A nurse is caring for an adult client diagnosed with an anxiety disorder. Which intervention(s) would be appropriate for the nurse to implement for the client? (Select all that apply)

Choice A reason: Asking other nurses whether they have noticed anything unusual before taking official action is an informal peer consultation that does not constitute an appropriate or sufficient response to a potential case of healthcare worker substance diversion. While collegial communication may occur naturally, it should not precede or replace formal reporting to the appropriate authority. Diversion of controlled substances such as diazepam — a Schedule IV benzodiazepine — by a healthcare worker is a serious legal, ethical, and patient safety issue that mandates formal reporting. Relying on informal peer inquiry delays the formal investigation process and may compromise evidence integrity and patient safety.

Choice B reason: Directly and accusatorially confronting the nurse by stating "I know you've been stealing diazepam" is inappropriate for multiple reasons. This approach is presumptuous, as it assumes guilt without formal investigation, and constitutes a personal confrontation that could escalate conflict, prompt denial, or create a hostile work environment. Healthcare workers suspected of substance diversion deserve due process and formal evaluation, and confrontational accusations without evidence of a formal finding are both professionally inappropriate and legally problematic. The role of the observing nurse is to report observations to management, not to conduct an independent investigation or make accusations.

Choice C reason: Independently observing the nurse while injections are prepared and administered, without formal authorization, constitutes surveillance of a colleague that exceeds the scope of an individual nurse's professional role and may compromise the integrity of a formal institutional investigation. While clinical observation of practice patterns is part of peer oversight in some quality improvement frameworks, conducting informal surveillance of a suspected substance-diverting colleague without managerial direction is outside the bounds of appropriate professional conduct. This action should only be undertaken as part of a formally authorized investigation initiated and directed by nursing management and administration.

Choice D reason: Calling the manager and formally reporting the observed clinical anomalies — including the pattern of diazepam injections being ineffective when administered by a specific nurse, and the nurse returning from lunch with slurred speech and euphoria suggesting benzodiazepine intoxication — is the most appropriate and professionally responsible action. This response activates the formal institutional reporting and investigation process, protects patient safety by removing a potentially impaired healthcare worker from clinical duties, ensures compliance with regulatory obligations regarding controlled substance diversion, and initiates the chain of accountability necessary for appropriate legal, disciplinary, and supportive intervention. This action is consistent with professional nursing ethics codes and the standards of practice for reporting impaired colleagues.

Choice A reason: Returning to college to complete a degree in nursing represents a positive, goal-directed, and achievement-oriented behavior that reflects resilience and adaptive coping. While children of alcoholics (COAs) may demonstrate a range of outcomes, pursuing higher education and professional development is not a behavior that is specifically correlated with adverse childhood experiences in households affected by alcohol use disorder. Rather, it suggests successful channeling of personal resources and is more consistent with outcomes seen in individuals who have developed effective coping mechanisms, potentially through therapeutic intervention or social support networks.

Choice B reason: Having several trusting relationships with friends reflects healthy interpersonal functioning and emotional security, which is actually the opposite of what is typically observed in adult children of alcoholics (ACOAs). Research in the field of addictology and family systems theory identifies significant difficulties with trust as one of the most prominent and persistent psychological sequelae of growing up in an alcoholic household. Children raised in environments of parental alcoholism frequently develop pervasive mistrust, fear of vulnerability, and difficulty forming stable, close, and trusting relationships. Several trusting friendships therefore do not correlate with this home life.

Choice C reason: Drinking alcohol to excess 3 days per week is a behavior strongly correlated with being raised in an alcoholic household. Children of alcoholics are at significantly elevated genetic and environmental risk for developing alcohol use disorder themselves, as demonstrated by family, twin, and adoption studies indicating a heritability of approximately 40 to 60% for alcohol use disorder. Environmental modeling of excessive alcohol consumption as a coping mechanism, normalization of heavy drinking, and lack of healthy emotional regulation strategies all contribute to increased risk. This behavior directly reflects the known psychosocial sequelae of growing up in an alcoholic home.

Choice D reason: Holding on to bad relationships due to fear of being alone is a classic psychosocial correlate of adult children of alcoholics. Growing up in a chaotic, emotionally unpredictable household with alcoholic parents typically results in insecure attachment styles, low self-esteem, difficulty tolerating aloneness, and a learned pattern of tolerating dysfunction in relationships. The fear of abandonment and compulsive need to maintain relationships regardless of their quality reflects the emotional deprivation and relational instability experienced in childhood and is widely recognized in the ACOA literature as a defining behavioral pattern.

Choice E reason: Multiple divorces accompanied by tumultuous spousal relationships are also consistent with the long-term relational and psychosocial consequences of growing up in an alcoholic home. Adult children of alcoholics frequently exhibit impaired interpersonal functioning characterized by poor communication skills, emotional dysregulation, difficulty with conflict resolution, and selection of partners who replicate familiar but dysfunctional relational dynamics. The high rate of marital instability in this population is supported by epidemiological research and clinical observations, reflecting the lasting impact of early-life exposure to disordered family systems on adult relational health.