A client with recurrent headaches has been told by the physician that the cause is likely psychosomatic. The client reports this conversation to the nurse and says, "That just can't be true! My head hurts so bad sometimes that it makes me sick to my stomach." Which is the nurse's best response?

To say "well, that's not what your doctor thinks."

To say nothing and sit quietly with the client

To give the client some privacy and time to calm down

To say "the pain in your head is very real."

Answer and Explanation

The Correct Answer is D

Somatic symptom disorders involve the manifestation of physical symptoms that are exacerbated by psychological distress rather than a primary organic etiology. This condition involves the brain-body axis, where emotional stressors are converted into physiological sensations, such as pain or gastrointestinal upset. The patient's experience is characterized by genuine suffering, and the nurse must address the physical symptoms as valid while simultaneously exploring the underlying psychological triggers and coping mechanisms.

Rationale:

A. Contradicting the client by stating that the doctor thinks differently creates a non-therapeutic confrontation. This approach dismisses the client's experience and severely damages the nurse-client trust. It focuses on an external professional disagreement rather than the client's immediate need for validation and psychological support regarding their physical pain.

B. Sitting quietly without speaking may be interpreted as disinterest or agreement with the physician's potentially stigmatizing label. Although silence is sometimes therapeutic, in this specific context, the client is seeking explicit validation of their physical suffering. Failing to provide a verbal response can leave the client feeling isolated and misunderstood during a moment of distress.

C. Providing privacy and leaving the room can be perceived as emotional abandonment. Clients experiencing psychosomatic symptoms often feel judged or ignored by healthcare providers, and withdrawing at this moment reinforces those negative perceptions. The nurse should remain present to help the client process their feelings rather than leaving them alone to escalate.

D. Acknowledging that the pain is real is the most therapeutic intervention. This response validates the client’s subjective experience without contradicting the physician’s diagnosis. By confirming the reality of the sensation, the nurse reduces the client's defensiveness, which is a necessary prerequisite for later exploring the psychological factors contributing to the physiological response.

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Correct Answer is B

Explanation

Mandated outpatient treatment, or assisted outpatient treatment, is a legal intervention for individuals with severe mental illness who have a history of treatment noncompliance. It targets those at risk for homelessness, incarceration, or frequent hospitalization due to their inability to maintain autonomous psychiatric stability within the community.

Rationale:

A. Living in a stable residential environment with family support generally precludes the need for legal mandates. The client has schizophrenia, but the presence of a support system suggests they are likely managing their condition without the high-risk factors that necessitate court-ordered community intervention.

B. This client represents a high-risk vulnerable population often targeted by mandated programs. The combination of homelessness, mental health instability, and legal involvement for survival crimes typically triggers court-ordered treatment to prevent the revolving door of recidivism and psychiatric crisis.

C. Repeat driving offenses usually result in forensic rehabilitation or substance abuse counseling rather than mandated psychiatric outpatient treatment. Although the behavior is illegal, it falls under addiction services and criminal justice sanctions rather than the specific statutes governing long-term community mental health mandates.

D. Employment instability, while socially disruptive, does not meet the statutory threshold for legal intervention. Quitting jobs is not a safety risk or a criminal act. Therefore, the legal system cannot mandate medical treatment based solely on the client’s professional failures or manic impulsivity.

A. Overprotective parents B. Being raised in an urban area C. One parent who is an alcoholic D. Parents who practiced strict discipline

Correct Answer is C

Explanation

The development of a substance use disorder is influenced by a complex interplay of genetic, environmental, and developmental factors. However, familial history, specifically the presence of a parent with a substance use disorder, is consistently identified as the most potent predictor due to both genetic predisposition and environmental modeling.

Rationale:

A. Overprotective parenting, or helicopter parenting, may affect a child's autonomy or coping skills, but it is not a primary clinical predictor for substance abuse. Although it may contribute to anxiety disorders, it does not carry the same statistical weight as a direct genetic or environmental link to addiction.

B. The availability of substances may differ between urban and rural settings, but the geographic location itself is not a significant biological or familial risk factor. Substance abuse occurs across all socioeconomic and geographic boundaries; the family unit's internal dynamics are far more influential than the external environment.

C. Having a parent who is an alcoholic is the most significant risk factor because it combines genetic vulnerability with environmental exposure. Children of parents with alcohol use disorders are statistically four times more likely to develop a substance use disorder themselves. This risk stems from inherited neurobiological traits and the normalization of substance use as a coping mechanism within the household.

D. Strict discipline, while potentially impacting the parent-child relationship or self-esteem, is not a primary driver of addiction. In fact, inconsistent or permissive parenting, where boundaries are absent, is often more closely associated with early-onset substance use than a structured, albeit strict, disciplinary environment.

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A client with recurrent headaches has been told by the physician that the cause is likely psychosomatic. The client reports this conversation to the nurse and says, "That just can't be true! My head hurts so bad sometimes that it makes me sick to my stomach." Which is the nurse's best response?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which client would most likely be mandated outpatient treatment?

Correct Answer is B

Explanation

The nurse is assessing a client's risk factors for developing a substance abuse disorder. Which family characteristic would the nurse identify as the most significant risk factor?

Correct Answer is C

Explanation

The client says to the nurse, "I know I can learn to cope with my family situation. By getting help here at the clinic, I'll be able to deal with them more effectively, and I won't be so stressed out all the time." This client is demonstrating a high level of which personal characteristic?

Before the period of the enlightenment, treatment of the mentally ill included:

The client tells the nurse, "I don't think you can help me. Every time I talk to you, I am reminded of my mother, and I hated her." The nurse should recognize this as:

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The nurse in the psychiatric unit is aware the atmosphere can change at any time. At which point in the stages of aggressive incidents is intervention least likely to be effective in preventing physically aggressive behavior?

The bereaved client has worked through many processes of grief with the nurse. Which are eventual outcomes of the emotional dimension of grieving? Select all that apply.

A nurse is assessing a newly diagnosed depressed client. What question should the nurse prioritize?