Chapter 22: Physical Problems, Psychological Sources Nursing School Test Banks

Chapter 22: Physical Problems, Psychological Sources
Test Bank

MULTIPLE CHOICE

1. The human physiological stress response mechanism is also called the ____ response.
a. Startle
b. Neuroleptic
c. Homeostasis
d. Fight-or-flight
ANS: D
The stress response is also called the fight-or-flight response (general adaptation response) and occurs in an attempt to maintain homeostasis.

DIF: Cognitive Level: Knowledge REF: p. 250 OBJ: 1
TOP: Role of Emotions in Health KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

2. People who are able to recognize and defuse their stressors early ____ suffer from the physical effects of stress.
a. Never
b. Often
c. Always
d. Seldom
ANS: D
People who are able to recognize and defuse their stressors early seldom experience the physical effects of stress. It is nearly impossible to never experience or always feel the effects of stress.

DIF: Cognitive Level: Comprehension REF: p. 251 OBJ: 2
TOP: Anxiety and Stress KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

3. Most psychosomatic problems and somatoform disorders begin in:
a. Puberty
b. Adulthood
c. Childhood
d. Adolescence
ANS: C
How an individual perceives and responds to stress is established in childhood.

DIF: Cognitive Level: Knowledge REF: p. 251 OBJ: 3
TOP: Childhood Sources KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

4. The physiological stress response has an effect on _____ system(s).
a. Many body
b. Only the nervous
c. The gastrointestinal
d. The cardiovascular and respiratory
ANS: A
When an individual perceives stress, the body initiates production of a cascade of biochemicals that affect many body systems.

DIF: Cognitive Level: Knowledge REF: p. 251 OBJ: 2
TOP: Anxiety and Stress KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

5. Several studies have demonstrated that significant ____ changes occur in people who displayed hostile or negative behaviors.
a. Attitudinal
b. Behavioral
c. Gastrointestinal
d. Immune-mediated
ANS: D
Several studies have demonstrated that significant immune function and blood pressure changes occur in people who displayed hostile or negative behaviors during periods of conflict.

DIF: Cognitive Level: Comprehension REF: p. 251 OBJ: 2
TOP: Anxiety and Stress KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

6. Somatization disorder is a polysymptomatic disorder, which means that the disorder is associated with ____ symptoms.
a. Few signs and
b. Polymorphic
c. Many signs and
d. Specific signs and
ANS: C
Somatization is a polysymptomatic disorder (i.e., one associated with many signs and symptoms).

DIF: Cognitive Level: Knowledge REF: p. 253 OBJ: 6
TOP: Somatization Disorder KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

7. The client had recently witnessed a horrific auto accident. Now she is complaining of double vision, loss of balance, and a constant lump in her throat. She is exhibiting the signs and symptoms of:
a. Anxiety reaction
b. Behavioral disorder
c. Conversion disorder
d. Posttraumatic stress reaction
ANS: C
These are classic signs of a conversion disorder, which is a somatoform disorder that presents as problems related to sensory or motor functions. These disorders most commonly are seen in individuals of lower socioeconomic status who have little knowledge of health care.

DIF: Cognitive Level: Application REF: p. 256 OBJ: 6
TOP: Conversion Disorder KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

8. La belle indifference is a characteristic that most often is associated with:
a. Anxiety reaction
b. Conversion disorder
c. Depressive disorder
d. Posttraumatic stress reaction
ANS: B
La belle indifference is a lack of concern about the nature or the implications of the signs or symptoms that are being experienced. The complete opposite reaction of dramatic and hysterical behavior can be seen in conversion disorder.

DIF: Cognitive Level: Knowledge REF: p. 256 OBJ: 6
TOP: Conversion Disorder KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

9. The client can acknowledge the possibility that she exaggerates her symptoms, but she continues to hold on to the belief that something is physically wrong, in the face of evidence to the contrary. What is the clients diagnosis most likely to be?
a. Malingering
b. Hypochondriasis
c. A conversion reaction
d. Body dysmorphic disorder
ANS: B
This describes the diagnosis of hypochondriasis and is seen most often in early adulthood with individuals who were exposed to a serious illness or a life-threatening condition at an early age. Malingering refers to a condition in which an individual is purposefully engaging in factitious signs and symptoms of a disease. A conversion reaction refers to a somatoform disorder that presents as problems related to sensory or motor functions. Body dysmorphic disorder refers to a disorder characterized by a preoccupation with ones own physical differences or defects.

DIF: Cognitive Level: Application REF: p. 257 OBJ: 8
TOP: Hypochondriasis KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

10. The client thinks her nose is so ugly that most people cannot bear to look at her. She often describes herself as ugly. Which condition is the client experiencing?
a. Somatization
b. Hypochondriasis
c. A conversion reaction
d. Body dysmorphic disorder
ANS: D
Body dysmorphic disorder refers to a disorder that is characterized by a preoccupation with ones own physical differences or defects.

DIF: Cognitive Level: Application REF: p. 257 OBJ: N/A
TOP: Other Somatoform Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

11. The main feature of a factitious disorder is that symptoms are purposefully produced to allow the individual to:
a. Get out of work.
b. Assume the sick role.
c. Assume control of treatment.
d. Get the attention of health care providers.
ANS: B
The most important feature of a factitious disorder is that symptoms are purposefully produced to enable the individual to assume the sick role.

DIF: Cognitive Level: Comprehension REF: p. 258 OBJ: 8
TOP: Factitious Disorders and Malingering
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

12. The client complains of severe back pain and is excused from work. Later, he is seen water skiing and jogging. These behaviors describe:
a. Malingering
b. Somatization
c. Hypochondriasis
d. A factitious disorder
ANS: A
People who are malingering purposefully produce the signs or symptoms of illness for some form of gain.

DIF: Cognitive Level: Application REF: p. 258 OBJ: 8
TOP: Factitious Disorders and Malingering
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

13. A male client is so preoccupied with his thinning hair that he is missing work and avoiding social gatherings. This client is exhibiting signs of:
a. Hypochondriasis
b. Conversion disorder
c. Body dysmorphic disorder
d. Factitious disorder
ANS: C
Body dysmorphic disorder is characterized by a preoccupation with a physical difference or defect. Hypochondriasis is an intense fear or preoccupation with a serious disease or medical condition. Conversion disorder is a somatoform disorder that involves presentation of problems related to sensory and motor functions. Factitious disorder refers to intentional production of symptoms.

DIF: Cognitive Level: Application REF: p. 257 OBJ: 6
TOP: Other Somatoform Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

14. In the __________ culture, mental and emotional disorders are expressed as somatoform complaints on the basis of the belief that the body is the property of the ancestors.
a. Japanese
b. Hispanic
c. Southeast Asian
d. Korean
ANS: D
Koreans believe that the body is the property of the ancestors. In the cultures of the Japanese and Southeast Asians, emotional and mental distresses are also expressed through physical signs and symptoms, but the belief that the body is the property of the ancestors is not associated with these cultures. In the Hispanic culture, physical complaints may be associated with mal ojo (the evil eye). It is important to know how somatoform complaints may surface in different cultures. Each culture has its own set of beliefs and ways of expressing those beliefs.

DIF: Cognitive Level: Knowledge REF: p. 254 OBJ: 5
TOP: Cultural Influences KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

15. A female client frequently complains of chest pain, has had extensive physiological testing with negative results, and sees several different medical doctors. This client is exhibiting signs and symptoms characteristic of:
a. Hypochondriasis
b. Conversion disorder
c. Body dysmorphic disorder
d. Factitious disorder
ANS: A
These are characteristic signs and symptoms of hypochondriasis. Factitious disorder is intentional production of symptoms. Conversion disorder is a somatoform disorder with a presentation of problems related to sensory and motor functions. Body dysmorphic disorder is characterized by a preoccupation with a physical difference or defect.

DIF: Cognitive Level: Application REF: p. 257 OBJ: 7
TOP: Hypochondriasis KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

16. Your client is a wife and mother who, in addition to doing most of the household tasks, has a difficult time saying no to helping out with functions at school and church. Based on Fromms psychodynamic theory, what illness is she more prone to develop?
a. Cardiac problems
b. High blood pressure
c. Alcoholism
d. Gastric ulcer
ANS: D
According to psychodynamic theory, certain personality types are more prone to certain illnesses. The more aggressive personality is more prone to cardiovascular disease. The quiet, uncomplaining, overburdened person may suffer from ulcers, joint problems, or skin rashes.

DIF: Cognitive Level: Application REF: p. 252 OBJ: 4
TOP: Theories of Psychophysical Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

17. Once the acute feelings of illness are resolved, what is an appropriate intervention when treating a client with a psychosocial problem?
a. Avoid expression of feelings as this will provide a relapse of acute symptoms.
b. Minimize secondary gains.
c. Convey an attitude that such behavior is not acceptable.
d. Assist the client to limit social network to avoid additional stress.
ANS: B
A key intervention for clients with psychosocial problems is to minimize the secondary gains once the acute phase is resolved. It is recommended that the caregiver encourage expression of feelings rather than physical complaints. An accepting attitude is necessary to build trust. Assisting the client and family to increase their social network to will help fill social needs.

DIF: Cognitive Level: Application REF: p. 258 OBJ: 9
TOP: Implications for Caregivers KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

18. A mother brings her 9-month-old son to the emergency department because he stopped breathing at home. She demands that he receive a full diagnostic work-up. When asked for the name of her pediatrician, she states she has not found one she is satisfied with. The nurse suspects:
a. Projection
b. Malingering
c. Conversion disorder
d. Munchausens syndrome by proxy
ANS: D
Factitious disorder by proxy (Munchausens syndrome by proxy) most often involves a caregiver who induces signs of illness in a child and presents the child for medical care. Diagnosis is difficult because offenders commonly remove their victims as soon as the disorder is suspected.

DIF: Cognitive Level: Application REF: p. 258 OBJ: 8
TOP: Factitious Disorders and Malingering
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

19. A woman arrives at the hospital complaining of chest pains and shortness of breath. She has come in several times over the past two 2 weeks and the staff is doubtful that her symptoms are real. What is the first action for the health care team to implement?
a. Complete a history, physical, and diagnostics.
b. Arrange for a psychiatric consult.
c. Provide discharge instructions and arrange for a follow-up visit.
d. Obtain a prescription for an antianxiety agent.
ANS: A
The first goal of care in every case is to rule out the presence of any physical disease or dysfunction.

DIF: Cognitive Level: Application REF: p. 256 OBJ: 9
TOP: Conversion Disorder KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

20. Which of the following are characteristics of somatoform disorders? (Select all that apply.)
a. Relieve anxiety
b. Decrease depression
c. Have no organic medical source
d. Are related to a medical condition
e. Significantly impair ones level of functioning
f. Often occur in those who must cope with illness
g. Occur in clients who are unaware of or unable to express emotional distress
ANS: A, C, E, G
These are the criteria for the diagnosis of a somatoform disorder, which is defined as feeling physical symptoms with no diagnosable organic medical condition.

DIF: Cognitive Level: Knowledge REF: p. 256 OBJ: 6
TOP: Criteria for Diagnosis KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

21. Which are the essential features of conversion disorder? (Select all that apply.)
a. Preoccupation with fears of disease
b. Deficits in motor function
c. Long history of vague complaints
d. Deficits in sensory function
ANS: B, D
Deficits in motor and sensory function are specific to conversion disorders. Preoccupation with fears of disease is typical of hypochondriasis, and a long history of vague complaints is common with somatization disorder.

DIF: Cognitive Level: Comprehension REF: p. 256 OBJ: 6
TOP: Conversion Disorder KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

22. Which of the following are indicative of hypochondriasis? (Select all that apply.)
a. Symptoms most commonly appear in early childhood.
b. First diagnosed following a severe stressor.
c. More frequent in person exposed to a serious illness in childhood.
d. Sufferers usually have strained interpersonal relationships.
ANS: B, C, D
Hypochondriasis commonly occurs in early adulthood and is more frequent in persons exposed to serious illness or life-threatening condition in childhood. In some cases, initial diagnosis follows a severe stressor such as a death of a loved one. People with hypochondriasis often have strained interpersonal relationships, as they are focused on themselves, expecting special treatment.

DIF: Cognitive Level: Application REF: p. 257 OBJ: 7
TOP: Hypochondriasis KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

COMPLETION

23. __________ is the biochemical fight-or-flight response that is a survival tool against stressors.

ANS:
General adaptation syndrome
Hans Seyle discovered this during studies of biochemical reactions to stress.

DIF: Cognitive Level: Knowledge REF: p. 251 OBJ: 1
TOP: Anxiety and Stress KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

24. In the past, disorders that were emotionally related to physical problems were called __________ illnesses.

ANS:
psychosomatic
This term is still used by many laypersons. The more recent term is psychophysical disorders.

DIF: Cognitive Level: Knowledge REF: p. 252 OBJ: 4
TOP: Common Psychophysical Problems
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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