A patient in a forensic psychiatric facility has been found not guilty by reason of insanity after committing a violent crime. The court determined that the patient did not understand that their actions were wrong at the time of the offense due to a severe mental illness. This legal decision is based on which of the following principles?

Irresistible impulse

Substantial capacity test

Durham Rule

M’Naghten Rule

Answer and Explanation

The Correct Answer is D

Choice A reason: The irresistible impulse test focuses on a defendant’s inability to control their actions due to mental illness, even if they understand the act’s wrongfulness. The scenario emphasizes the patient’s lack of understanding of wrongfulness, not impulse control, making this choice incorrect for the legal standard described.

Choice B reason: The substantial capacity test, part of the Model Penal Code, assesses whether a defendant lacks the capacity to appreciate the criminality of their conduct or conform to the law. The scenario specifically highlights not understanding wrongfulness, aligning more directly with M’Naghten, making this less precise.

Choice C reason: The Durham Rule states that a defendant is not criminally responsible if their act was a product of mental disease. It is broader and less specific than M’Naghten, which focuses on understanding wrongfulness, making it less applicable to the scenario described.

Choice D reason: The M’Naghten Rule holds that a defendant is not guilty by reason of insanity if, due to mental illness, they did not understand the nature or wrongfulness of their actions. This directly matches the scenario’s emphasis on the patient’s inability to understand wrongfulness, making it the correct choice.

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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. Disenfranchised grief B. Anticipatory grief C. Complicated grief D. Chronic grief

Correct Answer is A

Explanation

Choice A reason: Disenfranchised grief occurs when a loss is not socially acknowledged, such as in a non-traditional relationship, preventing open mourning. This leads to suppressed emotions and potential psychological distress, as the individual feels isolated in their grief, making this the correct choice for the described scenario.

Choice B reason: Anticipatory grief occurs before an expected loss, such as during a terminal illness, where individuals mourn in advance. The scenario describes grief after a death, not before, and the issue is lack of social recognition, not anticipation, making this choice incorrect.

Choice C reason: Complicated grief involves prolonged, intense grief that impairs functioning, often with unresolved emotions. While the woman’s sadness is significant, the key issue is the inability to mourn openly due to social stigma, not prolonged grief, making this choice incorrect.

Choice D reason: Chronic grief refers to persistent grief without resolution, often over years. The scenario does not indicate a prolonged duration but rather the social barrier to mourning a non-recognized relationship, aligning with disenfranchised grief, not chronic grief, making this choice incorrect.

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

A woman experiences deep sadness after the death of her “side-piece,” but she feels unable to openly mourn because their relationship was not recognized openly. The nurse identifies this as an example of:

Correct Answer is A

Explanation

A nurse is caring for an elderly patient with advanced dementia who is unable to make healthcare decisions independently. The patient’s adult child has been appointed legal guardian. What is the nurse’s best action regarding the patient’s care decisions?

What is psychomotor retardation as seen in psychiatric patients?

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A patient recently diagnosed with type 2 diabetes tells the nurse, “This is all my fault. If I had taken better care of myself, I wouldn’t be in this situation.” Which response by the nurse is the most therapeutic?

A patient with depression tells the nurse, “Sometimes I think people would be better off without me being alive.” Which closed-ended question should the nurse ask next to assess the patient’s safety?

During a psychiatric assessment, a patient frequently shifts from one topic to another and never returns to the original question asked by the nurse. This pattern of speech is best described as:

What is waxy flexibility in psychiatric patients?

A nurse is reviewing the medication orders for four patients. Which patient should the nurse anticipate receiving a lower dose of medication?