The PMHNP is asked to evaluate a 21-year-old woman with a tear of her anterior cruciate ligament (ACL). The orthopedic surgeon who requested the evaluation says the patient has been in the hospital for 2 days and is scheduled for surgery tomorrow. The patient complains of anxiety about her upcoming surgery. She is afebrile, her heart rate is 95, and her blood pressure is 110/76. She is not currently in pain; her knee pain is controlled by acetaminophen. Which of the following is the most appropriate medication for this patient based on this scenario?

Choice A reason: Carbamazepine is an anticonvulsant used for seizure disorders and certain mood disorders. It does not have a rapid anxiolytic effect suitable for acute preoperative anxiety. Choice B reason: Clonidine is an alpha-2 agonist used for hypertension and sometimes off-label for anxiety, but it is not first-line for acute situational anxiety and has slower onset than benzodiazepines. Choice C reason: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used for chronic anxiety and depression. It does not act rapidly enough for acute preoperative anxiety. Choice D reason: Lorazepam is a benzodiazepine with rapid onset that can effectively reduce situational anxiety before surgery. It is appropriate for short-term use in acute anxiety scenarios such as preoperative stress, with careful monitoring for sedation and respiratory effects.