CARN Treatment Planning & Implementation 4 — Questions and Answers
Question 1: A CARN nurse notices that a patient's treatment plan has not been updated in six months despite multiple significant life changes. The nurse should:
- Continue with the existing plan since it was evidence-based when written
- Initiate a plan review and update it to reflect the patient's current status (Correct answer)
- Notify the physician only and await instructions
- Discharge the patient and create a new admission
Correct answer: Initiate a plan review and update it to reflect the patient's current status
Treatment plans must be reviewed and updated regularly to reflect changes in the patient's clinical status, circumstances, and treatment goals.
Question 2: A patient with cannabis use disorder states they do not believe cannabis is harmful. Using the Stages of Change model, this patient is most likely in which stage?
- Contemplation
- Preparation
- Precontemplation (Correct answer)
- Action
Correct answer: Precontemplation
In precontemplation, the individual does not recognize the problem or see a need for change.
Question 3: When a patient with a sedative-hypnotic use disorder requires treatment, the nurse plans for which unique risk compared to other substance use disorders?
- Higher risk of psychological dependence with no physical withdrawal
- Potential for life-threatening withdrawal requiring medical management (Correct answer)
- Minimal withdrawal symptoms that resolve within 24 hours
- Withdrawal symptoms that are uncomfortable but never medically dangerous
Correct answer: Potential for life-threatening withdrawal requiring medical management
Sedative-hypnotic withdrawal can cause seizures and delirium, making it potentially fatal and requiring medically supervised management.
Question 4: A nurse is implementing a contingency management intervention in an outpatient setting. This involves:
- Providing vouchers or prizes to patients who demonstrate drug-free urines (Correct answer)
- Requiring patients to pay a deposit that is forfeited if they relapse
- Using confrontation when a patient tests positive for substances
- Mandating that patients attend 90 AA meetings in 90 days
Correct answer: Providing vouchers or prizes to patients who demonstrate drug-free urines
Contingency management uses positive reinforcement, such as vouchers or prizes, to reward verified drug abstinence and treatment engagement.
Question 5: A patient with nicotine use disorder is starting pharmacotherapy. Which combination is approved by the FDA and shown to be most effective for smoking cessation?
- Varenicline (Chantix) plus bupropion SR (Correct answer)
- Nicotine replacement therapy plus disulfiram
- Bupropion SR plus naltrexone
- Nicotine replacement therapy plus acamprosate
Correct answer: Varenicline (Chantix) plus bupropion SR
Combining varenicline with bupropion SR has demonstrated superior quit rates compared to either medication alone in clinical trials.
Question 6: Which principle of trauma-informed care is MOST important to implement when treating patients with addiction and trauma histories?
- Ensuring patients process all traumatic memories before addressing substance use
- Creating physical and emotional safety in all aspects of treatment (Correct answer)
- Avoiding any discussion of trauma until the patient achieves 90 days of sobriety
- Requiring disclosure of trauma history as a condition of treatment
Correct answer: Creating physical and emotional safety in all aspects of treatment
Safety is the foundational principle of trauma-informed care; all other healing occurs within a context of felt safety.
Question 7: A nurse is working with a patient who has repeatedly relapsed to opioid use following naltrexone treatment. The most appropriate modification to the treatment plan is:
- Discontinue all pharmacotherapy as the patient is treatment-resistant
- Switch to extended-release injectable naltrexone to address adherence issues (Correct answer)
- Increase therapy frequency only and make no medication changes
- Refer the patient to a 12-step program as the sole intervention
Correct answer: Switch to extended-release injectable naltrexone to address adherence issues
Extended-release injectable naltrexone eliminates adherence barriers associated with daily oral dosing, which is a common cause of treatment failure.
CARN Treatment Planning & Implementation 4
A CARN nurse notices that a patient's treatment plan has not been updated in six months despite multiple significant life changes.
The nurse should: