Chapter 29-T

Question 1

1. A client diagnosed with somatic symptom disorder is most likely to exhibit which personality disorder characteristics?
   A. Uses “splitting” and manipulation in relationships
   B. Is socially irresponsible, exploitative, and guiltless and disregards rights of others
   C. Expresses heightened emotionality, seductiveness, and strong dependency needs
   D. Uncomfortable in social situations; perceived as timid, withdrawn, cold, and strange

Answer 1

ANS: C
It has been suggested that in somatic symptom disorder, there may be some overlapping of personality characteristics and features associated with histrionic personality disorder. These features include heightened emotionality, impressionistic thought and speech, seductiveness, strong dependency needs, and a preoccupation with symptoms and oneself. Somatic symptom disorder is characterized by the expression of multiple somatic complaints associated with psychosocial distress and without medical basis.

Question 2

2. A nurse is working with a client diagnosed with somatic symptom disorder. What predominant symptoms should a nurse expect to assess?
   A. Disproportionate and persistent thoughts about the seriousness of one’s symptoms
   B. Amnestic episodes in which the client is pain free
   C. Excessive time spent discussing psychosocial stressors
   D. Lack of physical symptoms

Answer 2

ANS: A
The primary focus in somatic symptom disorder is on physical symptoms that suggest medical disease but which have no basis in organic pathology. Although the symptoms are associated with psychosocial distress, the individual focuses on the seriousness of the physical symptoms rather than the underlying psychosocial issues.

Question 3

3. Which would be considered an appropriate outcome when planning care for an inpatient client diagnosed with somatic symptom disorder?
   A. The client will admit to fabricating physical symptoms to gain benefits by day 3.
   B. The client will list three potential adaptive coping strategies to deal with stress by day 2.
   C. The client will comply with medical treatments for physical symptoms by day 3.
   D. The client will openly discuss physical symptoms with staff by day 4.

Answer 3

ANS: B
The nurse should determine that an appropriate outcome for a client diagnosed with somatic symptom disorder would be for the client to list three potential adaptive coping strategies to deal with stress by day 2. Because the symptoms of somatic symptom disorder are associated with psychosocial distress, increasing coping skills may help the client reduce symptoms.

Question 4

4. Carly has been diagnosed with somatic symptom disorder. As the nurse is talking with Carly and her family, which of the following statements suggest primary or secondary gains that the physical symptoms are providing for the client?
   A. The family agrees that Carly began having physical symptoms after she lost her job.
   B. Carly states that even though medical tests have not found anything wrong, she is convinced her headaches are indicative of a brain tumor.
   C. Carly’s mother reports that someone from the family stays with Carly each night because the physical symptoms are incapacitating.
   D. Carly states she noticed feeling hotter than usual the last time she had a headache.

Answer 4

ANS: C
It is important for the nurse to identify gains that the symptoms might be providing for the client, since these can reinforce illness behavior. Having family attend to the patient when she is symptomatic could reinforce increased dependency and attention needs.

Question 5

5. A nursing instructor is teaching about the etiology of dissociative disorders from a psychoanalytical perspective. What student statement about clients diagnosed with this disorder indicates that learning has occurred?
   A. “Dissociative behaviors occur when individuals repress distressing mental information from their conscious awareness.”
   B. “When their physical symptoms relieve them from stressful situations, their amnesia is reinforced.
   C. “People with dissociative disorders typically have strong egos.”
   D. “There is clear and convincing evidence of a familial predisposition to this disorder.”

Answer 5

ANS: A
The nurse should understand that from a psychoanalytical perspective, dissociation occurs because of repression of painful information or experiences.

Question 6

6. An inpatient client is newly diagnosed with dissociative identity disorder (DID) stemming from severe childhood sexual abuse. Which nursing intervention takes priority?
A. Encourage exploration of sexual abuse
B. Encourage guided imagery
C. Establish trust and rapport
D. Administer antianxiety medications

Answer 6

ANS: C
The nurse should prioritize establishing trust and rapport when beginning to work with a client diagnosed with dissociative identity disorder. DID was formerly called multiple personality disorder. Each personality views itself as a separate entity and must be treated as such to establish rapport. Trust is the basis of every therapeutic relationship

Question 7

7. A client diagnosed with dissociative identity disorder (DID) switches personalities when confronted with destructive behavior. The nurse recognizes that this dissociation serves which function?
   A. It is a means to attain secondary gain.
   B. It is a means to explore feelings of excessive and inappropriate guilt.
   C. It serves to isolate painful events so that the primary self is protected.
   D. It serves to establish personality boundaries and limit inappropriate impulses.

Answer 7

ANS: C
The nurse should anticipate that a client who switches personalities when confronted with destructive behavior is dissociating in order to isolate painful events so that the primary self is protected. The transition between personalities is usually sudden, dramatic, and precipitated by stress.

Question 8

8. A client is diagnosed with dissociative identity disorder (DID). What is the primary goal of therapy for this client?
   A. To recover memories and improve thinking patterns
   B. To prevent social isolation
   C. To decrease anxiety and need for secondary gain
   D. To collaborate among subpersonalities to improve functioning

Answer 8

ANS: D
The nurse should anticipate that the primary therapeutic goal for a client diagnosed with DID is to collaborate among subpersonalities to improve functioning. Some clients choose to pursue a lengthy therapeutic regimen to achieve integration, a blending of all the personalities into one. The goal is to optimize the client’s ability to function appropriately and achieve optimal personal potential.

Question 9

9. Which of the following statements accurately describes dissociative fugue?
   A. Dissociative fugue is not precipitated by stressful events.
   B. Dissociative fugue is characterized by sudden, unexpected travel or bewildered wandering with inability to recall some or all of one’s past.
   C. Dissociative amnesia and dissociative fugue are completely different types of disorders.
   D. Dissociative fugue is characterized by a sense of observing oneself from outside the body.

Answer 9

ANS: B
Dissociative fugue is characterized by unexpected travel or bewildered wandering, and amnesia for all or part of one’s past. Dissociative fugue is a subtype of dissociative amnesia.

Question 10

10. Which should the nurse recognize as an example of localized amnesia?
    A. A client cannot relate any lifetime memories, including personal identity.
    B. A client can relate family memories but has no recollection of a particular brother.
    C. A client cannot remember events surrounding a fatal car accident.
    D. A client whose home was destroyed by a tornado only remembers waking up in the hospital.

Answer 10

ANS: C

An individual with localized amnesia is unable to recall all incidents associated with a stressful event.

Question 11

11. Neurological tests have ruled out pathology in a client’s sudden lower-extremity paralysis. Which nursing care should be included for this client?
    A. Deal with physical symptoms in a detached manner.
    B. Challenge the validity of physical symptoms.
    C. Meet dependency needs until the physical limitations subside.
    D. Encourage a discussion of feelings about the lower-extremity problem.

Answer 11

ANS: A
The nurse should assist the client in dealing with physical symptoms in a detached manner to avoid reinforcing the symptoms by providing secondary gains. This is an example of a conversion disorder in which symptoms affect voluntary motor or sensory functioning. Examples include paralysis, aphonia, seizures, coordination disturbance, difficulty swallowing, urinary retention, akinesia, blindness, deafness, double vision, anosmia, and hallucinations.

Question 12

12. The family of a client diagnosed with conversion disorder asks the nurse, “Will his paralysis ever go away?” Which of these responses by the nurse is evidence-based?
    A. “Most symptoms of conversion disorder resolve within a few weeks.”
    B. “Typically people who have conversion disorder symptoms that include paralysis will be paralyzed for the rest of their lives.”
    C. “The only people who recover are those that develop conversion disorder symptoms without a precipitating stressful event.”
    D. “Technically, he could walk now since he is intentionally feigning paralysis.”

Answer 12

ANS: A
The evidence supports that most conversion disorder symptoms resolve within a few weeks, and about 20% will have a relapse within 1 year.

Question 13

13. A client is diagnosed with illness anxiety disorder. Which of the following symptoms is the client most likely to exhibit? Select all that apply.
    A. Obsessive-compulsive traits
    B. Pseudocyesis
    C. Disabling fear of having a serious illness
    D. Multiple pronounced physical symptoms
    E. Depression

Answer 13

ANS: A, C, E
Illness anxiety disorder involves a preoccupation with and fear of having or acquiring a serious disease. Somatic symptoms are either absent or mild in intensity.

Question 14

14. A client is exhibiting symptoms of generalized amnesia. Which of the following questions should the nurse ask to confirm this diagnosis? Select all that apply.
    A. “Can you tell me your name and where you live?”
    B. “Have you ever traveled suddenly or unexpectedly away from home?”
    C. “Have you recently experienced any traumatic event?”
    D. “Have you ever felt detached from your environment?”
    E. “Have you had any history of memory problems?”

Answer 14

ANS: A, C, E
An individual who has generalized amnesia has amnesia for his or her identity and total life history. The first question assesses orientation to identity. Items C and D assess for awareness of current issues and historical issues, respectively. Affirmative descriptions of either of these issues would rule out generalized amnesia.

Question 15

15. Which of the following somatic symptom and dissociative disorders are identified with known effective pharmacological treatments for that disorder? Select all that apply.
    A. Antidepressants have been used effectively in treating pain associated with somatic symptom disorder.
    B. Lithium has been effective in treating illness anxiety disorder.
    C. Muscle relaxants have been effective in resolving conversion disorder symptoms.
    D. The antidepressant clomipramine (Anafranil) has shown promise in treating depersonalization-derealization disorder.

Answer 15

ANS: A, D
The nurse should recognize that psychological therapies are central treatment modalities for these disorders, although evidence exists that for specific issues (as those identified in items A and C), psychopharmacological agents have demonstrated effectiveness.