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A nursing instructor is explaining to a group of nursing students that in addition to facing the stigma associated with being mentally ill, forensic clients who are mentally ill also experience the stigma associated with being a criminal. One of the students asks the instructor how the stigma associated with criminality might influence nursing care. Which response by the instructor would be most appropriate?
- A. Nurses may be reluctant to care for mentally ill criminals because of unrealistic fears for their own safety and that of their other clients.
- B. Nurses may prefer to care for forensic clients because they do not believe criminals can be mentally ill.
- C. An example would be volunteering to work only with forensic clients because of the belief that forensic clients experience only mild mental health problems.
- D. An example would be unfounded fear of what such clients might do after they are discharged from treatment.
Correct Answer: A
Rationale: Stigma associated with criminality can lead nurses to be reluctant to care for forensic clients due to unrealistic safety fears (A). Option B is incorrect, as nurses do not typically deny mental illness in criminals. Option C misrepresents nurses? motivations, and option D focuses on post-discharge fears, which is less relevant to direct care.
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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.
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.
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 nurse?s friend is considering going into forensic nursing and asks the nurse to explain the connection between mental illness and being convicted of a crime. Which response by the nurse would be most accurate?
- A. Mentally ill men are less likely than nonmentally ill men to be convicted of a crime.
- B. Mentally ill women are less likely than nonmentally ill women to be convicted of a crime.
- C. Women who are incarcerated are more likely to receive mental health services than men.
- D. African American offenders often receive more mental health treatment than other offenders.
Correct Answer: C
Rationale: Women who are incarcerated are more likely to receive mental health services than men (C), as studies show higher rates of mental health intervention for female inmates due to greater recognition of their needs. Mentally ill individuals (A, B) are not less likely to be convicted; mental illness often increases legal involvement. African American offenders (D) typically face disparities in access, not more treatment.
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.