NRSG 126 - MH_Exam 2 Study Guide.

NRSG 126 Mental Health Nursing
Exam 2 Blueprint and Preparation information
Anxiety and trauma and stress disorders, Mood Disorders (Depression, Bipolar), suicide

General Blueprint of the Exam
There are approximately (the term approximate is used as some questions bridge multiple units):
20 Questions content area: Anxiety, trauma and stress disorders Chapters 10 and 11
 Levels of anxiety & interventions
o Mild
 Perceptual field heightened; alert & can see, hear, grasp what’s happening; can
identify issues producing anxiety
 Able to work toward goal; can alert person that something is wrong and
stimulate action
 Slight discomfort, restlessness, irritability/impatience, mild tensions-relieving
behavior (foot/finger tapping, lip chewing, fidgeting)
o Moderate
 Perceptual field narrowed, can attend to more if pointed out by another
 Can solve problems but not optimally, benefit from guidance of others, can alert
person something is wrong & stimulate action
 Voice tremors, change in pitch, difficulty concentrating, shakiness, repetitive q’s,
somatic complaint (H/A, urinary urgency, backache, insomnia), increase RR & P,
increase muscle tension, moderate tension relieving behavior (pacing, banging
hands on table)
o Interventions for mild to moderate
 Identify anxiety, “you look upset”, and assess level
 Nonverbal language to show interest
 Encourage to talk about feelings/concerns
 Avoid closing off avenues of communication, focus on pt concerns
 Ask q’s to clarify what is being said
 Help pt identify thoughts/feelings before onset of anxiety
 Encourage problem solving
 Assist developing alternate solutions to problem (role play, model behavior)
 Explore behaviors that have worked in past
 Provide outlets for dissipating excess energy
o Severe
 Perceptual field greatly reduced, focus on details, attention scattered, may not
be able to grasp what is happening even when pointed out, environment is
blocked out
 Unable to see connections between events or details, distorted perceptions,
unable to do problem solving & discovery of solutions
 Feelings of dread, ineffective functioning, confusion, purposeless activity, sense
of impending doom, more intense somatic complaints (H/A, nausea, dizzy,
sleepy), hyperventilation, tachycardia, withdrawal, loud/rapid speech, threats &
demands

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, o Panic
 Unable to focus on environment, utmost state of terror & emotional paralysis,
feels like ceases to exist, possible hallucinations or delusions
 May be mute, extreme psychomotor agitation leading to exhaustion,
disorganize/irrational reasoning, unable to do problem solving & discover
solutions
 Experience of terror, immobility/severe hyperactivity, dilated pupils,
unintelligible communication or inability to speak, severe shakiness,
sleeplessness, severe withdrawal, hallucinations or delusions
o Interventions for severe to panic
 Maintain calm manner
 Always remain with person
 Minimize environmental stimuli, quiet setting
 Use clear/simple statements
 Low-pitched voice, speak slow
 Reinforce reality
 Listen for themes in communication
 Attend to physical & safety needs
 Physical limits may need to be set for safety; firm & authoritative voice
 Give opportunities for gross motor movement and exercise
 When constantly moving, offer high-calorie fluids
 Assess need for medication
 Defense mechanisms
o Healthy defenses
 Altruism: conflicts & stressor addressed by meeting others needs
 Sublimation: unconscious process of substituting strong impulses which are not
acceptable for acceptable activity (man with hostile feelings may become a
butcher or participate in rough contact sports)
 Humor: dealing by emphasizing amusing or ironic aspects of conflict
 Suppression: conscious denial of a disturbing situation/feeling
o Intermediate defenses
 Repression: exclusion of unwanted experiences, emotions, ideas from conscious
awareness
 Displacement: transfer of emotions to another person, object, or situation
 Reaction formation: unacceptable feelings/behavior kept out of awareness by
developing opposite emotion/behavior
 Somatization: repressed anxiety shown in form of physical symptoms
 Undoing: performing action to make up for former behavior
 Rationalization: justifying unreasonable ideas, actions, feelings by developing
acceptable explanations for behavior
o Immature defenses
 Passive aggression: dealing with conflict/stress by indirectly expressing
aggression toward others



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