# A nurse is caring for a client with generalized anxiety disorder who is experiencing a panic attack. The client reports palpitations, dizziness, and feelings of losing control. Which nursing intervention should the nurse implement first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=543336  
> language: ko  
> subject: Mental Health

## 문제

A nurse is caring for a client with generalized anxiety disorder who is experiencing a panic attack. The client reports palpitations, dizziness, and feelings of losing control. Which nursing intervention should the nurse implement first?

## 보기

1. Administer prescribed lorazepam immediately
2. Encourage the client to discuss their feelings about the panic attack
3. Stay with the client and guide them through slow, deep breathing exercises **✔ 정답**
4. Remove the client from the current environment to a quiet room

**정답: 3**

## 해설

During a panic attack, staying with the client and guiding slow, deep breathing helps regain control and provides immediate emotional support. Other interventions like medication or discussion are important but secondary to stabilizing breathing.

## 심화 해설

Understanding the Priority During a Panic Attack

When a client with generalized anxiety disorder experiences a panic attack, the immediate physiological response is driven by sympathetic nervous system activation, often manifesting as hyperventilation. The client's report of palpitations and dizziness is directly linked to this rapid, shallow breathing pattern. Hyperventilation leads to excessive exhalation of carbon dioxide, causing respiratory alkalosis. This shift in blood pH triggers cerebral vasoconstriction, which reduces blood flow to the brain and intensifies the sensation of dizziness and the terrifying feeling of losing control. [2] The priority is to interrupt this escalating physiological cycle, as a client in this state cannot effectively process verbal discussion or learn new coping skills until their acute symptoms begin to subside.

Why Staying and Guiding Breathing is the First Action

The most immediate and evidence-based non-pharmacological intervention is to stay with the client and guide them through slow, deep breathing exercises. This technique, often called breathing retraining, directly counteracts the hyperventilation that fuels the panic attack. [2] By modeling a calm presence and providing simple, clear instructions for paced breathing, the nurse helps the client restore a more normal respiratory rate and depth, which corrects the CO2 imbalance and alleviates the distressing physical sensations. This intervention is foundational because it addresses the physiological driver of the panic symptoms, is non-invasive, and empowers the client with a tool to regain a sense of control. It is a core component of cognitive behavioral therapy (CBT), which is a well-established, evidence-based intervention for anxiety disorders.

Analyzing the Other Options

- Option 1: Administer prescribed lorazepam immediately. While lorazepam is a fast-acting benzodiazepine that can effectively reduce acute anxiety, medication administration is not the absolute first nursing intervention. The nurse must first utilize non-pharmacological techniques that are immediately available and have no side effects. Guiding breathing exercises can be initiated within seconds, whereas obtaining and administering medication takes longer. Furthermore, helping a client master a self-regulation technique can be more therapeutic long-term than immediately relying on medication.

- Option 2: Encourage the client to discuss their feelings about the panic attack. During the peak of a panic attack, a client's cognitive processing is severely impaired by overwhelming fear and physiological distress. Asking them to explore their feelings is not only ineffective but can be counterproductive, as it may increase their focus on the terrifying sensations. This therapeutic communication technique is valuable but should be implemented after the acute physiological symptoms have been stabilized and the client is able to reflect calmly.

- Option 4: Remove the client from the current environment to a quiet room. While reducing environmental stimuli is a helpful strategy for managing anxiety, abruptly moving a client who is dizzy and feeling a loss of control can be disorienting and unsafe. The immediate priority is to help the client stabilize physiologically right where they are. Once the breathing is controlled and the client is more grounded, the nurse can then offer to move to a quieter space if needed. The principle of safety and stabilization in the present moment takes precedence.References (research sources)

- [2]Use of breathing retraining exercises and SSRIs in patients with hyperventilation syndrome.Research articleWharram CE, MovaseghiGargari M, Smeenge DM. (2025) · DOI: 10.1136/bcr-2024-263409

## 임상 시나리오

Managing Acute Panic AttackPrioritize Breathing Retraining to Reverse Hyperventilation
During a panic attack, hyperventilation causes excessive CO2 exhalation, leading to respiratory alkalosis and cerebral vasoconstriction. This physiological cascade intensifies dizziness and a sense of losing control. The nurse's first action is to stay with the client and guide slow, deep breathing to restore normal CO2 levels.

Use a calm, firm voice to instruct the client to inhale slowly through the nose for 3 seconds and exhale slowly through pursed lips for 4 to 5 seconds. This breathing retraining directly counteracts the sympathetic surge and alleviates palpitations.

CautionDo not attempt complex verbal discussion or ask the client to describe feelings during the acute attack. Cognitive processing is impaired due to altered cerebral blood flow. Administer prescribed benzodiazepines only if breathing techniques fail to reduce symptoms or as a secondary intervention.

## 핵심 개념

- **Panic Attack** — A sudden and extreme surge of fear or discomfort that peaks within minutes. It is accompanied by various physical symptoms such as chest pain, difficulty breathing, dizziness, and a fear of dying.
- **Hyperventilation** — Breathing that is faster or deeper than the body needs. This lowers the carbon dioxide (CO2) level in the blood, causing respiratory alkalosis and symptoms that feel like hypoxia (dizziness, tingling in the hands and feet, chest pain).
- **Respiratory Alkalosis** — A state where excessive carbon dioxide is expelled from the blood due to hyperventilation, causing the blood pH to rise (shifting toward alkalinity). This is the cause of many physical symptoms that appear during a panic attack.
- **Sympathetic Nervous System Activation** — The "Fight-or-Flight" response to stress or threat. It causes increased heart rate, elevated blood pressure, rapid breathing, muscle tension, and serves as the physiological basis for panic attacks.
- **Nurse-Initiated Intervention** — Nursing interventions that can be performed independently based on the nurse's judgment and responsibility without a doctor's prescription. Typical examples include guiding breathing during a panic attack or staying with the patient.

## 같은 주제 문제

- [A nurse is assessing a 45-year-old client who was admitted to the emergency department wit…](https://mymerci.kr/pages/nclex_q.php?qn_id=543334)
- [A nurse is assessing a client with generalized anxiety disorder who has been experiencing …](https://mymerci.kr/pages/nclex_q.php?qn_id=543335)
- [A nurse is caring for a 30-year-old client with social anxiety disorder who is experiencin…](https://mymerci.kr/pages/nclex_q.php?qn_id=543337)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._