CARN-AP Certification Exam Test Bank 2026/2027 –
Addictions Nursing Advanced Practice – Set A
Complete Practice Questions & Detailed Verified
Answers
SECTION 1: QUESTIONS 1–50
1. A client presents requesting treatment for opioid use disorder. Which assessment is the priority
before selecting treatment?
A. Favorite food
B. Current opioid use, last use, withdrawal status, overdose history, medical conditions,
medications, and treatment goals
C. Educational level only
D. Employment history only
Rationale: Comprehensive assessment determines diagnosis, immediate safety risks, withdrawal
status, treatment eligibility, medication selection, and individualized goals.
2. A client who regularly uses fentanyl reports that they have stopped using opioids and now
have severe diarrhea, muscle aches, yawning, sweating, anxiety, and abdominal cramping.
Which condition is most likely?
A. Opioid intoxication
B. Opioid withdrawal
C. Alcohol withdrawal
D. Stimulant intoxication
Rationale: Gastrointestinal distress, myalgias, autonomic symptoms, anxiety, and yawning are
characteristic opioid-withdrawal manifestations.
3. Which finding in a client with opioid intoxication requires immediate intervention?
A. Mild constipation
B. Pinpoint pupils
,C. Euphoria
D. Slow, shallow respirations with decreased responsiveness
Rationale: Respiratory depression is the life-threatening complication of opioid overdose and
requires immediate intervention.
4. A client is found unconscious with suspected opioid overdose. Which medication should the
nurse prepare to administer?
A. Disulfiram
B. Acamprosate
C. Naloxone
D. Varenicline
Rationale: Naloxone is an opioid antagonist used to rapidly reverse opioid-induced respiratory
depression.
5. A 38-year-old client reports escalating opioid use despite repeated attempts to stop. The client
has missed work, spends increasing amounts of time obtaining opioids, and continues using
despite recurrent overdose. Which diagnosis is most consistent with these findings?
A. Opioid intoxication
B. Opioid withdrawal
C. Opioid use disorder
D. Substance-induced psychotic disorder
Rationale: Persistent problematic opioid use associated with impaired control, functional
impairment, and continued use despite harm is characteristic of opioid use disorder.
6. Which neurotransmitter system is most directly associated with the reinforcing effects of many
addictive substances?
A. Acetylcholine only
B. Mesolimbic dopamine signaling
C. Histamine only
D. Melatonin
Rationale: The mesolimbic dopamine pathway plays an important role in reward, reinforcement,
salience, and addiction-related learning.
7. A client says, "I don't understand why I keep returning to cocaine even though I know it is
destroying my relationships." Which neurobiological concept best explains this behavior?
A. Complete absence of decision-making ability
B. Changes in reward, motivation, learning, and executive-control circuits
,C. Permanent destruction of all dopamine neurons
D. Lack of awareness of consequences
Rationale: Addiction involves neuroadaptations affecting reward, motivation, stress, learning,
and executive-control systems, which can contribute to compulsive substance use.
8. A client reports craving alcohol whenever passing a bar where they previously drank heavily.
Which mechanism best explains this phenomenon?
A. Acute intoxication
B. Conditioned cue reactivity
C. Medication tolerance
D. Respiratory depression
Rationale: Environmental cues previously paired with substance use can become conditioned
stimuli that trigger craving and increase relapse risk.
9. Which assessment finding most strongly supports a diagnosis of moderate or severe substance
use disorder?
A. One episode of recreational use
B. Continued use despite significant interpersonal, occupational, or medical consequences
C. Family disapproval alone
D. Occasional craving without impairment
Rationale: Continued substance use despite recurrent consequences is a core feature of
clinically significant substance use disorder.
10. After naloxone administration, a client becomes awake and agitated but begins developing
recurrent respiratory depression several minutes later. What is the nurse's priority action?
A. Discharge the client immediately
B. Continue monitoring and provide additional naloxone/supportive care as clinically
indicated
C. Administer disulfiram
D. Give alcohol
Rationale: Naloxone may have a shorter duration of action than some opioids, especially long-
acting opioids, so recurrent respiratory depression requires continued monitoring and possible
repeat dosing.
11. A client with opioid use disorder asks about medications that reduce mortality and improve
treatment retention. Which treatment is appropriate?
, A. Antipsychotic monotherapy
B. Medication treatment with methadone or buprenorphine when clinically appropriate
C. Benzodiazepine monotherapy
D. Disulfiram
Rationale: Methadone and buprenorphine are evidence-based medications for opioid use
disorder and are associated with improved treatment outcomes.
12. A client is taking buprenorphine and asks why it can treat opioid use disorder despite being
an opioid. Which explanation is best?
A. It has no opioid-receptor activity.
B. It is a partial mu-opioid receptor agonist that can reduce withdrawal and craving with a
ceiling effect on some opioid effects.
C. It permanently blocks all receptors.
D. It produces no physical dependence.
Rationale: Buprenorphine is a partial mu-opioid receptor agonist with high receptor affinity and
a ceiling effect that contributes to its safety profile.
13. A client who recently used fentanyl takes the first dose of buprenorphine and develops abrupt
severe withdrawal. What is the most likely explanation?
A. Serotonin syndrome
B. Precipitated opioid withdrawal
C. Alcohol withdrawal
D. Stimulant crash
Rationale: Buprenorphine's high receptor affinity can displace full opioid agonists and
precipitate withdrawal when initiated before sufficient spontaneous withdrawal has occurred.
14. A client taking methadone reports palpitations and syncope. Which concern should the
advanced practice nurse prioritize?
A. Mild constipation
B. QT-interval prolongation and potentially serious cardiac arrhythmia
C. Increased appetite
D. Dry skin
Rationale: Methadone can prolong the QT interval and increase the risk of torsades de pointes
in susceptible patients.
15. A client with opioid use disorder wants an opioid antagonist rather than an opioid agonist or
partial agonist. Which medication may be considered?
Addictions Nursing Advanced Practice – Set A
Complete Practice Questions & Detailed Verified
Answers
SECTION 1: QUESTIONS 1–50
1. A client presents requesting treatment for opioid use disorder. Which assessment is the priority
before selecting treatment?
A. Favorite food
B. Current opioid use, last use, withdrawal status, overdose history, medical conditions,
medications, and treatment goals
C. Educational level only
D. Employment history only
Rationale: Comprehensive assessment determines diagnosis, immediate safety risks, withdrawal
status, treatment eligibility, medication selection, and individualized goals.
2. A client who regularly uses fentanyl reports that they have stopped using opioids and now
have severe diarrhea, muscle aches, yawning, sweating, anxiety, and abdominal cramping.
Which condition is most likely?
A. Opioid intoxication
B. Opioid withdrawal
C. Alcohol withdrawal
D. Stimulant intoxication
Rationale: Gastrointestinal distress, myalgias, autonomic symptoms, anxiety, and yawning are
characteristic opioid-withdrawal manifestations.
3. Which finding in a client with opioid intoxication requires immediate intervention?
A. Mild constipation
B. Pinpoint pupils
,C. Euphoria
D. Slow, shallow respirations with decreased responsiveness
Rationale: Respiratory depression is the life-threatening complication of opioid overdose and
requires immediate intervention.
4. A client is found unconscious with suspected opioid overdose. Which medication should the
nurse prepare to administer?
A. Disulfiram
B. Acamprosate
C. Naloxone
D. Varenicline
Rationale: Naloxone is an opioid antagonist used to rapidly reverse opioid-induced respiratory
depression.
5. A 38-year-old client reports escalating opioid use despite repeated attempts to stop. The client
has missed work, spends increasing amounts of time obtaining opioids, and continues using
despite recurrent overdose. Which diagnosis is most consistent with these findings?
A. Opioid intoxication
B. Opioid withdrawal
C. Opioid use disorder
D. Substance-induced psychotic disorder
Rationale: Persistent problematic opioid use associated with impaired control, functional
impairment, and continued use despite harm is characteristic of opioid use disorder.
6. Which neurotransmitter system is most directly associated with the reinforcing effects of many
addictive substances?
A. Acetylcholine only
B. Mesolimbic dopamine signaling
C. Histamine only
D. Melatonin
Rationale: The mesolimbic dopamine pathway plays an important role in reward, reinforcement,
salience, and addiction-related learning.
7. A client says, "I don't understand why I keep returning to cocaine even though I know it is
destroying my relationships." Which neurobiological concept best explains this behavior?
A. Complete absence of decision-making ability
B. Changes in reward, motivation, learning, and executive-control circuits
,C. Permanent destruction of all dopamine neurons
D. Lack of awareness of consequences
Rationale: Addiction involves neuroadaptations affecting reward, motivation, stress, learning,
and executive-control systems, which can contribute to compulsive substance use.
8. A client reports craving alcohol whenever passing a bar where they previously drank heavily.
Which mechanism best explains this phenomenon?
A. Acute intoxication
B. Conditioned cue reactivity
C. Medication tolerance
D. Respiratory depression
Rationale: Environmental cues previously paired with substance use can become conditioned
stimuli that trigger craving and increase relapse risk.
9. Which assessment finding most strongly supports a diagnosis of moderate or severe substance
use disorder?
A. One episode of recreational use
B. Continued use despite significant interpersonal, occupational, or medical consequences
C. Family disapproval alone
D. Occasional craving without impairment
Rationale: Continued substance use despite recurrent consequences is a core feature of
clinically significant substance use disorder.
10. After naloxone administration, a client becomes awake and agitated but begins developing
recurrent respiratory depression several minutes later. What is the nurse's priority action?
A. Discharge the client immediately
B. Continue monitoring and provide additional naloxone/supportive care as clinically
indicated
C. Administer disulfiram
D. Give alcohol
Rationale: Naloxone may have a shorter duration of action than some opioids, especially long-
acting opioids, so recurrent respiratory depression requires continued monitoring and possible
repeat dosing.
11. A client with opioid use disorder asks about medications that reduce mortality and improve
treatment retention. Which treatment is appropriate?
, A. Antipsychotic monotherapy
B. Medication treatment with methadone or buprenorphine when clinically appropriate
C. Benzodiazepine monotherapy
D. Disulfiram
Rationale: Methadone and buprenorphine are evidence-based medications for opioid use
disorder and are associated with improved treatment outcomes.
12. A client is taking buprenorphine and asks why it can treat opioid use disorder despite being
an opioid. Which explanation is best?
A. It has no opioid-receptor activity.
B. It is a partial mu-opioid receptor agonist that can reduce withdrawal and craving with a
ceiling effect on some opioid effects.
C. It permanently blocks all receptors.
D. It produces no physical dependence.
Rationale: Buprenorphine is a partial mu-opioid receptor agonist with high receptor affinity and
a ceiling effect that contributes to its safety profile.
13. A client who recently used fentanyl takes the first dose of buprenorphine and develops abrupt
severe withdrawal. What is the most likely explanation?
A. Serotonin syndrome
B. Precipitated opioid withdrawal
C. Alcohol withdrawal
D. Stimulant crash
Rationale: Buprenorphine's high receptor affinity can displace full opioid agonists and
precipitate withdrawal when initiated before sufficient spontaneous withdrawal has occurred.
14. A client taking methadone reports palpitations and syncope. Which concern should the
advanced practice nurse prioritize?
A. Mild constipation
B. QT-interval prolongation and potentially serious cardiac arrhythmia
C. Increased appetite
D. Dry skin
Rationale: Methadone can prolong the QT interval and increase the risk of torsades de pointes
in susceptible patients.
15. A client with opioid use disorder wants an opioid antagonist rather than an opioid agonist or
partial agonist. Which medication may be considered?
