Varcarolis Ch. 33: Forensic Psychiatric Nursing
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...
Varcarolis Ch. 33: Forensic Psychiatric Nursing
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. ✔️c. lists community resources for
prescription assistance.
To increase medication adherence, reduce the risk of relapse, and prevent further criminal activity due
to mental illness, the persons 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.
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. ✔️d. becoming more frightened, agitated, and
combative.
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 reexperience 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.
3. An inmate was diagnosed with posttraumatic stress disorder (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 inmates release. ✔️c. Contact a supervisor authorized to make an exception to
the restraint policy and explain why an alternate response is needed.
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 inmates 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 patients
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 inmates release from restraint.
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