CARN - Certified Addictions Registered Nurse Nursing Interventions and Treatment Questions and Answers — Questions and Answers
Question 1: A nurse is implementing a contingency management (CM) program for a client with stimulant use disorder. Which of the following nursing actions best aligns with the principles of this intervention?
- Exploring the client's internal motivation for change through collaborative conversation.
- Providing a gift card for each verified stimulant-free urine drug screen. (Correct answer)
- Administering a prescribed medication to reduce cravings and withdrawal symptoms.
- Teaching the client cognitive-behavioral techniques to identify and reframe negative thought patterns.
Correct answer: Providing a gift card for each verified stimulant-free urine drug screen.
Contingency management is a behavioral therapy that provides tangible rewards to reinforce positive behaviors, such as abstinence. Providing a gift card for a negative drug screen is a direct application of this principle, using positive reinforcement to encourage the desired behavior. The other options describe different, though also valuable, interventions: motivational interviewing, medication-assisted treatment, and cognitive-behavioral therapy.
Question 2: A client is admitted for methamphetamine withdrawal. The nurse's plan of care should prioritize monitoring for which of the following conditions during the first few days of withdrawal?
- Hypertensive crisis and tachycardia.
- Severe gastrointestinal bleeding.
- Intense cravings and profound depression. (Correct answer)
- Life-threatening seizures and delirium tremens.
Correct answer: Intense cravings and profound depression.
While physical symptoms occur, methamphetamine withdrawal is primarily characterized by severe psychological symptoms. During the initial 'crash' phase (the first 1-2 days), individuals experience extreme fatigue, but this is followed by a period of intense cravings, anhedonia (inability to feel pleasure), and severe depression, which can include suicidal ideation. While vital signs can fluctuate, a hypertensive crisis is not typical, and seizures are less common than with alcohol or benzodiazepine withdrawal.
Question 3: A nurse is using Motivational Interviewing (MI) with a client who is ambivalent about quitting alcohol. The client states, 'I know I should stop drinking, but it's how I relax after work.' Which nursing response best demonstrates the MI principle of 'rolling with resistance'?
- "You will damage your liver if you don't stop drinking immediately."
- "It sounds like you see some benefits to drinking, but you're also worried about it." (Correct answer)
- "Let's set a quit date right now to get you started on the right path."
- "Why do you feel the need to rely on alcohol to relax?"
Correct answer: "It sounds like you see some benefits to drinking, but you're also worried about it."
The correct response is an example of a complex reflection, a key technique in MI. It acknowledges both sides of the client's ambivalence without creating opposition ('rolling with resistance'). This validates the client's perspective and encourages further exploration. The other options are confrontational, directive, or could be perceived as judgmental, which are contrary to the spirit of MI.
Question 4: A nurse is providing education to a person who injects drugs as part of a harm reduction program. Which of the following instructions is the MOST critical to include to prevent vein damage and injury?
- "Always use a new, sterile syringe and needle for every injection."
- "Clean the injection site with an alcohol swab before every use."
- "Make sure the needle's bevel is facing up and release the tourniquet before injecting." (Correct answer)
- "Rotate injection sites regularly to give veins time to heal."
Correct answer: "Make sure the needle's bevel is facing up and release the tourniquet before injecting."
While all options are important harm reduction strategies, ensuring the bevel is up allows the needle to enter the vein more smoothly, and releasing the tourniquet before injecting prevents excessive pressure that can rupture or 'blow' the vein. Using clean supplies and rotating sites are crucial for preventing infection and long-term vein collapse, but the immediate technique of injection is most critical for preventing acute vein injury.
Question 5: A client with a co-occurring diagnosis of Post-Traumatic Stress Disorder (PTSD) and Opioid Use Disorder (OUD) is beginning an integrated treatment program. The nurse understands that the primary rationale for an integrated approach is that:
- Treating the substance use disorder first will resolve the PTSD symptoms.
- PTSD symptoms are often a primary driver for substance use and relapse. (Correct answer)
- Separate treatment programs are more specialized and therefore more effective.
- Pharmacotherapy for OUD is contraindicated in patients with PTSD.
Correct answer: PTSD symptoms are often a primary driver for substance use and relapse.
Research and clinical practice show a strong link between PTSD and SUD, with many individuals using substances to self-medicate or cope with trauma-related symptoms like anxiety, hyperarousal, and intrusive memories. An integrated treatment model addresses both disorders concurrently, recognizing that untreated PTSD symptoms are a significant risk factor for substance use relapse. Treating them separately or sequentially is less effective.
Question 6: A nurse is preparing to administer the first dose of sublingual buprenorphine to a client for Opioid Use Disorder. To prevent precipitated withdrawal, which assessment finding is essential before administration?
- The client reports a strong craving for opioids.
- The client has a Clinical Opiate Withdrawal Scale (COWS) score of 13.
- The client's last use of heroin was 4 hours ago. (Correct answer)
- The client has a history of multiple previous detoxification attempts.
Correct answer: The client's last use of heroin was 4 hours ago.
Buprenorphine is a partial opioid agonist with high affinity for the mu-opioid receptor. If given when a full agonist (like heroin or fentanyl) is still occupying those receptors, buprenorphine will displace the full agonist and can induce a sudden, severe withdrawal. To avoid this, treatment should be initiated only when the client is in mild-to-moderate withdrawal, indicated by an objective measure like a COWS score of 12-14 or higher. Last use of a short-acting opioid should typically be at least 12-24 hours prior.
CARN - Certified Addictions Registered Nurse Nursing Interventions and Treatment Questions and Answers
A nurse is implementing a contingency management (CM) program for a client with stimulant use disorder.
Which of the following nursing actions best aligns with the principles of this intervention?