The client was prescribed buprenorphine-naloxone in the emergency department for opioid use disorder. When the client presents to the psychiatrist's office for a follow-up visit, what assessment finding indicates effectiveness of the buprenorphine-naloxone?
Correct Answer Rationale: A reduction in heroin use from daily to once in the last seven days indicates that buprenorphine-naloxone is working to help the client manage their dependency and reduce their opioid use.
Question 2
A client with opioid use disorder is prescribed methadone as part of their treatment plan. Which of the following findings suggests that the client is receiving an appropriate dose of methadone?
Correct Answer Rationale: A properly adjusted dose of methadone will alleviate cravings and withdrawal symptoms without producing the euphoria associated with opioid misuse, helping the client maintain stability.
Question 3
A client with opioid use disorder is started on naloxone to reverse an opioid overdose. After administration, which of the following outcomes is most important to assess for in the client?
Correct Answer Rationale: Naloxone is an opioid antagonist that temporarily reverses the life-threatening effects of an opioid overdose, such as respiratory depression. The priority is to ensure that the client's breathing and oxygenation are stable.
Question 4
Family members bring a teenager to the emergency department whom they claim uses cocaine and appears to be experiencing withdrawals. What assessment finding supports the family's concern?
Correct Answer Rationale: Cocaine withdrawal symptoms can include agitation, fatigue, vivid or unpleasant dreams, and difficulty sleeping. The other options do not indicate withdrawal symptoms from cocaine.
Question 5
A client with opioid use disorder arrives at the clinic and reports feeling nauseous and sweating excessively. Which of the following assessment findings would support opioid withdrawal?
Correct Answer Rationale: Opioid withdrawal symptoms include muscle aches, dilated pupils, nausea, sweating, and irritability. These symptoms are signs of the body reacting to the absence of opioids after dependency has developed.
Question 6
A client with a history of heroin use disorder is admitted to the hospital for detoxification. The nurse suspects opioid withdrawal and prepares to assess the client. Which of the following findings would be most indicative of opioid withdrawal?
Correct Answer Rationale: These are common signs of opioid withdrawal. Symptoms like yawning, restlessness, and rhinorrhea (runny nose) are early indicators of opioid withdrawal as the body adjusts to the absence of opioids.
Question 7
Based on the nurse's notes, at what time should the nurse have first suspected that the client may have used cocaine and intervened?
Chart: Jara Stelt, 25yo, admitted for cocaine abuse. 1550: Client in bed, VS stable, no distress. 1615: Client in group therapy. 1720: Client with visitor, no distress. 1830: Nurse finds bed empty, client and visitor in closed bathroom. 1850: Client irritable, VS elevated (BP 142/90, HR 110). 1945: More irritable, VS further elevated (BP 144/90, HR 114). 2010: Client found unresponsive with tourniquet, syringe, cocaine found.
Correct Answer Rationale: At 1850, the client had elevated vital signs, including an increased heart rate and blood pressure, along with irritability. These signs may be indicative of stimulant use, such as cocaine.
Question 8
Based on the nurse's notes, at what time should the nurse recognize both subjective and objective symptoms of withdrawal from a substance use disorder and intervene?
Chart: Emily Torres, 32yo, admitted for substance use disorder. 0920: Client in bed, VS stable, no distress. 1020: Client up, slightly restless. 1130: Client reports feeling shaky, slightly nauseous, denies cravings. VS: BP 118/76, HR 78. 1230: Client more agitated, shaking hands, reports feeling "anxious" and "jittery." VS: BP 132/86, HR 94. 1310: Client visibly sweating, trembling, reports severe anxiety and dizziness. VS: BP 138/88, HR 100.
Correct Answer Rationale: At 1230, the client demonstrates both subjective signs (anxiety, feeling "jittery") and objective signs (shaking hands, elevated BP and HR). Early intervention at this point helps prevent further escalation of withdrawal symptoms.
Question 9
Based on the nurse's notes, when should the nurse suspect that the client may be experiencing opioid withdrawal and intervene?
Chart: Michael Green, 28yo, admitted for opioid use disorder. 0800: Client calm, VS stable. 0900: Client slightly tired, feels "a little off," denies major symptoms. 1030: Client feels "weak" and "sluggish," denies opioid cravings. 1200: Client nauseous, sweating, restless. VS: BP 126/82, HR 88. States "I need something to take the edge off." 1300: Client sweating, shaking, rhinorrhea, muscle aches. VS: BP 140/90, HR 110. Admits to using heroin the night before.
Correct Answer Rationale: Symptoms of opioid withdrawal include nausea, muscle aches, diaphoresis, irritability, agitation, rhinorrhea, and pupillary dilation. These symptoms begin at 1200 but become clear at 1300 when the client admits to using heroin the night before.
Question 10
The client who is being discharged from the hospital after treatment for opioid addiction asks the nurse how to facilitate a full recovery from drug use after discharge. What response by the nurse is appropriate?
Correct Answer Rationale: Understanding triggers and stressors that could lead to a relapse is an essential part of recovery for individuals with opioid use disorder. It empowers the client to identify high-risk situations, develop coping strategies, and seek support.
Question 11
The client diagnosed with opioid use disorder is preparing to return to work after completing a treatment program. What is the nurse's best recommendation to help prevent relapse during the transition back to daily life?
Correct Answer Rationale: Being aware of potential triggers, including environments or people associated with past drug use, is crucial in the recovery process. Having a plan in place to manage these triggers can reduce the risk of relapse.
Question 12
A client with a history of opioid use disorder is preparing for discharge from the hospital. The client asks the nurse, "I'm really scared about going back to my old environment where I used to use. What can I do to avoid relapsing?" Which response by the nurse is most appropriate?
Correct Answer Rationale: The most appropriate nursing response is to help the client create a comprehensive discharge plan that includes connecting with support groups, follow-up care, and resources for ongoing support.
Question 13
While admitting a 23-year-old client with substance abuse disorder to the unit, the client's mother asks the nurse about inclusion into the client's plan of care. What response by the nurse is appropriate?
Correct Answer Rationale: Involving family members in treatment is often beneficial in the recovery process for clients with substance abuse disorder, especially through family therapy. However, it is important that the client gives consent for family involvement.
Question 14
The nurse is admitting a 30-year-old client with substance use disorder to the unit. The client's partner asks how they can support the client's recovery. What response by the nurse is appropriate?
Correct Answer Rationale: Involving family members in therapy can provide support to the client and help the family understand how to be helpful in recovery. However, it is important that this is done with the client's consent and willingness to include the family.
Question 15
The nurse is developing a care plan for a 25-year-old client admitted for heroin addiction. The client's father asks the nurse about his role in the recovery process. What is the most appropriate response by the nurse?
Correct Answer Rationale: Family involvement is an essential component of addiction treatment, especially in family therapy. It helps educate family members on addiction dynamics and enables them to provide emotional and practical support.
Question 16
Based on the nurse's notes of client teaching performed, what statement indicates inaccurate teaching provided to the client?
Chart: Samuel Pider, 28yo, admitted for opioid addiction. Nurse taught: "Methadone replaces the opioid to which you are addicted. It will be given to you orally. If you don't like it, it can be stopped immediately and changed to another drug. Do not take methadone on the streets. Methadone will help you to not crave the illegal drug. It will be used on a long-term basis."
Correct Answer Rationale: Methadone is a long-term treatment for opioid use disorder, and discontinuing or changing it abruptly without proper guidance from the healthcare provider can have serious consequences, such as withdrawal symptoms or relapse. Methadone must be tapered under medical supervision.
Question 17
Based on the nurse's notes of client teaching performed, what statement indicates inaccurate teaching provided to the client?
Chart: Lila Macon, 32yo, for opioid use disorder. Nurse explained: "Buprenorphine-naloxone is used to prevent withdrawal and cravings from opioids. It will help you gradually reduce your dependence on opioids. If you take the medication as directed, you will not have cravings or feel withdrawal symptoms. You can take it for as long as you need."
Correct Answer Rationale: While buprenorphine-naloxone can reduce cravings and withdrawal, it is not guaranteed to completely eliminate them for all clients. Some individuals may still experience mild cravings or withdrawal symptoms, especially early in the treatment process.
Question 18
Based on the nurse's notes of client teaching performed, what statement indicates inaccurate teaching was provided to the client?
Chart: Henry Torres, 40yo, for opioid use disorder treatment with prescriptions for naltrexone and counseling. Nurse provided the following information: "Naltrexone works by blocking the effects of opioids in your brain. It will help reduce cravings and prevent any high you may experience if you relapse. It is important to take naltrexone exactly as prescribed, and you should not take opioids while on this medication. If you relapse, it can cause severe withdrawal symptoms."
Correct Answer Rationale: Naltrexone is an opioid antagonist that blocks the euphoric effects of opioids, but it does not cause withdrawal symptoms if a client relapses. However, if naltrexone is initiated too soon after recent opioid use, it can precipitate withdrawal symptoms due to its opioid-blocking action.
Question 19
When the nurse reviews the result of the CAGE Alcohol Abuse Screening Tool that the client has completed, how should the nurse interpret the result?
CAGE Results: C (Cut down) = Yes, A (Annoyed) = No, G (Guilty) = No, E (Eye-opener) = Yes → Score: 2 Yes answers
Correct Answer Rationale: The result of the CAGE screening tool indicates that the client has answered "Yes" to two or more of the four questions. This suggests a possible alcoholism problem that requires further assessment.
Question 20
When the nurse reviews the result of the AUDIT Alcohol Screening Tool that the client has completed, how should the nurse interpret the result?
AUDIT Results showing: drinks 2-3 times/week, 5-6 drinks per occasion, weekly inability to stop, weekly guilt, monthly blackouts, prior injury from drinking.
Correct Answer Rationale: The score range of 20-29 points on the AUDIT Alcohol Screening Tool indicates a possible alcohol use disorder that warrants further assessment. The tool's scoring helps identify the severity of alcohol-related issues.
Question 21
When the nurse reviews the result of the DAST (Drug Abuse Screening Test) that the client has completed, how should the nurse interpret the results?
DAST Results: Used drugs other than medical = Yes, More than one drug at a time = No, Withdrawal symptoms = Yes, Illegal activities to obtain drugs = Yes, Takes drugs to relax/feel better = Yes → Score: 4 Yes answers
Correct Answer Rationale: A score of 4 points on the DAST indicates a possible drug use disorder. The questions are designed to assess the severity of drug use and its impact on the client's life. A positive response to multiple questions signals a potential substance use problem.
Question 22
The nurse in a psychiatric unit is caring for several clients. Which client should the nurse recommend for group therapy?
Correct Answer Rationale: The client on methadone for 2 months without relapse is the most appropriate recommendation for group therapy. This client is stable enough to participate and can benefit from peer support.
Question 23
The nurse in a psychiatric unit is caring for several clients. Which client should the nurse recommend for group therapy?
Correct Answer Rationale: Clients with opioid use disorder who are willing to participate can greatly benefit from group therapy, as it provides peer support, reduces isolation, and offers structure for recovery.
Question 24
The nurse on a behavioral health unit is evaluating clients for group therapy. Which client is the best candidate for this intervention?
Correct Answer Rationale: Group therapy is most beneficial for clients who have insight into their condition and a willingness to engage with others. A client with opioid use disorder who is currently taking methadone can gain significant support and coping strategies through group therapy.
Question 25
When working with a client that is non-compliant in treatment, what is the nurse's first intervention?
Correct Answer Rationale: The first step in addressing non-compliance is understanding the underlying reasons for it. This can involve asking the client open-ended questions to explore their concerns, barriers to treatment, or any misconceptions they may have.
Question 26
A client with substance use disorder is enrolled in an outpatient treatment program and is struggling with consistent attendance. What is the nurse's most appropriate action?
Correct Answer Rationale: The nurse's first action should be to explore the reasons behind the client's difficulty with attendance. This could involve addressing practical, emotional, or logistical barriers that may prevent participation.
Question 27
The nurse is working with a client who has been in a long-term residential treatment program for substance use disorder. The client is preparing to transition to an outpatient program. What is the nurse's most important role in this transition?
Correct Answer Rationale: The nurse's most important role in the transition to outpatient care is ensuring that the client has a strong support system and access to community resources. These resources are essential to maintain progress after transitioning from a residential program.