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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.
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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.
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.
When describing the relapse cycle to a group of families of clients experiencing co-occurring disorders, which of the following would the nurse identify as occurring first?
- A. Hospitalization
- B. Decompensation
- C. Stabilization
- D. Discharge
Correct Answer: B
Rationale: Decompensation (B) occurs first in the relapse cycle, as psychiatric symptoms worsen, leading to substance use, hospitalization (A), stabilization (C), and discharge (D).
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.
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.