Case Studies in Clinical Psychology: Observations and
Analysis from Hospital-Based Interns, Study Guides,
Projects, Research of Psychology
A client who experienced a myocardial infarction was transferred from critical care to a step-
down unit. The client then used the call bell every 15 minutes for minor requests and
complaints. Staff nurses reported feeling inadequate and unable to satisfy the client's needs.
When the nurse manager intervenes directly with this client, 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?"
a. "I'm wondering if you are feeling anxious about your illness and being left alone."
A client reports fears of having cervical cancer and says to the nurse, "I've had Pap smears 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
b. Illness anxiety disorder (hypochondriasis)
A client diagnosed with a somatic symptom disorder says, "My pain is from an undiagnosed
injury. I can't take care of myself. I need pain medicine six or seven times a day. I feel like a baby
because my family has to help me so much." What is the most important nursing assessment?
a. mood.
b. cognitive style.
c. secondary gains.
d. identity and memory.
c. secondary gains.
1|Page
,What is an essential difference between somatic symptom disorders and factitious disorders?
a. Somatic symptom disorders are under voluntary control, whereas factitious disorders are
unconscious and automatic.
b. Factitious disorders are precipitated by psychological factors, whereas somatic symptom
disorders are related to stress.
c. Factitious disorders are individually determined and related to childhood sexual abuse,
whereas somatic symptom disorders are culture bound.
d. Factitious disorders are under voluntary control, whereas somatic symptom disorders involve
expression of psychological stress through somatization.
d. Factitious disorders are under voluntary control, whereas somatic symptom disorders involve
expression of psychological stress through somatization.
A client says, "I know I have a brain tumor despite the results of the magnetic resonance
imaging (MRI). The radiologist is wrong. People who have brain tumors vomit, and yesterday I
vomited all day." Which response by the nurse fosters cognitive reframing?
a. "You do not have a brain tumor. The more you talk about it, the more it reinforces your
belief."
b. "Let's see if there are any other possible explanations for your vomiting."
c. "You seem so worried. Let's talk about how you're feeling."
d. "We need to talk about something else."
b. "Let's see if there are any other possible explanations for your vomiting."
Which treatment modality should a nurse recommend to help a client diagnosed with a somatic
symptom disorder to cope more effectively?
a. Flooding
b. Response prevention
c. Relaxation techniques
d. Systematic desensitization
c. Relaxation techniques
Which assessment question could a nurse ask to help identify secondary gains associated with a
somatic symptom disorder?
a. "What are you unable to do now but were previously able to do?"
b. "How many doctors have you seen in the last year?"
2|Page
,c. "Who do you talk to when you're upset?"
d. "Did you experience abuse as a child?"
a. "What are you unable to do now but were previously able to do?"
A client diagnosed with a somatic symptom disorder has been in treatment for 4 weeks. The
client says, "Although I'm still having pain, I notice it less and am able to perform more
activities." The nurse should evaluate the treatment plan as at what degree of success?
a. marginally
b. minimally
c. partially
d. totally
c. partially
A child has a history of multiple hospitalizations for recurrent systemic infections. The child is
not improving in the hospital, despite aggressive treatment. Factitious disorder imposed on
another is suspected. Which nursing interventions are appropriate? (Select all that apply.)
a. Increase private visiting time for the parents to improve bonding.
b. Keep careful, detailed records of visitation and untoward events.
c. Place mittens on the child to reduce access to ports and incisions.
d. Encourage family members to visit in groups of two or three.
e. Interact with the client frequently during visiting hours
b. Keep careful, detailed records of visitation and untoward events.
d. Encourage family members to visit in groups of two or three.
e. Interact with the client frequently during visiting hours
Which assessment findings suggest the possibility of a factitious disorder, imposed on self-type?
(Select all that apply.)
a. History of multiple hospitalizations without findings of physical illness
b. History of multiple medical procedures or exploratory surgeries
c. Going from one doctor to another seeking the desired response
d. Claims illness to obtain financial benefit or other incentive
e. Difficulty describing symptoms
a. History of multiple hospitalizations without findings of physical illness
b. History of multiple medical procedures or exploratory surgeries
3|Page
, A client diagnosed with a somatic symptom disorder says, "Why has God chosen me to be sick
all the time and unable to provide for my family? The burden on my family is worse than the
pain I bear." Which nursing diagnoses apply to this client? (Select all that apply.)
a. Spiritual distress
b. Decisional conflict
c. Adult failure to thrive
d. Impaired social interaction
e. Ineffective role performance
a. Spiritual distress
e. Ineffective role performance
A nurse assesses a client suspected of having somatic symptom disorder. Which assessment
findings regarding this client support the suspected diagnosis? (Select all that apply.)
a. Female
b. Reports frequent syncope
c. Rates pain as "1" on a scale of "10"
d. First diagnosed with a skin rash at age 12
e. Reports insomnia often resulting from back pain
a. Female
b. Reports frequent syncope
d. First diagnosed with a skin rash at age 12
e. Reports insomnia often resulting from back pain
A nurse's neighbor says, "I saw a news story about a man without any known illness who died
suddenly after his ex-wife committed suicide. Was that a coincidence, or can emotional shock
be fatal?" The nurse should respond by noting that what serious medical conditions may be
complicated by emotional stress? (Select all that apply.)
a. cancer.
b. hip fractures.
c. hypertension.
d. immune disorders.
e. cardiovascular disease
a. cancer.
c. hypertension.
4|Page
Analysis from Hospital-Based Interns, Study Guides,
Projects, Research of Psychology
A client who experienced a myocardial infarction was transferred from critical care to a step-
down unit. The client then used the call bell every 15 minutes for minor requests and
complaints. Staff nurses reported feeling inadequate and unable to satisfy the client's needs.
When the nurse manager intervenes directly with this client, 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?"
a. "I'm wondering if you are feeling anxious about your illness and being left alone."
A client reports fears of having cervical cancer and says to the nurse, "I've had Pap smears 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
b. Illness anxiety disorder (hypochondriasis)
A client diagnosed with a somatic symptom disorder says, "My pain is from an undiagnosed
injury. I can't take care of myself. I need pain medicine six or seven times a day. I feel like a baby
because my family has to help me so much." What is the most important nursing assessment?
a. mood.
b. cognitive style.
c. secondary gains.
d. identity and memory.
c. secondary gains.
1|Page
,What is an essential difference between somatic symptom disorders and factitious disorders?
a. Somatic symptom disorders are under voluntary control, whereas factitious disorders are
unconscious and automatic.
b. Factitious disorders are precipitated by psychological factors, whereas somatic symptom
disorders are related to stress.
c. Factitious disorders are individually determined and related to childhood sexual abuse,
whereas somatic symptom disorders are culture bound.
d. Factitious disorders are under voluntary control, whereas somatic symptom disorders involve
expression of psychological stress through somatization.
d. Factitious disorders are under voluntary control, whereas somatic symptom disorders involve
expression of psychological stress through somatization.
A client says, "I know I have a brain tumor despite the results of the magnetic resonance
imaging (MRI). The radiologist is wrong. People who have brain tumors vomit, and yesterday I
vomited all day." Which response by the nurse fosters cognitive reframing?
a. "You do not have a brain tumor. The more you talk about it, the more it reinforces your
belief."
b. "Let's see if there are any other possible explanations for your vomiting."
c. "You seem so worried. Let's talk about how you're feeling."
d. "We need to talk about something else."
b. "Let's see if there are any other possible explanations for your vomiting."
Which treatment modality should a nurse recommend to help a client diagnosed with a somatic
symptom disorder to cope more effectively?
a. Flooding
b. Response prevention
c. Relaxation techniques
d. Systematic desensitization
c. Relaxation techniques
Which assessment question could a nurse ask to help identify secondary gains associated with a
somatic symptom disorder?
a. "What are you unable to do now but were previously able to do?"
b. "How many doctors have you seen in the last year?"
2|Page
,c. "Who do you talk to when you're upset?"
d. "Did you experience abuse as a child?"
a. "What are you unable to do now but were previously able to do?"
A client diagnosed with a somatic symptom disorder has been in treatment for 4 weeks. The
client says, "Although I'm still having pain, I notice it less and am able to perform more
activities." The nurse should evaluate the treatment plan as at what degree of success?
a. marginally
b. minimally
c. partially
d. totally
c. partially
A child has a history of multiple hospitalizations for recurrent systemic infections. The child is
not improving in the hospital, despite aggressive treatment. Factitious disorder imposed on
another is suspected. Which nursing interventions are appropriate? (Select all that apply.)
a. Increase private visiting time for the parents to improve bonding.
b. Keep careful, detailed records of visitation and untoward events.
c. Place mittens on the child to reduce access to ports and incisions.
d. Encourage family members to visit in groups of two or three.
e. Interact with the client frequently during visiting hours
b. Keep careful, detailed records of visitation and untoward events.
d. Encourage family members to visit in groups of two or three.
e. Interact with the client frequently during visiting hours
Which assessment findings suggest the possibility of a factitious disorder, imposed on self-type?
(Select all that apply.)
a. History of multiple hospitalizations without findings of physical illness
b. History of multiple medical procedures or exploratory surgeries
c. Going from one doctor to another seeking the desired response
d. Claims illness to obtain financial benefit or other incentive
e. Difficulty describing symptoms
a. History of multiple hospitalizations without findings of physical illness
b. History of multiple medical procedures or exploratory surgeries
3|Page
, A client diagnosed with a somatic symptom disorder says, "Why has God chosen me to be sick
all the time and unable to provide for my family? The burden on my family is worse than the
pain I bear." Which nursing diagnoses apply to this client? (Select all that apply.)
a. Spiritual distress
b. Decisional conflict
c. Adult failure to thrive
d. Impaired social interaction
e. Ineffective role performance
a. Spiritual distress
e. Ineffective role performance
A nurse assesses a client suspected of having somatic symptom disorder. Which assessment
findings regarding this client support the suspected diagnosis? (Select all that apply.)
a. Female
b. Reports frequent syncope
c. Rates pain as "1" on a scale of "10"
d. First diagnosed with a skin rash at age 12
e. Reports insomnia often resulting from back pain
a. Female
b. Reports frequent syncope
d. First diagnosed with a skin rash at age 12
e. Reports insomnia often resulting from back pain
A nurse's neighbor says, "I saw a news story about a man without any known illness who died
suddenly after his ex-wife committed suicide. Was that a coincidence, or can emotional shock
be fatal?" The nurse should respond by noting that what serious medical conditions may be
complicated by emotional stress? (Select all that apply.)
a. cancer.
b. hip fractures.
c. hypertension.
d. immune disorders.
e. cardiovascular disease
a. cancer.
c. hypertension.
4|Page
