The family of a patient with schizophrenia who has been stable for a year reports to the community mental health nurse that the patient reports feeling tense and having difficulty concentrating. He sleeps only 3 to 4 hours nightly and has begun to talk about creatures called 'volmers' hiding in the warehouse where he works and undoing his work each night. This information most likely suggests:

Correct Answer: D

Rationale: The correct answer is D: relapse of his schizophrenia. The patient's symptoms of feeling tense, difficulty concentrating, poor sleep, and delusional beliefs about creatures at work indicate a worsening of his psychotic symptoms. This suggests a relapse of schizophrenia, a chronic mental illness characterized by periods of stability and exacerbation of symptoms. The patient's previous stability for a year makes medication nonadherence less likely. While psychoeducation may be beneficial, the patient's current symptoms require more immediate intervention for relapse management. The information provided does not directly indicate the chronic nature of his illness, but rather an acute exacerbation. Therefore, D is the most appropriate choice based on the presented symptoms and clinical understanding of schizophrenia.

Correct Answer: B

Rationale: The correct answer is B: Confusion and disbelief. During the acute phase of rape-trauma syndrome, the victim may experience feelings of confusion and disbelief as they try to process the traumatic event. This initial reaction is a common response to such a severe and violating experience. The victim may struggle to comprehend what has happened to them, leading to feelings of shock and disbelief. This phase is characterized by emotional numbing, disorientation, and difficulty in making decisions. Decreased motor activity (Choice A) is not specific to the acute phase of rape-trauma syndrome and can be a general response to trauma. Flashbacks and dreams (Choice C) are more commonly associated with the intrusion phase of the syndrome, which occurs after the acute phase. Fears and phobias (Choice D) may develop later in the reorganization phase of the syndrome as the victim tries to cope with the aftermath of the trauma.

Correct Answer: A

Rationale: The correct answer is A: The acute phase reaction. This behavior is characteristic of the immediate emotional response following a traumatic event like sexual assault. The victim may exhibit shock, disbelief, and emotional distress. In this scenario, the victim's reaction of disbelief and repetitive statements align with the acute phase reaction. The other options are incorrect because the angry stage (B) and delayed reaction (C) occur later in the trauma response process, while the long-term phase (D) reflects a more prolonged period of adjustment and coping.

Correct Answer: A

Rationale: The correct answer is A: The need for the batterer to control. This is the key component in wife battering, as it is rooted in the batterer's desire to establish power and dominance over their partner. Teaching batterers more effective ways to cope involves addressing this underlying need for control. Explanation of other choices: B: Alcohol abuse by the batterer - While alcohol abuse may exacerbate violent behavior, it is not the primary cause of wife battering. C: History of psychotic behavior - Psychotic behavior may contribute to violence, but it is not the key component in wife battering. D: Failure of the woman to assert herself - Blaming the victim is not appropriate; the responsibility lies with the batterer's need for control.

Correct Answer: A

Rationale: The correct answer is A because using open-ended questions allows the client to express themselves freely, promoting a sense of control and empowerment. This approach helps build trust and rapport, enabling the client to share their experiences more openly. Choice B is incorrect because closed-ended questions limit the client's ability to fully express themselves. Choice C is incorrect as open-ended questions encourage deeper reflection and discussion, which may not be easily understood by anxious individuals. Choice D is incorrect because while clients can refuse to answer sensitive questions, open-ended questions actually encourage them to share more, rather than withhold information.