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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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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.
The parents of a client with schizophrenia who also abuses alcohol asks the nurse, 'What can we do to help our son from relapsing after he is discharged from the hospital?' Which response by the nurse would be most appropriate?
- A. There?s really not much you can do; your son is responsible for maintaining his own sobriety.
- B. Avoid letting him take any mood-altering chemicals because they may trigger his delusional thinking.
- C. Make sure he goes to at least two Alcoholics Anonymous meetings a week, gets a sponsor, and calls his sponsor on a daily basis.
- D. Report any side effects he develops so they can be treated and therefore won?t tempt him to stop taking his prescribed medications.
Correct Answer: D
Rationale: Reporting side effects (D) helps ensure medication adherence, a key factor in preventing relapse in schizophrenia and alcohol abuse, as side effects often lead to discontinuation. Option A dismisses family involvement, option B is overly restrictive, and option C is specific to AA but less critical than medication management.
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.