A nurse in a mental health facility is assessing a client.

• The client has a medical history of major depressive disorder for 20 years, anxiety disorder, suicide ideation during teenage years, and psychotherapy for the past 10 years with a therapist.
• The client's mother committed suicide when the client was 25 years of age, and the father died of heart disease 10 years ago.
• The client has a history of alcohol misuse, attended in-patient rehabilitation 4 years ago with no alcohol use since that time.
• The nurse notes indicate good physical health with no reported morbidities.

For each client assessment finding, specify if the finding is a potential risk for suicide or a protective factor against suicide.

Choice A rationale: Having the client join a therapy group immediately upon admission might not be the most therapeutic action. The client is experiencing panic-level anxiety, which is characterized by a heightened state of arousal and fear. Introducing the client to a group setting at this time could potentially increase their anxiety levels due to the unfamiliar environment and people.

Choice B rationale: Suggesting that the client rest in bed might seem like a good idea, as rest can help reduce stress and anxiety. However, this action alone might not be the most therapeutic for a client experiencing panic-level anxiety. The client might continue to experience high levels of anxiety while alone in their room, and without the presence of a healthcare professional, they might not have the necessary support to manage their anxiety.

Choice C rationale: Remaining with the client for a while is the most therapeutic action at this time. The presence of the nurse can provide a sense of safety and security for the client, which can help reduce their anxiety levels. The nurse can also use this time to assess the client’s anxiety levels, provide reassurance, and implement appropriate interventions to help manage the client’s anxiety.

Choice D rationale: Medicating the client with a sedative might help reduce the client’s anxiety levels, but it should not be the first action taken. Medication should be considered as part of a comprehensive treatment plan that includes non-pharmacological interventions, such as providing a safe and supportive environment, using therapeutic communication, and teaching the client coping strategies.

Choice A rationale: Agoraphobia is a type of anxiety disorder where the person fears and avoids places or situations that might cause them to panic, feel trapped, or helpless. The goal of treatment for agoraphobia is to help the person feel less anxious and fearful about being in places or situations that they perceive as difficult to escape from. This is often achieved through a combination of cognitive-behavioral therapy (CBT) and medication. In CBT, the person learns to understand and change thought patterns that lead to troublesome feelings, behaviors, and symptoms.

Gradual exposure to the feared situation, under controlled conditions, can help the person gain better control over their anxiety. Therefore, the statement “I plan to sit on a park bench for a few minutes each day” indicates an understanding of the goals of treatment as it suggests a willingness to gradually expose oneself to feared situations.

Choice B rationale: The statement “I can try participating in group therapy every week” does not necessarily indicate an understanding of the goals of treatment for agoraphobia. While group therapy can be beneficial for many mental health conditions, it is not specific to the treatment of agoraphobia. In the context of agoraphobia, the focus of treatment is more on individual cognitive-behavioral therapy and gradual exposure to feared situations.

Choice C rationale: The statement “I will join a book club in my neighborhood” does not necessarily indicate an understanding of the goals of treatment for agoraphobia. Joining a book club could potentially provide social support and a sense of community, which can be beneficial for mental health in general. However, it does not specifically address the fears and avoidance behaviors associated with agoraphobia.

Choice D rationale: The statement “I should avoid entering elevators and other closed spaces” indicates a misunderstanding of the goals of treatment for agoraphobia. Avoidance of feared situations is a common symptom of agoraphobia, and treatment aims to reduce this avoidance behavior, not reinforce it. Therefore, this statement suggests a need for further education about the goals of treatment.