A client who is experiencing a panic attack has just arrived at the emergency department. Which is the priority nursing intervention for this client?
Stay with the client and reassure of safety.
Administer a dose of diazepam.
Leave the client alone in a quiet room so that she can calm down.
Encourage the client to talk about what triggered the attack.
The Correct Answer is A
Panic attacks are acute episodes of intense fear accompanied by physiological symptoms (tachycardia, dyspnea, trembling) and cognitive distress (fear of dying or losing control). Immediate nursing priorities focus on safety, de-escalation, and preventing further escalation of anxiety.
Rationale for correct answers
A. Staying with the client provides emotional support and prevents feelings of abandonment, while reassuring safety reduces perceived threat, helping to ground the client during overwhelming physiological arousal.
Rationale for incorrect answers
B. While diazepam may be used for acute anxiety, it is not the first-line intervention before non-pharmacological strategies (e.g., grounding techniques) are attempted.
C. Isolation can worsen panic, as the client may interpret abandonment as confirmation of danger, increasing helplessness and hyperventilation.
D. Discussing triggers is premature during acute panic, as the client’s impaired cognition prevents rational processing until physiological symptoms stabilize.
Take Home Points
- Immediate panic attack management prioritizes safety and emotional presence over verbal intervention.
- Reassurance and a calm demeanor help regulate the client’s autonomic hyperactivity.
- Pharmacological options are secondary unless agitation threatens safety.
- Avoid isolating the client, as solitude can intensify perceived danger.
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Related Questions
Correct Answer is C
Explanation
Generalized anxiety disorder involves excessive, uncontrollable worry that persists for at least six months and interferes with daily functioning. It presents with restlessness, muscle tension, and impaired concentration. Suppression of thoughts, such as trying to "forget worries," is maladaptive and prevents emotional processing. Effective treatment includes cognitive behavioral therapy and anxiety-reducing techniques like relaxation training and exposure to triggers through guided therapy.
Rationale for correct answers
C. The desire to forget worries suggests avoidance, not processing. This shows the client needs to verbalize emotions to reduce internal tension and improve long-term coping.
Rationale for incorrect answers
A. Insight involves recognizing the impact of anxiety and understanding patterns. Avoidance behavior, like trying to forget, lacks self-awareness and does not reflect insight.
B. Improved coping is shown by active management such as cognitive restructuring or relaxation. Forgetting worries is a passive, ineffective defense that hinders emotional resolution.
D. Treatment success includes functional improvements and adaptive coping. Avoiding thoughts contradicts therapeutic goals of confronting and managing anxiety consciously.
Take Home Points
- Avoidance of anxiety triggers is a common but ineffective defense mechanism in GAD.
- Emotional verbalization is essential for processing and managing anxiety disorders.
- Insight involves recognizing the nature of one’s condition and its effects on behavior.
- Effective coping in GAD includes cognitive and behavioral strategies, not suppression.
Correct Answer is B
Explanation
Buspirone is a serotonin 5‑HT₁A partial agonist used for generalized anxiety disorder. It has a delayed onset of action, typically taking 2–4 weeks to reach effectiveness. Daily dosing maintains steady-state levels and not for immediate relief. It does not cause sedation, tolerance, or dependency like benzodiazepines, and is contraindicated in acute anxiety needing rapid reduction.
Rationale for correct answers
B. Buspirone requires consistent steady-state accumulation before reducing anxiety. Daily dosing is necessary to achieve therapeutic plasma levels and efficacy in GAD, unlike benzodiazepines.
Rationale for incorrect answers
A. Alprazolam (Xanax) can be effective for GAD but has rapid onset and dependency risk. Buspirone’s recommendation is based on mechanism and onset, not because benzodiazepines are ineffective for GAD.
C. Changing to PRN dosing would not allow buspirone to reach effective concentrations and would undermine therapeutic goals. That suggestion could lead to treatment failure and misunderstanding of its pharmacokinetics.
D. Advising that her friend should take Xanax daily is inappropriate. Benzodiazepines pose risks of tolerance, dependence, and withdrawal and are typically not recommended for continuous, long-term GAD management.
Take Home Points
- Buspirone requires daily dosing to build up effective serum levels for GAD management.
- It has no rapid anxiolytic effects and is unsuitable for PRN use in acute anxiety episodes.
- Benzodiazepines like alprazolam are fast‑acting but carry dependency risks and are not ideal for long‑term use.
- Patient education on onset, mechanism, and dosing rationale promotes adherence and therapeutic success.
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