C HAPTER 17: S OMATIC S YMPTOM D ISORDERS
Halter: Varcarolis’ Foundations of Psychiatric -Mental Health Nursing: A
Clinical Approach, 9th Edition
MULTIPLE CHOICE
1. Which comment by a client who recentl y experienced a m yocardial
infarction indicates use of maladaptive, ineffective coping strategies?
a. “My employer should have paid for a health club membership for
me.”
b. “My famil y will see me through this. It won’t be easy, but I will
never be alone.”
c. “My heart attack was no fun, but it showed me up the importance of
a good diet and more exercise.”
d. “I accept that I have heart disease. Now I need to decide if I will be
able to continue m y work dail y.”
ANS: A
Blaming someone else and rationalizing one’s failure to exercise are
not adaptive coping strategies. Seeing the glass as half full, using
social and religious supports, and confronting one’s situation are seen
as more effective strategies. The distracters demonstrate effective
coping associated with a serious medical condition.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
TOP: Nursing Process: Assessment MSC: Client Needs:
Psychosocial Integrity
,2. A nurse assesses a client diagnosed with conversion (functional
neurological) disorder. Which comment is most characteristic of this
client?
a. “Since m y father died, I’ve been short of breath and had sharp pains
that go down m y left arm, but I think it’s just indige stion.”
b. “I have dail y problems with nausea, vomiting, and diarrhea. My skin
is very dry, and I think I’m getting seriousl y dehydrated.”
c. “Sexual intercourse is painful. I pretend as if I’m asleep so I can
avoid it. I think it’s starting to cause problems wi th m y marriage.”
d. “I get choked very easil y and have trouble swallowing when I eat. I
think I might have cancer of the esophagus.”
ANS: A
Clients with conversion (functional neurological) disorder demonstrate
a lack of concern regarding the seriousness of symptoms. This lack of
concern is termed la belle indifférence. There is also a specific,
identifiable cause for the development of the symptoms; in this
instance, the death of a parent would precipitate stress. The distracters
relate to sexual dysfunctio n and illness anxiet y disorder.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
TOP: Nursing Process: Assessment MSC: Client Needs:
Psychosocial Integrity
3. A client who experienced a m yocardial infarction was transferred from
critical care to a step - down unit. The client then used the call bell every
15 minutes for minor requests and complaints. Staff nurses reported
feeling inadequate and unable to satisfy the client’s needs. When the nurse
, manager intervenes directl y with this client, which commen t is most
therapeutic?
a. “I’m wondering if you are feeling anxious about your illness and
being left alone.”
b. “The staff are concerned that you are not satisfied with the care you
are receiving.”
c. “Let’s talk about why you use your call light so frequentl y. It is a
problem.”
d. “You frustrate the staff by calling them so often. Why are you doing
that?”
ANS: A
This client is experiencing anxiet y associated with a serious medical
condition. Verbalization is an effective outlet for anxiet y. “I’m
wondering if you ar e anxious …” focuses on the emotions underl ying
the behavior rather than the behavior itself. This opening conveys the
nurse’s willingness to listen to the client’s feelings and an
understanding of the commonl y seen concern about not having a nurse
always nearby as in the intensive care unit. The other options focus on
the behavior or its impact on nursing and do not help the client with
her emotional needs.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
TOP: Nursing Process: Implementation MSC: Cli ent
Needs: Psychosocial Integrit y
4. A client reports fears of having cervical cancer and says to the nurse,
“I’ve had Pap smears by six different doctors. The results were normal,
but I’m sure that’s because of errors in the laboratory.” Which disorder
would the nurse suspect?
Halter: Varcarolis’ Foundations of Psychiatric -Mental Health Nursing: A
Clinical Approach, 9th Edition
MULTIPLE CHOICE
1. Which comment by a client who recentl y experienced a m yocardial
infarction indicates use of maladaptive, ineffective coping strategies?
a. “My employer should have paid for a health club membership for
me.”
b. “My famil y will see me through this. It won’t be easy, but I will
never be alone.”
c. “My heart attack was no fun, but it showed me up the importance of
a good diet and more exercise.”
d. “I accept that I have heart disease. Now I need to decide if I will be
able to continue m y work dail y.”
ANS: A
Blaming someone else and rationalizing one’s failure to exercise are
not adaptive coping strategies. Seeing the glass as half full, using
social and religious supports, and confronting one’s situation are seen
as more effective strategies. The distracters demonstrate effective
coping associated with a serious medical condition.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
TOP: Nursing Process: Assessment MSC: Client Needs:
Psychosocial Integrity
,2. A nurse assesses a client diagnosed with conversion (functional
neurological) disorder. Which comment is most characteristic of this
client?
a. “Since m y father died, I’ve been short of breath and had sharp pains
that go down m y left arm, but I think it’s just indige stion.”
b. “I have dail y problems with nausea, vomiting, and diarrhea. My skin
is very dry, and I think I’m getting seriousl y dehydrated.”
c. “Sexual intercourse is painful. I pretend as if I’m asleep so I can
avoid it. I think it’s starting to cause problems wi th m y marriage.”
d. “I get choked very easil y and have trouble swallowing when I eat. I
think I might have cancer of the esophagus.”
ANS: A
Clients with conversion (functional neurological) disorder demonstrate
a lack of concern regarding the seriousness of symptoms. This lack of
concern is termed la belle indifférence. There is also a specific,
identifiable cause for the development of the symptoms; in this
instance, the death of a parent would precipitate stress. The distracters
relate to sexual dysfunctio n and illness anxiet y disorder.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
TOP: Nursing Process: Assessment MSC: Client Needs:
Psychosocial Integrity
3. A client who experienced a m yocardial infarction was transferred from
critical care to a step - down unit. The client then used the call bell every
15 minutes for minor requests and complaints. Staff nurses reported
feeling inadequate and unable to satisfy the client’s needs. When the nurse
, manager intervenes directl y with this client, which commen t is most
therapeutic?
a. “I’m wondering if you are feeling anxious about your illness and
being left alone.”
b. “The staff are concerned that you are not satisfied with the care you
are receiving.”
c. “Let’s talk about why you use your call light so frequentl y. It is a
problem.”
d. “You frustrate the staff by calling them so often. Why are you doing
that?”
ANS: A
This client is experiencing anxiet y associated with a serious medical
condition. Verbalization is an effective outlet for anxiet y. “I’m
wondering if you ar e anxious …” focuses on the emotions underl ying
the behavior rather than the behavior itself. This opening conveys the
nurse’s willingness to listen to the client’s feelings and an
understanding of the commonl y seen concern about not having a nurse
always nearby as in the intensive care unit. The other options focus on
the behavior or its impact on nursing and do not help the client with
her emotional needs.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
TOP: Nursing Process: Implementation MSC: Cli ent
Needs: Psychosocial Integrit y
4. A client reports fears of having cervical cancer and says to the nurse,
“I’ve had Pap smears by six different doctors. The results were normal,
but I’m sure that’s because of errors in the laboratory.” Which disorder
would the nurse suspect?
