The psychiatric forensic nurse examiner has been asked by the ...

[joblessjake]

The psychiatric forensic nurse examiner has been asked by the defendant's lawyer to determine the patient's legal sanity. The priority task of the nurse will be to:
 
  a. determine if the defendant understands the charges and can assist in his own defense.
  b. reconstruct the defendant's mental state and motives at the time of the crime.
  c. complete a risk assessment to determine if he is a danger to self or others.
  d. collect and compile evidence to determine whether a crime was committed.

Question 2

A patient with bipolar disorder was hospitalized 5 days ago and has received lithium 600 mg TID. The staff now observes agitation, pressured speech, poor personal hygiene, hyperactivity, and bizarre clothing. Select the nurse's best action.
 
  a. Consider the need to measure the serum lithium level. The patient may not be swallowing the medication.
  b. Include the patient in psychoeducational groups about personal hygiene, dressing, and grooming.
  c. Ask the health care provider to prescribe an increased dose and frequency of lithium.
  d. Continue to monitor and document the patient's speech patterns and motor activity.

[blazinlyss]

Answer to Question 1

B
Legal sanity is determined for the specific time of the alleged crime, so reconstructing the defendant's mental state, motivation, thinking, and other elements of functioning at the time of the alleged crime is essential to making the determination. The defendant's ability to understand the charges and assist in his defense is pertinent to an evaluation of competency. Unless the court has specifically asked for a risk assessment (which would be unusual), the risk assessment is the responsibility of clinical staff caring for the patient, not the forensic nurse examiner. Police collect evidence about the crime, and the prosecutor compiles it; the forensic nurse examiner does not participate in evidence collection other than that related to the assessment of the patient's state of mind at the time of the alleged crime.

Answer to Question 2

A
The patient is continuing to exhibit manic symptoms. The lithium level may be low from cheeking medication. The prescribed dose is high, so one would not expect the dose to be increased.

[joblessjake]

Excellent

[diana chang]

TYSM