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A nurse is interviewing a client who has a co-occurring diagnosis. The client is trying to explain why it is so easy to start drinking again even though hospitalization and prescribed medications can eventually control his mental problems. Which statement by the client would the nurse interpret as reflecting the client?s beliefs?
- A. It just seems easier and cheaper to go out and get a bottle or a fix than it does to keep paying for medications with money I don?t have.
- B. If I come out of the hospital and keep taking my prescribed medications, I know I will function better, but I won?t be able to escape my feelings or feel high like I do when I drink.
- C. I just don?t like the side effects my prescribed medications cause, and, besides that, I can never remember to take them at specific times or with food.
- D. I don?t like to take them because then my spouse expects me to be more responsible and to help around the house more often. I don?t have to be bothered with that when I drink or use.
Correct Answer: B
Rationale: The client?s statement in option B reflects a common belief in co-occurring disorders, where substance use provides an escape or euphoria that medications do not, driving relapse. Option A focuses on cost, option C on side effects, and option D on avoiding responsibility, all less central to the emotional pull of substance use.
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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.
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 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.
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 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.