forensic psychiatric nursing Flashcards
A person diagnosed with bipolar disorder ran out of money, did not refill a lithium prescription, and then relapsed. After assaulting several people in the community, this person was convicted and sentenced. Prior to parole, which outcome has priority for the correctional nurse to achieve?
a.The person agrees in writing to continue lithium therapy.
b.The person is reestablished on an appropriate dose of lithium.
c.The person lists community resources for prescription assistance.
d.The person agrees to a follow-up appointment in an outpatient clinic.
ANS: C
To increase medication adherence, reduce the risk of relapse, and prevent further criminal activity due to mental illness, the person’s awareness of community resources for medication refills and medication-related services is the most important outcome. Agreeing to take lithium, being reestablished on medication in jail, and agreeing to follow-up mental health care are important, but none of these will address the primary reason for the criminal behaviour—the relapse caused by inability to access medication in the community.
An inmate was diagnosed with post-traumatic stress disorder (PTSD) caused by severe sexual abuse. One day this inmate sees a person with characteristics similar to the perpetrator, has a flashback, and then attacks the person. Correctional officers place the inmate in restraint. In what way should the correctional nurse anticipate that the inmate would react to restraint?
a.By committing to counselling to reduce the incidence of flashbacks
b.By becoming less likely to assault others during future flashbacks
c.By gradually calming and returning from the flashback to reality
d.By becoming more frightened, agitated, and combative
ANS: D
The correctional nurse recognizes that events occurring in the present reality are likely to be incorporated into a flashback, leading the inmate to become more frightened and desperate to escape. Even if no longer experiencing a flashback, people will likely re-experience their original trauma if restrained, including the emotions experienced during that trauma, leading to increased fearfulness and resistance to the jail restraints. Restraints are not likely to calm the individual or reduce aggressiveness but instead increase the sense of helplessness and desperation.
An inmate was diagnosed with post-traumatic stress disorder (PTSD) caused by severe sexual abuse. One day this inmate sees a person with similar characteristics to the perpetrator, has a flashback, and then attacks the person. Correctional officers place the inmate in restraint. Which action by the correctional nurse is most appropriate?
a.Plan to meet with the inmate for debriefing after release from the required period of restraint.
b.Support the use of restraints as needed to control violent outbursts and assure the safety of all inmates.
c.Contact a supervisor authorized to make an exception to the restraint policy and explain why an alternate response is needed.
d.Confront the correctional officers who initiated the restraint, explain the inappropriateness of this action, and request the inmate’s release.
ANS: C
Nurses have advocacy responsibilities, regardless of the setting. The optimum outcome in this situation would be to minimize the duration of the restraint episode. The inmate and others are at risk of injury until the inmate is calm. The restraints will likely worsen and extend the inmate’s distress and agitation. Supporting the use of restraints ignores the need of select inmates for alternate responses that do not paradoxically worsen the situation instead of help it. Meeting with the patient to calm her after her release would be the second most helpful response, but it does not shorten the duration of the patient’s restraint. Confronting the officers is unlikely to be successful, since they are following proper procedures; accusing them of improper actions will likely increase defensiveness rather than expedite the inmate’s release from restraint.
The correctional nurse assesses a new prisoner beginning incarceration after committing a sex crime. The prisoner speaks in a low voice and tearfully tells the nurse, “My life might as well be over. There is no hope I will ever fit into society after I get out of prison. My family disowned me.” Select the nurse’s priority action.
a.Advise guards to place the inmate in solitary confinement.
b.Offer to contact the inmate’s family to convey these feelings of remorse.
c.Alert the guards of the risk for suicide and implement suicide precautions.
d.Meet with the inmate weekly to discuss these feelings and explore coping strategies.
ANS: C
The inmate is experiencing significant shame and self-loathing, facing many significant losses (freedom, status in the community, perhaps his career), separated from his support system, and evidences hopelessness. Patients with mental illness that are incarcerated are four times more likely to commit suicide than other prisoners. These all suggest a significant risk of suicide. The priority response would be to alert the guards of the inmate’s risk to self and implement suicide precautions. Safety is the primary issue; none of the other options is appropriate relative to suicide prevention.
A correctional nurse working in a county jail assesses all new inmates who report taking psychotropic medication or have symptoms of psychiatric disorders. Because of the high volume of newly incarcerated individuals, which skill is most essential for this nurse?
a.Documenting information that could be used as trial evidence
b.Quickly and skillfully assessing risks for suicide and violence
c.Having a comprehensive understanding of community resources
d.Counselling inmates to promote successful adaptation to incarceration
ANS: B
Newly incarcerated prisoners are often in crisis and may be suicidal. Others may be mentally ill and experiencing relapse. Therefore, being able to quickly and skillfully assess for risk of suicide and violence is an essential skill for the correctional nurse. Documenting potential evidence may occur but is not typically the primary or priority role of a correctional nurse. Community resources and counselling are helpful but would not be a priority compared to risk assessment and reduction.
A psychiatric clinical nurse specialist works with a defendant as a competency evaluator. A staff member asks, “Why are you spending so much time with that defendant? You spend one-to-one time and write volumes. Usually, we give defendants some medication and return them to court.” Select the clinical nurse specialist’s most appropriate response.
a.My role is to be an advocate for the defendant, so I have to know him well and build a trusting relationship.”
b.My focus is providing intensive psychotherapy to ensure the defendant becomes competent before returning to court.”
c.The specialized assessments I make on behalf of the court require very lengthy and detailed interviews, so it takes a lot of time.”
d.“I spend the time observing, assessing, and documenting competency, writing a report, and preparing expert testimony for the court.”
ANS: D
The competency evaluator has to determine the patient’s current competence to act on his own behalf during his trial; without competency, the inmate cannot stand trial. Determining competency goes well beyond the mental status, functional, and risk assessments most psychiatric nurses are accustomed to and are very complex and time-consuming. A complete formal report is prepared for the court and all pertinent details addressed in anticipation of questioning by officers of the court. The evaluator represents the court, not the patient. Interviews of the inmate are only a portion of the evaluator’s work. Evaluators help the court determine competency but do not intervene to increase the patient’s competency.
During arraignment, a defendant behaves bizarrely, fails to respond to the judge’s questions, and shouts obscenities. The judge orders an evaluation by a forensic nurse examiner. Which information provided by the examiner will be most important to the court at this time?
a.The defendant’s mental state at the time of the crime
b.The defendant’s competence to proceed with trial
c.The cause of the defendant’s courtroom behaviour
d.The defendant’s history and cognitive abilities
ANS: B
Competence to proceed refers to one’s capacity to assist the attorney and understand legal proceedings. Evidence is collected by a careful evaluation of a forensic client’s mental status at the time of the offence. This evaluation aids in determining the individual’s fitness to stand trial and may later influence the sentence. Forensic psychiatric nurses may spend many hours with an accused individual collecting evidence and carefully documenting the dialogue. In this capacity, the role of the 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. Canadian law specifies that a person cannot be tried for a criminal offence if because of a mental disorder he or she is unable to provide a defence. An incompetent individual is remanded to a locked facility for treatment to regain competency. The court will desire a full assessment of the patient’s present mental state related to his ability to assist in his own defence, but at this time, the court is not interested in his state of mind at the time of the original crime nor his history.
A psychiatric forensic nurse examiner was asked by a defendant’s attorney to determine the defendant’s fitness to stand trial. What is the priority task of the nurse examiner?
a.Determine if the defendant understands the charges and can assist the attorney with the defence.
b.Complete a risk assessment to determine if the defendant is a danger to self or others.
c.Complete a court-ordered evaluation of criminal responsibility.
d.Collect and compile evidence to determine whether a crime occurred.
ANS: C
It is the accused individual’s capacity at the time of trial that is in question in determining fitness to stand trial. The court may decide that an individual found unfit to stand trial is to be treated for the purpose of making the individual fit to stand trial. The nurse would be conducting a court-ordered evaluation of criminal responsibility. The defendant’s ability to understand the charges and assist in his defence is pertinent to an evaluation of competency. Unless the court has specifically asked for a risk assessment (which would be unusual), the risk assessment is the responsibility of clinical staff caring for the patient, not the forensic nurse examiner. Police collect evidence about the crime, and the prosecutor compiles it. A forensic nurse examiner does not participate in evidence collection other than that related to the assessment of the patient’s state of mind at the time of the alleged crime.
Select the best question for a psychiatric forensic nurse examiner to ask when assessing the fitness to stand trial of an individual charged with a crime.
a.Tell me about what you were thinking at the time of the alleged crime.”
b.What would you do if you heard a fire alarm going off where you live?”
c.At this time, are you having any experiences that others might think strange?”
d.Do you feel as though you would like to harm yourself or anyone else at the present time?”
ANS: A
Evidence collection is central to the role of the forensic psychiatric nurse. For example, evidence is collected by a careful evaluation of a forensic client’s mental status at the time of the offence. This evaluation aids in determining the individual’s fitness to stand trial and may later influence the sentence. Criminal responsibility refers to the mental state of a defendant at the time of the offence. A person is “not criminally responsible” (NCR) if he or she has a mental disorder that makes the person unable to judge the nature or quality of the criminal act or to understand that the act was wrong at the time it was committed. Assessing what the patient was thinking at the time of the alleged crime will provide insight into the person’s mental status. The distracters apply to other parts of a mental status assessment and do not assess the patient’s state at the time of the alleged crime.
In which circumstance would a psychiatric forensic nurse examiner determine it appropriate for a defendant and attorney to consider a “not criminally responsible” defence? At the time of the crime, the defendant did which of the following?
a.Shot a drug dealer who tried to overcharge for cocaine
b.Acted on auditory hallucinations of the voice of God commanding, “Kill the children.”
c.Tampered with the brakes on his wife’s car after discovering she had an extramarital affair
d.Was frightened because of a home robbery the preceding night, assumed a family member was another burglar, and shot him
ANS: B
A person is “not criminally responsible” (NCR) if he or she has a mental disorder that makes the person unable to judge the nature or quality of the criminal act or to understand that the act was wrong at the time it was committed. The defendant, demonstrating symptoms of psychosis and acting on the direction of command hallucinations, could use the defence of “not criminally responsible” because he was unable to recognize his action as wrong due to a psychiatric illness. The other options suggest the defendant knew right from wrong, had the capacity to know the nature and quality of the act, and had the capacity to form intent to commit the crime.
A nurse testifies about care provided to a patient in the 8 hours before a successful suicide. The nurse responds to questions about observations regarding the patient’s behaviour. In what capacity was this nurse testifying?
a.Forensic nurse examiner
b.Expert witness
c.Hostile witness
d.Consultant
ANS: B
Forensic psychiatric nurses may function as a forensic nurse examiner, expert witness, and consultant to the criminal justice system, law enforcement, or health care agencies. An expert witness shares professional expertise about the defendant or elements of the crime and testifies on behalf of the prosecution or defendant. Forensic nurse examiners conduct court-ordered examinations and provide written reports and court testimony regarding the findings of the examinations, but they do not give direct patient care. Consultants are neutral experts who educate or advise the court or its officers on technical matters such as standards of nursing care.
The highest degree of credibility is required by a nurse who provides testimony before the court as which of the following?
a.Hostile witness
b.Expert witness
c.Correctional nurse
d.Critical care nurse
ANS: B
An expert witness is recognized by the court as having a higher level of skill or expertise in a specific area. In addition to testifying about involvement with the individual and documentation of the interactions, an expert witness is permitted by the court to give a professional opinion. A hostile witness does not apply in this situation. Correctional and critical care nurses may testify as fact witnesses.
What chronic condition is an individual that is incarcerated in a Canadian Federal Institutions more likely to have than someone in the general population?
a.COPD
b.Diabetes
c.Multiple sclerosis
d.Cystic fibrosis
ANS: B
Chronic conditions more common in incarcerated individuals as compared to the general population are diabetes, asthma, and cardiovascular disorders. There is no evidence to suggest that COPD, multiple sclerosis, or cystic fibrosis is more likely in the incarcerated population.
A correctional nurse plans a health education series for male prison inmates based upon the greatest likelihood of experiencing which mental health disorder while incarcerated?
a.Mood disorder
b.Schizophrenia
c.Hallucinations
d.Bipolar disease
ANS: A
The most common mental health disorder experienced by male inmates is mood disorders. They are four times more likely to have a mood disorder than individuals that are not incarcerated. Although they are three times more likely to experience schizophrenia, the greatest likelihood is that they will experience a mood disorder.
Health problems most commonly encountered by correctional nurses are which of the following?
a.Routine infections and minor trauma
b.Chronic medical and psychiatric disorders
c.Similar to the non-incarcerated population
d.injuries acquired during arrest or incarceration
ANS: B
Correctional nurses provide care for inmates who have disproportionately high rates of mental illness, substance abuse, tuberculosis, AIDS, hepatitis, diabetes, and other chronic disorders and infections. The health problems of inmates are more complex and chronic, not similar to their non-incarcerated peers. Trauma is an important issue that affects inmate health, but it is not the primary health issue for this population as a whole.
