Challenges in Substance Use Management
5. A patient who has been drinking a six-pack of beer each night to relax
after work has been having trouble staying asleep through the night.
When she wakes up at 2 a.m. she takes diphenhydramine 25 mg to
help her fall back asleep, but this makes her sleep through the alarm
clock and late for work. She also reports having a headache through
midmorning until she gets her second cup of coffee. She thinks this is
related to her alcohol use and has unsuccessfully tried to cut down
several times in the past year. Which of the following disorders best
describes this patient’s condition?
A. Alcohol use disorder
B. Withdrawal syndrome
C. Caffeine use disorder
D. Insomnia
Challenges in Substance Use Management
6. The physiological process in which structural changes occur in the brain,
increasing the likelihood of addiction over time and increasing the risk
of relapse after a period of sobriety, is called:
A. Cognitive restructuring
B. Neuroadaptation
C. Neurogenesis
D. Cerebral ischemia
7. The PMHNP is evaluating a 45-year-old man in the emergency
department; he has no past psychiatric history and presents with
passive suicidal ideations and emotional lability. Which of the
following tests is essential in helping formulate a preliminary
diagnosis and treatment plan?
A. 12-lead EKG
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B. Urine toxicology
C. Complete blood count
D. Liver profile
8. A 43-year-old man is requesting medication-assisted treatment for
addiction with Suboxone and wants to begin immediately to “get his
life back.” What should the PMHNP do first?
A. Assess his current level and history of use
B. Prescribe Suboxone 2 mg SL daily to start now
C. Provide psychoeducation regarding Suboxone maintenance
D. Refer the patient to an inpatient detox facility
9. Which of the following medications is preferred for a 21-year-old male
with a history of polysubstance use disorder and difficulty with
medication adherence?
A. Naltrexone 50 mg PO only when planning to use substances
B. Naltrexone 50 mg PO daily
C. Naltrexone 380 mg IM monthly
D. Methadone maintenance APA