1
NCLEX PN Exam Bank Substance Use
Disorders and Withdrawal Monitoring
Table of Contents
Subtopic 1: Recognition and Assessment of Substance Use Disorders ............................. 2
Subtopic 2: Management of Alcohol Withdrawal and Delirium Tremens (DTs) .................. 11
Subtopic 3: Opioid Use Disorder and Withdrawal Management ...................................... 20
Subtopic 4: Sedative, Hypnotic, and Anxiolytic Use Disorders ........................................ 30
Subtopic 5: Stimulant Use Disorders and Withdrawal (e.g., Cocaine, Methamphetamine) 39
Subtopic 6: Cannabis and Hallucinogen Use Disorders ................................................. 48
Subtopic 7: Prescription Drug Abuse (Benzodiazepines, Sedative-Hypnotics, and Others) 58
Subtopic 8: Inhalants and Volatile Substance Use Disorders .......................................... 67
Subtopic 9: Substance Use in Pregnancy and Neonatal Withdrawal ................................ 76
Subtopic 10: Ethical, Legal, and Interdisciplinary Considerations in Substance Use
Management .............................................................................................................. 86
, 2
Subtopic 1: Recognition and Assessment of Substance
Use Disorders
Question 1
A nurse is assessing a patient suspected of alcohol use disorder. Which assessment
finding supports this diagnosis?
A. Pinpoint pupils
B. Elevated liver enzymes
C. Low blood pressure
D. Bradycardia
Correct Answer: B. Elevated liver enzymes
Rationale: Chronic alcohol use can lead to liver damage, which is reflected in elevated liver
enzymes (AST, ALT). Pinpoint pupils suggest opioid use. Hypotension and bradycardia are
not characteristic of alcohol use disorder.
Question 2
Which screening tool is most appropriate for assessing alcohol use disorder in a primary
care setting?
A. PHQ-9
B. CAGE Questionnaire
C. CIWA-Ar Scale
D. GAD-7
Correct Answer: B. CAGE Questionnaire
, 3
Rationale: The CAGE questionnaire is a brief and validated tool to identify potential alcohol
use disorder. CIWA-Ar is used for assessing withdrawal severity, not screening.
Question 3
A nurse is performing a withdrawal assessment on a patient admitted for alcohol
detoxification. Which finding requires immediate attention?
A. Mild tremors
B. Auditory hallucinations
C. Diaphoresis
D. Insomnia
Correct Answer: B. Auditory hallucinations
Rationale: Hallucinations during alcohol withdrawal can indicate impending delirium
tremens, a medical emergency. Other symptoms are common and less urgent.
Question 4
Which of the following lab findings is most suggestive of chronic alcohol use?
A. Low WBC count
B. Low potassium
C. Elevated mean corpuscular volume (MCV)
D. Decreased BUN
Correct Answer: C. Elevated mean corpuscular volume (MCV)
Rationale: Chronic alcohol use is associated with macrocytic anemia, reflected by
elevated MCV.
, 4
Question 5
A nurse suspects opioid use disorder in a patient. Which assessment finding best supports
this?
A. Constricted pupils
B. Hypertension
C. Hyperreflexia
D. Diarrhea
Correct Answer: A. Constricted pupils
Rationale: Miosis (pinpoint pupils) is a hallmark sign of opioid use. Withdrawal may present
with diarrhea and hypertension, but use is associated with constricted pupils and
sedation.
Question 6
Which behavioral finding is a red flag for stimulant use disorder?
A. Flat affect
B. Hyperactivity and agitation
C. Somnolence
D. Bradykinesia
Correct Answer: B. Hyperactivity and agitation
Rationale: Stimulant use (e.g., cocaine, methamphetamine) leads to increased energy,
agitation, and paranoia.
NCLEX PN Exam Bank Substance Use
Disorders and Withdrawal Monitoring
Table of Contents
Subtopic 1: Recognition and Assessment of Substance Use Disorders ............................. 2
Subtopic 2: Management of Alcohol Withdrawal and Delirium Tremens (DTs) .................. 11
Subtopic 3: Opioid Use Disorder and Withdrawal Management ...................................... 20
Subtopic 4: Sedative, Hypnotic, and Anxiolytic Use Disorders ........................................ 30
Subtopic 5: Stimulant Use Disorders and Withdrawal (e.g., Cocaine, Methamphetamine) 39
Subtopic 6: Cannabis and Hallucinogen Use Disorders ................................................. 48
Subtopic 7: Prescription Drug Abuse (Benzodiazepines, Sedative-Hypnotics, and Others) 58
Subtopic 8: Inhalants and Volatile Substance Use Disorders .......................................... 67
Subtopic 9: Substance Use in Pregnancy and Neonatal Withdrawal ................................ 76
Subtopic 10: Ethical, Legal, and Interdisciplinary Considerations in Substance Use
Management .............................................................................................................. 86
, 2
Subtopic 1: Recognition and Assessment of Substance
Use Disorders
Question 1
A nurse is assessing a patient suspected of alcohol use disorder. Which assessment
finding supports this diagnosis?
A. Pinpoint pupils
B. Elevated liver enzymes
C. Low blood pressure
D. Bradycardia
Correct Answer: B. Elevated liver enzymes
Rationale: Chronic alcohol use can lead to liver damage, which is reflected in elevated liver
enzymes (AST, ALT). Pinpoint pupils suggest opioid use. Hypotension and bradycardia are
not characteristic of alcohol use disorder.
Question 2
Which screening tool is most appropriate for assessing alcohol use disorder in a primary
care setting?
A. PHQ-9
B. CAGE Questionnaire
C. CIWA-Ar Scale
D. GAD-7
Correct Answer: B. CAGE Questionnaire
, 3
Rationale: The CAGE questionnaire is a brief and validated tool to identify potential alcohol
use disorder. CIWA-Ar is used for assessing withdrawal severity, not screening.
Question 3
A nurse is performing a withdrawal assessment on a patient admitted for alcohol
detoxification. Which finding requires immediate attention?
A. Mild tremors
B. Auditory hallucinations
C. Diaphoresis
D. Insomnia
Correct Answer: B. Auditory hallucinations
Rationale: Hallucinations during alcohol withdrawal can indicate impending delirium
tremens, a medical emergency. Other symptoms are common and less urgent.
Question 4
Which of the following lab findings is most suggestive of chronic alcohol use?
A. Low WBC count
B. Low potassium
C. Elevated mean corpuscular volume (MCV)
D. Decreased BUN
Correct Answer: C. Elevated mean corpuscular volume (MCV)
Rationale: Chronic alcohol use is associated with macrocytic anemia, reflected by
elevated MCV.
, 4
Question 5
A nurse suspects opioid use disorder in a patient. Which assessment finding best supports
this?
A. Constricted pupils
B. Hypertension
C. Hyperreflexia
D. Diarrhea
Correct Answer: A. Constricted pupils
Rationale: Miosis (pinpoint pupils) is a hallmark sign of opioid use. Withdrawal may present
with diarrhea and hypertension, but use is associated with constricted pupils and
sedation.
Question 6
Which behavioral finding is a red flag for stimulant use disorder?
A. Flat affect
B. Hyperactivity and agitation
C. Somnolence
D. Bradykinesia
Correct Answer: B. Hyperactivity and agitation
Rationale: Stimulant use (e.g., cocaine, methamphetamine) leads to increased energy,
agitation, and paranoia.
