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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.
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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 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.
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).
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.
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.