A 33-year-old male client scored 12 on the Alcohol Use Disorders Identification Test (AUDIT). What is the next step for the psychiatric-mental health nurse practitioner who administered the test?
No intervention is required.
Provide a brief intervention to reduce use.
Assess the need for detoxification.
Order a phosphatidylethanol (PEth) test.
The Correct Answer is B
Choice A reason: A score of 12 on the AUDIT indicates hazardous or harmful alcohol use. No intervention would be inappropriate and neglectful of the clinical implications of the score.
Choice B reason: A score between 8 and 15 on the AUDIT suggests hazardous drinking. The recommended next step is a brief intervention, which involves structured advice or counseling aimed at reducing alcohol consumption and preventing escalation.
Choice C reason: Detoxification assessment is appropriate for scores above 20 or when there are signs of physical dependence and withdrawal. A score of 12 does not automatically warrant detox evaluation.
Choice D reason: PEth testing is a biomarker for alcohol use but is not a standard follow-up for an AUDIT score of 12. It may be used in legal or forensic contexts but is not necessary in routine clinical practice at this stage.
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Correct Answer is C
Explanation
Choice A reason: Traumatic brain injury typically requires a history of head trauma, which is not mentioned in this case. While it can cause unresponsiveness, there is no evidence of injury or fall, making this diagnosis less likely.
Choice B reason: Seizures can cause sudden loss of consciousness, but they are usually followed by postictal confusion or convulsions, which are not described here. Additionally, there is no history of epilepsy or seizure-like activity.
Choice C reason: Alcohol intoxication is the most likely diagnosis given the context of fraternity involvement and sudden unresponsiveness. College initiation events often involve binge drinking, and even if the patient rarely drinks, peer pressure or hazing could lead to acute alcohol poisoning. This fits the clinical picture and social context.
Choice D reason: Cardiopulmonary arrest is a critical condition, but it is a consequence rather than a diagnosis. It could result from alcohol poisoning, but without evidence of cardiac or respiratory disease, it is not the primary diagnosis.
Correct Answer is A
Explanation
Choice A reason: This response reflects a core principle of motivational interviewing—expressing empathy and highlighting ambivalence. It validates the client’s conflicting feelings and opens the door for deeper exploration of values and goals, which can enhance motivation for change.
Choice B reason: This response is confrontational and may provoke defensiveness. Motivational interviewing avoids judgment and instead fosters collaboration and self-reflection.
Choice C reason: This statement is shaming and accusatory. It undermines the supportive tone of motivational interviewing and may damage rapport, reducing the likelihood of behavior change.
Choice D reason: While honesty is important, this directive approach lacks the client-centered spirit of motivational interviewing. It imposes a solution rather than guiding the client to discover their own motivation.
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