An older male resident of a long-term care facility who is chronically depressed has become more reclusive and refuses to leave his room today. His family moved away from the local area, and they are unable to visit as much as they did in the past. Which comment by the nurse is likely to be most helpful to this client?

Choice A reason: Cancer screening, anger, gastritis, and daily intake are not part of the CAGE questionnaire, which focuses on cut down, annoyance, guilt, and eye-opener. These factors are unrelated to the validated screening tool, making this incorrect for exploring alcohol use based on CAGE criteria.

Choice B reason: The CAGE questionnaire screens for alcohol dependence by assessing efforts to cut down, annoyance when questioned, guilt about drinking, and using alcohol as an eye-opener. These directly identify problematic drinking patterns, aligning with addiction screening evidence, making this the correct choice for in-depth exploration.

Choice C reason: Consumption, liver enzymes, and gastrointestinal issues are relevant to alcohol use but not part of the CAGE questionnaire. CAGE focuses on behavioral indicators like guilt and annoyance. This choice includes non-CAGE criteria, making it incorrect for the screening tool’s specific focus.

Choice D reason: Minimizing drinking and missing family events are not CAGE criteria, though guilt is. The full CAGE framework (cut down, annoyance, guilt, eye-opener) better captures alcohol dependence. This choice is incomplete and includes non-CAGE items, making it incorrect for CAGE-based exploration.

Choice A reason: Progressive exposure to crowds is part of desensitization but is not the highest priority initially. Without trust and a safe environment, exposure may overwhelm the client, hindering therapy. Establishing trust ensures the client feels secure to engage in desensitization, making this less immediate than building rapport.

Choice B reason: Substituting positive thoughts helps manage anxiety but is secondary to establishing trust. Without a safe, trusting environment, cognitive strategies may be ineffective for a client with agoraphobia. Trust facilitates engagement in therapy, making this intervention less critical than creating a calm, supportive setting initially.

Choice C reason: Establishing trust by providing a calm, safe environment is the highest priority, as it builds the foundation for desensitization therapy. For agoraphobia, feeling secure enables the client to engage in exposure and cope with anxiety, aligning with psychiatric nursing principles for anxiety disorder management.

Choice D reason: Deep breathing is a useful coping strategy for anxiety but is less critical than establishing trust. Without a safe environment, the client may not feel secure enough to practice techniques during crowd exposure. Trust is foundational for therapeutic success, making this intervention secondary.