CARN Assessment and Diagnosis 5 — Questions and Answers
Question 1: A nurse is using motivational interviewing during an addiction assessment. Which response best demonstrates the 'reflective listening' technique?
- 'You should seriously consider stopping your drug use.'
- 'It sounds like you feel torn between wanting to quit and enjoying the relief substances provide.' (Correct answer)
- 'Have you tried AA or NA before?'
- 'I'm going to refer you to inpatient treatment today.'
Correct answer: 'It sounds like you feel torn between wanting to quit and enjoying the relief substances provide.'
Reflective listening involves paraphrasing or reflecting back the patient's feelings and ambivalence without judgment, a core technique in motivational interviewing.
Question 2: 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?
- Contemplation
- Preparation
- Precontemplation (Correct answer)
- Maintenance
Correct answer: Precontemplation
A patient who uses substances and does not recognize a problem or need for change is in the precontemplation stage.
Question 3: Which finding on a comprehensive liver panel would most specifically suggest alcoholic hepatitis in a patient with alcohol use disorder?
- AST:ALT ratio greater than 2:1 (Correct answer)
- Isolated elevation of ALT only
- Decreased alkaline phosphatase
- Normal bilirubin with elevated albumin
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 4: A nurse documents polysubstance use in a patient's assessment. Which combination poses the highest risk for fatal respiratory depression?
- Cannabis and caffeine
- Opioids and benzodiazepines (Correct answer)
- Alcohol and stimulants
- Hallucinogens and antihistamines
Correct answer: Opioids and benzodiazepines
The combination of opioids and benzodiazepines synergistically depresses the CNS and respiratory drive, markedly increasing overdose mortality risk.
Question 5: An addiction nurse is assessing a patient for stimulant use disorder. Which symptom cluster is most characteristic of cocaine withdrawal?
- Seizures, hallucinations, and hypertension
- Depressed mood, fatigue, hypersomnia, and increased appetite (Correct answer)
- Nausea, vomiting, and abdominal cramping
- Diaphoresis, tremor, and tachycardia
Correct answer: Depressed mood, fatigue, hypersomnia, and increased appetite
Cocaine withdrawal presents with a 'crash' characterized by dysphoria, fatigue, hypersomnia, and increased appetite rather than physiological instability.
Question 6: 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
- Lack of social support and living with active substance users (Correct answer)
- Previous completion of a detoxification program
- Employment in a healthcare setting
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 7: 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?
- Wernicke's encephalopathy
- Alcohol withdrawal delirium (delirium tremens) (Correct answer)
- Simple alcohol withdrawal seizure
- Korsakoff syndrome
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).
CARN Assessment and Diagnosis 5
A nurse is using motivational interviewing during an addiction assessment.
Which response best demonstrates the 'reflective listening' technique?