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A nurse has just transferred from a general psychiatric unit to work on a forensic psychiatric unit. The nurse finds it easier to communicate with these clients because, for the most part, their inappropriate behaviors and cognitive disorders have responded positively to treatment. Many of the clients have been on the unit for 3 or more years, and the nurse has been unable to note any indicators of psychiatric problems in several of the clients. The nurse has grown exceptionally close to one client who has gone out of his way to make the nurse feel welcome and appreciated. One afternoon in December, the client asks the nurse for her address so he can send her a Christmas card. Which response by the nurse would be most appropriate?
- A. Sure, let me write it down for you; it would be great to hear from you.
- B. I read that you molested a 4-year-old girl. I have a 2-year-old child. I would be crazy to give you my address.
- C. We need to get to know each other better before I would feel comfortable about giving you my address.
- D. It is inappropriate for me to give you my address because our relationship is professional rather than social.
Correct Answer: D
Rationale: Maintaining professional boundaries by stating the relationship is professional (D) is the most appropriate response, preventing inappropriate personal interactions. Sharing the address (A) violates boundaries, mentioning the crime (B) is unprofessional, and suggesting future closeness (C) blurs boundaries.
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A group of nurses who have recently been hired to work in the mental health division of a large federal prison system are undergoing orientation. A nurse is discussing medication administration for the clients. Which statement would the nurse most likely include in this presentation?
- A. Our inmates have to take their medication; to facilitate this, most of our oral medications are dissolved in water before we hand them to a prisoner.
- B. Our inmates have the same rights as any clients do. If they refuse medications and become a danger to themselves, we still cannot give any medications.
- C. Our inmates have to take their medications; we routinely give them injections so they can?t cheek their medications.
- D. If our inmates refuse to take their medications, we have to get a court order that mandates compliance with prescribed medications.
Correct Answer: D
Rationale: In a prison setting, if inmates refuse medications, a court order may be required to mandate compliance (D), especially for mental health treatment in forensic clients. Dissolving medications (A) or using injections (C) to prevent cheeking is not standard practice, and inmates retain some rights to refuse (B) unless a court order is obtained.
A student nurse has been asked by the mental health nursing instructor to plan educational interventions for a forensic client with whom the student has been working. Which of the following would be most important for the student nurse to include in the plan?
- A. Explanation of the genetic and neurologic factors associated with criminal behavior
- B. Description of information about pertinent legal and court proceedings that are pending
- C. Explanation of how nutrition and exercise can promote physical and mental well-being
- D. A list of community providers the client?s family members can contact for assistance and support
Correct Answer: C
Rationale: Educating the client on how nutrition and exercise promote physical and mental well-being (C) is most relevant, as it empowers the client to manage health post-discharge. Genetic factors (A) are not directly actionable, legal proceedings (B) are outside nursing scope, and provider lists for family (D) are less client-focused.
A psychiatric nurse who works with forensic clients is describing the roles and responsibilities to a group of nursing students. Which of the following would the nurse emphasize as critical before initiating medication therapy for a forensic client?
- A. Court order for medication
- B. Determination of not guilty by reason of insanity
- C. Informed consent
- D. Identification of history for aggression
Correct Answer: C
Rationale: Informed consent (C) is critical before initiating medication therapy, even in forensic settings, to respect client autonomy unless overridden by a court order. A court order (A) is only needed if consent is refused, NGRI status (B) is unrelated, and aggression history (D) informs but does not precede consent.
When preparing the plan of care for a forensic client, a nurse determines not to investigate the details of the crime. Which of the following best supports the rationale for the nurse?s decision?
- A. Knowing the crime details would be extremely frightening for the nurse.
- B. Denying the crime details will help to protect the nurse from undue anxiety.
- C. It will keep the nurse?s attitudes about the crime from influencing care.
- D. It will help maintain proper professional boundaries between the nurse and the client.
Correct Answer: C
Rationale: Avoiding crime details prevents the nurse?s attitudes about the crime from influencing care (C), ensuring unbiased, therapeutic treatment. Fear (A) and anxiety (B) are less relevant, and boundaries (D) are maintained through other professional practices, not just avoiding crime details.
A nurse is working with a forensic client on early recognition. On which area would the nurse and client focus?
- A. Medication side effects
- B. Aggressive behavior signals
- C. Violations of informed consent
- D. Discharge needs
Correct Answer: B
Rationale: Early recognition focuses on identifying aggressive behavior signals (B) to prevent escalation in forensic clients. Medication side effects (A), informed consent (C), and discharge needs (D) are important but not the primary focus of early recognition training.