CARN Nursing Interventions and Treatment 3 — Questions and Answers
Question 1: A patient with alcohol use disorder is prescribed acamprosate. What is the primary mechanism of this medication?
- Blocks opioid receptors to reduce reward from alcohol
- Inhibits aldehyde dehydrogenase causing aversive reaction
- Modulates glutamate and GABA to reduce post-acute withdrawal craving (Correct answer)
- Increases serotonin reuptake to decrease impulsivity
Correct answer: Modulates glutamate and GABA to reduce post-acute withdrawal craving
Acamprosate modulates glutamate (NMDA) and GABA systems to reduce the neurochemical imbalance that drives craving during early abstinence.
Question 2: A nurse is caring for a neonate born to a mother who used opioids during pregnancy. The infant has a Finnegan Neonatal Abstinence Scoring score of 9. What is the appropriate next step?
- Begin pharmacological treatment with morphine or methadone (Correct answer)
- Continue non-pharmacological comfort measures and recheck in 2 hours
- Discharge the infant to foster care per hospital policy
- Administer naloxone to reverse residual opioid effects
Correct answer: Begin pharmacological treatment with morphine or methadone
A Finnegan score of 8 or higher on two consecutive assessments (or ≥ 12 on a single assessment) generally triggers pharmacological treatment.
Question 3: Which harm reduction intervention has the strongest evidence for reducing HIV transmission among people who inject drugs (PWID)?
- Mandatory drug testing before providing services
- Syringe services programs (SSPs) (Correct answer)
- Inpatient detoxification followed by abstinence-based treatment
- Antiviral prophylaxis without addressing injection practices
Correct answer: Syringe services programs (SSPs)
Syringe services programs reduce needle sharing and have substantial evidence for decreasing HIV and hepatitis C transmission among PWID.
Question 4: A patient with stimulant use disorder asks about medications approved by the FDA to treat cocaine dependence. What is the most accurate nursing response?
- Buprenorphine is FDA-approved for cocaine use disorder
- Naltrexone is FDA-approved for cocaine use disorder
- No FDA-approved pharmacotherapy currently exists for cocaine use disorder (Correct answer)
- Disulfiram is FDA-approved and first-line 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 5: When using the transtheoretical model (stages of change), a patient says, 'I know my drinking is a problem and I'm thinking about quitting—maybe in the next few months.' In which stage is this patient?
- Precontemplation
- Contemplation (Correct answer)
- Preparation
- Action
Correct answer: Contemplation
Contemplation is characterized by awareness of the problem and consideration of change within the next 6 months, but without a firm commitment or plan.
Question 6: 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?
- Neuroleptic malignant syndrome
- Serotonin syndrome (Correct answer)
- Anticholinergic toxidrome
- 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 7: A nurse is providing relapse prevention education. Which cognitive-behavioral strategy teaches patients to recognize internal and external triggers before a craving escalates?
- Urge surfing
- Cue exposure and response prevention
- Functional analysis of substance use (Correct answer)
- 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.
CARN Nursing Interventions and Treatment 3
A patient with alcohol use disorder is prescribed acamprosate.
What is the primary mechanism of this medication?