A client who delivered a healthy newborn 4 weeks ago calls her provider's office and tells the nurse, "This baby constantly cries.
My partner works all the time, and I can't take any more.”. Which of the following responses is the nurse's priority?

The nurse should anticipate prescriptions for methadone as well as group therapy.

Rationale for correct answers

Methadone is a long-acting opioid agonist used in medication-assisted treatment (MAT) for heroin withdrawal and opioid dependence. Given the client’s history of heroin use and symptoms suggestive of withdrawal, methadone can alleviate withdrawal symptoms while preventing cravings and relapse.

Group therapy is a key component of substance use disorder treatment, providing peer support, relapse prevention strategies, and coping mechanisms. The client has already expressed willingness to participate in outpatient therapy and identified cravings as a challenge, making group therapy beneficial for sustained recovery.

Rationale for incorrect Response 1 options

• Disulfiram: Used for alcohol dependence, but this client does not report alcohol use.
• Naltrexone: Used to prevent opioid or alcohol relapse but does not treat withdrawal symptoms, making methadone a better choice during acute withdrawal.
• Lorazepam: A benzodiazepine used for alcohol withdrawal and anxiety, but it is not first-line for opioid or methamphetamine withdrawal.

Rationale for incorrect Response 2 options

• Electroconvulsive therapy: Primarily used for severe depression or treatment-resistant mood disorders, not substance use disorder management.
• Antidepressant medication: The client has no history of depression or psychiatric disorders, making behavioral therapies a better fit for recovery.
• Antipsychotic medication: No psychotic symptoms such as delusions or hallucinations are reported, so antipsychotics are not indicated.

Choice A rationale

Seeking out a staff member during urges to self-harm demonstrates the effectiveness of a verbal safety contract. This behavior indicates the client is adhering to the agreement by reaching out for support instead of acting on the urges, signifying an increased ability to manage self-destructive impulses through communication and engagement with the treatment team.

Choice B rationale

Spending time alone when experiencing overwhelming feelings might indicate avoidance rather than effective coping. While some alone time can be therapeutic, relying solely on isolation could prevent the client from practicing new coping skills and engaging with support systems, potentially undermining the safety contract's goal of seeking help.

Choice C rationale

Avoiding discussion of difficult emotions with the treatment team suggests a lack of trust or engagement in the therapeutic process. An effective safety contract relies on open communication about feelings and urges to ensure the client receives timely support and can work through difficult emotions in a safe environment.

Choice D rationale

Attempting to suppress feelings of anger and frustration is an unhealthy coping mechanism. Suppressing emotions can lead to a buildup of internal tension, potentially increasing the likelihood of acting on self-harm urges. A safety contract aims to help the client identify and express emotions in constructive ways, not suppress them.