CARN Patient Assessment and Diagnosis 5 — Questions and Answers
Question 1: 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?
- Tolerance
- Withdrawal
- Use despite persistent physical health consequences (Correct answer)
- 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 2: When assessing a patient for methamphetamine use disorder, which constellation of findings is most characteristic of acute intoxication?
- Miosis, bradycardia, sedation, and slurred speech
- Mydriasis, hyperthermia, extreme weight loss, and paranoia (Correct answer)
- Jaundice, ascites, and elevated transaminases
- Euphoria, increased appetite, and hypersomnia
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 3: A patient's family member tells the nurse that the patient has been hiding alcohol around the house and drinking secretly. In the context of addiction assessment, this behavior most reflects:
- Casual recreational drinking
- Loss of control and preoccupation consistent with moderate-to-severe AUD (Correct answer)
- Cultural drinking practices that should not be pathologized
- Situational stress response that will self-resolve
Correct answer: Loss of control and preoccupation consistent with moderate-to-severe AUD
Concealment of alcohol and covert drinking indicate loss of control and preoccupation, hallmarks of moderate-to-severe alcohol use disorder.
Question 4: A nurse completing a comprehensive biopsychosocial assessment asks about family history of substance use disorders. This question is clinically relevant because:
- Insurance requires family history documentation
- Family history identifies a genetic risk factor for developing SUD (Correct answer)
- Family members must consent to treatment
- Knowing family history determines which substances the patient is likely using
Correct answer: Family history identifies a genetic risk factor for developing SUD
First-degree relatives of individuals with SUD have significantly higher genetic risk, making family history a key component of risk stratification.
Question 5: Which assessment finding best indicates that a patient in alcohol withdrawal has progressed to delirium tremens (DTs)?
- Mild hand tremor and anxiety
- Insomnia and diaphoresis
- Global confusion, agitation, fever, and autonomic instability (Correct answer)
- Nausea and mild hypertension
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 6: During assessment, a patient reports craving alcohol intensely whenever they drive past a bar they used to frequent. This is best explained by which concept?
- Cross-tolerance
- Environmental cue-induced craving via classical conditioning (Correct answer)
- Protracted abstinence syndrome
- Neuroadaptation and physical dependence
Correct answer: Environmental cue-induced craving via classical conditioning
Environmental stimuli (bars, people, places) become conditioned cues that trigger craving through classical conditioning, a key mechanism in relapse vulnerability.
Question 7: 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
- Risk for injury related to altered neurological status secondary to opioid withdrawal (Correct answer)
- Disturbed body image related to substance use
- Ineffective coping related to financial stress
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.
CARN Patient Assessment and Diagnosis 5
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?