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NCLEX · Crisis Intervention

A client in the emergency department is hyperventilating and says: 'I can't breathe — I'm dying.' Vital signs are: RR 32, SpO2 98%, HR 102. What is the most likely cause and appropriate nursing response?

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Correct answer

Panic attack with hyperventilation — stay calm, speak slowly and reassuringly, encourage slow controlled breathing, reassure that their oxygen saturation is normal, and avoid telling them to 'calm down'

  1. A Pulmonary embolism — prepare anticoagulation
  2. B Asthma attack — prepare bronchodilators
  3. C Panic attack with hyperventilation — stay calm, speak slowly and reassuringly, encourage slow controlled breathing, reassure that their oxygen saturation is normal, and avoid telling them to 'calm down'
  4. D Respiratory failure — prepare for intubation

Why this is the answer

Panic attack with hyperventilation:

Clinical picture: SpO2 98% confirms adequate oxygenation (true respiratory emergency would show declining SpO2); rapid rate is from anxiety, not hypoxia; patient is ventilating EXCESSIVELY (not insufficiently).

Hyperventilation physiology: Blowing off CO2 causes respiratory alkalosis → cerebral vasoconstriction → lightheadedness, tingling, chest tightness → increased fear → more hyperventilation (vicious cycle).

Management: Stay with the client; calm, unhurried presence; speak slowly and quietly; reassure about SpO2 ('Your oxygen level is perfectly normal'); coach slow diaphragmatic breathing (inhale 4 counts, exhale 6 counts); do NOT use paper bag over face (outdated, can cause hypoxia); rule out medical causes (pulmonary embolism has similar presentation but SpO2 would be declining); obtain 12-lead ECG to rule out cardiac cause; anxiolytic may be ordered.

Communication: Never say 'you just need to calm down' — this is dismissive and escalates anxiety.

Source: NCLEX-PN PS — Crisis Intervention, Panic Attack Hyperventilation

Practice more questions

This question is from our NCLEX Practice Tests practice test. Take the full practice test to test your knowledge across all Crisis Intervention and other topics.

Take the PN: Psychosocial Integrity practice test →

About this topic: Crisis Intervention

Crisis intervention on the NCLEX-PN tests the immediate priorities when a client is in acute distress: safety first, a calm and directive approach, assessing suicide or violence risk, and knowing when to escalate. Questions are scenario-based and usually have a single safest action. This is one of 1 PN: Psychosocial Integrity questions on crisis intervention, each with a full explanation on a single study page.

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