CARN Patient Assessment and Diagnosis 2 — Questions and Answers
Question 1: A patient presents with diaphoresis, tachycardia, and hypertension 18 hours after last alcohol use. Which assessment finding most indicates impending severe withdrawal?
- Temperature of 99.1°F
- Tremors of the hands and tongue
- Onset of visual hallucinations (Correct answer)
- Mild anxiety and insomnia
Correct answer: Onset of visual hallucinations
Visual hallucinations signal progression toward severe alcohol withdrawal and risk for delirium tremens.
Question 2: When using the CRAFFT screening tool with adolescent patients, the nurse should understand it is designed to assess risk related to:
- Chronic pain and opioid misuse
- Alcohol and other substance use while in cars, alone, or to relax/forget (Correct answer)
- Tobacco dependence severity
- Gambling and behavioral addictions
Correct answer: Alcohol and other substance use while in cars, alone, or to relax/forget
CRAFFT screens adolescents for substance use risk using questions about riding in a Car, using substances Alone, to Relax, Forget, among other triggers.
Question 3: A nurse is assessing a patient for opioid use disorder. Which finding from the urine drug screen requires the most immediate clinical follow-up?
- Positive for prescribed buprenorphine
- Positive for cocaine metabolites
- Negative result in a patient on MOUD who denies recent use (Correct answer)
- Positive for caffeine metabolites
Correct answer: Negative result in a patient on MOUD who denies recent use
A negative urine screen in a patient prescribed MOUD may indicate diversion and warrants urgent clinical reassessment.
Question 4: Which DSM-5 criterion distinguishes a substance use disorder from substance dependence in clinical assessment?
- DSM-5 removed the abuse/dependence dichotomy and uses a single spectrum disorder with severity specifiers (Correct answer)
- DSM-5 requires 30 days of continuous use for diagnosis
- DSM-5 diagnosis requires both physical and psychological symptoms
- DSM-5 requires failed detox attempts before diagnosis
Correct answer: DSM-5 removed the abuse/dependence dichotomy and uses a single spectrum disorder with severity specifiers
The DSM-5 replaced the DSM-IV categories of abuse and dependence with a single substance use disorder rated mild, moderate, or severe.
Question 5: During a motivational assessment, a patient states: 'I know drinking is causing problems, but I'm not sure I want to quit.' This statement best reflects which stage of the Transtheoretical Model?
- Precontemplation
- Contemplation (Correct answer)
- Preparation
- Action
Correct answer: Contemplation
Acknowledging problems while being ambivalent about change is the hallmark of the contemplation stage.
Question 6: A patient being assessed for stimulant use disorder reports paranoia, insomnia, and 72 hours without sleep. Which physiological assessment finding would the nurse most expect?
- Bradycardia and miosis
- Tachycardia, hypertension, and mydriasis (Correct answer)
- Hypotension and respiratory depression
- Hypothermia and bradypnea
Correct answer: Tachycardia, hypertension, and mydriasis
Stimulant intoxication produces sympathomimetic effects including tachycardia, elevated blood pressure, and dilated pupils.
Question 7: Which screening tool is validated for use in primary care settings to identify unhealthy alcohol use in adults and includes a single-question screen?
- CAGE questionnaire
- AUDIT-C
- Single Alcohol Screening Question (SASQ) (Correct answer)
- CIWA-Ar
Correct answer: Single Alcohol Screening Question (SASQ)
The Single Alcohol Screening Question asks about heavy drinking days and is validated for identifying unhealthy alcohol use in primary care.
CARN Patient Assessment and Diagnosis 2
A patient presents with diaphoresis, tachycardia, and hypertension 18 hours after last alcohol use.
Which assessment finding most indicates impending severe withdrawal?