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A client with co-occurring disorders of schizophrenia and substance abuse is admitted for treatment. Which of the following would the nurse be least likely to identify as a priority for this client?
- A. Assessment
- B. Group therapy
- C. Control of psychiatric symptoms
- D. Treatment of withdrawal symptoms
Correct Answer: B
Rationale: Group therapy (B) is least likely to be a priority during acute admission, as assessment (A), controlling psychiatric symptoms (C), and treating withdrawal symptoms (D) address immediate safety and stabilization needs.
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A client has a co-occurring diagnosis of alcoholism and bipolar disorder. He was brought to the emergency department by two policemen who had broken up a fight that the client had gotten into in a neighborhood bar. The client is intrusive and verbose about having diplomatic immunity and his pressing need to tour the bistate area to promote his bid for the presidency. The client has had multiple admissions to the hospital?s psychiatric unit, and he has almost always experienced alcohol withdrawal syndrome immediately after his previous admissions. Which of the following would be a priority for this client?
- A. Administering prescribed mood-stabilizing medications to control his delusional thinking because doing so will curtail his desire to drink
- B. Taking baseline vital signs and then monitoring them on an ongoing basis to ascertain if the client is exhibiting early signs of alcohol withdrawal
- C. Suggesting that client refrain from being intrusive and annoying others with his constant chatter about his delusional thinking
- D. Referring the client to an outpatient community substance abuse treatment center because his addiction has to be adequately addressed before his bipolar problems can be effectively treated
Correct Answer: B
Rationale: Monitoring for alcohol withdrawal syndrome (B) is the priority due to its potential for life-threatening complications, given the client?s history. Administering mood stabilizers (A) is important but secondary to immediate safety. Suggesting behavioral changes (C) is ineffective during acute mania, and outpatient referral (D) is premature during an acute crisis.
A nurse is readmitting a client with a co-occurring diagnoses of schizophrenia and alcohol abuse who has relapsed. The client says, 'I?m just a failure. I?ll never be anything but just a drunk.' Which response by the nurse would be most appropriate?
- A. Relapse is a normal part of recovery; you can learn from this experience so it will be easier to avoid it or a similar one in the future.
- B. Face it, you will always be an alcoholic, and relapse is inevitable because it is part of the illness.
- C. If you didn?t have disturbed thoughts from your schizophrenia, you wouldn?t be tempted to drink.
- D. Please clarify something for me. When you say, ?just a drunk,? what exactly are you trying to say?
Correct Answer: A
Rationale: Stating that relapse is a normal part of recovery (A) is therapeutic, offering hope and framing the relapse as a learning opportunity. Option B is defeatist, option C oversimplifies the relationship between disorders, and option D avoids addressing the client?s feelings directly.
A nurse is working as part of an interdisciplinary treatment team for a client diagnosed with a mental illness and substance abuse disorder. As part of the recovery process, which of the following would be most important for the team to do initially?
- A. Provide a series of short-term hospitalizations that apply leverage to pressure the client into adhering to a prescribed treatment regimen.
- B. Establish rules that will enhance the client?s recognition of staff as authority figures who know what is best for the client?s care and well-being.
- C. Use heavy confrontation, intense emotional pressure, and discouragement of the use of medications since all medications have the potential to be addictive.
- D. Provide immediate help with a situational crisis the client is experiencing to promote trust in the client and have the client buy into the treatment process.
Correct Answer: D
Rationale: Providing immediate help with a situational crisis (D) builds trust, a critical first step for engaging clients with co-occurring disorders in treatment. Short-term hospitalizations (A) and establishing authority (B) are less effective initially, and heavy confrontation (C) is counterproductive and inappropriate.
A group of nursing students are reviewing information about co-occurring disorders and risks for substance abuse. The students demonstrate understanding of the information when they identify which psychiatric disorder as being associated with the highest risk for substance abuse?
- A. Mania
- B. Panic disorder
- C. Antisocial personality disorder
- D. Phobias
Correct Answer: C
Rationale: Antisocial personality disorder (C) has the highest risk for substance abuse due to impulsivity and disregard for consequences. Mania (A) and panic disorder (B) carry risks but are less associated, and phobias (D) have minimal direct correlation.
The nurse is reviewing a client?s medical record and finds that he has received treatment for his co-occurring disorders in the primary health care setting. The nurse interprets this as which quadrant of care?
- A. Category I
- B. Category II
- C. Category III
- D. Category IV
Correct Answer: A
Rationale: Category I (A) refers to low-severity mental health and substance use disorders treated in primary care settings. Categories II?IV involve higher severity or specialized care settings.