Anxiety and Panic Attacks: Nursing Priorities

Mental Health · Anxiety & Mood Disorders·Updated 2026-10-28

What it is

Anxiety is a response to a perceived threat that activates the sympathetic nervous system: tachycardia, rapid breathing, tremor and sweating. A panic attack is an abrupt surge of intense fear that peaks within minutes, with palpitations, chest pain, dyspnea, dizziness, tingling and a fear of dying. As anxiety rises, the perceptual field narrows, so care shifts from teaching and problem-solving to presence, safety and short, simple directions.

What the NCLEX focuses on

During a panic attack, stay with the client, speak calmly in short sentences, reduce stimuli and guide slow breathing; explore triggers only after anxiety decreases.
Hyperventilation causes respiratory alkalosis: lightheadedness and tingling around the mouth and fingertips.
Chest pain with hypotension, diaphoresis, radiating pain or a change in consciousness is treated as cardiac until ruled out.
Agoraphobia is fear of places where escape is difficult, often after panic attacks; social anxiety is fear of judgment or embarrassment.
SSRIs and SNRIs are first-line long-term treatment; benzodiazepines are for short-term use because of sedation and dependence.
Buspirone has no dependence risk but takes weeks to work, so it is not used for acute anxiety.
Cognitive behavioral therapy, relaxation training and gradual exposure reduce avoidance.

Priority nursing actions

Stay with the client, remain calm and ensure safety.
Assess vital signs and SpO2, and rule out a physical cause such as cardiac ischemia, hypoglycemia or hypoxemia.
Move the client to a quiet, low-stimulus area and give brief, direct instructions.
Coach slow breathing and give the prescribed PRN anxiolytic if anxiety stays severe.
Once anxiety is mild to moderate, explore triggers and teach coping skills.

Numbers to know

Level or item	Client finding	Nursing approach
Mild anxiety	Alert, wide perceptual field	Best time to teach
Moderate anxiety	Narrowed focus, follows directions	Guide problem-solving
Severe anxiety	Cannot learn or solve problems	Reduce stimuli; brief, clear directions
Panic	Disorganized, cannot follow complex directions	Stay with client; ensure safety; short commands
Hyperventilation	PaCO2 below 35 mm Hg, pH above 7.45	Coach slow breathing
SSRI onset	First improvement after 2 to 4 weeks	Take daily even before benefit
Benzodiazepine	Rapid onset; dependence with daily use	Short-term only; taper, never stop abruptly

Common exam traps

Choosing to ask what triggered the attack while the client is in panic: wrong because a client in panic cannot process questions.
Choosing to leave the client alone or walk the client down a hallway: wrong because the client needs a calm person present and low stimulation.
Choosing to call crushing chest pain with diaphoresis a panic attack: wrong because a cardiac cause is ruled out first.
Choosing buspirone as a PRN for acute panic: wrong because it takes weeks to work.
Choosing to help the client avoid feared places: wrong because avoidance reinforces fear; gradual exposure reduces it.

What to teach

Practice slow diaphragmatic breathing and relaxation daily, not only during attacks.
Take the SSRI every day; benefit builds over weeks; do not stop it suddenly.
With a benzodiazepine, avoid alcohol and driving until the effect is known, and never stop it abruptly.
Limit caffeine and nicotine, exercise regularly and keep a regular sleep schedule.

Try 2 NCLEX-style questions on this topic

From the NCLEXPace question bank. Pick your answers, then check them inside NCLEXPace.

Question 1 · QID A0EDE8CB

A client reports sudden chest symptoms and fear. For each finding, indicate whether it is consistent with a panic attack or warrants ruling out a cardiac event.

	Consistent with a panic attack	Warrants ruling out a cardiac event
Racing heart and a sense of impending doom that began during an argument
Chest pain accompanied by hypotension and a change in level of consciousness
Tingling around the mouth and in the fingertips that resolves within 20 minutes
Crushing substernal pain radiating to the left arm with diaphoresis

Question 2 · QID BEB3EB48

A client on the unit suddenly reports feeling like they are going to die, with rapid breathing, a racing heart, and trembling hands. Which action should the nurse take first?

Select the best answer.

A. Ask another staff member to bring the client's prescribed anxiety medication so it can be given as soon as possible
B. Ask the client to identify the event, thought, or sensation that immediately preceded the rapid breathing and racing heart
C. Stay with the client and speak in a calm, reassuring voice
D. Guide the client to a quiet hallway and encourage slow walking while coaching controlled breathing and observing the physical symptoms

See the answers and full rationales

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More tips on Mental Health

Therapeutic Communication: Choosing the Best ResponseRecognize therapeutic techniques and the blocks that shut clients down, so you can pick the best nurse response on the NCLEX.Suicide Risk: Assessment, Observation and SafetyAsk directly about suicide, match observation to the plan and means, and recognize the warning signs the NCLEX tests most.Alcohol Withdrawal and Delirium TremensLearn the withdrawal timeline, CIWA-Ar scoring, benzodiazepine treatment, thiamine before glucose, and seizure and DT precautions.

Sources

Halter MJ. Varcarolis' Foundations of Psychiatric-Mental Health Nursing: A Clinical Approach. 9th ed. Elsevier; 2022.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision (DSM-5-TR). American Psychiatric Association Publishing; 2022.
Harding MM, Kwong J, Hagler D, Reinisch C. Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 12th ed. Elsevier; 2023; Chapter: Fluid, Electrolyte, and Acid-Base Imbalances.

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