Demo | Clinical Case
Clinical Judgment Case
Complete the sentence by selecting the most appropriate options from the drop-down lists.
Case Overview
A 28-year-old client is admitted to the medical unit after reporting sudden paralysis of the right arm that began shortly after witnessing a serious motor vehicle accident involving a family member.
Diagnostic testing, including CT scan, MRI, laboratory studies, and neurologic examination, reveals no physiologic abnormalities. The client appears calm when discussing the paralysis and repeatedly asks when the arm function will return.
Complete the Sentence
Correct Answer
Condition: Conversion Disorder
Supporting Finding: Neurologic symptoms begin after severe stress with normal diagnostic findings.
Rationale
Conversion Disorder, also known as Functional Neurological Symptom Disorder, is characterized by one or more neurologic symptoms such as paralysis, blindness, seizures, or sensory loss that cannot be explained by an underlying neurologic or medical condition.
Symptoms often occur after a significant psychological stressor and are not intentionally produced. Although diagnostic testing is normal, the client’s symptoms are real and should not be dismissed.
Nursing care focuses on acknowledging the client’s experience, promoting functional independence, and avoiding reinforcement of maladaptive behaviors.
Why This Finding Supports the Condition
The sudden onset of paralysis immediately following a traumatic event, combined with normal neurologic testing, is the hallmark finding of conversion disorder.
The symptoms are inconsistent with objective clinical findings and are associated with psychological conflict rather than intentional symptom production.
Incorrect Options
- Somatic Symptom Disorder: The client has persistent physical symptoms with excessive anxiety, distress, or disruption of daily life. The focus is not sudden neurologic deficit after severe stress.
- Factitious Disorder: The client intentionally produces or exaggerates symptoms to assume the sick role, without an obvious external reward.
- Illness Anxiety Disorder: The client has little or no physical symptoms but has persistent fear of having or developing a serious illness.
- Malingering: The client intentionally produces or exaggerates symptoms for an external benefit, such as money, avoiding work, obtaining medication, or avoiding legal responsibility.
Nursing Concept
When differentiating these disorders on the NCLEX, first determine whether symptoms are intentionally produced and whether an external reward is present.
- Conversion Disorder: Not intentional; neurologic symptoms occur after psychological stress with no medical explanation.
- Somatic Symptom Disorder: Physical symptoms are present with excessive worry about those symptoms.
- Factitious Disorder: Symptoms are intentionally produced to assume the sick role without external incentives.
- Illness Anxiety Disorder: Fear of serious illness despite minimal or no symptoms.
- Malingering: Symptoms are intentionally produced for clear external benefit or secondary gain.