A 16-year-old girl is being evaluated by the PMHNP for a chief complaint of anxiety. She worries about her friends who have started drinking, especially her female friends. She assures the PMHNP she has never used a psychoactive substance. Which of the following is an appropriate next step for the PMHNP?
Ask question 1 of the CRAFFT
Ask the client the CAGE questions
Give the client advice on what to say to her friends
Move on from substance use to the next issue
The Correct Answer is A
Choice A reason: The CRAFFT screening tool is specifically designed for adolescents and young adults to assess substance use and related risks. Asking question 1 — “Have you ever ridden in a Car driven by someone (including yourself) who was ‘high’ or had been using alcohol or drugs?” — is a developmentally appropriate and validated approach for this age group.
Choice B reason: The CAGE questionnaire is intended for adults and is less effective in identifying substance use issues in adolescents. It lacks the contextual sensitivity needed for youth screening.
Choice C reason: While offering advice may be helpful later, the priority is to assess the client’s own risk and exposure. Prematurely giving advice without screening may overlook important information.
Choice D reason: Moving on without screening would be inappropriate. Even if the client denies use, her concern about peers warrants further exploration using a validated tool like CRAFFT.
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Related Questions
Correct Answer is B
Explanation
Choice A reason: While PMP data may reveal patterns suggestive of inappropriate prescribing, its primary function is not to police prescribers but to support safe prescribing practices.
Choice B reason: The PMP allows prescribers to review controlled substance prescriptions linked to their patients and DEA numbers. It helps identify potential misuse, diversion, and overlapping prescriptions, supporting clinical decision-making and regulatory compliance.
Choice C reason: The PMP monitors prescribing across all licensed providers, not just nurse practitioners and physician assistants. This choice inaccurately limits its scope.
Choice D reason: The PMP tracks all controlled substance prescriptions, not just those for patients with substance use disorders. It is a broad surveillance and safety tool.
Correct Answer is D
Explanation
Choice A reason: The Department of Health and Human Services oversees public health programs and agencies but does not directly provide financial incentives for rare disease drug development.
Choice B reason: The National Organization for Rare Disorders advocates for patients and supports research, but it is not a legislative body and does not enact financial incentive programs.
Choice C reason: The Food and Drug Administration regulates drug approval and safety. While it administers the Orphan Drug Act, it is not the source of the legislation itself.
Choice D reason: The Orphan Drug Act, passed in 1983, provides financial incentives such as tax credits, grant funding, and market exclusivity to encourage pharmaceutical companies to develop treatments for rare diseases affecting fewer than 200,000 people in the U.S.
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