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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 nurse is working with a forensic client on de-escalation techniques. Which activity would be most appropriate as a grounding physical activity?
- A. Drumming
- B. Rocking in a rocking chair
- C. Aerobic exercise
- D. Yoga
Correct Answer: B
Rationale: Rocking in a rocking chair (B) is a calming, grounding activity that helps reduce agitation in forensic clients. Drumming (A) and aerobic exercise (C) may be stimulating, and yoga (D) requires more focus, making them less effective for immediate de-escalation.
A psychiatric nursing instructor is trying to explain to a group of students how clients identified as guilty but mentally ill (GBMI) and not guilty by reason of insanity (NGRI) differ. Which of the following would be most appropriate for the instructor to include in the discussion?
- A. GBMI clients are treated in a hospital setting, and they are often discharged sooner than NGRI clients.
- B. NGRI clients are treated in a correctional setting, and they are discharged sooner than GBMI clients.
- C. GBMI clients are treated in a hospital setting, and their discharge is handled through the correctional parole system.
- D. NGRI clients are treated in a hospital setting, and their discharge is determined by the courts.
Correct Answer: D
Rationale: NGRI clients are treated in a hospital setting with discharge determined by courts (D), as their mental illness prevented criminal responsibility. GBMI clients (A, C) are typically managed in correctional settings with parole oversight, not hospital discharge. NGRI clients are not discharged sooner (B).
A nurse is discussing follow-up care with a forensic client who is being discharged the following week. The client asks the nurse what problems to expect regarding his follow-up care. Which response by the nurse would be most appropriate?
- A. You probably won?t experience any difficulty in finding the care you need after you are discharged.
- B. You will have to find weekly transportation back to the inpatient forensic unit for your follow-up care.
- C. You may experience some difficulty in finding a community provider who will be willing to offer you care because providers generally have a long waiting list.
- D. You may experience some difficulty in finding a community provider to provide you care because of safety and liability concerns.
Correct Answer: D
Rationale: Forensic clients may face difficulty finding community providers due to safety and liability concerns (D) stemming from their criminal history. No difficulty (A) is overly optimistic, returning to the inpatient unit (B) is not typical, and long waiting lists (C) are less specific than safety concerns.
The nurse is performing an admission assessment on a forensic client. Which of the following would be most important for the nurse to include when explaining the purpose of the assessment to the client?
- A. This is just a routine assessment, and we will be discussing specific events that have led to you being admitted to this unit.
- B. I will be asking you questions so we can determine how to best meet your needs.
- C. It is important during this initial assessment that you relate the specific details of the crimes of your case so we can effectively treat you.
- D. I will be asking you questions that will focus on mental health and behavioral issues rather than on the specific details of any crimes associated with your case.
Correct Answer: D
Rationale: Explaining that the assessment focuses on mental health and behavioral issues (D) is most appropriate, as it clarifies the therapeutic purpose and avoids delving into crime details, which could bias care. Routine assessment (A) is vague, discussing crime events (C) is inappropriate, and option B is less specific.
A client with mental illness and arrested has been found to be unfit to stand trial, and the client is admitted to a forensic mental health facility. The nurse understands that the client can be hospitalized for up to which duration to become fit?
- A. 3 months
- B. 6 months
- C. 1 year
- D. 5 years
Correct Answer: C
Rationale: Clients found unfit to stand trial may be hospitalized for up to 1 year (C) to restore competency, as per typical U.S. legal standards, with extensions possible if needed. Shorter durations (A, B) are insufficient, and 5 years (D) is excessive unless specified by the court.