# A nurse is assessing a client with generalized anxiety disorder who has been experiencing increased anxiety symptoms. Which assessment finding would be the MOST concerning and require immediate nursing intervention?

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> subject: Mental Health

## 문제

A nurse is assessing a client with generalized anxiety disorder who has been experiencing increased anxiety symptoms. Which assessment finding would be the MOST concerning and require immediate nursing intervention?

## 보기

1. Reports of chest pain, shortness of breath, and feeling like "I'm going to die" **✔ 정답**
2. Restlessness and difficulty concentrating on the nurse's questions
3. Trembling hands and sweating palms during the interview
4. Expressing worry about multiple life situations and future events

**정답: 1**

## 해설

Chest pain, shortness of breath, and feelings of impending doom indicate a panic attack requiring immediate assessment to rule out cardiac causes. Other options represent typical anxiety symptoms manageable with standard interventions.

## 심화 해설

Clinical Reasoning and Prioritization

In a client with generalized anxiety disorder (GAD) reporting increased anxiety, the nurse must rapidly differentiate between an exacerbation of baseline anxiety symptoms and a more acute, potentially life-threatening event. The key is to recognize that symptoms which mimic a serious medical emergency require immediate physiological assessment and intervention before they can be attributed to a psychiatric cause.

The most concerning finding is the report of chest pain, shortness of breath, and a sense of impending doom ("I'm going to die"). While these are classic symptoms of a panic attack, they are clinically indistinguishable from an acute coronary syndrome (ACS) or other life-threatening cardiopulmonary events. The nurse's immediate priority is to rule out a physiological emergency. This is a critical safety principle in psychiatric nursing: new or worsening somatic symptoms with high acuity must first be assessed for a medical etiology. A case report by Nmezi (2026) illustrates this exact scenario in a clinical setting, where a patient with no prior psychiatric history developed an acute panic attack during a medical procedure, presenting with severe anxiety, palpitations, and chest tightness [1]. The report underscores that such symptoms, whether in a patient with known anxiety or not, demand immediate and serious attention to ensure patient safety, including vital sign monitoring, cardiac assessment, and provider notification [1].

In contrast, the other options represent symptoms that are consistent with an exacerbation of GAD itself. Restlessness and difficulty concentrating are core cognitive and motor symptoms of heightened anxiety. Trembling hands and sweating palms are expected autonomic arousal signs during a stressful interview. Expressing worry about multiple life situations is the hallmark of GAD's excessive and pervasive worry. While these findings are clinically significant and require therapeutic nursing interventions like providing a calm environment and using active listening, they do not signal an immediate threat to the client's physiological stability. The nurse's first action must always address the highest priority on the hierarchy of needs, which is physiological safety.

References (research sources)

- [1]Acute Panic Attack During Spinal Anesthesia: Successful Management With Intraoperative Psychological Intervention.Research articleNmezi J. (2026) · DOI: 10.7759/cureus.111343

## 임상 시나리오

Acute Chest Pain in the Anxious PatientRuling Out Medical Etiology First
When a patient with Generalized Anxiety Disorder reports new or worsening chest pain, shortness of breath, or a sense of impending doom, the nurse must prioritize medical stabilization. These symptoms are indistinguishable from Acute Coronary Syndrome (ACS).

Immediate nursing actions include obtaining a full set of vital signs, specifically O2 saturation and blood pressure, applying oxygen if hypoxic, and obtaining a 12-lead EKG within 10 minutes of presentation. Notify the Rapid Response Team or provider immediately.

CautionNever assume chest pain is "just anxiety" in a patient with a psychiatric history. This diagnostic overshadowing can delay critical treatment for life-threatening conditions like myocardial infarction or pulmonary embolism.

## 핵심 개념

- **Generalized Anxiety Disorder** — Generalized anxiety disorder. An anxiety disorder characterized by excessive and difficult-to-control worry about various everyday life events or activities, lasting for at least six months.
- **Panic Attack** — Panic attack. An acute episode where sudden, intense fear or discomfort peaks within minutes, accompanied by various physical/cognitive symptoms such as palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, and fear of dying.
- **Impending Doom** — Feeling of impending doom. A symptom where the patient experiences an intense and irrational sensation that they are in serious danger or about to die. An important sign that can appear in acute life-threatening situations such as panic attacks, myocardial infarction, or pulmonary embolism.
- **Prioritization** — Priority setting. The nurse's decision-making process of ranking the most urgent and important problems to address first among multiple patients or a single patient's multiple needs.
- **Sympathetic Nervous System Activation** — Sympathetic nervous system activation. A "fight-or-flight" response to stress or danger, causing physiological changes such as increased heart rate, elevated blood pressure, sweating, trembling, and pupil dilation. It becomes excessively activated in states of anxiety and panic.

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