Mental Health final exam (835 Questions with 1 n n n n n n n
00% Correct Answers) n n
What are the 3 main impulse control problems? -
n n n n n n n n
Correct answer 1. Intermittent explosive disorder
n n n n n n
2. Pyromania
n
3. Kleptomania
n
What is the underlying problem with the impulse control difficulties? -
n n n n n n n n n n
Correct answer Anxiety - their actions relieve anxiety or cause pleasure
n n n n n n n n n n n
Tx for all impulse disorders [intermittent explosive disorder, pyromania, klept
n n n n n n n n n
omania]? - Correct answer SSRI's + Group Therapy
n n n n n n n n
(but none of these are really that great)
n n n n n n n
What impulse disorder results in an violent act that's out of proportion to the in
n n n n n n n n n n n n n n
itial stressor, followed by the pt being calm, relaxed, and showing no remorse
n n n n n n n n n n n n
? - Correct answer Intermittent Explosive Disorder
n n n n n n
What are the diagnostic criteria for intermittent explosive disorder? -
n n n n n n n n n
Correct answer 1. Twice a week in 3 months without harm
n n n n n n n n n n n
OR
2. 3 times a year with harm
n n n n n n
What's the definition of pyromania? -
n n n n n
nCorrect answer Deliberate fire setting on >1 occasion + fascination and grat
n n n n n n n n n n n
ification with fire setting and related behaviors
n n n n n n
What's the difference between arson and pyromania? -
n n n n n n n
Correct answer Arson: causing harm or destruction for monetary gain
n n n n n n n n n n
Pyromania: lowers anxiety or gives sexual arousal or pleasure
n n n n n n n n
What's the difference b/w theft and kleptomania? -
n n n n n n n
Correct answer Theft: Desire for object and able to resist, object has value a
n n n n n n n n n n n n n n
nd pt can't afford. Planned. Object is used or kept w/o remorse or guilt
n n n n n n n n n n n n n
,Kleptomania: lowers anxiety and unable to resist. Object has no value, pt can
n n n n n n n n n n n n n
afford it. Unplanned, without help. Often object is stashed, gifted, or returned.
n n n n n n n n n n n n
Remorse and guilt are present n n n n
T/F: Patients with kleptomania feel no guilt or remorse after stealing an object
n n n n n n n n n n n n
- Correct answer False! They have intense guilt
n n n n n n n n
A person diagnosed with bipolar disorder ran out of money, did not refill a lithi
n n n n n n n n n n n n n n
um prescription, and then relapsed. After assaulting several people in the co
n n n n n n n n n n n
mmunity, this person was convicted and sentenced. Prior to parole, which out
n n n n n n n n n n n
come has priority for the correctional nurse to achieve? The person:
n n n n n n n n n n
A. agrees in writing to continue lithium therapy.
n n n n n n n
B. is reestablished on an appropriate dose of lithium.
n n n n n n n n
C. lists community resources for prescription assistance.
n n n n n n
D. agrees to a follow-up appointment in an outpatient clinic. -
n n n n n n n n n n
Correct answer C
n n n
To increase medication adherence, reduce the risk of relapse, and prevent fu
n n n n n n n n n n n
rther criminal activity due to mental illness, the person's awareness of commu
n n n n n n n n n n n
nity resources for medication refills and medication-
n n n n n n
related services is the most important outcome. Agreeing to take lithium, bein
n n n n n n n n n n n
g reestablished on medication in the jail, and agreeing to follow-
n n n n n n n n n n
up mental health care are important, but none of these will address the primar
n n n n n n n n n n n n n
y reason for the criminal behavior: the relapse caused by inability to access m
n n n n n n n n n n n n n
edication in the community. n n n
An inmate was diagnosed with posttraumatic stress disorder (PTSD) caused
n n n n n n n n n n
by severe sexual abuse. One day this inmate sees a person with characteristi
n n n n n n n n n n n n
cs similar to the perpetrator, has a flashback, and then attacks the person. Co
n n n n n n n n n n n n n
rrectional officers place the inmate in restraint. The correctional nurse should
n n n n n n n n n n n
anticipate that the inmate would react to restraint by:
n n n n n n n n
A. committing to counseling to reduce the incidence of flashbacks.
n n n n n n n n n
B. becoming less likely to assault others during future flashbacks.
n n n n n n n n n
,C. gradually calming and returning from the flashback to reality.
n n n n n n n n n
D. becoming more frightened, agitated, and combative. - Correct answer D
n n n n n n n n n n
The correctional nurse recognizes that events occurring in the present reality
n n n n n n n n n n n
are likely to be incorporated into a flashback, leading the inmate to become m
n n n n n n n n n n n n n
ore frightened and desperate to escape. Even if no longer experiencing a flas
n n n n n n n n n n n n
hback, persons will likely reexperience their original trauma if restrained, incl
n n n n n n n n n n
uding the emotions experienced during that trauma, leading to increased fear
n n n n n n n n n n
fulness and resistance to the jail restraints. Restraints are not likely to calm th
n n n n n n n n n n n n n
e individual or reduce aggressiveness but instead increase the sense of helpl
n n n n n n n n n n n
essness and desperation. n n
An inmate was diagnosed with posttraumatic stress disorder (PTSD) caused
n n n n n n n n n n
by severe sexual abuse. One day this inmate sees a person with similar char
n n n n n n n n n n n n n
acteristics to the perpetrator, has a flashback, and then attacks the person. C
n n n n n n n n n n n n
orrectional officers place the inmate in restraint. Which action by the correctio
n n n n n n n n n n n
nal nurse is most appropriate?
n n n n
A. Plan to meet with the inmate for debriefing after release from the required p
n n n n n n n n n n n n n n
eriod of restraint. n n
B. Support use of restraints as needed to control violent outbursts and assure
n n n n n n n n n n n n
nthe safety of all inmates.
n n n n
C. Contact a supervisor authorized to make an exception to the restraint polic
n n n n n n n n n n n n
y and explain why an alternate response is needed.
n n n n n n n n
D. Confront the correctional officers who initiated the restraint, explain the ina
n n n n n n n n n n n
ppropriateness of this action, and request the inmate's release - n n n n n n n n n
nCorrect answer C n n
Nurses have advocacy responsibilities, regardless of the setting. The optimu
n n n n n n n n n
m outcome in this situation would be to minimize the duration of the restraint e
n n n n n n n n n n n n n n
pisode. The inmate and others are at risk of injury until the inmate is calm. Th
n n n n n n n n n n n n n n n
e restraints will likely worsen and extend the inmate's distress and agitation.
n n n n n n n n n n n n
Supporting the use of restraints ignores the need of select inmates for alterna
n n n n n n n n n n n n
te responses that do not paradoxically worsen the situation instead of help it.
n n n n n n n n n n n n n
Meeting with the patient to calm her after her release would be the second mo
n n n n n n n n n n n n n n
st helpful response, but it does not shorten the duration of the patient's restrai
n n n n n n n n n n n n n
nt. Confronting the officers is unlikely to be successful, since they are followin
n n n n n n n n n n n n
g proper procedures; accusing them of improper actions will likely increase d
n n n n n n n n n n n
efensiveness rather than expedite the inmate's release from restraint. n n n n n n n n
, The correctional nurse assesses a new prisoner beginning incarceration after
n n n n n n n n n
ncommitting a sex crime. The prisoner speaks in a low voice and tearfully tells
n n n n n n n n n n n n n n
the nurse, "My life might as well be over. There is no hope I will ever fit into so
n n n n n n n n n n n n n n n n n n
ciety after I get out of prison. My family disowned me." Select the nurse's prior
n n n n n n n n n n n n n n
ity action.
n
A. Advise guards to place the inmate in solitary confinement.
n n n n n n n n n
B. Offer to contact the inmate's family to convey these feelings of remorse.
n n n n n n n n n n n n
C. Alert the guards of the risk for suicide and implement suicide precautions.
n n n n n n n n n n n n
D. Meet with the inmate weekly to discuss these feelings and explore coping
n n n n n n n n n n n n n
strategies. - Correct answer C n n n n
The inmate is experiencing significant shame and self-
n n n n n n n
loathing, facing many significant losses (freedom, status in the community, p
n n n n n n n n n n
erhaps his career), separated from his support system, and evidences hopel
n n n n n n n n n n
essness. These all suggest a significant risk of suicide. The priority response
n n n n n n n n n n n n
would be to alert the guards of the inmate's risk to self and implement suicide
n n n n n n n n n n n n n n n
precautions. Safety is the primary issue; none of the other options is appropri
n n n n n n n n n n n n
ate relative to suicide prevention.
n n n n
A correctional nurse working in a county jail assesses all new inmates who re
n n n n n n n n n n n n n
port taking psychotropic medication or have symptoms of psychiatric disorder
n n n n n n n n n
s. Because of the high volume of newly incarcerated individuals, which skill is
n n n n n n n n n n n n n
most essential for this nurse?
n n n n
A. Documenting information that could be used as trial evidence
n n n n n n n n n
B. Quickly and skillfully assessing risks for suicide and violence
n n n n n n n n n
C. Having a comprehensive understanding of community resources
n n n n n n n
D. Counseling inmates to promote successful adaptation to incarceration -
n n n n n n n n n
Correct answer B
n n n
Newly incarcerated prisoners are often in crisis and may be suicidal. Others
n n n n n n n n n n n n
may be mentally ill and experiencing relapse. Therefore, being able to quickly
n n n n n n n n n n n
and skillfully assess for risk of suicide and violence is an essential skill for the
n n n n n n n n n n n n n n n n
correctional nurse. Documenting potential evidence may occur but is not typi
n n n n n n n n n n
00% Correct Answers) n n
What are the 3 main impulse control problems? -
n n n n n n n n
Correct answer 1. Intermittent explosive disorder
n n n n n n
2. Pyromania
n
3. Kleptomania
n
What is the underlying problem with the impulse control difficulties? -
n n n n n n n n n n
Correct answer Anxiety - their actions relieve anxiety or cause pleasure
n n n n n n n n n n n
Tx for all impulse disorders [intermittent explosive disorder, pyromania, klept
n n n n n n n n n
omania]? - Correct answer SSRI's + Group Therapy
n n n n n n n n
(but none of these are really that great)
n n n n n n n
What impulse disorder results in an violent act that's out of proportion to the in
n n n n n n n n n n n n n n
itial stressor, followed by the pt being calm, relaxed, and showing no remorse
n n n n n n n n n n n n
? - Correct answer Intermittent Explosive Disorder
n n n n n n
What are the diagnostic criteria for intermittent explosive disorder? -
n n n n n n n n n
Correct answer 1. Twice a week in 3 months without harm
n n n n n n n n n n n
OR
2. 3 times a year with harm
n n n n n n
What's the definition of pyromania? -
n n n n n
nCorrect answer Deliberate fire setting on >1 occasion + fascination and grat
n n n n n n n n n n n
ification with fire setting and related behaviors
n n n n n n
What's the difference between arson and pyromania? -
n n n n n n n
Correct answer Arson: causing harm or destruction for monetary gain
n n n n n n n n n n
Pyromania: lowers anxiety or gives sexual arousal or pleasure
n n n n n n n n
What's the difference b/w theft and kleptomania? -
n n n n n n n
Correct answer Theft: Desire for object and able to resist, object has value a
n n n n n n n n n n n n n n
nd pt can't afford. Planned. Object is used or kept w/o remorse or guilt
n n n n n n n n n n n n n
,Kleptomania: lowers anxiety and unable to resist. Object has no value, pt can
n n n n n n n n n n n n n
afford it. Unplanned, without help. Often object is stashed, gifted, or returned.
n n n n n n n n n n n n
Remorse and guilt are present n n n n
T/F: Patients with kleptomania feel no guilt or remorse after stealing an object
n n n n n n n n n n n n
- Correct answer False! They have intense guilt
n n n n n n n n
A person diagnosed with bipolar disorder ran out of money, did not refill a lithi
n n n n n n n n n n n n n n
um prescription, and then relapsed. After assaulting several people in the co
n n n n n n n n n n n
mmunity, this person was convicted and sentenced. Prior to parole, which out
n n n n n n n n n n n
come has priority for the correctional nurse to achieve? The person:
n n n n n n n n n n
A. agrees in writing to continue lithium therapy.
n n n n n n n
B. is reestablished on an appropriate dose of lithium.
n n n n n n n n
C. lists community resources for prescription assistance.
n n n n n n
D. agrees to a follow-up appointment in an outpatient clinic. -
n n n n n n n n n n
Correct answer C
n n n
To increase medication adherence, reduce the risk of relapse, and prevent fu
n n n n n n n n n n n
rther criminal activity due to mental illness, the person's awareness of commu
n n n n n n n n n n n
nity resources for medication refills and medication-
n n n n n n
related services is the most important outcome. Agreeing to take lithium, bein
n n n n n n n n n n n
g reestablished on medication in the jail, and agreeing to follow-
n n n n n n n n n n
up mental health care are important, but none of these will address the primar
n n n n n n n n n n n n n
y reason for the criminal behavior: the relapse caused by inability to access m
n n n n n n n n n n n n n
edication in the community. n n n
An inmate was diagnosed with posttraumatic stress disorder (PTSD) caused
n n n n n n n n n n
by severe sexual abuse. One day this inmate sees a person with characteristi
n n n n n n n n n n n n
cs similar to the perpetrator, has a flashback, and then attacks the person. Co
n n n n n n n n n n n n n
rrectional officers place the inmate in restraint. The correctional nurse should
n n n n n n n n n n n
anticipate that the inmate would react to restraint by:
n n n n n n n n
A. committing to counseling to reduce the incidence of flashbacks.
n n n n n n n n n
B. becoming less likely to assault others during future flashbacks.
n n n n n n n n n
,C. gradually calming and returning from the flashback to reality.
n n n n n n n n n
D. becoming more frightened, agitated, and combative. - Correct answer D
n n n n n n n n n n
The correctional nurse recognizes that events occurring in the present reality
n n n n n n n n n n n
are likely to be incorporated into a flashback, leading the inmate to become m
n n n n n n n n n n n n n
ore frightened and desperate to escape. Even if no longer experiencing a flas
n n n n n n n n n n n n
hback, persons will likely reexperience their original trauma if restrained, incl
n n n n n n n n n n
uding the emotions experienced during that trauma, leading to increased fear
n n n n n n n n n n
fulness and resistance to the jail restraints. Restraints are not likely to calm th
n n n n n n n n n n n n n
e individual or reduce aggressiveness but instead increase the sense of helpl
n n n n n n n n n n n
essness and desperation. n n
An inmate was diagnosed with posttraumatic stress disorder (PTSD) caused
n n n n n n n n n n
by severe sexual abuse. One day this inmate sees a person with similar char
n n n n n n n n n n n n n
acteristics to the perpetrator, has a flashback, and then attacks the person. C
n n n n n n n n n n n n
orrectional officers place the inmate in restraint. Which action by the correctio
n n n n n n n n n n n
nal nurse is most appropriate?
n n n n
A. Plan to meet with the inmate for debriefing after release from the required p
n n n n n n n n n n n n n n
eriod of restraint. n n
B. Support use of restraints as needed to control violent outbursts and assure
n n n n n n n n n n n n
nthe safety of all inmates.
n n n n
C. Contact a supervisor authorized to make an exception to the restraint polic
n n n n n n n n n n n n
y and explain why an alternate response is needed.
n n n n n n n n
D. Confront the correctional officers who initiated the restraint, explain the ina
n n n n n n n n n n n
ppropriateness of this action, and request the inmate's release - n n n n n n n n n
nCorrect answer C n n
Nurses have advocacy responsibilities, regardless of the setting. The optimu
n n n n n n n n n
m outcome in this situation would be to minimize the duration of the restraint e
n n n n n n n n n n n n n n
pisode. The inmate and others are at risk of injury until the inmate is calm. Th
n n n n n n n n n n n n n n n
e restraints will likely worsen and extend the inmate's distress and agitation.
n n n n n n n n n n n n
Supporting the use of restraints ignores the need of select inmates for alterna
n n n n n n n n n n n n
te responses that do not paradoxically worsen the situation instead of help it.
n n n n n n n n n n n n n
Meeting with the patient to calm her after her release would be the second mo
n n n n n n n n n n n n n n
st helpful response, but it does not shorten the duration of the patient's restrai
n n n n n n n n n n n n n
nt. Confronting the officers is unlikely to be successful, since they are followin
n n n n n n n n n n n n
g proper procedures; accusing them of improper actions will likely increase d
n n n n n n n n n n n
efensiveness rather than expedite the inmate's release from restraint. n n n n n n n n
, The correctional nurse assesses a new prisoner beginning incarceration after
n n n n n n n n n
ncommitting a sex crime. The prisoner speaks in a low voice and tearfully tells
n n n n n n n n n n n n n n
the nurse, "My life might as well be over. There is no hope I will ever fit into so
n n n n n n n n n n n n n n n n n n
ciety after I get out of prison. My family disowned me." Select the nurse's prior
n n n n n n n n n n n n n n
ity action.
n
A. Advise guards to place the inmate in solitary confinement.
n n n n n n n n n
B. Offer to contact the inmate's family to convey these feelings of remorse.
n n n n n n n n n n n n
C. Alert the guards of the risk for suicide and implement suicide precautions.
n n n n n n n n n n n n
D. Meet with the inmate weekly to discuss these feelings and explore coping
n n n n n n n n n n n n n
strategies. - Correct answer C n n n n
The inmate is experiencing significant shame and self-
n n n n n n n
loathing, facing many significant losses (freedom, status in the community, p
n n n n n n n n n n
erhaps his career), separated from his support system, and evidences hopel
n n n n n n n n n n
essness. These all suggest a significant risk of suicide. The priority response
n n n n n n n n n n n n
would be to alert the guards of the inmate's risk to self and implement suicide
n n n n n n n n n n n n n n n
precautions. Safety is the primary issue; none of the other options is appropri
n n n n n n n n n n n n
ate relative to suicide prevention.
n n n n
A correctional nurse working in a county jail assesses all new inmates who re
n n n n n n n n n n n n n
port taking psychotropic medication or have symptoms of psychiatric disorder
n n n n n n n n n
s. Because of the high volume of newly incarcerated individuals, which skill is
n n n n n n n n n n n n n
most essential for this nurse?
n n n n
A. Documenting information that could be used as trial evidence
n n n n n n n n n
B. Quickly and skillfully assessing risks for suicide and violence
n n n n n n n n n
C. Having a comprehensive understanding of community resources
n n n n n n n
D. Counseling inmates to promote successful adaptation to incarceration -
n n n n n n n n n
Correct answer B
n n n
Newly incarcerated prisoners are often in crisis and may be suicidal. Others
n n n n n n n n n n n n
may be mentally ill and experiencing relapse. Therefore, being able to quickly
n n n n n n n n n n n
and skillfully assess for risk of suicide and violence is an essential skill for the
n n n n n n n n n n n n n n n n
correctional nurse. Documenting potential evidence may occur but is not typi
n n n n n n n n n n
