Chapter 19 My Nursing Test Banks

 

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank
Chapter 19

Question 1

Type: MCSA

The nurse finds that the client with a somatoform disorder has physical symptoms, but there is no evidence of physiologic disease. The client may have decreased amounts of serotonin and endorphins, causing the client to experience an increased sensitivity to pain. This explanation of the clients symptoms is based in:

1. Communication theory.

2. Humanistic theory.

3. Biologic theory.

4. Genetic theory.

Correct Answer: 3

Rationale 1: Research has shown that brain abnormalities such as decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Communication theorists believe somatization is nonverbal body language intended to communicate a message to significant others. Humanistic theorists believe one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Rationale 2: Research has shown that brain abnormalities such as decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Communication theorists believe somatization is nonverbal body language intended to communicate a message to significant others. Humanistic theorists believe one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Rationale 3: Research has shown that brain abnormalities such as decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Communication theorists believe somatization is nonverbal body language intended to communicate a message to significant others. Humanistic theorists believe one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Rationale 4: Research has shown that brain abnormalities such as decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Communication theorists believe somatization is nonverbal body language intended to communicate a message to significant others. Humanistic theorists believe one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Describe theories that aid in the understanding of dissociative, somatoform, and factitious disorders.

Question 2

Type: MCSA

The client states, I was reared in a chaotic, alcoholic family situation. The nurse knows that the most useful theory for explaining the clients somatoform disorder would come from:

1. Humanistic theory.

2. Psychosocial theory.

3. Biologic theory.

4. Genetic theory.

Correct Answer: 2

Rationale 1: Psychosocial theorists believe that the client did not receive adequate nurturing. Biologic theorists believe that decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Humanistic theorists believe that one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Rationale 2: Psychosocial theorists believe that the client did not receive adequate nurturing. Biologic theorists believe that decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Humanistic theorists believe that one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Rationale 3: Psychosocial theorists believe that the client did not receive adequate nurturing. Biologic theorists believe that decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Humanistic theorists believe that one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Rationale 4: Psychosocial theorists believe that the client did not receive adequate nurturing. Biologic theorists believe that decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Humanistic theorists believe that one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Describe theories that aid in the understanding of dissociative, somatoform, and factitious disorders.

Question 3

Type: MCSA

The nurse finds that the client with a pain disorder has been in a physically and verbally abusive relationship. The client feels guilty and fears a loss of love. According to psychoanalytic concepts, this is believed to be a(n):

1. Unconscious conflict from childhood that was reawakened in adulthood by a similar situation.

2. Environmental factor.

3. Stress related to relationships.

4. Brain abnormality.

Correct Answer: 1

Rationale 1: The psychosocial theory addresses the psychoanalytic concepts of a repressed affect that is transformed into pain. Brain abnormality as an explanation of the pain disorder reflects biologic theory. Stress related to relationships as an explanation of the pain disorder derives from a humanistic view. Environmental factors are a component of the genetic theory.

Rationale 2: The psychosocial theory addresses the psychoanalytic concepts of a repressed affect that is transformed into pain. Brain abnormality as an explanation of the pain disorder reflects biologic theory. Stress related to relationships as an explanation of the pain disorder derives from a humanistic view. Environmental factors are a component of the genetic theory.

Rationale 3: The psychosocial theory addresses the psychoanalytic concepts of a repressed affect that is transformed into pain. Brain abnormality as an explanation of the pain disorder reflects biologic theory. Stress related to relationships as an explanation of the pain disorder derives from a humanistic view. Environmental factors are a component of the genetic theory.

Rationale 4: The psychosocial theory addresses the psychoanalytic concepts of a repressed affect that is transformed into pain. Brain abnormality as an explanation of the pain disorder reflects biologic theory. Stress related to relationships as an explanation of the pain disorder derives from a humanistic view. Environmental factors are a component of the genetic theory.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Describe theories that aid in the understanding of dissociative, somatoform, and factitious disorders.

Question 4

Type: MCSA

The nurse is presenting an in-service on dissociative disorder. The nurse knows that which of the following is most often used to explain the occurrence of dissociative disorder in psychiatric clients?

1. Psychosocial theories

2. Biological theories

3. Genetic theories

4. Physical theories

Correct Answer: 1

Rationale 1: Although biologic and genetic factors are being studied as potential etiological factors, psychosocial theories are used most often to explain dissociative disorders.

Rationale 2: Although biologic and genetic factors are being studied as potential etiological factors, psychosocial theories are used most often to explain dissociative disorders.

Rationale 3: Although biologic and genetic factors are being studied as potential etiological factors, psychosocial theories are used most often to explain dissociative disorders.

Rationale 4: Although biologic and genetic factors are being studied as potential etiological factors, psychosocial theories are used most often to explain dissociative disorders.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Describe theories that aid in the understanding of dissociative, somatoform, and factitious disorders.

Question 5

Type: MCSA

A client is being seen in the clinic for right-hand paresthesia that the client does not seem to be overly concerned about. The condition developed abruptly after being caught cheating on an exam by the teacher. The paresthesia also ended abruptly as well. Which symptom most clearly relates to la belle indiffrence?

1. Being caught cheating on the exam

2. Right-hand paresthesia

3. Lack of concern over the paresthesia

4. Paresthesia beginning and ending abruptly

Correct Answer: 3

Rationale 1: La belle indiffrence describes a relative lack of concern over a physical problem like a paresthesia. La belle indiffrence does not refer to the nature of the physical problem or the course of the problem; therefore, the paresthesia itself and its abrupt onset and conclusion are not symptoms of la belle indiffrence. The client may or may not be concerned about being caught cheating on the exam, but that is not a physical problem.

Rationale 2: La belle indiffrence describes a relative lack of concern over a physical problem like a paresthesia. La belle indiffrence does not refer to the nature of the physical problem or the course of the problem; therefore, the paresthesia itself and its abrupt onset and conclusion are not symptoms of la belle indiffrence. The client may or may not be concerned about being caught cheating on the exam, but that is not a physical problem.

Rationale 3: La belle indiffrence describes a relative lack of concern over a physical problem like a paresthesia. La belle indiffrence does not refer to the nature of the physical problem or the course of the problem; therefore, the paresthesia itself and its abrupt onset and conclusion are not symptoms of la belle indiffrence. The client may or may not be concerned about being caught cheating on the exam, but that is not a physical problem.

Rationale 4: La belle indiffrence describes a relative lack of concern over a physical problem like a paresthesia. La belle indiffrence does not refer to the nature of the physical problem or the course of the problem; therefore, the paresthesia itself and its abrupt onset and conclusion are not symptoms of la belle indiffrence. The client may or may not be concerned about being caught cheating on the exam, but that is not a physical problem.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Compare and contrast the biopsychosocial characteristics of various dissociative, somatoform, and factitious disorders.

Question 6

Type: MCSA

The nurse would teach the adolescent with a conversion disorder what the person gets from having the disorder. This explanation would include a discussion of:

1. Preoccupation with the belief that the person has a serious disease without physical evidence.

2. Primary and secondary gains.

3. An overreaction by caregivers to the clients somatic complaints.

4. A pain cure.

Correct Answer: 2

Rationale 1: Primary and secondary gains are the two mechanisms thought to explain what a person gets from a conversion disorder. An overreaction by caregivers to the clients somatic complaints addresses somatization disorder. A pain cure would be discussed with a pain-disordered person. Hypochondriasis is a persons preoccupation with the belief that the person has a serious disease without physical evidence.

Rationale 2: Primary and secondary gains are the two mechanisms thought to explain what a person gets from a conversion disorder. An overreaction by caregivers to the clients somatic complaints addresses somatization disorder. A pain cure would be discussed with a pain-disordered person. Hypochondriasis is a persons preoccupation with the belief that the person has a serious disease without physical evidence.

Rationale 3: Primary and secondary gains are the two mechanisms thought to explain what a person gets from a conversion disorder. An overreaction by caregivers to the clients somatic complaints addresses somatization disorder. A pain cure would be discussed with a pain-disordered person. Hypochondriasis is a persons preoccupation with the belief that the person has a serious disease without physical evidence.

Rationale 4: Primary and secondary gains are the two mechanisms thought to explain what a person gets from a conversion disorder. An overreaction by caregivers to the clients somatic complaints addresses somatization disorder. A pain cure would be discussed with a pain-disordered person. Hypochondriasis is a persons preoccupation with the belief that the person has a serious disease without physical evidence.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Compare and contrast the biopsychosocial characteristics of various dissociative, somatoform, and factitious disorders.

Question 7

Type: MCSA

A 24-year-old client with body dysmorphic disorder (BDD) tells the nurse that he plans to have a surgical procedure that will affect his appearance. The nurse understands that this plan is an effort to:

1. Suppress intrusive thoughts.

2. Deal with multiple physical complaints.

3. Treat associated depression.

4. Cure the imagined defect.

Correct Answer: 4

Rationale 1: Clients with BDD may use cosmetic surgery to cure the imagined defect. Cosmetic surgery does not treat associated depression, deal with multiple physical complaints, or suppress intrusive thoughts.

Rationale 2: Clients with BDD may use cosmetic surgery to cure the imagined defect. Cosmetic surgery does not treat associated depression, deal with multiple physical complaints, or suppress intrusive thoughts.

Rationale 3: Clients with BDD may use cosmetic surgery to cure the imagined defect. Cosmetic surgery does not treat associated depression, deal with multiple physical complaints, or suppress intrusive thoughts.

Rationale 4: Clients with BDD may use cosmetic surgery to cure the imagined defect. Cosmetic surgery does not treat associated depression, deal with multiple physical complaints, or suppress intrusive thoughts.

Global Rationale:

Cognitive Level: Creating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Compare and contrast the biopsychosocial characteristics of various dissociative, somatoform, and factitious disorders.

Question 8

Type: MCSA

The client states that she has been ill and in pain since childhood. Her many symptoms are not caused intentionally, nor are they feigned. She has seen many doctors. Consistent with this clients disorder, the nurse believes the pain the client experiences is:

1. Fake.

2. Exaggerated.

3. Real.

4. For attention.

Correct Answer: 3

Rationale 1: This client has somatization disorder and is genuinely experiencing pain. It is not fake or for attention as with factitious disorders, or exaggerated.

Rationale 2: This client has somatization disorder and is genuinely experiencing pain. It is not fake or for attention as with factitious disorders, or exaggerated.

Rationale 3: This client has somatization disorder and is genuinely experiencing pain. It is not fake or for attention as with factitious disorders, or exaggerated.

Rationale 4: This client has somatization disorder and is genuinely experiencing pain. It is not fake or for attention as with factitious disorders, or exaggerated.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Compare and contrast the biopsychosocial characteristics of various dissociative, somatoform, and factitious disorders.

Question 9

Type: MCSA

The nurse is working with a client who is being admitted to the psychiatricmental health unit. The client was missing for two weeks and returned home not knowing any time had passed. Which of the following dissociative disorders has this client experienced?

1. Amnesia

2. Depersonalization disorder

3. Fugue

4. Dissociative identity disorder (DID)

Correct Answer: 3

Rationale 1: A person with dissociative fugue wanders, usually far from home and for days, perhaps even weeks or months, at a time. During this period, clients completely forget their past life and associations; but unlike people with amnesia, they are unaware of having forgotten anything. When they return to their former consciousness, they do not remember the period of fugue.

Rationale 2: A person with dissociative fugue wanders, usually far from home and for days, perhaps even weeks or months, at a time. During this period, clients completely forget their past life and associations; but unlike people with amnesia, they are unaware of having forgotten anything. When they return to their former consciousness, they do not remember the period of fugue.

Rationale 3: A person with dissociative fugue wanders, usually far from home and for days, perhaps even weeks or months, at a time. During this period, clients completely forget their past life and associations; but unlike people with amnesia, they are unaware of having forgotten anything. When they return to their former consciousness, they do not remember the period of fugue.

Rationale 4: A person with dissociative fugue wanders, usually far from home and for days, perhaps even weeks or months, at a time. During this period, clients completely forget their past life and associations; but unlike people with amnesia, they are unaware of having forgotten anything. When they return to their former consciousness, they do not remember the period of fugue.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Compare and contrast the biopsychosocial characteristics of various dissociative, somatoform, and factitious disorders.

Question 10

Type: MCSA

The nurse is caring for a client with a history of admissions to several hospitals over the last several years. Each hospitalization was for a different disorder in which there was no physical evidence. The medical record indicates the client is a pathological liar. Which of the following disorders does the client suffer from?

1. A somatoform disorder

2. Factitious disorder by proxy

3. Adult factitious disorder

4. Dissociative identity disorder

Correct Answer: 3

Rationale 1: When the disorder is severe, chronic, and unremittinginvolving repeated hospitalizations, traveling between health care providers and health care facilities, and pathological lying of an intriguing and fantastic nature (termed pseudologica fantastica)it is often referred to as Munchausen syndrome or adult factitious disorder (AFD). Factitious disorder by proxy sometimes called Munchausen by proxy syndrome(MBPS) occurs when parents or caregivers deliberately induce signs of an illness in another person, usually their own child. There is no evidence the client is suffering from dissociative identity disorder or a somatoform disorder.

Rationale 2: When the disorder is severe, chronic, and unremittinginvolving repeated hospitalizations, traveling between health care providers and health care facilities, and pathological lying of an intriguing and fantastic nature (termed pseudologica fantastica)it is often referred to as Munchausen syndrome or adult factitious disorder (AFD). Factitious disorder by proxy sometimes called Munchausen by proxy syndrome(MBPS) occurs when parents or caregivers deliberately induce signs of an illness in another person, usually their own child. There is no evidence the client is suffering from dissociative identity disorder or a somatoform disorder.

Rationale 3: When the disorder is severe, chronic, and unremittinginvolving repeated hospitalizations, traveling between health care providers and health care facilities, and pathological lying of an intriguing and fantastic nature (termed pseudologica fantastica)it is often referred to as Munchausen syndrome or adult factitious disorder (AFD). Factitious disorder by proxy sometimes called Munchausen by proxy syndrome(MBPS) occurs when parents or caregivers deliberately induce signs of an illness in another person, usually their own child. There is no evidence the client is suffering from dissociative identity disorder or a somatoform disorder.

Rationale 4: When the disorder is severe, chronic, and unremittinginvolving repeated hospitalizations, traveling between health care providers and health care facilities, and pathological lying of an intriguing and fantastic nature (termed pseudologica fantastica)it is often referred to as Munchausen syndrome or adult factitious disorder (AFD). Factitious disorder by proxy sometimes called Munchausen by proxy syndrome(MBPS) occurs when parents or caregivers deliberately induce signs of an illness in another person, usually their own child. There is no evidence the client is suffering from dissociative identity disorder or a somatoform disorder.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Compare and contrast the biopsychosocial characteristics of various dissociative, somatoform, and factitious disorders.

Question 11

Type: MCSA

The nurse is caring for a client with somatization disorder. When providing a report to the staff on the next shift, it is important for the nurse to relate the:

1. Amount of time the client talked about physical complaints.

2. Trigger for the clients worries.

3. Use of abdominal breathing at the first sign of anxiety.

4. The clients source of the original anxiety.

Correct Answer: 1

Rationale 1: Somatization disorder deals with physical problems that are found to have no organic basis. The amount of time the client talked about physical complaints is crucial to evaluate whether the client meets the goal of decreasing that time. The use of abdominal breathing at the first sign of anxiety, the clients source of the original anxiety, and the trigger for the clients worries are not priorities with somatization disorders.

Rationale 2: Somatization disorder deals with physical problems that are found to have no organic basis. The amount of time the client talked about physical complaints is crucial to evaluate whether the client meets the goal of decreasing that time. The use of abdominal breathing at the first sign of anxiety, the clients source of the original anxiety, and the trigger for the clients worries are not priorities with somatization disorders.

Rationale 3: Somatization disorder deals with physical problems that are found to have no organic basis. The amount of time the client talked about physical complaints is crucial to evaluate whether the client meets the goal of decreasing that time. The use of abdominal breathing at the first sign of anxiety, the clients source of the original anxiety, and the trigger for the clients worries are not priorities with somatization disorders.

Rationale 4: Somatization disorder deals with physical problems that are found to have no organic basis. The amount of time the client talked about physical complaints is crucial to evaluate whether the client meets the goal of decreasing that time. The use of abdominal breathing at the first sign of anxiety, the clients source of the original anxiety, and the trigger for the clients worries are not priorities with somatization disorders.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Differentiate among somatoform disorders, factitious disorders, and malingering.

Question 12

Type: MCSA

An 18-year-old client who joined the military shortly after graduating from high school is admitted to the mental health unit for depression and suicidal ideation. He tells the nurse the military is not what he expected and he wants to go home. The nurse observes a variance in affect between his interaction with peers and staff. The nurse suspects:

1. Conversion disorder.

2. Factitious disorder.

3. Malingering.

4. Body dysmorphic disorder.

Correct Answer: 3

Rationale 1: Malingering describes a person deliberately faking symptoms; it is usually adopted to obtain a secondary gain. Factitious disorder describes a person assuming a sick role by intentionally producing or feigning illness. People with body dysmorphic disorder are preoccupied by an imagined defect. A person with a conversion disorder will report impaired physical function related to the expression of a psychologic conflict.

Rationale 2: Malingering describes a person deliberately faking symptoms; it is usually adopted to obtain a secondary gain. Factitious disorder describes a person assuming a sick role by intentionally producing or feigning illness. People with body dysmorphic disorder are preoccupied by an imagined defect. A person with a conversion disorder will report impaired physical function related to the expression of a psychologic conflict.

Rationale 3: Malingering describes a person deliberately faking symptoms; it is usually adopted to obtain a secondary gain. Factitious disorder describes a person assuming a sick role by intentionally producing or feigning illness. People with body dysmorphic disorder are preoccupied by an imagined defect. A person with a conversion disorder will report impaired physical function related to the expression of a psychologic conflict.

Rationale 4: Malingering describes a person deliberately faking symptoms; it is usually adopted to obtain a secondary gain. Factitious disorder describes a person assuming a sick role by intentionally producing or feigning illness. People with body dysmorphic disorder are preoccupied by an imagined defect. A person with a conversion disorder will report impaired physical function related to the expression of a psychologic conflict.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Differentiate among somatoform disorders, factitious disorders, and malingering.

Question 13

Type: MCSA

A client is certain she has cancer and peritonitis despite her doctors reassurance she does not. She most likely is experiencing:

1. Malingering.

2. Conversion disorder.

3. Hypochondriasis.

4. Factitious disorder.

Correct Answer: 3

Rationale 1: This client is preoccupied with the belief she has a serious illness that is not medically present; this is hypochondriasis. Malingering describes a person deliberately faking symptoms and usually results in a secondary gain. Factitious disorder describes a person who assumes a sick role by intentionally producing or feigning illness. A person with conversion disorder will report impaired physical function related to the expression of a psychological conflict.

Rationale 2: This client is preoccupied with the belief she has a serious illness that is not medically present; this is hypochondriasis. Malingering describes a person deliberately faking symptoms and usually results in a secondary gain. Factitious disorder describes a person who assumes a sick role by intentionally producing or feigning illness. A person with conversion disorder will report impaired physical function related to the expression of a psychological conflict.

Rationale 3: This client is preoccupied with the belief she has a serious illness that is not medically present; this is hypochondriasis. Malingering describes a person deliberately faking symptoms and usually results in a secondary gain. Factitious disorder describes a person who assumes a sick role by intentionally producing or feigning illness. A person with conversion disorder will report impaired physical function related to the expression of a psychological conflict.

Rationale 4: This client is preoccupied with the belief she has a serious illness that is not medically present; this is hypochondriasis. Malingering describes a person deliberately faking symptoms and usually results in a secondary gain. Factitious disorder describes a person who assumes a sick role by intentionally producing or feigning illness. A person with conversion disorder will report impaired physical function related to the expression of a psychological conflict.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Differentiate among somatoform disorders, factitious disorders, and malingering.

Question 14

Type: MCSA

The nurse cares for several clients with somatoform disorders, regularly reassessing their status. The nurse is aware that it is:

1. Easy to be kind, nonjudgmental, and understanding.

2. Challenging because of the psychobiologic factors involved.

3. Best to include objective information only.

4. Best to include subjective information only.

Correct Answer: 2

Rationale 1: It can be difficult to assess the client because of the psychobiologic factors involved. It is not always easy to be kind, nonjudgmental, and understanding with this group of clients. Both objective and subjective information should be included in the assessment.

Rationale 2: It can be difficult to assess the client because of the psychobiologic factors involved. It is not always easy to be kind, nonjudgmental, and understanding with this group of clients. Both objective and subjective information should be included in the assessment.

Rationale 3: It can be difficult to assess the client because of the psychobiologic factors involved. It is not always easy to be kind, nonjudgmental, and understanding with this group of clients. Both objective and subjective information should be included in the assessment.

Rationale 4: It can be difficult to assess the client because of the psychobiologic factors involved. It is not always easy to be kind, nonjudgmental, and understanding with this group of clients. Both objective and subjective information should be included in the assessment.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Perform a thorough and comprehensive assessment of clients with dissociative, somatoform, and factitious disorders.

Question 15

Type: MCSA

A client presents to the community clinic describing abdominal pain, refuses to complete informational forms, and dismisses the nurses assessment attempts while demanding to be seen immediately by a doctor. Which approach would be best for the nurse to use when assessing for somatoform disorders?

1. Realize client judgment is intact.

2. Avoid personalizing the behavior by recognizing that somatization is part of the illness.

3. Have sympathy for the psychopathology of the disorder.

4. Expect the client to respond appropriately to the nurses need to complete the assessment.

Correct Answer: 2

Rationale 1: The best approach is to avoid personalizing the behavior by recognizing that somatization is part of the illness. The nurse should have empathy, not sympathy for the psychopathology of the disorder. Given the self-absorption common to this disorder, it may be unrealistic to expect the client to respond appropriately to the nurses need to complete the assessment. With this disorder, client judgment is impaired.

Rationale 2: The best approach is to avoid personalizing the behavior by recognizing that somatization is part of the illness. The nurse should have empathy, not sympathy for the psychopathology of the disorder. Given the self-absorption common to this disorder, it may be unrealistic to expect the client to respond appropriately to the nurses need to complete the assessment. With this disorder, client judgment is impaired.

Rationale 3: The best approach is to avoid personalizing the behavior by recognizing that somatization is part of the illness. The nurse should have empathy, not sympathy for the psychopathology of the disorder. Given the self-absorption common to this disorder, it may be unrealistic to expect the client to respond appropriately to the nurses need to complete the assessment. With this disorder, client judgment is impaired.

Rationale 4: The best approach is to avoid personalizing the behavior by recognizing that somatization is part of the illness. The nurse should have empathy, not sympathy for the psychopathology of the disorder. Given the self-absorption common to this disorder, it may be unrealistic to expect the client to respond appropriately to the nurses need to complete the assessment. With this disorder, client judgment is impaired.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Perform a thorough and comprehensive assessment of clients with dissociative, somatoform, and factitious disorders.

Question 16

Type: MCMA

The nurse knows that performing an assessment on a client with dissociative disorder can be challenging. The nurse knows it is important to include which of the following in the assessment?

Standard Text: Select all that apply.

1. Memory

2. Identity

3. Consciousness

4. Clients spouse

5. Awareness of time

Correct Answer: 1,2,3,5

Rationale 1: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Rationale 2: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Rationale 3: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Rationale 4: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Rationale 5: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Perform a thorough and comprehensive assessment of clients with dissociative, somatoform, and factitious disorders.

Question 17

Type: MCMA

The nurse is working with a client who has been diagnosed with a somatoform disorder. The nurse knows it is important to include which of the following interventions in the clients plan of care?

Standard Text: Select all that apply.

1. Encourage verbalization of feelings.

2. Encourage the client to write in a journal

3. Establish a weekly routine

4. Establish a trusting relationship.

5. Encourage the discussion of physical symptoms

Correct Answer: 1,2,4

Rationale 1: Encourage verbalization of feelings: Verbalization is healthier than somatization.

Rationale 2: Encourage the client to write in a journal: Increases personal insight.

Rationale 3: Establish a weekly routine: A daily routine, not weekly, should be encouraged for this client as it will decrease the clients anxiety.

Rationale 4: Establish a trusting relationship: Promotes clients psychologic safety.

Rationale 5: Encourage the discussion of physical symptoms: The patient should be discouraged from discussing physical symptoms because it frees up time for problem-solving activities and decreases the reinforcement of secondary gain.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate an understanding of therapeutic interventions for clients experiencing selected dissociative, somatoform, and factitious disorders into their plan of care.

Question 18

Type: MCSA

The nurse is caring for a client who has been diagnosed with dissociative disorder. The nurse knows that an appropriate intervention to promote effective role performance is to:

1. Encourage the client to have no contact with friends and family.

2. Ignore the clients other personalities.

3. Help the client alienate family members who do not believe the client is sick.

4. Include family members is therapy.

Correct Answer: 4

Rationale 1: It is important to work with the clients family in order to help everyone in the family unit to adjust to role performance alterations. Including family members in a therapeutic counseling relationship helps them learn new ways of dealing with the client. As stated earlier, considerable secondary gain is often associated with dissociative behavior: some clients may use the illness to escape responsibility and get special treatment. Families often need support in learning to avoid reinforcing dissociative behavior by acting as the source of secondary gain.

Rationale 2: It is important to work with the clients family in order to help everyone in the family unit to adjust to role performance alterations. Including family members in a therapeutic counseling relationship helps them learn new ways of dealing with the client. As stated earlier, considerable secondary gain is often associated with dissociative behavior: some clients may use the illness to escape responsibility and get special treatment. Families often need support in learning to avoid reinforcing dissociative behavior by acting as the source of secondary gain.

Rationale 3: It is important to work with the clients family in order to help everyone in the family unit to adjust to role performance alterations. Including family members in a therapeutic counseling relationship helps them learn new ways of dealing with the client. As stated earlier, considerable secondary gain is often associated with dissociative behavior: some clients may use the illness to escape responsibility and get special treatment. Families often need support in learning to avoid reinforcing dissociative behavior by acting as the source of secondary gain.

Rationale 4: It is important to work with the clients family in order to help everyone in the family unit to adjust to role performance alterations. Including family members in a therapeutic counseling relationship helps them learn new ways of dealing with the client. As stated earlier, considerable secondary gain is often associated with dissociative behavior: some clients may use the illness to escape responsibility and get special treatment. Families often need support in learning to avoid reinforcing dissociative behavior by acting as the source of secondary gain.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate an understanding of therapeutic interventions for clients experiencing selected dissociative, somatoform, and factitious disorders into their plan of care.

Question 19

Type: MCSA

When working with clients with somatoform disorders, the nurse knows the priority intervention is to:

1. Encourage clients to participate in group therapy to receive feedback about the effect of their behavior on others.

2. Tone down clients characteristic extravagance.

3. Establish a trusting relationship.

4. Express respectful skepticism regarding clients oversimplifications and overdramatizations.

Correct Answer: 3

Rationale 1: A trusting relationship is essential to effective therapy. To tone down clients characteristic extravagance, express respectful skepticism regarding their oversimplifications and overdramatizations, and encourage participation in group therapy to receive feedback about the effect of their behavior on others are appropriate interventions, but they are not priorities.

Rationale 2: A trusting relationship is essential to effective therapy. To tone down clients characteristic extravagance, express respectful skepticism regarding their oversimplifications and overdramatizations, and encourage participation in group therapy to receive feedback about the effect of their behavior on others are appropriate interventions, but they are not priorities.

Rationale 3: A trusting relationship is essential to effective therapy. To tone down clients characteristic extravagance, express respectful skepticism regarding their oversimplifications and overdramatizations, and encourage participation in group therapy to receive feedback about the effect of their behavior on others are appropriate interventions, but they are not priorities.

Rationale 4: A trusting relationship is essential to effective therapy. To tone down clients characteristic extravagance, express respectful skepticism regarding their oversimplifications and overdramatizations, and encourage participation in group therapy to receive feedback about the effect of their behavior on others are appropriate interventions, but they are not priorities.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate an understanding of therapeutic interventions for clients experiencing selected dissociative, somatoform, and factitious disorders into their plan of care.

Question 20

Type: MCSA

To intervene effectively with clients with somatoform disorders, it is essential that the nurse:

1. Help the client express a decreased degree of comfort regarding physical symptoms.

2. Encourage the clients expression of feelings symbolically through physical symptoms.

3. Address client anxiety at a later time.

4. Recognize and understand the clients self-perception as demonstrating an inability to cope.

Correct Answer: 4

Rationale 1: Recognize and understand the clients self-perception as an inability to cope and as part of the disorder. Do not encourage expression of feelings symbolically through physical symptoms. Client anxiety should be addressed at the present time, not at a later date. The client should express an increased degree of comfort regarding physical symptoms.

Rationale 2: Recognize and understand the clients self-perception as an inability to cope and as part of the disorder. Do not encourage expression of feelings symbolically through physical symptoms. Client anxiety should be addressed at the present time, not at a later date. The client should express an increased degree of comfort regarding physical symptoms.

Rationale 3: Recognize and understand the clients self-perception as an inability to cope and as part of the disorder. Do not encourage expression of feelings symbolically through physical symptoms. Client anxiety should be addressed at the present time, not at a later date. The client should express an increased degree of comfort regarding physical symptoms.

Rationale 4: Recognize and understand the clients self-perception as an inability to cope and as part of the disorder. Do not encourage expression of feelings symbolically through physical symptoms. Client anxiety should be addressed at the present time, not at a later date. The client should express an increased degree of comfort regarding physical symptoms.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Analyze possible personal challenges to professional practice when caring for clients with dissociative, somatoform, and factitious disorders.

Question 21

Type: MCSA

The nurse is caring for a 15-month-old who is admitted to the hospital for the fifth time in six months with severe diarrhea. The patients mother has been diagnosed with Munchausen by proxy syndrome (MBPS) as she has been giving her child large doses of laxatives to make the child sick. The nurse is having difficulty dealing with the situation. Which of the following is the best way for the nurse to proceed?

1. Confront the mother about making her child sick.

2. Seek clinical supervision to cope with situation.

3. Refuse to take care of the child and family.

4. Have as little contact with the mother as possible.

Correct Answer: 2

Rationale 1: It is difficult for health care providers to deal with situations in which a caregiver (usually a parent) deliberately injures the person under their care. In these situations, health care providers should seek clinical supervision or a consultant to help them to cope with their personal responses.

Rationale 2: It is difficult for health care providers to deal with situations in which a caregiver (usually a parent) deliberately injures the person under their care. In these situations, health care providers should seek clinical supervision or a consultant to help them to cope with their personal responses.

Rationale 3: It is difficult for health care providers to deal with situations in which a caregiver (usually a parent) deliberately injures the person under their care. In these situations, health care providers should seek clinical supervision or a consultant to help them to cope with their personal responses.

Rationale 4: It is difficult for health care providers to deal with situations in which a caregiver (usually a parent) deliberately injures the person under their care. In these situations, health care providers should seek clinical supervision or a consultant to help them to cope with their personal responses.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Analyze possible personal challenges to professional practice when caring for clients with dissociative, somatoform, and factitious disorders.

Question 22

Type: MCSA

A client is newly diagnosed with dissociative identity disorder. To support this client, who is struggling to accept the diagnosis, the nurse would:

1. Flood the client with stressful stimuli.

2. Actively listen to each identity state and provide support.

3. Assess for secondary gain to confront the client.

4. Discourage the use of psychometric tests.

Correct Answer: 2

Rationale 1: The most effective intervention would be to actively listen to each identity state and provide support. Discouraging the use of psychometric tests that might support the diagnosis, confronting with secondary gain issues, and flooding the client with stressful stimuli are not helpful interventions for this client.

Rationale 2: The most effective intervention would be to actively listen to each identity state and provide support. Discouraging the use of psychometric tests that might support the diagnosis, confronting with secondary gain issues, and flooding the client with stressful stimuli are not helpful interventions for this client.

Rationale 3: The most effective intervention would be to actively listen to each identity state and provide support. Discouraging the use of psychometric tests that might support the diagnosis, confronting with secondary gain issues, and flooding the client with stressful stimuli are not helpful interventions for this client.

Rationale 4: The most effective intervention would be to actively listen to each identity state and provide support. Discouraging the use of psychometric tests that might support the diagnosis, confronting with secondary gain issues, and flooding the client with stressful stimuli are not helpful interventions for this client.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Analyze possible personal challenges to professional practice when caring for clients with dissociative, somatoform, and factitious disorders.

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank

Copyright 2012 by Pearson Education, Inc.

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