Test Bank For Psychiatric Mental Health Nursing 5th Edition By Fortinash

Test Bank For 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