A patient is admitted to a forensic psychiatric facility after being found not guilty by reason of insanity. Court records show that although the patient understood their actions were wrong, they were unable to control their behavior due to a severe mental illness. This legal decision is most consistent with which of the following standards?

Durham Rule

M’Naghten Rule

Tarasoff Rule

Irresistible impulse

Answer and Explanation

The Correct Answer is D

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.

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Correct Answer is A

Explanation

Choice A reason: Reflecting the patient’s guilt and inviting further discussion is therapeutic, as it validates emotions and encourages exploration of feelings. This engages the patient’s emotional processing, fostering coping and reducing self-blame through empathetic communication, making this the correct choice.

Choice B reason: Telling the patient not to blame themselves dismisses their feelings, potentially inhibiting emotional expression. This nontherapeutic response fails to explore the patient’s guilt, which could stem from perceived control over their condition, making this choice incorrect.

Choice C reason: Advising to focus on the future minimizes the patient’s current emotional distress, a nontherapeutic approach. It overlooks the need to process guilt, which can affect diabetes management adherence, making this response less effective than exploring feelings.

Choice D reason: Downplaying diabetes as “not a big deal” invalidates the patient’s emotional experience, a nontherapeutic response. It fails to address guilt, which could impact psychological adjustment to the diagnosis, making this choice incorrect for therapeutic communication.

A. Inappropriate affect B. Flat affect C. Labile affect

Correct Answer is A

Explanation

Choice A reason: Inappropriate affect, where emotions like manic laughter mismatch the context of loss, is common in disorders like schizophrenia. It reflects limbic-prefrontal dysregulation, causing emotional responses to be incongruent with the situation, making this the correct choice for the described behavior.

Choice B reason: Flat affect involves minimal or no emotional expression, often in schizophrenia or depression. The patient’s manic laughter is an active, inappropriate response, not a lack of emotion, making this choice incorrect for the scenario described.

Choice C reason: Labile affect involves rapid emotional shifts, such as laughing to crying, seen in bipolar disorder. The scenario describes a single inappropriate response (manic laughter), not shifts, making this choice incorrect for the patient’s presentation.

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Naxlex Comprehensive Predictor Exams

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?

Correct Answer is A

Explanation

During a mental health assessment, a patient laughs manically while describing a recent loss of a loved one. The nurse recognizes this emotional expression as:

Correct Answer is A

Explanation

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?

A client on a psychiatric unit states, “It’s a waste of time being here. I can’t talk to you or anyone.” Which is the correct nursing response?

A patient recently lost her spouse and says, “I don’t know how I’m going to live without him.” Which of the following responses by the nurse is nontherapeutic?

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 patient missed a treatment option. Later, the patient appears withdrawn and avoids eye contact when discussing calling loved ones. Which is the best nursing action?

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?

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:

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: