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: Checking with the physician before releasing information to a legal guardian is unnecessary, as guardians have legal authority to access patient information. This response delays care coordination and disregards the guardian’s role, potentially hindering decision-making, making it incorrect.

Choice B reason: Requiring patient consent is inappropriate for a patient with advanced Alzheimer’s, who lacks decision-making capacity. The court-appointed guardian has legal authority to receive medical information, as they act in the patient’s best interest, making this response incorrect.

Choice C reason: Restricting information to immediate family ignores the legal guardian’s authority. Guardians, regardless of family status, are legally entitled to medical updates to make informed care decisions, as they represent the patient’s interests, making this response incorrect.

Choice D reason: Providing the guardian with medication and care plan updates is appropriate, as they have legal authority to make healthcare decisions for the patient. This ensures informed decision-making and complies with legal and ethical standards, making this the correct choice.

A. Help the patient control emotional outbursts B. Provide the patient with a plan of action C. Assess the patient’s perception of a problem D. Inform the patient of priority problems

Correct Answer is C

Explanation

Choice A reason: While therapeutic communication can help patients manage emotions, controlling outbursts is a secondary outcome, not a primary goal. It involves techniques like de-escalation, but the focus is on understanding the patient’s emotional state through active listening, not directly controlling behavior, making this choice less accurate.

Choice B reason: Providing a plan of action is a nursing intervention, not a primary goal of therapeutic communication. Communication aims to explore patient perspectives and build trust, not to deliver directives. Plans are developed after understanding the patient’s needs, making this choice incorrect.

Choice C reason: Assessing the patient’s perception of a problem is a key goal of therapeutic communication. Techniques like active listening and open-ended questions help nurses understand the patient’s subjective experience, identifying psychological issues and tailoring interventions, making this the correct choice for the goal described.

Choice D reason: Informing the patient of priority problems is an educational or directive action, not a primary goal of therapeutic communication. Communication focuses on exploring patient perspectives, not imposing nurse-identified priorities, which could disrupt trust and engagement, making this choice incorrect.

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Naxlex Comprehensive Predictor Exams

An elderly patient with advanced Alzheimer’s disease is admitted to the unit. The nurse is informed that the patient has a court-appointed legal guardian. The guardian arrives and asks for information about the patient’s medications and plan of care. What is the nurse’s best response?

Correct Answer is D

Explanation

The nurse uses a variety of therapeutic communication skills when working with patients. Which of the following is a therapeutic goal that can be accomplished through the use of therapeutic communication?

Correct Answer is C

Explanation

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:

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:

What is waxy flexibility in psychiatric patients?

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?

A nurse is caring for a patient diagnosed with schizophrenia. During the interaction, the nurse notices that the patient’s facial expressions are minimal and do not seem to match the emotions being expressed verbally. This is an example of:

A patient becomes agitated and physically aggressive on the unit, requiring the use of restraints. Which of the following actions by the nurse is appropriate when applying and managing restraints?

A patient is brought to the psychiatric unit by family members after expressing suicidal thoughts but refuses voluntary admission. The healthcare team proceeds with involuntary commitment. Which of the following statements best describes involuntary commitment?

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: