Patients 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 dysfunction and illness anxiety disorder. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 17-8, 9 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 14. A patient who experienced a myocardial infarction was transferred from critical care to a
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step-down unit. The patient then used the call bell every 15 minutes for minor requests and complaints. Staff nurses reported feeling inadequate and unable to satisfy the patient’s needs. When the nurse manager intervenes directly with this patient, which comment 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 frequently. It is a problem.” d. “You frustrate the staff by calling them so often. Why are you doing that?” ANS: A
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This patient is experiencing anxiety associated with a serious medical condition. Verbalization is an effective outlet for anxiety. “I’m wondering if you are anxious …” focuses on the emotions underlying the behavior rather than the behavior itself. This opening conveys the nurse’s willingness to listen to the patient’s feelings and an understanding of the commonly 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 patient with her emotional needs.
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PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 17-9 to 12 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
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15. A patient reports fears of having cervical cancer and says to the nurse, “I’ve had Pap smears
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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? a. Conversion (functional neurological) disorder b. Illness anxiety disorder (hypochondriasis) c. Somatic symptom disorder d. Factitious disorder
eB
ANS: B
Patients with illness anxiety disorder have fears of serious medical problems, such as cancer or heart disease. These fears persist despite medical evaluations and interfere with daily functioning. There are no complaints of pain. There is no evidence of factitious or conversion disorder.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 17-6, 7 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
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