Exam 3: NSG221/ NSG 221 (Latest 2024/ 2025 Update) Mental Health | Guide with Questions and Verified Answers| 100% Correct- Herzing

Exam 3: NSG221/ NSG 221 (Latest 2024/ 2025 Update) Mental Health | Guide with Questions and Verified Answers| 100% Correct- Herzing

Exam 3: NSG221/ NSG 221 (Latest 2024/
2025 Update) Mental Health | Guide with
Questions and Verified Answers| 100%
Correct- Herzing
Q: Nursing Interventions Mild Anxiety:
Answer:
Mild anxiety is an asset to the client and requires no direct intervention. People with mild anxiety
can learn and solve problems and are even eager for information. Teaching can be effective when
the client is mildly anxious.
Q: Nursing Interventions Moderate Anxiety:
Answer:
With moderate anxiety, the nurse must be certain that the client is following what the nurse is
saying. The client’s attention can wander, and he or she may have some difficulty concentrating
over time. Speaking in short, simple, and easy-to-understand sentences is effective; the nurse
must stop to ensure that the client is still taking in information correctly. The nurse may need to
redirect the client back to the topic if the client goes off on a tangent.
Q: Nursing Interventions: Panic
Answer:
During panic anxiety, the person’s safety is the primary concern. The nurse must keep talking to
the person in a comforting manner, even though the client cannot process what the nurse is
saying. Going to a small, quiet, and nonstimulating environment may help reduce anxiety. The
nurse can reassure the person that this is anxiety, it will pass, and he or she is in a safe place. The
nurse should remain with the client until the panic recedes. Panic-level anxiety is not indefinite,
but it can last from 5 to 30 minutes.
Q: Nursing interventions Severe Anxiety:

Answer:
When anxiety becomes severe, the client can no longer pay attention or take in information. The
nurse’s goal must be to lower the person’s anxiety level to moderate or mild before proceeding
with anything else. It is also essential to remain with the person because anxiety is likely to
worsen if he or she is left alone. Talking to the client in a low, calm, and soothing voice can help.
If the person cannot sit still, walking with him or her while talking can be effective. What the
nurse talks about matters less than how he or she says the words. Helping the person take deep
even breaths can help lower anxiety.
Q: Malingering
Answer:
Malingering is the intentional production of false or grossly exaggerated physical or
psychological symptoms; it is motivated by external incentives such as avoiding work, evading
criminal prosecution, obtaining financial compensation, or obtaining drugs. People who malinger
have no real physical symptoms or grossly exaggerate relatively minor symptoms. Their purpose
is some external incentive or outcome that they view as important and results directly from the
illness. People who malinger can stop the physical symptoms as soon as they have gained what
they wanted
Q: Factitious Disorder
Answer:
Factitious disorder, imposed on self, occurs when a person intentionally produces or feigns
physical or psychological symptoms solely to gain attention. People with factitious disorder may
even inflict injury on themselves to receive attention
Q: Munchausen & Munchausen by Proxy
Answer:
The common term for factitious disorder imposed on self is Munchausen syndrome. A variation
of factitious disorder, imposed on others, is commonly called Munchausen syndrome by proxy,
and occurs when a person inflicts illness or injury on someone else to gain the attention of
emergency medical personnel or to be a “hero” for saving the victim

Q: Primary Gain
Answer:
Primary gains are the direct internal benefits that being sick provides, such as relief of anxiety,
conflict, or distress
Q: Secondary Gain
Answer:
Secondary gains are the external or personal benefits received from others because one is sick,
such as attention from family members and comfort measures (e.g., being brought tea, receiving
a back rub). The person soon learns that he or she “needs to be sick” to have his or her emotional
needs met.
Q: Hypersomnolence Disorder Definition
Answer:
Excessive sleepiness for at least 1 month that involves either prolonged sleep episodes or daily
daytime sleeping that causes significant distress or impairment in functioning. Major sleep
episodes may be 8 to 12 hours long, and the person has difficulty waking up
Q: Narcolepsy Definition
Answer:
Chronic excessive sleepiness characterized by repeated, irresistible sleep attacks. After sleeping
10 to 20 minutes, the person is briefly refreshed until the next sleep attack.
Q: Circadian Rhythm Sleep-Wake Disorder Definition
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Somatic Symptom Illnesses CharacteristicsMalingering The intentional production of false or grossly exaggerated physical or psychological symptomso Motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining financial compensation, or obtaining drugso These people have no real physical symptoms or grossly exaggerate relatively minor symptomso These people can stop the physical symptoms as soon as they have gained what they wanted
Factitious disorders Imposed on self (Munchausen), occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attentiono People with this disorder may even inflict injury on themselves to receive attentiono No voluntary control over symptoms
Munchausen by proxy “occurs when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a “”hero”” for saving the victimo No voluntary control over symptoms”
Primary gain The direct internal benefits that being sick provides, such as relief of anxiety, conflict, or distress
Secondary gain “The external or personal benefits received from others because one is sick, such as attention from family members and comfort measures (e.g., being brought tea, receiving a back rub)- The person soon learns that he or she “”needs to be sick”” to have his or her emotional needs met”
Nursing Care/Actions – Establish a daily routine, Promote adequate nutrition and sleep- Expression of emotional feeling- Recognize the relationship between stress/coping and physical symptoms- Keep a journal, Limit time spent on physical complaints- Limit primary and secondary gains
emotional coping strategies • Relaxation techniques, deep breathing, guided imagery, and distraction
Problem-focused coping strategies: Problem-solving strategies and role-playing
Pharmacologic treatment for somatic illness Antidepressants such as Fluoxetine, Paroxetine (Paxil), and sertraline (Zoloft)- For clients with a pain disorder, referral to a chronic pain clinic may be useful- Clients learn methods of pain management, such as visual imaging and relaxation- Services such as physical therapy to maintain and build muscle tone help improve functional abilities- Providers should avoid prescribing and administering narcotic analgesics to these clients because of the risk for dependence or abuse- Client can use nonsteroidal anti-inflammatory agents to help reduce pain
Parasomnias Characterized by abnormal behavior or psychological events that are associated with sleep, specific sleep stages or sleep wake transitions
Narcolepsy Chronic excessive sleepiness characterized by repeated, irresistible sleep attackso After sleeping 10 to 20 minutes, the person is briefly refreshed until the next sleep attack
Hypersomnolence disorder Excessive sleepiness for at least 1 month that involves either prolonged sleep episodes or daily daytime sleeping that causes significant distress or impairment in functioning
Circadian rhythm sleep-wake disorder Bright light therapy that consists of being exposed to bright lights for wakefulness and avoiding bright lights when sleep is desired; Melatonin can help when taken before bedIo Persistent or recurring sleep disruption resulting from altered functioning of circadian rhythm or a mismatch between circadian rhythm and external demands
Substance-induced sleep disorder Involves a prominent disturbance in sleep due to the direct physiological effects of a substance, such as alcohol, other drugs, or toxins- Insomnia and hypersomnia are most common- Treatment of the underlying substance use or abuse generally leads to improvement in sleep
Effective Treatments for sleep disorders Melatonin- produced by pineal gland, influences sleep-wake cycles- Valerian- perennial flowering plant, and the root has been used for centuries as a treatment for anxiety and insomniao It is believed that valerian increases the amount of GABA in the brain- Benzodiazepine (Diazepam) widely used for anxiety and insomnia and are also used for several other indicationso Diazepam enhances the inhibitory effect of GABA to relieve anxiety, tension, and nervousness and to produce sleep- Ramelteon (Rozerem), a melatonin agonist, is used for the long-term treatment of insomnia characterized by difficulty with sleep onset- Zaleplon (Sonata) oral, nonbenzodiazepine hypnotic approved for the short-term treatment (7-10 days) of insomnia- Overall, this drug is effective in helping people get to sleep- Zolpidem (Ambien, Ambien CR)- A nonbenzodiazepine hypnotic that differs structurally from the benzodiazepines but produces similar effectso This drug is a Schedule IV drug approved for short-term treatment (7-10 days) of insomnia
Causes of sleep disturbance Mood disorders, anxiety disorders, schizophrenia, and other psychotic disorders are often associated with sleep disturbances- Treatment of the underlying mental disorder is indicated to resolve the sleep disorder- Sleep disorder due to a general medical condition may involve insomnia, hypersomnia, parasomnias, or a combination of these attributable to a medical condition- These sleep disturbances may result from degenerative neurologic illnesses, cerebrovascular disease, endocrine conditions, viral and bacterial infection, coughing, or pain
Teachings – measures to promote relaxation, rest, sleep “Establish a regular schedule for going to bed and arising- Avoid sleep deprivation, and the desire to “”catch up”” by excessive sleeping- Do not eat large meals before bedtime; however, a light snack is permissible, even helpful- Avoid daytime naps, unless necessitated by advanced age or physical condition- Exercise daily, particularly in the late afternoon or early evening, as exercise before retiring may interfere with sleep- Minimize or eliminate caffeine and nicotine ingestion- Do not look at the clock while lying in bed- Keep the temperature in the bedroom slightly cool- Do not drink alcohol in an attempt to sleep; it will worsen sleep disturbances and produce poor-quality sleep- Do not use the bed for reading, working, watching television, and so forth- If you are worried about something, try writing it down on paper and assigning a- designated time to deal with it-then, let it go- Soft music, relaxation tapes, or “”white noise”” may be helpful; experiment with different methods to find those that are beneficial for you”
Types of Mood Disorders – Mood disorder interferes with a person’s life, plaguing the individual with drastic and long-term sadness, agitation, or elation- Accompanying self-doubt, guilt, and anger alter life activities, especially those that involve self-esteem, occupation, and relationships- The primary mood disorders are major depressive disorder and bipolar disorder (formerly called manic-depressive illness)
Major depressive disorder Typically involves 2 weeks or more of a sad mood or lack of interest in life activities, with at least four other symptoms of depression such as anhedonia and changes in weight, sleep, energy, concentration, decision-making, self-esteem, and goalso A major depressive episode lasts at least 2 weeks, during which the person experiences a depressed mood or loss of pleasure in nearly all activitieso Symptoms of major depression:• Changed in eating habits, resulting in unplanned weight gain or loss;• Hypersomnia or insomnia; impaired concentration, decision-making, or problem-solving ability; inability to cope with daily life• Feelings of worthlessness, hopelessness, guilt, or despair; thoughts of death and/or suicide• Overwhelming fatigue; and rumination with pessimistic thinking with no hope of improvemento These symptoms result in significant distress or impairment of social, occupational, or other important areas of functioning
Genetic theories First degree relatives (same as alcoholism)
Neurochemical theories Serotonin, norepinephrine, possibly acetylcholine and dopamine
Neuroendocrine influences Hormones (thyroid, adrenal, parathyroid, pituitary glands)
Psychosocial stressors In interpersonal events that appear to trigger certain physiological and chemical changes in the brain which significantly alters the balance of the neurotransmitters; this can be a psychodynamic theory or cultural consideration
Psychodynamic theories Self-deprecation (anger turned inward)o Ideal ego- wants to be perfect, cannot achieveo Mania as defenses against underlying depression• Keep them safe• A distinct period of time during which mood is abnormally and persistently elevated expansive or irritable• These manic episodes include inflated self-esteem or grandiosity, decreased sleep, excessive or pressured speech• Unrelenting speech, they can be rapid and often talking loud without pauses• They can have flight of ideas, distractibility, increased activity or psychomotor agitation• Excessive movement and pleasure seeking or risk-taking activities with a high potential for painful consequenceso Depression as reaction to life experienceo Rejecting or unloving parents (insecurity, loneliness)o Cognitive distortions (magnify negative events or traits, minimize anything positive)
Treatment/Therapy Antidepressants somehow interact with the two neurotransmitters, norepinephrine, and serotonin, that regulate mood, arousal, attention, sensory processing, and appetite
Teaching and Nursing thoughts for Antidepressants Suicide is always a primary consideration when treating clients with depression- SSRIs: venlafaxine, nefazodone, and bupropion are often better choices for those who are potentially suicidal or highly impulsive because they carry no risk of lethal overdose in contrast to the cyclic compounds and MAOIs- Therapeutic effects may not occur for 2-4 weeks- Do not take other OTC cough medicine and St. John Wart without consulting the provider- Avoid alcohol; do not stop taking abruptly- Tricyclic is taken at night, SSRI is taken in the morning, and SNRI is taken with food in the morning and evening- The increased activity and improved mood that antidepressants produce can provide the energy for suicidal clients to carry out the acto Thus, the nurse must assess suicide risk even when clients are receiving antidepressants- It is also important to ensure that clients ingest the medication and are not saving it in an attempt to commit suicide
Depression treatment besides medications: Psychiatrists may use electroconvulsive therapy (ECT) to treat depression inselect groups, such as clients who do not respond to antidepressants or those who experience intolerable side effects at therapeutic doses (particularly older adults)- A combination of psychotherapy and medications is considered the most effective treatment for depressive disorders in both children and adults
Pharmacological treatment – Evaluating effectiveness Antidepressant drugs are primarily used in the treatment of major depressive illness, anxiety disorder, the depressed phase of bipolar, and psychotic depression
Nursing Care for Depression The priority is to determine whether a client with depression is suicidal- If a client has suicidal ideation or hears voices commanding him or her to commit suicide, measures to provide a safe environment are necessaryo Provide safety for the client and others- Institute suicide precautions if Indicated- Begin a therapeutic relationship by spending nondemanding time with the client- Promote completion of activities of daily living by assisting the client only as necessary- Establish adequate nutrition and hydration- Promote sleep and rest- Engage the client in activities- Encourage the client to verbalize and describe emotions- Work with the client to manage medication and side effects
Bipolar▪ Characteristics Diagnosed when a person’s mood fluctuates to extremes of mania and/or depression- Mania is a distinct period during which mood is abnormally and persistently elevated, expansive, or irritable- Typically, this period lasts about 1 week (unless the person is hospitalized and treated sooner), but it may be longer for some individuals- Manic Episode- Inflated self-esteem or grandiosity; decreased sleep- The person’s mood may be excessively cheerful, enthusiastic, and expansive, or the person may be irritable, especially when he or she is told no or has rules to follow- The person often denies any problems, placing the blame on others for any difficulties he or she experiences
Hypomania A period of abnormally and persistently elevated, expansive, or irritable mood and some other milder symptoms of maniao The difference is that hypomanic episodes do not impair the person’s ability to function {in fact, he or she may be quite productive
Bipolar 1 disorder one or more manic or mixed episodesusually accompanied by major depressive episodes
Bipolar 2 disorder one or more major depressive episodes accompanied by at least one hypomanic episode
Nursing care- Assessment for bipolar o Historyo General appearance and motor behavior (clothes reflecting elevated mood)o Mood and affect (periods of euphoria, grandiosity)o Thought process and content (circumstantiality, tangentiality)o Sensorium and intellectual processes (disoriented to time)o Judgment and insighto Self-concept (exaggerated self-esteem)o Roles and relationships (in manic phase can rarely fulfill role responsibilities)o Physiological and self-care considerationso Outcome identification, examples:• No injury to self or others• Balance of rest, sleep, and activity• Socially appropriate behavior
intervention bipolar Providing for safety, meeting physiological needso Providing therapeutic communication, do not scold or chastise themo Promoting appropriate behaviors, managing medicationso Providing client and family teaching
Pharmacological treatment bipolar Treatment for bipolar disorder involves a lifetime regimen of medications-either an antimanic agent- lithium or anticonvulsant medications used as mood stabilizerso Lithium, Atypical Antipsychotics, and Anticonvulsants
Anticonvulsants in bipolar- Used as mood-stabilizing agents in bipolar disorder because they modify nerve cell functiono Carbamazepine {Tegretol}, lamotrigine {Lamictal}, and valproate {Depakene} are currently approved by the FDA for treating bipolar disordero The drugs are typically used for patients who do not respond to lithium- Several anticonvulsants traditionally used to treat seizure disorders have proved helpful in stabilizing the moods of people with bipolar illness
Lithium Doses should be relatively low initially and may increase gradually according to regular measurements of serum drug levelso Before beginning lithium therapy, obtain baseline electrolytes, studies of renal, cardiac, and thyroid status because adverse drug effects involve these organ systems- When lithium therapy begins measure the serum drug concentration two or three time weekly in the morning, 12 hours trough after the last dose of the drug dosage is based on serum drug levels, control of symptoms, and occurrence of adverse effect- Lithium carbonate (Lithobid) the protype is a naturally occurring metallic salt that is used in patients with bipolar disorder, mainly to treat and prevent manic episodes- Long-term treatment: Atypical Antipsychotics- Used to decrease dopamine activity in the treatment of the mania phase of bipolar disorder, including reducing acute mania, psychomotor agitation, and psychosis- Currently aripiprazole, olanzapine (monotherapy or combination with fluoxetine), quetiapine, risperidone, and ziprasidone are approved by the FDA for this indication
Types of suicidal ideation Suicidal ideation- Thinking about killing oneself- Active suicidal ideation- A person thinks about and seeks ways to commit suicide- Passive suicidal ideation- A person thinks about wanting to die or wishes he or she were dead but has no plans to cause his or her death
Nursing care/Assessing Risk in suicide Priority Interventiono A history of previous suicide attempts increases risk for suicideo The first 2 years after an attempt represents the highest risk period, especially the first 3 monthso Those with a relative who committed suicide are at increased risk for suicide, the closer the relationship, the greater the risko Intervention for suicide or suicidal ideation becomes the first priority of nursing careo The nurse assumes an authoritative role to help clients stay safeo In this crisis situation, clients see few or no alternatives to resolve their problemso The nurse lets clients know they’re safety is the primary concern and takes precedence over other needs or wishes
Eating Disorders- Types: Anorexia Nervosa, Bulimia Nervosao Binge Eating Disorder, Night Eating Syndrome
Anorexia Nervosa- Life-threatening eating disorder characterized by the client’s restriction of nutritional intake necessary to maintain a minimally normal bodyweight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exist
Bulimia Nervosa- An eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising• The amount of food consumed during a binge episode is much larger than a person would normally eat
Binge Eating Disorder- Characterized by recurrent episodes of binge eating; no inappropriate behaviors, such as purging or excessive exercise or abuse of laxative; guilt, shame, and disgust about eating behaviors; and psychological distress
Night Eating Syndrome- Characterized by morning anorexia, evening hyperphagia (consuming 50% of daily calories after the last evening meal), and nighttime awakenings (at least once a night) to consume snacks• It is associated with life stress, low self- esteem, anxiety, depression, and adverse reactions to weight loss
Pica Persistent ingestion of nonfood substances
Rumination Repeated regurgitation of food that is then rechewed, re-swallowed, or spit outo Orthorexia Nervous (orthorexia)- An obsession with proper or healthful eating
Risk factorso Anorexia Obesity, dieting at an early age, issues of developing autonomy and having control over self and environment• Dissatisfaction with body image, the family lacks emotional support• Parental maltreatment; cannot deal with conflict, cultural ideal of being thin• Media focus on beauty, thinness, fitness• Preoccupation with achieving the ideal body
o Bulimia Nervosa Obesity; early dieting; possible serotonin and norepinephrine disturbance• Chromosome 1 susceptibility, self-perceptions of being overweight, fat, unattractive, and undesirable• Dissatisfaction with body image, chaotic family with loose boundaries; parental maltreatment including possible physical or sexual abuse, weight-related teasing

• Treatment optionso Anorexia- Amitriptyline (Elavil) and the antihistamine cyproheptadine (Periactin) in high doses up to 28 mg/day can promote weight gain in inpatients with anorexia nervosa• Olanzapine (Zyprexa)- Has been used with success because of its antipsychotic effect on bizarre body image distortions and associated weight gain• Fluoxetine (Prozac)- Has some effectiveness in preventing relapse in clients whose weight has been partially or completely restored
  o Bulimia- Drugs, such as desipramine {Norpramin}, imipramine {Tofranil}, amitriptyline {Elavil}, nortriptyline {Pamelor}, phenelzine {Nardil}, and fluoxetine {Prozac}, were prescribed in the same dosage used to treat depression• Antidepressants were more effective than were the placebos in reducing binge eating• They also improved mood and reduced preoccupation with shape and weight; however, most of the positive results were short- termo It may be that the primary contribution of medications is treating the comorbid disorders frequently seen with bulimia
  Nursing care – inpatient- Intervention: Nurse-client contract, stabilizing- highest priority, establish treatment protocols, weight at the same time, step on scale backwards, meals at certain timeso Smaller meals many times a day, staff interacting appropriately, set time to eat-can’t eat over 2 hours (30 minutes to eat), observed for an hour after eating, can’t go to bathroom unless you stand there and watcho Strict I&O, weighted first thing in the morning with same scaleo don’t talk about food a lot with them-talk about other thingso Positive reinforcement, don’t threaten- if they don’t eat, they are going to get NGT forced down and forced to eato If the status doesn’t improve then feeding tube may happen, after nutrition is stabilized-talk about feelings regarding disorder and gaining weighto Change perceptions of body and recognize positive thingso Develop realistic perception and food relationship, food diary-how do you feel
  Assessment of eating disorders o Heart/BP/skin integrity- dry (don’t bathe every day because dryness)o Look at mucous membrane, oral care very importanto Seen by dietician, if need to lose weight-how to go about it (diet, exercise not discourage from plateau)
• Interdisciplinary team pharm (antidepressant), psychotherapy, cognitive therapy, family therapy, group therapyo OT, nutrition counselor, social worker
• Excoriation Disorder: Dermatillomania Skin picking)- Categorized as a self- soothing behavior
• Trichotillomania Chronic repetitive hair pulling)- A self-soothing behavior that can cause distress and functional impairmento Onset in childhood is most common, but it can also persist into adulthood with development of anxiety and depression
  Body Dysmorphia Disorder (BDD) “Preoccupation with an imagined or slight defect in physical appearance that causes significant distress for the individual and interferes with functioning in daily lifeo The person ruminates and worries about the defect, often blaming all of life’s problems on his or her “”flawed”” appearance, that is, the appearance is the reason the person is unsuccessful at work or finding a significant other, for feelings of unhappiness, etc…”
• Onychophagia Chronic nail-bite
• Oniomania Compulsive buying)- An acquisition type of reward-seeking behavioro The pleasure is in acquiring the purchased object rather than any subsequent enjoyment of its use
• Disruptive behavior disorder- Problems with the person’s ability to regulate his or her own emotions or behavioro They are characterized by persistent patterns of behavior that involve anger, hostility, and/or aggression toward people and property
  Behavioral manifestations “- Clients with OCD often seem tense, anxious, worried, and fretful- They may have difficulty relating symptoms because of embarrassment- During assessment of mood and affect, clients report ongoing overwhelming feelings of anxiety in response to the obsessive thoughts, images, or urges- They may look sad and anxious- Many clients describe the obsessions as arising from nowhere during the middle of- normal activities- The client recognizes that the obsessions are irrational, but he or she cannot stop them- During exploration of self-concept, the client voices concern that he or she is “”going crazy.””- Feelings of powerlessness to control the obsessions or compulsions contribute to low self-esteem- symptoms: Severe anxiety”
  Relaxation techniques – Offer encouragement, support, and compassion- Be clear with the client that you believe he or she can change- Encourage the client to talk about feelings, obsessions, and rituals in detail- Gradually decrease time for the client to carry out ritualistic behaviors- Assist the client using exposure and response prevention behavioral techniques- Encourage the client to use techniques to manage and tolerate anxiety responses- Assist the client in completing daily routine and activities within agreed-upon time limits- Encourage the client to develop and follow a written schedule with specified times and activities
  Medications 1st line – 1st line- SSRI Antidepressants-Fluvoxamine (Luvox) and Sertraline (Zoloft)
  Optimal treatment for OCD combines medication and behavioral therapy- SSRI antidepressants- fluvoxamine (Luvox) and sertraline (Zoloft), are first-line choices, followed by venlafaxine (Effexor)- Treatment-resistant OCD may respond to second- generation antipsychotics – Antianxiety drugs are also used to treat OCD
  Medication 2nd gens 2nd line- Second generation antipsychotics- Risperidone (Risperdal), Quetiapine- {Seroquel}, or Olanzapine (Zyprexa)