A nurse is caring for a client who has factitious disorder. The client states, "I am so tired of living like this. Maybe I should just end it all." Which of the following actions should the nurse take?

A. Determining whether the client has entered an alter personality is relevant to dissociative identity disorder, not factitious disorder. In factitious disorder, the client intentionally produces or feigns symptoms, often for attention or care, but they do not have distinct personalities that take control. When a client expresses suicidal thoughts, focusing on diagnostic differentiation is secondary to immediate safety. B. Encouraging relaxation techniques, such as deep breathing or mindfulness, may be helpful in managing anxiety or stress in the long term, but it is not the priority when a client expresses suicidal ideation. Focusing on relaxation first could delay critical safety interventions. C. Any statement such as “Maybe I should just end it all” is a serious warning sign. The nurse’s priority is to assess the client for suicidal ideation and self-harm. This includes asking direct questions about thoughts, plans, intent, and access to means. A thorough assessment allows the nurse to determine the immediate level of risk and implement safety measures, such as one-to-one observation, removing dangerous items, or involving mental health providers. This action aligns with the nursing principle of client safety as the top priority. D. While group therapy can be a valuable component of long-term psychiatric treatment, it is not an immediate intervention when a client expresses potential suicidal thoughts. The nurse must first ensure the client’s safety and stabilize risk before moving on to therapy or skill-building activities.