An adult is pacing about the unit and wringing his hands. He is breathing rapidly and complains of palpitations and nausea and he has difficulty focusing on what the nurse is saying. He says he is having a heart attack but refuses to rest. The nurse would interpret his level of anxiety as?

1. A

   Mild

2. B

   Moderate

3. C

   Severe

4. D

   Panic

Appeared in: DHS 2018 shift 1st

Explanation

• The patient is exhibiting symptoms of the highest level of anxiety, known as panic.
• Key indicators include extreme psychomotor agitation (pacing, wringing hands), severe physiological symptoms (rapid breathing, palpitations, nausea), and significant cognitive impairment (difficulty focusing).
• The most telling sign is the loss of rational thought and sense of impending doom, demonstrated by his firm belief that he is having a heart attack.
• At the panic level, the perceptual field is completely disrupted, and the individual is unable to process information or follow directions, which is consistent with his difficulty focusing on the nurse.

Why Other Options Were Wrong

• Option A: Mild anxiety is characterized by increased alertness and a broadened perceptual field. The patient's symptoms are far more severe and debilitating.
• Option B: In moderate anxiety, the perceptual field narrows, but the individual can still process information and follow directions with assistance. This patient is unable to focus at all.
• Option C: Severe anxiety involves a greatly reduced perceptual field and significant somatic symptoms. However, it typically does not involve the complete loss of rational thought or the profound sense of terror and impending doom (e.g., 'I'm having a heart attack') seen in panic.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Assessment of Anxiety Levels in acute care settings.
• A primary nursing responsibility is to stay with a patient experiencing a panic attack to ensure their safety and provide reassurance. The environment should be made as calm and non-stimulating as possible.
• Communication must be simple, clear, and brief. Use a calm, matter-of-fact tone. Do not try to reason with the patient's irrational fears during the peak of the attack.
• It is crucial to rule out any underlying medical conditions (like an actual myocardial infarction) but also to recognize that the symptoms of panic can perfectly mimic them.

How to Approach the Question

• First, carefully read the clinical scenario and list all the patient's signs and symptoms (behavioral, physiological, and cognitive).
• Note the keywords: 'pacing,' 'wringing hands' (psychomotor agitation), 'breathing rapidly,' 'palpitations,' 'nausea' (somatic symptoms), 'difficulty focusing' (cognitive impairment), and 'says he is having a heart attack' (cognitive distortion/fear).
• Recall the four levels of anxiety as defined by Peplau: Mild, Moderate, Severe, and Panic.
• Systematically compare the patient's cluster of symptoms to the defining characteristics of each level.
• Identify the most severe symptoms as the key differentiators. In this case, the inability to focus and the belief of having a heart attack strongly point away from mild/moderate and even severe anxiety, landing squarely in the panic category.
• Select the option that best encompasses the totality and severity of the patient's presentation.

Concept Tested & Keywords

• Concept Tested: Assessment of Anxiety Levels
• Stem keywords: pacing, wringing hands, breathing rapidly, palpitations, nausea, difficulty focusing, heart attack
• Lead-in keywords: interpret his level of anxiety
• Clinical cues: The patient's subjective belief of having a heart attack is a key indicator of panic-level cognitive distortion.

Question ID

QdH8Sk5O4SzmVMNJ_5M-3P

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor p. 1025-1027

E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 2 (pp 290-564 of 579) p. 88-90