A patient diagnosed with schizophrenia tells the nurse, “I hear voices sometimes, but they don’t bother me.” Which of the following is the most appropriate open-ended response by the nurse to further assess the patient’s experience?

Do the voices come from the TV or the radio?

Tell me more about what the voices say to you.

Are the voices telling you to harm yourself or others?

Do you hear the voices more during the day or night?

Answer and Explanation

The Correct Answer is B

Choice A reason: Asking if voices come from external sources like TV assumes a delusional origin and closes off exploration. Open-ended questions are needed to assess the nature and impact of auditory hallucinations in schizophrenia, making this choice nontherapeutic.

Choice B reason: Asking the patient to describe the voices’ content is an open-ended response that encourages detailed disclosure. This helps assess the hallucinations’ nature, frequency, and impact on behavior, aiding in risk assessment and treatment planning, making this the correct choice.

Choice C reason: Asking about harm is a closed-ended question that assumes a specific risk, potentially limiting exploration of the hallucination’s full context. While safety is critical, open-ended questions better assess the patient’s experience initially, making this choice less appropriate.

Choice D reason: Asking about the timing of voices is closed-ended and limits the depth of assessment. Understanding the content and impact of hallucinations is more critical for schizophrenia management, as timing alone does not reveal risk or severity, making this choice incorrect.

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Correct Answer is D

Explanation

Choice A reason: The Durham Rule holds that a defendant is not criminally responsible if their act was a product of mental disease. It is broad and does not specifically address the inability to control behavior despite knowing wrongfulness, making it less applicable than irresistible impulse.

Choice B reason: The M’Naghten Rule focuses on a defendant’s inability to understand the nature or wrongfulness of their actions due to mental illness. The scenario emphasizes inability to control behavior, not lack of understanding, making this choice incorrect.

Choice C reason: The Tarasoff Rule requires clinicians to warn potential victims of a patient’s threat, unrelated to insanity defenses. It addresses duty to protect, not the legal standard for criminal responsibility, making this choice irrelevant to the scenario.

Choice D reason: The irresistible impulse standard applies when a defendant understands their actions were wrong but cannot control their behavior due to mental illness. This matches the scenario, where the patient’s inability to control actions led to the insanity ruling, making this the correct choice.

A. Labile affect B. Flat affect C. Restricted affect D. Blunted affect

Correct Answer is A

Explanation

Choice A reason: Labile affect, common in bipolar disorder, involves rapid, unpredictable shifts in emotional expression, such as moving from laughter to crying. This reflects dysregulation in the limbic system and prefrontal cortex, leading to exaggerated emotional responses. The sudden mood swings described align with this condition, making it the correct choice.

Choice B reason: Flat affect describes a severe reduction or absence of emotional expression, often seen in schizophrenia or severe depression. Patients display minimal facial or vocal changes, unlike the rapid emotional shifts in the scenario. This lack of emotional variability does not match the described behavior, making this choice incorrect.

Choice C reason: Restricted affect refers to a limited range of emotional expression, less severe than flat affect, often seen in mood disorders or personality disorders. It does not involve rapid shifts between emotions, as described in the question, but rather a consistently narrowed emotional range, making this choice incorrect.

Choice D reason: Blunted affect involves a reduced intensity of emotional expression, common in schizophrenia or post-traumatic stress disorder. Patients show muted responses, not rapid shifts between intense emotions like laughter and crying. This does not align with the described bipolar disorder behavior, making this choice incorrect.

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A patient diagnosed with schizophrenia tells the nurse, “I hear voices sometimes, but they don’t bother me.” Which of the following is the most appropriate open-ended response by the nurse to further assess the patient’s experience?

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Correct Answer is D

Explanation

A nurse observes a patient with bipolar disorder who suddenly shifts from laughing joyfully to crying within minutes during the therapy session. This sudden and intense change in emotional expression is an example of:

Correct Answer is A

Explanation

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