NURS 222: Substance Use Disorders & Withdrawal Management 2026
|WCU
1. A client admitted for alcohol detoxification presents with a heart rate of 124
bpm, blood pressure 158/98 mmHg, and coarse tremors. Which medication
class is the priority for preventing progression to Delirium Tremens (DTs)?
A. Alpha-2 adrenergic agonists
B. Antipsychotics
C. Benzodiazepines
D. Anticonvulsants
Answer: C
Rationale: Benzodiazepines are the gold standard for alcohol withdrawal management as
they provide cross-tolerance to alcohol, enhancing GABA activity to prevent seizures and
DTs.
2. When administering the Clinical Institute Withdrawal Assessment for Alcohol
(CIWA-Ar), the nurse notes a score of 18. What is the most appropriate nursing
action?
A. Initiate pharmacological intervention as per standing orders
B. Continue routine monitoring every 8 hours
C. Discharge the patient to a community support group
D. Withhold all sedative medications
Answer: A
Rationale: A CIWA-Ar score higher than 8-10 usually indicates the need for
pharmacological intervention (typically benzodiazepines) to prevent severe withdrawal
complications.
,3. A client with a 10-year history of heavy alcohol use presents with ataxia,
nystagmus, and acute confusion. Which nutritional deficiency is the nurse most
likely to suspect?
A. Vitamin B12 (Cobalamin)
B. Folic acid
C. Vitamin B6 (Pyridoxine)
D. Vitamin B1 (Thiamine)
Answer: D
Rationale: The triad of ataxia, nystagmus, and confusion is indicative of Wernicke’s
encephalopathy, caused by a severe thiamine (B1) deficiency common in chronic
alcoholism.
4. A client is prescribed Disulfiram for alcohol abstinence. Which statement by
the client indicates a need for further teaching?
A. I will avoid drinking beer and wine.
B. I need to wait at least 12 hours after my last drink before starting this.
C. I must check the labels of cough syrups and mouthwashes for alcohol.
D. I can use alcohol-based hand sanitizer as long as I don’t swallow it.
Answer: D
Rationale: Disulfiram can cause a reaction even from topical absorption or inhalation of
alcohol vapors in some individuals; however, the most critical teaching is avoiding all forms
of alcohol ingestion, including hidden sources in foods and toiletries.
, 5. Which mechanism of action best describes how Naltrexone assists in
maintaining sobriety for clients with Alcohol Use Disorder?
A. It creates a toxic reaction when alcohol is consumed.
B. It increases GABA levels to reduce anxiety.
C. It acts as a sedative to mimic the effects of alcohol.
D. It blocks the opioid receptors to reduce the craving and reward of drinking.
Answer: D
Rationale: Naltrexone is an opioid antagonist that reduces the reinforcing ‘high’ associated
with alcohol consumption and significantly diminishes cravings.
6. A nurse is caring for a client in opioid withdrawal. Which clinical assessment
tool is most appropriate for this patient?
A. CIWA-Ar
B. CAGE
C. PHQ-9
D. COWS
Answer: D
Rationale: The Clinical Opiate Withdrawal Scale (COWS) is specifically designed to assess
and monitor the severity of opioid withdrawal symptoms.
7. A patient is brought to the emergency department with suspected opioid
overdose. Which finding would the nurse consider the most critical priority?
A. Pinpoint pupils
B. Heart rate of 55 beats per minute
C. Respiratory rate of 6 breaths per minute
D. Drowsiness and slurred speech
Answer: C
Rationale: Respiratory depression is the most life-threatening complication of opioid
overdose and requires immediate intervention with Naloxone and airway management.
|WCU
1. A client admitted for alcohol detoxification presents with a heart rate of 124
bpm, blood pressure 158/98 mmHg, and coarse tremors. Which medication
class is the priority for preventing progression to Delirium Tremens (DTs)?
A. Alpha-2 adrenergic agonists
B. Antipsychotics
C. Benzodiazepines
D. Anticonvulsants
Answer: C
Rationale: Benzodiazepines are the gold standard for alcohol withdrawal management as
they provide cross-tolerance to alcohol, enhancing GABA activity to prevent seizures and
DTs.
2. When administering the Clinical Institute Withdrawal Assessment for Alcohol
(CIWA-Ar), the nurse notes a score of 18. What is the most appropriate nursing
action?
A. Initiate pharmacological intervention as per standing orders
B. Continue routine monitoring every 8 hours
C. Discharge the patient to a community support group
D. Withhold all sedative medications
Answer: A
Rationale: A CIWA-Ar score higher than 8-10 usually indicates the need for
pharmacological intervention (typically benzodiazepines) to prevent severe withdrawal
complications.
,3. A client with a 10-year history of heavy alcohol use presents with ataxia,
nystagmus, and acute confusion. Which nutritional deficiency is the nurse most
likely to suspect?
A. Vitamin B12 (Cobalamin)
B. Folic acid
C. Vitamin B6 (Pyridoxine)
D. Vitamin B1 (Thiamine)
Answer: D
Rationale: The triad of ataxia, nystagmus, and confusion is indicative of Wernicke’s
encephalopathy, caused by a severe thiamine (B1) deficiency common in chronic
alcoholism.
4. A client is prescribed Disulfiram for alcohol abstinence. Which statement by
the client indicates a need for further teaching?
A. I will avoid drinking beer and wine.
B. I need to wait at least 12 hours after my last drink before starting this.
C. I must check the labels of cough syrups and mouthwashes for alcohol.
D. I can use alcohol-based hand sanitizer as long as I don’t swallow it.
Answer: D
Rationale: Disulfiram can cause a reaction even from topical absorption or inhalation of
alcohol vapors in some individuals; however, the most critical teaching is avoiding all forms
of alcohol ingestion, including hidden sources in foods and toiletries.
, 5. Which mechanism of action best describes how Naltrexone assists in
maintaining sobriety for clients with Alcohol Use Disorder?
A. It creates a toxic reaction when alcohol is consumed.
B. It increases GABA levels to reduce anxiety.
C. It acts as a sedative to mimic the effects of alcohol.
D. It blocks the opioid receptors to reduce the craving and reward of drinking.
Answer: D
Rationale: Naltrexone is an opioid antagonist that reduces the reinforcing ‘high’ associated
with alcohol consumption and significantly diminishes cravings.
6. A nurse is caring for a client in opioid withdrawal. Which clinical assessment
tool is most appropriate for this patient?
A. CIWA-Ar
B. CAGE
C. PHQ-9
D. COWS
Answer: D
Rationale: The Clinical Opiate Withdrawal Scale (COWS) is specifically designed to assess
and monitor the severity of opioid withdrawal symptoms.
7. A patient is brought to the emergency department with suspected opioid
overdose. Which finding would the nurse consider the most critical priority?
A. Pinpoint pupils
B. Heart rate of 55 beats per minute
C. Respiratory rate of 6 breaths per minute
D. Drowsiness and slurred speech
Answer: C
Rationale: Respiratory depression is the most life-threatening complication of opioid
overdose and requires immediate intervention with Naloxone and airway management.
