RPNCE - Registered Psychiatric Nurse of Canada Examination Co-occurring Disorders and Addictions Questions and Answers — Questions and Answers
Question 1: A client with a known diagnosis of Bipolar I Disorder is admitted during a manic episode. They are agitated, have pressured speech, and report using stimulants "to keep the energy up." What is the RPN's priority nursing action?
- Develop a detailed psychoeducational plan about substance use.
- Initiate a referral to an addictions counsellor.
- Ensure the client's immediate physical safety and medical stability. (Correct answer)
- Administer a PRN dose of a mood stabilizer immediately.
Correct answer: Ensure the client's immediate physical safety and medical stability.
The combination of a manic episode and recent stimulant use places the client at high risk for cardiac complications, dehydration, and exhaustion. The priority action is to ensure physiological stability and safety, which precedes all other interventions.
Question 2: Which of the following best describes the principle of an 'integrated treatment' model for clients with co-occurring disorders?
- The client must complete a substance detoxification program before starting psychotherapy.
- The mental health disorder and the substance use disorder are treated at the same time, by the same team. (Correct answer)
- The client attends a mental health clinic and is referred to a separate agency for substance use treatment.
- The client's family members are primarily responsible for coordinating care between different providers.
Correct answer: The mental health disorder and the substance use disorder are treated at the same time, by the same team.
Integrated treatment is an evidence-based approach where mental health and substance use disorders are addressed concurrently by the same team or in a highly coordinated fashion. This contrasts with sequential (treating one disorder then the other) or parallel (treating both at the same time but by different, uncoordinated teams) models.
Question 3: An RPN is working with a client who has schizophrenia and a cannabis use disorder. The client is not ready to commit to complete abstinence from cannabis. Which intervention best aligns with a harm reduction approach?
- Informing the client that continued cannabis use will make their antipsychotic medication ineffective.
- Discharging the client from the service until they are willing to abstain.
- Collaborating with the client to identify strategies to reduce the frequency and quantity of cannabis use. (Correct answer)
- Insisting the client attend a 12-step meeting for marijuana anonymous.
Correct answer: Collaborating with the client to identify strategies to reduce the frequency and quantity of cannabis use.
Harm reduction aims to reduce the negative consequences of substance use without requiring abstinence. Collaborating with the client to reduce their use is a practical, client-centered strategy that meets them 'where they are at' and can help build a therapeutic alliance while minimizing harm.
Question 4: A client with a long history of Panic Disorder, who has been taking a high dose of a prescribed benzodiazepine for several years, abruptly stops their medication. They present with severe anxiety, tachycardia, tremors, and perceptual disturbances. The RPN should recognize these symptoms are most likely indicative of:
- A paradoxical reaction to the medication.
- The onset of a new psychotic disorder.
- A severe relapse of their underlying panic disorder.
- Benzodiazepine withdrawal syndrome. (Correct answer)
Correct answer: Benzodiazepine withdrawal syndrome.
The symptom cluster of severe anxiety, autonomic hyperactivity (tachycardia), tremors, and perceptual disturbances after abruptly stopping long-term, high-dose use is characteristic of benzodiazepine withdrawal. While it can mimic an anxiety relapse, the presence of new physiological and perceptual symptoms points strongly toward withdrawal.
Question 5: An RPN is using Motivational Interviewing (MI) with a client who is ambivalent about reducing their alcohol use, which they state helps with their social anxiety. Which statement by the RPN best exemplifies the MI principle of 'developing discrepancy'?
- "You have to stop drinking if you want to get your anxiety under control."
- "It sounds like the alcohol helps you feel more comfortable socially in the short term, yet you've also mentioned that it has led to arguments with your partner. How do you see these two things fitting together?" (Correct answer)
- "I think you should try going to an AA meeting to see how others have managed."
- "Let's be clear, your drinking is the main problem here, not your anxiety."
Correct answer: "It sounds like the alcohol helps you feel more comfortable socially in the short term, yet you've also mentioned that it has led to arguments with your partner. How do you see these two things fitting together?"
Developing discrepancy is a core component of Motivational Interviewing where the clinician highlights the inconsistencies between the client's current behaviors and their broader goals or values. This statement is non-judgmental, reflects both sides of the client's ambivalence, and invites them to explore the conflict, which can enhance motivation for change.
Question 6: A client with co-occurring major depressive disorder and opioid use disorder is being considered for naltrexone treatment. The RPN must ensure which critical prerequisite is met before the first dose is administered?
- The client's depressive symptoms are in full remission.
- The client has been completely abstinent from opioids for at least 7-10 days. (Correct answer)
- The client has secured stable housing.
- The client has successfully completed a 12-step program.
Correct answer: The client has been completely abstinent from opioids for at least 7-10 days.
Naltrexone is an opioid antagonist, meaning it blocks opioid receptors. If administered to a person who is physically dependent on opioids, it will precipitate an acute and severe withdrawal syndrome. Therefore, a period of abstinence (typically 7-14 days depending on the opioid) is a critical safety requirement before initiation.
RPNCE - Registered Psychiatric Nurse of Canada Examination Co-occurring Disorders and Addictions Questions and Answers
A client with a known diagnosis of Bipolar I Disorder is admitted during a manic episode.
They are agitated, have pressured speech, and report using stimulants "to keep the energy up." What is the RPN's priority nursing action?