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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.
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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 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.
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 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.
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.