CARN - Certified Addictions Registered Nurse Patient Assessment and Diagnosis Questions and Answers — Questions and Answers
Question 1: A nurse is using the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) scale to assess a patient. The patient scores 12. Based on this score, which of the following is the most appropriate nursing action?
- Continue to monitor the patient as this indicates mild withdrawal. (Correct answer)
- Request an order for a loading dose of a benzodiazepine for severe withdrawal.
- Discontinue the assessment as the score is not clinically significant.
- Prepare for immediate seizure precautions and rapid response team activation.
Correct answer: Continue to monitor the patient as this indicates mild withdrawal.
A CIWA-Ar score between 8 and 15 is generally considered to indicate mild to moderate withdrawal. A score of 12 falls into this range, suggesting the need for continued monitoring and potentially symptom-triggered medication, but it does not typically indicate severe withdrawal requiring a loading dose or immediate seizure precautions. Scores of 15 or more usually indicate severe withdrawal.
Question 2: When conducting a comprehensive biopsychosocial assessment for a patient with a suspected substance use disorder, which component is MOST crucial for the addictions nurse to explore to understand the context of the substance use?
- A detailed list of all prescribed medications in the last five years.
- A chronological history of mental health symptoms and treatment, especially during periods of abstinence. (Correct answer)
- The patient's highest level of education and employment history.
- The patient's family history of cardiovascular disease.
Correct answer: A chronological history of mental health symptoms and treatment, especially during periods of abstinence.
A key part of a biopsychosocial assessment for co-occurring disorders is understanding the relationship between mental health symptoms and substance use. Exploring the history of mental health symptoms, particularly during times when the patient was not using substances, helps differentiate between substance-induced symptoms and a primary mental health disorder, which is critical for accurate diagnosis and effective treatment planning.
Question 3: According to the DSM-5 criteria for Substance Use Disorder (SUD), which of the following best represents the category of 'Impaired Control'?
- Continuing to use the substance despite recurrent social or interpersonal problems.
- Developing tolerance, needing more of the substance to achieve the desired effect.
- Using the substance in situations where it is physically hazardous.
- Taking the substance in larger amounts or over a longer period than was originally intended. (Correct answer)
Correct answer: Taking the substance in larger amounts or over a longer period than was originally intended.
The DSM-5 groups its 11 criteria for SUD into four categories: Impaired Control, Social Impairment, Risky Use, and Pharmacological Criteria. Taking more of a substance than intended is a classic example of the 'Impaired Control' category, which also includes unsuccessful efforts to cut down and spending a great deal of time obtaining the substance.
Question 4: A nurse is assessing a patient for opioid withdrawal using the Clinical Opiate Withdrawal Scale (COWS). The patient has a resting heart rate of 105 bpm, reports feeling anxious, and has moderately dilated pupils. Which of these findings would contribute the HIGHEST score to the COWS assessment for that specific item?
- Restlessness
- Pupil size (Correct answer)
- Anxiety or Irritability
- Resting Pulse Rate
Correct answer: Pupil size
According to the COWS scale, a resting pulse rate of 101-120 bpm scores a 2. Mild anxiety scores a 1 or 2. Restlessness is scored from 0-5. However, pupils that are moderately dilated score a 2, and pupils so dilated that only the rim of the iris is visible score a 5, which is the highest possible score for any single item on the scale besides restlessness or GI upset. Of the options provided, pupil size has the potential to contribute the highest score for its specific parameter if maximally dilated.
Question 5: A nurse in a primary care clinic wants to implement a quick screening tool for unhealthy alcohol use. Which tool is known for its brevity (4 questions) and focus on identifying lifetime alcohol problems rather than just current drinking patterns?
- AUDIT-C (Alcohol Use Disorders Identification Test - Consumption)
- CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, Revised)
- COWS (Clinical Opiate Withdrawal Scale)
- CAGE Questionnaire (Correct answer)
Correct answer: CAGE Questionnaire
The CAGE questionnaire is a widely used, four-question screening tool. A key feature is that its questions probe for lifetime problems related to alcohol use (e.g., 'Have you ever felt you should Cut down?'). This contrasts with tools like the AUDIT-C, which focuses more on recent consumption patterns. CIWA-Ar and COWS are assessment tools for withdrawal, not screening tools for unhealthy use.
Question 6: A patient is admitted for alcohol detoxification. During the initial nursing assessment, the patient reports 'feeling bugs crawling under my skin.' The nurse should document this as which of the following?
- Auditory hallucinations
- Tactile disturbances (Correct answer)
- Visual disturbances
- Paroxysmal sweats
Correct answer: Tactile disturbances
The sensation of bugs crawling on or under the skin is known as formication, which is a type of tactile disturbance or hallucination. On the CIWA-Ar scale, this symptom is specifically assessed under 'Tactile Disturbances.' Auditory disturbances involve hearing things, visual disturbances involve seeing things, and paroxysmal sweats refer to sudden episodes of sweating.
CARN - Certified Addictions Registered Nurse Patient Assessment and Diagnosis Questions and Answers
A nurse is using the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) scale to assess a patient.
The patient scores 12.
Based on this score, which of the following is the most appropriate nursing action?