Psych EAQ's

A patient with paranoid schizophrenia tells the nurse, "I'm here on a top-secret mission for the President. Don't tell anyone I am here." Which response by the nurse would be most therapeutic? "You have lost touch with reality, which is a symptom of your illness." "Let's talk about something other than your mission for the President." "Your admission papers do not list you as an employee of the President." "It sounds like you have some concerns about your privacy. You are safe here."

"It sounds like you have some concerns about your privacy. You are safe here." It is important not to challenge the patient's beliefs, even if they are unrealistic. Challenging undermines the patient's trust in the nurse. The nurse should try to understand the underlying feelings or thoughts that the patient's message conveys.

The nurse understands that the "I" in "SOAPIE" stands for what? Intention Irregularity Intervention Intravenous

"SOAPIE" is an acronym for problem-oriented charting and stands for "subjective data, objective data, assessment, plan, intervention, and evaluation." Intention, intravenous, and irregularity are not part of SOAPIE.

During a one-to-one session a patient is crying while telling the nurse of his or her father's recent death from a car accident. Which nursing response illustrates empathy? I know that you will get over this. It just takes time." "That must have been such a hard situation to deal with." "I'm so sorry. My father died two years ago, so I know how you are feeling." "You need to focus on yourself right now. You deserve to take time just for you."

"That must have been such a hard situation to deal with." The statement "That must have been such a hard situation to deal with" reflects understanding of the patient's feelings, which is empathy. Feeling sorry for the patient represents sympathy, whereas not addressing the patient's concern belittles the patient's feelings of grief he or she is expressing by changing the subject. Telling the patient he or she will get over it does not reflect empathy and is closed-ended.

A nurse is interviewing a patient who has attempted suicide. What question does the nurse ask to start the interview? "What if you hadn't survived?" "Are you happy that you survived?" "What made you attempt suicide?" "Did you really want to commit suicide?"

"What made you attempt suicide?" A nurse always starts an interview by asking open-ended questions of the patient, like what made the patient attempt suicide. This helps to know the patient and establishes a rapport. Whether the patient is happy about his or her survival or whether the patient really wanted to attempt suicide are closed-ended questions. These questions limit the conversation and stop the patient from sharing information. "What if you hadn't survived?" is a projective question that may make the patient feel guilty and hinder the conversation. p. 143

A registered nurse is called to testify as a fact witness in a trial. As a fact witness, to what can the nurse testify? What was witnessed What the nurse was told by a third party What was witnessed or performed personally What was documented by other healthcare workers

A fact witness testifies regarding what was personally seen or heard, performed, or documented regarding a patient's care and testifies to first-hand experience only. Fact witnesses cannot testify to what was told to them by another person, only what they witnessed themselves. The nurse may testify only to documentation that he or she performed.

An expert witness is recognized by the court as having which of the following? Evidence of a crime having been committed A higher level of skill or expertise in a designated area Law enforcement knowledge to be a consultant to a defense attorney A thorough knowledge of the laws and rules that the defense uses to provide evidence to the court

A higher level of skill or expertise in a designated area An expert witness is recognized by the court as having a higher level of skill or expertise in a designated area. The expert witness usually testifies regarding his or her involvement with the patient as well as any documentation made by the expert witness.

An adult patient has been admitted with signs and symptoms that support a diagnosis of severe anxiety. Which assessment data will the nurse recognize as a possible physical source of the patient's symptomology? SATA a.septicemia b.b12 deficiency c.hypoglycemia d.hyperthyroidism e.CHF

A,C,D,E Several medical conditions and physical illnesses may mimic psychiatric illnesses. Conditions that can mimic anxiety include CHF, hyperthyroidism, hypoglycemia, septicemia, and more. B12 deficiency is associated with depression, not anxiety.

During a clinical interview the patient falls silent after disclosing that she was sexually abused as a child. The nurse should Allow the patient to break the silence Reach out and gently touch the patient's arm Reassure the patient that the abuse was not her fault Quickly break the silence and encourage the patient to continue

Allow the patient to break the silence Silence is not a "bad" thing. It gives the speaker time to think through a point or collect his or her thoughts. p. 142

Which type of nursing diagnosis does the nurse use for a patient who has a high probability of developing pressure ulcers due to "wanting to only stay in bed" related to fatigue and severe depression? a. risk b. health promotion c.rating scale d. problem focused

Answer- Risk The nurse would use a risk diagnosis for the patient who has a high probability of developing pressure ulcers. Risk diagnoses are used when patients have a high probability of developing problematic experiences or responses. Common problems involving secondary risk include falls, self-injury, pressure ulcers, and infection.

The nurse is newly assigned to care for a patient with anxiety. What are the possible approaches the nurse can use while caring for this patient? Arrange for a chaplain, if the patient agrees to it. Provide comfort items before they are requested. Communicate clearly and concretely with the patient. Always tell things that the nurse can do for the patient. Avoid using distractions such as magazines and video games.

Arrange for a chaplain, if the patient agrees to it. Provide comfort items before they are requested. Communicate clearly and concretely with the patient. Always tell things that the nurse can do for the patient. Providing comfort items such as herbal tea before they are requested to a patient with baseline anxiety can help in building rapport. The nurse should also try to minimize ambiguity to reduce anxiety by communicating clearly and concretely with such patients. The nurse should also tell the patient clearly about the things that the nurse can do and cannot do for the patients. Help from a chaplain can also aid in reducing the anxiety levels, if the patient agrees to it. Distractions such as magazines and video games may be used to distract the patient from the stressors causing anxiety.

A nurse preparing an education plan includes a component designed to help the patient access and use community supports. The nurse can consider the educational component successful when the patient does which of the following? Identifies stressful events Remains medication compliant Can discuss early signs of relapse Arranges to attend a money management workshop

Arranges to attend a money management workshop Although each outcome is desirable, only a money management workshop relates directly to accessing and using community supports.

Which communication techniques should the nurse use with a patient who has been identified as having difficulty expressing thoughts and feelings? Using emotionally charged words and gestures Offering opinions and avoiding periods of silence Asking open-ended questions and seeking clarification Asking closed-ended questions requiring "yes" or "no" answers

Asking open-ended questions and seeking clarification Open-ended questions give the patient the widest possible latitude in answering. Also, the patient can take the lead in the interview. Seeking clarification helps the patient clarify his or her own thoughts and promotes mutual understanding.

A nurse is about to interview a patient whose glasses and hearing aid were placed in safekeeping during admission. Before beginning the interview, the nursing intervention that will best facilitate data collection is to Give the patient the glasses and hearing aid Assist the patient in putting on glasses and hearing aid Explain the importance of wearing the hearing aid and glasses Ask the patient if he or she needs his or her glasses and hearing aid

Assist the patient in putting on glasses and hearing aid A patient whose hearing or sight is impaired may have difficulty providing information if these items have been removed from his or her possession. Assisting the patient in wearing these assistive devices is the best initial intervention.

A juvenile is quite impressed by the forensic nurse generalist caring for him. The juvenile asks the forensic nurse generalist more about the profession. What educational background is needed in order to work as a forensic nurse generalist? Baccalaureate or associate degree or diploma Completing a certificate program in the area of forensic nursing Educational background in psychiatric assessment and intervention Medical knowledge to make expert judgments based on autopsy results Educational background in sexual assaults of all types and in varied populations

Baccalaureate or associate degree or diploma Completing a certificate program in the area of forensic nursing Forensic nurse generalists should be able to assess and treat victims of violence, collect and preserve evidence, and properly document all these acts. They need to be proficient in understanding the legal system. They are usually nurses with a baccalaureate or associate degree or a diploma in nursing. In addition, they acquire special knowledge and skills by completing a certificate program in an area of forensic nursing. Forensic nurses in advanced practice are those who have completed graduate level education with a broad focus on forensic nursing. They have an educational background in psychiatric assessment and intervention, and sexual assaults of all types with varied populations. They also have the knowledge to make expert judgments based on autopsy results in the role of a nurse coroner.

The nurse is providing discharge teaching to an adult patient with anger and aggression. The patient has two small children at home. Which concept should the nurse discuss with this patient? The patient should leave the children whenever angry. See if the children can stay with a relative or a friend. Children can learn aggression by observing it in others. Report to the healthcare provider if the children start acting out violently.

Children can learn aggression by observing it in others. Social learning researchers believe that children learn aggression by observing and imitating the behavior of others. In this scenario, the parent should be taught this information so that the parent can be aware of the fact that the children may be observing any angry or aggressive behaviors. It is not appropriate for the nurse to suggest leaving the children alone, having others watch the children, or reporting if the children act out violently. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. p. 506

A forensic nurse is appointed as a criminal profiler. What is the responsibility of the nurse as a criminal profiler? Act as an advocate to the perpetrator and his or her family. Constantly assess the behavior of the perpetrator in the jail. Collect all the data available at the crime scene, and reconstruct the evidence. Be a part of an investigation team in white-collar crimes but not in serial crimes.

Collect all the data available at the crime scene, and reconstruct the evidence. A forensic nurse can act as a criminal profiler. The responsibilities of a criminal profiler nurse are to collect all the data available at the crime scene and reconstruct the evidence. They are especially involved in psychopathology criminal cases. They are involved in serial crime cases, so assessment of the psychology of the perpetrator should be performed. This helps to trace the pattern of crime and stop it. The criminal profiler should not act as an advocate of the perpetrator and his or her family. This is the role of the consultant. The criminal profiler need not assess the behavior of the perpetrator continuously. This is the role of the forensic nurse examiner and hostage nurse.

A patient tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the patient may be experiencing a.Congruence b.Empathetic feelings c.Countertransference d.Positive transference

Positive Transference Transference involves the patient experiencing feelings toward a nurse that belong to a significant person in the patient's past.

Which statement is true regarding the practice of correctional facility nursing? Delusional behaviors currently are reported in 25% of state prison inmates. Correctional nursing includes the delivery of both medical and mental health care services. Incarcerated men and women are at high risk for serious medical and mental health illnesses. Currently one in four federal inmates diagnosed with a mental health problem receives treatment. The experience earned by a correctional nurse meets the qualifications for forensic nursing practice.

Delusional behaviors currently are reported in 25% of state prison inmates. Correctional nursing includes the delivery of both medical and mental health care services. Incarcerated men and women are at high risk for serious medical and mental health illnesses. Currently one in four federal inmates diagnosed with a mental health problem receives treatment. Incarcerated men and women have higher rates of serious and chronic physical and mental illnesses than the general population. Correctional facilities are required to provide "adequate" health services to inmates, either directly or through community health services organizations. This includes treatment for both mental and physical illness. According to the United States Department of Justice (2006), one in four federal prisoners with a mental health problem received treatment during their incarceration. Delusions and hallucinations were the most commonly identified psychotic symptoms, with 25% of state inmates reporting at least one of the two symptoms. Education is the key in determining the level of expertise and whether one merits the title forensic nurse (either psychiatric mental health or correctional). Working in a correctional setting does not qualify one as a forensic nurse; rather, it is the advanced education and clinical practice that qualifies one as a forensic nurse.

Which of the following would not be considered a responsibility of a psychiatric forensic nurse? Forensic examiner Direct care to inmates Competency therapist Consultant to law enforcement

Direct care to inmates The psychiatric forensic nurse may function as a forensic examiner, competency therapist, consultant to law enforcement, or consultant to the criminal justice system. Correctional nurses provide nursing care directed to inmates' physical and mental health needs.

A multi-infarct dementia patient has clouding of the sensorium and gets agitated and aggressive. What interventions are appropriate to ensure the patient's safety? Place the patient's bed near the doorway Display the patient's schedule in the room Keep familiar objects in the patient's room Place a rocking chair near the patient's bed Ensure that the patient is in a social environmen

Display the patient's schedule in the room Keep familiar objects in the patient's room Place a rocking chair near the patient's bed Patients with multi-infarct dementia get aggressive due to disorientation and the clouding of sensorium. The nurse can reduce stress and aggression in these patients by increasing orientation. The nurse should establish a daily routine and display the schedule in the patient's room. The nurse should place a rocking chair in the patient's room. It helps in relaxing and is a rhythmic source of self-soothing. Patients can be made comfortable by placing familiar objects and photographs around. The patient's bed must be placed away from the doorway. The patient should be kept in such a place where there are minimal sensory stimuli. This would help in calming the patient. pp. 515-516

A nursing student wishes to study further to be able to initiate and conduct research in the field of forensics. What is the minimum educational degree that the nurse needs to obtain to be able to do this? Clinical nurse specialist Certified nurse-midwife Doctor of nursing practice Doctor of philosophy in nursing

Doctor of philosophy in nursing A doctor of philosophy (PhD) degree prepares the nurse to be able to start and carry out research in the field of forensics. Such research ultimately enhances the practice of forensic nursing. Nurses with the credentials of clinical nurse specialist or certified nurse midwife have graduate level education with a broad focus on forensics. They have knowledge about nursing and legal content and are able to collaborate among the disciplines in the care of victims and perpetrators. A doctor of nursing practice (DNP) degree prepares the nurse to be able to evaluate evidence-based forensic medicine. They are thus able to apply such evidence for the enhancement of education, clinical practice, systems management, and nursing leadership. p. 602

A nurse is assigned to conduct a clinical interview of a patient with Alzheimer's disease. The nurse starts the interview by asking the patient, "What would you like to discuss?" Which therapeutic technique did the nurse follow? Giving broad openings Suggesting collaboration Exploring the patient's thoughts Encouraging description of perception Eugene on target

Giving broad openings The nurse asked a question that made the patient articulate his or her thoughts better. The question indicated that the patient should start the conversation. Therefore, the nurse used the therapeutic technique of broad openings. Description of perception helps the nurse to understand the patient's perception. Exploring is aimed at knowing the ideas and experiences of the patient. Collaboration deals with communication related to working with the patient on the patient's problems. p. 143, Table 9.2

When approaching an angry patient, which safety considerations should be taken? Stand close to the patient for reassurance and to convey caring. Call security and wait until they arrive before approaching the patient. Have other staff as backup, and stand far enough away to avoid injury. Take the patient to his or her room so the nurse can speak with him or her alone.

Have other staff as backup, and stand far enough away to avoid injury. Safety considerations for staff include enlisting other staff to be present, keeping a safe distance from the patient, and approaching the patient in a nonthreatening or nonconfrontational manner. Standing close to the patient or having the patient go to his or her room with the nurse do not allow for staff safety; security personnel may escalate the patient's behavior and should be kept in the background until needed to assist. Furthermore, the patient has an immediate need to be assisted by staff if possible without waiting for security. p. 509

Which statement is true regarding cognitive-behavioral therapy (CBT)? Identifies distorted thinking Effective in reducing delusion Employs the technique of "self-talk" Assists in improving social functioning Negative reinforcement is used to change behaviors

Identifies distorted thinking Effective in reducing delusion Employs the technique of "self-talk" Assists in improving social functioning CBT has been shown to be effective in helping persons with serious mental illness (SMI) reduce and cope with symptoms, such as delusions and impaired social functioning. The cognitive component of CBT focuses on patterns of thinking and "self-talk". It identifies distorted thinking and negative self-talk, and guides patients to substitute more effective forms of thinking. The behavioral component of CBT uses natural consequences and positive reinforcers (rewards) to shape the person's behavior in a more positive or adaptive manner.

How will the nurse working with a patient diagnosed with severe and persistent mental illness implement rehabilitation principles? Reviewing earlier treatment plans for errors Focusing assessment on the patient's deficits Identifying and reinforcing the patient's strengths Considering the need to lower expectations periodically

Identifying and reinforcing the patient's strengths Although deficits are assessed and addressed, implementation of rehabilitation is dependent on reinforcement of identified patient strengths.

Which statement is true regarding incarcerated persons and serious mental illness? Incarceration often causes decompensation in those with serious mental illness. Incarceration does not appear to play a role in how a person with serious mental illness functions. Those with serious mental illness who are incarcerated see remission of symptoms while in prison. Incarceration plays a role in that people with serious mental illness receive treatment they may have not had outside of prison.

Incarceration often causes decompensation in those with serious mental illness. Correctional nurses provide care for many patients with serious mental illness. Because psychiatric facilities for the management of such emergencies are scarce, often these patients end up in jail instead of in a hospital. Once they are in jail, their psychiatric condition often worsens without adequate psychiatric intervention. Incarcerated patients see a remission of symptoms while in prison and incarceration does not appear to play a role in how a person with serious mental illness functions are not correct statements, and incarceration may in fact prevent the inmate from receiving appropriate treatment.

Why does the prognosis of a patient with serious mental illness seem threatened even though initially the patient does well? Ineffective follow-up visits Interruptions in treatment Degraded quality of medicines Resistance to taking medications Drug costs and increased co-pays

Interruptions in treatment Resistance to taking medications Drug costs and increased co-pays Patients with chronic mental illness may have interruptions of treatment for several reasons, such as financial problems or shifting to some less costly neighborhood far from essential resources. They develop a resistance to taking medications because of anosognosia, or lack of awareness. This affects their health and prognosis. Mental illness drugs are very costly. The increasing co-pays create difficulties for unemployed persons. This also may be a reason for discontinuing treatment or treatment irregularity and the patient's prognosis is affected. The follow-up visits are effective for providing continuous treatment and care and for monitoring the disease. The medicines are properly regulated, and each batch is checked for quality before coming to the market.

The nurse is educating a patient on the importance of establishing a meaningful life. What is considered an appropriate way of achieving a meaningful life? Learning to help others or volunteering Concentrating on things other than the illness Properly following plans for institutionalization Being punctual and well-mannered for every medical visit

Learning to help others or volunteering A patient with mental illness faces many difficulties in life. To establish a meaningful life, the patient should reset his or her goal in life. Ways like learning to help others or volunteering can set an achievable goal and add meaning to life. The nurse should also teach the patient about the illness and how to overcome it. Institutionalization mainly focuses on illness and living with it. It does not focus on providing meaning to life. The patient becomes dependent on others and has low confidence and self-esteem. The patient should be punctual for each follow-up visit, but this is not related to having a meaningful life.

Which neurotransmitter imbalance has been shown to be related to impulsive aggression? Low levels of serotonin High levels of dopamine High levels of acetylcholine Low levels of γ-aminobutyric acid

Low levels of serotonin Low serotonin levels have been implicated in several research studies as being a factor in impulsive aggression. There is no current research to support low levels of γ-aminobutyric acid, high levels of dopamine, or high levels of acetylcholine.

What is the role of the nurse coroner? Preserving potential evidence Creating appropriate treatment plans Acting as a consultant to law enforcement agencies Making an expert judgment regarding the circumstances of death

Making an expert judgment regarding the circumstances of death The nurse coroner assesses the deceased by understanding his or her condition and by using evidence. Therefore, the nurse coroner is involved in making an expert judgment regarding the circumstances of death. Preserving potential evidence and creating appropriate treatment plans are the roles of forensic nurses. A psychotherapist acts as a consultant to law enforcement agencies.

The nurse maintains a record of regular supplies of hot meals, clothing, transportation, and mailing addresses of patients with severe mental illness. Which community service (or program) can the nurse use to perform these functions? Guardianship Housing services Multiservice centers Partial hospital programs

Multiservice centers There are many community services and programs for the effective treatment and care of patients with severe mental illness. Multiservice centers work in collaboration with the other services listed to supply hot meals, clothing, and mailing address to the patient. Housing services are provided to patients who have committed an offense while suffering from severe mental illness. It helps the patient to maintain stability and live independently without depending on others. In partial hospital programs, the patient is given treatment similar to that provided to an inpatient of a psychiatric ward. Patients from inpatient units are referred to partial hospitalization programs after effective treatment. These programs help to stabilize the patient within the community and their surroundings. In guardianship, a person is appointed to make treatment decisions for a patient with impaired judgment.

A nurse is assessing anger and aggression in geriatric patients. What appropriate factors should the nurse assess in the patients? Presence of delusions Tendency to cause harm to others Presence of preoccupied thoughts Presence of attention-seeking behavior Feelings of helplessness in a stressful situation

Presence of delusions Tendency to cause harm to others Anger and aggression in geriatric patients is indicated by presence of delusions, hyperactivity, and irritability. The patients develop a tendency to cause harm to others due to their delusional state. Presence of attention-seeking behavior is seen in histrionic personality disorders and it doesn't indicate the aggressiveness of the patient. Feelings of helplessness are seen in depressive patients when they are exposed to stressful situations. Patients with aggressiveness adopt defensive behavior when exposed to stressful situations. Presence of preoccupied thoughts can be used to assess obsessive-compulsive disorder.

When considering the interaction between verbal and nonverbal communication, what is the best word to complete this analogy: verbal communication relates to content as nonverbal communication relates to Touch Conflict Process Double messages

Process The verbal message is sometimes referred to as the content of the message, and the nonverbal behavior is called the process of the message.

Which statement by the nurse reflects the process occurring in the clinical interview? "You are frowning. What are you feeling?" "When is your child custody hearing going to be held?" "What makes you think your health care provider will give you a pass?" "Give me an example of something your wife does that 'drives you nuts.'"

Process refers to nonverbal behavior. Nonverbal behavior is often a more accurate gauge of patient feelings than what is being verbalized. p. 141

A patient with dissociative identity disorder tells the nurse, "Unknowingly I committed theft in my house." The nurse asks the patient, "If you were given a chance to go back and change your action, would you?" Which category of question did the nurse ask? Projective question Open-ended question Closed-ended question Presupposition question

Projective questions help the patient to articulate and explore his or her thoughts and feelings. Closed-ended questions are usually used in initial assessment. They constrict the communication between the patient and nurse. Open-ended questions are used to encourage the patient to share information. Presupposition questions are also known as miracle questions. They help in identifying the patient's goals. pp. 143, 145

A patient who has to undergo coronary artery bypass surgery says, "Since childhood I have been afraid of being operated on, and today I'm about to undergo a major surgery." The nurse replies, "You are afraid of being operated on?" Which method of effective communication did the nurse follow? Exploring Restating Reflecting Paraphrasing

Restating The nurse used the technique of restating by using the same key words the patient used. This technique helps to explore significant subjects more thoroughly. Exploring is used to examine the patient's ideas and experience by asking questions. Reflecting is used to better understand the patient by asking questions or making statements that reflect the patient's feelings about an issue. With paraphrasing, the content remains the same but different words are used by the nurse. It is used to make sure the perceptions made by the nurse are appropriate.

The nurse avoids peer feedback and recommendations from the nurse supervisor. Which type of countertransference reaction does this indicate? Anger Rescue Boredom Dishonesty

Resue Avoiding peer feedback and recommendations of the nurse supervisor indicates that the nurse has the rescue reaction. If the nurse is inattentive to the patient's needs and makes an inappropriate response, it indicates the feeling of boredom. If the nurse speaks loudly and requests to be taken off the case, it indicates the feeling of anger. If the nurse avoids sharing the information given by the patient to the primary health care provider, it indicates dishonesty. p. 129, Table 8.2

What is the most restrictive method for dealing with an aggressive patient who is out of control? Seclusion A show of force Verbal intervention Antipsychotic medication

Seclusion is the most restrictive method listed, because it curtails the patient's freedom of ambulation. A show of force, verbal intervention, and antipsychotic medication are not as restricting.

Patients with serious mental illness (SMI) deal with many social problems. What is the most difficult problem faced by these patients? Lack of mental health care coverage Acceptance of assistance from others Poor understanding of the disease process Stigma resulting in discrimination and isolation

Stigma resulting in discrimination and isolation Patients with serious mental illness are discriminated against and isolated from normal people. Such social stigma is due to a lack of understanding of the diseases and certain assumptions about the patients. Some insurance providers may limit mental health coverage. However, this is an economic challenge and not a social problem faced by patients with SMI. Patients are encouraged to do their own daily activities and often do not get assistance from others. People may have a stigma against these patients. The patients themselves also avoid seeking assistance because of poor self-image and social isolation. Due to illness the patients show a reduced power of understanding. They have little knowledge of their illnesses. Normal people do not understand patients with SMI as these patients are unable to express themselves well.

What term is used to identify the concept that violence may result from a history of victimization? Aired grievances Shared governance Trauma-informed care Learned helplessness

Trauma-informed care is an older concept of providing care that has been reintroduced. It is based on the notion that disruptive patients often have histories that include violence and victimization. These traumatic histories can impede patients' ability to self-soothe, result in negative coping responses, and create a vulnerability to coercive interventions (e.g., restraint) by staff. Trauma-informed care focuses on the patient's past experiences of violence or trauma and the role it currently plays in his or her life. Shared governance and learned helplessness do not refer to a care concept that helps reduce violence. p. 507

Which question will the forensic psychiatric nurse focus on when considering whether a person accused of a crime meets the criteria of being legally insane? Was the person's judgment skewed by drugs or alcohol? Was there ever similar behavior committed by this person previously? Did a medical or psychiatric condition affect the person's judgment? Was the person cognitively able to actually form the intent to commit the act? Did a psychiatric condition affect the person's ability to control his or her impulses?

Was the person's judgment skewed by drugs or alcohol? Did a medical or psychiatric condition affect the person's judgment? Was the person cognitively able to actually form the intent to commit the act? Did a psychiatric condition affect the person's ability to control his or her impulses? Legal sanity is defined as the individual's ability to distinguish right from wrong with reference to the act charged, capacity to understand the nature and quality of the act charged, and capacity to form the intent to commit the crime. Legal sanity is determined for the specific time of the act; prior acts in the past are not considered relevant to current sanity. Irresistible impulse stipulates that even if the defendant knew the criminal act was wrong but could not control his or her behavior because of a psychiatric illness or a mental defect, the defendant is not guilty by reason of insanity.

A generalist psychiatric forensic nurse must have which of the following? Expert level nursing skills The ability to be nonjudgmental Many years of experience in many areas of nursing Earned an advanced degree in psychiatric forensic nursing

The ability to be nonjudgmental The forensic psychiatric nurse is highly skilled in interpersonal communications and able to develop collegial relationships with those in other disciplines. A prerequisite is the ability to listen and accept others' values and motivations in a nonjudgmental fashion. In the generalist role, nurses are prepared at the entry level as a college/university-degree, associate-degree, or diploma graduate, which prepares them to function as direct care providers and patient advocates.

Who provides care to a patient who is in jail and diagnosed with a mental illness? The criminal profiler The correctional nurse The hostage negotiator The forensic nurse generalist

The correctional nurse A correctional nurse provides health care to people who are charged under the criminal justice system. A criminal profiler collects the data available and formulates a hypothesis. A hostage negotiator provides training in communication skills to law enforcement officers. A forensic nurse generalist assesses victims of violence, collects evidence, and keeps proper documentation.

A patient with a history of suicidal gestures phones the nurse and says, "I am feeling a need to cut myself today." Which Nursing Outcomes Classification (NOC) is most applicable to the patient's comment?

answer- suicide self restraint The patient's comment indicates verbalization of suicidal ideas rather than acting upon them. This behavior is an aspect of suicide self-restraint. Self-care relates to activities of daily living. The patient has communicated; however, it is more relevant to suicide self-control. Aggression self-control relates to the potential for violence with others.

The nurse observes that some of the patients are leaving the room without completing the task during group therapy. What intervention does the nurse implement for the next session to ensure that patients will participate? a.Avoid giving mathematical tasks to the patients during group therapy. b.Avoid giving instructions in a firm voice to patients during group therapy. c.Avoid maintaining eye contact with patients during group therapy. d.Avoid interacting with staff and other patients not in group therapy.

d.Avoid interacting with staff and other patients not in group therapy. The nurse should not feel helpless when patients do not participate in a group activity or if they walk out before completing the given work. The nurse should motivate the patients by interacting and effectively communicating with them. Interacting with the staff and other patients not in group therapy may make the patients feel rejected. Giving mathematical tasks like simple addition and subtraction helps improve the patients' problem-solving ability. Giving instructions in a firm voice helps patients understand the instructions properly and follow them. Maintaining eye contact with the patients while giving instructions helps the patients develop trust that the nurse is there to help them.

Which statement by a forensic patient may show that he or she is legally sane? "I don't understand what I did that was so wrong." "I know what I did was wrong but I had no money and had to get some." "I was responding to the voices in my head telling me to hurt those people." "I was raised in lots of foster homes and I never did learn about doing right."

"I know what I did was wrong but I had no money and had to get some." Legal sanity is defined as the individual's ability to distinguish right from wrong with reference to the act charged, capacity to understand the nature and quality of the act charged, and capacity to form the intent to commit the crime. The statements "I don't understand what I did that was so wrong," "I was responding to the voices in my head telling me to hurt those people," and "I was raised in lots of foster homes and I never did learn about doing right" do not illustrate the requirements for legal sanity

A patient in a rehabilitation center says, "I am left alone because of my addiction." What would be an appropriate response by the nurse? "I don't agree with you." "Everything will be all right." "Why did you get addicted?" "I would like to stay here with you."

"I would like to stay here with you." Saying that the nurse would be with the patient indicates that the nurse is available for communicating with the patient and understands his or her problems. A patient feels criticized when asked the reason for addiction; it often makes the patient defensive and is not a good therapeutic response. The response that everything will be all right gives false hope to the patient. The patient may feel offended and may stop sharing his or her feelings. Disagreeing with the patient makes the patient defensive.

A workshop was conducted for police officials by the American Psychiatric Nurses Association. The nurses discussed the criminal offenses committed by mentally ill patients. Which statement about patients with severe mental illness is appropriate? "The patients are not impulsive; they remain calm and neutral." "Patients with severe mental illness are involved in violent crimes." "Advocates believe that imprisonment of the patient will deter the crime." "The patients despair and become overstressed because of imprisonment."

"The patients despair and become overstressed because of imprisonment." Patients with severe mental illness may get involved in crimes because of their irrational thoughts and delusions. However, these patients should not be imprisoned because it makes the patient despair and become overstressed by victimization. It can often have adverse effects on the physical and mental condition of the patient due to emotional trauma. The patients are not calm and neutral. They commit crimes because of impaired judgment, desperation, and impulsivity. The patients often are involved in nonviolent crimes such as petty theft because of a lack of income and resources. Most advocates consider imprisonment as harmful to the patient because it can make the patient feel rejected and cause withdrawal. They suggest keeping the patient under clinical care and supervision rather than in jail.

The nurse is teaching a group of nursing students about approaches to treating patients with severe mental illness. Which response by a student indicates effective learning regarding functions of assertive community treatment (ACT)? "Treating patients in their environment reduces inpatient admission." "Treating patients with symptoms of delusions reduces impaired social functions." "Crisis intervention is provided from 9 am to 9 pm to patients with severe mental illness." "Patients are involved in group exercises, which are meant to test their attention and memory."

"Treating patients in their environment reduces inpatient admission." Evidence-based treatment approaches can be used as an adjuvant treatment for patients with severe mental illness. ACT is given to patients who cannot avail themselves of the treatment because of low income and/or lack of awareness. A group of health care professionals form a team to provide the patient with complete care and treatment in their environment, and hospitalization is not required. The treatment of delusions and dementia is emphasized in cognitive and behavioral therapy, which focus on the thought processes of the patient to identify disoriented thinking and negative self-talk. In ACT, one of the members of the team is always available to provide 24-hour crisis intervention to the patient. In cognitive enhancement therapy, patients are given group exercises to improve their attention and memory.

A patient is very upset about her newborn being diagnosed with erythroblastosis fetalis. What is an appropriate response by the nurse? "You must be feeling very upset." "Things get worse before they get better." "Why didn't you take the Rh immunoglobulins?" "Try to get out of the situation as soon as possible."

"You must be feeling very upset." When the nurse says that the patient must be feeling very upset, it reflects the feelings of the patient, which is the most appropriate nursing response. The patient gets an impression of being understood, which encourages the patient to express feelings and ideas. When a nurse responds by saying that things get worse before they get better, it gives an impression to the patient that the nurse is unable to understand the patient's feelings and the patient may feel degraded. Asking the patient the reason for not taking Rh immunoglobulins makes the patient feel judged. Giving premature advice, such as to get out of the situation as soon as possible, indicates that the nurse is unable to understand the patient's feelings and is giving an opinion. p. 144, Table 9.2

A patient suffering from serious mental illness undergoes relapse due to nonadherence to treatment. The patient does not spend responsibly and is homeless due to not paying rent regularly. Which response would be most therapeutic? The patient is shifted to a community home to avoid homelessness. A guardianship program is employed to manage the financial needs. The patient is encouraged to live with the condition and develop social skills. The case manager is advised to take more responsibility in the management of the case.

A guardianship program is employed to manage the financial needs. A guardianship program would be implemented in this case. This involves appointment of a person to make decisions on behalf of the patient when the patient's judgment is impaired. The patient should be encouraged to stay in his or her own setting and does not need to shift to a community home. This will boost the patient's confidence and independence. The patient's challenges should be assessed and help provided in those aspects. The patient should not be left to live with this condition. Help needs to be provided. The case managers' roles are limited, and they cannot work as guardians of the patients. Guardians are appointed by the court. They may be attorneys or the patient's significant others.

The case manager determines that the patient diagnosed with schizophrenia would profit from a structured environment and having simple responsibilities. Which community resource could provide this? Inpatient hospitalization Partial hospitalization Supportive group therapy A psychosocial rehabilitation program

A psychosocial rehabilitation program Psychosocial rehabilitation programs are designed to provide daily structure for patients to promote socialization and vocational skills.

Which statement supports the fact that a therapeutic nurse-patient relationship exists? a.The nurse and patient respect the established relational boundaries. b.The nurse takes responsibility for providing a safe milieu. c.The patient is responsible for determining the outcomes of the relationship. d.Confidentiality is viewed as a core component of the relationship. e.Both nurse and patient have an expectation of consistency within the relationship.

ABDE The nurse-patient relationship is the basis of all psychiatric mental health nursing treatment approaches, regardless of the specific goals. The very first connections between nurse and patient are to establish an understanding that the nurse is safe, confidential, reliable, and consistent and that the relationship will be conducted within appropriate and clear boundaries. Outcomes of the relationship are agreed mutually on by nurse and patient.

The nurse includes the recovery model in the treatment plan of a patient with a serious mental illness. Which appropriate action does the nurse follow while caring for this patient? The nurse emphasizes the present illness of the patient. The nurse focuses on the existing strengths of the patient. The nurse focuses on the dysfunction and disabilities of the patient. The nurse encourages the patient to accept assistance from the staff.

According to the recovery model, the nurse focuses on the strengths and abilities of the patient. The nurse should encourage the patient to realize strengths and to practice them in problem solving. It instills the hope of effective recovery and better response. Focusing on the dysfunction and disabilities of the patient can make the patient feel helpless. The nurse should emphasize the patient's future treatment outcomes rather than the present illness. The nurse should encourage the patient to become independent and self-determined by allowing the patient to make decisions. Having the staff help make decisions hinders the improvement of the patient's decision-making skills.

A patient with diabetic nephropathy requests chocolates and gets aggressive when the nurse denies the request. The patient abuses the staff when the staff refuses to fulfill the demands. What appropriate action should the nurse take for an effective patient-nurse communication? Acknowledge the patient's demand Counsel the patient in an isolated room Make prominent eye contact with patient Sit near the patient during the conversation

Acknowledging the demands and needs of the aggressive patient makes the patient feel that the nurse is available to help. The nurse should set the goals and should clearly explain the patient's need to control aggressive behavior and anger. The nurse should make the eye contact at the same level to decrease the sense of intimidation in the patient. The aggressive patient can cause physical harm, so the nurse should maintain a distance of one foot farther than the patient can reach with their arms or legs, and avoid sitting any nearer to the patient. The nurse should not counsel the patient in an isolated room. The nurse should counsel in a room which is visible to the staff. This would be helpful in ensuring the nurse's safety. pp. 508, 513

The forensic psychiatric nurse is working as a consultant for a mental health agency. In this role, what actions might the nurse undertake? Act as an advocate for the perpetrator of the crime Testify regarding own experience when caring for the patient Act as a resource for information on mental illness for the victim Guide further cross-examination by providing information on mental illness Provide clues about the type of individual who may have committed a certain crime

Act as an advocate for the perpetrator of the crime Act as a resource for information on mental illness for the victim Guide further cross-examination by providing information on mental illness As consultants, forensic psychiatric nurses act on behalf of the well-being of the person in their care. This is irrespective of the side they represent in a court case. They may act as advocates of the perpetrator or as a resource of information for the victim. They may also be asked to listen to the witness testimony and guide cross-examination by providing information about the mental disorder. Expert witnesses do not testify about their own personal experience with the patients and their care. This is done by the forensic psychiatric nurse in the role of a fact witness. Forensic psychiatric nurses sometimes inform law enforcement agencies about the type of mental health patient who may have committed a certain crime. They do so in the role of a criminal profiler rather than in the role of a consultant.

A nurse is caring for a patient scheduled for surgery. The nurse finds that the patient is anxious. The nurse formulates the diagnosis as "anxiety related to uncertainty about surgery." Which diagnoses type does this diagnosis belong to? Risk diagnoses Actual diagnoses Medical diagnoses Health promotion diagnoses

Actual diagnoses Actual diagnoses are the problems that currently exist. Medical diagnoses are made by the primary health care professionals based on the symptoms and the diagnostic tests. Risk diagnoses refer to the possibility of developing problematic occurrences or responses. Health promotion diagnoses mean the wish or motivation for improving the health standard. pp. 115-116

A nurse is caring for a patient who has been readmitted to the mental health unit due to medication noncompliance. What intervention can the nurse employ to ensure the patient is taking the medication? Simplifying the patient's medication regimen Administering a long-acting form of medication Checking the patient's mouth after administering the medication Engaging the patient in conversation after administering the medication

Administering a long-acting form of medication When other interventions have been unsuccessful, the use of medication monitoring and long-acting forms of medication can be utilized to increase the likelihood that the needed medication will be in the patient's system. Simplifying the patient's medication regimen may be more acceptable to the patient when the patient is discharged from the unit. Checking the patient's mouth or engaging the patient in a conversation after administering the medication is of limited benefit, as the patient may still be able to hide pills.

How does a nurse provide self-care assistance to a person with serious mental illness? Advise the patient to help others or be a volunteer. Teach the patient about the use of public transportation. Instruct on the appropriate and safe storage of medicines. Advise the person to accept help from the family if unable to do any work. Assist the person in building a safe routine for cooking, cleaning, and shopping.

Advise the patient to help others or be a volunteer. Teach the patient about the use of public transportation. Instruct on the appropriate and safe storage of medicines. the nurse should assist the patient to understand how to use public transport to promote self-care. The patient should participate in the care by doing simple chores at home, like storing the medication in a safe and appropriate place. The nurse should help the patient build a routine for cooking, cleaning, and shopping so that the patient can do the daily chores, which is empowering for the patient. Initially the short-term goals should be achieved. To help others or be a volunteer is not a goal in self-care assistance. The patient should be encouraged to do his or her own work and not accept help from family members.

In order to be proficient in assessment and treatment of victims and perpetrators of violence, what knowledge must the forensic nurse generalist have? An understanding of the legal system Standards of care for both victims and perpetrators Proper procedures to collect, preserve, and document evidence How to protect the rights of someone being questioned by police How to initiate and conduct research in an area of forensics to advance nursing science

An understanding of the legal system Standards of care for both victims and perpetrators Proper procedures to collect, preserve, and document evidence The forensic nurse generalist should have an understanding of the legal system and should know the standards of care for both victims and perpetrators as well as the proper procedures to collect, preserve, and document evidence. Attorneys are responsible for protecting the rights of someone being questioned by police. A doctor of philosophy (PhD) should know how to initiate and conduct research in an area of forensics to advance nursing science.

Which nursing diagnosis for a psychiatric patient is structured and worded correctly?

Answer - Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting "I'm not worthy of eating" The diagnosis "Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting 'I'm not worthy of eating'" contains all the required components: problem statement, the etiology, and supporting data.

A new nurse provides care to a mental health patient under the direct supervision of the seasoned nurse. The new nurse documents the patient's status. Which finding in the medical chart causes the nurse to intervene?

Answer- Patient is noncompliant Using the term "noncompliant" when referring to the patient is not appropriate documentation for the best standard of care. The term "noncompliant" has negative connotations and should be replaced with the term "nonadherence." Documenting anxiety the patient reports is appropriate. Documenting the patient's affect is appropriate. Documenting the patient's fears is appropriate.

The nurse establishes a health promotion diagnosis by making which statement? a.Risk for falls as evidenced by fatigue, dizziness, and unsteady gait b.Anxiety related to traumatic childhood experience as evidenced by the patient reporting being unable to face large crowds c.Readiness for enhanced coping as evidenced by seeking a social support group for people who have battled alcoholism d.Depression related to divorce from spouse as evidenced by stating, "I cannot get out of bed," and accompanied by crying and bouts of insomnia

Answer- Readiness for enhanced coping as evidenced by seeking a social support group for people who have battled alcoholism Health promotion diagnoses include the patient's motivation and desire to improve. This type of diagnosis is supported by defining characteristics and always begin with the phrase "Readiness for enhanced...." Problem-focused diagnoses include judgments about undesirable human responses to a condition or life event, such as depression related to divorce and anxiety related to traumatic experiences. Risk diagnoses have to do with a level of vulnerability of the patient. These diagnoses always begin with the phrase "Risk for" followed by the main problem, such as a risk for falls.

How does the nurse best engage in self-analysis that will benefit a specific nurse-patient relationship? Asking, "What barriers exist that make it difficult for me to provide effective care for this patient?" Avoiding conflict with the patient by seldom setting boundaries or disagreeing with his or her beliefs. Refraining from expressing any negative feelings about a patient's behaviors. Reporting to the nurse manager that, "I've tried but I just can't work therapeutically with this patient."

Asking, "What barriers exist that make it difficult for me to provide effective care for this patient?" Self-analysis is best reflected in the nurse's willingness to evaluate personal feelings about patients to first identify and then eliminate any barriers there may be to an effective therapeutic relationship. The nurse's role includes setting appropriate boundaries and exploring the possible causes of maladaptive or dangerous patient behaviors. Asking for a change in assignments should occur only when all other attempts to manage barriers have failed. The nurse's role includes setting appropriate boundaries and exploring the possible causes of maladaptive or dangerous patient behaviors.

A patient with a long history of schizophrenia lives alone in the community. The patient complains of increasing depression and says, "My parents will never be proud of me like they are of my brothers and sisters." What is the highest priority nursing intervention? Assess the patient for suicidal ideation and intent Suggest the patient attend a community support group Confer with the patient's family regarding recent behavioral changes Assess the patient's compliance with the prescribed antipsychotic medication regimen

Assess the patient for suicidal ideation and intent Suicide occurs 12 times more frequently in persons with serious mental illness (SMI). Persons with SMIs often experience profound feelings of loss regarding their current life and future. These losses can lead to grief that, along with the chronicity of the illness and its impact on daily life, can contribute to despair and depression. A community support group, conferring with the patient's family, and assessing the patient's compliance with medication are not the nurse's first priority.

When assessing a mentally ill patient, a nurse finds that the patient has auditory hallucinations. In which category should the nurse consider this symptom during the mental status examination? Speech problems Cognitive disturbances Behavioral disturbances Perceptual disturbances

Auditory hallucinations are considered perceptual disturbances as they affect the patient's perceptions. Cognitive disturbances involve problems with orientation, level of consciousness, memory, attention, abstraction, insight, and judgment. Behavioral disturbances include abnormal body movements or difference in eye contact. Speech problems involve impairment in rate and volume of speech.

Why is suicide common among patients with serious mental illness (SMI)? Social stigma Indifference to life Comorbid conditions Chronic grief and loss

Chronic grief and loss The chronic nature of mental illness and its impacts on daily life prevent patients from returning to normal lives. Patients with mental illness experience chronic grief and loss, which causes depression and suicidality. Patients with SMIs are misunderstood easily, and due to their conditions, normal people avoid them. Due to this and also the illness, they develop an indifference to life. This may or may not be associated with increased suicidal tendencies but is not a direct cause of suicidality. They suffer from comorbid conditions that require special attention from the primary health care providers. They lose confidence to go outside and interact with peers because of the social stigma attached to mental illness.

The court has subpoenaed the nurse as an expert witness for a case. What act by the nurse establishes trustworthiness of the testimony provided as an expert witness? Sharing certificates of professional training Showing evidence of academic preparation Communicating in a concise and convincing manner Providing evidence of practical experience in the field

Communicating in a concise and convincing manner When the nurse communicates in a concise and convincing way, it represents a good presentation style. A good presentation style reflects the degree of honesty in demeanor. It is needed to establish trustworthiness of the nurse's testimony. By sharing certificates of professional training and showing evidence of academic preparation, the nurse establishes expertise in the field. When the nurse provides evidence of having practical experience in the field, it also shows that the nurse is an expert in the field.

A person kidnapped a movie star but was later captured and charged. Which assessment finding regarding this kidnapper is most likely to support use of the legal insanity defense (i.e., at the time of the crime, the kidnapper demonstrated which of the following)? Obsessions Perseveration Delusional thinking Psychomotor retardation

Delusional thinking is an indicator of psychosis, or loss of touch with reality. In most states, the presence of a major mental disorder (usually referring to those that cause psychoses: delusions, hallucinations, and disorganized thought) is a prerequisite for a finding of legal insanity. Obsessions, perseveration, and psychomotor retardation show signs and symptoms associated with mental illness, but are not associated with psychosis.

What is the role of the forensic nurse? Direct physical care to crime victims Providing care to perpetrators of crimes Expert witness testimony for legal cases Inmate evaluation regarding specific psychiatric diagnoses reparing prosecution or defense strategies in criminal cases

Direct physical care to crime victims Providing care to perpetrators of crimes Expert witness testimony for legal cases Inmate evaluation regarding specific psychiatric diagnoses Forensic nurses provide direct services to crime victims and perpetrators of crime, and consultation services to colleagues in nursing, medicine, social work, rehabilitation, and law, as well as offering expert court testimony in cases related to their area of practice and expertise, input on policy changes within the corrections settings, and evaluation services regarding specific medical and psychiatric diagnoses for inmates. Their role does not include direct involvement in the preparation of court cases.

Which activity is associated with the role of the forensic nurse generalist? Documents the physical and mental health assessment findings of a patient who was beaten during a robbery. Testifies in court regarding methods regularly used to address the forensic needs of crime victims. Determines whether a crime victim is medically and emotionally stable enough to testify in court. Collects the physical evidence found on the body of a patient who was raped. Creates a treatment plan of a patient who was assaulted physically.

Documents the physical and mental health assessment findings of a patient who was beaten during a robbery. Testifies in court regarding methods regularly used to address the forensic needs of crime victims. . Collects the physical evidence found on the body of a patient who was raped. Creates a treatment plan of a patient who was assaulted physically. Basic roles of the forensic nurse include creation of appropriate treatment plans as well as the collection, documentation, and preservation of potential evidence. In forensic nursing, the nurse-patient relationship occurs based on the possibility that a crime has been committed, but it is not the role of the forensic nurse to make a decision as to guilt or innocence or whether a victim is being candid in reporting what happened. Nor do forensic nurses determine the patient's ability to testify in a court of law.

Which factor promoting patient growth occurs when the nurse attempts to understand the world from the patient's perspective? Empathy Genuineness Positive regard Countertransference

Empathy Empathy occurs when the nurse attempts to understand the world from the patient's perspective. Genuineness refers to the nurse's ability to be open, honest, and authentic in interactions with patients. Positive regard implies respect; it is the ability to view another person as being worthy of caring and as someone who has strengths and achievement potential. Countertransference does not promote patient growth. It occurs when the nurse unconsciously displaces feelings related to significant figures in the nurse's past onto the patient.

Which type of nursing diagnosis consists of the "problem" and "defining characteristics" as its structural components? Syndromes Risk diagnosis Actual diagnosis Health promotion diagnosis

Health promotion diagnosis A problem along with defining characteristics describes the central idea of diagnoses for health promotion. The main theme of health promotion diagnoses is to motivate for an improved standard of living. It is characterized by developing new strategies for enhanced coping mechanisms. A problem and defining characteristics do not describe the diagnoses for syndromes, risk factors, and acute conditions. A problem with or without related factors and defining characteristics describes the process of diagnosis for syndromes. A problem and related factors and defining characteristics describe the process of diagnoses for acute conditions. A problem and defining characteristics/risk factors describe the process of diagnoses for risk factors.

Which intervention demonstrates that the nurse understands the therapeutic value of silence? Helping the patient refocus by saying," You started to tell me what you wanted for lunch." Recognizing that the conversation of a patient being treated for schizophrenia may be affected by prescribed medications. Self-reflecting on one's personal level of comfort regarding periods of conversational silence. Providing the cognitively impaired patient more time to formulate and express thoughts. Interjecting therapeutic silence when talking with children and teenagers because they like to direct conversations.

Helping the patient refocus by saying," You started to tell me what you wanted for lunch." Recognizing that the conversation of a patient being treated for schizophrenia may be affected by prescribed medications. Self-reflecting on one's personal level of comfort regarding periods of conversational silence. Providing the cognitively impaired patient more time to formulate and express thoughts. It is crucial to recognize that some psychiatric disorders, such as major depression and schizophrenia, and medications may cause an overall slowing of thought processes. Patience and gentle prompting can help patients gather their thoughts. Conversely, silence is not always therapeutic. Although a less-talkative nurse may be comfortable with silence, this mode of communication may make the patient feel like a fountain of information to be drained dry. Additionally, children and adolescents in particular tend to feel uncomfortable with silence. p. 142

Psychiatric nurses use basic nursing interventions in all settings. The basic nursing interventions include all but which of the following? Health teaching Housing access Crisis intervention Case management

Housing access Nurses encounter the severely mentally ill in the acute psychiatric setting, community treatment, and medical-surgical units and clinics. All psychiatric nurses use the following basic interventions with these patients: crisis intervention, psychobiological intervention, health teaching for patients and families, counseling, case management, milieu therapy, promotion of self-care activities, and psychiatric rehabilitation.

The nurse is performing an assessment of a patient with sickle cell anemia. During the assessment, the nurse tries to develop trust and establish rapport with the patient. Which intervention does the nurse perform in this phase of nurse-patient interaction? Promote problem-solving skills. Teach alternative ways of expressing feelings. Inform the patient about the scheduled meeting. Share the feelings of helplessness with colleagues and health care provider.

Inform the patient about the scheduled meeting. During the orientation phase, the nurse tries to develop trust and establish rapport with the patient. The nurse schedules an interview and informs the patient of the time, date, and duration of the meeting. This indicates the concern of the nurse toward the patient and encourages the patient to express his or her thoughts and feelings to the nurse. During the working phase, the nurse promotes problem-solving skills and teaches alternative ways to express feelings. In the preorientation phase, the nurse takes the advice of colleagues and the health care provider before interacting with the patient.

A patient diagnosed with schizophrenia is being discharged from the hospital. Which interventions or goals related to planning for discharge would support the recovery model of care? The patient will attend groups that teach how to cope with the present illness. The patient's parents will receive education on how to manage the patient's deficits. Interventions will focus on medication adherence. Interventions will focus on the patient's stated wish for independent living.

Interventions will focus on the patient's stated wish for independent living. The recovery model is patient-centered, instills hope and empowerment, emphasizes the person and the future, encourages independence and self-determination, and focuses on achieving goals of the patient's choosing and meaningful living. The National Alliance on Mental Illness (NAMI) and the President's New Freedom Commission on Mental Health (2003) both support the recovery model of care rather than the rehabilitation model, which focuses on the illness and the present. Attending groups, education on how to manage the patient's deficits, and medication adherence all follow the rehabilitation model, focusing on the illness.

The nurse is caring for a client with serious mental illness. What basic nursing interventions are appropriate in such a situation? Involve the patient in treatment planning. Focus on treating the patient's symptoms. Acknowledge the patient's thinking process. Maintain a sustained therapeutic relationship. Enable the patient to respond to social stigma.

Involve the patient in treatment planning. Maintain a sustained therapeutic relationship. Enable the patient to respond to social stigma. The nurse should involve the patient in treatment planning. This will enable the patient to understand why he or she needs to take the medication. This increases the patient's adherence to treatment and improves the outcome. The nurse should develop and maintain a sustained therapeutic relationship with the patient. This increases the patient's trust and increases adherence. The nurse should also help the patient to recognize and respond to social stigma. Stigma predisposes patients to isolation and reduces access to support. Recognition and response to stigma improve socialization and increase the quality of life. The nurse should not focus on treating the patient's symptoms. Rather, the focus should be on emphasizing the quality of life. This conveys an interest in the patient rather than the illness and builds therapeutic alliance. Instead of acknowledging the patient's thinking process, the nurse should aid in effective reality testing and help the patient to counter disorganized thinking.

A person accused of murdering a child says, "The spirit forces said I had to do it. I didn't want to hurt that child." Which component of legal insanity is most applicable to this comment? Incompetence Irresponsibility McNaughton rule Irresistible impulse

Irresistible impulse This comment by the accused person indicates psychotic thought processes. Irresistible impulse is part of the McNaughton rules. It stipulates that even if a defendant knew the criminal act was wrong but could not control his or her behavior because of a psychiatric illness or a mental defect, the defendant is not guilty. Incompetence is a legal designation that means a person is unable to make meaningful decisions or engage in deliberative thought processes and is therefore not responsible for his or her own behavior. The McNaughton rules state that to be considered legally insane, an accused person with a mental disorder either must not know the nature and quality of the act or must not know whether the act is right or wrong.

What statement is true regarding the role of an advanced level forensic psychiatric nurse? Is a member of a multidisciplinary forensic team. Is open minded, accepting the point of view of others. Has a high degree of mastery of interpersonal communication skills. Plays a role in determining the guilt or innocence of a person accused of committing a crime. Thrives in environments that are intellectually stimulating while pushing the limits of traditional nursing boundaries.

Is a member of a multidisciplinary forensic team. Is open minded, accepting the point of view of others. Has a high degree of mastery of interpersonal communication skills. Thrives in environments that are intellectually stimulating while pushing the limits of traditional nursing boundaries. The forensic psychiatric nurse is highly skilled in interpersonal communications and able to develop collegial relationships with those in other disciplines. A prerequisite is the ability to listen and accept others' values and motivations in a nonjudgmental fashion. Forensic psychiatric nursing appeals to a particular type of nurse, one who thrives in a stimulating intellectual environment, seeks out opportunities to apply clinical skills to complex legal problems, and enjoys pushing the limits of traditional boundaries. In this capacity, the role of the advanced level forensic psychiatric nurse is not to determine guilt or innocence but to provide assessment data that can help make a final diagnosis within the multidisciplinary forensic team.

A male patient diagnosed with a severe mental illness and institutionalized for most of his adult life recently has been transferred to a supervised community-based residential home that houses several other adult men. The patient is resistant to going to day therapy and has begun to socially isolate if allowed. He has apparent weight loss and has become uncooperative. What is the most likely reason for these changes? Is experiencing a decreased sense of self Has begun showing signs of independence Is lazy now that he is not on a regular schedule Has begun exhibiting a lack of desire to attend the day program

Is experiencing a decreased sense of self Before deinstitutionalization of the severely mentally ill beginning in 1975, psychiatric hospitals were the long-term residences for many people. Medical paternalism was a pervasive philosophical stance at that time. The health care approach to severely mentally ill persons was that of making all their decisions. Patients became institutionalized, that is, they could not think independently and lost the ability to problem solve. Much of a person's behavior became a combination of the disease process and the decreased sense of self that resulted from the lack of autonomy.

A patient with mental illness and substance abuse is enrolled in vocational rehabilitation services. How does this help the patient improve his or her quality of life? It teaches the patients skills to negotiate or resolve conflict. It encourages supported-employment services for the patients. It combines the patient's employment with mental health services. It shifts the patient to a community home to reduce financial need. It stresses anxiety reduction while treating the current stage of illness

It encourages supported-employment services for the patients. It combines the patient's employment with mental health services. Employers are given some financial incentives to employ a person with mental illness. Such supported-employment services are encouraged in vocational rehabilitation programs. Mental health services are combined with employment to help the patient socially and financially and also take care of the patient's health. Supportive psychotherapy is an approach that stresses anxiety reduction and therapeutic alliance when providing therapy for the current stage of the illness. Social skills training is an approach that teaches the patient different skills to negotiate or resolve conflict. This is not included as part of vocational rehabilitation services. The patients are trained to become independent so that they can take care of their own financial needs. They are not shifted to community homes.

A much-needed role for forensic nurses to assume is which of the following? Medication administration Liaison with parole officers Prison milieu management Primary prevention programs

Liaison with parole officers smoother transitions from prison to parole are desirable. Continuity of care is essential to maintain the individual outside the structure of the prison system. Collaboration between the prison system and the parole system would benefit the patient.

The nurse finds that a patient with severe mental illness also has substance abuse. The primary health care provider prescribes a medication for treating substance abuse. Which drug does the nurse anticipate in the patient's prescription? Methadone Carbamazepine Acetaminophen Dextroamphetamine

Methadone Substance abuse can be seen in patients with severe mental illness. These patients are prescribed detoxification drugs such as methadone, a synthetic opioid drug. It is used to reduce opioid dependency in patients who have substance abuse. Carbamazepine is an antiepileptic drug used to treat epilepsy. Acetaminophen is prescribed to relieve pain such as headaches and backaches. Dextroamphetamine is a central nervous system stimulant prescribed to enhance alertness and wakefulness in the patient.

The patient's priority nursing diagnosis has been established as risk for self-directed violence: suicide related to multiple losses. The priority outcome would be that the patient will Attend self-help group daily Refrain from attempting suicide Be placed on suicide precautions State absence of feelings of powerlessness

Refraining from suicidal attempts is the only outcome that addresses the risk for self-directed violence. The absence of a feeling of powerlessness is not appropriate for the stated nursing diagnosis. Being placed on suicide watch and attending self-help groups are interventions.

A young adult with serious mental illness (SMI) often visits the care facility and is sometimes hospitalized for exacerbations of symptoms for short periods of time. What are the drawbacks of hospitalizing a patient only for acute care? Dependent behavior Resistance to aftercare Brief recovery and relapse Poor insight into the illness Inability to recognize own needs

Resistance to aftercare Brief recovery and relapse Poor insight into the illness Infrequent brief hospitalizations may be needed for acute care of young adults who have never been institutionalized. Once they leave the health care facility, it is difficult to make them follow aftercare recommendations. As a result, they often develop resistance to the aftercare recommendations and refuse aftercare. They experience brief recovery and relapse as they go through very limited periods of treatment. They are in constant denial of their disease and treatment as they have little understanding of their disease. Mental illness also plays a role here. People who are institutionalized for a long period develop dependent behavior because all their decisions are made by the care providers. Such patients often live lives of passivity and are unable to recognize their own needs and act accordingly.

The family of a rape victim wants to know if the nurse has the required expertise to examine the victim as this is a medicolegal case. How does a nurse go on to specialize and become a sexual assault nurse examiner (SANE)? SANEs are specialized forensic nurses in advanced practice. SANEs are typically trained for five days in either an online platform or in classroom setting. SANEs have an educational background about all types of sexual assault in varied populations. SANEs are deemed competent to conduct exams themselves after 40 hours of SANE

SANEs are typically trained for five days in either an online platform or in classroom setting. The International Association of Forensic Nurses (IAFN) has clear guidelines for the preparation of SANEs. The training is typically for 40 hours in five days. The training is available either online or in a classroom setting. SANEs need not be specialized forensic nurses in advanced practice. They are forensic nurse generalists who are trained in the care of victims of sexual assault. Those trained to care for adult victims are SANE-As, whereas those trained in care of pediatric victims are SANE-Ps. All nurses who work as SANEs do not have a certification. Advanced practice registered nurses in forensics have an educational background in all types of sexual assault and in varied populations. After the 40 hours of SANE training, the nurses do not become competent to conduct exams themselves. They need to be preceptored by an expert SANE and then sit for the national certification exam through the IAFN.

Which rating tool is used by the nurse when assessing a patient with schizophrenia? Cognitive Capacity Screening Examination (CCSE) Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) Scale for Assessment of Negative Symptoms (SANS) Recovery Attitude and Treatment Evaluator (RAATE)

Scale for Assessment of Negative Symptoms (SANS) Nurses and medical care professionals make use of several assessment tools for evaluation and monitoring of psychiatric disorders. The Scale for Assessment of Negative Symptoms is the assessment tool used for patients with schizophrenia. The Cognitive Capacity Screening Examination, Yale-Brown Obsessive-Compulsive Scale, and Recovery Attitude and Treatment Evaluator are not used for patients with schizophrenia. The Cognitive Capacity Screening Examination is used for cognitively impaired patients. The Yale-Brown Obsessive-Compulsive Scale is used for patients with obsessive-compulsive disorder. The Recovery Attitude and Treatment Evaluator is used for patients of substance use disorders.

The forensic psychiatric nurse is expected to use professional opinion when assessing a defendant. On what basis does the nurse form a professional opinion? Value systems Nurse's education Scientific principles Uniform standards Family upbringing

Scientific principles Uniform standards Professional opinion is objective and unbiased. It is based on scientific principles and certain uniform standards set by research. Personal opinion is the opinion of the nurse and may not be a universally accepted truth. It may be based on the education of the nurse and vary depending on the education that the nurse has received. Personal opinion may also depend on the family upbringing of the nurse and what the nurse has been taught when growing up in a family environment. The nurse's personal opinion may be based on acquired value systems which may vary from person to person. Thus, personal opinions are quite subjective while professional opinions are objective.

A reduction in which violence indicator demonstrates the achievement of a Healthy People 2020 goal? Sexual violence Firearm related deaths Abductions by strangers Child maltreatment deaths Bullying among adolescents

Sexual violence Firearm related deaths Child maltreatment deaths Bullying among adolescents Healthy People 2020 goal injury and violence prevention objectives include a reduction in firearm-related deaths, sexual violence, bullying among adolescents, and child maltreatment deaths. A violent crime abduction (kidnapping) by strangers currently is not listed as a goal.

A patient has relapses of mental illness several times and is known to be nonadherent to treatment. What interventions can make the patient compliant to medication? Short-acting medications are used to minimize side effects. Side effects are actively managed to minimize or avoid distress. Confrontation is helpful if a cultural belief impedes compliance to medication. Simple treatment regimens, understandable to the patient, are put in place. Effective and well-tolerated medications, acceptable to the patient, are prescribed

Side effects are actively managed to minimize or avoid distress. Simple treatment regimens, understandable to the patient, are put in place. Effective and well-tolerated medications, acceptable to the patient, are prescribed. The side effects of medications should be managed actively so that the patient does not feel distressed from taking them. A simple treatment regimen should be in place so that it is not complicated for the patient to follow regularly. The nurse should discuss with the patient about effective, well-tolerated medicines he or she should be prescribed. Long-acting medications should be used so that the patient does not have to take them as frequently. The nurse should provide culturally sensitive care; otherwise patients may refuse to accept a process of treatment that conflicts with their culture beliefs and practices.

A correctional nurse is performing an assessment of a patient who is a perpetrator of repeated offenses. Which factors does the nurse document in the patient's case report? Brain tumor Substance abuse Multiple sclerosis Hallucinations and delusions Posttraumatic stress disorder

Substance abuse Hallucinations and delusions Posttraumatic stress disorder Patients who commit repeated offenses have serious mental illness. The correctional nurse should identify such patients and recommend hospitalization. These patients have posttraumatic stress disorder, hallucination, delusions, and substance abuse. They suffer from such disorders due to lack of proper treatment and resources. Brain tumor and multiple sclerosis are not majorly found in psychiatric patients.

A 78-year-old patient diagnosed with multi-infarct dementia is agitated because an unfamiliar staff person is providing care. Which intervention is appropriate for de-escalating this patient's agitation? Repeatedly reinforce the patient's orientation. Talk with the patient individually about familiar family and friends. Administer a medication with sedative properties to reduce agitation. Reduce environmental stimulation by placing the patient in a quiet room until the agitation subsides.

Talk with the patient individually about familiar family and friends. Patients with cognitive deficits, such as multi-infarct dementia, are vulnerable to agitation. When a nurse shows interest in the patient's life, the nurse establishes him- or herself as a safe, understanding person. In turn, the patient often becomes calmer and more open to redirection. As patients reminisce in this fashion, they often bring themselves into the present. Reality orientation (providing the correct information about place, date, and current life circumstances) may be comforting, but repeatedly providing reality orientation may increase agitation and lead to aggression. Sedating medication may calm agitation, but further clouds the patient's sensorium, which makes disorientation worse and increases the risk of injury. p. 515

After assessing a defendant in a murder case, the nurse reports to the court that the person is legally insane. On what basis does the nurse provide such an opinion? The defendant agrees it was wrong to have killed somebody. The defendant agrees with the severity of the crime. The defendant understands that the penalty could be death. The defendant lacks feelings of guilt or remorse.

The defendant agrees it was wrong to have killed somebody. If the defendant takes on the blame of the murder, it means the defendant knew that it was wrong. Even in such a case, the defendant can be deemed to be legally insane, if the defendant was unable to control the impulse to commit the murder because of a psychiatric illness. If the defendant understands the severity of the crime and the punishment, the defendant is legally sane to face the proceedings of the court. If the defendant lacks feelings of guilt or remorse, the act cannot have been due to an impulsive behavior. The defendant is, therefore, considered to be legally sane.

The nurse best ensures appropriate patient care when choosing an intervention from a Nursing Interventions Classification that matches both The defining data and the nursing diagnosis The medical diagnosis and the nursing diagnosis The nursing diagnosis and the condition's etiology The condition's etiology and the patient's symptomology

The defining data and the nursing diagnosis When choosing nursing interventions from the Nursing Interventions Classification or some other source, the nurse selects interventions that fit the nursing diagnosis (e.g., risk for suicide) and that match the defining data

Which mental health diagnosis is considered to be within the government's severe and persistent mental illness (SPMI) and serious mental illness (SMI) classifications? Schizophrenia Panic disorder Bipolar disorder Narcissist personality disorder Obsessive-compulsive disorder

The federal government's classifications of SPMI and SMI apply to those who are affected most deeply by psychiatric disorders. Disorders that fall into this category include severe forms of depression, panic disorder, and obsessive-compulsive disorder, as well as schizophrenia, schizoaffective, and bipolar disorder. Narcissist personality disorder is not classified among the SPMI or SMI disorders.

Which statement about nonverbal behavior is true? A calm expression means a patient has a low level of anxiety. The meaning of nonverbal behavior varies among cultures and individuals. Eye contact is a reliable indicator of a patient's attentiveness and engagement. Adult patients are more responsive to therapeutic touch than verbal intervention.

The meaning of nonverbal behavior varies among cultures and individuals. Use of eye contact, body language, and touch varies widely among individuals and cultures. Cultural norms dictate a person's comfort or lack of comfort with direct eye contact and touch. Even within cultures, there are individual variations. Verbal and nonverbal communication are often incongruent.

The student nurse is caring for a patient who left school after attempting suicide. The patient asks if the nurse likes being in nursing school. What is the nurse's most appropriate response? "We're here to talk about you." "Why don't we talk about how you liked being in school?" "It must be hard for you to talk about school after what happened." "It's a lot of work! But I'm learning so much, and it's very rewarding."

The most appropriate response by the nurse is, "It's a lot of work! But I'm learning so much, and it's very rewarding." A small amount of self-disclosure on the nurse's part may strengthen the therapeutic relationship. "We're here to talk about you" is not likely to strengthen the therapeutic relationship. "Why don't we talk about how you liked being in school?" and "It must be hard for you to talk about school after what happened" redirect the question to something the patient may not yet feel comfortable discussing. Test-Taking Tip: Look for answers that focus on the patient or are directed toward feelings.

A forensic nurse examiner is assigned by the court to evaluate an accused rapist in order to collect medical evidence of a sexual assault. While evaluating the defendant, what appropriate actions does the nurse follow? The nurse evaluates the defendant's behavior at the jail and courtroom. The nurse suggests imprisonment if the defendant has despairing thoughts. The nurse remains empathetic and accepting while interacting with the defendant. The nurse gives the professional opinion based on the education of the defendant.

The nurse evaluates the defendant's behavior at the jail and courtroom. A forensic examiner conducts the behavioral evaluation of the defendant or accused with the court order. The nurse should observe the patient's clinical history and behavior at the scene of the incident, jail, and the courtroom. This helps the nurse to effectively evaluate the patient's mental condition. The nurse should not be empathetic and accepting with the defendant. The nurse should be neutral, objective, and detached while evaluating the patient's behavior. This helps to give an effective and unbiased report to the court. Professional opinion can be given by considering scientific principles and advanced education in a specific field. Personal opinion is given by considering upbringing, value system, and education. The nurse should suggest hospitalization and treatment if the defendant has a mental illness. Aggressive behavior and despairing thoughts indicate mental illness.

The nurse checks the medical history of a patient with severe mental illness and learns that the patient is depressed because of a relapse of the illness. Which action does the nurse initially follow to provide effective care? The nurse performs crisis intervention for the patient. The nurse checks the need for isolation of the patient. The nurse encourages the patient to interact with his or her peers. The nurse suggests that the patient adhere to his or her medication

The nurse performs crisis intervention for the patient. The patient who has a relapse may feel depressed and hopeless. The nurse should initially perform a crisis intervention for the patient, which helps the patient to regain confidence in his or her treatment and in his or her health care professionals. During crisis intervention, the nurse can identify the reason for the relapse. The patient may be depressed because of ineffective treatment. Initially suggesting that the patient adhere to his or her medications will lead to the withdrawal of the patient. Patients with severe mental illness are not violent and need not be isolated. After the crisis intervention the nurse can encourage the patient to interact with peers to improve the patient's social interaction skills.

A forensic nurse is appointed as an expert witness by the court for a sexual assault case. What is the responsibility of the forensic nurse as an expert witness? The nurse should prove that the defendant is innocent. The nurse should make the defendant feel comfortable. The nurse should provide concise information to the court. The nurse should testify about the initial care provided to the victim.

The nurse should provide concise information to the court. The nurse should communicate in a concise and convincing fashion in the court. The nurse should give an expert opinion about the victim's condition and should give a clear medical condition of the victim. This helps the court to make an appropriate judgment. The nurse should not support the defendant and should not try to make the defendant feel comfortable. The nurse should be objective and neutral. The nurse should not act as an advocate to prove the innocence of the defendant. This is considered a breach of professional boundaries. The forensic nurse does not testify regarding the first or initially performed assessments of the victim.

A nurse is conducting an interview with a patient admitted after a suicide attempt. During the interview process, the nurse becomes unsure of how to respond. What is the nurse's best course of action? Say nothing. Change the subject. Provide reassurance. Ask why the patient made the statement.

The nurse's best course of action is to say nothing. Silence provides meaningful moments of reflection for both participants. Changing the subject may convey a lack of respect and sensitivity that will hinder further communication. Providing reassurance without understanding why could be a false reassurance. Asking why the patient made a statement implies criticism and often has the effect of causing the patient to become defensive.

When caring for a person with major depression, the nurse documents a nursing diagnosis of social isolation. What is the reason for the nurse's decision? The patient has difficulty expressing thoughts. The patient shows inappropriate interpersonal behaviors. The patient is preoccupied with his or her own thoughts. The patient considers himself or herself useless and no good anymore.

The patient is preoccupied with his or her own thoughts. The nurse makes a nursing diagnosis of social isolation when the patient is preoccupied with his or her own thoughts. The patient spends much of his or her time in deep thought and stays away from any kind of intimacy or social interaction. When the patient has difficulty expressing his or her thoughts, the nursing diagnosis is impaired verbal communication. The patient has difficulty putting words and sentences together to express thoughts. When the patient shows inappropriate interpersonal behaviors, the nursing diagnosis is impaired social interaction. Unlike in social isolation, such a person wants to interact but is unable to interact effectively with others. When the patient says he or she is no good anymore, it indicates self-negating verbalization. The nursing diagnosis in such a case is chronic low self-esteem.

A student nurse wants to improve her communication and interviewing skills with patients. Which appropriate method does the nurse follow? The student nurse interacts with multiple patients. The student nurse asks each patient more questions. The student nurse maintains written records of the nurse-patient session. The student nurse asks an observing clinician to note the conversation during interviews.

The student nurse maintains written records of the nurse-patient session. Written records of a nurse-patient session are called process recordings. These records help in reviewing clinical interactions with the patient and give an idea of how to respond to different situations. Process recordings consist of both verbal and nonverbal communication between the patient and the nurse. Having an observing clinician distracts the concentration of both the patient and the nurse. Interacting with more patients can help to some extent but without proper documentation and approach, it wouldn't progress. Asking too many questions of the patient will make the patient annoyed and is not a good practice for effective communication and interviewing.

An orientation class was conducted for forensic psychiatric nursing students. The nurse addresses the students and states the roles and functions of the forensic nurse in health care. Which statement is appropriate about the function of forensic psychiatric nurses? To apply medical-surgical knowledge while caring for the victim of abuse To create and follow a generalized treatment plan for all the victims of abuse To decide whether the perpetrator is responsible for the abuse of the victim To assess whether the statements made by the victim against the perpetrator are genuine

To apply medical-surgical knowledge while caring for the victim of abuse The forensic nurse should apply the medical-surgical knowledge to care for the victims of abuse. This helps to effectively collaborate with law practitioners by collecting the evidence and testifying in the court. It is not the role of the nurse to assess whether the victim is making a genuine statement as this indicates a judgmental attitude on the part of the nurse. It is not the role of the nurse to decide that the perpetrator is responsible for the abuse as that is the role of the law. The nurse should help the law in collecting and preserving the evidence. The nurse should make an appropriate treatment plan for each individual victim. A generalized treatment plan may not be effective as each patient experiences different levels of physical and emotional trauma

An individual is found not guilty by reason of insanity after planting explosive devices in a local church. What would be the nurse's expectation regarding this person? Will have a new trial after psychiatric stability has been attained. Was unable to provide useful assistance to the defense attorney. Will be treated for mental illness in a prison or other forensic setting. Was unable to act with intent at the time of the offense because of mental illness

Was unable to act with intent at the time of the offense because of mental illness The McNaughton rules state that to be considered legally insane, an accused person with a mental disorder either must not know the nature and quality of the act or must not know whether the act is right or wrong. Whereas legal insanity is determined by the defendant's thinking in the past at the time of the offense, competence to proceed is determined by the defendant's present thinking at the time of the trial. It is defined as the capacity to assist one's attorney and understand the legal proceedings. Because competence to proceed is a determination of mental capacity in the present, the defendant's competency must be determined each time he or she goes to court. A prior finding of incompetence, even if caused by a developmental disability or mental illness, does not preclude a subsequent finding of competency in a later, unrelated case. A person found guilty but mentally ill will receive treatment for mental illness in a prison or forensic setting.

After formulating nursing diagnoses for a newly admitted patient, what is the nurse's next action?

answer- Determining the goals and outcome criteria Formulation of goals and outcome criteria follow the nursing diagnosis step of the process. Assessment data may be revisited when evaluating outcomes. The plan is not implemented until outcome identification and planning has occurred. Documenting the plan is an aspect of planning.

A nurse is assessing a 10-year-old child who is suspected of having emotional problems. Which methods does the nurse apply to obtain relevant information?

answer- Interview and Observe Children often show their emotions while playing, acting, or drawing; hence an interview along with observation of such activities is required. An interview can help in giving information but needs to be done with observation as children show their emotions through play. Observation can provide only information that can be perceived, but it should be applied with an interview for interaction. Assessment of children can be done better with an interview and observation than with lab work and radiologic examinations.