A nurse on an inpatient mental health unit is assisting with the care of a client who is experiencing panic level anxiety. Which of the following findings should the nurse expect?

A. Voice tremors are typically associated with mild or moderate anxiety. In these cases, clients may exhibit nervousness, slight shakiness, or tremulous speech, but they retain rational thought and can still process information. Voice tremors alone do not indicate a panic state. B. Shakiness is a physical symptom that often accompanies moderate anxiety. It reflects sympathetic nervous system activation—like increased heart rate or muscle tension—but the client can usually maintain focus and follow instructions. C. Poor concentration also appears with mild to moderate anxiety, where stress may cause distraction or difficulty focusing, but clients are still capable of problem-solving and decision-making. D. Depersonalization is a hallmark symptom of panic-level anxiety. It involves a sense of detachment from oneself or the environment, feelings of unreality, or as if one is observing themselves from outside their body. At this level, the client may also experience tunnel vision, distorted perceptions, palpitations, hyperventilation, chest pain, and fear of losing control or dying. Cognitive functioning is severely impaired, making it difficult for the client to communicate or follow directions.