Chapter 21 - Somatic Symptom Illnesses:
Test Bank for Psychiatric-Mental Health Nursing, 8th Edition
1. Psychosomatic illness refers to physical symptoms that are either created or
worsened by psychic influences. Which conditions are thought to be attributed to
the connection between mind and body? Select all that apply.
A) Diabetes
B) Arthritis
C) Hypertension
D) Headache
E) Colitis
Answer: A, C, D, E
Explanation: Psychosomatic conditions are those where emotional and psychological factors
significantly influence physical health. Diabetes, hypertension, colitis, and tension headaches
are all examples where stress and emotions can initiate, exacerbate, or maintain physical
symptoms. Arthritis is generally not classified as a primarily psychosomatic illness.
2. Which of the following are possible with psychosomatic illness? Select all that
apply.
A) Real symptoms can begin.
B) Real symptoms can continue.
C) Real symptoms can worsen.
D) Unrelated symptoms can occur.
E) Clients can control these symptoms.
Answer: A, B, C, D
Explanation: Psychosomatic illnesses involve real physical symptoms that can start, persist,
or intensify due to psychological factors. Stress can also cause physical symptoms unrelated
to a diagnosed medical condition. Importantly, clients do not willfully or consciously control
these symptoms.
3. The client asks the nurse, "What does having psychosomatic symptoms mean?"
What should the nurse reply?
A) "It means you're not physically sick."
B) "It means that stress and/or emotions are causing your symptoms."
C) "It means that you'll be well when you get your life in order."
D) "It means that your symptoms are a product of your imagination."
Answer: B
,Explanation: This response accurately explains that psychosomatic symptoms are real
physical manifestations caused or exacerbated by psychological factors like stress or
emotional distress, without dismissing the client's experience.
4. Which is the primary gain associated with developing physical symptoms in
response to stress?
A) Accept dependency
B) Decrease anxiety
C) Experience attention
D) Suppress anger
Answer: B
Explanation: Primary gain is the direct psychological benefit of symptom formation, which is
the reduction of anxiety or relief from internal emotional conflict.
5. A client with a somatic symptom illness asks what is causing her physical
symptoms. Which would be the appropriate explanation for the nurse to offer?
A) Physical symptoms can be attributed to an organic cause.
B) Physical symptoms are deliberately expressed in order to benefit in some way.
C) Physical symptoms are independent of the amount of the client's psychic distress.
D) Physical symptoms are an involuntary way of dealing with psychic conflict.
Answer: D
Explanation: Somatic symptom illnesses involve physical symptoms that suggest a medical
condition but have no demonstrable organic cause. These symptoms are an unconscious
expression of psychological distress and are not under the client's voluntary control.
6. The husband of a woman with a somatic symptom illness asks the nurse why the
doctors cannot find anything wrong with her. Which would be the appropriate
explanation for the nurse to offer?
A) "She is not really experiencing the symptoms. She is making them up to get
attention."
B) "There is no physical cause. Mental distress is causing the symptoms, even though
she is not aware of it."
C) "She controls the symptoms when she isn't feeling much stress. It is hard to
diagnose when the symptoms are intermittent."
D) "There is a physical cause. It just has not been detected yet."
Answer: B
,Explanation: This response validates that the client's symptoms are real and distressing, while
explaining that they stem from psychological factors rather than an undetected physical
illness.
7. Which is the primary gain for a client with conversion disorder?
A) Emotional detachment
B) Emotional support from family
C) Identification of anxious feelings
D) Relief from emotional conflict
Answer: D
Explanation: In conversion disorder, the primary gain is the relief from an unconscious
emotional conflict through the development of physical symptoms, which symbolically
represent the conflict.
8. A client with somatic symptom illness tells the nurse that she is sick so often that
her husband and children take over most of the household duties, such as
cooking, cleaning, doing laundry, and so forth. Which is this evidence of?
A) Dysfunctional family unit
B) Primary gain
C) Role reversal
D) Secondary gain
Answer: D
Explanation: Secondary gains are the external benefits received from being ill, such as
increased attention, sympathy, or relief from normal responsibilities and duties.
9. Psychosocial theorists propose that somatic symptom illnesses are an indirect
expression of stress and anxiety through physical symptoms. Which is the
primary defense mechanism used in somatoform disorders?
A) Somatization
B) Identification
C) Internalization
D) Repression
Answer: C
Explanation: Internalization is the primary defense mechanism, where individuals
unconsciously direct stress, anxiety, or frustration inward rather than expressing them
outwardly, leading to physical symptoms (somatization).
, 10. Which are the factors that are currently considered to be possible reasons for the
increased incidence of somatization in women? Select all that apply.
A) Boys in the United States are taught to be stoic and to "take it like a man," causing
them to offer fewer physical complaints as adults.
B) Women seek medical treatment more often than men, and it is more socially
acceptable for them to do so.
C) Childhood sexual abuse, which is related to somatization, happens more frequently
to girls.
D) Women more often receive treatment for psychiatric disorders with strong somatic
components such as depression.
E) Unexplained female pains result from migration of the uterus throughout the
woman's body.
Answer: A, B, C, D
Explanation: Sociocultural factors, including gender role socialization, higher help-seeking
behavior, and increased prevalence of trauma and comorbid psychiatric disorders in women,
contribute to the higher incidence of somatization in women. The "wandering uterus" theory
is an outdated historical belief.
11. A client is seen in the primary care clinic complaining of headaches. The client
appears extremely distressed and insists that she must have a brain tumor.
Which diagnosis is most probable for this client?
A) Conversion disorder
B) Pain disorder
C) Brain cancer
D) Hypochondriasis
Answer: D
Explanation: Hypochondriasis involves a preoccupation with the fear of having a serious
disease based on the misinterpretation of bodily sensations, despite medical reassurance to
the contrary.
12. An actor has prepared extensively for his first stage production. On the morning
of the opening of the play, the actor awakens with laryngitis. From which
disorder is the actor most likely suffering?
A) Acute upper respiratory infection
B) Conversion disorder
C) Hysteria
D) Somatization disorder
Answer: B
Test Bank for Psychiatric-Mental Health Nursing, 8th Edition
1. Psychosomatic illness refers to physical symptoms that are either created or
worsened by psychic influences. Which conditions are thought to be attributed to
the connection between mind and body? Select all that apply.
A) Diabetes
B) Arthritis
C) Hypertension
D) Headache
E) Colitis
Answer: A, C, D, E
Explanation: Psychosomatic conditions are those where emotional and psychological factors
significantly influence physical health. Diabetes, hypertension, colitis, and tension headaches
are all examples where stress and emotions can initiate, exacerbate, or maintain physical
symptoms. Arthritis is generally not classified as a primarily psychosomatic illness.
2. Which of the following are possible with psychosomatic illness? Select all that
apply.
A) Real symptoms can begin.
B) Real symptoms can continue.
C) Real symptoms can worsen.
D) Unrelated symptoms can occur.
E) Clients can control these symptoms.
Answer: A, B, C, D
Explanation: Psychosomatic illnesses involve real physical symptoms that can start, persist,
or intensify due to psychological factors. Stress can also cause physical symptoms unrelated
to a diagnosed medical condition. Importantly, clients do not willfully or consciously control
these symptoms.
3. The client asks the nurse, "What does having psychosomatic symptoms mean?"
What should the nurse reply?
A) "It means you're not physically sick."
B) "It means that stress and/or emotions are causing your symptoms."
C) "It means that you'll be well when you get your life in order."
D) "It means that your symptoms are a product of your imagination."
Answer: B
,Explanation: This response accurately explains that psychosomatic symptoms are real
physical manifestations caused or exacerbated by psychological factors like stress or
emotional distress, without dismissing the client's experience.
4. Which is the primary gain associated with developing physical symptoms in
response to stress?
A) Accept dependency
B) Decrease anxiety
C) Experience attention
D) Suppress anger
Answer: B
Explanation: Primary gain is the direct psychological benefit of symptom formation, which is
the reduction of anxiety or relief from internal emotional conflict.
5. A client with a somatic symptom illness asks what is causing her physical
symptoms. Which would be the appropriate explanation for the nurse to offer?
A) Physical symptoms can be attributed to an organic cause.
B) Physical symptoms are deliberately expressed in order to benefit in some way.
C) Physical symptoms are independent of the amount of the client's psychic distress.
D) Physical symptoms are an involuntary way of dealing with psychic conflict.
Answer: D
Explanation: Somatic symptom illnesses involve physical symptoms that suggest a medical
condition but have no demonstrable organic cause. These symptoms are an unconscious
expression of psychological distress and are not under the client's voluntary control.
6. The husband of a woman with a somatic symptom illness asks the nurse why the
doctors cannot find anything wrong with her. Which would be the appropriate
explanation for the nurse to offer?
A) "She is not really experiencing the symptoms. She is making them up to get
attention."
B) "There is no physical cause. Mental distress is causing the symptoms, even though
she is not aware of it."
C) "She controls the symptoms when she isn't feeling much stress. It is hard to
diagnose when the symptoms are intermittent."
D) "There is a physical cause. It just has not been detected yet."
Answer: B
,Explanation: This response validates that the client's symptoms are real and distressing, while
explaining that they stem from psychological factors rather than an undetected physical
illness.
7. Which is the primary gain for a client with conversion disorder?
A) Emotional detachment
B) Emotional support from family
C) Identification of anxious feelings
D) Relief from emotional conflict
Answer: D
Explanation: In conversion disorder, the primary gain is the relief from an unconscious
emotional conflict through the development of physical symptoms, which symbolically
represent the conflict.
8. A client with somatic symptom illness tells the nurse that she is sick so often that
her husband and children take over most of the household duties, such as
cooking, cleaning, doing laundry, and so forth. Which is this evidence of?
A) Dysfunctional family unit
B) Primary gain
C) Role reversal
D) Secondary gain
Answer: D
Explanation: Secondary gains are the external benefits received from being ill, such as
increased attention, sympathy, or relief from normal responsibilities and duties.
9. Psychosocial theorists propose that somatic symptom illnesses are an indirect
expression of stress and anxiety through physical symptoms. Which is the
primary defense mechanism used in somatoform disorders?
A) Somatization
B) Identification
C) Internalization
D) Repression
Answer: C
Explanation: Internalization is the primary defense mechanism, where individuals
unconsciously direct stress, anxiety, or frustration inward rather than expressing them
outwardly, leading to physical symptoms (somatization).
, 10. Which are the factors that are currently considered to be possible reasons for the
increased incidence of somatization in women? Select all that apply.
A) Boys in the United States are taught to be stoic and to "take it like a man," causing
them to offer fewer physical complaints as adults.
B) Women seek medical treatment more often than men, and it is more socially
acceptable for them to do so.
C) Childhood sexual abuse, which is related to somatization, happens more frequently
to girls.
D) Women more often receive treatment for psychiatric disorders with strong somatic
components such as depression.
E) Unexplained female pains result from migration of the uterus throughout the
woman's body.
Answer: A, B, C, D
Explanation: Sociocultural factors, including gender role socialization, higher help-seeking
behavior, and increased prevalence of trauma and comorbid psychiatric disorders in women,
contribute to the higher incidence of somatization in women. The "wandering uterus" theory
is an outdated historical belief.
11. A client is seen in the primary care clinic complaining of headaches. The client
appears extremely distressed and insists that she must have a brain tumor.
Which diagnosis is most probable for this client?
A) Conversion disorder
B) Pain disorder
C) Brain cancer
D) Hypochondriasis
Answer: D
Explanation: Hypochondriasis involves a preoccupation with the fear of having a serious
disease based on the misinterpretation of bodily sensations, despite medical reassurance to
the contrary.
12. An actor has prepared extensively for his first stage production. On the morning
of the opening of the play, the actor awakens with laryngitis. From which
disorder is the actor most likely suffering?
A) Acute upper respiratory infection
B) Conversion disorder
C) Hysteria
D) Somatization disorder
Answer: B
