CARN Treatment Modalities and Interventions 4 — Questions and Answers
Question 1: A patient in opioid withdrawal is prescribed clonidine. The nurse understands this medication manages withdrawal by:
- Activating opioid receptors to reduce withdrawal symptoms
- Suppressing noradrenergic hyperactivity in the locus coeruleus (Correct answer)
- Blocking dopamine release to reduce cravings
- Increasing GABA transmission to reduce anxiety
Correct answer: Suppressing noradrenergic hyperactivity in the locus coeruleus
Clonidine is an alpha-2 adrenergic agonist that suppresses the noradrenergic overactivity responsible for many opioid withdrawal symptoms such as anxiety, sweating, and tachycardia.
Question 2: A nurse is facilitating a Matrix Model group for stimulant use disorder. This evidence-based approach combines which elements?
- Individual psychoanalysis and inpatient detoxification
- CBT, family education, 12-step facilitation, and relapse prevention (Correct answer)
- Pharmacotherapy and aversive conditioning
- Hypnotherapy and peer mentorship only
Correct answer: CBT, family education, 12-step facilitation, and relapse prevention
The Matrix Model integrates cognitive-behavioral therapy, relapse prevention, family involvement, and 12-step participation into a structured outpatient program for stimulant use disorder.
Question 3: When conducting a SBIRT screening, a patient scores 8–15 on the AUDIT-C alcohol screening tool. The appropriate nurse response is:
- No intervention needed; score is within normal limits
- Provide a brief motivational intervention and refer if needed (Correct answer)
- Immediate referral to inpatient detoxification
- Initiate naltrexone therapy without further assessment
Correct answer: Provide a brief motivational intervention and refer if needed
An AUDIT score of 8–15 indicates hazardous or harmful drinking warranting a brief intervention; scores of 20+ indicate possible dependence requiring referral.
Question 4: A nurse is working with a patient who relapses after 6 months of sobriety. Using a therapeutic frame consistent with addictions nursing, the nurse should:
- Discharge the patient for non-compliance with treatment
- Explore the relapse as a learning opportunity and adjust the treatment plan (Correct answer)
- Increase the frequency of random drug testing as a punitive measure
- Withhold medications until the patient demonstrates commitment
Correct answer: Explore the relapse as a learning opportunity and adjust the treatment plan
Relapse is viewed as a common part of the recovery process; the therapeutic response is to analyze what happened, reinforce engagement, and revise the plan accordingly.
Question 5: Which pharmacotherapy is specifically indicated to reduce heavy drinking days in patients with alcohol use disorder who do not require complete abstinence?
- Disulfiram
- Acamprosate
- Naltrexone (Correct answer)
- Gabapentin
Correct answer: Naltrexone
Naltrexone reduces the rewarding effects of alcohol and has demonstrated efficacy in reducing heavy drinking days even when abstinence is not the stated goal.
Question 6: A patient in recovery from alcohol use disorder is prescribed acamprosate (Campral). The nurse explains it works by:
- Creating an aversive reaction when alcohol is consumed
- Blocking opioid receptors to reduce alcohol cravings
- Restoring glutamate balance disrupted by chronic alcohol use (Correct answer)
- Increasing dopamine transmission in reward pathways
Correct answer: Restoring glutamate balance disrupted by chronic alcohol use
Acamprosate modulates glutamate neurotransmission dysregulated by chronic alcohol exposure, reducing the post-withdrawal hyperexcitability that drives protracted abstinence symptoms.
Question 7: A patient with co-occurring PTSD and alcohol use disorder is best served by which treatment approach according to current evidence?
- Treating PTSD only after achieving 6 months of sobriety
- Treating alcohol use disorder first before addressing PTSD
- Integrated dual-diagnosis treatment addressing both conditions concurrently (Correct answer)
- Referring PTSD exclusively to mental health and AUD to addiction services separately
Correct answer: Integrated dual-diagnosis treatment addressing both conditions concurrently
Integrated treatment that simultaneously addresses co-occurring substance use and mental health disorders produces better outcomes than sequential or parallel treatment.
CARN Treatment Modalities and Interventions 4
A patient in opioid withdrawal is prescribed clonidine.
The nurse understands this medication manages withdrawal by: