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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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A client with schizophrenia and substance abuse disorder is admitted to a detoxification program. The client has been prescribed neuroleptic medications for schizophrenia. When caring for this client, the nurse would implement interventions to reduce the client?s risk for relapse, integrating knowledge that relapse frequently is secondary to which of the following?
- A. Poor social skills
- B. Lack of vocational skills
- C. Medication non-adherence
- D. Dysfunctional family systems
Correct Answer: C
Rationale: Medication non-adherence (C) is a primary cause of relapse in schizophrenia, as neuroleptics control symptoms, and stopping them often leads to symptom recurrence and substance use. Poor social skills (A), lack of vocational skills (B), and dysfunctional family systems (D) contribute but are less directly linked to relapse than non-adherence.
A nurse is teaching a group of hospitalized clients who have co-occurring disorders involving cognitive disorders and alcoholism about the relapse cycle. Which statement would the nurse most likely include during this teaching session?
- A. After you are discharged, there is a tendency to use alcohol rather than your prescribed medications to self-medicate your psychiatric symptoms. This allows your psychiatric symptoms to surface again, and they, in turn, lead to rehospitalization. Your symptoms are again controlled with medications until you are discharged, and the cycle starts all over again.
- B. Your alcoholism causes you to hallucinate, and you need to take prescribed medications to control the hallucinations. When you try to stop drinking and stay abstinent, your hallucinations disappear; consequently, you stop taking your prescribed medications because they?re gone. Then you celebrate with alcohol, and this triggers a relapse; the alcoholism causes hallucinations, and the whole thing starts over again.
- C. Your dependence on alcohol and your psychiatric illness are unrelated. Experiencing disturbing thoughts does not cause alcoholism, and alcoholism does not cause your disturbing thoughts. It all boils down to medication compliance.
- D. The cycle is triggered by repeated attempts to stop drinking. Without the levels of alcohol your system has come to tolerate, you begin to develop psychiatric symptoms. Then you have to be hospitalized and treated for your psychosis again. Everything is fine until the next time you try to stop drinking, and then the cycle repeats itself.
Correct Answer: A
Rationale: Option A accurately describes the relapse cycle in co-occurring disorders, where clients use alcohol to self-medicate psychiatric symptoms, leading to symptom recurrence, rehospitalization, and repeated cycles due to medication non-adherence. Option B incorrectly ties alcoholism directly to hallucinations, option C oversimplifies the relationship, and option D misattributes psychiatric symptoms to alcohol withdrawal.
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 nurse is working with a client with depression and substance abuse on ways to promote recovery. Which of the following would be most important for the nurse to include? Select all that apply.
- A. A positive social network
- B. Compliance to treatment
- C. Avoidance of hospitalization
- D. Supportive housing
- E. Community vocational rehabilitation
Correct Answer: A,B,D,E
Rationale: A positive social network (A), treatment compliance (B), supportive housing (D), and vocational rehabilitation (E) promote recovery by addressing social, medical, and practical needs. Avoiding hospitalization (C) is not a goal, as it may be necessary for stabilization.
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.