Chapter 42: Caring for Persons with Co-occurring Mental Disorders

Format: Multiple Choice

Client Needs: Psychosocial Integrity

Cognitive Level: Analyze

Integrated Process: Nursing

Objective: 1

Page and Header: 820, Introduction/Key Concept

1. A client diagnosed with major depression visits the mental health clinic and tells the nurse, “I’ve recently started using marijuana quite frequently.” The nurse determines that the manifestation of the client’s co-occurring disorder reflects which diagnosis?

A) Primary mental illness with subsequent substance use

B) Primary substance abuse disorder with psychopathologic sequelae

C) Dual primary diagnoses

D) A common etiology

Page and Header: 823, Health Issues

2. The nurse preparing a presentation for a group of mental health care providers on the topic of co-occurring disorders plans to include information about health care providers and their response to these clients. Which information 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) Providers commonly underdiagnose personality disorders in those who take illicit substances.

C) Providers commonly ignore the existence of concurrent mental health disorders.

D) Providers have difficulty determining which problem is in most immediate need.

Page and Header: 827, Mood Disorders and Substance Use

3. The nurse is caring for an adolescent client diagnosed with depression and substance abuse. Which action would be most appropriate for the nurse to take?

A) Determine if the client is experiencing hyperactivity.

B) Ask if the client is having thoughts of self-harm.

C) Determine if the client is exhibiting Wernicke’s syndrome.

D) Ask if the client has had problems with excessive anxiety.

Page and Header: 19, Psychotic Disorders and Substance Use

4. A client diagnosed 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. Which topic is a priority?

A) Poor social skills

B) Lack of vocational skills

C) Medication nonadherence

D) Dysfunctional family systems

Page and Header: 821, Clinical Course and Relapse; 820, Key concept

5. A nurse is providing education on the “relapse cycle” to a group of hospitalized clients who have co-occurring disorders involving cognitive disorders and alcoholism. Which statement would the nurse most likely include during this teaching session?

A) “After you are discharged, there is a tendency to use alcohol rather than your prescribed medications to self-medicate your psychiatric symptoms. This allows your psychiatric symptoms to surface again, and they, in turn, lead to rehospitalization. Your symptoms are again controlled with medications until you are discharged, and the cycle starts all over again.”

B) “Your alcoholism causes you to hallucinate, and you need to take prescribed medications to control the hallucinations. When you try to stop drinking and stay abstinent, your hallucinations disappear; consequently, you stop taking your prescribed medications because they’re gone. Then you celebrate with alcohol, and this triggers a relapse; the alcoholism causes hallucinations, and the whole thing starts over again.”

C) “Your dependence on alcohol and your psychiatric illness are unrelated. Experiencing disturbing thoughts does not cause alcoholism, and alcoholism does not cause your disturbing thoughts. It all boils down to medication compliance.”

D) “The cycle is triggered by repeated attempts to stop drinking. Without the levels of alcohol your system has come to tolerate, you begin to develop psychiatric symptoms. Then you have to be hospitalized and treated for your psychosis again. Everything is fine until the next time you try to stop drinking, and then the cycle repeats itself.”

Page and Header: 822, Nature of Co-occurring Disorders

6. A nurse is interviewing a client who has a co-occurring diagnosis of substance use disorder and bipolar disorder. The client is trying to explain why it is so easy to start drinking again, even though hospitalization and prescribed medications can eventually “control” the 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.”

Page and Header: 11, Stages of Interdisciplinary Treatment

7. A nurse is working as part of an interdisciplinary treatment team for a client diagnosed with a mental illness and substance use disorder. As part of the recovery process, which action 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, in order to promote trust in the client and have the client buy into the treatment process.

Page and Header: 830, Crisis Stabilization

8. A client with a co-occurring diagnosis of alcoholism and bipolar disorder was brought to the emergency department by two policemen for disorderly conduct. The client is intrusive and verbose about having diplomatic immunity and has a pressing need to tour the area to promote a bid for the presidency. The client has had multiple admissions to the hospital’s psychiatric unit, and has almost always experienced alcohol withdrawal syndrome immediately after previous admissions. Which action is priority for this client?

A) Administer prescribed mood-stabilizing medications to control delusional thinking, since doing so will curtail the desire to drink.

B) Take baseline vital signs and then monitoring them on an ongoing basis to ascertain if the client is exhibiting early signs of alcohol withdrawal syndrome.

C) Suggest that the client refrain from being intrusive and annoying others with constant chatter about delusional thinking.

D) Refer the client to an outpatient community substance abuse treatment center, because the addiction has to be adequately addressed before bipolar problems can be effectively treated.

Page and Header: 19, Psychotic Disorders and Substance Use

9. The parents of a client diagnosed with schizophrenia and alcohol use disorder asks the nurse, “What can we do to help our child from relapsing after discharge from the hospital?” Which response by the nurse would be most appropriate?

A) “There’s really not much you can do; your child is responsible for maintaining sobriety.”

B) “Avoid letting your child take any mood-altering chemicals because they may trigger delusional thinking.”

C) “Make sure your child attends at least two Alcoholics Anonymous meetings a week, gets a sponsor, and calls the sponsor on a daily basis.”

D) “Report any medication side effects so they can be treated, and therefore won’t tempt your child to stop taking the prescribed medications.”

Page and Header: 821, Clinical Course and Relapse

10. A nurse is readmitting a client diagnosed with co-occurring diagnoses of schizophrenia and alcohol use disorder 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 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?”

Page and Header: 828, Personality Disorders and Substance Use

11. A group of nursing students is reviewing information about co-occurring disorders and risks for substance use disorder. The students demonstrate understanding of the information when they identify which psychiatric disorder as being associated with the highest risk for substance use?

A) Mania

B) Panic disorder

C) Antisocial personality disorder

D) Phobias

Page and Header: 821, Clinical Course and Relapse

12. When describing the relapse cycle to a group of families of clients experiencing co-occurring disorders, which step would the nurse identify as occurring first?

A) Hospitalization

B) Decompensation

C) Stabilization

D) Discharge

Page and Header: 830, Early Stages of Recovery from Substance Use

13. A nurse is working with a client diagnosed with co-occurring disorders who is in the early stages of recovery. The client has abstained from alcohol for the past three weeks. During a follow-up visit, the nurse is educating the client on the effects of alcohol on the body. Which factor 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, which hinders the ability to learn new things.

D) The underlying effects of the substance abuse will prevent the client from being able to learn.

Page and Header: 830, Crisis Stabilization

14. A client diagnosed with co-occurring disorders of schizophrenia and substance use disorder is admitted for treatment. Which implementation 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

Page and Header: 821, Clinical Course and Relapse

15. The nurse is interviewing a client diagnosed with bipolar disorder who is recovering from another episode of acute alcohol withdrawal. Which client statement will alert the nurse to obtain additional information during the interview?

A) “I don’t even like drinking, but when I drink, I can make friends, and I need people in my life.”

B) “I cannot believe that I kept buying drinks for strangers just so I could get high and party.”

C) “I was so sick, but I am happy that I didn’t get really bad and have hallucinations like last time.”

D) “I drink when I get in a manic phase because I can use alcohol to cover my outrageous behavior.”

Page and Header: 829, Patient Education

16. What setting is most supportive of patient education for a young adult with co-occurring disorders (COD)?

A) Individual sessions

B) Family sessions

C) Group sessions

D) Skills sessions

Page and Header: 822, Nature of Co-occurring Disorders

17. In a group session, the clients are discussing their belief that having a few drinks of alcohol worked better to manage their symptoms of depression than the medications prescribed by health care practitioners. What is the best statement about medication that the nurse can introduce to the group members for further discussion?

A) “Both the medications and the alcohol can affect one’s thoughts and feelings.”

B) “Medication is used to manage an illness; alcohol sets a person up for addiction.”

C) “Think about what makes life worse: the medications prescribed or use of alcohol.”

D) “Often alcohol and medication do the same thing, only medication does it safely.”

Page and Header: 822, Staff Attitudes

18. Which behaviors associated with addiction are barriers to effective nurse–patient relationships? Select all that apply.

A) Denial

B) Neediness

C) Nonadherence

D) Manipulation

E) Cognitive impairment

Page and Header: 830, Crisis Stabilization; 831, Recovery

19. A nurse is working with a client diagnosed with depression and substance use disorder on ways to promote recovery. Which factor would be most important for the nurse to include in the discussion? Select all that apply.

A) A positive social network

B) Compliance to treatment

C) Avoidance of hospitalization

D) Supportive housing

E) Community vocational rehabilitation

Page and Header: 825, Relapse Prevention

20. The treatment team has been working with a young client diagnosed with bipolar disorder and polysubstance use that includes cocaine. In preparing to review and revise the client’s plan of care, what significant information needs to be evaluated in order to update the client’s present treatment? Select all that apply.

A) Memory loss

B) Family problems

C) Medical illnesses

D) Financial difficulties

E) Recent hospitalizations