Panic with a risk of harm to self or others needs a safe environment and extra staff; never leave the patient alone.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client newly prescribed lithium should be taught to:
Answer: B. Maintain consistent fluid and sodium intake, take it with food, have levels monitored, and report early toxicity (nausea, tremor, diarrhea). Dehydration and low sodium raise lithium to toxic levels.
Question 2 of 5
A client with severe COPD expresses anxiety and fear during episodes of dyspnea. Which nursing intervention is most appropriate to help reduce the client's anxiety?
Answer: B. Staying with the client and coaching slow, pursed-lip breathing provides reassurance and helps break the cycle of anxiety and dyspnea that can worsen breathlessness. Leaving the client alone, dismissing the fear, or telling the client to simply calm down would increase anxiety and is not therapeutic.
Question 3 of 5
A client with severe anxiety is pacing and unable to focus. The nurse's priority is to:
Answer: B. Reduce stimulation, stay with the client, remain calm, and use simple directions; severe/panic anxiety impairs learning, so detailed teaching is deferred until anxiety decreases.
Question 4 of 5
A client becomes very anxious the morning of surgery and reports a racing heart and difficulty concentrating on the nurse's instructions. What is the nurse's best initial action?
Answer: A. High preoperative anxiety can impair the client's ability to process information. The nurse stays with the client, speaks calmly, and uses simple reassurance and slow breathing to reduce anxiety so teaching can be understood. Leaving the client alone, rushing through teaching, or dismissing the anxiety as routine does not address the client's distress.
Question 5 of 5
A client experiencing severe anxiety is at which level when they can focus only on immediate concerns, have a narrowed perceptual field, and difficulty problem-solving but can still respond to direction?
Answer: C. At the severe anxiety level the perceptual field is greatly reduced, the client focuses on scattered details, and learning and problem-solving are difficult, but the client can still respond to firm direction. Mild anxiety enhances learning; panic level involves loss of rational thought and possible disorganization.
Keep the streak going with more questions like these, each with a full rationale.
What is levels of anxiety?
As anxiety rises, the perceptual field narrows: mild anxiety sharpens attention and learning, while severe and panic levels leave the person unable to focus, solve problems or take in information. The nurse identifies the level first and matches the intervention to it — teaching at low levels, safety and calm presence at high levels.
Key points to remember
- Mild: alert, wide perception and motivated; learning and problem-solving improve (some restlessness is possible).
- Moderate: focus narrows to the immediate concern; can still learn with direction; heart rate, muscle tension and speech rate rise.
- Severe: perception is greatly reduced and scattered; cannot learn or solve problems; headache, nausea, trembling and hyperventilation are common.
- Panic: loss of control and disorganized thinking, possibly hallucinations or inability to speak; risk of harm to self or others.
- Physical signs come from the fight-or-flight response: rapid pulse and breathing, sweating, dry mouth and dilated pupils.
- Defense mechanisms and coping strategies manage anxiety; at high levels they can become maladaptive.
Nursing priorities
- Identify the level of anxiety before choosing an intervention.
- Mild to moderate: encourage the person to talk about the feeling, explore its cause, and teach coping and problem-solving skills.
- Severe to panic: stay with the patient, use short simple sentences and a calm firm voice, and reduce stimulation (quiet room, fewer people).
- Guide slow, deep breathing and give simple, direct instructions.
- Give anti-anxiety medication as ordered when other measures are not enough, and keep the environment safe.
Patient teaching
- Learn your early signs of rising anxiety and use a coping strategy before it escalates.
- Practice slow breathing, progressive muscle relaxation and regular physical activity.
- Limit caffeine and alcohol, which can worsen anxiety.
Red flags: report now
- Panic with a risk of harm to self or others needs a safe environment and extra staff; never leave the patient alone.
- Do not teach, explain complex information, or ask for decisions during severe or panic anxiety.
- Do not assume chest pain, shortness of breath or palpitations are anxiety; rule out physical causes first.
References
Clinical references for this topic
