Free PMHNP board review · 10 practice questions

Substance Use Screening Practice Questions

Choose among CAGE, AUDIT, DAST-10, and CRAFFT and interpret results.

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Independent educational practice, not official ANCC exam items. Not affiliated with or endorsed by ANCC. Not individual clinical advice; use current prescribing information, local protocols, and clinical judgment in practice.

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Question 1 of 10

A clinician wants an adult alcohol screen that covers consumption, dependence-related symptoms, and consequences. Which tool best fits?

  1. A. CRAFFT
  2. B. GAD-7
  3. C. AUDIT
  4. D. DAST-10
Show answer and explanation for question 1

Correct answer: C. AUDIT

AUDIT is the alcohol-focused instrument covering these domains.

Why the other answers are less appropriate

  • D. DAST-10: DAST-10 targets nonalcohol drug problems.
  • A. CRAFFT: CRAFFT is designed for adolescent and young-adult substance-use screening.
  • B. GAD-7: GAD-7 measures anxiety symptoms.

Question 2 of 10

A 16-year-old is being screened for alcohol and other drug risks. Which instrument is specifically validated for this age group?

  1. A. CRAFFT
  2. B. Adult CAGE alone
  3. C. HAM-D
  4. D. Mini-Cog
Show answer and explanation for question 2

Correct answer: A. CRAFFT

CRAFFT is validated for adolescents and young adults ages 12–21.

Why the other answers are less appropriate

  • B. Adult CAGE alone: CAGE alone is not the best age-appropriate comprehensive choice here.
  • C. HAM-D: HAM-D measures depressive symptom severity.
  • D. Mini-Cog: Mini-Cog assesses cognitive impairment rather than substance use.

Question 3 of 10

An adult reports nonmedical prescription stimulant use. Which instrument specifically assesses drug-related problems apart from alcohol?

  1. A. AUDIT-C
  2. B. Standard CAGE
  3. C. PHQ-9
  4. D. DAST-10
Show answer and explanation for question 3

Correct answer: D. DAST-10

DAST-10 addresses nonalcohol drug-related problems, including nonmedical medication use.

Why the other answers are less appropriate

  • A. AUDIT-C: AUDIT-C focuses on alcohol consumption.
  • B. Standard CAGE: Standard CAGE is alcohol-focused.
  • C. PHQ-9: PHQ-9 addresses depressive symptoms.

Question 4 of 10

A patient has a negative CAGE but reports recurrent episodes of heavy drinking. What is the best next step?

  1. A. Replace the alcohol assessment with DAST-10.
  2. B. Assess current consumption with an appropriate alcohol screen and clinical follow-up.
  3. C. Treat the negative CAGE as proof of low-risk drinking.
  4. D. Diagnose severe alcohol use disorder from quantity alone.
Show answer and explanation for question 4

Correct answer: B. Assess current consumption with an appropriate alcohol screen and clinical follow-up.

CAGE can miss current unhealthy use before established consequences; a negative result does not end assessment.

Why the other answers are less appropriate

  • C. Treat the negative CAGE as proof of low-risk drinking.: CAGE is not sufficiently sensitive to all unhealthy drinking patterns.
  • D. Diagnose severe alcohol use disorder from quantity alone.: Diagnosis requires assessment of disorder criteria, not quantity alone.
  • A. Replace the alcohol assessment with DAST-10.: DAST-10 does not replace an alcohol-specific assessment.

Question 5 of 10

An adult’s AUDIT result is above the screening threshold used by the clinic. Which interpretation is most accurate?

  1. A. The result is meaningful only if the patient has abnormal liver tests.
  2. B. The result warrants further assessment of drinking, harm, and possible alcohol use disorder.
  3. C. The result alone establishes alcohol dependence.
  4. D. The score determines a medication regardless of medical history.
Show answer and explanation for question 5

Correct answer: B. The result warrants further assessment of drinking, harm, and possible alcohol use disorder.

A positive screen identifies a need for assessment; it does not independently establish a diagnosis or treatment.

Why the other answers are less appropriate

  • C. The result alone establishes alcohol dependence.: A diagnostic interview is still necessary.
  • D. The score determines a medication regardless of medical history.: Treatment depends on diagnosis, risk, goals, and contraindications.
  • A. The result is meaningful only if the patient has abnormal liver tests.: Laboratory abnormalities are not required for a meaningful positive screen.

Question 6 of 10

A 15-year-old reports no personal substance use but has ridden with an impaired driver. What should the clinician do?

  1. A. End counseling because the adolescent does not use substances.
  2. B. Diagnose the adolescent with a substance use disorder.
  3. C. Count the driver’s substance use as the adolescent’s personal consumption.
  4. D. Address riding safety and make a concrete plan to avoid impaired drivers.
Show answer and explanation for question 6

Correct answer: D. Address riding safety and make a concrete plan to avoid impaired drivers.

CRAFFT includes the CAR risk because exposure to impaired driving matters even without personal use.

Why the other answers are less appropriate

  • A. End counseling because the adolescent does not use substances.: This misses an important injury-prevention opportunity.
  • B. Diagnose the adolescent with a substance use disorder.: Riding exposure does not establish the adolescent’s substance use disorder.
  • C. Count the driver’s substance use as the adolescent’s personal consumption.: The two exposures should be documented distinctly.

Question 7 of 10

A clinic is using CRAFFT 2.1. A patient’s score is 2. Which statement best guides the next step?

  1. A. The score raises concern and calls for further assessment of substance use and related problems.
  2. B. The score proves a severe substance use disorder.
  3. C. The score can be ignored if school grades are good.
  4. D. The score establishes which substance caused every endorsed problem.
Show answer and explanation for question 7

Correct answer: A. The score raises concern and calls for further assessment of substance use and related problems.

A score of 2 or more increases concern for a substance use disorder and supports further evaluation.

Why the other answers are less appropriate

  • B. The score proves a severe substance use disorder.: Severity requires a diagnostic assessment.
  • C. The score can be ignored if school grades are good.: Academic performance does not rule out substance-related harm.
  • D. The score establishes which substance caused every endorsed problem.: The interview must clarify substances, circumstances, and consequences.

Question 8 of 10

A clinician switches from the standard CAGE to CAGE-AID. Which practice best preserves valid interpretation?

  1. A. Add the scores from both tools into a single severity scale.
  2. B. Use a positive result as a stand-alone diagnosis.
  3. C. Use the selected instrument’s exact wording, instructions, and validated interpretation.
  4. D. Assume every CAGE-family version has identical thresholds and content.
Show answer and explanation for question 8

Correct answer: C. Use the selected instrument’s exact wording, instructions, and validated interpretation.

Related instrument names do not make their populations, wording, or scoring interchangeable.

Why the other answers are less appropriate

  • D. Assume every CAGE-family version has identical thresholds and content.: Adaptations must be interpreted using their own instructions.
  • A. Add the scores from both tools into a single severity scale.: The combined score has not been established as a valid scale.
  • B. Use a positive result as a stand-alone diagnosis.: Screening requires follow-up assessment.

Question 9 of 10

A patient is sweating, tremulous, tachycardic, and confused after abruptly stopping heavy daily alcohol use. A screening form has not yet been completed. What is the priority?

  1. A. Finish the AUDIT before responding to the symptoms.
  2. B. Use a negative CAGE to decide whether evaluation is necessary.
  3. C. Schedule a routine substance-use interview next month.
  4. D. Urgent medical assessment for possible alcohol withdrawal.
Show answer and explanation for question 9

Correct answer: D. Urgent medical assessment for possible alcohol withdrawal.

An acute potentially dangerous presentation takes priority over routine screening.

Why the other answers are less appropriate

  • A. Finish the AUDIT before responding to the symptoms.: Completing a form must not delay medical evaluation.
  • B. Use a negative CAGE to decide whether evaluation is necessary.: A screen cannot rule out an acute withdrawal emergency.
  • C. Schedule a routine substance-use interview next month.: The symptoms require prompt assessment.

Question 10 of 10

A patient’s screening responses seem inconsistent with the amount they report drinking. Which approach is most useful?

  1. A. Clarify serving sizes, time frame, and questions without judgment.
  2. B. Record intentional deception as established fact.
  3. C. Change the answers to fit the clinician’s impression.
  4. D. Discard the screening result and avoid further discussion.
Show answer and explanation for question 10

Correct answer: A. Clarify serving sizes, time frame, and questions without judgment.

Clarification can uncover differences in drink size, recall, or understanding and improve the assessment.

Why the other answers are less appropriate

  • B. Record intentional deception as established fact.: Inconsistency has multiple possible explanations.
  • C. Change the answers to fit the clinician’s impression.: Clinicians should clarify rather than substitute unverified answers.
  • D. Discard the screening result and avoid further discussion.: The discrepancy is a reason to explore, not stop.

Turn missed questions into focused review

Identify the clue that supports the best answer, then explain why the closest alternative is less appropriate. Return to the linked article to revisit a missed concept. This short practice set does not predict certification performance.

Frequently asked questions

Can a positive substance-use screen establish a diagnosis?

No. Follow up on the substance, pattern, consequences, diagnostic criteria, and immediate safety concerns.

Does a negative CAGE rule out unhealthy drinking?

No. CAGE can miss unhealthy current consumption, particularly before consequences develop. Use an appropriate current-use screen and clinical assessment.