Certified Addictions Registered Nurse (CARN) Exam — Questions and Answers

Question 1: A patient with opioid use disorder is concerned about stigma at a new pharmacy. Which nurse education intervention is most helpful?

Advise the patient to discontinue MOUD to avoid stigmatizing interactions
Provide information about patient rights, anti-discrimination laws, and how to find supportive pharmacies (Correct answer)
Suggest the patient use multiple pharmacies to avoid being recognized
Advise the patient to conceal their diagnosis from pharmacy staff

Correct answer: Provide information about patient rights, anti-discrimination laws, and how to find supportive pharmacies

Education about patient rights, anti-discrimination protections, and resources for finding supportive pharmacies empowers patients to navigate stigma effectively.

Question 2: A nurse is educating a patient about acamprosate for alcohol use disorder. Which statement is most accurate?

Acamprosate helps reduce cravings by modulating glutamate activity (Correct answer)
Acamprosate is metabolized extensively by the liver
Acamprosate causes a severe reaction if alcohol is consumed
Acamprosate works best when started before the patient stops drinking

Correct answer: Acamprosate helps reduce cravings by modulating glutamate activity

Acamprosate modulates glutamatergic neurotransmission to reduce protracted withdrawal symptoms and alcohol cravings after abstinence is established.

Question 3: Which ethical principle is most directly challenged when a patient with a co-occurring disorder refuses recommended psychiatric medication due to a substance-use-related cognitive impairment?

Beneficence
Justice
Veracity
Autonomy (Correct answer)

Correct answer: Autonomy

When cognitive impairment from substance use affects decision-making capacity, the patient's autonomy to refuse treatment is in tension with their ability to make an informed, voluntary decision.

Question 4: A patient presents with diaphoresis, tachycardia, and hypertension 18 hours after last alcohol use. Which assessment finding most indicates impending severe withdrawal?

Mild anxiety and insomnia
Tremors of the hands and tongue
Temperature of 99.1°F
Onset of visual hallucinations (Correct answer)

Correct answer: Onset of visual hallucinations

Visual hallucinations signal progression toward severe alcohol withdrawal and risk for delirium tremens.

Question 5: A patient with stimulant use disorder asks about medications approved by the FDA to treat cocaine dependence. What is the most accurate nursing response?

No FDA-approved pharmacotherapy currently exists for cocaine use disorder (Correct answer)
Buprenorphine is FDA-approved for cocaine use disorder
Disulfiram is FDA-approved and first-line for cocaine use disorder
Naltrexone is FDA-approved for cocaine use disorder

Correct answer: No FDA-approved pharmacotherapy currently exists for cocaine use disorder

As of current guidelines, there are no FDA-approved medications specifically for cocaine or stimulant use disorder; treatment relies on behavioral interventions.

Question 6: The ethical principle of fidelity in addiction nursing refers primarily to:

Distributing limited treatment resources fairly
Providing equal treatment to all patients regardless of their substance of use
Accurately representing one's qualifications and credentials
Keeping promises and maintaining trust within the therapeutic relationship (Correct answer)

Correct answer: Keeping promises and maintaining trust within the therapeutic relationship

Fidelity involves maintaining loyalty, keeping commitments, and honoring agreements made with patients to build and sustain therapeutic trust.

Question 7: A nurse notes that a patient in alcohol withdrawal is experiencing formication (sensation of insects crawling on the skin). This finding is best classified as:

A visual hallucination
Alcohol hallucinosis
Delirium tremens
A tactile hallucination (Correct answer)

Correct answer: A tactile hallucination

Formication is a tactile hallucination involving the sensation of things crawling on or under the skin, distinct from visual or auditory hallucinations.

Question 8: What is the goal of support strategies during addiction treatment?

To help patients develop coping mechanisms and stay committed to recovery (Correct answer)
To increase the patient’s exposure to high-risk situations
To discourage the patient from continuing with their treatment
To focus only on physical detoxification

Correct answer: To help patients develop coping mechanisms and stay committed to recovery

The primary goal of support strategies in addiction treatment is to equip patients with effective coping mechanisms and strengthen their commitment to recovery. These strategies provide a safe environment, encouragement, and practical tools to navigate challenges, manage stress, and build resilience. Such support is crucial for maintaining sobriety and preventing relapse over the long term.

Question 9: Which finding on a comprehensive liver panel would most specifically suggest alcoholic hepatitis in a patient with alcohol use disorder?

Decreased alkaline phosphatase
AST:ALT ratio greater than 2:1 (Correct answer)
Normal bilirubin with elevated albumin
Isolated elevation of ALT only

Correct answer: AST:ALT ratio greater than 2:1

An AST:ALT ratio greater than 2:1 is a classic laboratory pattern associated with alcoholic hepatitis.

Question 10: A patient being assessed for stimulant use disorder reports paranoia, insomnia, and 72 hours without sleep. Which physiological assessment finding would the nurse most expect?

Hypotension and respiratory depression
Bradycardia and miosis
Tachycardia, hypertension, and mydriasis (Correct answer)
Hypothermia and bradypnea

Correct answer: Tachycardia, hypertension, and mydriasis

Stimulant intoxication produces sympathomimetic effects including tachycardia, elevated blood pressure, and dilated pupils.

Question 11: According to the DSM-5, the severity of a substance use disorder is determined by the number of diagnostic criteria met within a 12-month period. A patient who meets four criteria would be diagnosed with which level of severity?

Moderate (Correct answer)
At-Risk
Mild
Severe

Correct answer: Moderate

The DSM-5 specifies the severity of a substance use disorder based on the number of criteria met: 2-3 criteria indicate a mild disorder, 4-5 criteria indicate a moderate disorder, and 6 or more criteria indicate a severe disorder. Therefore, a patient meeting four criteria falls into the moderate category.

Question 12: Informed consent for medication-assisted treatment requires that patients receive information about all of the following EXCEPT:

Benefits and expected outcomes of the medication
The nurse's personal opinion about the best treatment choice (Correct answer)
Risks and potential side effects
Available alternatives to medication

Correct answer: The nurse's personal opinion about the best treatment choice

Informed consent requires objective information about benefits, risks, and alternatives; the nurse's personal opinion is not a required component.

Question 13: A nurse is providing relapse prevention education. Which cognitive-behavioral strategy teaches patients to recognize internal and external triggers before a craving escalates?

Functional analysis of substance use (Correct answer)
Urge surfing
Cue exposure and response prevention
Contingency management

Correct answer: Functional analysis of substance use

Functional analysis identifies the antecedents (triggers), behaviors, and consequences of substance use, forming the foundation of relapse prevention planning.

Question 14: When providing education to a patient beginning buprenorphine therapy, the nurse should emphasize that sublingual films should be:

Chewed and then swallowed
Swallowed whole with water for faster absorption
Held under the tongue until fully dissolved (Correct answer)
Crushed and mixed with juice

Correct answer: Held under the tongue until fully dissolved

Buprenorphine sublingual films must be held under the tongue until fully dissolved to ensure proper absorption through the sublingual mucosa.

Question 15: Which education strategy is most effective for improving medication adherence in patients on medications for opioid use disorder (MOUD)?

Collaborative goal-setting, addressing side effect concerns, and using reminder tools (Correct answer)
Threatening to discontinue treatment if doses are missed
Providing written instructions without verbal follow-up
Pill organizers alone are sufficient for all patients

Correct answer: Collaborative goal-setting, addressing side effect concerns, and using reminder tools

Collaborative goal-setting, addressing side effects, and practical reminder tools together support adherence by addressing motivational, informational, and logistical barriers.

Question 16: 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?

Focusing on past traumas as the primary cause of current substance use.
Requiring clients to create a detailed narrative of their traumatic experiences.
Utilizing confrontational techniques to challenge denial about substance use.
Teaching present-focused coping skills to establish safety from both trauma symptoms and substance use. (Correct answer)

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 17: A patient in recovery identifies 'people, places, and things' associated with past drug use as things to avoid. This concept is best described as:

Cognitive distortions about use
Negative reinforcement patterns
Environmental cue conditioning (Correct answer)
Emotional dysregulation triggers

Correct answer: Environmental cue conditioning

Environmental cues become conditioned stimuli through repeated pairing with substance use, capable of triggering cravings even years into recovery via classical conditioning.

Question 18: Which type of coping skill education is most evidence-based for patients with co-occurring PTSD and substance use disorder?

Focusing solely on 12-step attendance without addressing PTSD
Teaching patients to suppress trauma-related thoughts to avoid distress
Encouraging patients to address trauma only after 5 years of sobriety
Integrated trauma-informed approaches such as Seeking Safety (Correct answer)

Correct answer: Integrated trauma-informed approaches such as Seeking Safety

Seeking Safety is an evidence-based, integrated intervention that simultaneously addresses PTSD and substance use without requiring trauma processing.

Question 19: When using the SAMHSA No Wrong Door approach for individuals with co-occurring disorders, the primary goal is to:

Separate mental health and addiction services for clearer accountability
Allow any system entry point to connect individuals to comprehensive services (Correct answer)
Ensure patients are triaged to the most restrictive level of care
Require patients to self-identify their primary diagnosis for routing

Correct answer: Allow any system entry point to connect individuals to comprehensive services

The No Wrong Door approach ensures that regardless of which system a person enters — mental health, substance use, or primary care — they are connected to comprehensive, coordinated services for all their needs.

Question 20: 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.
Recommending the client find a new peer group immediately upon discharge.
Integrating care through an Assertive Community Treatment (ACT) team. (Correct answer)

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.

Question 21: When comparing the prognosis of individuals with a single substance use disorder to those with a co-occurring SUD and a mental health disorder, the presence of the dual diagnosis is most strongly associated with which outcome?

Lower overall lifetime healthcare costs.
A faster response to initial pharmacological treatment.
A higher rate of successfully completing treatment programs.
Increased rates of relapse, hospitalization, and homelessness. (Correct answer)

Correct answer: Increased rates of relapse, hospitalization, and homelessness.

Individuals with co-occurring disorders face significant challenges, as the symptoms of each disorder can exacerbate the other. This interaction leads to more severe symptoms, poorer treatment outcomes, higher rates of relapse for both conditions, and increased utilization of acute services like hospitalization compared to those with a single disorder.

Question 22: Which of the following best describes the 'bidirectional relationship' between mental health disorders and substance use disorders?

Mental illness always causes substance use disorders
Substance use always causes mental illness
The disorders are unrelated and must be treated independently
Each disorder can trigger, worsen, or maintain the other disorder (Correct answer)

Correct answer: Each disorder can trigger, worsen, or maintain the other disorder

The bidirectional relationship means mental illness can lead to substance use and vice versa, with each disorder reinforcing and complicating the other.

Question 23: A nurse is treating a patient with opioid use disorder and PTSD. Which therapeutic modality has the STRONGEST evidence base for treating both conditions concurrently?

12-step facilitation
Psychodynamic therapy
Supportive counseling
Seeking Safety (Correct answer)

Correct answer: Seeking Safety

Seeking Safety is a present-focused cognitive-behavioral therapy with strong evidence specifically designed for individuals with co-occurring PTSD and substance use disorders.

Question 24: When performing a nursing assessment on a patient prescribed methadone for OUD, which cardiac risk does the nurse most need to monitor?

QTc interval prolongation (Correct answer)
ST elevation
Right bundle branch block
Atrial fibrillation

Correct answer: QTc interval prolongation

Methadone is associated with QTc prolongation and risk of Torsades de Pointes, requiring baseline and periodic ECG monitoring.

Question 25: 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?

CAGE Questionnaire (Correct answer)
COWS (Clinical Opiate Withdrawal Scale)
AUDIT-C (Alcohol Use Disorders Identification Test - Consumption)
CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, Revised)

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 26: What is the role of cognitive-behavioral therapy (CBT) in addiction treatment?

To focus only on physical withdrawal symptoms
To help patients change negative thought patterns and behaviors associated with addiction (Correct answer)
To isolate the patient from other treatment modalities
To increase the patient’s dependence on substances

Correct answer: To help patients change negative thought patterns and behaviors associated with addiction

Cognitive-behavioral therapy (CBT) is a cornerstone of addiction treatment, focusing on identifying and changing maladaptive thought patterns and behaviors that contribute to substance use. It teaches patients to recognize triggers, challenge distorted thinking, and develop healthier coping mechanisms. CBT empowers individuals to manage cravings and avoid relapse by altering their responses to internal and external cues.

Question 27: A patient with opioid use disorder who is breastfeeding asks if they can continue buprenorphine. The nurse's education should convey that:

Buprenorphine is absolutely contraindicated during breastfeeding
Buprenorphine transfers minimally into breast milk and breastfeeding is generally supported while on stable MOUD (Correct answer)
Breastfeeding is only safe if the buprenorphine dose is below 8 mg/day
The patient must choose between breastfeeding and MOUD with no middle option

Correct answer: Buprenorphine transfers minimally into breast milk and breastfeeding is generally supported while on stable MOUD

Current evidence supports breastfeeding in stable MOUD patients because buprenorphine transfers minimally into breast milk, and the benefits of breastfeeding outweigh the risks.

Question 28: A patient asks about the HALT acronym taught in relapse prevention education. What does HALT stand for?

Hostile, Apathetic, Lethargic, Tense
Hopeless, Angry, Lonely, Tired
Hungry, Angry, Lonely, Tired (Correct answer)
Hesitant, Anxious, Listless, Troubled

Correct answer: Hungry, Angry, Lonely, Tired

HALT stands for Hungry, Angry, Lonely, Tired — emotional and physical states that increase vulnerability to relapse.

Question 29: 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?

Visual disturbances
Auditory hallucinations
Paroxysmal sweats
Tactile disturbances (Correct answer)

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.

Question 30: A CARN is asked to participate in a research study examining patient outcomes in addiction treatment. Which action reflects proper ethical conduct regarding research participation?

Prioritize research protocol adherence over individual patient clinical needs
Enroll patients who would benefit from the intervention without formal consent to maximize research benefit
Collect de-identified outcome data without consent since it poses minimal risk
Ensure patients provide voluntary informed consent and understand the right to withdraw (Correct answer)

Correct answer: Ensure patients provide voluntary informed consent and understand the right to withdraw

Research ethics require voluntary, informed consent and the right to withdraw without penalty, regardless of the perceived benefit of the intervention.

Question 31: A law enforcement officer presents a photo of an individual to a CARN at the front desk of a substance use disorder (SUD) clinic and asks, "Is this person a patient here?" The officer does not have a court order or a signed patient consent form. According to federal law 42 CFR Part 2, what is the nurse's required response?

State that federal law prohibits confirming or denying whether any individual is a patient. (Correct answer)
Acknowledge the individual is a patient but refuse to provide any further details.
Ask the officer to wait while the nurse checks the patient census.
Provide the information, as law enforcement investigations are an exception to confidentiality.

Correct answer: State that federal law prohibits confirming or denying whether any individual is a patient.

Federal regulation 42 CFR Part 2 provides stringent confidentiality protections for individuals receiving treatment for substance use disorders at federally assisted programs. It prohibits disclosing any information that would identify a person as having or having had a substance use disorder, which includes acknowledging their status as a patient. This protection is stricter than HIPAA and applies even to law enforcement inquiries without a specific court order or patient consent.

Question 32: During alcohol withdrawal, lorazepam is often preferred over diazepam in patients with severe liver disease. Why?

Lorazepam undergoes direct glucuronidation and does not rely on oxidative hepatic metabolism (Correct answer)
Lorazepam has no active metabolites and requires cytochrome P450 enzymes
Lorazepam has a lower risk of respiratory depression
Lorazepam has a longer half-life requiring less frequent dosing

Correct answer: Lorazepam undergoes direct glucuronidation and does not rely on oxidative hepatic metabolism

Lorazepam is metabolized via direct glucuronidation, bypassing CYP450 enzymes compromised in liver disease, preventing toxic accumulation.

Question 33: A nurse is developing a plan of care for an Indigenous client who is struggling with alcohol use disorder. The client expresses that they find more healing in traditional ceremonies than in conventional group therapy. To provide culturally competent care, what should be the nurse's first step?

Refer the client to the facility's chaplain for generic spiritual guidance.
Document the client's resistance to standard treatment in the medical record.
Acknowledge the client's beliefs and explore ways to integrate traditional healing practices with the evidence-based treatment plan. (Correct answer)
Educate the client on the evidence-based effectiveness of the facility's group therapy model.

Correct answer: Acknowledge the client's beliefs and explore ways to integrate traditional healing practices with the evidence-based treatment plan.

Cultural competence in addiction treatment involves understanding, respecting, and integrating the client's diverse cultural beliefs and values into their care. Rather than imposing a single treatment model, the nurse should collaborate with the client to create a holistic plan that respects their cultural identity. Acknowledging their beliefs and finding ways to integrate traditional practices, such as involving a community elder or allowing participation in ceremonies alongside clinical treatment, is a hallmark of patient-centered, culturally competent care.

Question 34: Which assessment finding best indicates that a patient in alcohol withdrawal has progressed to delirium tremens (DTs)?

Insomnia and diaphoresis
Mild hand tremor and anxiety
Nausea and mild hypertension
Global confusion, agitation, fever, and autonomic instability (Correct answer)

Correct answer: Global confusion, agitation, fever, and autonomic instability

Delirium tremens is defined by the triad of confusion, autonomic instability, and agitation, typically occurring 48–96 hours after last drink and carrying mortality risk.

Question 35: Which of the following statements best defines the 'integrated treatment' model, which is considered the gold standard for co-occurring disorders?

The patient must complete a detoxification program before becoming eligible for mental health services.
The patient's most severe disorder is treated to remission before the second disorder is addressed.
The patient sees a psychiatrist for medication and is referred to a separate addiction counselor for substance use therapy.
Services for both the mental health and substance use disorders are provided concurrently by the same team in the same location. (Correct answer)

Correct answer: Services for both the mental health and substance use disorders are provided concurrently by the same team in the same location.

Integrated treatment is an evidence-based approach where a single team of providers works together to address both mental health and substance use disorders at the same time and in the same setting. This model contrasts with sequential treatment (treating one disorder then the other) and parallel treatment (separate providers treating the disorders simultaneously), which can lead to fragmented care.

Question 36: Which statement about nicotine use in patients with substance use disorder is accurate and should be included in patient education?

Smoking cessation should always be addressed after achieving sobriety from all other substances
Treating nicotine dependence concurrently with other SUDs improves overall recovery outcomes (Correct answer)
Nicotine replacement therapy is contraindicated in patients with opioid use disorder
Patients with SUD are not interested in quitting tobacco and should not be counseled

Correct answer: Treating nicotine dependence concurrently with other SUDs improves overall recovery outcomes

Research shows that addressing nicotine dependence concurrently with other substance use disorders does not jeopardize sobriety and improves long-term outcomes.

Question 37: When conducting a social history as part of an addiction assessment, which factor is most strongly associated with increased risk of relapse?

Patient age over 50
Previous completion of a detoxification program
Employment in a healthcare setting
Lack of social support and living with active substance users (Correct answer)

Correct answer: Lack of social support and living with active substance users

Lack of social support and living with individuals who actively use substances are among the strongest environmental risk factors for relapse.

Question 38: A nurse implementing Brief Strategic Family Therapy (BSFT) with an adolescent's family would MOST focus on:

The adolescent's peer relationships exclusively
Identifying and restructuring maladaptive family interaction patterns (Correct answer)
Medication adherence education
Individual CBT for the adolescent

Correct answer: Identifying and restructuring maladaptive family interaction patterns

BSFT targets maladaptive family interaction patterns that are believed to maintain the adolescent's substance use behavior.

Question 39: A patient 3 months into recovery states, 'I can go to parties where everyone is drinking — I have strong willpower now.' The nurse recognizes this as:

A cognitive distortion that significantly increases relapse risk (Correct answer)
Evidence of well-developed coping skills
A healthy sign of growing self-confidence in recovery
An appropriate goal for someone in late-stage recovery

Correct answer: A cognitive distortion that significantly increases relapse risk

Overconfidence and underestimating high-risk situations ('I'm cured') is a cognitive distortion common in early recovery that substantially elevates relapse risk.

Question 40: An addictions nurse, Mark, has been working closely with a client, Sarah, for several months. Sarah is now stable in her recovery and is preparing for discharge. Sarah suggests they connect on social media to stay in touch. Which of the following actions by Mark best upholds professional boundaries?

Suggesting they connect through a professional networking site instead of a personal social media platform.
Accepting the request but limiting his interactions with her posts.
Gently declining the request, explaining that the nurse-client relationship must remain professional to support her long-term recovery. (Correct answer)
Waiting six months after discharge before accepting her friend request.

Correct answer: Gently declining the request, explaining that the nurse-client relationship must remain professional to support her long-term recovery.

Maintaining professional boundaries is crucial for protecting the patient and the therapeutic nature of the nurse-client relationship. Connecting on personal social media blurs these lines and can create a dual relationship, which is a boundary violation. The most ethical and professional response is to clearly and kindly decline while reinforcing the therapeutic reason for the boundary, which is to protect the client's ongoing recovery.

Question 41: In integrated dual diagnosis treatment (IDDT), the primary advantage over sequential treatment is:

Mental health treatment is prioritized over addiction treatment
Patients must achieve sobriety before addressing mental health needs
Both disorders are addressed simultaneously by the same treatment team (Correct answer)
It is less expensive and requires fewer providers

Correct answer: Both disorders are addressed simultaneously by the same treatment team

IDDT ensures that both disorders are treated concurrently by the same team, eliminating gaps and inconsistencies that occur with sequential approaches.

Question 42: What is the first step in addiction assessment?

Gathering detailed patient history and information (Correct answer)
Providing immediate therapy
Creating a treatment plan
Administering a diagnostic test

Correct answer: Gathering detailed patient history and information

The first step in addiction assessment is to collect comprehensive information about the patient's substance use, medical history, mental health, and social context. This detailed history provides a foundational understanding of their unique situation, which is critical for accurate diagnosis and developing an effective, individualized treatment plan. Without this initial data, subsequent steps would lack essential context.

Question 43: Which DSM-5 criterion for substance use disorder refers to spending a great deal of time obtaining, using, or recovering from the substance?

Withdrawal
Time criterion (Correct answer)
Tolerance
Craving

Correct answer: Time criterion

The time criterion (criterion 5) specifies that much time is spent in activities necessary to obtain, use, or recover from the substance.

Question 44: 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 severity of the depressive symptoms reported on admission.
The client's score on a standardized depression screening tool like the PHQ-9.
The persistence of depressive symptoms after a sustained period of abstinence. (Correct answer)
The client's family history of depression.

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 45: A CARN is treating a patient with borderline personality disorder (BPD) and opioid use disorder. Which therapeutic approach has the strongest evidence for treating BPD in this population?

Dialectical Behavior Therapy (DBT) (Correct answer)
12-step facilitation alone
Psychoanalytic therapy
Standard CBT without modification

Correct answer: Dialectical Behavior Therapy (DBT)

DBT was originally developed for BPD and has been adapted for co-occurring substance use disorders, with strong evidence supporting its effectiveness.

Question 46: A patient who has maintained abstinence from alcohol for several months is prescribed acamprosate (Campral). The nurse should explain that the primary goal of this medication is to:

Treat underlying depression that often co-occurs with alcohol use disorder.
Induce a negative physical reaction if alcohol is consumed.
Restore the balance between GABA and glutamate neurotransmission to reduce cravings. (Correct answer)
Reduce acute withdrawal symptoms such as tremors and seizures.

Correct answer: Restore the balance between GABA and glutamate neurotransmission to reduce cravings.

Acamprosate is thought to work by modulating and normalizing alcohol-disrupted brain activity, specifically by restoring the balance between the excitatory neurotransmitter glutamate and the inhibitory neurotransmitter GABA. This action helps to reduce the protracted withdrawal symptoms like craving and anxiety that can lead to relapse.

Question 47: A patient with severe alcohol use disorder develops delirium tremens 72 hours after last drink. Which pharmacological intervention is the first-line treatment?

Haloperidol to control agitation and hallucinations
Phenobarbital as first-line because it is safer than benzodiazepines
High-dose benzodiazepines titrated to symptom control using CIWA-Ar (Correct answer)
Clonidine to manage autonomic hyperactivity

Correct answer: High-dose benzodiazepines titrated to symptom control using CIWA-Ar

Benzodiazepines are first-line for delirium tremens; they enhance GABA-A activity to suppress CNS hyperexcitability and are titrated using symptom-triggered protocols like CIWA-Ar.

Question 48: What is a key indicator of opioid addiction during assessment?

Frequent urination
Increased appetite
Using opioids in larger amounts and experiencing withdrawal symptoms (Correct answer)
Lack of interest in social activities

Correct answer: Using opioids in larger amounts and experiencing withdrawal symptoms

Key indicators of opioid addiction include a pattern of using opioids in larger amounts or over a longer period than intended, along with the development of withdrawal symptoms when use is discontinued or reduced. These symptoms, such as muscle aches, nausea, and intense cravings, signify physical dependence and are crucial for diagnosis. Identifying these patterns guides appropriate treatment strategies.

Question 49: 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?

"Rotate injection sites regularly to give veins time to heal."
"Make sure the needle's bevel is facing up and release the tourniquet before injecting." (Correct answer)
"Clean the injection site with an alcohol swab before every use."
"Always use a new, sterile syringe and needle for every injection."

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 50: What is the primary goal of Seeking Safety, an evidence-based intervention used with patients who have co-occurring PTSD and substance use disorder?

Teaching coping skills and establishing safety without requiring trauma narration (Correct answer)
Reducing medication dependence
Developing 12-step program engagement
Trauma processing through exposure techniques

Correct answer: Teaching coping skills and establishing safety without requiring trauma narration

Seeking Safety focuses on present-focused coping skills and establishing safety without requiring patients to discuss trauma details.

Question 51: The ventral tegmental area (VTA) sends dopaminergic projections to which structure most critically involved in drug reward?

Amygdala
Nucleus accumbens (Correct answer)
Prefrontal cortex
Hippocampus

Correct answer: Nucleus accumbens

The VTA projects dopaminergic neurons to the nucleus accumbens (NAc), forming the mesolimbic pathway central to reward and addiction.

Question 52: When a patient with a sedative-hypnotic use disorder requires treatment, the nurse plans for which unique risk compared to other substance use disorders?

Minimal withdrawal symptoms that resolve within 24 hours
Withdrawal symptoms that are uncomfortable but never medically dangerous
Potential for life-threatening withdrawal requiring medical management (Correct answer)
Higher risk of psychological dependence with no physical withdrawal

Correct answer: Potential for life-threatening withdrawal requiring medical management

Sedative-hypnotic withdrawal can cause seizures and delirium, making it potentially fatal and requiring medically supervised management.

Question 53: Which behavior by a CARN would be considered a violation of the ANA Code of Ethics?

Reporting unsafe staffing levels to administration
Refusing to care for a patient due to their substance of choice (Correct answer)
Participating in public education about addiction as a disease
Advocating for policy changes to improve addiction treatment access

Correct answer: Refusing to care for a patient due to their substance of choice

The ANA Code of Ethics prohibits discrimination in care provision; nurses may not refuse to care for patients based on diagnosis or substance use.

Question 54: Which statement about tobacco use disorder and mental illness is most accurate?

Smoking rates among individuals with schizophrenia are similar to the general population
Nicotine replacement therapy is contraindicated in patients with schizophrenia
Mental illness protects against nicotine dependence
People with mental illness consume approximately 44% of all cigarettes sold in the US (Correct answer)

Correct answer: People with mental illness consume approximately 44% of all cigarettes sold in the US

Research indicates that people with mental illness consume approximately 44% of all cigarettes sold in the US, reflecting the extremely high rates of tobacco use disorder in this population.

Question 55: When assessing a patient for methamphetamine use disorder, which constellation of findings is most characteristic of acute intoxication?

Jaundice, ascites, and elevated transaminases
Euphoria, increased appetite, and hypersomnia
Miosis, bradycardia, sedation, and slurred speech
Mydriasis, hyperthermia, extreme weight loss, and paranoia (Correct answer)

Correct answer: Mydriasis, hyperthermia, extreme weight loss, and paranoia

Methamphetamine intoxication produces dilated pupils, elevated temperature, severe weight loss from appetite suppression, and paranoid ideation.

Question 56: The ethical principle of veracity in addiction nursing practice requires the nurse to:

Share information selectively based on the patient's stage of change
Provide truthful information even when it may be difficult for patients to hear (Correct answer)
Tell patients only what they need to know to remain compliant with treatment
Withhold negative prognosis information to maintain patient hope

Correct answer: Provide truthful information even when it may be difficult for patients to hear

Veracity obligates nurses to be truthful with patients, which includes honest communication about prognosis, risks, and treatment limitations.

Question 57: The DSM-5 diagnoses substance use disorder on a severity continuum. Which combination of criteria count correctly defines 'severe' SUD?

6 or more criteria (Correct answer)
2-3 criteria
4-5 criteria
1 criterion plus hospitalization

Correct answer: 6 or more criteria

DSM-5 classifies SUD as mild (2-3 criteria), moderate (4-5 criteria), and severe (6 or more criteria).

Question 58: Nicotine's addictive properties are primarily mediated through its action on:

Serotonin transporters in the raphe nuclei
Mu-opioid receptors in the nucleus accumbens
Nicotinic acetylcholine receptors (nAChRs) on VTA dopamine neurons (Correct answer)
GABA-B autoreceptors in the prefrontal cortex

Correct answer: Nicotinic acetylcholine receptors (nAChRs) on VTA dopamine neurons

Nicotine directly activates alpha4beta2 nicotinic acetylcholine receptors on VTA dopamine neurons, stimulating dopamine release in the nucleus accumbens and producing reinforcement.

Question 59: A patient with benzodiazepine use disorder is being tapered using a long-acting agent. What is the clinical rationale for using a long-acting benzodiazepine like diazepam for taper?

The prolonged half-life produces a smoother, self-tapering effect that reduces withdrawal severity (Correct answer)
They are preferred because they can be administered intramuscularly
Long-acting agents are safer because they do not affect GABA receptors
Long-acting agents have a stronger euphoric effect, reducing cravings more effectively

Correct answer: The prolonged half-life produces a smoother, self-tapering effect that reduces withdrawal severity

Diazepam's long half-life and active metabolites create a gradual, self-tapering plasma level decrease, producing a smoother withdrawal and reducing seizure risk.

Question 60: A patient in early recovery asks why they should avoid over-the-counter cough medicines containing dextromethorphan (DXM). What is the best explanation?

DXM interacts with most antibiotics
DXM causes liver damage in recovering patients
DXM is only dangerous when combined with food
DXM has dissociative properties and abuse potential that can trigger relapse (Correct answer)

Correct answer: DXM has dissociative properties and abuse potential that can trigger relapse

DXM is a dissociative agent with significant abuse potential and can trigger relapse or cross-addiction in recovering individuals.

Question 61: A patient who has been on long-term, high-dose benzodiazepine therapy abruptly stops taking the medication. The nurse should be most concerned about the patient developing:

Hypertensive crisis
Serotonin syndrome
Neuroleptic malignant syndrome
Grand mal seizures (Correct answer)

Correct answer: Grand mal seizures

Abrupt cessation of benzodiazepines, which are GABA-A receptor agonists, can lead to a severe and potentially life-threatening withdrawal syndrome. This is characterized by central nervous system hyperexcitability, which can manifest as anxiety, insomnia, tremors, and in severe cases, seizures and delirium.

Question 62: Which of the following best describes 'diagnostic overshadowing' in the context of co-occurring disorders?

A patient hiding their substance use from providers
The use of multiple diagnoses to explain one set of symptoms
A comorbid condition that worsens substance use outcomes
Attributing psychiatric symptoms solely to substance use, missing underlying mental illness (Correct answer)

Correct answer: Attributing psychiatric symptoms solely to substance use, missing underlying mental illness

Diagnostic overshadowing occurs when clinicians attribute all symptoms to one condition (substance use) and fail to recognize or diagnose a co-occurring psychiatric disorder.

Question 63: Which statement best describes the role of GABA in sedative-hypnotic substance use disorders?

Alcohol and benzodiazepines inhibit GABA-A receptors, causing CNS stimulation
Alcohol and benzodiazepines enhance GABA-A activity, and chronic use leads to receptor downregulation and tolerance (Correct answer)
Chronic alcohol use upregulates GABA receptors, explaining tolerance
GABA plays no significant role in sedative-hypnotic dependence

Correct answer: Alcohol and benzodiazepines enhance GABA-A activity, and chronic use leads to receptor downregulation and tolerance

Alcohol and benzodiazepines potentiate GABA-A inhibitory activity; with chronic use, receptors downregulate causing tolerance, and abrupt cessation causes CNS excitability and withdrawal.

Question 64: The role of the hippocampus in addiction is best characterized as:

Encoding and contextual retrieval of drug-related memories that trigger craving (Correct answer)
Generating the initial euphoric response to drugs
Controlling the autonomic symptoms of withdrawal
Regulating respiratory depression during opioid overdose

Correct answer: Encoding and contextual retrieval of drug-related memories that trigger craving

The hippocampus encodes episodic and contextual memories of drug use; these memories can be retrieved by environmental contexts, powerfully triggering craving and relapse.

Question 65: A patient on buprenorphine/naloxone reports severe withdrawal symptoms 18 hours after their last heroin use. What is the priority nursing action before initiating the first dose?

Confirm the patient is in moderate objective opioid withdrawal using a scale like COWS (Correct answer)
Administer the first dose immediately to relieve discomfort
Obtain a urine drug screen and wait 48 hours for results
Contact the prescriber to switch to full-agonist methadone

Correct answer: Confirm the patient is in moderate objective opioid withdrawal using a scale like COWS

Buprenorphine induction must be delayed until the patient displays objective withdrawal signs (COWS ≥ 8–12) to prevent precipitated withdrawal.

Question 66: A patient with alcohol use disorder is being discharged. Which education topic is highest priority to reduce risk of life-threatening complications?

Benefits of joining a gym for physical health
Dietary restrictions for a low-sodium diet
Signs and symptoms of alcohol withdrawal including seizures and delirium tremens (Correct answer)
How to manage mild insomnia with herbal teas

Correct answer: Signs and symptoms of alcohol withdrawal including seizures and delirium tremens

Alcohol withdrawal can progress to seizures and delirium tremens, which are potentially fatal, making this the highest priority discharge education topic.

Question 67: A patient with known bipolar I disorder and alcohol use disorder presents to the emergency department in a manic state, exhibiting agitation and paranoia. What is the CARN's initial priority action?

Ensure the safety of the patient and the clinical environment. (Correct answer)
Initiate a protocol for alcohol withdrawal.
Administer a long-acting antipsychotic as ordered.
Obtain a detailed history of the patient's substance use.

Correct answer: Ensure the safety of the patient and the clinical environment.

According to the principles of patient safety and crisis management, the immediate priority in a situation with agitation and paranoia is to ensure the safety of the patient, staff, and others in the environment. De-escalation techniques and creating a safe milieu precede all other interventions, including detailed assessments or non-emergent medication administration.

Question 68: A patient with cannabis use disorder reports intense cravings during urge surfing practice. The nurse explains that urge surfing is effective because:

It replaces cannabis cravings with a craving for healthy behaviors
It teaches patients that cravings peak and subside naturally without acting on them (Correct answer)
It uses distraction to suppress awareness of cravings
It permanently eliminates cravings through extinction

Correct answer: It teaches patients that cravings peak and subside naturally without acting on them

Urge surfing teaches patients to observe cravings mindfully, recognizing that they rise and fall like waves—resisting them does not require acting on them.

Question 69: Which CARN-relevant pharmacological concept explains why tolerance develops more quickly to opioid euphoria than to opioid-induced constipation?

Different opioid receptor subtypes mediate each effect, with varying rates of desensitization
Gastrointestinal receptors do not undergo downregulation as rapidly as CNS receptors (Correct answer)
Constipation receptors are in the periphery and less affected by CNS adaptation
Constipation is mediated by kappa receptors, which are inherently more stable

Correct answer: Gastrointestinal receptors do not undergo downregulation as rapidly as CNS receptors

Enteric nervous system mu-opioid receptors downregulate slowly compared to CNS reward receptors, so constipation persists while euphoria diminishes with chronic use.

Question 70: The primary purpose of a continuing care plan (aftercare plan) in addiction treatment is to:

Identify patients who are likely to relapse
Support sustained recovery and prevent relapse after discharge (Correct answer)
Satisfy insurance requirements for reimbursement
Document that the treatment team completed all required paperwork

Correct answer: Support sustained recovery and prevent relapse after discharge

Continuing care plans outline ongoing support, community resources, and relapse prevention strategies to sustain recovery post-discharge.

Question 71: A patient on methadone maintenance therapy reports QTc prolongation on ECG. What is the most appropriate nursing action?

Administer a beta-blocker
Increase the methadone dose gradually
Discontinue methadone immediately
Notify the prescriber and monitor for arrhythmias (Correct answer)

Correct answer: Notify the prescriber and monitor for arrhythmias

Methadone can prolong the QTc interval, increasing risk of torsades de pointes, so the prescriber must be notified and cardiac monitoring initiated.

Question 72: When performing a urine drug screen interpretation, a nurse knows that false-positive results for opioids can be caused by which common substance?

Quinolone antibiotics
Poppy seed consumption (Correct answer)
Vitamin C supplementation
Ibuprofen

Correct answer: Poppy seed consumption

Poppy seeds contain morphine and codeine in small amounts and can cause false-positive immunoassay results for opioids.

Question 73: When using the CRAFFT screening tool with adolescent patients, the nurse should understand it is designed to assess risk related to:

Chronic pain and opioid misuse
Tobacco dependence severity
Alcohol and other substance use while in cars, alone, or to relax/forget (Correct answer)
Gambling and behavioral addictions

Correct answer: Alcohol and other substance use while in cars, alone, or to relax/forget

CRAFFT screens adolescents for substance use risk using questions about riding in a Car, using substances Alone, to Relax, Forget, among other triggers.

Question 74: In dialectical behavior therapy (DBT) for co-occurring substance use and borderline personality disorder, which skill module teaches patients to tolerate distress without making it worse?

Emotion regulation
Mindfulness
Distress tolerance (Correct answer)
Interpersonal effectiveness

Correct answer: Distress tolerance

Distress tolerance skills in DBT help patients survive crises and painful emotions without engaging in impulsive behaviors such as substance use.

Question 75: A patient with alcohol use disorder undergoes assessment and scores a 7 on the CIWA-Ar. Which clinical response is most appropriate?

Increase monitoring frequency and consider PRN symptom-triggered medication (Correct answer)
Discharge with follow-up in 48 hours
Transfer to the ICU for intensive monitoring
Initiate intravenous benzodiazepine infusion immediately

Correct answer: Increase monitoring frequency and consider PRN symptom-triggered medication

A CIWA-Ar score of 7 indicates mild withdrawal; increased monitoring and symptom-triggered (PRN) benzodiazepines are appropriate at this level.

Question 76: A nurse notes that a patient in recovery has begun minimizing addiction severity and believes they could use substances 'just occasionally now.' This is most consistent with:

Appropriate development of insight and self-awareness
Successful progress in harm reduction therapy
Euphoric recall and addictive thinking patterns (Correct answer)
Post-acute withdrawal syndrome affecting judgment

Correct answer: Euphoric recall and addictive thinking patterns

Euphoric recall and minimization are addictive thinking distortions that romanticize past use and erode commitment to abstinence, often preceding relapse.

Question 77: Which of the following is an example of Recovery Support Services (RSS)?

Medical detoxification unit
Methadone maintenance clinic visits
Inpatient psychiatric stabilization facility
Recovery housing (sober living environment) (Correct answer)

Correct answer: Recovery housing (sober living environment)

Recovery Support Services are non-clinical, community-based supports such as recovery housing, peer support, transportation, and employment assistance that sustain long-term recovery.

Question 78: Which communication technique in Motivational Interviewing (MI) involves reflecting back a deeper meaning or emotion beneath what the patient explicitly stated?

Simple reflection
Complex reflection (Correct answer)
Amplified reflection
Double-sided reflection

Correct answer: Complex reflection

Complex reflections add meaning, emotion, or interpretation beyond the patient's literal words to deepen engagement and promote insight.

Question 79: Why is it essential to monitor a patient’s progress during treatment?

To make the patient feel inadequate if they don’t meet expectations
To ensure the patient is not following the treatment plan
To track progress, adjust the plan, and ensure successful recovery (Correct answer)
To prevent the patient from participating in future therapy sessions

Correct answer: To track progress, adjust the plan, and ensure successful recovery

Monitoring a patient's progress during addiction treatment is essential to assess the effectiveness of interventions and identify areas needing adjustment. This ongoing evaluation allows the treatment team to tailor the plan to the patient's evolving needs. By tracking progress, the team can ensure strategies remain relevant and supportive, maximizing the chances of successful, long-term recovery.

Question 80: During assessment, a patient reports using heroin but denies needing help. According to Prochaska's stages of change model, which stage best describes this patient?

Maintenance
Preparation
Precontemplation (Correct answer)
Contemplation

Correct answer: Precontemplation

A patient who uses substances and does not recognize a problem or need for change is in the precontemplation stage.

Question 81: Which relapse prevention model identifies high-risk situations, coping responses, and self-efficacy as its core components?

Gorski's CENAPS Model
Marlatt's Cognitive-Behavioral Model (Correct answer)
Prochaska's Transtheoretical Model
Miller's Motivational Enhancement Model

Correct answer: Marlatt's Cognitive-Behavioral Model

Marlatt's Cognitive-Behavioral Model identifies high-risk situations, the individual's coping response, and self-efficacy as the key determinants of whether relapse occurs.

Question 82: In the context of addiction assessment, 'telescoping' refers to which phenomenon?

Gradual dose escalation over time
Alternating periods of use and abstinence
Reduction in withdrawal severity with each detox episode
Women progressing more rapidly from first use to dependence than men (Correct answer)

Correct answer: Women progressing more rapidly from first use to dependence than men

Telescoping describes the accelerated progression from initiation of substance use to dependence observed in women compared to men.

Question 83: Why is it important to assess a patient’s substance use history before starting pharmacological treatment?

To delay the start of treatment until the patient feels better
To force the patient to stop using all substances immediately
To determine if the patient is eligible for free treatment
To personalize treatment and avoid potential drug interactions (Correct answer)

Correct answer: To personalize treatment and avoid potential drug interactions

Assessing a patient's substance use history before starting pharmacological treatment is crucial for several reasons. It allows healthcare providers to personalize the treatment plan by selecting the most appropriate medication and dosage based on the specific substances used, duration, and severity of dependence. More importantly, it helps identify potential drug interactions, contraindications, and co-occurring medical conditions, ensuring patient safety and maximizing treatment efficacy.

Question 84: Neuroadaptation to chronic opioid use leads to upregulation of which intracellular signaling pathway, contributing to tolerance?

PKA/cAMP pathway (Correct answer)
mTOR pathway
JAK-STAT pathway
PI3K/Akt pathway

Correct answer: PKA/cAMP pathway

Chronic opioid exposure causes upregulation of the adenylyl cyclase/cAMP/PKA pathway (cAMP superactivation), which underlies tolerance and withdrawal symptoms.

Question 85: During a motivational assessment, a patient states: 'I know drinking is causing problems, but I'm not sure I want to quit.' This statement best reflects which stage of the Transtheoretical Model?

Contemplation (Correct answer)
Precontemplation
Action
Preparation

Correct answer: Contemplation

Acknowledging problems while being ambivalent about change is the hallmark of the contemplation stage.

Question 86: Post-Acute Withdrawal Syndrome (PAWS) is best characterized by:

Return of acute withdrawal symptoms following a period of abstinence
Withdrawal symptoms that appear only after administration of opioid antagonists
Severe physical withdrawal symptoms requiring medically supervised detox
Protracted psychological and emotional symptoms persisting weeks to months after acute withdrawal (Correct answer)

Correct answer: Protracted psychological and emotional symptoms persisting weeks to months after acute withdrawal

PAWS involves protracted psychological symptoms — mood instability, cognitive difficulties, sleep disturbances, and cravings — that persist for weeks to months after acute withdrawal resolves.

Question 87: Which of the following is a core principle of Trauma-Informed Care (TIC) when establishing a therapeutic environment for clients with substance use disorders?

Maintaining a strict, hierarchical relationship between staff and clients to provide structure.
Focusing treatment exclusively on the substance use disorder before addressing any trauma.
Emphasizing physical and psychological safety in all interactions and environments. (Correct answer)
Requiring clients to provide a detailed account of their trauma history during intake.

Correct answer: Emphasizing physical and psychological safety in all interactions and environments.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), a primary and foundational principle of a trauma-informed approach is ensuring the physical and psychological safety of clients and staff. This creates an environment where healing is possible and seeks to actively avoid re-traumatization.

Question 88: Which instrument is the gold-standard structured interview for diagnosing substance use disorders according to DSM-5 criteria?

CAGE questionnaire
AUDIT
MAST (Michigan Alcoholism Screening Test)
SCID-5 (Structured Clinical Interview for DSM-5) (Correct answer)

Correct answer: SCID-5 (Structured Clinical Interview for DSM-5)

The SCID-5 is the gold-standard structured diagnostic interview used to assess and confirm DSM-5 substance use disorder diagnoses.

Question 89: Which psychosocial intervention uses a structured 12-step philosophy and emphasizes peer support and spiritual growth as components of recovery?

Cognitive Behavioral Therapy
Contingency management
Alcoholics Anonymous facilitation therapy (Correct answer)
Dialectical Behavior Therapy

Correct answer: Alcoholics Anonymous facilitation therapy

Twelve-step facilitation therapy is based on the AA philosophy and actively engages patients in 12-step community programs emphasizing peer support and spirituality.

Question 90: Which of the following is the primary mechanism by which naltrexone assists in the treatment of both alcohol and opioid use disorders?

It mimics the effects of the substance to reduce withdrawal symptoms.
It restores the balance of glutamate in the brain to reduce cravings.
It causes an aversive reaction when the substance is used, discouraging further consumption.
It is an opioid receptor antagonist that blocks the euphoric and rewarding effects of opioids and alcohol. (Correct answer)

Correct answer: It is an opioid receptor antagonist that blocks the euphoric and rewarding effects of opioids and alcohol.

Naltrexone is a pure opioid receptor antagonist. For opioid use disorder, it directly blocks the opioid receptors, preventing the euphoric effects of heroin or other opioids. For alcohol use disorder, it blocks the endogenous opioid system's response to alcohol, reducing the pleasurable feelings and reinforcement associated with drinking.

Question 91: Which finding on the CIWA-Ar scale would most urgently prompt a nurse to administer as-needed benzodiazepines?

Score of 18 with agitation and perceptual disturbances (Correct answer)
Score of 8 with mild diaphoresis
Score of 4 with mild tremors
Score of 2 with slight anxiety

Correct answer: Score of 18 with agitation and perceptual disturbances

A CIWA-Ar score of 18 with agitation and perceptual disturbances indicates severe withdrawal requiring immediate pharmacological intervention.

Question 92: Nicotine replacement therapy (NRT) works by delivering nicotine via a non-tobacco route. What is the primary therapeutic goal of NRT?

Producing the same CNS euphoria as cigarettes to prevent relapse
Sensitizing nicotinic receptors to make future smoking aversive
Reducing withdrawal symptoms and craving without the harmful tobacco combustion products (Correct answer)
Blocking nicotinic receptors to prevent nicotine from producing any effect

Correct answer: Reducing withdrawal symptoms and craving without the harmful tobacco combustion products

NRT reduces nicotine withdrawal and craving by providing controlled nicotine exposure, allowing the patient to quit smoking without the harmful chemicals in tobacco smoke.

Question 93: Which psychosocial intervention is specifically designed to enhance a patient's internal motivation to change addictive behaviors by exploring ambivalence?

12-Step Facilitation Therapy
Cognitive Behavioral Therapy (CBT)
Dialectical Behavior Therapy (DBT)
Motivational Interviewing (MI) (Correct answer)

Correct answer: Motivational Interviewing (MI)

Motivational Interviewing is a patient-centered, directive counseling style designed to elicit and strengthen motivation for change by resolving ambivalence.

Question 94: A patient with generalized anxiety disorder (GAD) and benzodiazepine use disorder requires anxiolytic treatment. The safest pharmacological option is:

Diazepam with weekly prescription refills
Alprazolam due to its rapid onset of action
Buspirone, a non-benzodiazepine anxiolytic (Correct answer)
Lorazepam at a reduced dose

Correct answer: Buspirone, a non-benzodiazepine anxiolytic

Buspirone is a non-addictive anxiolytic without abuse potential, making it the safest option for patients with co-occurring benzodiazepine use disorder.

Question 95: When using motivational interviewing, a nurse reflects back a patient's ambivalence by saying 'So on one hand you want to quit drinking, but on the other, alcohol helps you cope with stress.' This technique is called:

Reframing
Amplified reflection
Simple reflection
Double-sided reflection (Correct answer)

Correct answer: Double-sided reflection

A double-sided reflection explicitly acknowledges both sides of ambivalence, helping the patient hear their own conflicting statements.

Question 96: A patient is admitted with suspected alcohol withdrawal. The nurse notes that the last drink was 72 hours ago and the patient is now experiencing visual hallucinations. Which condition does this most likely represent?

Simple alcohol withdrawal seizure
Wernicke's encephalopathy
Korsakoff syndrome
Alcohol withdrawal delirium (delirium tremens) (Correct answer)

Correct answer: Alcohol withdrawal delirium (delirium tremens)

Visual hallucinations occurring 48-96 hours after last drink, often with autonomic instability and confusion, are hallmarks of alcohol withdrawal delirium (delirium tremens).

Question 97: A nurse documents that a patient meets criteria for 'alcohol use disorder with physiological dependence.' Which DSM-5 criterion must be present to add this specifier?

Blood alcohol level above 0.15% at admission
Three or more prior treatment episodes
Evidence of tolerance or withdrawal (Correct answer)
Daily alcohol consumption for at least 90 days

Correct answer: Evidence of tolerance or withdrawal

The DSM-5 physiological dependence specifier is applied when either tolerance or withdrawal (or both) are present as part of the alcohol use disorder criteria.

Question 98: A nurse is using the FRAMES approach during a brief intervention. Which element involves providing the patient with a menu of options for changing their substance use?

Advice
Menu of strategies (Correct answer)
Responsibility
Feedback

Correct answer: Menu of strategies

The 'M' in FRAMES stands for Menu of strategies, offering multiple change options to enhance patient autonomy and self-efficacy.

Question 99: Which receptor type mediates alcohol's positive reinforcing effects through the mesolimbic dopamine system?

Only NMDA glutamate receptors
Multiple systems including mu-opioid, GABA-A, and dopamine receptors acting in concert (Correct answer)
Exclusively GABA-A receptors
Primarily nicotinic acetylcholine receptors in isolation

Correct answer: Multiple systems including mu-opioid, GABA-A, and dopamine receptors acting in concert

Alcohol's rewarding effects involve multiple receptor systems: mu-opioid receptors trigger dopamine release, GABA-A activation produces anxiolysis and euphoria, and NMDA blockade contributes to its reinforcing profile.

Question 100: When assessing a patient using the DAST-10 (Drug Abuse Screening Test), a score of 6 or higher indicates:

Substantial drug problems requiring further assessment and intervention (Correct answer)
No problem; continue monitoring
A low-risk use pattern
Results are inconclusive and the test should be repeated

Correct answer: Substantial drug problems requiring further assessment and intervention

DAST-10 scores of 6–8 indicate substantial drug problems, and scores of 9–10 indicate severe problems, both warranting clinical intervention.

Question 101: A nurse assesses a patient for nicotine dependence using the Fagerström Test. The most critical item predicting dependence severity is:

Whether the patient smokes indoors
How much the patient spends on cigarettes weekly
Whether the patient smokes within 30 minutes of waking (Correct answer)
How many cigarettes the patient smokes per day

Correct answer: Whether the patient smokes within 30 minutes of waking

Time to first cigarette after waking is the strongest predictor of nicotine dependence severity on the Fagerström scale.

Question 102: Which physiological effect explains why GHB (gamma-hydroxybutyrate) is particularly dangerous when combined with alcohol?

Competitive inhibition of alcohol dehydrogenase raising blood alcohol levels
Additive hepatotoxicity from shared metabolic pathways
Combined QTc prolongation causing fatal arrhythmias
Synergistic CNS depression due to both agents enhancing GABA activity (Correct answer)

Correct answer: Synergistic CNS depression due to both agents enhancing GABA activity

Both GHB and alcohol enhance GABAergic CNS depression; their combination produces synergistic respiratory depression and sedation, greatly increasing overdose risk.

Question 103: Which educational content is most appropriate when teaching a patient about relapse as part of the chronic disease model of addiction?

Relapse means treatment has failed and a more restrictive approach is needed immediately
Relapse is a normal part of many chronic diseases and should prompt a reassessment of the treatment plan (Correct answer)
Any relapse cancels all prior progress made in recovery
Relapse is a sign that the patient lacks willpower and commitment

Correct answer: Relapse is a normal part of many chronic diseases and should prompt a reassessment of the treatment plan

Within the chronic disease model, relapse is viewed similarly to symptom recurrence in other chronic diseases — it signals a need to adjust treatment, not abandon it.

Question 104: Clonidine is sometimes used in opioid withdrawal management. What is its primary mechanism in this context?

It enhances GABA release to reduce anxiety during withdrawal
It inhibits dopamine reuptake to compensate for reward deficits
It blocks mu-opioid receptors to prevent relapse
It stimulates alpha-2 adrenergic receptors, suppressing noradrenergic hyperactivity that drives withdrawal symptoms (Correct answer)

Correct answer: It stimulates alpha-2 adrenergic receptors, suppressing noradrenergic hyperactivity that drives withdrawal symptoms

Opioid withdrawal activates the locus coeruleus; clonidine's alpha-2 agonism suppresses this noradrenergic hyperactivity, reducing sweating, anxiety, and GI distress.

Question 105: When treating a patient with co-occurring Post-Traumatic Stress Disorder (PTSD) and an Alcohol Use Disorder (AUD), which class of medication should be avoided or used with extreme caution for managing anxiety symptoms due to its high potential for misuse?

Prazosin
Benzodiazepines (Correct answer)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Beta-blockers

Correct answer: Benzodiazepines

Benzodiazepines, while effective for short-term anxiety, carry a high risk of tolerance, dependence, and misuse. This risk is significantly elevated in individuals with a history of a substance use disorder, making them a poor choice for ongoing anxiety management in this population. There is mounting evidence of harms associated with chronic benzodiazepine use in patients with PTSD, particularly those who also have an SUD.

Question 106: The DAST-10 is designed to screen for problems related to which substance category?

Drug use other than alcohol (Correct answer)
All substances including alcohol
Tobacco only
Alcohol only

Correct answer: Drug use other than alcohol

The DAST-10 (Drug Abuse Screening Test) specifically screens for problems related to drug use, excluding alcohol.

Question 107: A CARN has a credible reason to believe a colleague is diverting opioid medications intended for patients. According to the ANA Code of Ethics, what is the nurse's primary responsibility?

Confront the colleague directly and threaten to report them if the behavior continues.
Wait to gather definitive proof before taking any action to avoid a false accusation.
Report the observations immediately to the nursing supervisor in accordance with facility policy. (Correct answer)
Anonymously report the colleague to the state board of nursing without informing the employer.

Correct answer: Report the observations immediately to the nursing supervisor in accordance with facility policy.

The ANA Code of Ethics states that the nurse's primary commitment is to the patient. Provision 3.5 emphasizes the duty to protect patients from harm by acting on impaired practice. While some guidelines suggest approaching the colleague, the overriding ethical and legal duty is to ensure patient safety by reporting the issue through the proper chain of command, which is typically the nursing supervisor. This allows the organization to take immediate steps to protect patients and address the impaired practice.

Question 108: A patient with opioid use disorder discloses they have been drinking heavily while on buprenorphine. The nurse's priority ethical and clinical obligation is to:

Report the patient to the prescribing physician and discontinue treatment
Immediately discontinue buprenorphine to prevent harm
Document the disclosure and assess safety risk without punitive response (Correct answer)
Notify family members about the concurrent alcohol use

Correct answer: Document the disclosure and assess safety risk without punitive response

The nurse should document, assess safety, and respond therapeutically rather than punitively, as non-judgmental care is foundational in addiction nursing.

Question 109: A nurse performing an addiction assessment documents that a patient continues using substances despite a physician-confirmed diagnosis of alcohol-related liver disease. Under DSM-5 criteria, this finding best satisfies which criterion?

Use despite persistent physical health consequences (Correct answer)
Tolerance
Withdrawal
Failure to fulfill major role obligations

Correct answer: Use despite persistent physical health consequences

Continued use despite a known physical health condition worsened by substance use meets the DSM-5 criterion of use despite persistent or recurrent physical problems.

Question 110: In Prochaska's Transtheoretical Model, which stage is characterized by the patient making specific plans to change behavior within the next 30 days?

Contemplation
Maintenance
Action
Preparation (Correct answer)

Correct answer: Preparation

The Preparation stage involves intending to take action soon (within 30 days) and beginning to make specific plans, such as calling a treatment center.

Question 111: Cocaine's primary mechanism of action that produces euphoria involves:

Blocking reuptake of dopamine, serotonin, and norepinephrine (Correct answer)
Stimulating GABA-B receptors in the nucleus accumbens
Activation of mu-opioid receptors in the VTA
Directly releasing acetylcholine at nicotinic receptors

Correct answer: Blocking reuptake of dopamine, serotonin, and norepinephrine

Cocaine blocks dopamine, norepinephrine, and serotonin transporters, increasing their synaptic concentration, with dopamine elevation in the nucleus accumbens driving euphoria.

Question 112: When a patient in a recovery program experiences a relapse, the nurse's PRIORITY intervention is to:

Recommend the patient attend 90 AA meetings in 90 days
Discharge the patient for violating the treatment contract
Assess safety and detox needs, then reassess and modify the treatment plan (Correct answer)
Administer the predetermined behavioral consequence per the program contract

Correct answer: Assess safety and detox needs, then reassess and modify the treatment plan

A relapse requires immediate safety assessment (including need for detoxification) and clinical reassessment of the treatment plan, as relapse is an expected part of the chronic disease course.

Question 113: Gamma-hydroxybutyrate (GHB) withdrawal is most similar in presentation and management to withdrawal from which substance?

Hallucinogens such as LSD
Opioids such as heroin
Stimulants such as cocaine
Sedative-hypnotics such as alcohol and benzodiazepines (Correct answer)

Correct answer: Sedative-hypnotics such as alcohol and benzodiazepines

GHB acts on GABA-B receptors and GHB receptors; withdrawal produces CNS hyperexcitability similar to alcohol and benzodiazepine withdrawal, including seizures and delirium.

Question 114: Delta FosB accumulation in the nucleus accumbens after repeated drug exposure is significant because it:

Causes immediate sedation
Reverses neuroplasticity changes
Blocks dopamine synthesis
Acts as a long-lasting transcription factor increasing addiction vulnerability (Correct answer)

Correct answer: Acts as a long-lasting transcription factor increasing addiction vulnerability

Delta FosB is a stable transcription factor that accumulates with repeated drug exposure and persistently alters gene expression, increasing addiction vulnerability.

Question 115: A patient in alcohol withdrawal requests to leave against medical advice (AMA). The CARN's primary ethical responsibility is to:

Immediately consult the ethics committee before the patient leaves
Physically prevent the patient from leaving given the medical risk
Ensure the patient is fully informed of the risks and document the interaction (Correct answer)
Contact law enforcement to enforce a medical hold

Correct answer: Ensure the patient is fully informed of the risks and document the interaction

Unless the patient lacks decision-making capacity, the nurse must respect autonomy by ensuring informed refusal and thorough documentation.

Question 116: When educating a patient about harm reduction strategies for injection drug use, the nurse should include information about:

Restricting fluids to reduce vein damage
Using clean syringes, never sharing equipment, and wound care (Correct answer)
How to obtain prescription opioids legally to replace street drugs
Avoiding all contact with other people who use drugs

Correct answer: Using clean syringes, never sharing equipment, and wound care

Harm reduction education includes syringe exchange programs, sterile equipment use, and wound care to reduce infection and disease transmission risk.

Question 117: A patient with opioid use disorder is being considered for Medication-Assisted Treatment (MAT). When comparing methadone and buprenorphine, what is a key pharmacological difference a CARN should understand?

Buprenorphine has a 'ceiling effect' on respiratory depression, making it safer in an overdose than methadone. (Correct answer)
Methadone is a partial opioid agonist, while buprenorphine is a full opioid agonist.
Buprenorphine has a longer half-life than methadone, requiring less frequent dosing.
Methadone can be prescribed in an office-based setting, whereas buprenorphine is restricted to opioid treatment programs.

Correct answer: Buprenorphine has a 'ceiling effect' on respiratory depression, making it safer in an overdose than methadone.

Buprenorphine is a partial mu-opioid agonist, meaning its effects plateau at higher doses. This 'ceiling effect' applies to respiratory depression, making it a safer option concerning overdose risk compared to methadone, which is a full opioid agonist and has no ceiling effect.

Question 118: A nurse counsels a patient with alcohol use disorder who has achieved 6 months of sobriety. What is accurate about ongoing relapse risk?

Relapse risk returns to near zero after 6 months of sustained sobriety
Relapse risk only exists when patients are exposed to environmental triggers
Completing a 12-Step program eliminates significant relapse risk
Relapse risk is highest in the first year and remains elevated for several years (Correct answer)

Correct answer: Relapse risk is highest in the first year and remains elevated for several years

Relapse risk is highest during the first year of recovery and remains significantly elevated for several years, reflecting the chronic nature of addiction.

Question 119: The ASI (Addiction Severity Index) assesses problem severity across how many life domains?

9
5
4
7 (Correct answer)

Correct answer: 7

The ASI evaluates seven domains: medical, employment/support, alcohol, drug, legal, family/social, and psychiatric status.

Question 120: Which of the following is a relapse WARNING SIGN rather than an external trigger?

Passing a bar where the patient used to drink
Smelling alcohol at a family gathering
Increased social isolation and withdrawal from support (Correct answer)
Seeing friends who continue to use substances

Correct answer: Increased social isolation and withdrawal from support

Warning signs like social isolation and attitude changes are internal behavioral/emotional shifts that precede relapse, distinguishable from external environmental triggers.

Question 121: Phosphatidylethanol (PEth) is a biomarker that can detect alcohol use for up to how long after consumption?

Up to 3 months
Up to 3-4 weeks (Correct answer)
5-7 days
24-48 hours

Correct answer: Up to 3-4 weeks

PEth, a direct alcohol biomarker, can be detected in blood for up to 3-4 weeks after heavy alcohol consumption.

Question 122: Which statement about Medication-Assisted Treatment (MAT) and recovery is most accurate?

MAT is only appropriate for acute detoxification and should not be used long-term
Patients maintained on MAT medications are not in 'true' recovery
Participation in 12-Step programs requires patients to discontinue MAT medications
MAT combined with counseling consistently improves long-term recovery outcomes (Correct answer)

Correct answer: MAT combined with counseling consistently improves long-term recovery outcomes

Strong evidence shows that MAT (buprenorphine, methadone, naltrexone) combined with psychosocial treatment significantly improves retention, reduces relapse, and lowers mortality.

Question 123: Which of the following best describes the pharmacokinetic advantage of the buprenorphine transdermal patch compared to sublingual formulations?

Greater ceiling effect on analgesia
Elimination via renal excretion only
Avoidance of first-pass metabolism and steady plasma levels (Correct answer)
Higher bioavailability and faster onset of action

Correct answer: Avoidance of first-pass metabolism and steady plasma levels

Transdermal buprenorphine bypasses first-pass hepatic metabolism and provides consistent plasma concentrations over days, improving adherence and reducing peak-trough fluctuations.

Question 124: A patient with alcohol use disorder states, "I know I should cut back for my health, but a few beers with my friends is the only way I can relax after a tough week." Which response by the CARN best demonstrates the principle of developing discrepancy in Motivational Interviewing?

"It's good that you recognize the need to cut back. Let's set a goal for you to only have two beers next time."
"Why don't you just invite your friends to do something that doesn't involve drinking?"
"You need to find a healthier way to relax or you'll face serious health consequences."
"It sounds like on one hand, you value your health, and on the other hand, relaxing with friends is very important to you. How do you see these two things fitting together?" (Correct answer)

Correct answer: "It sounds like on one hand, you value your health, and on the other hand, relaxing with friends is very important to you. How do you see these two things fitting together?"

This response is a complex reflection that highlights the patient's internal conflict (discrepancy) between their stated values (health) and their current behavior (drinking to relax), without judgment. This technique helps the patient explore their own ambivalence and motivations for change, which is a core tenet of Motivational Interviewing.

Question 125: A 28-year-old patient presents with rhinorrhea, lacrimation, goosebumps, and a COWS score of 18. Which level of opioid withdrawal does this represent?

Moderate withdrawal
Moderately severe withdrawal
Mild withdrawal
Severe withdrawal (Correct answer)

Correct answer: Severe withdrawal

A COWS score of 13 or higher indicates severe opioid withdrawal requiring prompt clinical intervention.

Question 126: Which screening tool is specifically validated for identifying unhealthy alcohol use in primary care settings?

PHQ-9
AUDIT-C (Correct answer)
CAGE-AID
DAST-10

Correct answer: AUDIT-C

The AUDIT-C is a validated 3-item screen derived from the full AUDIT, specifically designed for rapid detection of unhealthy alcohol use in primary care.

Question 127: A patient is being assessed for opioid withdrawal using the Clinical Opiate Withdrawal Scale (COWS). The nurse observes a resting heart rate of 115 bpm, beads of sweat on the patient's forehead, and the patient is unable to sit still for more than a few seconds. These objective findings would contribute to which components of the COWS score?

Runny Nose/Tearing, Gooseflesh Skin, and Tremor
Resting Pulse Rate, Sweating, and Restlessness (Correct answer)
GI Upset, Tremor, and Yawning
Bone/Joint Aches, Pupil Size, and Anxiety/Irritability

Correct answer: Resting Pulse Rate, Sweating, and Restlessness

The COWS is an 11-item scale that includes objective measures. A heart rate of 115 bpm would be scored under Resting Pulse Rate, visible beads of sweat fall under the Sweating category, and the inability to sit still is rated under Restlessness. The other options list different components of the COWS scale that do not match the described symptoms.

Question 128: An assessment reveals that a patient uses substances primarily in social situations and when anxious. This finding suggests the nurse should screen for:

Primary psychotic disorder
Bipolar disorder, manic phase
Antisocial personality disorder
Co-occurring anxiety disorder and SUD (Correct answer)

Correct answer: Co-occurring anxiety disorder and SUD

Situational use linked to anxiety is a classic presentation of self-medication, warranting dual diagnosis screening for anxiety disorders co-occurring with SUD.

Question 129: A patient in early recovery asks what 'urge surfing' means. The nurse BEST explains it as:

Observing cravings as waves that rise and fall without acting on them (Correct answer)
Distracting oneself with physical exercise during cravings
Avoiding all situations that trigger cravings
Using medication to reduce craving intensity

Correct answer: Observing cravings as waves that rise and fall without acting on them

Urge surfing, from mindfulness-based relapse prevention, teaches patients to ride out cravings like waves — observing them without acting on them until they pass naturally.

Question 130: A patient in a therapeutic community (TC) for methamphetamine addiction repeatedly violates community norms. According to TC philosophy, this behavior is BEST addressed by:

Peer-run encounter groups to confront the behavior (Correct answer)
Immediate discharge from the program
Increasing the patient's medication dose
One-on-one sessions with the nurse only

Correct answer: Peer-run encounter groups to confront the behavior

Therapeutic communities use the community itself as the agent of change, with peer encounter groups being a core method for addressing problematic behavior.

Question 131: A patient with nicotine use disorder is starting pharmacotherapy. Which combination is approved by the FDA and shown to be most effective for smoking cessation?

Nicotine replacement therapy plus acamprosate
Varenicline (Chantix) plus bupropion SR (Correct answer)
Nicotine replacement therapy plus disulfiram
Bupropion SR plus naltrexone

Correct answer: Varenicline (Chantix) plus bupropion SR

Combining varenicline with bupropion SR has demonstrated superior quit rates compared to either medication alone in clinical trials.

Question 132: Which education content should the nurse prioritize when a patient with stimulant use disorder is being discharged?

Instructions for tapering stimulants over two weeks
Prescription medication options available for cocaine use disorder
How to manage stimulant cravings with antihistamines
Recognition of stimulant-induced psychosis signs and the importance of outpatient follow-up (Correct answer)

Correct answer: Recognition of stimulant-induced psychosis signs and the importance of outpatient follow-up

Stimulant withdrawal can precipitate psychosis, making recognition of symptoms and timely outpatient follow-up critical discharge education priorities.

Question 133: Which benzodiazepine property makes long-acting agents preferred for managing alcohol withdrawal syndrome?

Self-tapering effect due to long half-life reducing seizure risk (Correct answer)
Higher abuse potential requiring closer monitoring
Faster onset providing quicker symptom relief
Increased potency requiring lower doses

Correct answer: Self-tapering effect due to long half-life reducing seizure risk

Long-acting benzodiazepines like diazepam or chlordiazepoxide provide a self-tapering effect, smoothing withdrawal and reducing seizure and delirium risk.

Question 134: A patient with cocaine use disorder asks about FDA-approved pharmacotherapy. Which statement is most accurate?

Modafinil is FDA-approved and highly effective for cocaine use disorder
Naltrexone is FDA-approved for cocaine use disorder
There are currently no FDA-approved medications specifically for cocaine use disorder (Correct answer)
Disulfiram is FDA-approved as first-line treatment for cocaine use disorder

Correct answer: There are currently no FDA-approved medications specifically for cocaine use disorder

As of 2025, no medications are FDA-approved specifically for cocaine use disorder, though several (topiramate, disulfiram) show limited evidence in research settings.

Question 135: Which therapeutic approach emphasizes that the meaning a person assigns to events — not the events themselves — determines emotional and behavioral responses?

Gestalt therapy
Narrative therapy
Rational Emotive Behavior Therapy (REBT) (Correct answer)
Psychodynamic therapy

Correct answer: Rational Emotive Behavior Therapy (REBT)

REBT, developed by Albert Ellis, holds that irrational beliefs about events (not events themselves) cause emotional disturbance and maladaptive behaviors like substance use.

Question 136: A patient with methamphetamine use disorder asks about pharmacological treatment options. The addictions nurse should inform the patient that:

No FDA-approved pharmacotherapy currently exists for stimulant use disorder (Correct answer)
Methadone is used as maintenance therapy for stimulant dependence
Bupropion is FDA-approved specifically for meth use disorder
Naltrexone is the first-line approved treatment for stimulant use disorder

Correct answer: No FDA-approved pharmacotherapy currently exists for stimulant use disorder

As of current guidelines, there is no FDA-approved medication for stimulant use disorder; treatment relies primarily on behavioral interventions such as contingency management.

Question 137: When documenting a nursing diagnosis for a patient with opioid use disorder presenting in withdrawal, which NANDA-I diagnosis is most appropriate?

Ineffective health maintenance related to lack of knowledge
Disturbed body image related to substance use
Ineffective coping related to financial stress
Risk for injury related to altered neurological status secondary to opioid withdrawal (Correct answer)

Correct answer: Risk for injury related to altered neurological status secondary to opioid withdrawal

Opioid withdrawal causes altered neurological status, autonomic instability, and potential for falls or injury, making risk for injury the most clinically urgent nursing diagnosis.

Question 138: A patient with schizophrenia in recovery from methamphetamine use disorder begins experiencing worsening psychosis. The CARN should first:

Reduce the antipsychotic dose to minimize side effects
Assume relapse to methamphetamine and obtain a urine drug screen (Correct answer)
Increase antipsychotic medication immediately without assessment
Discharge the patient to an emergency psychiatric facility

Correct answer: Assume relapse to methamphetamine and obtain a urine drug screen

Methamphetamine use can worsen psychotic symptoms, and confirming or ruling out relapse through drug screening is the essential first step.

Question 139: When educating an older adult patient about alcohol use disorder, the nurse should particularly address:

Age-related pharmacokinetic changes that increase alcohol's effects and drug interaction risks (Correct answer)
That alcohol use disorder is rare in adults over 65 and likely misdiagnosed
That naltrexone is contraindicated in all patients over 70
That brief interventions are not effective for older adults

Correct answer: Age-related pharmacokinetic changes that increase alcohol's effects and drug interaction risks

Aging causes reduced hepatic metabolism and total body water, increasing blood alcohol concentration and drug interaction risk at lower consumption levels.

Question 140: Buprenorphine's 'ceiling effect' on respiratory depression is primarily due to its action as a:

Partial agonist at mu receptors (Correct answer)
Pure antagonist at all opioid receptors
Full antagonist at kappa receptors
Full opioid agonist at mu receptors

Correct answer: Partial agonist at mu receptors

Buprenorphine's partial agonist activity at mu-opioid receptors creates a ceiling effect, reducing the risk of fatal respiratory depression compared to full agonists.

Question 141: A patient scores 20 on the AUDIT-C. What does this indicate?

The score is outside the valid range (Correct answer)
Hazardous or harmful alcohol use
Low-risk drinking
Moderate alcohol use

Correct answer: The score is outside the valid range

The AUDIT-C maximum score is 12; a score of 20 is impossible, indicating a scoring or administration error.

Question 142: When comparing the pharmacology of nicotine delivery via electronic cigarettes (vaping) versus traditional combustible cigarettes, which of the following is most accurate?

Vaping delivers nicotine to the brain more rapidly than smoking.
E-cigarettes are a non-addictive alternative to smoking.
Traditional cigarettes deliver carbon monoxide, while e-cigarettes do not. (Correct answer)
Both methods deliver identical amounts of nicotine per puff.

Correct answer: Traditional cigarettes deliver carbon monoxide, while e-cigarettes do not.

The combustion of tobacco in traditional cigarettes produces thousands of chemicals, including carbon monoxide and tar, which are largely absent in the aerosol from e-cigarettes. While both deliver the addictive substance nicotine, the byproducts of combustion are the primary source of smoking-related harm. Nicotine delivery from vaping can be slower and less efficient than from smoking, especially in new users, and it is still an addictive substance.

Question 143: When a patient with opioid use disorder is transitioning from inpatient to outpatient care, the nurse ensures which action is completed BEFORE discharge?

Insurance pre-authorization is obtained for the next five years of treatment
The patient has demonstrated mastery of all 12 steps
A follow-up appointment with outpatient services is confirmed and documented (Correct answer)
The patient has completed a minimum of 30 days of sobriety

Correct answer: A follow-up appointment with outpatient services is confirmed and documented

Confirmed outpatient follow-up appointments before discharge significantly reduce the risk of treatment dropout and overdose death in the transition period.

Question 144: A patient presents to the ED with agitation, diaphoresis, hyperthermia, and muscle rigidity after combining their prescribed SSRI with illegally obtained MDMA. What condition should the nurse suspect?

Anticholinergic toxidrome
Serotonin syndrome (Correct answer)
Neuroleptic malignant syndrome
Sympathomimetic crisis

Correct answer: Serotonin syndrome

Serotonin syndrome results from excess serotonergic activity and is classically triggered by combining serotonergic agents (SSRI + MDMA), presenting with the triad of agitation, autonomic instability, and neuromuscular abnormalities.

Question 145: Which screening tool uses the mnemonic CAGE to assess alcohol use disorder?

CAGE questionnaire (Correct answer)
MAST
DAST-10
AUDIT

Correct answer: CAGE questionnaire

The CAGE questionnaire uses four questions about Cutting down, Annoyance, Guilt, and Eye-opener to screen for alcohol problems.

Question 146: When using the FRAMES approach in brief intervention for alcohol misuse, what does the letter 'M' represent?

Monitoring alcohol intake
Menu of change options (Correct answer)
Motivational enhancement
Medical feedback

Correct answer: Menu of change options

In FRAMES, 'M' stands for Menu, meaning offering a range of strategies and options for the patient to choose from to reduce drinking.

Question 147: A nurse is caring for a patient experiencing withdrawal from a short-acting opioid like heroin. Which of the following symptoms would the nurse expect to see peak within 1 to 3 days after the last use?

Euphoria and sense of calm
Respiratory depression and constricted pupils
Constipation and urinary retention
Rhinorrhea, muscle aches, and gastrointestinal distress (Correct answer)

Correct answer: Rhinorrhea, muscle aches, and gastrointestinal distress

The peak of withdrawal from short-acting opioids such as heroin typically occurs between 24 and 72 hours. Symptoms are often flu-like and include runny nose (rhinorrhea), lacrimation, muscle and bone pain, diarrhea, nausea, and vomiting. The other options are symptoms of opioid intoxication, not withdrawal.

Question 148: A patient with opioid use disorder is pregnant. The recommended pharmacotherapy approach is:

Prescribe naltrexone as the safest option during pregnancy
Withhold all medications until after delivery to avoid neonatal exposure
Advise medically supervised rapid detoxification to protect the fetus
Initiate methadone or buprenorphine maintenance therapy (Correct answer)

Correct answer: Initiate methadone or buprenorphine maintenance therapy

Methadone or buprenorphine maintenance is the standard of care in pregnancy as it reduces illicit opioid use, overdose risk, and fetal exposure to cycles of withdrawal.

Question 149: A nurse is educating the spouse of a person with a severe alcohol use disorder who is resistant to treatment. The nurse introduces the Community Reinforcement Approach and Family Training (CRAFT) model. What is the primary goal of this modality for the spouse?

To practice 'tough love' and detachment to allow the person to hit rock bottom.
To learn skills that positively reinforce sobriety and encourage the person to enter treatment. (Correct answer)
To focus solely on their own recovery and well-being through a 12-step program like Al-Anon.
To organize a surprise, confrontational intervention with other family and friends.

Correct answer: To learn skills that positively reinforce sobriety and encourage the person to enter treatment.

The Community Reinforcement Approach and Family Training (CRAFT) model is an evidence-based therapy that teaches concerned significant others (CSOs) positive, non-confrontational strategies to influence their loved one's behavior. The three main goals are to help the person reduce their substance use, engage them in treatment, and improve the CSO's own quality of life. It focuses on positive reinforcement and communication, rather than confrontation or detachment.

Question 150: When educating a patient with low health literacy about opioid tapering, which communication strategy is most effective?

Use the teach-back method with simple, plain language (Correct answer)
Provide a detailed 20-page pamphlet for home review
Delegate all education to the pharmacist
Use medical terminology to maintain professionalism

Correct answer: Use the teach-back method with simple, plain language

The teach-back method with plain language confirms patient understanding and is the gold standard for low-literacy populations.

Question 151: A nurse is conducting a comprehensive addiction assessment and asks about the patient's first use, age of onset, and escalation pattern. This information primarily helps determine:

Whether law enforcement should be notified
Insurance coverage eligibility
The exact substance purchased and street cost
Chronicity, developmental impact, and disease progression (Correct answer)

Correct answer: Chronicity, developmental impact, and disease progression

Establishing onset age and use trajectory informs the chronicity of the disorder, developmental consequences, and appropriate treatment intensity.

Certified Addictions Registered Nurse (CARN) Exam

The CARN certification validates the specialized knowledge, experience, and clinical judgment of registered nurses working in the field of addictions nursing.

150

Questions

180 min

Time Limit

70%

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