The PMHNP is working at an outpatient substance use facility clinic that provides treatment with buprenorphine. Which of the following is the clinic most likely to use in its policies and procedures prior to the induction of buprenorphine?
CDT
PHQ9
CIWA-AR
COWS
The Correct Answer is D
Choice A reason: CDT (Carbohydrate-Deficient Transferrin) is a biomarker used to detect chronic alcohol consumption. It is not relevant to opioid withdrawal or buprenorphine induction.
Choice B reason: PHQ-9 is a depression screening tool. While useful in behavioral health settings, it does not assess opioid withdrawal symptoms and is not used for buprenorphine induction.
Choice C reason: CIWA-AR (Clinical Institute Withdrawal Assessment for Alcohol, Revised) is used to assess alcohol withdrawal severity. It is not appropriate for evaluating opioid withdrawal.
Choice D reason: COWS (Clinical Opiate Withdrawal Scale) is the standard tool used to assess the severity of opioid withdrawal. It helps determine the appropriate timing for buprenorphine induction to avoid precipitated withdrawal. It is widely used in substance use treatment protocols.
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Correct Answer is C
Explanation
Choice A reason: The CAGE questionnaire is designed for adults and lacks sensitivity for adolescent substance use patterns. It does not address the social and behavioral context relevant to youth.
Choice B reason: The AUDIT is a validated tool for identifying alcohol use disorders but is more appropriate for adults. While it can be adapted for adolescents, CRAFFT is preferred due to its developmental appropriateness.
Choice C reason: The CRAFFT screening tool is specifically developed for adolescents and young adults. It assesses both substance use and associated risky behaviors, making it ideal for this scenario. It is brief, easy to administer, and validated for use in pediatric populations.
Choice D reason: The CIWA-AR is used to assess alcohol withdrawal severity in individuals already diagnosed with alcohol dependence. It is not a screening tool and is inappropriate for initial assessment in adolescents.
Correct Answer is A
Explanation
Choice A reason: When a patient makes a credible threat of serious harm to an identifiable individual, the PMHNP has a duty to warn and protect. This includes notifying law enforcement to prevent potential violence. This action is supported by legal precedents such as the Tarasoff ruling and aligns with ethical obligations to protect third parties.
Choice B reason: While warning the potential victim may seem appropriate, it is not the most secure or legally sound method. Law enforcement is better equipped to assess and manage threats, and direct contact with the victim may pose risks or violate procedural safeguards.
Choice C reason: Indirectly warning the victim through a third party is unreliable and may delay intervention. It also risks breaching confidentiality without ensuring the threat is properly addressed.
Choice D reason: Doing nothing in the face of a credible threat violates both ethical and legal responsibilities. Confidentiality has limits, especially when public safety is at risk.
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