A nurse works with a patient to establish goals/outcomes. The nurse believes that one outcome suggested by the patient is not in the patient’s best interest. What is the nurse’s best action?

Choice A reason: Active suicidality, linked to severe serotonin deficits, requires inpatient hospitalization for constant monitoring to ensure safety. Partial hospitalization is insufficient for acute risk, as it lacks 24-hour supervision, making this patient inappropriate for this less intensive care setting.

Choice B reason: Agoraphobia and panic episodes, driven by norepinephrine surges, benefit from partial hospitalization’s structured psychoeducation and therapy. Relaxation techniques reduce amygdala hyperactivity, supporting outpatient management with daily support, making this patient suitable for partial hospitalization’s intensive, non-residential treatment.

Choice C reason: Stable lithium levels indicate controlled bipolar disorder, not requiring partial hospitalization. Regular follow-up manages neurotransmitter balance, suitable for outpatient care. Partial hospitalization is for active symptoms, not stable patients, making this an incorrect referral choice.

Choice D reason: Alcohol use concerns suggest outpatient substance abuse programs, not partial hospitalization. While dopamine reward pathways are involved, partial hospitalization targets acute psychiatric symptoms, not substance issues alone, making this patient unsuitable for this level of care.

Choice A reason: Discussing ego states is rooted in transactional analysis, not cognitive therapy. Ego states involve conscious and unconscious personality aspects, unrelated to addressing cognitive distortions like negative self-perception in inadequacy. Cognitive therapy targets thought patterns, not personality structures, making this approach scientifically irrelevant for the described intervention.

Choice B reason: Cognitive therapy focuses on identifying and modifying distorted thoughts, such as irrational beliefs about inadequacy, which are linked to altered serotonin and dopamine signaling in depression. By restructuring these thoughts, the therapy improves emotional regulation and behavior, aligning with evidence-based treatment for addressing feelings of inadequacy.

Choice C reason: Negative reinforcement is a behavioral therapy technique, not cognitive therapy. It involves removing aversive stimuli to increase desired behaviors, unrelated to addressing cognitive distortions like self-blame. Cognitive therapy targets thought patterns, not behavioral conditioning, making this approach scientifically inappropriate for the described therapeutic context.

Choice D reason: Focusing on unconscious processes is psychoanalytic, not cognitive, therapy. Inadequacy feelings stem from conscious cognitive distortions, not unconscious conflicts. Cognitive therapy corrects faulty thinking linked to neurotransmitter imbalances, not repressed memories, making this option misaligned with the scientific basis of the therapy described.