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?
“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.”
“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.”
“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.”
“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?”
The Correct Answer is C
Somatic symptom disorder presents with recurrent physical complaints that are distressing and often medically unexplained. These symptoms are real, persistent, and emotionally charged. Nursing care must balance validation with structured boundaries to avoid reinforcing symptom preoccupation. Therapeutic communication should acknowledge the symptom while maintaining routine and promoting functional engagement.
Rationale for correct answers
3. This response acknowledges the symptom and ensures continuity of care by reporting it, while maintaining structure by encouraging group therapy attendance.
Rationale for incorrect answers
1. Dismissing the complaint as “in your head” reflects invalidating language and undermines therapeutic rapport, increasing emotional distress.
2. Skipping group therapy reinforces avoidance, which may worsen functional impairment and reduce engagement in therapeutic activities.
4. Offering new medication without assessment promotes reinforcement of somatic focus and may lead to unnecessary pharmacologic interventions.
Take Home Points
- Nursing responses should validate symptoms while maintaining therapeutic boundaries and routine.
- Avoid reinforcing symptom preoccupation through excessive attention or unnecessary interventions.
- Encourage participation in structured activities to promote functional improvement.
- Balance empathy with clinical judgment to support emotional and physical well-being.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Conversion disorderpresents with neurological symptoms such as paralysis, blindness, or seizuresthat are inconsistent with medical findings. A classic feature is la belle indifférence, an apparent lack of concern about the symptoms. This paradoxical indifference, despite potentially disabling symptoms, reflects the unconscious nature of the disorder and helps differentiate it from malingering or factitious disorder. The symptoms are real to the patient and not intentionally produced.
Rationale for correct answers
2.Indifference to symptoms, known as la belle indifférence, is a hallmark of conversion disorder and reflects unconscious defensemechanisms.
Rationale for incorrect answers
1.Extreme distress is more typical of somatic symptom disorder, where patients are highly preoccupied with their symptoms.
3.Labile mood is associated with affective disorders, not a defining feature of conversion disorder.
4.Multiple complaints suggest somatic symptom disorder, not conversion disorder which typically presents with one dramatic neurological symptom.
Take Home Points
- Conversion disorder features neurological symptoms without medical explanation and often includes la belle indifférence.
- Indifference to symptoms helps differentiate conversion disorder from other somatic-related disorders.
- Somatic symptom disorder involves multiple complaints and high emotional distress about symptoms.
- Accurate assessment of symptom presentation and emotional response is key to differential diagnosis.
Correct Answer is D
Explanation
Duloxetineis a serotonin-norepinephrine reuptake inhibitor (SNRI) used for chronic pain, major depression, and generalized anxiety disorder. It modulates descending inhibitory pain pathways by increasing serotonin and norepinephrine levels in the central nervous system. It is FDA-approved for fibromyalgia, diabetic neuropathy, and musculoskeletal pain, making it suitable for patients with somatic symptom disorder where pain is the predominant feature. It is contraindicated in uncontrolled narrow-angle glaucoma and should be used cautiously in hepatic impairment.
Rationale for correct answers
4.Duloxetine targets both painand mood symptoms by enhancing serotonergic and noradrenergic transmission, making it effective for somatic symptom disorder with pain predominance.
Rationale for incorrect answers
1.Chlorpromazine is an antipsychotic used for psychosis, not indicated for somatic symptom disorder or pain management.
2.Diazepam is a benzodiazepine used for anxietyand muscle spasms, but it carries dependency risks and lacks efficacy for chronic pain.
3.Carbamazepine is an anticonvulsant used for seizuresand trigeminal neuralgia, not appropriate for generalized somatic pain.
Take Home Points
- Duloxetine is effective for somatic symptom disorder with predominant pain due to its dual action on serotonin and norepinephrine.
- Benzodiazepines are not first-line for chronic somatic pain due to tolerance and dependency risks.
- Antipsychotics and anticonvulsants are reserved for specific psychiatric or neurological conditions, not somatic pain syndromes.
- Always assess comorbidities and contraindications before initiating pharmacologic treatment for somatic symptom presentations.
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