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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.
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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.
The nurse is caring for a female adolescent client diagnosed with depression and substance abuse. Which of the following would be most appropriate for the nurse to do?
- A. Determine if the client is experiencing hyperactivity.
- B. Ask her if she is having thoughts of harming herself.
- C. Determine if the client is exhibiting Wernicke?s syndrome.
- D. Ask the client if she has had problems with excessive anxiety.
Correct Answer: B
Rationale: Asking about suicidal thoughts (B) is most appropriate, as depression in adolescents with substance abuse significantly increases suicide risk, requiring immediate assessment. Hyperactivity (A) is less relevant, Wernicke?s syndrome (C) is specific to thiamine deficiency in alcoholism, and anxiety (D) is secondary to suicide risk.
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 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.
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.