CARN Assessment and Diagnosis 2 — Questions and Answers
Question 1: A patient scoring 15 on the CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol) should be managed with which intervention?
- Outpatient monitoring only
- Pharmacological treatment with benzodiazepines (Correct answer)
- Immediate discharge with written instructions
- Non-pharmacological comfort measures alone
Correct answer: Pharmacological treatment with benzodiazepines
A CIWA-Ar score of 15 or higher indicates severe alcohol withdrawal requiring pharmacological intervention, typically with benzodiazepines.
Question 2: When assessing a patient for opioid use disorder, which physical finding is most consistent with chronic opioid use?
- Pupillary dilation
- Track marks and venous sclerosis at injection sites (Correct answer)
- Hypertension and tachycardia at rest
- Skin flushing and diaphoresis
Correct answer: Track marks and venous sclerosis at injection sites
Track marks and venous sclerosis are classic physical signs of repeated intravenous opioid use.
Question 3: The DSM-5 diagnoses substance use disorder on a severity continuum. Which combination of criteria count correctly defines 'severe' SUD?
- 2-3 criteria
- 4-5 criteria
- 6 or more criteria (Correct answer)
- 1 criterion plus hospitalization
Correct answer: 6 or more criteria
DSM-5 classifies SUD as mild (2-3 criteria), moderate (4-5 criteria), and severe (6 or more criteria).
Question 4: A patient in opioid withdrawal reports severe muscle cramping, diarrhea, and yawning. Using the COWS scale, which domain captures the yawning symptom?
- Autonomic signs (Correct answer)
- GI upset
- Restlessness
- Sweating
Correct answer: Autonomic signs
Yawning is scored under autonomic signs on the Clinical Opiate Withdrawal Scale (COWS).
Question 5: Which screening tool is specifically validated for identifying unhealthy alcohol use in primary care settings?
- DAST-10
- AUDIT-C (Correct answer)
- CAGE-AID
- PHQ-9
Correct answer: AUDIT-C
The AUDIT-C is a validated 3-item screen derived from the full AUDIT, specifically designed for rapid detection of unhealthy alcohol use in primary care.
Question 6: A nurse is assessing a patient who uses methamphetamine daily. Which psychiatric symptom is most commonly associated with stimulant use disorder?
- Hypersomnia during intoxication
- Paranoid psychosis (Correct answer)
- Opioid-like euphoria
- Severe respiratory depression
Correct answer: Paranoid psychosis
Paranoid psychosis, including hallucinations and delusions, is a common psychiatric complication of chronic methamphetamine use.
Question 7: During a comprehensive addiction assessment, which domain is assessed by asking about a patient's employment, legal history, and living situation?
- Medical history
- Biopsychosocial functioning (Correct answer)
- Withdrawal severity
- Family genogram
Correct answer: Biopsychosocial functioning
Employment, legal history, and living situation are components of the biopsychosocial assessment that evaluates functioning across multiple life domains.
CARN Assessment and Diagnosis 2
A patient scoring 15 on the CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol) should be managed with which intervention?