A patient who is being counseled for somatoform pain disorder ...

[Marty]

A patient who is being counseled for somatoform pain disorder states he believes his pain is the result of an undiagnosed injury.
 
  He adds that he cannot adhere to his plan for care involving performing his own activities of daily living, walking 20 minutes daily, and using pain medication only at bedtime. He states he feels like a baby because his wife and children must provide so much care for him. The nurse understands that it is most important to assess: a. mood.
  b. cognitive style.
  c. secondary gains.
  d. identity and memory.

Question 2

A nurse is asked to explain why ageism is a problem among health care workers. The nurse should cite that ageism results in: (Select all that apply.)
 
  a. failure of the elderly to receive necessary medical information.
  b. development of public policy that discriminates against the elderly.
  c. staff shortages because caregivers prefer working with younger adults.
  d. the perception that elderly consume a smaller share of medical resources.
  e. more ancillary than professional personnel discriminate with regard to age.

[dominiqueenicolee]

Answer to Question 1

C
Secondary gains reinforce maladaptive behavior and should be assessed in all cases where maladaptive behavior continues for an extended period of time despite efforts and opportunities to change. Here, the patient's dependency needs may be being met through care from his family, who do not realize that their caring for him is extending his somatic concerns. Mood is not suggested as an important element based on the data here, and although it should always be assessed in any psychiatric disorder, it is less likely to be contributing to his somatic focus than are secondary gains. The same is true of cognitive style, memory, and identity.

Answer to Question 2

A, B, C
Because of society's negative stereotyping of the elderly as having little to offer, some staff persons avoid working with older patients. Staff shortages in long-term care are often greater than those for acute care. Elderly patients are often given less information about their conditions and are given fewer treatment options than younger patients, because some health care staff members perceive them as less able to understand. This problem exists among both professional and ancillary personnel. Public policy discriminates against programs for the elderly. Anger exists because the elderly are perceived to consume a disproportionately large share of medical resources.