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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: The PHQ-9 is a depression screening tool that includes one item on suicidal ideation. While useful for identifying depression and some suicide risk, it is not designed to assess comprehensive suicide risk, especially in individuals with borderline personality disorder.
Choice B reason: The SBQ-R is specifically designed to assess suicide risk. It evaluates lifetime suicidal ideation and attempts, frequency of ideation, threat of suicide, and self-reported likelihood of future suicidal behavior. It is validated for use in both clinical and non-clinical populations and is particularly useful in assessing risk in individuals with borderline personality disorder.
Choice C reason: The ACSS-FAD measures fearlessness about death, which is a component of the interpersonal theory of suicide. While it provides insight into one aspect of suicide risk, it does not assess overall risk or history of suicidal behavior.
Choice D reason: The INQ assesses perceived burdensomeness and thwarted belongingness, which are psychological states associated with suicide risk. However, it does not directly evaluate suicidal behavior or intent, making it less comprehensive than the SBQ-R.
Correct Answer is C
Explanation
Choice A reason: Creutzfeldt-Jacob disease is a rare neurodegenerative disorder caused by prion proteins. It presents with rapidly progressive dementia, myoclonus, and motor dysfunction, but does not typically include the classic triad of Wernicke’s encephalopathy.
Choice B reason: Lewy body dementia is characterized by fluctuating cognition, visual hallucinations, and parkinsonian features. While it may include motor and cognitive symptoms, it does not typically present with the acute ocular and vestibular signs seen in Wernicke’s encephalopathy.
Choice C reason: Wernicke’s encephalopathy is a neurologic emergency caused by thiamine deficiency, often due to chronic alcohol abuse. The classic triad includes ophthalmoplegia (e.g., nystagmus), ataxia, and confusion. The patient’s history and symptoms strongly support this diagnosis.
Choice D reason: Delirium is an acute disturbance in attention and cognition, often reversible and multifactorial. While it may coexist with Wernicke’s encephalopathy, it does not explain the specific ocular and vestibular findings.
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