Chapter 16: Psychophysiological Responses and Somatoform and Sleep Disorders My Nursing Test Banks

Chapter 16: Psychophysiological Responses and Somatoform and Sleep Disorders

Test Bank

MULTIPLE CHOICE

1. Which patient is most likely exhibiting a somatization disorder?

a.

A person with chronic pain in the right ankle after a skiing injury

b.

A person who experiences occasional chest pain after a myocardial infarction

c.

A college graduate who cannot maintain steady employment because of multiple vague complaints

d.

A person who dislikes going out to social events with large groups because of embarrassment about facial acne

ANS: C

Somatization disorder is often characterized by multiple vague complaints that encourage others to take care of the individual and enable the individual to avoid demands of adult responsibility. The patients described in the other options have either a physiological basis for the complaint or a disturbed body image.

DIF: Cognitive Level: Analysis REF: Text Page: 246

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. Which patient is most likely exhibiting a conversion disorder?

a.

A toddler with frequent ear infections

b.

An athlete with exercise-induced asthma

c.

A night guard who suddenly goes blind

d.

An older adult whose fractured foot is not healing well

ANS: C

Conversion disorder is a type of somatoform disorder in which symptoms of some physical illness appear without any underlying organic cause. The organic symptom reduces the patients anxiety and usually gives a clue to the conflict.

DIF: Cognitive Level: Analysis REF: Text Page: 246

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

3. A patient is diagnosed with conversion disorder that is evidenced by paralysis of the right hand. Which nursing intervention should be implemented?

a.

Focus discussions on the patients inability to fulfill usual roles.

b.

Focus discussions on the patients unusual and unexplainable physical symptom.

c.

Spend time with the patient to give recognition for positive qualities and strengths.

d.

Spend time with the patient when the patient is helpless to perform self-care activities because of paralysis.

ANS: C

Spending time with a patient focusing on strengths and positive attributes builds self-esteem and self-confidence. This intervention also reduces secondary gains. The remaining options are not therapeutic for patients with conversion disorders.

DIF: Cognitive Level: Application REF: Text Page: 247

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

4. Which intervention should a nurse select to help a patient cope more effectively with chronic pain disorder?

a.

Mild opioids

b.

Benzodiazepines

c.

Relaxation techniques

d.

Response prevention

ANS: C

The intervention selected will be one that can be used over the long term. Relaxation training, which helps the patient control tension and anxiety and thereby reduce pain, can be an effective long-term strategy. Benzodiazepines and opioids produce dependency and are not useful for long-term management. Response prevention rarely is used to treat chronic pain.

DIF: Cognitive Level: Application REF: Text Page: 255

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

5. Which patient would be at greatest risk of encountering the exhaustion phase of the general adaptation syndrome?

a.

A patient who is scheduled for knee replacement surgery

b.

A patient who has high self-efficacy and has recently accepted a job promotion

c.

A patient who has had elective rhinoplasty to correct a prominent hump in the bridge of the nose

d.

A person who has severe osteoarthritis and was admitted to a nursing home after the death of a caretaker spouse 2 months ago

ANS: D

The exhaustion phase of the general adaptation syndrome often is associated with loss. The patient with osteoarthritis has lost a spouse and the ability to live at home.

DIF: Cognitive Level: Analysis REF: Text Page: 251

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

6. A nurse plans care for a patient at risk for development of a psychophysiological disorder associated with multiple stressors. In the assessment of the patients coping resources, which factor would the nurse consider initially?

a.

The social support available to the patient

b.

Whether there has been sustained grief over a recent loss

c.

Whether the patient is overworked with too many commitments

d.

Strain associated with the patients parenting duties

ANS: A

Coping resources are characteristics of the person, group, or environment that help people adapt to stress. A social support system is considered a coping resource; the other distracters for this question would be considered stressors.

DIF: Cognitive Level: Application REF: Text Page: 251

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

7. A patient diagnosed with essential hypertension reports feeling pressured by the demands made by family, friends, and an employer. Which role-play situation, as part of a patient education plan for coping with stress, would most likely help the patient develop effective stress-reduction skills?

a.

Patient offering to help a friend organize a church group activity

b.

Patient saying no to a request made by the employer to work overtime

c.

Patient accepting a verbal demonstration of caring and concern from spouse

d.

Patient asking a work subordinate to be prepared to come to work on time

ANS: B

If the patient reports feeling pressured, this suggests that the patient needs to learn to say no to some requests made by family, friends, and the employer. The correct answer is the only role-playing situation listed that addresses this problem.

DIF: Cognitive Level: Analysis REF: Text Page: 246

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

8. A patient has been instructed to use crutches in order to rest an injured foot. At a follow-up appointment, the patient admits to beginning a walking program. A nurse can assess this behavior as evidence the patient is employing:

a.

projection.

b.

regression.

c.

rationalization.

d.

compensation.

ANS: D

The patient uses compensation in an attempt to prove that he or she is healthy and in control of his or her body.

DIF: Cognitive Level: Comprehension REF: Text Page: 252

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

9. A patient has had two rhinoplasties but continues to seek further surgery. The patient has been told repeatedly that further surgery is not indicated. The patient tells a nurse, My life will be ruined unless my appearance can be improved. The patients thinking suggests:

a.

hypochondriasis.

b.

conversion disorder.

c.

somatization disorder.

d.

body dysmorphic disorder.

ANS: D

Preoccupation with an imagined defect in appearance suggests body dysmorphic disorder.

DIF: Cognitive Level: Application REF: Text Page: 254

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

10. A patient diagnosed with body dysmorphic disorder says, Im seriously dissatisfied with the appearance of my nose. Its ruining my life. A possible nursing diagnosis to consider for this patient is:

a.

anxiety.

b.

disturbed body image.

c.

ineffective coping skills.

d.

ineffective role performance.

ANS: B

Disturbed body image is a nursing diagnosis that is useful in most instances when body dysmorphic disorder is present. There is no data to support activity intolerance or ineffective sexuality pattern, and more data would be necessary to support ineffective role performance.

DIF: Cognitive Level: Comprehension REF: Text Page: 254

TOP: Nursing Process: Diagnosis|Nursing Process: Analysis

MSC: NCLEX: Psychosocial Integrity

11. Which type of treatment is likely to be effective for a patient diagnosed with body dysmorphic disorder whose nose is the focus of concern?

a.

Short-term benzodiazepine use to reduce anxiety

b.

Biofeedback to control physical responses to anxiety

c.

Antidepressant therapy to increase self-esteem, self-confidence, and outlook

d.

Cognitive behavioral therapy to challenge distorted thinking and interrupt self-critical thoughts

ANS: D

The patient has distorted thinking about the appearance of his nose and has highly negative and self-critical thoughts. Cognitive behavioral therapy can address and change these automatic responses.

DIF: Cognitive Level: Application REF: Text Page: 254

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

12. A patient says, Although numerous assessments and diagnostic tests over the past year have shown no evidence of organic disease Im still anxious and sure something is wrong. The nurse should suspect the presence of:

a.

hypochondriasis.

b.

chronic pain disorder.

c.

chronic major depression.

d.

body dysmorphic disorder.

ANS: A

Hypochondriasis involves preoccupation with fears of having a serious disease on the basis of the persons misinterpretation of body symptoms.

DIF: Cognitive Level: Comprehension REF: Text Page: 246

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

13. A patient diagnosed with hypochondriasis says, No one believes I have a brain tumor! I have terrible headaches and episodes of blurred vision. Im going to die. Which nursing approach fosters cognitive restructuring?

a.

Tell me about your relationships with the significant people in your life.

b.

You must be very worried about your condition. Lets discuss these feelings.

c.

Lets look at the evidence that suggests you have a brain tumor and consider the possible explanations for the symptoms.

d.

Your concern is unfounded. The more you talk about it, the more real your false idea seems. Lets talk about something else.

ANS: C

Questioning the evidence is a cognitive restructuring technique that can be effective in changing distorted thinking. Patients with hypochondriasis often ignore any possibilities except those that support their distorted thinking. Learning that headaches, visual disturbances, weakness, and vomiting can have causes other than brain tumors can be helpful.

DIF: Cognitive Level: Analysis REF: Text Page: 247

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

14. Doctor shopping, which is common among patients with somatoform disorders, suggests to a nurse that a patient:

a.

is denying the psychological component of the illness.

b.

cannot be successfully treated on an outpatient basis.

c.

uses rationalization to cope with anxiety aroused by the physical symptoms.

d.

has chosen to display symptoms of a physical illness to avoid responsibilities.

ANS: A

Doctor shopping occurs when a patient makes an effort to find a physician who will find an organic basis for the symptoms he or she is exhibiting. The patient demonstrating this behavior rejects any suggestion that there may be a psychological component associated with the physical symptom. The remaining options are not generally true of patients diagnosed with somatoform disorders.

DIF: Cognitive Level: Comprehension REF: Text Page: 246

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

15. A staff nurse decides to ignore an unfavorable evaluation from the nurse manager but now complains about getting little satisfaction from work, feels tired all the time, and cant wait for the shift to end. The nurses behavior is characteristic of which stage of the general adaptation syndrome?

a.

Alarm

b.

Resistance

c.

Exhaustion

d.

Resolution

ANS: B

During the stage of resistance, one of the three stages of the general adaptation syndrome identified by Selye, the body adapts to stress, functions at a lower than optimal level, and requires a greater than usual expenditure of energy for survival.

DIF: Cognitive Level: Application REF: Text Page: 244

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

16. A nurse is working with a patient exhibiting psychophysiological symptoms. It is important that the nurse understand that the patients symptoms are:

a.

feigned.

b.

psychosomatic.

c.

serious and require treatment.

d.

only serious if associated with actual pathology.

ANS: C

Psychophysiological disorders have stress-related physical symptoms associated with organic pathology. Treatment of symptoms and mitigation of psychological factors are indicated.

DIF: Cognitive Level: Comprehension REF: Text Page: 249

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

17. A nurse is working with a patient who has been diagnosed with a somatoform disorder. The patient asks, My last tests didnt show anything. When will I have more diagnostic testing? Which nursing response would be most therapeutic?

a.

You are resisting the idea that you do not have a physical illness.

b.

No more tests will be ordered. Your health maintenance organization (HMO) wont pay for repeating any tests.

c.

We think you need a rest from all the testing. Well consider more tests at a later time.

d.

Since the tests were all negative, we will focus next on evaluating the role of stress in your life.

ANS: D

This approach acknowledges the reality of the patients symptoms and suggests the possibility of stress as a contributing factor.

DIF: Cognitive Level: Analysis REF: Text Page: 248

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

18. A nurse planning care for a patient who has somatoform disorder needs to be aware that these patients often have relationship problems associated with:

a.

anger.

b.

dependency.

c.

detachment.

d.

misplaced objectivity.

ANS: B

Dependency is the need for others to care for the patient. Clinicians have observed that many patients with somatization disorders display dependency. Having physical symptoms allows a patient to meet dependency needs in a socially acceptable way.

DIF: Cognitive Level: Comprehension REF: Text Page: 247

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

19. A business executive is in the cardiac care unit (CCU) after a myocardial infarction. When the patient is told that it is not possible to have a telephone in the room, the patient angrily berates the nurse and demands to see a physician. Which response by the nurse would be the most therapeutic?

a.

Ill call your physician.

b.

Ill arrange for you to have a telephone.

c.

I can see that being ill is difficult for you.

d.

You are just too ill to make business calls.

ANS: C

Empathy shown by the nurses response may pave the way for discussion of the effect and meaning of illness for the patient. Arranging for a personal telephone is not therapeutic since it is not permitted and is likely to increase the patients stress level. The remaining options are nontherapeutic since they do not positively address the patients anger.

DIF: Cognitive Level: Application REF: Text Page: 256

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

20. Which expected outcome would be appropriate for a patient with a somatoform disorder?

a.

Patients anxiety level will decrease from severe to moderate.

b.

Patient will demonstrate compliance with antianxiety medication regimen.

c.

Patient will be able to cope with stress without being preoccupied with physical symptoms.

d.

Patient will express feelings verbally rather than through the development of physical symptoms.

ANS: D

Because the patient with a somatoform disorder is using physical symptoms to express feelings, the goal of verbalizing feelings is appropriate.

DIF: Cognitive Level: Application REF: Text Page: 246

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

21. Which strategy would be most therapeutic when helping a patient with a psychophysiological disorder to develop insight?

a.

Spend time with the patient to identify strengths.

b.

Identify dysfunctional coping mechanisms for the patient.

c.

Suggest that the patients use of denial is interfering with developing insight.

d.

Help the patient become aware of feelings when physical symptoms are present.

ANS: D

The process of insight-oriented therapy for patients with psychophysiological disorders requires that the patients underlying feelings be recognized and supportively confronted.

DIF: Cognitive Level: Application REF: Text Page: 252

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

22. A patient with a history of insomnia has been taking 15 mg of chlordiazepoxide (Librium) at bedtime for the past year. The patient reports having difficulty falling asleep and wakes up frequently during the night. The most appropriate nursing diagnosis to consider is:

a.

disturbed sleep pattern related to anxiety.

b.

moderate anxiety related to disturbed sleep pattern.

c.

insomnia related to tolerance to chlordiazepoxide (Librium).

d.

thought disorder related to intolerance of chlordiazepoxide (Librium).

ANS: C

Chlordiazepoxide (Librium) is a benzodiazepine. Tolerance to benzodiazepines develops quickly and leaves the patient needing larger doses of the drug to obtain the desired effect. Because tolerance and dependence on benzodiazepines occur, their use should be short-term.

DIF: Cognitive Level: Analysis REF: Text Page: 255

TOP: Nursing Process: Nursing Diagnosis|Nursing Process: Analysis

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

23. A patient admitted with conversion disorder was prematurely forced to acknowledge the psychological nature of what was thought to be paralysis. The morning after, the patient called a nurse and reports, I am blind. This set of circumstances is evidence of the _____ disorder.

a.

unpredictability of the

b.

defensive nature of the

c.

intentional nature of the

d.

manipulative tendencies of patients with conversion

ANS: B

Conversion symptoms serve the purpose of relieving the patients anxiety, which is engendered by a conflict. When the symptom must be given up before the conflict is resolved and the patient has no alternative strategy for coping with the repressed anxiety, another symptom may replace the first.

DIF: Cognitive Level: Application REF: Text Pages: 246-247

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24. A nurse is caring for a patient diagnosed with extreme stress. The nurse is focusing interventions on the promotion of adaptive psychophysiological patient responses. Which intervention is included in the plan of care?

a.

Monitoring the patients medication

b.

Monitoring the patients physical health

c.

Shifting the patients attention away from the symptoms

d.

Providing education to promote change in the patients health practices

ANS: D

One of the most important ways of promoting adaptive psychophysiological responses involves changing health habits. People who adopt positive health practices and good health measures can prevent biopsychosocial illnesses.

DIF: Cognitive Level: Analysis REF: Text Page: 254

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. Which nursing actions would enhance the development of a therapeutic relationship with a patient diagnosed with a psychophysiological disorder? (Select all that apply.)

a.

Assure the patient that the problem is easily treated since it is imagined.

b.

Approach the patient with the understanding that the symptoms are real.

c.

Encourage the patient to identify triggers that make the symptoms worse.

d.

Encourage the patient to identify situations that make the symptoms better.

e.

Provide the patient with a list of behaviors that are the focus of the problem.

ANS: B, C, D

Psychophysiological illness should never be dismissed as imagined or all in ones head. The patient with the nurses guidance needs to identify the problematic behaviors. These approaches will cause the patient to withdraw from the nurse and prevent the formation of a therapeutic relationship. The remaining options will assist in the development of a therapeutic relationship.

DIF: Cognitive Level: Application REF: Text Pages: 245-246

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

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