A client recently diagnosed with schizophrenia is brought to the mental health clinic by the identical twin sibling for the first follow-up visit after hospitalization. The client’s sibling says to the nurse, "I read that schizophrenia runs in families. I guess I'm doomed." Which is the best response by the nurse?

"At the moment, I would worry more about how your sibling is doing."

"You are at risk for the disease. However, there are other factors that contribute to the development of schizophrenia."

"Would you like to talk to a health care provider about this?"

"The odds are about 50-50 that you will come down with the disease as well."

Answer and Explanation

The Correct Answer is B

Choice A reason: Redirecting the sibling’s concern to the patient minimizes and dismisses the sibling’s anxiety. This is not therapeutic.

Choice B reason: Schizophrenia has a genetic component, especially in identical twins, but environment and other factors also play roles. This response provides accurate information while reducing unnecessary fear.

Choice C reason: Offering referral may be helpful later, but it does not immediately address the sibling’s expressed concern or provide reassurance.

Choice D reason: Saying there is a 50-50 chance is inaccurate and unnecessarily alarming. The risk is higher in identical twins but not absolute.

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Correct Answer is A

Explanation

Choice A reason: This response acknowledges the client’s experience without reinforcing the hallucination. It demonstrates empathy, maintains reality orientation, and builds trust, which are crucial therapeutic approaches.

Choice B reason: Challenging hallucinations with logic is not effective and can increase client defensiveness or distress. It may also escalate paranoia rather than reduce it.

Choice C reason: Avoiding the client ignores their distress and can increase isolation. Engagement is necessary to provide reassurance and therapeutic support.

Choice D reason: Directly denying the hallucination can invalidate the client’s experience, leading to mistrust and further paranoia. A more supportive acknowledgment is preferred.

A. The client was unable to distinguish right from wrong due to a mental disorder at the time of the crime. B. The client had a documented history of mental illness prior to the crime. C. The client was compelled by uncontrollable impulses to commit the act. D. The client was unaware of the consequences of their actions due to intoxication.

Correct Answer is A

Explanation

Choice A reason: The M’Naghten Rule requires proof that, due to mental illness, the person did not understand the nature of the act or could not distinguish right from wrong at the time of the offense. This is the key standard used in many jurisdictions for insanity defenses.

Choice B reason: Having a history of mental illness alone is not sufficient; the rule focuses on the client’s mental state during the offense, not prior diagnoses.

Choice C reason: Being driven by uncontrollable impulses is not part of the M’Naghten criteria. This falls more under the “irresistible impulse” test, which is separate.

Choice D reason: Intoxication, even if it impairs judgment, does not qualify under the M’Naghten Rule. Voluntary substance use generally excludes insanity defenses.

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Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

A client is on trial for a violent offense and the defense claims the client was legally insane at the time of the act. According to the M'Naghten Rule, which criterion must be met for the insanity defense to be valid?

Correct Answer is A

Explanation

A nurse is assessing a client diagnosed with schizophrenia who is exhibiting positive symptoms. Which of the following findings should the nurse expect? (Select all that apply.)

A nurse is educating a client starting on risperidone. Which of the following statements best explains the unique pharmacological action of second-generation antipsychotics compared to first-generation antipsychotics?

A client with schizophrenia is prescribed olanzapine. During a follow-up visit, the client reports increased appetite and weight gain. Which nursing action is most appropriate to address this concern?

A client charged with assault pleads not guilty by reason of insanity under the Durham Rule. Which statement best reflects the criteria used in this legal standard?

A patient diagnosed with schizophrenia tells the nurse, "The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say." Which response by the nurse would be most therapeutic?

A client is experiencing a panic attack characterized by intense fear, hyperventilation, chest pain, and feelings of impending doom. Which nursing intervention is most appropriate to help the client during this panic stage?