Psychiatric Mental Health Nursing 5th Edition By Fortinash
Chapter 11: Somatoform, Factitious, and Dissociative Disorders
Test Bank
MULTIPLE CHOICE
1. Which question would the nurse performing an admission interview for a patient with suspected dissociative amnesia disorder identify as a priority?
a. “What help would you like us to give you?”
b. “Are you experiencing a high level of anxiety?”
c. “Do you find rituals make you feel more comfortable?”
d. “How would you describe your childhood memories?”
ANS: D
Due to a recent increase in reported cases of dissociative amnesia involving previously forgotten early childhood memories, assessing such memories would have priority with this patient. Obsessive-compulsive disorder is not generally viewed as a co-morbid disorder of dissociative amnesia. The remaining options would not provide much specific information for this patient’s condition.
DIF: Cognitive Level: Application REF: Page 209
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
2. Which nursing assessment finding would support a diagnosis of somatoform disorder?
a. Patient reports a family history of depression
b. The onset of symptoms beginning at age 38
c. An abnormality of the patient’s left heart ventricle
d. Complaints of diarrhea and an erratic menstrual cycle
ANS: D
The diagnosis of somatization disorder requires that symptoms indicate there is involvement of multiple organ systems (e.g., gastrointestinal, reproductive, neurologic). Structural anomalies would indicate a medical problem exists. An early onset of symptoms (prior to age 30) is not recognized as a criterion for the diagnosis. A family history of depression is not a criterion for the diagnosis.
DIF: Cognitive Level: Application REF: Page 209
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
3. To differentiate between somatoform and conversion disorders, the nurse will direct the assessment to determine the presence of the critical defining factor associated with conversion disorder. Which is true about a conversion reaction?
a. Symptoms are generally associated with pain or sexual function.
b. Symptoms are not accounted for by a medical condition.
c. Symptoms are precipitated by psychological factors.
d. Symptoms are under the patient’s voluntary control.
ANS: C
Symbolic psychological factors are identified as being related to the onset or exacerbation of a conversion symptom. An absence of a medical cause is present in both the case of conversion and somatization disorders. The conversion symptom is not limited to pain or sexual function nor is not under voluntary control.
DIF: Cognitive Level: Application REF: Page 210
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
4. A diagnosis of dissociative identity disturbance has been identified for a patient who has stated that he is unable to distinguish between himself and his surroundings. What is an appropriate outcome for this patient?
a. Refers to himself as “the patient”
b. Identifies the onset of increasing anxiety
c. Uses manipulative behaviors to meet needs
d. Displays ability to suppress feelings of dissatisfaction
ANS: B
Dissociative identity disturbance is exacerbated when the patient’s anxiety escalates. Identification of increasing anxiety permits the patient to exercise anxiety-management strategies and prevent dissociation. The patient should be expressing such feelings to others. The patient should refer to himself in the first person. Use of manipulative behavior is not desirable in this or any other patient.
DIF: Cognitive Level: Application REF: Page 215 TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
5. A patient comes to the ED stating that he suddenly became deaf. It is determined that his wife has recently asked for a divorce. What is the basis for the possibility that this patient is experiencing a conversion disorder?
a. Inventing the symptom helps in diverting attention from the marital problems.
b. Such a traumatic life change is likely to result in some form of mental illness.
c. The loss is a protective mechanism to help deal with overwhelming anxiety.
d. Men often exhibit this disorder since it is more accepted than showing sadness.
ANS: C
The scenario suggests that the patient is experiencing symptoms of conversion disorder, an anxiety disorder in which the symptom affects voluntary sensory or motor function and mimics a neurological disorder as a result of extreme anxiety, such as learning of his wife’s desire to divorce him. There is no organic basis for the hearing loss but it is not under the patient’s voluntary control. Most traumas are not dealt with by developing a mental illness but by rather coping effectively. Males are as likely as females to display conversion disorder symptoms.
DIF: Cognitive Level: Application REF: Page 208
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
6. A patient reports severe pain during intercourse since being sexually assaulted three years ago. What is the first step in confirming the diagnosis of a pain disorder?
a. Evaluating the patient’s understanding of the emotional effects of the assault
b. Asking the patient to keep a journal of her feelings regarding the assault
c. Assessing the patient for posttraumatic stress disorder
d. Ruling out a physical cause of the pain
ANS: D
While psychological factors have an important role in the onset, severity, exacerbation, or maintenance of the pain, initially the presence of a physical cause of the pain must be ruled out. The assessment of the patient’s understanding of the disorder or recording of feelings regarding the trauma are not priorities until a diagnosis of pain disorder is made. Posttraumatic stress disorder is not generally characterized with reports of sustained pain.
DIF: Cognitive Level: Application REF: Page 210 TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
7. A patient has developed an acute loss of hearing and is diagnosed with a conversion disorder. Which nursing diagnosis would be most appropriate?
a. Hearing impairment
b. Panic-level anxiety
c. Disturbed sensory perception
d. Denial due to a medical condition
ANS: C
The diagnosis of conversion disorder in this case results in a disruption of the patient’s ability to perceive sensations, not a true loss or impairment of hearing. There is no evidence to support panic-level anxiety or a medical condition causing denial.
DIF: Cognitive Level: Application REF: Page 210 TOP: Nursing Process: Analysis
MSC: NCLEX: Psychosocial Integrity
8. A patient experiencing the sudden onset of blindness is diagnosed with a conversion disorder. Which nursing intervention would be most therapeutic?
a. Suggesting to the patient that this is possibly malingering
b. Assisting him to make an appointment with an ophthalmologist
c. Providing nursing care in a supportive but matter-of-fact manner
d. Providing an occupational therapy consult to address the needs of a blind person
ANS: C
Interacting in a supportive but matter-of-fact way reduces the potential for any secondary reward on the part of the patient. The patient is not feigning illness, so is not a malingerer. An appointment with an eye doctor is not needed since the source of the blindness is not physical. The person is not permanently blind, so occupational therapy at this point is not a priority.
DIF: Cognitive Level: Application REF: Page 210
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
9. A patient is being evaluated for the diagnosis of hypochondriasis. Which assessment observation of the patient would serve to confirm this diagnosis?
a. Reports, “Pain in my back is certainly from a spinal tumor.”
b. Patient expresses no concern over her sudden loss of hearing.
c. Patient shows insight into the role stress plays in the illness.
d. Reports, “I don’t like doctors and so I haven’t been to one in years.”
ANS: A
With this disorder, the individual focuses on fears of having or the idea of having a serious medical disorder on the basis of his or her misinterpretation of bodily symptoms such as assuming pain is the result of a tumor. La belle indifference, showing little or no concern, occurs with conversion disorders. Individuals with hypochondriasis make multiple visits to physicians with health concerns. Showing insight into the condition would not be displayed at the time of diagnosis, since such improvement is a result of appropriate treatment.
DIF: Cognitive Level: Application REF: Pages 210-211
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
10. A patient who inaccurately believes he has stomach cancer is recommended cognitive theory to help address this false believe. Which intervention is most consistent with a cognitive theory approach?
a. Continuing to challenge the patient about the rationality of his belief
b. Assisting him to reinterpret the meaning of the sensations his body is creating
c. Urging him to have a ‘second opinion’ consult with another medical specialist
d. Rewarding him with praise and acceptance when he states, “I do not have cancer.”
ANS: B
Cognitive theorists believe that patients with somatic symptoms misinterpret the meaning of body functions and sensations and become overly alarmed by them and so help patients to reinterpret the meaning of body sensations. Continuing to challenge the patient regarding the belief is not therapeutic and should be avoided. Reinterpretation of thoughts is an appropriate cognitive approach. Rewarding appropriate behavior is a behavioral technique. Encouraging a second opinion is not helpful at this point since it is not likely to change his belief.
DIF: Cognitive Level: Application REF: Page 208
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
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