CARN Nursing Interventions and Treatment 4 — Questions and Answers
Question 1: A patient with opioid use disorder refuses all medications and prefers an abstinence-based program. What is the nurse's most appropriate response using a person-centered approach?
- Insist the patient accept MOUD because it is evidence-based and reduces mortality
- Respect the patient's preference, provide education on MOUD benefits and risks of refusal, and support their chosen treatment plan (Correct answer)
- Discharge the patient as they are non-compliant with standard of care
- Contact the prescriber to override the patient's decision
Correct answer: Respect the patient's preference, provide education on MOUD benefits and risks of refusal, and support their chosen treatment plan
Person-centered care requires respecting patient autonomy while ensuring informed consent by educating patients about all evidence-based options including MOUD benefits.
Question 2: Which assessment tool is most appropriate for a nurse to use to quickly screen for unhealthy alcohol use in an outpatient primary care setting?
- CIWA-Ar
- AUDIT-C (Correct answer)
- DAST-10
- ASI
Correct answer: AUDIT-C
The AUDIT-C (three-item Alcohol Use Disorders Identification Test-Consumption) is a validated, brief screening tool for unhealthy alcohol use in primary care.
Question 3: A patient with co-occurring PTSD and alcohol use disorder is beginning treatment. Which integrated treatment approach is recommended over sequential treatment?
- Treating PTSD first, then initiating alcohol use disorder treatment after 6 months of sobriety
- Treating alcohol use disorder first until stable, then starting PTSD therapy
- Providing simultaneous treatment for both conditions in a coordinated plan (Correct answer)
- Referring to separate specialists who communicate quarterly
Correct answer: Providing simultaneous treatment for both conditions in a coordinated plan
Integrated treatment addressing both PTSD and substance use disorder simultaneously produces better outcomes than sequential or parallel non-coordinated approaches.
Question 4: A nurse is administering a daily supervised dose of buprenorphine/naloxone. The patient states they feel 'sick' despite taking the medication. What is the most likely cause?
- Naloxone component is precipitating withdrawal
- The buprenorphine dose is too high causing toxicity
- The dose is insufficient and the patient is in partial withdrawal (Correct answer)
- The patient has developed tolerance to naloxone
Correct answer: The dose is insufficient and the patient is in partial withdrawal
Persistent withdrawal symptoms on sublingual buprenorphine/naloxone typically indicate an insufficient dose, as naloxone has negligible sublingual absorption.
Question 5: When developing a discharge plan for a patient completing inpatient detoxification from alcohol, which element most strongly reduces the risk of relapse and mortality?
- Scheduling a follow-up appointment in 90 days
- Providing a prescription for a benzodiazepine to manage any residual anxiety
- Initiating pharmacotherapy (e.g., naltrexone or acamprosate) and linking to ongoing outpatient care before discharge (Correct answer)
- Advising the patient to attend AA meetings and call if problems arise
Correct answer: Initiating pharmacotherapy (e.g., naltrexone or acamprosate) and linking to ongoing outpatient care before discharge
Warm handoff to continuing care and initiation of FDA-approved pharmacotherapy before discharge significantly reduce post-detox relapse and overdose death.
Question 6: A nurse notices a colleague taking controlled substances from a patient's medication tray. What is the nurse's immediate legal and ethical obligation?
- Speak privately with the colleague and encourage them to seek help before reporting
- Report the observation to a supervisor immediately per facility policy and state nursing board requirements (Correct answer)
- Document the behavior and wait to see if it recurs before acting
- Confront the colleague directly and demand they return the medication
Correct answer: Report the observation to a supervisor immediately per facility policy and state nursing board requirements
Diversion of controlled substances is illegal; nurses have a mandatory obligation to report suspected diversion immediately to protect patients and public safety.
Question 7: Which statement accurately describes the concept of 'therapeutic limit setting' in addiction nursing practice?
- Setting strict punitive consequences to modify manipulative behavior
- Establishing clear, consistent boundaries that protect the therapeutic relationship and patient safety while conveying respect (Correct answer)
- Refusing to engage with patients who are actively using substances
- Using negative reinforcement to extinguish drug-seeking behaviors
Correct answer: Establishing clear, consistent boundaries that protect the therapeutic relationship and patient safety while conveying respect
Therapeutic limit setting involves communicating clear, non-punitive expectations that maintain safety and structure while preserving the dignity of the nurse-patient relationship.
CARN Nursing Interventions and Treatment 4
A patient with opioid use disorder refuses all medications and prefers an abstinence-based program.
What is the nurse's most appropriate response using a person-centered approach?