Anxiety & Trauma-Related Disorders — NCLEX Lesson — Mental Health A&P · Assessment · Mental Health · Anxiety & Trauma Condition Lesson · NCLEX-PN / NCLEX-RN · Psychosocial Integrity

Anxiety is alarm without real danger. Panic is alarm at full blast. Phobia is alarm tied to one thing. OCD is alarm that says wash, check, repeat. PTSD is alarm stuck on after trauma. Same system — amygdala, cortisol, norepinephrine — different story. Nurse stays calm, keeps safe, teaches coping, never forces.

In this lesson

Lesson Objectives
Why This Matters
Disease Overview
Pathophysiology
Risk Factors
Signs & Symptoms
Nursing Assessment
Diagnostic Tests
Laboratory Tests
Medications
Nursing Interventions
Potential Complications
Patient Education
Clinical Judgment
Clinical Connections
NCLEX High-Yield
Memory Aids
Case Study
Practice Questions
Key Takeaways
References

Lesson Objectives

Differentiate generalized anxiety, panic disorder, phobias, OCD, and PTSD by cause, onset, core features, and functional impact and explain WHY.
Explain neurobiological pathophysiology: amygdala hyperactivity, HPA axis cortisol, norepinephrine, serotonin, GABA deficiency, and learned conditioning.
Identify levels of anxiety mild moderate severe panic and link to nursing actions stay with client, reduce stimuli, do not leave, do not restrain, short simple sentences.
Prioritize care: safety first, never force exposure, never interrupt compulsion abruptly, therapeutic communication, grounding, breathing, CBT, exposure response prevention ERP, EMDR.
Provide teaching for SSRIs 4-6 week lag, benzodiazepine short-term dependence fall risk, coping skills, trauma-informed care, and when to seek emergency.

Why This Disease Matters

Prevalence: Anxiety disorders most common mental illness US 40 million adults 19% yearly, lifetime 31%. GAD 3% yearly women 2x men, panic disorder 2-3%, specific phobia 12%, social phobia 7%, OCD 1-2% lifetime, PTSD 6-8% lifetime 12 million US yearly, veterans 15-30%. 60% chronic, onset childhood adolescence.

Patient safety: Panic mimics MI chest pain dyspnea tachy → misdiagnosed, but cannot assume panic until medical ruled out. Severe anxiety and PTSD increase suicide risk 2-3x, substance use self-medication, NMS serotonin syndrome from meds, falls from benzodiazepines. PTSD flashback dissociation → vulnerability exploitation, aggression when startled. OCD washing checking → skin breakdown falls from checking locks stove, time lost hours daily. Phobia avoidance → impaired functioning. Restraint worsens anxiety trauma re-traumatization.

NCLEX importance: Psychosocial Integrity heavily tested. Levels of anxiety mild restlessness ↑ learning, moderate narrowed focus needs direction, severe can't think disorganized needs safety, panic unable to function disorganized may have psychotic features needs stay with client do not leave. Panic attack: stay with client, short simple sentences, reduce stimuli, do not touch without permission, offer PRN per order, no open-ended questions in panic. OCD: never interrupt compulsion abruptly → ↑ anxiety, allow time before procedure, ritual is coping. Phobia: never force exposure flooding without consent. PTSD: trauma-informed care, grounding 5-4-3-2-1 technique, avoid triggers loud noises touch, no restraints, assess suicide, nightmares flashbacks. Medications SSRIs first line sertraline paroxetine, buspirone for GAD no sedation dependence but 2-4 weeks lag, benzodiazepines alprazolam short-term 2-4 weeks dependence fall risk respiratory depression, propranolol for performance anxiety.

Why nurses encounter them: Every setting ED chest pain anxiety, primary care chronic anxiety, school phobia, med-surg pre-op anxiety, psych unit panic PTSD OCD. Therapeutic communication is nursing.

Connecting to prior lessons From A&P: Limbic system amygdala fear center, HPA axis hypothalamus pituitary adrenal cortisol stress, sympathetic norepinephrine fight-flight ↑ HR BP RR diaphoresis pupils dilate, GABA inhibitory calming deficient in anxiety. From assessment: MSE appearance behavior speech mood affect thought perception cognition, anxiety scale 0-10, GAD-7 PHQ-9 C-SSRS, cultural expressions susto. Defense mechanisms intellectualization rationalization displacement.

Disease Overview

Disorder	What it is	Core feature	Functional impact
Generalized Anxiety Disorder GAD	Excessive worry >6 months 3+ symptoms restless fatigue concentration irritability muscle tension sleep disturbance hard to control	Chronic apprehension free-floating anxiety	Work school impaired concentration
Panic disorder	Recurrent unexpected panic attacks abrupt intense fear 10 min peak + 4+ somatic symptoms palpitations dyspnea chest pain choking dizzy derealization fear dying + worry about next attack	Full sympathetic alarm false MI	Avoidance agoraphobia can't leave house
Phobias — specific, social, agoraphobia	Marked irrational fear of object situation social scrutiny, avoidance, anxiety out of proportion	Conditioned fear — blood injection injury spiders heights flying	Avoidance limits life
OCD	Obsessions recurrent intrusive thoughts images urges anxiety-provoking + compulsions repetitive behaviors mental acts aimed to neutralize anxiety washing checking counting, time >1h day distress	Anxiety → obsession → compulsion → relief → loop	Hours daily skin breakdown
PTSD	After trauma actual/threatened death serious injury sexual violence — 4 clusters: intrusion re-experiencing flashbacks nightmares, avoidance of reminders, negative mood cognition guilt blame, arousal hypervigilance startle insomnia >1 month functional impairment	Alarm stuck on after trauma	Nightmares flashbacks avoidance can't work relationships suicide risk

Pathophysiology

Normal physiology: Stress → amygdala signals hypothalamus → HPA axis cortisol and sympathetic norepinephrine → HR ↑ BP ↑ RR ↑ glucose mobilized pupils dilated diaphoresis — fight-flight adaptive. GABA inhibits anxiety, serotonin mood regulation. After stress, parasympathetic returns baseline. Coping adaptive exercise support problem solving. ↓ What goes wrong — Anxiety GAD: Genetics + temperament + trauma → amygdala hyperactive + prefrontal cortex underactive can't regulate fear + GABA deficiency insufficient inhibition + serotonin norepinephrine imbalance + HPA axis chronic cortisol ↑ → chronic worry muscle tension restless fatigue insomnia irritability concentration poor. WHY muscle tension: sympathetic chronic contraction. WHY fatigue: cortisol exhausts Selye exhaustion stage. Learning: worry reinforced by temporary relief. ↓ Panic: Locus coeruleus norepinephrine burst → sudden massive sympathetic activation HR ↑ BP ↑ RR ↑ dyspnea chest pain choking dizziness paresthesia derealization fear dying fear losing control peak 10 min → catastrophic interpretation → more norepinephrine loop. WHY chest pain dyspnea: sympathetic bronchial constriction intercostal tension hyperventilation ↓ CO2 paresthesia. Agoraphobia avoidance prevents panic but reinforces fear. ↓ Phobia: Classical conditioning — neutral object paired with fear trauma → amygdala learns object = danger → avoidance prevents extinction → anxiety maintained. Social phobia fear scrutiny amygdala hyperactive. WHY avoidance: reduces anxiety short term reinforces long term. ↓ OCD: Genetics + basal ganglia orbitofrontal cortex hyperactive error detection + serotonin low + learned: obsession intrusive thought "germs will kill" → anxiety ↑ → compulsion washing checking counting → anxiety ↓ temporarily → reinforced → loop time-consuming. WHY not psychosis: insight often preserved "I know irrational but can't stop". WHY skin breakdown: washing compulsion. ↓ PTSD: Trauma actual threatened death injury sexual violence → amygdala hyperactive stores fear memory + hippocampus smaller impaired context + prefrontal cortex underactive can't extinguish + HPA axis dysregulation cortisol low paradoxically but norepinephrine high → intrusion flashbacks nightmares re-experiencing triggered by reminders, avoidance to reduce distress, negative mood cognition guilt blame anhedonia, arousal hypervigilance exaggerated startle insomnia irritability. WHY flashback: amygdala replays trauma as if now. WHY avoidance: reduces distress short term maintains PTSD. Trauma-informed brain. ↓ Progression: Chronic untreated → depression 60% comorbidity, substance self-medication → withdrawal ↑ anxiety, suicide risk ↑, occupational dysfunction, medical illness HTN cardiac due to chronic sympathetic. OCD hours lost, PTSD dissociation.

Risk Factors

Non-modifiable	Modifiable / Preventable	High-risk populations
Genetics first-degree anxiety OCD PTSD, temperament behavioral inhibition shy, age child adolescent onset anxiety phobia, female GAD panic 2x, history trauma ACEs	Chronic stress, trauma abuse neglect combat sexual assault accident, learned behavior overprotective parenting modeling, substance caffeine nicotine stimulants withdrawal alcohol benzodiazepine withdrawal, medical hyperthyroid cardiac, poor coping, sleep deprivation, social isolation, lack support, overuse social media	Women GAD panic phobia 2x, children adolescents separation anxiety social phobia, veterans first responders survivors abuse assault disaster, healthcare workers chronic stress, family history anxiety OCD, prior trauma ACEs score high

Signs and Symptoms

Category	Finding & WHY
Early — GAD	Restlessness feeling keyed up, fatigue, concentration poor, irritability, muscle tension headache, sleep disturbance. WHY: chronic sympathetic cortisol ↑ tension.
Early — Panic attack	Abrupt fear peak 10 min + 4+ : palpitations tachy, dyspnea chest tightness, choking, dizzy lightheaded paresthesia tingling hyperventilation ↓ CO2, derealization depersonalization, fear dying losing control. WHY: norepinephrine burst sympathetic + hyperventilation ↓ CO2.
Early — Phobia	Marked fear of specific object situation social scrutiny out of proportion, anxiety when exposed, avoidance, knows irrational. WHY: conditioned amygdala.
Early — OCD	Obsessions intrusive thoughts contamination harm symmetry → anxiety, compulsions washing checking counting ordering praying repetitive to neutralize >1h day. WHY: basal ganglia error detection loop.
Early — PTSD	Intrusion flashbacks nightmares distress at reminders, avoidance thoughts places people, negative mood guilt blame anhedonia detachment, arousal hypervigilance startle insomnia irritability anger. WHY: amygdala hyperactive hippocampus context failure.
Expected — Levels of anxiety	Mild: restless increased awareness learning ↑, Moderate: narrowed focus needs direction, Severe: can't think disorganized needs safety short sentences, Panic: unable to function disorganized may have psychotic features needs stay with client do not leave. WHY: anxiety impairs cognition Yerkes-Dodson inverted U mild improves performance severe impairs.
Late / Complicated	Chronic GAD depression anhedonia, panic agoraphobia housebound, phobia avoidance life limited, OCD skin breakdown dermatitis from washing, time hours lost job loss, PTSD depression substance self-medication suicide risk, dissociation depersonalization.
Emergency	Panic mimics MI chest pain dyspnea must rule out medical emergency first, severe anxiety with SI plan, PTSD flashback dissociation violence risk when startled, OCD severe self-harm from compulsion, serotonin syndrome hyperthermia clonus after SSRI + MAOI, substance withdrawal.

Red flags Panic chest pain dyspnea — rule out MI PE asthma before assuming panic. Panic with SI plan means intent — safety first. PTSD flashback dissociation command hallucinations? Assess safety. Severe anxiety can't swallow breathe — O2? Serotonin syndrome hyperthermia tremor clonus diaphoresis confusion after SSRI + MAOI. Never force exposure in phobia — re-traumatization. Never interrupt OCD compulsion abruptly — ↑ anxiety severe.

Nursing Assessment

Subjective: Chief complaint worry fear panic ritual trauma. HPI OLDCARTS: onset duration frequency triggers coping what helps what worsens, severity 0-10 anxiety panic frequency. Past psych history anxiety depression trauma abuse, suicide attempts self-harm, prior hospitalizations therapy what helped, trauma ACEs type when, substance caffeine nicotine alcohol drugs last use withdrawal. Meds adherence psychotropics side effects, medical hyperthyroid cardiac asthma meds theophylline steroids. Social stressors school work family finances housing legal relationships support system cultural beliefs about anxiety trauma, strengths. Coping adaptive vs maladaptive, defense mechanisms. Spiritual. Sleep appetite libido. Suicide: ideation intent plan means protective factors ask directly. PTSD: trauma type date, intrusion flashbacks nightmares avoidance negative mood arousal >1 month, dissociation, guilt blame, substance self-medication, functioning.

Objective: Vitals HR ↑ BP ↑ RR ↑ temp? diaphoresis, weight loss, general appearance grooming hygiene, behavior psychomotor agitation pacing restless vs retardation, tremor, eye contact culturally appropriate, speech rate volume pressured loud rapid vs slow, mood subjective anxious fearful, affect objective congruent constricted labile, thought process logical vs circumstantial flight ideas vs obsession rumination, thought content worry catastrophic SI/HI delusions, perception no hallucinations vs flashback dissociation, cognition alert oriented x4 attention concentration impaired anxiety, memory, insight judgment good vs impaired, GAD-7 PHQ-9 C-SSRS PCL-5 PTSD checklist, Y-BOCS OCD severity, MSE. Milieu: stimuli noise crowd, safety contraband.

Priority / Focused	Why / Action
Levels of anxiety mild moderate severe panic	Mild restless learning ↑ encourage problem solving, moderate narrowed focus needs direction short sentences reduce stimuli, severe disorganized can't think safety stay with client short simple sentences low stimuli do not leave, panic unable to function may have psychotic features stay with client do not leave reduce stimuli short simple sentences offer PRN per order do not touch without permission no open-ended questions.
Panic attack vs medical MI PE	Panic palpitations dyspnea chest pain choking dizzy paresthesia derealization fear dying peak 10 min, but chest pain dyspnea must rule out medical MI PE asthma first — vitals ECG O2 pulse oximetry per order before assuming panic, notify provider.
PTSD trauma-informed	Intrusion flashbacks nightmares avoidance negative mood arousal hypervigilance startle insomnia >1 month, ask trauma with permission "Is it okay to ask about trauma?" avoid re-traumatization, grounding 5-4-3-2-1, assess suicide substance dissociation, no restraints loud noises touch without permission, nightmares sleep.
OCD ritual time	Obsessions contamination harm symmetry + compulsions washing checking counting >1h day distress, assess time skin breakdown, never interrupt abruptly → severe anxiety, allow time before procedure, ERP exposure response prevention per therapy, assess insight, depression suicide risk.
Phobia avoidance	Specific fear out of proportion avoidance knows irrational, assess fear object situation social scrutiny, never force exposure flooding without consent gradual systematic desensitization per therapy, breathing coping.

Diagnostic Tests

Test	Purpose / Why / Findings / Nursing
Clinical interview DSM-5-TR criteria + PHQ-9 GAD-7 PCL-5 PTSD Checklist Y-BOCS Yale-Brown OCD Scale C-SSRS	Purpose diagnosis severity. GAD excessive worry >6 months 3+ symptoms, panic recurrent unexpected attacks + worry about next, phobia marked fear avoidance out of proportion 6 months, OCD obsessions + compulsions >1h distress, PTSD trauma + 4 clusters >1 month functional impairment. GAD-7 0-4 minimal 5-9 mild 10-14 moderate 15-21 severe, PCL-5 ≥31 PTSD probable, Y-BOCS severity. Nursing administer in private quiet therapeutic, explain purpose confidentiality limits.
Medical workup to rule out organic: TSH T4 hyperthyroid mimics anxiety, ECG, pulse oximetry, BMP, CBC, tox screen, ETOH level	Purpose rule out medical mimics hyperthyroid tachy anxiety, cardiac MI, asthma dyspnea, substance caffeine stimulant, withdrawal. Expected normal. Abnormal hyperthyroid TSH low T4 high anxiety tachy. Nursing vitals ECG O2 per order, explain medical must be ruled out before psych diagnosis, no caffeine 2h before.

Test

Purpose / Why / Findings / Nursing

Clinical interview DSM-5-TR criteria + PHQ-9 GAD-7 PCL-5 PTSD Checklist Y-BOCS Yale-Brown OCD Scale C-SSRS

Purpose diagnosis severity. GAD excessive worry >6 months 3+ symptoms, panic recurrent unexpected attacks + worry about next, phobia marked fear avoidance out of proportion 6 months, OCD obsessions + compulsions >1h distress, PTSD trauma + 4 clusters >1 month functional impairment. GAD-7 0-4 minimal 5-9 mild 10-14 moderate 15-21 severe, PCL-5 ≥31 PTSD probable, Y-BOCS severity. Nursing administer in private quiet therapeutic, explain purpose confidentiality limits.

Medical workup to rule out organic: TSH T4 hyperthyroid mimics anxiety, ECG, pulse oximetry, BMP, CBC, tox screen, ETOH level

Purpose rule out medical mimics hyperthyroid tachy anxiety, cardiac MI, asthma dyspnea, substance caffeine stimulant, withdrawal. Expected normal. Abnormal hyperthyroid TSH low T4 high anxiety tachy. Nursing vitals ECG O2 per order, explain medical must be ruled out before psych diagnosis, no caffeine 2h before.

Laboratory Tests

Lab	Purpose / Normal / Abnormal / Trend / Priority
TSH 0.4-4.0, T4 5-12, ECG, Glucose 70-140, Tox screen, BMP	Purpose rule out hyperthyroid anxiety tachy weight loss, hypoglycemia anxiety, substance stimulant, electrolyte imbalance. Normal TSH normal. Abnormal TSH low T4 high hyperthyroid anxiety tachy, needs treatment not just anxiolytic. Trend decreasing HR with treatment good. Priority chest pain dyspnea must rule out MI PE asthma first vitals ECG O2 notify provider STAT before assuming panic.
If on meds: LFTs, BUN/Cr, CBC if carbamazepine, Lithium level if mood stabilizer, Pregnancy test before meds	Purpose baseline before SSRIs benzodiazepines. Normal LFTs. Abnormal ↑ hold per provider. Priority pregnancy test before valproate teratogenic.

Medications

Class / Meds	Mechanism & Nursing/Teaching
SSRIs first line GAD panic OCD PTSD: Sertraline (Zoloft) Paroxetine (Paxil) Fluoxetine (Prozac) Escitalopram (Lexapro)	Mechanism: blocks serotonin reuptake ↑ serotonin calming. Indication: all anxiety disorders GAD panic OCD PTSD depression comorbidity. Side: nausea GI upset headache activation anxiety first week, sexual dysfunction, weight gain, SI ↑ first weeks Black Box Warning 24 yo. Serious: serotonin syndrome hyperthermia clonus tremor diaphoresis confusion after SSRI + MAOI St. John's wort. Nursing: take same time daily, 4-6 weeks for effect not PRN, continue even if feeling better, taper not abrupt discontinuation syndrome dizziness flu-like, monitor SI first weeks C-SSRS, teach no alcohol MAOI foods? Not needed for SSRI, no St. John's wort, report hyperthermia clonus.
SNRIs: Venlafaxine (Effexor XR) Duloxetine (Cymbalta) for GAD panic	Mechanism: blocks serotonin norepinephrine. Side: HTN venlafaxine, nausea, sexual dysfunction. Nursing: BP monitor venlafaxine, 4-6 weeks lag, taper, no MAOI.
Buspirone (BuSpar) for GAD only	Mechanism: 5-HT1A partial agonist anxiolytic no sedation dependence. Indication: GAD not panic OCD PTSD. Side: dizziness nausea headache. Nursing: 2-4 weeks lag not PRN, no sedation no dependence good for elderly, take consistently with/without food, no grapefruit? Not major, no alcohol, no benzodiazepine cross tolerance.
Benzodiazepines short-term 2-4 weeks: Alprazolam (Xanax) Lorazepam (Ativan) Clonazepam (Klonopin) Diazepam (Valium) — for panic severe anxiety acute	Mechanism: enhances GABA calming fast 30-60 min. Indication: acute panic severe anxiety short-term bridge until SSRI works. Contra: substance use history, elderly fall risk, COPD respiratory depression, pregnancy. Side: sedation dizziness fall, confusion elderly, respiratory depression, dependence tolerance withdrawal seizures if abrupt. Black box: concomitant opioid → profound sedation respiratory depression death. Nursing: short-term 2-4 weeks only, no driving, fall precautions, no alcohol opioids, taper not abrupt withdrawal seizures, monitor RR sedation, teach no driving, lock meds, elderly 0.5 dose, antidote flumazenil.
Beta-blocker Propranolol (Inderal) for performance anxiety panic somatic symptoms	Mechanism: blocks norepinephrine sympathetic ↓ HR tremor. Side: bradycardia hypotension bronchospasm asthma contraindicated. Nursing: HR BP before, hold if HR <60 SBP <100 per order, no abrupt stop, no asthma, take with food.
OCD specific: Clomipramine tricyclic, Antipsychotic augmentation per provider for severe OCD	Clomipramine serotonin, side anticholinergic sedation. Nursing EKG QT, no driving.
PTSD specific: Prazosin for nightmares per provider off-label, no benzodiazepines first line for PTSD worsens	Prazosin alpha blocker reduces nightmares, side orthostatic hypotension. Nursing BP HR, take at night, orthostatic teaching rise slowly.

Nursing Interventions — Prioritized

Priority	Intervention & WHY
Safety — ABCs always first	Vitals HR BP RR SpO2, rule out medical chest pain dyspnea ECG O2 per order before assuming panic, suicidal ideation with plan means intent — 1:1 remove ligatures notify STAT C-SSRS, panic stay with client do not leave reduce stimuli short simple sentences do not touch without permission no open-ended questions in panic offer PRN per order, PTSD flashback grounding 5-4-3-2-1 name 5 things you see 4 feel 3 hear 2 smell 1 taste reorient present safe, no restraints loud noises, OCD never interrupt compulsion abruptly → severe anxiety allow time before procedure ritual is coping, phobia never force exposure flooding without consent.
Breathing / Coping	Mild anxiety: encourage problem solving learning ↑. Moderate: short sentences reduce stimuli direction, breathing diaphragmatic 4-7-8 inhale 4 hold 7 exhale 8 WHY ↓ sympathetic, grounding 5-4-3-2-1 WHY brings to present, progressive muscle relaxation, mindfulness, CBT thought challenging, ERP exposure response prevention for OCD phobia gradual per therapy, EMDR for PTSD per provider.
Comfort	Low stimuli quiet private, limit caffeine nicotine stimulants, sleep hygiene, exercise 30 min daily, nutrition hydration, distraction music, support person if helpful, therapeutic communication open-ended reflection not false reassurance.
Education / Interdisciplinary	Psychiatry psychology CBT ERP EMDR, pharmacy med teaching, social work resources, support groups NAMI, teach SSRIs 4-6 weeks lag not PRN continue even if better taper not abrupt SI risk first weeks, buspirone 2-4 weeks lag no sedation dependence not PRN, benzodiazepines short-term 2-4 weeks dependence fall risk no driving no alcohol opioids taper not abrupt flumazenil antidote, propranolol HR BP hold if <60 <100 no asthma, prazosin orthostatic, exposure therapy gradual not flooding.

Potential Complications

Complication	Early signs	Nursing response / Emergency
Depression suicide 60% comorbidity, Substance self-medication	Anhedonia anergia worthlessness hopelessness guilt SI plan means, ↑ alcohol drugs	C-SSRS PHQ-9 Q9 positive → 1:1 remove ligatures notify STAT safety precautions, no safety contract alone, substance counseling, dual diagnosis referral.
Serotonin syndrome, Panic agoraphobia housebound, OCD skin breakdown time loss, PTSD dissociation	Hyperthermia clonus tremor diaphoresis confusion after SSRI + MAOI, panic avoidance can't leave house, OCD washing hands raw, PTSD flashback dissociation	Stop serotonergic agent notify STAT rapid response cooling benzodiazepines per order cyproheptadine per order, for agoraphobia gradual exposure per therapy not flooding, OCD skin care emollients allow time, PTSD grounding 5-4-3-2-1 trauma-informed.
Medical mimic missed MI PE	Chest pain dyspnea tachy	Rule out medical first ECG O2 vitals notify STAT before assuming panic.

Patient Education

Disease process: Anxiety alarm without danger GAD chronic worry 6 months, panic full alarm 10 min peak chest pain dyspnea fear dying, phobia conditioned fear avoidance, OCD obsession anxiety compulsion relief loop >1h day, PTSD alarm stuck after trauma 4 clusters intrusion avoidance negative mood arousal >1 month.
Lifestyle: Sleep hygiene 7-9h regular bedtime, exercise 30 min daily ↑ serotonin GABA, limit caffeine nicotine alcohol stimulants worsen anxiety, balanced diet hydration, mindfulness meditation yoga, breathing 4-7-8 grounding 5-4-3-2-1, CBT thought diary, avoid isolation, support system, no substance self-medication.
Med adherence: SSRIs 4-6 weeks for effect not PRN take same time daily continue even if better taper not abrupt discontinuation syndrome dizziness flu-like monitor SI first weeks Black Box <24 yo report hyperthermia clonus serotonin syndrome no St. John's wort MAOI, buspirone 2-4 weeks lag not PRN no sedation dependence no alcohol, benzodiazepines short-term 2-4 weeks only dependence fall risk no driving no alcohol opioids taper not abrupt seizures antidote flumazenil, propranolol HR BP hold if <60 <100 no asthma, prazosin orthostatic rise slowly take at night.
Home care: Coping card breathing grounding, exposure hierarchy for phobia OCD ERP gradual not flooding per therapy allow time ritual, PTSD grounding safe place avoid triggers loud noises ask permission before touch, sleep routine nightmare log prazosin per order, skin care if washing compulsion emollients, no caffeine before bed.
Follow-up: Therapy CBT ERP EMDR weekly, psychiatry med check, support groups NAMI, crisis hotline 988, PCP medical rule out.
Warning / Emergency: Chest pain dyspnea rule out medical call 911 if new severe, SI plan means intent call 988 1:1 emergency, serotonin syndrome hyperthermia clonus tremor diaphoresis confusion after new med combo emergency stop drug ER, PTSD flashback dissociation violence risk when startled safety plan, panic frequent worsening agoraphobia can't leave house → call provider.

Clinical Judgment (NCSBN CJMM)

Recognize Cues: 28F reports abrupt panic attack 15 min palpitations tachy 110 chest tightness dyspnea dizziness paresthesia tingling fear dying fear losing control peak 10 min 3x week, worry about next attack avoids grocery store agoraphobia, no chest pain with exertion no wheeze, caffeine 4 coffees day, no prior trauma, GAD-7 16 moderate-severe, PHQ-9 10 moderate Q9 denies SI, vitals HR 110 BP 128/78 RR 22 SpO2 98% RA, no fever, no SI plan, no substance other than caffeine, no hyperthyroid signs, ECG normal per provider.
Analyze Cues: Panic disorder recurrent unexpected panic attacks + 4+ somatic palpitations dyspnea chest tightness dizziness paresthesia derealization fear dying + worry about next attack + avoidance agoraphobia grocery store, rule out medical MI PE hyperthyroid — vitals ECG O2 normal caffeine 4 coffees worsens sympathetic, GAD-7 high anxiety moderate-severe, PHQ-9 moderate depression comorbidity 60%, no SI protective, no PTSD trauma no OCD ritual no specific phobia object but agoraphobia avoidance, mild-moderate anxiety level during interview moderate narrowed focus.
Prioritize Hypotheses: #1 Panic disorder with agoraphobia severe anxiety panic risk. #2 Risk for medical mimic must rule out before psych diagnosis but ECG normal. #3 Ineffective coping caffeine maladaptive avoidance.
Generate Solutions: Safety stay with client during panic short simple sentences reduce stimuli low noise do not leave do not touch without permission no open-ended questions in panic, offer PRN per order benzodiazepine short-term bridge, rule out medical ECG O2 per order already done notify provider if chest pain dyspnea new, breathing diaphragmatic 4-7-8 grounding 5-4-3-2-1, reduce caffeine nicotine, CBT panic psychoeducation thought challenging catastrophic interpretation, exposure hierarchy gradual not flooding for agoraphobia grocery store small steps, meds SSRI sertraline first line 4-6 weeks lag not PRN buspirone not for panic, benzodiazepine short-term 2-4 weeks dependence fall risk, propranolol for somatic, teach coping, support, crisis plan 988.
Take Action: Stayed with client during panic attack 15 min short simple sentences "I'm here, you are safe, breathe with me", reduced stimuli quiet room, offered water, PRN lorazepam 0.5mg per order short-term, vitals q15min HR 110→88 RR 22→18 SpO2 98%, ECG O2 already normal, notified provider, breathing teaching 4-7-8 grounding 5-4-3-2-1, caffeine reduction plan 4→1 coffee day, SSRI sertraline teaching 4-6 weeks lag not PRN taper not abrupt SI monitoring Black Box, referred CBT ERP for panic agoraphobia, support group, safety plan 988.
Evaluate Outcomes: After 1 week panic attacks 3x→1x week, HR resting 110→82, GAD-7 16→10, PHQ-9 10→7, uses breathing grounding, caffeine 1 coffee, attends therapy exposure hierarchy grocery store 5 min with support, no SI, no chest pain dyspnea new, no serotonin syndrome, adherence SSRI continues. Continue CBT gradual exposure not flooding, taper benzodiazepine per provider short-term, follow-up psychiatry 2 weeks, PCP caffeine hyperthyroid ruled out, crisis hotline 988 coping card.

Clinical Connections — commonly confused on NCLEX

Feature	GAD	Panic Disorder	Phobia	OCD	PTSD
Cause	Chronic worry + amygdala hyperactive GABA ↓	Locus coeruleus norepinephrine burst + catastrophic interpretation	Conditioned fear object situation social	Basal ganglia hyperactive + serotonin low + loop obsession → compulsion	Trauma actual threatened death injury sexual violence + amygdala hyperactive hippocampus smaller
Assessment	Worry >6 months 3+ restless fatigue concentration irritability muscle tension sleep	Recurrent unexpected panic attacks abrupt fear peak 10 min 4+ palpitations dyspnea chest pain choking dizzy paresthesia derealization fear dying + worry about next + avoidance agoraphobia	Marked fear specific object social scrutiny out of proportion avoidance 6 months knows irrational	Obsessions intrusive anxiety + compulsions washing checking counting >1h day distress insight often preserved	Trauma + 4 clusters intrusion flashbacks nightmares avoidance negative mood guilt anhedonia arousal hypervigilance startle insomnia >1 month
Diagnostics	GAD-7 severity	Clinical + rule out MI PE ECG O2	Clinical fear avoidance	Y-BOCS severity	PCL-5 ≥31 PTSD
Treatment	SSRI first line buspirone GAD only CBT coping breathing no caffeine	SSRI first line benzodiazepine short-term bridge propranolol somatic breathing grounding stay with client short sentences reduce stimuli do not leave, CBT panic, exposure gradual for agoraphobia	SSRI, CBT systematic desensitization gradual exposure not flooding without consent, breathing	SSRI higher dose often needed clomipramine, CBT ERP exposure response prevention never interrupt abruptly allow time ritual	SSRI sertraline paroxetine prazosin nightmares trauma-informed grounding 5-4-3-2-1 CBT EMDR no benzodiazepines first line no restraints loud noises touch permission safety
Priority nursing	Levels anxiety mild moderate severe panic actions, therapeutic communication, coping	Stay with client do not leave short simple sentences reduce stimuli no open-ended in panic offer PRN, rule out medical first	Never force exposure, breathing coping gradual	Never interrupt compulsion abruptly allow time ritual coping, assess skin breakdown time lost, ERP	Trauma-informed grounding no restraints, suicide assessment, nightmares, avoid triggers

NCLEX High-Yield Review — What the NCLEX Wants You to Know

Levels: mild restless learning ↑, moderate narrowed focus needs direction, severe can't think disorganized needs safety, panic unable to function stay with client do not leave short simple sentences reduce stimuli no open-ended questions no touch without permission offer PRN
Panic mimics MI chest pain dyspnea — rule out medical ECG O2 vitals before assuming panic — never dismiss chest pain
OCD never interrupt compulsion abruptly → ↑ severe anxiety — allow time ritual is coping — ERP exposure response prevention gradual per therapy
Phobia never force exposure flooding without consent — systematic desensitization gradual — breathing coping
PTSD trauma-informed grounding 5-4-3-2-1 avoid triggers loud noises touch permission no restraints nightmares flashbacks suicide risk substance
SSRIs first line GAD panic OCD PTSD 4-6 weeks lag not PRN taper not abrupt discontinuation syndrome Black Box SI <24 yo, buspirone GAD only 2-4 weeks lag no sedation dependence not PRN, benzodiazepines short-term 2-4 weeks dependence fall risk no driving no alcohol opioids Black Box profound sedation death with opioids antidote flumazenil
Serotonin syndrome hyperthermia clonus tremor diaphoresis confusion after SSRI + MAOI St. John's wort emergency stop drug

Common distractors: Leaving client in panic alone to calm down — stay with client. Asking open-ended questions in panic — short simple sentences only. Forcing phobia exposure — never force. Interrupting OCD ritual — never interrupt abruptly. Assuming chest pain panic without ruling out MI — always rule out medical first. Giving benzodiazepine long-term — short-term 2-4 weeks dependence. Using buspirone PRN — not PRN needs 2-4 weeks lag.

Memory Aids

Anxiety levels: M M S P — Mild restless learning ↑, Moderate narrowed focus needs direction, Severe can't think needs safety, Panic can't function stay with client short sentences reduce stimuli
Panic stay: S S R N — Stay with client, Short simple sentences, Reduce stimuli, No open-ended questions No leave
OCD: Don't I C — Don't Interrupt Compulsion abruptly
Phobia: Don't F — Don't Force Flooding
PTSD: T R A U M A — Trauma Re-experiencing Avoidance Unable mood Arousal >1 month — grounding 5-4-3-2-1
SSRIs: 4-6 weeks lag not PRN taper SI Black Box, Benzos: Short-term 2-4 weeks dependence fall no driving flumazenil

Case Study

Patient: John 30M veteran returns from combat 6 months ago reports nightmares flashbacks of IED explosion avoids crowds fireworks, hypervigilance startle loud noise, guilt "I should have saved buddy", anhedonia detachment from family, insomnia irritability anger, uses alcohol to cope, denies SI plan but passive "maybe better off dead", no HI, no command hallucinations, vitals HR 100 BP 130/84 RR 20 SpO2 97% RA, appears tense hypervigilant scanning, speech normal, mood anxious dysphoric affect constricted congruent, thought process linear, perception flashback dissociation not psychosis, cognition oriented x4 attention poor, insight fair, GAD-7 15 moderate-severe, PHQ-9 16 moderately severe Q9 passive SI, PCL-5 45 high PTSD probable, C-SSRS passive ideation no plan means.

Step 1 Recognize Cues: Trauma combat IED explosion 6 months ago, intrusion flashbacks nightmares distress at fireworks crowds, avoidance crowds fireworks thoughts, negative mood guilt blame anhedonia detachment, arousal hypervigilance exaggerated startle insomnia irritability anger >1 month functional impairment job family, alcohol maladaptive coping self-medication, passive SI "better off dead" no plan means but risk, no HI, no command hallucinations, tense hypervigilant scanning, GAD-7 15 PHQ-9 16 Q9 passive PCL-5 45 high, C-SSRS passive ideation, no medical chest pain dyspnea but HR 100 BP 130/84 mild sympathetic, substance caffeine? alcohol.

Step 2 Analyze Cues: PTSD diagnostic trauma actual threatened death + 4 clusters intrusion flashbacks nightmares avoidance negative mood guilt anhedonia arousal hypervigilance startle insomnia irritability >1 month functional impairment, comorbidity depression GAD-7 15 PHQ-9 16 moderate-severe, passive SI risk, substance alcohol self-medication increases risk, no active SI plan means but passive ideation needs safety assessment, hyperarousal sympathetic HR BP mild ↑, no medical mimic MI but rule out not needed now no chest pain dyspnea, trauma-informed care needed, no psychosis flashback dissociation vs hallucination, insight fair.

Step 3 Prioritize: #1 Safety passive SI risk + PTSD hyperarousal + substance alcohol. #2 PTSD symptoms flashbacks nightmares avoidance hypervigilance. #3 Ineffective coping alcohol guilt. #4 Self-care sleep.

Step 4 Plan: Safety C-SSRS detailed passive vs active intent plan means protective family, 1:1 if active SI plan, remove means, notify provider STAT psychiatry, trauma-informed approach ask permission before touching questions "Is it okay to ask about trauma?" avoid re-traumatization, grounding 5-4-3-2-1 safe place, reduce stimuli low noise, no restraints loud fireworks, sleep hygiene nightmare log prazosin per order if provider orders orthostatic teaching, substance counseling alcohol, coping adaptive breathing mindfulness exercise support, CBT trauma-focused EMDR per therapy referral, meds SSRI sertraline first line PTSD 4-6 weeks lag not PRN SI monitoring Black Box, no benzodiazepines first line worsens PTSD, propranolol not first line, involve family with consent support, crisis hotline 988 safety plan, cultural veteran stigma.

Step 5 Take Action: Provider notified psychiatry, C-SSRS passive ideation no plan means protective family faith but safety plan created means restriction remove firearms per policy, 1:1 not needed but q15min checks, trauma-informed grounding taught 5-4-3-2-1 practiced during flashback, quiet room no loud noises, permission before touch, sleep hygiene dark room no caffeine before bed, alcohol counseling referral AA, SSRI sertraline started per order teaching 4-6 weeks lag taper not abrupt SI monitoring, prazosin 1mg at night per order for nightmares orthostatic teaching rise slowly BP HR check, no benzodiazepines, CBT referral EMDR, support group veterans, family meeting with consent, crisis hotline 988 coping card.

Step 6 Evaluate & Discharge: After 1 week nightmares 5→2 week flashbacks less, hypervigilance decreased HR 100→84, GAD-7 15→9 PHQ-9 16→10 Q9 no passive SI now, PCL-5 45→30, no SI plan, uses grounding breathing, alcohol 6 beers→2 beers day, sleep 4h→6h, attends therapy, no serotonin syndrome, adherence SSRI continues. Discharge: meds sertraline prazosin teaching orthostatic no driving sedation, trauma-informed coping grounding safe place, CBT EMDR weekly, support groups NAMI veteran group, substance counseling, sleep hygiene no caffeine alcohol before bed, safety plan means restriction 988, when to seek emergency SI plan means flashback dissociation violence risk hyperthermia clonus serotonin syndrome. Follow-up psychiatry 1 week PCP.

NCLEX Practice Questions

1. A client is having a panic attack with palpitations, dyspnea, chest tightness, dizziness, fear of dying. What is priority nursing action?

Leave client alone in quiet room to calm down and ask open-ended questions about childhood
Tell client "You are having panic, not MI, don't worry" and give caffeine
Force client to do exposure to crowds immediately to prevent agoraphobia
Stay with client, do not leave, reduce stimuli quiet room, short simple sentences, do not touch without permission, vitals ECG O2 per order to rule out medical, offer PRN per order, breathing grounding 5-4-3-2-1 after acute

Rationale

Answer: 4. Why 4 correct: Panic level unable to function needs stay with client do not leave reduce stimuli short simple sentences no open-ended questions no touch without permission vitals ECG O2 to rule out medical MI PE before assuming panic offer PRN short-term benzodiazepine per order breathing grounding after. Why others wrong: 1. Leaving alone unsafe open-ended questions in panic overwhelms — short simple only. 2. False reassurance caffeine worsens sympathetic panic mimics MI must rule out medical first. 3. Forcing exposure flooding without consent re-traumatization never force.

2. A client with OCD washes hands 50 times day skin raw. What should the nurse do?

Interrupt washing abruptly and tell client to stop to prevent skin breakdown
Allow time for ritual before procedure, never interrupt abruptly, assess time skin breakdown, teach ERP exposure response prevention per therapy gradual, emollients skin care, SSRI teaching
Punish client for washing to extinguish behavior
Agree that washing is needed because germs will kill and provide extra soap

Rationale

Answer: 2. Why 2 correct: OCD ritual is coping never interrupt abruptly → severe anxiety, allow time before procedure, assess time skin breakdown, ERP gradual per therapy, SSRI first line high dose often needed, skin care emollients. Why others wrong: 1. Interrupting abruptly ↑ severe anxiety decompensation. 3. Punishment nontherapeutic worsens anxiety. 4. Agreeing with obsession reinforces OCD.

3. A client has PTSD after sexual assault reports flashbacks nightmares avoids reminders hypervigilance startle insomnia guilt. What is priority trauma-informed intervention?

Force client to recount trauma details loudly in crowded room to desensitize
Grounding 5-4-3-2-1 technique name 5 things you see 4 feel 3 hear 2 smell 1 taste, safe place, reduce stimuli low noise, ask permission before touch, avoid restraints loud noises, assess suicide, no benzodiazepines first line, SSRI prazosin nightmares per order
Restrain client to prevent flashbacks
Tell client "Forget trauma and move on"

Rationale

Answer: 2. Why 2 correct: PTSD trauma-informed grounding 5-4-3-2-1 brings to present safe, reduce stimuli low noise, permission before touch no restraints loud noises re-traumatization, suicide assessment, SSRI first line sertraline paroxetine prazosin nightmares orthostatic teaching, CBT EMDR per therapy. Why others wrong: 1. Forcing recount in crowded room re-traumatization violates trauma-informed consent. 3. Restraint worsens PTSD flashback re-traumatization. 4. "Forget trauma" dismissive nontherapeutic false reassurance.

4. A client with GAD is prescribed buspirone. What teaching is correct?

Take PRN for panic attacks works in 30 minutes no dependence
Take with grapefruit juice and alcohol for better effect
Buspirone for GAD only 2-4 weeks lag not PRN no sedation no dependence not for panic OCD PTSD, take consistently same time daily with/without food, no alcohol, continue even if feeling better
Stop abruptly when anxiety better no taper needed

Rationale

Answer: 3. Why 3 correct: Buspirone 5-HT1A partial agonist GAD only not panic OCD PTSD 2-4 weeks lag not PRN no sedation no dependence good elderly, take consistently, no alcohol, continue even if better. Why others wrong: 1. PRN 30 min is benzodiazepine not buspirone. 2. Grapefruit alcohol not recommended alcohol worsens anxiety. 4. Stop abruptly may cause return anxiety but not withdrawal like benzodiazepine but still taper per provider and continue even if better.

5. A client on sertraline and phenelzine MAOI develops hyperthermia 102F, tremor clonus diaphoresis confusion agitation. What should the nurse suspect?

Neuroleptic Malignant Syndrome NMS fever rigidity AMS autonomic instability after antipsychotic
Serotonin syndrome emergency — stop serotonergic agents notify provider STAT rapid response cooling vitals labs cyproheptadine per order
Extrapyramidal symptoms EPS tremor akathisia after antipsychotic
Panic attack

Rationale

Answer: 2. Why 2 correct: Serotonin syndrome hyperthermia clonus tremor diaphoresis confusion agitation after SSRI + MAOI St. John's wort combo excess serotonin emergency stop drug notify STAT cooling benzodiazepines cyproheptadine per order. Why others wrong: 1. NMS fever muscle rigidity AMS autonomic instability after antipsychotic haloperidol not SSRI+MAOI clonus absent in NMS. 3. EPS tremor akathisia rigidity but no hyperthermia AMS. 4. Panic chest pain dyspnea fear dying no hyperthermia clonus.

6. SATA. Which are expected findings in panic disorder? Select all that apply.

Pearly waxy nodule telangiectasia central ulceration nose
Recurrent unexpected panic attacks abrupt fear peak 10 min + 4+ somatic palpitations dyspnea chest pain choking dizziness paresthesia derealization fear dying fear losing control
Worry about next attack and avoidance agoraphobia can't leave house
Well-demarcated plaques silvery scale extensor elbows knees
Hyperventilation ↓ CO2 tingling, tachy HR ↑ BP ↑ RR ↑ diaphoresis

Rationale

Answers: 2, 3, 5. Why these: Panic recurrent unexpected attacks peak 10 min 4+ palpitations dyspnea chest pain choking dizzy paresthesia derealization fear dying losing control worry about next avoidance agoraphobia hyperventilation ↓ CO2 tingling sympathetic HR BP RR ↑ diaphoresis. Why others not panic: 1. BCC pearly waxy nodule nose skin cancer. 4. Psoriasis well-demarcated plaques silvery scale extensor.

7. SATA. Which are appropriate for PTSD care? Select all that apply.

Force exposure flooding without consent in crowded noisy room
Trauma-informed care grounding 5-4-3-2-1 safe place reduce stimuli low noise ask permission before touch no restraints
Assess suicide C-SSRS PHQ-9 Q9 substance use dissociation sleep nightmares
Use restraints to prevent flashbacks and tell client to forget trauma
SSRI sertraline paroxetine first line prazosin for nightmares orthostatic teaching CBT EMDR per therapy support groups crisis hotline 988

Rationale — Click

Answers: 2, 3, 5. Why these: PTSD trauma-informed grounding safe place reduce stimuli permission before touch no restraints suicide assessment C-SSRS PHQ-9 substance dissociation nightmares SSRI first line prazosin nightmares orthostatic CBT EMDR support 988. Why others wrong: 1. Force flooding without consent re-traumatization never force. 4. Restraints forget trauma nontherapeutic worsens PTSD.

8. Priority. Four clients: Client A panic attack chest tightness dyspnea HR 115 RR 24 SpO2 96%, Client B OCD washing hands, Client C phobia spiders stable, Client D GAD worry 5/10 stable. Who should the nurse see first?

Client 1 GAD worry 5/10 stable
Client 2 phobia spiders stable
Client 3 OCD washing hands stable
Client 4 panic attack chest tightness dyspnea HR 115 RR 24 SpO2 96% — rule out medical MI PE first

Rationale

Answer: 4. Why 4 first: Panic chest tightness dyspnea HR 115 RR 24 must rule out medical MI PE asthma first ECG O2 vitals notify provider STAT before assuming panic — ABCs safety. Why others later: 1. GAD worry 5/10 stable routine coping breathing CBT. 2. Phobia stable routine gradual exposure not flooding. 3. OCD washing stable allow time skin care ERP.

9. Delegation. Which task can the RN delegate to LPN/VN for a client with GAD?

Assess and diagnose PTSD vs panic and decide on EMDR
Interpret PCL-5 and prescribe SSRI
Check vitals anxiety scale 0-10 sleep appetite report SI plan means palpitations chest pain dyspnea and reinforce breathing grounding coping per plan and administer meds per order
Teach initial diagnosis of OCD and order ERP

Rationale

Answer: 3. Why 3 delegatable: LPN/VN can check vitals anxiety scale sleep appetite report SI plan means palpitations chest pain dyspnea reinforce breathing grounding coping per plan administer meds per order. Why others RN only: 1. Assess diagnose PTSD vs panic decide EMDR RN/provider. 2. Interpret PCL-5 prescribe SSRI provider/RN. 4. Teach initial diagnosis OCD order ERP provider/RN.

10. NGN Case Study. A 22F college student reports contamination obsession "germs will kill" washes hands 100x day 3h day skin raw bleeding, checking locks 20x, intrusive thoughts, knows irrational but can't stop, avoids classes due to time, GAD-7 14 moderate PHQ-9 12 moderate Q9 denies SI, Y-BOCS 28 severe, no HI, no command hallucinations, no trauma, no panic chest pain dyspnea, no substance, no hyperthyroid, vitals HR 88 BP 110/70 RR 18 SpO2 98% RA, appearance anxious hygiene fair hands raw, speech normal, mood anxious affect constricted, thought process ruminative obsession, insight fair, no SI plan.

a) What condition and cues support it? b) What are 3 priority actions and why? c) What indicates improvement and what teaching?

Model answer

a) OCD severe: Obsessions contamination "germs will kill" intrusive anxiety-provoking + compulsions washing hands 100x day 3h day checking locks 20x repetitive to neutralize anxiety >1h day distress time-consuming avoids classes functional impairment, knows irrational but can't stop insight fair, Y-BOCS 28 severe, GAD-7 14 PHQ-9 12 moderate comorbidity, no SI plan, no HI, no command hallucinations, no trauma PTSD, no panic chest pain dyspnea, no phobia specific object avoidance but compulsion not phobia, no medical hyperthyroid, hands raw bleeding skin breakdown.

b) Priorities: 1) Safety skin breakdown infection + time management — never interrupt compulsion abruptly → severe anxiety, allow time before procedure ritual is coping, assess time skin breakdown, emollients wound care per order, hand hygiene alternative, no punishment. 2) Therapeutic communication and ERP — CBT ERP exposure response prevention gradual per therapy not flooding, breathing grounding, thought challenging, allow extra time for ADLs, reduce stimuli, support. 3) Medications and coping — SSRI sertraline fluoxetine higher dose often needed for OCD 4-6 weeks lag not PRN taper not abrupt SI monitoring Black Box, clomipramine tricyclic alternative, teach no benzodiazepines first line for OCD, coping adaptive exercise journaling support groups, sleep hygiene, no caffeine, involve family with consent, assess depression suicide risk PHQ-9 Q9.

c) Improvement: Washing 100x→20x day time 3h→1h day Y-BOCS 28→16, hands raw→healed emollients, GAD-7 14→8 PHQ-9 12→6, attends classes, uses ERP breathing, no SI, no infection. Teaching: SSRI 4-6 weeks lag not PRN continue even if better taper not abrupt SI risk Black Box, clomipramine side anticholinergic, never interrupt compulsion abruptly allow time ritual coping ERP gradual per therapy not flooding, skin care emollients, coping breathing grounding, support groups NAMI, sleep hygiene no caffeine, when to seek emergency SI plan means skin infection fever hyperthermia clonus serotonin syndrome, crisis hotline 988. Follow-up psychiatry therapy CBT ERP weekly.

Key Takeaways

GAD chronic worry >6 months 3+ restless fatigue concentration irritability muscle tension sleep — SSRI first line buspirone GAD only 2-4 weeks lag not PRN no sedation dependence — CBT breathing coping no caffeine.
Panic abrupt fear peak 10 min 4+ palpitations dyspnea chest pain choking dizzy paresthesia derealization fear dying + worry about next avoidance agoraphobia — stay with client do not leave short simple sentences reduce stimuli no open-ended no touch without permission offer PRN short-term benzodiazepine bridge — rule out MI PE ECG O2 first.
Phobia marked irrational fear object social avoidance out of proportion 6 months knows irrational — never force exposure flooding without consent gradual systematic desensitization breathing.
OCD obsessions intrusive anxiety + compulsions washing checking counting >1h day distress — never interrupt abruptly allow time ritual is coping — ERP exposure response prevention gradual — SSRI high dose often needed clomipramine — skin breakdown care.
PTSD trauma + 4 clusters intrusion flashbacks nightmares avoidance negative mood guilt anhedonia arousal hypervigilance startle insomnia >1 month — trauma-informed grounding 5-4-3-2-1 safe place reduce stimuli permission before touch no restraints — SSRI sertraline paroxetine prazosin nightmares orthostatic CBT EMDR — suicide substance assessment.
Levels anxiety mild restless learning ↑ moderate narrowed focus needs direction severe can't think disorganized safety severe panic unable to function — SSRIs 4-6 weeks lag not PRN taper SI Black Box, benzos short-term 2-4 weeks dependence fall no driving no alcohol opioids flumazenil, serotonin syndrome hyperthermia clonus emergency.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.
National Institute of Mental Health. (2023). Anxiety disorders, panic disorder, OCD, PTSD statistics and treatment. NIMH.
Townsend, M. C., & Morgan, K. I. (2023). Psychiatric mental health nursing: Concepts of care in evidence-based practice (11th ed.). F. A. Davis.
Videbeck, S. L. (2020). Psychiatric-mental health nursing (8th ed.). Wolters Kluwer.
Varcarolis, E. M. (2021). Essentials of psychiatric mental health nursing (4th ed.). Elsevier.
Stein, M. B., & Sareen, J. (2015). Generalized anxiety disorder. New England Journal of Medicine, 373(21), 2059-2068.
Kroenke, K., Spitzer, R. L., Williams, J. B. W., et al. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317-325. GAD-7.
Weathers, F. W., Litz, B. T., Keane, T. M., et al. (2013). The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD.
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al. (1989). The Yale-Brown Obsessive Compulsive Scale. Archives of General Psychiatry, 46(11), 1006-1011. Y-BOCS.
American Nurses Association, American Psychiatric Nurses Association, & International Society of Psychiatric-Mental Health Nurses. (2022). Psychiatric-mental health nursing: Scope and standards of practice (3rd ed.). ANA.

Anxiety & Trauma-Related Disorders

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Welcome & Getting Started

Launch RN Simulator

Wellness Center

Nursing Foundations

Fundamentals & Safety

Pharmacology

Dosage Calculations

Leadership, Management & Delegation

Medical-Surgical Body Systems

Neurological System

Sensory System

Endocrine System

Respiratory System

Cardiovascular System

Hematologic/Immune/Lymphatic System

Gastrointestinal (GI) System

Renal & Genitourinary

Reproductive System

Musculoskeletal System

Integumentary System

Specialty Areas

Maternity

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Pediatrics

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NCLEX Success Center

Clinical Judgment Practice

Prioritization Practice

Delegation Practice

Lab Values

Final Review