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A client with major depression visits the mental health clinic and tells the nurse that he has recently started using marijuana quite frequently. The nurse determines that the manifestation of the client?s co-occurring disorder reflects which of the following?
- A. Primary mental illness with subsequent substance use
- B. Primary substance abuse disorder with psychopathologic sequelae
- C. Dual primary diagnoses
- D. A common etiology
Correct Answer: A
Rationale: The client?s major depression preceded the frequent marijuana use, suggesting primary mental illness with subsequent substance use (A) as a coping mechanism. Option B implies substance abuse came first, which is not indicated. Option C suggests equal primacy of both disorders, and option D implies a shared cause, both less likely given the sequence described.
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The parents of a client with schizophrenia who also abuses alcohol asks the nurse, 'What can we do to help our son from relapsing after he is discharged from the hospital?' Which response by the nurse would be most appropriate?
- A. There?s really not much you can do; your son is responsible for maintaining his own sobriety.
- B. Avoid letting him take any mood-altering chemicals because they may trigger his delusional thinking.
- C. Make sure he goes to at least two Alcoholics Anonymous meetings a week, gets a sponsor, and calls his sponsor on a daily basis.
- D. Report any side effects he develops so they can be treated and therefore won?t tempt him to stop taking his prescribed medications.
Correct Answer: D
Rationale: Reporting side effects (D) helps ensure medication adherence, a key factor in preventing relapse in schizophrenia and alcohol abuse, as side effects often lead to discontinuation. Option A dismisses family involvement, option B is overly restrictive, and option C is specific to AA but less critical than medication management.
The nurse is planning a presentation for a group of mental health care providers on the topic of co-occurring disorders. The nurse plans to include information about health care providers and their response to these clients. Which of the following would the nurse include as a major reason for these clients being often underserved and undertreated?
- A. Providers often focus treatment on the 12-step programs for substance abuse treatment.
- B. They commonly underdiagnose personality disorders in those who take illicit substances.
- C. Providers commonly ignore the existence of concurrent mental health disorders.
- D. They have difficulty determining which problem is in most immediate need.
Correct Answer: C
Rationale: Providers often ignore concurrent mental health disorders (C), focusing solely on substance abuse, which leads to undertreatment of co-occurring disorders. Option A is less accurate, as 12-step programs are not the primary focus of providers. Option B is specific to personality disorders, not the broader issue. Option D is a challenge but not the primary reason.
The nurse is caring for a female adolescent client diagnosed with depression and substance abuse. Which of the following would be most appropriate for the nurse to do?
- A. Determine if the client is experiencing hyperactivity.
- B. Ask her if she is having thoughts of harming herself.
- C. Determine if the client is exhibiting Wernicke?s syndrome.
- D. Ask the client if she has had problems with excessive anxiety.
Correct Answer: B
Rationale: Asking about suicidal thoughts (B) is most appropriate, as depression in adolescents with substance abuse significantly increases suicide risk, requiring immediate assessment. Hyperactivity (A) is less relevant, Wernicke?s syndrome (C) is specific to thiamine deficiency in alcoholism, and anxiety (D) is secondary to suicide risk.
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.
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.