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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.
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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 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 co-occurring disorders who is in the early stages of recovery. The client has been abstained from using alcohol for the past 3 weeks. During a follow-up visit, the nurse is working on teaching the client about the effects of alcohol on his body. Which of the following would be most important for the nurse to keep in mind about the client?
- A. The client will be highly suggestible to information, being unable to reason critically.
- B. The alcohol abuse has destroyed the brain cells that are necessary for learning.
- C. Some cognitive impairment may be present that hinders his ability to learn new things.
- D. The underlying effects of the substance abuse will prevent him from being able to learn.
Correct Answer: C
Rationale: Some cognitive impairment (C) may persist in early recovery from alcohol abuse, affecting learning ability, so teaching should be simplified. Options A, B, and D overestimate or mischaracterize the extent of cognitive impact.
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 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.