CARN - Certified Addictions Registered Nurse Managing Co-Occurring Disorders Questions and Answers — Questions and Answers
Question 1: A client with a known history of Bipolar I Disorder and Alcohol Use Disorder is admitted to an inpatient unit. The client is exhibiting pressured speech, psychomotor agitation, and grandiose delusions, and reports not sleeping for three days. What is the nurse's priority intervention?
- Initiate a referral to a dual-diagnosis support group.
- Administer a long-acting antipsychotic medication as ordered.
- Provide a low-stimulation, safe environment and monitor physiological status. (Correct answer)
- Develop a detailed, long-term relapse prevention plan with the client.
Correct answer: Provide a low-stimulation, safe environment and monitor physiological status.
In the acute manic phase of bipolar disorder, especially when complicated by substance use, the priority is client safety. This includes protecting the client and others from harm that could result from poor impulse control and agitation. Providing a structured, low-stimulation environment helps to decrease agitation, and monitoring physiological status (e.g., hydration, nutrition, cardiac status) is critical as the client may have neglected self-care. While other interventions are important, they are secondary to ensuring immediate safety and physiological stability.
Question 2: Which treatment model is considered the gold standard for clients with co-occurring substance use and severe mental illness, emphasizing that the same clinicians or team provide care for both disorders concurrently?
- Sequential Treatment
- Integrated Dual Disorder Treatment (IDDT) (Correct answer)
- Parallel Treatment
- The Four-Quadrant Model
Correct answer: Integrated Dual Disorder Treatment (IDDT)
Integrated Dual Disorder Treatment (IDDT) is the evidence-based, gold-standard model where the same team of providers delivers both mental health and substance abuse services simultaneously. This approach avoids the fragmentation of care seen in Sequential (one disorder treated, then the other) and Parallel (two separate teams treat disorders at the same time) models, leading to better engagement and outcomes.
Question 3: A nurse is co-facilitating a group using the "Seeking Safety" therapeutic model for clients with co-occurring PTSD and a substance use disorder. Which of the following is a core principle of this model?
- Requiring clients to create a detailed narrative of their traumatic experiences.
- Focusing on past traumas as the primary cause of current substance use.
- Teaching present-focused coping skills to establish safety from both trauma symptoms and substance use. (Correct answer)
- Utilizing confrontational techniques to challenge denial about substance use.
Correct answer: Teaching present-focused coping skills to establish safety from both trauma symptoms and substance use.
The "Seeking Safety" model is a present-focused therapy that prioritizes establishing safety and teaching coping skills. It deliberately avoids detailed, exploratory work on the trauma narrative (exposure therapy), as this can be destabilizing for clients in early recovery. The main goal is to help clients develop safe coping strategies for both their PTSD symptoms and substance use triggers.
Question 4: A client who is stable in treatment for Opioid Use Disorder (OUD) with buprenorphine is newly diagnosed with Generalized Anxiety Disorder (GAD). The addictions nurse should anticipate the provider will AVOID prescribing which class of medication due to its high potential for misuse and dangerous synergistic effects?
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Buspirone
- Hydroxyzine
- Benzodiazepines (Correct answer)
Correct answer: Benzodiazepines
Benzodiazepines, when combined with opioids like buprenorphine, significantly increase the risk of life-threatening respiratory depression. They also have a high potential for misuse and dependence, making them a high-risk choice for a client with a pre-existing substance use disorder. SSRIs, buspirone, and hydroxyzine are considered safer, non-addictive alternatives for managing anxiety in this population.
Question 5: A client is admitted for detoxification from a severe Alcohol Use Disorder. They report persistent anhedonia, low mood, and poor energy. What is the most critical factor for the nurse and treatment team to consider when differentiating between a substance-induced depressive disorder and a primary Major Depressive Disorder?
- The persistence of depressive symptoms after a sustained period of abstinence. (Correct answer)
- The client's family history of depression.
- The severity of the depressive symptoms reported on admission.
- The client's score on a standardized depression screening tool like the PHQ-9.
Correct answer: The persistence of depressive symptoms after a sustained period of abstinence.
The key diagnostic factor in distinguishing a substance-induced disorder from a primary mental health disorder is the timeline of symptoms in relation to substance use. If depressive symptoms resolve after a significant period of abstinence (e.g., several weeks), they are likely substance-induced. If the symptoms persist long after withdrawal has subsided, a primary Major Depressive Disorder is more likely. While family history and symptom severity are important clinical data, the persistence of symptoms post-abstinence is the most definitive factor.
Question 6: When developing a plan of care for a client with co-occurring Schizophrenia and Cocaine Use Disorder who has a history of homelessness and frequent hospitalizations, which of the following interventions is most crucial for promoting treatment adherence and long-term stability?
- Mandating daily attendance at a 12-step support group.
- Focusing exclusively on antipsychotic medication management to stabilize psychosis.
- Integrating care through an Assertive Community Treatment (ACT) team. (Correct answer)
- Recommending the client find a new peer group immediately upon discharge.
Correct answer: Integrating care through an Assertive Community Treatment (ACT) team.
Assertive Community Treatment (ACT) is an evidence-based practice designed for individuals with severe mental illness who are high-service users. The model uses a multidisciplinary team to provide intensive, 24/7, wrap-around services directly in the community, which includes integrated treatment for co-occurring substance use, case management, medication management, and housing support. This comprehensive, integrated approach is highly effective in improving outcomes like treatment adherence and housing stability for this complex population.
CARN - Certified Addictions Registered Nurse Managing Co-Occurring Disorders Questions and Answers
A client with a known history of Bipolar I Disorder and Alcohol Use Disorder is admitted to an inpatient unit.
The client is exhibiting pressured speech, psychomotor agitation, and grandiose delusions, and reports not sleeping for three days.
What is the nurse's priority intervention?