A nurse is reinforcing teaching with a client who has schizophrenia.
The nurse should identify which of the following manifestations as an indication of relapse?

Choice A rationale

Expressing increased comfort with their altered appearance in the mirror indicates a positive step towards acceptance of the changed body image following a mastectomy. This suggests the client is beginning to integrate the physical changes into their self-perception and is moving towards adaptation.

Choice B rationale

Worrying about a partner's perception, while a normal concern, does not necessarily indicate acceptance of the altered body image. It suggests preoccupation with external validation and potential insecurity about the physical changes' impact on the relationship, rather than internal acceptance.

Choice C rationale

Preferring loose-fitting clothing to conceal the changes suggests a desire to hide the altered body rather than accepting it. This behavior indicates a lack of comfort and potentially negative feelings about the mastectomy's physical consequences, hindering the process of body image adaptation.

Choice D rationale

Focusing on recovery and adapting to the changes demonstrates a proactive and accepting attitude towards the altered body image. This statement indicates a willingness to integrate the changes into their life and move forward, signifying a positive adjustment to their post-mastectomy self-perception.

Choice A rationale

Seeking out a staff member during urges to self-harm demonstrates the effectiveness of a verbal safety contract. This behavior indicates the client is adhering to the agreement by reaching out for support instead of acting on the urges, signifying an increased ability to manage self-destructive impulses through communication and engagement with the treatment team.

Choice B rationale

Spending time alone when experiencing overwhelming feelings might indicate avoidance rather than effective coping. While some alone time can be therapeutic, relying solely on isolation could prevent the client from practicing new coping skills and engaging with support systems, potentially undermining the safety contract's goal of seeking help.

Choice C rationale

Avoiding discussion of difficult emotions with the treatment team suggests a lack of trust or engagement in the therapeutic process. An effective safety contract relies on open communication about feelings and urges to ensure the client receives timely support and can work through difficult emotions in a safe environment.

Choice D rationale

Attempting to suppress feelings of anger and frustration is an unhealthy coping mechanism. Suppressing emotions can lead to a buildup of internal tension, potentially increasing the likelihood of acting on self-harm urges. A safety contract aims to help the client identify and express emotions in constructive ways, not suppress them.