NRSADVN RN PRACTICE IN PRIMARY CARE & SUBSTANCE USE DISORDER EXAM Q & A 2024, Exams of Nursing

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NRSADVN

RN Practice In Primary

Care & Substance Use

Disorder

Q & A w/ Rationales

1. A 45-year-old male patient presents to the primary care clinic with complaints of fatigue, weight loss, and frequent urination. He has a history of hypertension and smoking. The nurse suspects that he may have diabetes mellitus. Which of the following tests would be most appropriate to confirm the diagnosis? a) Fasting plasma glucose b) Oral glucose tolerance test c) Glycated hemoglobin (A1C) d) Random blood glucose Answer: c) Glycated hemoglobin (A1C) Rationale: A1C is a measure of the average blood glucose level over the past 2 to 3 months. It is a reliable indicator of diabetes mellitus and does not require fasting or oral glucose ingestion. A1C levels of 6.5% or higher indicate diabetes mellitus. Fasting plasma glucose, oral glucose tolerance test, and random blood glucose are also used to diagnose diabetes mellitus, but they are less accurate and more affected by factors such as food intake, stress, and medication.
2. A 25-year-old female patient visits the primary care clinic for a routine check-up. She reports that she has been using heroin for the past year and wants to quit. She has tried to stop several times but experienced withdrawal symptoms such as nausea, vomiting, diarrhea, muscle aches, and anxiety. She asks the nurse what treatment options are available for her. Which of the following

visits to a specialized clinic for administration. Naltrexone is another MAT for opioid use disorder, but it requires complete detoxification from opioids before initiation. It also has low adherence rates and may not be effective for patients with high cravings or severe dependence. Counseling and behavioral therapy are important components of opioid use disorder treatment, but they may not be sufficient without pharmacological intervention.

3. A 35-year-old male patient comes to the primary care clinic with complaints of chest pain, shortness of breath, palpitations, and sweating. He says that he has been experiencing these symptoms for the past month, especially when he is at work or in social situations. He denies any history of cardiac or respiratory problems. He admits that he has been feeling stressed, anxious, and depressed lately due to personal and professional issues. He also reveals that he has been drinking alcohol daily to cope with his emotions. The nurse suspects that he may have an anxiety disorder and alcohol use disorder. Which of the following actions by the nurse is most appropriate? a) Perform a physical examination and order an electrocardiogram (ECG) to rule out any cardiac causes of his symptoms. b) Ask him about his alcohol consumption patterns, frequency, quantity, and consequences using the CAGE questionnaire. c) Screen him for anxiety disorder using a validated tool such as the Generalized Anxiety Disorder 7-item (GAD-7) scale or the Hamilton Anxiety Rating Scale (HAM-A).

d) All of the above. Answer: d) All of the above. Rationale: The nurse should perform a comprehensive assessment of the patient's physical, mental, and substance use status. Chest pain, shortness of breath, palpitations, and sweating can be signs of a cardiac condition such as angina or myocardial infarction, or a respiratory condition such as asthma or pulmonary embolism. Therefore, the nurse should perform a physical examination and order an ECG to rule out any organic causes of his symptoms. The nurse should also screen him for alcohol use disorder using the CAGE questionnaire, which consists of four questions: Have you ever felt you should Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye- opener)? A positive response to two or more questions indicates a possible alcohol use disorder. The nurse should also screen him for anxiety disorder using a validated tool such as the GAD-7 scale or the HAM-A scale. The GAD- 7 scale consists of seven questions that ask how often the patient has been bothered by various symptoms of anxiety in the past two weeks. The total score ranges from 0 to 21, with higher scores indicating more severe anxiety. A score of 10 or more suggests a possible diagnosis of generalized anxiety disorder. The HAM-A scale consists of 14 items that rate the severity of different aspects of anxiety such as anxious mood, tension, fears, insomnia, somatic complaints, and behavior. The total score ranges from 0 to

diabetes mellitus, hypertension, and hyperlipidemia with her medication regimen and lifestyle modifications. However, she should not stop taking any of her medications without consulting her health care provider. Stopping metformin could lead to an increase in her blood glucose levels and increase her risk of complications such as retinopathy, nephropathy, neuropathy, and cardiovascular disease. Stopping lisinopril could lead to an increase in her blood pressure and increase her risk of stroke, heart attack, heart failure, and kidney damage. Stopping atorvastatin could lead to an increase in her LDL cholesterol and increase her risk of atherosclerosis, coronary artery disease, and peripheral artery disease. Therefore, the nurse should advise the patient to continue taking all her medications as prescribed to maintain her health outcomes and prevent any adverse events. B:

1. Which intervention is essential for a registered nurse (RN) practicing in primary care when caring for a patient with substance use disorder (SUD)? a) Providing comprehensive physical examinations b) Administering medications to manage withdrawal symptoms c) Promoting harm reduction strategies d) Conducting group therapy sessions

Answer: c) Promoting harm reduction strategies Rationale: In primary care settings, an RN's role includes promoting harm reduction strategies for patients with SUD. This approach focuses on minimizing the negative consequences associated with substance use, emphasizing safety, and encouraging safer substance use practices.

2. Which assessment finding should be of utmost concern to the RN practicing in primary care when conducting a physical examination for a patient with substance use disorder? a) Elevated blood pressure and heart rate b) Jaundiced sclera and skin c) Needle track marks on the upper extremities d) Profound anxiety and restlessness Answer: a) Elevated blood pressure and heart rate Rationale: Elevated blood pressure and heart rate can indicate cardiovascular strain caused by substance use or withdrawal. It is a critical finding that requires immediate attention to prevent potentially life-threatening complications.
3. According to best practice guidelines, which medication should an RN anticipate administering to a patient with opioid use disorder seeking assistance in primary care? a) Diazepam (Valium) b) Naltrexone (Vivitrol) c) Methadone (Dolophine) d) Acamprosate (Campral)

Rationale: Motivational interviewing is a patient-centered approach that focuses on enhancing intrinsic motivation to change behavior. It is particularly effective in primary care settings, as it respects a patient's autonomy and readiness to change.

6. How can an RN best support a patient with substance use disorder in a primary care setting to access resources for social and financial support? a) Provide direct financial assistance to the patient b) Refer the patient to community organizations offering support services c) Negotiate with the patient's employer for continued employment d) Assist the patient in securing a stable housing arrangement Answer: b) Refer the patient to community organizations offering support services Rationale: While an RN can provide resources and information, it is beyond their scope to directly provide financial assistance, negotiate employment arrangements, or secure housing. Referring the patient to community organizations that specialize in offering support services ensures their access to comprehensive social and financial support.
7. When providing education to a patient's family regarding their loved one's substance use disorder in a primary care setting, the RN should emphasize:

a) Enabling behaviors can worsen the condition b) Impose strict rules and consequences for relapses c) Publicly shame and stigmatize the patient's behavior d) Withdrawing emotional support as a form of punishment Answer: a) Enabling behaviors can worsen the condition Rationale: By emphasizing that enabling behaviors can worsen the patient's condition, the RN educates the family on the importance of avoiding behaviors that inadvertently support the addiction cycle. Encouraging healthy boundaries and seeking appropriate support are positive strategies for family members.

8. Which statement about alcohol withdrawal syndrome (AWS) is accurate for an RN practicing in primary care? a) AWS is a life-threatening emergency that necessitates immediate hospitalization b) AWS typically presents with mild-to-moderate withdrawal symptoms c) Benzodiazepines are not recommended in managing AWS d) Genuine seizures rarely occur during AWS Answer: b) AWS typically presents with mild-to-moderate withdrawal symptoms Rationale: While AWS can range from mild to severe, in most cases encountered in primary care settings, patients often exhibit mild-to-moderate withdrawal symptoms. Severe withdrawal symptoms may require immediate hospitalization.

11. Which nursing intervention is critical for the RN to implement during the management of opioid withdrawal in a primary care setting? a) Administer naloxone (Narcan) intranasally b) Provide patient education regarding naloxone administration c) Administer buprenorphine-naloxone (Suboxone) sublingually d) Initiate a comprehensive physical therapy program Answer: c) Administer buprenorphine-naloxone (Suboxone) sublingually Rationale: The administration of buprenorphine-naloxone is a recognized evidence-based intervention for the management of opioid withdrawal. It helps alleviate symptoms and reduce the risk of relapse.
12. Which is the most suitable nursing action when encountering a patient with substance use disorder disclosing suicidal ideation in a primary care setting? a) Call the emergency crisis hotline on behalf of the patient b) Immediately initiate the Baker Act or similar legal policies c) Assess for immediate danger and implement appropriate suicide prevention measures d) Encourage the patient to discuss their feelings openly with family and friends Answer: c) Assess for immediate danger and implement appropriate suicide prevention measures

Rationale: Safety is the priority when a patient discloses suicidal ideation. The RN must assess for immediate danger, implement appropriate suicide prevention measures (e.g., safety planning, involving crisis intervention resources), and establish ongoing support for the patient.

13. Which pharmacological intervention should the RN anticipate implementing for a patient experiencing alcohol withdrawal syndrome (AWS) in a primary care setting? a) Prescribing chlordiazepoxide (Librium) b) Administering naltrexone (Vivitrol) intramuscularly c) Initiating a course of disulfiram (Antabuse) d) Administering bupropion (Wellbutrin) Answer: a) Prescribing chlordiazepoxide (Librium) Rationale: Chlordiazepoxide is often prescribed for AWS to help manage withdrawal symptoms and prevent severe complications such as seizures and delirium tremens.
14. What is the primary goal of an RN providing primary care to patients with substance use disorder? a) Complete detoxification from all substances b) Reduce the risk of harm associated with substance use c) Achieve immediate abstinence from all substances d) Prevent the onset of substance use disorder in vulnerable populations Answer: b) Reduce the risk of harm associated with substance use Rationale: The primary goal of an RN providing primary

C:

Question 1: Which of the following is a characteristic of substance use disorder? A) A pattern of use that leads to impairment or distress B) Occasional use without negative consequences C) Controlled use without escalation D) Social use without impact on daily functioning Answer: A) A pattern of use that leads to impairment or distress Rationale: Substance use disorder is characterized by a pattern of use that results in impairment or distress, indicating the presence of a significant problem with substance use. Question 2: What is the primary goal of nursing care for individuals with substance use disorder in a primary care setting? A) Enabling continued substance use in a controlled manner B) Providing harm reduction strategies C) Facilitating complete abstinence from substances D) Minimizing the impact of substance use on daily life Answer: C) Facilitating complete abstinence from substances

Rationale: In a primary care setting, the primary goal of nursing care for individuals with substance use disorder is to facilitate complete abstinence from substances, promoting long-term recovery and improved health outcomes. Question 3: Which screening tool is commonly used by primary care providers to assess for substance use disorder? A) CAGE questionnaire B) PHQ- 9 C) Modified Checklist for Autism in Toddlers (M- CHAT) D) Geriatric Depression Scale (GDS) Answer: A) CAGE questionnaire Rationale: The CAGE questionnaire is a widely used screening tool in primary care settings to assess for potential issues related to alcohol use disorder. Question 4: What is the first-line pharmacotherapy for individuals with opioid use disorder in primary care? A) Naltrexone B) Methadone C) Buprenorphine D) Disulfiram Answer: C) Buprenorphine

members Rationale: Nurses play a crucial role in collaborating with interdisciplinary team members to provide comprehensive care for individuals with substance use disorder in a primary care setting. Question 7: Which approach is recommended for addressing substance use disorder in primary care? A) Stigmatizing individuals with the disorder B) Implementing a non-judgmental and empathetic approach C) Encouraging isolation and social withdrawal D) Minimizing the importance of family involvement Answer: B) Implementing a non-judgmental and empathetic approach Rationale: A non-judgmental and empathetic approach is recommended for addressing substance use disorder in primary care, fostering trust and promoting engagement in treatment. Question 8: What is the prevalence of co-occurring mental health disorders among individuals with substance use disorder in primary care? A) Approximately 10% B) Approximately 25% C) Approximately 50% D) Approximately 75%

Answer: C) Approximately 50% Rationale: Co-occurring mental health disorders are prevalent among individuals with substance use disorder in primary care, with approximately 50% of individuals experiencing such comorbidities. Question 9: Which nursing intervention is essential in the management of alcohol withdrawal in a primary care setting? A) Administering benzodiazepines as needed B) Encouraging continued alcohol consumption C) Limiting access to supportive resources D) Disregarding potential withdrawal symptoms Answer: A) Administering benzodiazepines as needed Rationale: Administering benzodiazepines as needed is an essential nursing intervention in the management of alcohol withdrawal, aiming to prevent severe withdrawal symptoms and complications. Question 10: What is the recommended frequency for monitoring individuals receiving pharmacotherapy for substance use disorder in a primary care setting? A) Weekly B) Monthly C) Quarterly D) Annually