CARN Patient Assessment and Diagnosis 3 — Questions and Answers
Question 1: A nurse assesses a patient 36 hours post-last benzodiazepine use. The patient scores 18 on the CIWA-Ar. What is the correct interpretation?
- Mild withdrawal; observation only needed
- Moderate withdrawal; pharmacological treatment indicated (Correct answer)
- Severe withdrawal; ICU transfer required immediately
- No clinically significant withdrawal present
Correct answer: Moderate withdrawal; pharmacological treatment indicated
A CIWA-Ar score of 15–20 indicates moderate withdrawal, warranting pharmacological management typically with benzodiazepines.
Question 2: When assessing a patient suspected of cannabis use disorder, the nurse should ask about which symptom cluster that appears within one week of heavy, prolonged use cessation?
- Seizures, hypertension, and diaphoresis
- Irritability, sleep disturbance, decreased appetite, and restlessness (Correct answer)
- Bradycardia, hypotension, and respiratory depression
- Hallucinations, psychosis, and fever
Correct answer: Irritability, sleep disturbance, decreased appetite, and restlessness
Cannabis withdrawal syndrome includes irritability, anxiety, sleep problems, and decreased appetite, typically peaking in the first week of abstinence.
Question 3: A patient with an extensive opioid use history presents with pinpoint pupils, decreased respirations of 8/min, and unresponsiveness. Which assessment action is the nurse's first priority?
- Administer naloxone per protocol (Correct answer)
- Obtain a urine drug screen
- Call the physician for medication orders
- Assess level of consciousness with sternal rub
Correct answer: Administer naloxone per protocol
Signs of opioid overdose with respiratory depression require immediate naloxone administration to reverse life-threatening CNS and respiratory depression.
Question 4: Which laboratory finding most strongly suggests chronic heavy alcohol use during a nursing assessment?
- Elevated serum creatinine
- Elevated gamma-glutamyl transferase (GGT) and mean corpuscular volume (MCV) (Correct answer)
- Low serum albumin
- Elevated BUN
Correct answer: Elevated gamma-glutamyl transferase (GGT) and mean corpuscular volume (MCV)
Chronically elevated GGT combined with macrocytosis (elevated MCV) is a sensitive marker of prolonged heavy alcohol consumption.
Question 5: In assessing trauma history as part of addiction intake, the nurse should prioritize asking because:
- Trauma history is required for insurance billing purposes
- Trauma and substance use disorders are highly co-occurring and trauma may drive use (Correct answer)
- Trauma history determines detox protocol choice
- Mandatory reporting laws require trauma documentation
Correct answer: Trauma and substance use disorders are highly co-occurring and trauma may drive use
High rates of co-occurring PTSD and SUD mean trauma-informed screening is essential for understanding the function of substance use and guiding treatment.
Question 6: When performing a nursing assessment on a patient prescribed methadone for OUD, which cardiac risk does the nurse most need to monitor?
- Atrial fibrillation
- QTc interval prolongation (Correct answer)
- Right bundle branch block
- ST elevation
Correct answer: QTc interval prolongation
Methadone is associated with QTc prolongation and risk of Torsades de Pointes, requiring baseline and periodic ECG monitoring.
Question 7: A patient minimizes substance use when answering AUDIT questions, reporting only occasional use. Which assessment strategy best addresses underreporting?
- Repeat the same questions more forcefully
- Use collateral information and biomarkers alongside self-report (Correct answer)
- Document patient's self-report and move on
- Administer a polygraph as part of the intake process
Correct answer: Use collateral information and biomarkers alongside self-report
Combining self-report with collateral history and laboratory biomarkers (GGT, MCV, ETG) increases accuracy when patients minimize use.
CARN Patient Assessment and Diagnosis 3
A nurse assesses a patient 36 hours post-last benzodiazepine use.
The patient scores 18 on the CIWA-Ar.
What is the correct interpretation?