dependency on pain medication.
B. Tolerance to the pain medication will make treatment very difficult.
C. The client will establish relationships with numerous providers to secure analgesics.
D. The cost of the analgesics will be a tremendous strain on the client’s finances.
Answer: A
Rationale: Clients with somatic symptom disorders who are overconcerned about their symptoms may become dependent on analgesic or antianxiety medication. While the results of medication dependency will add to the challenge of managing this disorder, it is not as worrisome as the real possibility of medication abuse. While the financial burden resulting from repeat physician office and emergency room visits seeking prescriptions is a concern, the primary worry is associated with direct client safety.
When gathering assessment data, which information would the nurse identify as reflecting a diagnosis of somatic symptom disorder? Select all that apply.
A. Spends excessive time investigating problem
B. Reports visual problems and limited range of motion in both hands
C. Has threatened to attempt suicide twice
D. Currently being treated for depression
E. Has not been able to hold a job for 3 years
Answer: A, C, D, E
Rationale: With somatic symptom disorder, the client spends excessive time investigating the health problem and the excessive worry or anxiety about the problem disrupts the person’s life. In addition, clients often demonstrate such need for attention, they are prone to threaten or even attempt suicide. Depression is a common comorbid mental health disorder associated with a somatic disorder. The secondary gain of this disorder is often significant.
A nurse manager is conducting a review class for the staff at the clinic about somatic disorders. Including factitious disorders. The nurse manager determines that the class was successful when the group makes which statement(s) about factitious disorders? Select all that apply.
A. The individual has a detailed, textbook knowledge of the reported illness.
B. Intentional infliction of harm to oneself or another is a characteristic of the disorder.
C. Symptoms are usually observable by others.
D. The individual is consciously falsifying the symptoms.
E. The individual's primary goal is to get attention for being sick.
Answer: A, B, D, E
Rationale: Individuals with factitious disorder deliberately falsify signs and symptoms of illness for the primary purpose of assuming the sick role. The symptoms may be intentionally induced in oneself or on another. Knowledge of a textbook description of the illness or unusual use of medical terminology also raises the possibility of a factitious disorder. The symptoms are always subjective and not observable by others and are not confirmable through diagnostic testing.
The nurse is assisting with the plan of care for a client diagnosed with a somatic symptom disorder. Based on the client’s needs, which nurse care focus would the nurse likely identify? Select all that apply.
A. Altered body image perception related to repressed unmet dependency needs
B. Sexual Dysfunction, related to an inability to feel pleasure
C. Self-Care Deficit, related to loss of cognitive function
D. Chronic Pain, related to severe physical ailment
E. Social Isolation, related to preoccupation with self and perceived illness
Answer: A, E
Rationale: Nursing care focus to address the problems related to these disorders may include altered body image perception, related to repressed unmet dependency needs and unsatisfactory interpersonal relationships and social isolation related to preoccupation with self and perceived illness. An inability to feel pleasure and the loss of cognitive function are not characteristic of this disorder. The pain is a result of severe anxiety and not a physical ailment.
A nurse is gathering data from a client who is suspected of having an illness anxiety disorder. Which findings would support this suspicion? Select all that apply.
A. Concerns continue despite medical testing and reassurance that a disease does not exist
B. Disproportionate level of anxiety and worry even if symptoms are minor
C. Loss of pain or touch sensation
D. Visits to numerous health care providers for the same problem
E. Statements reflecting obsession that an illness exists
Answer: A, B, D, E
Rationale: Illness anxiety disorder (previously known as hypochondriasis) is characterized by an excessive fear or preoccupation with having a serious illness that is based on a misinterpretation of somatic signs and symptoms. The concerns continue despite medical testing and reassurance that a disease does not exist. Anxiety and worry are not in proportion to the seriousness of the symptoms, with the client focusing all attention to the existence of an illness. The client will attempt to find a medical reason for the symptoms through appointments with many different providers.
A client is suspected of having factitious disorder. When reviewing the client's history and physical assessment, which finding(s) would support this suspicion? Select all that apply.
A. Client uses medical terminology to describe the condition.
B. Client exhibits the typical signs associated with the illness.
C. Client's laboratory reports are inconsistent with reported symptoms.
D. Client's symptoms are explicitly described and nonstereotyped.
E. Client's history is inconsistent with objective findings.
Answer: A, C, E
Rationale: Individuals with factitious disorder deliberately falsify signs and symptoms of illness for the primary purpose of assuming the sick role. They may describe a false history of illness or surgeries and may present falsified lab reports or other assessment findings. The description of symptoms is vague and stereotyped. Absence of typical symptoms that would usually be seen in persons presenting with the same concern is common. The inconsistencies between history and objective findings raise doubts about the legitimacy of the subjective symptoms and atypical presentation. Knowledge of a textbook description of the illness or unusual use of medical terminology also raises the possibility of a factitious disorder.