N3381 001 Exam 3 Study Guide
1. Discuss the etiology, behaviors, primary gain and the importance of focusing on emotional states rather
than physical symptoms for patients diagnosed with somatic symptom disorders.
somatic symptom disorders. medical findings are lacking in this disorder. Pt. history may include
multiple surgeries, substance abuse, marital difficulties, suicide attempts, chronic pain, and
impaired work/life functioning such as disability and high health care costs. somatic symptom
disorders are not physically based, but are emotionally/mentally based. the pt. will primarily focus
on the pain, and not the true psychological problem.
i. Psychosocial impairments such as depression and somatization are frequently associated
with increased pain intensity/disability days. low back pain is one of the most common
somatic symptoms for those who are feeling sad, exhausted or overwhelmed.
1. there are disproportionate/persistent thoughts about the seriousness of the
symptoms.
2. persistent high levels of anxiety about health/symptoms.
3. excessive time/energy devoted to these symptoms or health concerns.
ii. persistent = somatic pain that has continued with severe symptoms, marked impairment,
and long duration for more than 6 months.
iii. mild = one of the symptoms specified is fulfilled
iv. moderate = two or more symptoms are fulfilled
v. severe = two or more symptoms are fulfilled plus there are multiple somatic complaints
or one severe one.
2. Discuss important outcomes for patients diagnosed with somatic symptom disorder related to the impact
their behavior has on their family.
important outcomes for patients with somatic symptom disorders is that they will be able to live as
normal a life as possible. includes symptom/pain reduction, improved level of independence, and
overall better quality of life.
i. patient will identify/articulate feelings such as anger, shame, guilt, and remorse.
ii. patient will resume performance of work-role behaviors.
iii. patient will identify ineffective coping patterns.
iv. patient will make realistic appraisal of strengths/weaknesses.
3. Discuss the etiology, assessment factors (what does patient present with), associated behaviors and the
purpose of those behaviors for patients diagnosed with illness anxiety disorder (hypochondriasis) versus
conversion (functional neurological) disorder.
illness anxiety disorder. previously known as hypochondriasis. people who are preoccupied with
having/eventually developing a serious illness. despite negative medical evaluations/assurances,
patient fear continues to persist. pts with IAE exhibit high levels of anxiety and alarm about their
own health for at least 6 months. they may either excessively check for problems or avoid medical
care.
i. impairs the patient’s functioning due to anxiety. patient is more disturbed about the
potential implications of any disorder than with the disorder itself, and are alarmed by
any new bodily sensations. normal physical sensations such as sweating, abdomen
cramping, or etc. can be seen as an indication of disease.
ii. social media and news media can be a large or significant association with high stress
responses.
iii. those with IAE and comorbid depression may be underdiagnosed due to not having a
depressed mood or loss of interest as a prominent feature. it could, however, feature
differently especially in older adults, mimicking as delirium, catatonia, anxiety, and other
depressive disorders.
1. the use of electroconvulsive therapy has seen to work on patients with IAE and
comorbid mood disorders. especially in elderly patients, recovery was quick and
complete with ECT.
1
, functional neurological disorder (FND). conversion disorder. previously hysteria. chronic or
brief symptoms of altered voluntary motor/sensory function that can cause substantial distress or
psychosocial impairment. diagnosis rests on positive clinical findings that indicate the symptom is
not congruent with anatomy, physiology, or any known diseases. including if the symptom is
inconsistent at varying times.
i. based on psychoanalytic theory. Freud proposed that these unbearable effects of stressors
is then converted into a physical symptom, providing relief or an escape from the
conflict. a key feature of the coping mechanism repression. these physical manifestations
reduce the initial stressor by changing the individual’s circumstances.
ii. FND causation has varied from purely biological factors to psychological/traumatic
factors like childhood abuse, child sexual abuse, and family dysfunction; which are all
likely shapers of childhood development.
1. those with FND commonly have depression or dissociative disorder. a
comprehensive assessment of trauma history would contribute to the plan of
care.
4. Define and discuss and give examples of patient behaviors seen in cluster b personality disorders such as
problems with impulse control, manipulation, splitting and discuss best nursing interventions and the most
appropriate initial outcomes/goals for patients exhibiting these behaviors.
cluster b personality disorders. share emotional reactivity, such as erratic, dramatic, and
flamboyant behavior. patients carry poor impulse control and have an unclear sense of identity. a
large overlap among these disorders include substance use, depression, and eating disorders.
i. manipulation is the common behavioral mechanism for those among cluster b. this
includes antisocial, borderline, histrionic, and narcissistic personalities.
ii. splitting is defined as the polarization or division of beliefs, actions, objects, or persons
into good and bad. black and white. commonly seen in borderline personalities.
nursing interventions for cluster b.
1. develop a trusting relationship by demonstrating respect/positive regard. express
empathy, and follow through promises.
2. avoid the use of why questions to decrease defensiveness.
3. maintain interpersonal professionalism. do not punish or reject the patient for
maladaptive behaviors such as angry outbursts. gently resist the patient’s attempt to
establish an overly familiar relationship.
4. give the patient an opportunity to describe current stressors that lead to the
suicidal/self-harm behaviors. helps identify triggers.
5. support the patient to talk to staff when feeling sad/angry or feelings of hurting
themselves.
6. assign only two staff members to a patient to minimize splitting behaviors.
7. implement a clear/structured plan of care that is closely followed.
8. consider the use of a behavioral contract to spell out acceptable behaviors and support
personal safety.
9. set limits on manipulative behavior in a calm, non-accusatory manner. use
objective/specific language to describe the problematic behavior, and discuss the more
adaptive behaviors that can be substituted.
interventions of manipulation.
1. assess your own reaction towards the patient. assess your patient’s interactions before
labeling them as manipulative.
2. set limits on behaviors such as: arguing or begging. flattery or seductiveness.
instilling guilt/clinging. constantly seeking attention. pitting one
person/staff/group against one another. frequently disregarding the rules. constant
engagement in power struggles. angry, demanding behaviors.
3. intervene in manipulative behavior.
1. set limits in a calm, nonpunitive way.
2. be consistent. all limits adhered to by all staff.
3. behaviors should be documented.
4. provide clear boundaries/consequences.
2
, 5. enforce the consequences.
4. be vigilant. avoid: discussing yourself/other staff members with the patient. promising
to keep secrets for the patient. accepting gifts from the patient. doing special favors for
the patient.
interventions for impulsive behaviors.
1. discuss previous impulsive acts.
2. identify the thoughts and feelings preceding the impulsive acts.
3. explore effects of such acts on self/others.
4. discuss potential alternative behaviors to impulsive acts.
5. teach/refer patient to the appropriate place to learn needed coping skills.
5. Know the characteristic behaviors and appropriate nursing interventions for the following personality
disorders: antisocial, narcissistic, avoidant, schizoid, schizotypal, paranoid, and borderline including signs
and symptoms, behaviors, assessment, nursing interventions.
antisocial. cluster b personality. shows persistent disregard for/violates the rights of others, with a
lack of remorse for actions or hurting others. they believe they have the right to take what they
want, treat others unfairly, destroy the properties of others, and even hurt others in their best
interest. do not adhere to traditional values/standards of morality. little restraint in behavior, and
little sense of responsibility.
i. lack regard for the law and the rights of others. engage in criminal behaviors.
ii. history of persistent lying, deception, and conning others for the benefit/pleasure.
iii. tend to appear charming, engaging, and uncanny in their ability to find the right angle to
lure a person in, with the intent to exploit them for money, favors, or more sadistic
purposes.
iv. manipulative and irresponsible. promiscuous.
v. reckless disregard for the safety of others.
vi. physical aggressiveness. failure to honor work/financial commitments.
vii. impulsive, fail to plan ahead.
viii. history of irritability/aggression. includes child abuse, partner abuse, vindictive
behavior.
ix. often become bored and engage in risky or dangerous activities in order to feel alive.
x. can only be diagnosed at EIGHTEEN YEARS OR OLDER. may have been
diagnosed with conduct disorder before the age of fifteen.
xi. account for a disproportionate number of criminal arrests. includes violent offenses,
and is more often common in males. have difficulty learning from mistakes, and are
unresponsive to punishment.
narcissistic. cluster b. maladaptive response, characterized by a person’s grandiose sense of self-
importance. a preoccupation with fantasies of unlimited success. consider themselves special,
expect special treatment. may act arrogant and haughty. have a sense of entitlement that is striking.
require excessive admiration. lack empathy for the needs/feelings of others and exploit others to
meet their own needs. relationships are shallow/superficial, and based on what a person can
do for them. if they are at fault in some way, they always blame others for the problems they’ve
caused. often envious of the successes or possessions of others/believe others are envious of them.
i. 50-75% of narcissists are men. because of fragile self-esteem, they are prone to
depression, interpersonal difficulties, occupational problems, and feelings of rejection.
ii. comorbid conditions associated include eating disorders, mood disorders, substance-
related disorders, and antisocial personality disorder. can be abusive and prone to
impulsive/reckless behavior.
avoidant. cluster c personality. have high levels of anxiety/outward signs of fear with feelings of
low self-worth. tend to be hypersensitive to criticism or rejection. they often avoid situations
that require socialization. though they have a strong desire for affection and for relationships, they
are fearful of rejection, disappointment, criticism, or ridicule. spend most of their time in self-
imposed social isolation and experience depression and anxiety.
3
1. Discuss the etiology, behaviors, primary gain and the importance of focusing on emotional states rather
than physical symptoms for patients diagnosed with somatic symptom disorders.
somatic symptom disorders. medical findings are lacking in this disorder. Pt. history may include
multiple surgeries, substance abuse, marital difficulties, suicide attempts, chronic pain, and
impaired work/life functioning such as disability and high health care costs. somatic symptom
disorders are not physically based, but are emotionally/mentally based. the pt. will primarily focus
on the pain, and not the true psychological problem.
i. Psychosocial impairments such as depression and somatization are frequently associated
with increased pain intensity/disability days. low back pain is one of the most common
somatic symptoms for those who are feeling sad, exhausted or overwhelmed.
1. there are disproportionate/persistent thoughts about the seriousness of the
symptoms.
2. persistent high levels of anxiety about health/symptoms.
3. excessive time/energy devoted to these symptoms or health concerns.
ii. persistent = somatic pain that has continued with severe symptoms, marked impairment,
and long duration for more than 6 months.
iii. mild = one of the symptoms specified is fulfilled
iv. moderate = two or more symptoms are fulfilled
v. severe = two or more symptoms are fulfilled plus there are multiple somatic complaints
or one severe one.
2. Discuss important outcomes for patients diagnosed with somatic symptom disorder related to the impact
their behavior has on their family.
important outcomes for patients with somatic symptom disorders is that they will be able to live as
normal a life as possible. includes symptom/pain reduction, improved level of independence, and
overall better quality of life.
i. patient will identify/articulate feelings such as anger, shame, guilt, and remorse.
ii. patient will resume performance of work-role behaviors.
iii. patient will identify ineffective coping patterns.
iv. patient will make realistic appraisal of strengths/weaknesses.
3. Discuss the etiology, assessment factors (what does patient present with), associated behaviors and the
purpose of those behaviors for patients diagnosed with illness anxiety disorder (hypochondriasis) versus
conversion (functional neurological) disorder.
illness anxiety disorder. previously known as hypochondriasis. people who are preoccupied with
having/eventually developing a serious illness. despite negative medical evaluations/assurances,
patient fear continues to persist. pts with IAE exhibit high levels of anxiety and alarm about their
own health for at least 6 months. they may either excessively check for problems or avoid medical
care.
i. impairs the patient’s functioning due to anxiety. patient is more disturbed about the
potential implications of any disorder than with the disorder itself, and are alarmed by
any new bodily sensations. normal physical sensations such as sweating, abdomen
cramping, or etc. can be seen as an indication of disease.
ii. social media and news media can be a large or significant association with high stress
responses.
iii. those with IAE and comorbid depression may be underdiagnosed due to not having a
depressed mood or loss of interest as a prominent feature. it could, however, feature
differently especially in older adults, mimicking as delirium, catatonia, anxiety, and other
depressive disorders.
1. the use of electroconvulsive therapy has seen to work on patients with IAE and
comorbid mood disorders. especially in elderly patients, recovery was quick and
complete with ECT.
1
, functional neurological disorder (FND). conversion disorder. previously hysteria. chronic or
brief symptoms of altered voluntary motor/sensory function that can cause substantial distress or
psychosocial impairment. diagnosis rests on positive clinical findings that indicate the symptom is
not congruent with anatomy, physiology, or any known diseases. including if the symptom is
inconsistent at varying times.
i. based on psychoanalytic theory. Freud proposed that these unbearable effects of stressors
is then converted into a physical symptom, providing relief or an escape from the
conflict. a key feature of the coping mechanism repression. these physical manifestations
reduce the initial stressor by changing the individual’s circumstances.
ii. FND causation has varied from purely biological factors to psychological/traumatic
factors like childhood abuse, child sexual abuse, and family dysfunction; which are all
likely shapers of childhood development.
1. those with FND commonly have depression or dissociative disorder. a
comprehensive assessment of trauma history would contribute to the plan of
care.
4. Define and discuss and give examples of patient behaviors seen in cluster b personality disorders such as
problems with impulse control, manipulation, splitting and discuss best nursing interventions and the most
appropriate initial outcomes/goals for patients exhibiting these behaviors.
cluster b personality disorders. share emotional reactivity, such as erratic, dramatic, and
flamboyant behavior. patients carry poor impulse control and have an unclear sense of identity. a
large overlap among these disorders include substance use, depression, and eating disorders.
i. manipulation is the common behavioral mechanism for those among cluster b. this
includes antisocial, borderline, histrionic, and narcissistic personalities.
ii. splitting is defined as the polarization or division of beliefs, actions, objects, or persons
into good and bad. black and white. commonly seen in borderline personalities.
nursing interventions for cluster b.
1. develop a trusting relationship by demonstrating respect/positive regard. express
empathy, and follow through promises.
2. avoid the use of why questions to decrease defensiveness.
3. maintain interpersonal professionalism. do not punish or reject the patient for
maladaptive behaviors such as angry outbursts. gently resist the patient’s attempt to
establish an overly familiar relationship.
4. give the patient an opportunity to describe current stressors that lead to the
suicidal/self-harm behaviors. helps identify triggers.
5. support the patient to talk to staff when feeling sad/angry or feelings of hurting
themselves.
6. assign only two staff members to a patient to minimize splitting behaviors.
7. implement a clear/structured plan of care that is closely followed.
8. consider the use of a behavioral contract to spell out acceptable behaviors and support
personal safety.
9. set limits on manipulative behavior in a calm, non-accusatory manner. use
objective/specific language to describe the problematic behavior, and discuss the more
adaptive behaviors that can be substituted.
interventions of manipulation.
1. assess your own reaction towards the patient. assess your patient’s interactions before
labeling them as manipulative.
2. set limits on behaviors such as: arguing or begging. flattery or seductiveness.
instilling guilt/clinging. constantly seeking attention. pitting one
person/staff/group against one another. frequently disregarding the rules. constant
engagement in power struggles. angry, demanding behaviors.
3. intervene in manipulative behavior.
1. set limits in a calm, nonpunitive way.
2. be consistent. all limits adhered to by all staff.
3. behaviors should be documented.
4. provide clear boundaries/consequences.
2
, 5. enforce the consequences.
4. be vigilant. avoid: discussing yourself/other staff members with the patient. promising
to keep secrets for the patient. accepting gifts from the patient. doing special favors for
the patient.
interventions for impulsive behaviors.
1. discuss previous impulsive acts.
2. identify the thoughts and feelings preceding the impulsive acts.
3. explore effects of such acts on self/others.
4. discuss potential alternative behaviors to impulsive acts.
5. teach/refer patient to the appropriate place to learn needed coping skills.
5. Know the characteristic behaviors and appropriate nursing interventions for the following personality
disorders: antisocial, narcissistic, avoidant, schizoid, schizotypal, paranoid, and borderline including signs
and symptoms, behaviors, assessment, nursing interventions.
antisocial. cluster b personality. shows persistent disregard for/violates the rights of others, with a
lack of remorse for actions or hurting others. they believe they have the right to take what they
want, treat others unfairly, destroy the properties of others, and even hurt others in their best
interest. do not adhere to traditional values/standards of morality. little restraint in behavior, and
little sense of responsibility.
i. lack regard for the law and the rights of others. engage in criminal behaviors.
ii. history of persistent lying, deception, and conning others for the benefit/pleasure.
iii. tend to appear charming, engaging, and uncanny in their ability to find the right angle to
lure a person in, with the intent to exploit them for money, favors, or more sadistic
purposes.
iv. manipulative and irresponsible. promiscuous.
v. reckless disregard for the safety of others.
vi. physical aggressiveness. failure to honor work/financial commitments.
vii. impulsive, fail to plan ahead.
viii. history of irritability/aggression. includes child abuse, partner abuse, vindictive
behavior.
ix. often become bored and engage in risky or dangerous activities in order to feel alive.
x. can only be diagnosed at EIGHTEEN YEARS OR OLDER. may have been
diagnosed with conduct disorder before the age of fifteen.
xi. account for a disproportionate number of criminal arrests. includes violent offenses,
and is more often common in males. have difficulty learning from mistakes, and are
unresponsive to punishment.
narcissistic. cluster b. maladaptive response, characterized by a person’s grandiose sense of self-
importance. a preoccupation with fantasies of unlimited success. consider themselves special,
expect special treatment. may act arrogant and haughty. have a sense of entitlement that is striking.
require excessive admiration. lack empathy for the needs/feelings of others and exploit others to
meet their own needs. relationships are shallow/superficial, and based on what a person can
do for them. if they are at fault in some way, they always blame others for the problems they’ve
caused. often envious of the successes or possessions of others/believe others are envious of them.
i. 50-75% of narcissists are men. because of fragile self-esteem, they are prone to
depression, interpersonal difficulties, occupational problems, and feelings of rejection.
ii. comorbid conditions associated include eating disorders, mood disorders, substance-
related disorders, and antisocial personality disorder. can be abusive and prone to
impulsive/reckless behavior.
avoidant. cluster c personality. have high levels of anxiety/outward signs of fear with feelings of
low self-worth. tend to be hypersensitive to criticism or rejection. they often avoid situations
that require socialization. though they have a strong desire for affection and for relationships, they
are fearful of rejection, disappointment, criticism, or ridicule. spend most of their time in self-
imposed social isolation and experience depression and anxiety.
3
