A 43-year-old married man is admitted to an inpatient hospital for acute hepatitis. The PMHNP is consulted for a psychiatric evaluation after he admits to a long history of alcohol use beginning in college. He has gradually increased his nightly alcohol intake from a single 6-pack of beer to two 12-packs of beer, and his drinking has caused him to oversleep and miss work on occasion. He has had his wife phone in sick for him from time to time. He has tried to cut down on his drinking with little success. He admits he does have tremors and becomes anxious when he doesn't drink. Which diagnosis appears to be appropriate for this patient, based on this information?
Alcohol dependence
Alcohol use disorder, mild
Alcohol use disorder, moderate
Alcohol use disorder, severe
The Correct Answer is D
Choice A reason: "Alcohol dependence" is an outdated term replaced by "alcohol use disorder" in DSM-5. While it reflects chronic use, it lacks the diagnostic precision of the current classification.
Choice B reason: Mild alcohol use disorder involves 2–3 DSM-5 criteria. This patient meets significantly more: tolerance, withdrawal, unsuccessful attempts to cut down, continued use despite problems, and interference with responsibilities.
Choice C reason: Moderate alcohol use disorder involves 4–5 criteria. This patient exceeds that threshold, indicating a more severe pattern.
Choice D reason: Severe alcohol use disorder is diagnosed when 6 or more DSM-5 criteria are met. This patient demonstrates tolerance, withdrawal, impaired control, neglect of responsibilities, continued use despite harm, and deception (having his wife call in sick), meeting the criteria for severe classification.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Clinical guidelines from organizations such as the CDC and American College of Physicians recommend nonpharmacologic therapies (e.g., physical therapy, exercise, cognitive behavioral therapy) as first-line treatments for chronic low back pain. This response aligns with evidence-based practice and promotes safer, more sustainable pain management.
Choice B reason: While technically accurate, this response lacks the emphasis on guideline-based care and may imply that opioids are a likely next step. It does not promote the preferred initial approach.
Choice C reason: This statement may be factually incorrect depending on the PMHNP’s scope of practice and state regulations. It also avoids addressing the clinical appropriateness of opioids.
Choice D reason: Although screening for addiction is important, this response implies that opioids are a viable option pending screening, which may not be appropriate as a first-line treatment. It also lacks the broader context of guideline-based care.
Correct Answer is B
Explanation
Choice A reason: While 12-step facilitation and meditation can support recovery, they are not considered the primary evidence-based tools for relapse prevention. Meditation may help with stress management, but it lacks the structured approach needed to address triggers and cognitive distortions.
Choice B reason: Addiction counseling and medication-assisted therapy (MAT) are the two most validated and widely used tools for relapse prevention. Counseling provides behavioral strategies, coping mechanisms, and emotional support, while MAT addresses physiological cravings and withdrawal symptoms through medications like buprenorphine, methadone, or naltrexone.
Choice C reason: Cognitive behavioral therapy is a core component of relapse prevention, but pairing it with mind-body relaxation alone does not encompass the full scope of treatment. Relaxation techniques are supportive but not primary.
Choice D reason: Family therapy and yoga may enhance recovery by improving relationships and reducing stress, but they are adjunctive rather than primary tools. They do not directly target the mechanisms of relapse.
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