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?

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.

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.