CARN Patient Assessment and Diagnosis 4 — Questions and Answers
Question 1: 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:
- The exact substance purchased and street cost
- Chronicity, developmental impact, and disease progression (Correct answer)
- Whether law enforcement should be notified
- Insurance coverage eligibility
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.
Question 2: Which finding during an opioid withdrawal assessment using the COWS scale indicates severe withdrawal and warrants aggressive pharmacological management?
- COWS score of 5
- COWS score of 13–24
- COWS score of 36 or above (Correct answer)
- COWS score of 2–4
Correct answer: COWS score of 36 or above
A COWS score of 36 or above indicates severe opioid withdrawal requiring immediate and aggressive treatment intervention.
Question 3: During intake assessment, a patient reports using alcohol daily to prevent morning shakes. This pattern is best described as:
- Tolerance without dependence
- Psychological craving without physical dependence
- Physical dependence with use to avoid withdrawal symptoms (Correct answer)
- Recreational use with habituation
Correct answer: Physical dependence with use to avoid withdrawal symptoms
Using alcohol specifically to prevent withdrawal symptoms (shakes) indicates physical dependence and is a key diagnostic criterion for alcohol use disorder.
Question 4: A nurse assesses a patient for nicotine dependence using the Fagerström Test. The most critical item predicting dependence severity is:
- How many cigarettes the patient smokes per day
- Whether the patient smokes within 30 minutes of waking (Correct answer)
- Whether the patient smokes indoors
- How much the patient spends on cigarettes weekly
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 5: 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
- Co-occurring anxiety disorder and SUD (Correct answer)
- Antisocial personality disorder
- Bipolar disorder, manic phase
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 6: When assessing a patient using the DAST-10 (Drug Abuse Screening Test), a score of 6 or higher indicates:
- No problem; continue monitoring
- A low-risk use pattern
- Substantial drug problems requiring further assessment and intervention (Correct answer)
- 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 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
- A tactile hallucination (Correct answer)
- Delirium tremens
- Alcohol hallucinosis
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.
CARN Patient Assessment and Diagnosis 4
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: