Chapter 17: Somatic Symptom Disorders

Chapter 17: Somatic Symptom Disorders

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. Which assessment data would help the health care team distinguish symptoms of conversion (functional neurological) disorder from symptoms of illness anxiety disorder (hypochondriasis)?

ANS:  B

Patients with illness anxiety disorder (hypochondriasis) tend to be more anxious about their concerns and display more obsessive attention to detail, whereas the patient with conversion (functional neurological) disorder often exhibits less concern with the symptom they are presenting than would be expected. Neither disorder involves voluntary control of the symptoms.  Results of diagnostic testing for both would be negative (i.e., no physiological basis would be found for the symptoms). Secondary gains can occur in both disorders but are not necessary to either.  See relationship to audience response question.

PTS:   1                    DIF:    Cognitive Level: Apply (Application)

REF:   Page 325-327                                  TOP:   Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

2. Which prescription medication would the nurse expect to be prescribed for a patient diagnosed with a somatic symptom disorder?

ANS:  B

Various types of antidepressants may be helpful in somatic disorders directly by reducing depressive symptoms and hence somatic responses, but also indirectly by affecting nerve circuits that affect not only mood, but fatigue, pain perception, GI distress, and other somatic symptoms.  Patients may benefit from short-term use of anti-anxiety medication (benzodiazepines) but require careful monitoring because of risks of dependence.  Conventional antipsychotic medications would not be used, although selected atypical antipsychotics may be useful.  Narcotic analgesics are not indicated.

PTS:   1                    DIF:    Cognitive Level: Understand (Comprehension)

REF:   Page 335-336                                  TOP:   Nursing Process: Planning

MSC:  Client Needs: Psychosocial Integrity

3. A medical-surgical nurse works with a patient diagnosed with a somatic symptom disorder. Care planning is facilitated by understanding that the patient will probably:

ANS:  B

Patients with somatic symptom disorders go from one health care provider to another trying to establish a physical cause for their symptoms. When a psychological basis is suggested and a referral for counseling offered, these patients reject both.

PTS:   1                    DIF:    Cognitive Level: Understand (Comprehension)

REF:   Page 325        TOP:   Nursing Process: Planning

MSC:  Client Needs: Psychosocial Integrity

4. A patient has blindness related to conversion (functional neurological) disorder but is unconcerned about this problem. Which understanding should guide the nurse’s planning for this patient?

ANS:  B

Psychoanalytical theory suggests conversion reduces anxiety through production of a physical symptom symbolically linked to an underlying conflict. Conversion, not suppression, is the operative defense mechanism in this disorder.  While some MRI studies suggest that patients with conversion disorder have an abnormal pattern of cerebral activation, there is no actual alternation of nerve transmission.  The other distracters oversimplify the dynamics, suggesting that only dependency needs are of concern, or suggest conscious motivation (conversion operates unconsciously).  See relationship to audience response question.

PTS:   1                    DIF:    Cognitive Level: Understand (Comprehension)

REF:   Page 325-326                                  TOP:   Nursing Process: Planning