Chapter 33: Forensic Nursing |Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

MULTIPLE CHOICE 1. A person diagnosed with bipolar disorder ran out of money, did not refill a lithium prescription, and then relapsed. After assaulting several people in the community, this person was convicted and sentenced. Prior to parole, which outcome has priority for the correctional nurse to achieve? The person a. agrees in writing to continue lithium therapy. b. is reestablished on an appropriate dose of lithium. c. lists community resources for prescription assistance. d. agrees to a follow-up appointment in an outpatient clinic. ANS: C To increase medication adherence, reduce the risk of relapse, and prevent further criminal activity due to mental illness, the person‘s awareness of community resources for medication refills and medication-related services is the most important outcome. Agreeing to take lithium, being reestablished on medication in the jail, and agreeing to follow-up mental health care are important, but none of these will address the primary reason for the criminal behavior: the relapse caused by inability to access medication in the community. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 33-21 TOP: Nursing Process: Outcomes Identification MSC: Client Needs: Health Promotion and Maintenance 2. An inmate was diagnosed with posttraumatic stress disorder (PTSD) caused by severe sexual abuse. One day this inmate sees a person with characteristics similar to the perpetrator, has a flashback, and then attacks the person. Correctional officers place the inmate in restraint. The correctional nurse should anticipate that the inmate would react to restraint by a. committing to counseling to reduce the incidence of flashbacks. b. becoming less likely to assault others during future flashbacks. c. gradually calming and returning from the flashback to reality. d. becoming more frightened, agitated, and combative. ANS: D The correctional nurse recognizes that events occurring in the present reality are likely to be incorporated into a flashback, leading the inmate to become more frightened and desperate to escape. Even if no longer experiencing a flashback, persons will likely re-experience their original trauma if restrained, including the emotions experienced during that trauma, leading to increased fearfulness and resistance to the jail restraints. Restraints are not likely to calm the individual or reduce aggressiveness but instead increase the sense of helplessness and desperation. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 33-19, 21, 22 (Vignette) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 3. An inmate was diagnosed with PTSD caused by severe sexual abuse. One day this inmate sees a person with similar characteristics to the perpetrator, has a flashback, and then attacks the person. Correctional officers place the inmate in restraint. Which action by the correctional nurse is most appropriate? a. Plan to meet with the inmate for debriefing after release from the required period of restraint. b. Support use of restraints as needed to control violent outbursts and assure the safety of all inmates. c. Contact a supervisor authorized to make an exception to the restraint policy and explain why an alternate response is needed. d. Confront the correctional officers who initiated the restraint, explain the inappropriateness of this action, and request the inmate‘s release. ANS: C Nurses have advocacy responsibilities, regardless of the setting. The optimum outcome in this situation would be to minimize the duration of the restraint episode. The inmate and others are at risk of injury until the inmate is calm. The restraints will likely worsen and extend the inmate‘s distress and agitation. Supporting the use of restraints ignores the need of select inmates for alternate responses that do not paradoxically worsen the situation instead of help it. Meeting with the patient to calm her after her release would be the second most helpful response, but it does not shorten the duration of the patient‘s restraint. Confronting the officers is unlikely to be successful, since they are following proper procedures; accusing them of improper actions will likely increase defensiveness rather than expedite the inmate‘s release from restraint. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 33-8, 19, 21, 22 (Vignette) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 4. As a nurse in the prison clinic changes the dressing on an inmate‘s wound, the inmate says, ―You know I never did anything, right? I am totally innocent any crime.‖ Select the nurse‘s best response. a. I hear that same comment from most of the inmates here.‖ b. Whether you are innocent or guilty is of no concern to me.‖ c. Your innocence or guilt is the Court‘s decision, not my decision.‖ d. I trust you to tell me the truth. I will document your comments in your medical record.‖