Chapter 24: Forensic Nursing My Nursing Test Banks

Fortinash: Psychiatric Mental Health Nursing, 5th Edition

Chapter 24: Forensic Nursing

Test Bank

MULTIPLE CHOICE

1. What is the primary expected outcome when a victim of a violent crime is initially attended to by a forensic nurse?

a.

Their physical injuries will be assessed and treated.

b.

The evidence of the assault from their body will be preserved.

c.

The legal system will be provided with evidence of the crime.

d.

Their long-term emotional health will be of primary concern.

ANS: B

Forensic nurses fill a gap where the health care system interacts with the legal system by meeting the needs of victims and perpetrators of violent crimes through enhanced quality of care and preventive services. Observation, documentation, preservation, and notification are critical for determining the legal outcomes of cases that involve violence. Although it is true that the legal system is supported, that is not the focus of care in these cases. The remaining options are not responsibilities unique to the forensic nurse.

DIF: Cognitive Level: Application REF: Page 558 TOP: Nursing Process: Planning

MSC: NCLEX: Psychological Integrity

2. Which therapeutic outcome has resulted from the introduction of the specialized SANE nurse?

a.

ED staff are no longer involved in the care of rape victims.

b.

Retraumatizating of the rape victim has been decreased greatly.

c.

The rights of both the rape victim and the rapist are preserved.

d.

The rape victim is assured quality physical and mental healthcare.

ANS: B

The specialized attention of these nurses has addressed the long-standing issue of retraumatizing victims. The ED staff may still be involved in the physical care of the victim. The focus is not on the rights of the potential rapist. The physical and mental health needs of the victim are not the sole responsibility of the SANE nurse.

DIF: Cognitive Level: Application REF: Pages 555-556

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Psychosocial Integrity

3. When providing care to an assault victim, the forensic nurse will initially:

a.

Notify the police that an assault has occurred.

b.

Assess the individual for any resulting physical trauma.

c.

Bag all clothing to preserve any relevant evidence.

d.

Determine whether the victim as been sexually assaulted as well.

ANS: B

It is the role of the forensic nurse to immediately assess the assault victim for evidence of acute physical injuries. The remaining options do not have the priority that the individuals physical health needs demand.

DIF: Cognitive Level: Application REF: Page 556

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

4. Which intervention demonstrates the SANE nurses unique attention to the assessment of a sexual assault?

a.

Conducting the assessment in the most private exam room

b.

Not directly questioning the patient about the attack or the attacker

c.

Identifying that the patient is showing signs of anxiety by withdrawing

d.

Meticulously assessing the patient for signs of any resulting physical trauma

ANS: C

Throughout the physical examination, the SANE nurse will be attuned to the victims mental status and monitor him or her for signs and symptoms of anxiety, panic, and grief. The event and the assailant are topics that must be discussed. The remaining options identify interventions that are considered a nursing responsibility and not unique to the role of the SANE nurse.

DIF: Cognitive Level: Application REF: Page 556

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5. To best address the assault victims psychosocial needs, the forensic nurse:

a.

Warns the family that the patient will likely be suicidal

b.

Suggests that the family provide continuous supervision of the patient for at least 30 days

c.

Encourages the patient to discuss medication therapy with the physician prior to discharge from the ED

d.

Provides education to both the patient and the family regarding the signs of posttraumatic stress disorder (PTSD)

ANS: D

These patients are at extreme risk for PTSD, depression, and anxiety disorders, making education on such topics vitally important to their mental health. Although the patient may become depressed and have an increased risk for suicide, it is not true that the patient is likely to attempt such an act nor is it necessary to provide constant supervision. If such was needed, the patient would be hospitalized. The need for medications will be determined by the physician.

DIF: Cognitive Level: Application REF: Pages 556-557

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

6. Which nursing intervention demonstrates an understanding of the coping mechanisms often used by individuals who are not receiving formal treatment for their symptoms of postassault anxiety and stress?

a.

Providing smoking cessation materials

b.

Discussing the importance of safe sex

c.

Assessing for the abuse of marijuana

d.

Monitoring for weight gain since the assault

ANS: C

Rather than being engaged in formal treatment, 67% of a studys participants reported the use of illicit substances, mainly marijuana. The primary purpose for this substance use is to aid in numbing the victim from the effects of intrusive thoughts and to allow victims to self-medicate for the treatment of insomnia and irritability. Although some individuals will use cigarette smoking, sexual promiscuity, and eating as coping mechanisms, they do not appear to have the affects that marijuana has on managing the symptoms of anxiety and stress.

DIF: Cognitive Level: Application REF: Page 557

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

7. A patient, brought into the ED by family members who reported a fall, shares that the injury was actually a result of physical abuse. The patient tells the nurse that this is to be kept confidential because, that is my right. The nurse tells the patient that:

a.

It is a patient right but it was intended to protect patients.

b.

Nurses are required by law to report all incidents of abuse.

c.

The report will not mention the patients admission that abuse has occurred.

d.

The abuser needs to be stopped before they go on to really cause the patient harm.

ANS: B

Releasing patient information in the context of a criminal act, such as physical abuse, is exempt from confidentiality standards and laws, because the release of this information is for the protection of the victim; it is used to investigate the crime and potentially to apprehend the perpetrator. Although the remaining options are true, those statements do not adequately address the patients remarks.

DIF: Cognitive Level: Analysis REF: Page 558

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

8. Based on the importance of recognizing all the important elements for their role as part of the assaulted patients context or environment of care, the nurse will:

a.

Keep the family well informed of the patients status and plan of care.

b.

Document the patients statement for the purpose of future legal proceedings.

c.

Provide the staff with a detailed shift change report including the patients state of mind.

d.

Notify the local police with updates concerning the patients health status and verbal statements.

ANS: A

It is pertinent for nurses to adopt a family-centered approach that encompasses family members in caring interventions so that they are recognized as part of the patients context or environment. Providing effective shift change information is an expectation regardless of the nature of the care. The remaining options would be considered standard practice in cases involving violence as a crime and not related to the plan of care.

DIF: Cognitive Level: Application REF: Page 559 TOP: Nursing Process: Planning

MSC: NCLEX: Safe and Effective Care Environment

9. When preparing an educational session for urban adolescents concerning the personal impact of violence in their communities, the nurse includes information on:

a.

The need to report all incidences of violence to the local police

b.

How depression and anxiety can result from living in a violent environment

c.

The role of drug and alcohol abuse in the making of a violent neighborhood

d.

The role that neighborhood police officers play in the management of violence

ANS: B

Witnessing a violent crime and having knowledge of a violent crime in the family or community are considered precursors to posttraumatic illness. In addition to demonstrating symptoms of PTSD, adolescents who live in poor urban neighborhoods are more likely to be exposed to multiple incidents of violence during their adolescence, which is strongly linked to major depression and anxiety disorders, particularly among women. Although substance abuse does play a role in community violence, this option lacks the personal connect of the correct option, at least in this scenario. The remaining options do not relate to the personal but rather the communal impact of violence.

DIF: Cognitive Level: Application REF: Page 559 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

10. The nurse demonstrates an understanding of the physical effects of posttraumatic stress disorder (PTSD) when implementing which intervention for a patient who was abducted and assaulted three months ago?

a.

Regular evaluations for suicidal thoughts

b.

Explaining the need for appropriate use of a rescue inhaler

c.

Providing reinforcement for the patients new exercise program

d.

Evaluating the patients understanding of the proper use of analgesic medications

ANS: D

The presence of PTSDparticularly among those who have been exposed to violent crimesdemonstrates a heightened risk for negative health outcomes that include cardiac disease, intestinal problems, and chronic pain as common disorders found in patients with PTSD. Although suicide and stress certainly have a physical impact, they are considered psychiatric disorders. Respiratory issues are more related to anxiety disorders.

DIF: Cognitive Level: Application REF: Page 559

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

11. Which intervention should be given highest priority when attempting to gain the trust of the members of an urban family whose child has been violently assaulted and is in critical condition?

a.

Discussing the family needs with the childs multidisciplinary care team

b.

Constantly assuring them that their child is receiving quality nursing care

c.

Encouraging and respecting their right to ask questions about their child and the childs care

d.

Keeping them updated on the health and emotional status of their child during each shift

ANS: C

Assuring the family that you are not hiding facts from them will best assist in establishing a trusting relationship and can be facilitated by respecting and encouraging them to ask questions that will be answered honestly by the staff. The remaining options are appropriate but lack the interaction between nurse and family that the correct option possesses.

DIF: Cognitive Level: Analysis REF: Page 560 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

12. When encouraging healthy coping mechanisms for a group of parents attending a workshop for families who have lost children to violent crimes, the nurse focuses on:

a.

Discussing how the fathers are attempting to accept the death

b.

Providing the fathers with information on the value of crying

c.

Discussing the problems that occur when women suppress their feelings

d.

Encouraging the mothers to adopt a rigorous exercise plan to help manage grief

ANS: A

A study of parental coping showed that mothers preferred to use emotion-focused coping, whereas fathers preferred coping mechanisms that focused on restraint, acceptance, and suppression.

DIF: Cognitive Level: Application REF: Page 560

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

13. Which intervention is considered a responsibility of the forensic nurse working within the correctional prison system?

a.

Counseling inmate families

b.

Identifying postdischarge community resources

c.

Providing health care services to the prison staff

d.

Protecting the legal rights of the inmates while incarcerated

ANS: B

The nurse may identify and provide community linkages for inmates after discharge. The remaining options are not considered the responsibility of the forensic nurse when working in the correctional prison setting.

DIF: Cognitive Level: Application REF: Page 561

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

14. Which nursing intervention will best improve an inmates likelihood of not re-offending and thus not returning to the correctional system?

a.

Frequently screening inmates for mental health disorders

b.

Providing mandatory inmate focused anger management workshops

c.

Providing as needed (prn) medications for inmates with a history of depression

d.

Working with the families to prepare them for the inmates scheduled release

ANS: A

More than 250,000 incarcerated offenders are believed to have been diagnosed with or will develop a major mental illness while in the prison system. Without proper treatment and intervention, these offenders are at higher risk for violence recidivism, which is the criminal behavior of an offender after being released from incarceration. Frequent screenings for mental health disorders and the resulting treatment will have the greatest impact on this situation. PRN, as needed, treatment of mental disorders is not within the nurses scope unless covered by standing orders. Attention to anger management is appropriate but not as impactful as the correct option. Working with families is not a typical responsibility of a nurse in the prison environment.

DIF: Cognitive Level: Application REF: Page 561

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

15. Which intervention demonstrates that the nurse understands the risk factors for the commission of violent crimes?

a.

Reinforcement of anger management skills

b.

Substance abuse rehabilitation counseling

c.

Community focused depression screenings

d.

Counseling for adult victims of child abuse

ANS: B

In addition to major mental illnesses, a common issue that is seen in prison and offender populations is substance addiction. Substance abuse and addictionparticularly involving alcoholare strongly correlated with the commission of violent crime in the United States. Although the remaining options have varying degrees of impact on violent crime, none are as important as the correct option.

DIF: Cognitive Level: Analysis REF: Page 561

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

Copyright 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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