Melissa is a 20-year-old nursing student who visits her primary care provider for a refill on her birth control pills. During the admission assessment, Melissa shares with the intake nurse that her “anxiety has gotten much worse” during nursing school. She states, “I always feel tired, but I can’t sit down and relax. I feel like there is always more studying that I should be doing for my classes. Even though I’m tired at night, I don’t sleep well and wake up frequently throughout the night. If I can’t go back to sleep, I turn on my computer and study. I have also been getting headaches every day, and I think it is from being on the computer so much every day. My boyfriend keeps asking me why I am so crabby. Lately I have had a lot of test anxiety, and sometimes my mind goes blank during an exam even though I have memorized all of the material.”

The primary care provider diagnoses Melissa with Generalized Anxiety Disorder and encourages her to attend a local support group with other people experiencing anxiety. A beta-blocker is prescribed on an “as needed” basis for before exams or other types of performance assessments, and a referral is made to a psychotherapist for cognitive behavioral therapy. The discharge nurse encourages Melissa to talk about her anxieties with a close personal friend or family member, as well as implement other stress management strategies like daily exercise, healthy food choices, and journaling. She encourages Melissa to decrease her screen time before bedtime and to avoid studying in bed.

Melissa returns to the clinic in one month for a follow-up appointment. She reports that the stress management techniques have helped her to sleep better and improve her concentration. She took a beta-blocker before a recent exam and reports it helped reduce her anxiety, and she did not experience her mind going blank. She plans on seeing a psychotherapist after the semester ends if she still needs assistance with managing her anxiety.