Review Practice Exercise 2

Somatic Symptom and Related Disorders > Mental Health

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Practice Exercise 2

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Total Questions : 5

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Question 1:

Lorraine, a client diagnosed with somatic symptom disorder, states, “My doctor thinks I should see a psychiatrist. I can’t imagine why he would make such a suggestion.” What is the basis for Lorraine’s statement?

A. She thinks her doctor wants to get rid of her as a client. B. She does not understand the correlation of symptoms and stress. C. She thinks psychiatrists are only for “crazy” people. D. She thinks her doctor has made an error in diagnosis.

Answer and Explanation

Choice A:

The belief that the doctor wants to abandon her implies rejection, but this is not the core issue; Lorraine’s concern is rooted in misunderstanding.

Choice B:

Lorraine’s confusion reflects a lack of understanding of the link between psychological stress and physical symptoms. This is common in somatic symptom disorder, where emotional distress is somatized.

Choice C:

Associating psychiatry with “crazy” implies stigma, but the stem does not suggest Lorraine holds this belief specifically.

Choice D:

Thinking the diagnosis is wrong reflects denial, but Lorraine’s statement centers more on confusion than disbelief in the diagnosis.

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Question 2:

Lorraine, a client diagnosed with somatic symptom disorder, tells the nurse about a pain in her side. She says she has not experienced it before. Which is the most appropriate response by the nurse?

A. “I don’t want to hear about another physical complaint. You know they are all in your head. It’s time for group therapy now.” B. “Let’s sit down here together and you can tell me about this new pain you are experiencing. You’ll just have to miss group therapy today.” C. “I will report this pain to your physician. In the meantime, group therapy starts in 5 minutes. You must leave now to be on time.” D. “I will call your physician and see if he will order a new pain medication for your side. The one you have now doesn’t seem to provide relief. Why don’t you get some rest for now?”

Answer and Explanation

Choice A:

Dismissing the complaint as “in your head” reflects invalidating language and undermines therapeutic rapport, increasing emotional distress.

Choice B:

Skipping group therapy reinforces avoidance, which may worsen functional impairment and reduce engagement in therapeutic activities.

Choice C:

This response acknowledges the symptom and ensures continuity of care by reporting it, while maintaining structure by encouraging group therapy attendance.

Choice D:

Offering new medication without assessment promotes reinforcement of somatic focus and may lead to unnecessary pharmacologic interventions.

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Question 3:

Lucille has a diagnosis of somatic symptom disorder, predominantly pain. Which of the following medications would the psychiatric nurse practitioner most likely prescribe for Lucille?

A. Chlorpromazine (Thorazine) B. Diazepam (Valium) C. Carbamazepine (Tegretol) D. Duloxetine (Cymbalta)

Answer and Explanation

Choice A:

Chlorpromazine is an antipsychotic used for psychosis, not indicated for somatic symptom disorder or pain management.

Choice B:

Diazepam is a benzodiazepine used for anxiety and muscle spasms, but it carries dependency risks and lacks efficacy for chronic pain.

Choice C:

Carbamazepine is an anticonvulsant used for seizures and trigeminal neuralgia, not appropriate for generalized somatic pain.

Choice D:

Duloxetine targets both pain and mood symptoms by enhancing serotonergic and noradrenergic transmission, making it effective for somatic symptom disorder with pain predominance.

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Question 4:

The nurse is caring for a client with a conversion disorder. Which of the following assessments will the nurse expect to see?

A. Extreme distress over the physical symptom B. Indifference about the physical symptom C. Labile mood D. Multiple physical complaints

Answer and Explanation

Choice A:

Extreme distress is more typical of somatic symptom disorder, where patients are highly preoccupied with their symptoms.

Choice B:

Indifference to symptoms, known as la belle indifférence, is a hallmark of conversion disorder and reflects unconscious defense mechanisms.

Choice C:

Labile mood is associated with affective disorders, not a defining feature of conversion disorder.

Choice D:

Multiple complaints suggest somatic symptom disorder, not conversion disorder which typically presents with one dramatic neurological symptom.

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Question 5:

Paroxetine (Paxil) has been prescribed for a client with a somatic symptom illness. The nurse instructs the client to watch out for which of the following side effects?

A. Constipation B. Increased appetite C. Increased flatulence D. Nausea

Answer and Explanation

Choice A:

Constipation is a less frequent side effect and not among the most commonly reported with paroxetine use.

Choice B:

Increased appetite may occur but is not a primary concern with paroxetine; weight gain is more variable and dose-dependent.

Choice C:

Flatulence is not a notable side effect of paroxetine and is rarely reported in clinical practice or literature.

Choice D:

Nausea is a well-documented and common side effect of SSRIs like paroxetine due to increased serotonin activity in the gastrointestinal tract.

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Practice Exercise 2

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