ch.20

Question 1

1. A client diagnosed with somatic symptom disorder (SSD) is most likely to exhibit which
   personality disorder characteristics?
2. Experiences intense and chaotic relationships with fluctuating attitudes toward others.
3. Socially irresponsible, exploitative, guiltless, and disregards rights of others.
4. Self-dramatizing, attention seeking, overly gregarious, and seductive.
5. Uncomfortable in social situations, perceived as timid, withdrawn, cold, and strange.

Answer 1

3. Self-dramatizing, attention seeking, overly gregarious, and seductive.

Question 2

2. A nurse is working with a client diagnosed with SSD. What criteria would differentiate this
   diagnosis from illness anxiety disorder (IAD)?
3. The client diagnosed with SSD experiences physical symptoms in various body systems, and
   the client diagnosed with IAD does not.
4. The client diagnosed with SSD experiences a change in the quality of self-awareness, and the
   client diagnosed with IAD does not.
5. The client diagnosed with SSD disorder has a perceived disturbance in body image or
   appearance, and the client diagnosed with IAD does not.
6. The client diagnosed with SSD only experiences anxiety about the possibility of illness, and
   the client diagnosed with IAD does not.

Answer 2

1. The client diagnosed with SSD experiences physical symptoms in various body systems, and
   the client diagnosed with IAD does not.

Question 3

3. Which would be considered an appropriate outcome when planning care for an inpatient client
   diagnosed with SSD?
4. The client will admit to fabricating physical symptoms to gain benefits by day three.
5. The client will list three potential adaptive coping strategies to deal with stress by day two.
6. The client will comply with medical treatments for physical symptoms by day three.
7. The client will openly discuss physical symptoms with staff by day four.

Answer 3

2. The client will list three potential adaptive coping strategies to deal with stress by day two.

Question 4

4. Which are examples of primary and secondary gains that clients diagnosed with SSD:
   predominately pain, may experience?
5. Primary: chooses to seek a new doctor; Secondary: euphoric feeling from new medications
6. Primary: euphoric feeling from new medications; Secondary: chooses to seek a new doctor
7. Primary: receives get-well cards; Secondary: pain prevents attending stressful family reunion
8. Primary: pain prevents attending stressful family reunion; Secondary: receives get-well cards

Answer 4

4. Primary: pain prevents attending stressful family reunion; Secondary: receives get-well cards

Question 5

5. A nursing instructor is teaching about the etiology of IAD from a psychoanalytical
   perspective. What student statement about clients diagnosed with this disorder indicates that
   learning has occurred?
6. “They tend to have a familial predisposition to this disorder.”
7. “When the sick role relieves them from stressful situations, their physical symptoms are
   reinforced.”
8. “They misinterpret and cognitively distort their physical symptoms.”
9. “They express personal worthlessness through physical symptoms, because physical problems
   are more acceptable than psychological problems.”

Answer 5

4. “They express personal worthlessness through physical symptoms, because physical problems
   are more acceptable than psychological problems.”

Question 6

6. An inpatient client is newly diagnosed with dissociative identity disorder (DID) stemming
   from severe childhood sexual abuse. Which nursing intervention takes priority?
7. Encourage exploration of sexual abuse.
8. Encourage guided imagery.
9. Establish trust and rapport.
10. Administer antianxiety medications.

Answer 6

3. Establish trust and rapport.

Question 7

7. A client diagnosed with DID switches personalities when confronted with destructive
   behavior. The nurse recognizes that this dissociation serves which function?
8. It is a means to attain secondary gain.
9. It is a means to explore feelings of excessive and inappropriate guilt.
10. It serves to isolate painful events so that the primary self is protected.
11. It serves to establish personality boundaries and limit inappropriate impulses.

Answer 7

3. It serves to isolate painful events so that the primary self is protected.

Question 8

8. A client is diagnosed with DID. What is the primary goal of therapy for this client?
9. To recover memories and improve thinking patterns.
10. To prevent social isolation.
11. To decrease anxiety and need for secondary gain.
12. To collaborate among sub-personalities to improve functioning.

Answer 8

4. To collaborate among sub-personalities to improve functioning

Question 9

9. According to the DSM-5 diagnostic criteria for dissociative amnesia (DA), what symptom
   would be essential to meet the criteria for the subcategory of dissociative fugue?
10. An inability to recall important autobiographical information
11. Clinically significant distress in social and occupational functioning
12. Sudden unexpected travel or bewildered wandering
13. “Blackouts” related to alcohol toxicity

Answer 9

2. Clinically significant distress in social and occupational functioning

Question 10

10. Which situation is an example of selective amnesia?
11. A client cannot relate any lifetime memories.
12. A client can describe driving to Ohio but cannot remember the car accident that occurred.
13. A client often wanders aimlessly after sunset.
14. A client cannot provide personal demographic information during admission assessment.

Answer 10

2. A client can describe driving to Ohio but cannot remember the car accident that occurred.

Question 11

11. Neurological tests have ruled out pathology in a client’s sudden lower-extremity paralysis.
    Which nursing care should be included for this client?
12. Deal with physical symptoms in a detached manner.
13. Challenge the validity of physical symptoms.
14. Meet dependency needs until the physical limitations subside.
15. Encourage a discussion of feelings about the lower-extremity problem.

Answer 11

1. Deal with physical symptoms in a detached manner.

Question 12

12. Which combination of diagnoses and appropriate pharmacological treatments are correctly
    matched?
13. SSD: predominantly pain; treated with venlafaxine (Effexor)
14. IAD; treated with cefadroxil (Duricef)
15. Conversion disorder; treated with cyclobenzaprine (Flexeril)
16. Depersonalization-derealization disorder; treated with mometasone (Elocom

Answer 12

1. SSD: predominantly pain; treated with venlafaxine (Effexor)

Question 13

3. A nurse is reviewing progress notes on a newly admitted client. One progress note reveals
   that the client purposefully inserted a contaminated catheter into urethra, leading to a urinary
   tract infection. The nurse recognizes this behavior as characteristic of which mental disorder?
4. Illness anxiety disorder
5. Factitious disorder
6. Functional neurological symptom disorder
7. Depersonalization-derealization disorder

Answer 13

2. Factitious disorder

Question 14

14. A nursing instructor is teaching about the DSM-5 diagnosis of depersonalizationderealization
    disorder (D-DD). Which student statement indicates a need for further instruction?
15. “Clients with this disorder can experience emotional and/or physical numbing and a distorted
    sense of time.”
16. “Clients with this disorder can experience unreality or detachment with respect to their
    surroundings.”
17. “During the course of this disorder, individuals or objects are experienced as dreamlike, foggy,
    lifeless, or visually distorted.”
18. “During the course of this disorder, the client is out of touch with reality and is impaired in
    social, occupational, or other areas of functioning.”

Answer 14

4. “During the course of this disorder, the client is out of touch with reality and is impaired in