CARN Treatment Planning & Implementation 2 — Questions and Answers
Question 1: A patient with alcohol use disorder presents with co-occurring major depression. Which treatment planning approach is most appropriate?
- Treat depression first, then address alcohol use
- Treat alcohol use disorder first, then reassess depression
- Implement integrated dual-diagnosis treatment simultaneously (Correct answer)
- Refer to psychiatry exclusively and discharge from addiction services
Correct answer: Implement integrated dual-diagnosis treatment simultaneously
Integrated dual-diagnosis treatment addressing both disorders simultaneously produces better outcomes than sequential approaches.
Question 2: When establishing treatment goals with a patient, the CARN nurse should ensure goals are:
- Set by the clinical team based on best practices
- Broad and aspirational to motivate the patient
- Specific, measurable, achievable, relevant, and time-bound (SMART) (Correct answer)
- Identical to goals used for similar patients in the past
Correct answer: Specific, measurable, achievable, relevant, and time-bound (SMART)
SMART goals provide clear benchmarks for progress and are more likely to be achieved than vague objectives.
Question 3: A patient refuses to include family members in their treatment plan. The nurse should:
- Override the refusal because family involvement improves outcomes
- Document the refusal and respect the patient's autonomy (Correct answer)
- Discharge the patient for non-compliance
- Contact family members anyway without the patient's knowledge
Correct answer: Document the refusal and respect the patient's autonomy
Patient autonomy must be respected; the nurse documents the refusal and continues individualized care without violating confidentiality.
Question 4: Which level of care is most appropriate for a patient with moderate opioid withdrawal, no psychiatric comorbidities, and a stable home environment?
- Medically managed intensive inpatient (Level 4)
- Clinically managed low-intensity residential (Level 3.1)
- Intensive outpatient program (Level 2.1) (Correct answer)
- Outpatient services (Level 1)
Correct answer: Intensive outpatient program (Level 2.1)
Intensive outpatient (ASAM Level 2.1) provides structured treatment while allowing the patient to utilize their stable home support.
Question 5: A patient on buprenorphine/naloxone maintenance reports persistent cravings during evening hours. The most appropriate plan modification is:
- Increase the morning buprenorphine dose
- Add split dosing so part of the dose is taken in the evening (Correct answer)
- Discontinue buprenorphine and switch to methadone
- Recommend the patient practice more willpower
Correct answer: Add split dosing so part of the dose is taken in the evening
Split dosing buprenorphine/naloxone can address end-of-dose craving by maintaining more stable blood levels throughout the day.
Question 6: The primary purpose of a continuing care plan (aftercare plan) in addiction treatment is to:
- Satisfy insurance requirements for reimbursement
- Support sustained recovery and prevent relapse after discharge (Correct answer)
- Document that the treatment team completed all required paperwork
- Identify patients who are likely to relapse
Correct answer: Support sustained recovery and prevent relapse after discharge
Continuing care plans outline ongoing support, community resources, and relapse prevention strategies to sustain recovery post-discharge.
Question 7: A patient with stimulant use disorder asks about medication-assisted treatment options. The nurse correctly informs them that:
- Buprenorphine is FDA-approved for stimulant use disorder
- There are currently no FDA-approved medications specifically for stimulant use disorder (Correct answer)
- Naltrexone is the first-line pharmacotherapy for stimulant use disorder
- Disulfiram is effective for cocaine use disorder
Correct answer: There are currently no FDA-approved medications specifically for stimulant use disorder
As of current evidence, no medications have received FDA approval specifically for stimulant use disorder, though several are under investigation.
CARN Treatment Planning & Implementation 2
A patient with alcohol use disorder presents with co-occurring major depression.
Which treatment planning approach is most appropriate?