NSG 526 Exam 3 (2026/2027 Update) - Wilkes University Clinical Modalities in Advanced Psychiatric Mental Health Nursing Practice
Wilkes University | Passan School of Nursing
NSG 526 Exam 3 ( Update)
Clinical Modalities in Advanced Psychiatric Mental Health Nursing Practice
Rated A Guide | Verified Answers | 75-Question Comprehensive Examination
Total Questions 75 Multiple Choice
Cognitive Distribution ~25% Recall | ~55% Application | ~20% Analysis
Question Style ~70% Scenario-Based | ~20% Direct Recall | ~10% Clinical Judgment
Sections 6 (SUD | Child/Adolescent | Geriatric | Emergencies | Forensic | Integrated)
Aligned With 2026-2027 Wilkes NSG 526 Curriculum & APNA Competencies
Examination Instructions: Select the SINGLE BEST answer for each question. Each question includes the correct
answer and a comprehensive rationale reflecting advanced psychiatric-mental health nursing clinical reasoning,
evidence-based practice, and Wilkes University NSG 526 (2026-2027) curriculum competencies. Rationales integrate
psychopharmacology, therapeutic modalities, safety/legal/ethical frameworks, and interprofessional collaboration.
Section 1: Substance Use Disorders and Addiction Medicine (Q1-Q15)
Q1: A 47-year-old male presents to his PMHNP for an annual physical. He reports drinking 4-5
beers nightly on weekdays and 8-10 on weekend nights. The PMHNP initiates universal screening
per USPSTF Grade B recommendation. Which screening instrument is MOST appropriate to
identify alcohol use disorder in this primary care setting?
A. CAGE-AID, because it screens for both alcohol and drug use simultaneously
B. AUDIT-C, because it is a brief 3-item tool validated for unhealthy alcohol use in primary care
[CORRECT]
C. SMAST-G, because it is the geriatric-specific screening tool of choice
D. DAST-10, because it detects drug use disorders with high sensitivity
Correct Answer: B
Rationale: The USPSTF (Grade B) recommends universal screening for unhealthy alcohol use in adults 18+ in primary
care. AUDIT-C, a 3-item validated version of the AUDIT, is ideal for brief primary care encounters and detects hazardous
drinking with strong sensitivity. CAGE-AID screens for both alcohol and drug use but is less sensitive for early problem
drinking. SMAST-G is reserved for geriatric populations, and DAST-10 targets drug use only, not alcohol. Wilkes NSG 526
(2026-2027) emphasizes universal alcohol screening with AUDIT-C as the first-line tool in adult primary care.
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,NSG 526 Exam 3 (2026/2027 Update) - Wilkes University Clinical Modalities in Advanced Psychiatric Mental Health Nursing Practice
Q2: A 52-year-old female with alcohol use disorder (AUD) is admitted for inpatient withdrawal
management. Her CIWA-Ar score is 22. The PMHNP orders symptom-triggered lorazepam. Which
CIWA-Ar domain assesses the patient's report of 'feeling bugs crawling on my skin'?
A. Tremor
B. Tactile disturbances [CORRECT]
C. Auditory disturbances
D. Headache, fullness in head
Correct Answer: B
Rationale: The CIWA-Ar (Clinical Institute Withdrawal Assessment-Alcohol Revised) includes 10 domains:
nausea/vomiting, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual
disturbances, headache/fullness in head, and orientation. Tactile disturbances specifically assess paresthesias and the
sensation of bugs crawling (formication), which are classic alcohol withdrawal phenomena. Tremor is motor-based;
auditory/visual disturbances involve hallucinations in those respective modalities. A CIWA-Ar score of 22 indicates severe
withdrawal requiring inpatient benzodiazepine management.
Q3: A 61-year-old male with chronic alcohol use disorder presents with acute onset confusion,
ataxia, and nystagmus. Which intervention is MOST critical to administer BEFORE intravenous
glucose?
A. Intravenous haloperidol for agitation
B. Intravenous thiamine (vitamin B1) [CORRECT]
C. Oral naltrexone to reduce craving
D. Sublingual lorazepam for tremor
Correct Answer: B
Rationale: This patient presents with the classic triad of Wernicke's encephalopathy: confusion, ataxia, and
ophthalmoplegia/nystagmus. Thiamine MUST be administered BEFORE glucose to prevent precipitation or worsening of
Wernicke's encephalopathy. Glucose metabolism consumes thiamine, and giving dextrose first can accelerate thiamine
depletion and lead to irreversible Korsakoff syndrome (anterograde/retrograde amnesia with confabulation). Haloperidol
and lorazepam do not address the underlying thiamine deficiency. Naltrexone is for AUD maintenance, not acute
management.
Q4: A 38-year-old female with alcohol use disorder has completed medical detoxification and is
being discharged to outpatient treatment. She has normal liver function and no contraindications.
She reports strong alcohol cravings. Which pharmacotherapy is MOST appropriate to reduce both
craving and the rewarding effects of alcohol?
A. Disulfiram 250 mg PO daily, which produces aversion through acetaldehyde accumulation
B. Naltrexone 50 mg PO daily or 380 mg IM monthly, an opioid antagonist that reduces craving and
blocks euphoria [CORRECT]
C. Acamprosate 666 mg PO TID, which normalizes glutamatergic activity post-detox
D. Topiramate 200 mg PO daily, which modulates GABA and glutamate
Correct Answer: B
Rationale: Naltrexone (oral 50 mg daily or IM Vivitrol 380 mg monthly) is an opioid antagonist that reduces alcohol
craving and blocks the rewarding/euphoric effects of alcohol, supporting abstinence. Disulfiram causes aversion through
acetaldehyde accumulation but requires adherence and motivation. Acamprosate is most useful post-detox for craving
reduction but does not block euphoria. Topiramate is off-label. For a patient with normal liver function and prominent
craving, naltrexone is first-line per Wilkes NSG 526 AUD pharmacotherapy guidelines.
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,NSG 526 Exam 3 (2026/2027 Update) - Wilkes University Clinical Modalities in Advanced Psychiatric Mental Health Nursing Practice
Q5: A 29-year-old male with opioid use disorder (OUD) presents requesting treatment. He has been
using heroin IV daily and his last use was 8 hours ago. He is experiencing mild withdrawal (COWS
~10). The PMHNP initiates buprenorphine-naloxone. What is the BEST pharmacological rationale
for choosing buprenorphine over methadone for this patient?
A. Buprenorphine is a full mu agonist and therefore more effective for severe withdrawal
B. Buprenorphine is a partial mu agonist with a ceiling effect on respiratory depression, reducing
overdose risk and allowing office-based prescribing [CORRECT]
C. Methadone cannot be used because the patient has only mild withdrawal
D. Buprenorphine requires daily OTP visits which increases structure and accountability
Correct Answer: B
Rationale: Buprenorphine is a partial mu-opioid agonist with a ceiling effect on respiratory depression, making it safer in
overdose and divertible less than full agonists. It can be prescribed in office-based settings by waivered providers (and under
recent MAT Act changes, by any DEA-registered prescriber). Methadone is a full mu agonist requiring daily OTP (Opioid
Treatment Program) dosing. Buprenorphine induction requires the patient to be in mild-moderate withdrawal (COWS ≥8) to
avoid precipitated withdrawal. The partial agonist property is the key pharmacological advantage for safety.
Q6: A 34-year-old patient with opioid use disorder is being transitioned to extended-release
naltrexone (Vivitrol) IM. Which requirement is ESSENTIAL before initiating this medication?
A. The patient must have a COWS score of at least 12 to confirm withdrawal
B. The patient must be opioid-free for 7-10 days and pass a naloxone challenge to avoid
precipitated withdrawal [CORRECT]
C. The patient must be enrolled in a federally licensed Opioid Treatment Program
D. The patient must be co-prescribed a benzodiazepine for anxiety
Correct Answer: B
Rationale: Extended-release naltrexone (Vivitrol) is a mu-opioid antagonist that requires complete opioid detoxification
prior to initiation. Patients must be opioid-free for 7-10 days and ideally pass a naloxone challenge test; otherwise, the
antagonist will precipitate severe acute withdrawal. Unlike buprenorphine or methadone, naltrexone does not require OTP
enrollment. Co-prescribing benzodiazepines is generally avoided in OUD. The opioid-free period is the critical safety gate.
Q7: A 44-year-old male with chronic cocaine use disorder presents to the ED with acute
intoxication. Vitals: HR 132, BP 178/104, T 39.2°C, agitated and paranoid. The patient is diaphoretic
with muscle rigidity. Which management approach is MOST appropriate?
A. Administer haloperidol IM as first-line for cocaine-induced agitation
B. Administer IV lorazepam and initiate active cooling measures for hyperthermia [CORRECT]
C. Administer buprenorphine for cocaine craving reduction
D. Administer naloxone to reverse cocaine toxicity
Correct Answer: B
Rationale: Acute cocaine intoxication produces sympathomimetic toxicity: tachycardia, hypertension, hyperthermia,
agitation, and psychosis. First-line management is supportive care with IV benzodiazepines (lorazepam) to reduce agitation,
lower HR/BP, and prevent seizures, plus active cooling for hyperthermia. Antipsychotics like haloperidol are second-line
because they can worsen hyperthermia, lower seizure threshold, and contribute to rigidity. There are no FDA-approved
medications for cocaine use disorder; buprenorphine treats opioids, not stimulants. Naloxone reverses opioids, not cocaine.
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, NSG 526 Exam 3 (2026/2027 Update) - Wilkes University Clinical Modalities in Advanced Psychiatric Mental Health Nursing Practice
Q8: A 55-year-old female wishes to quit smoking. She has smoked 1 pack/day for 30 years. She
has a history of depression but no seizures. Per USPSTF Grade A recommendation, the PMHNP
offers both behavioral counseling and pharmacotherapy. Which medication has the HIGHEST
efficacy for smoking cessation but requires monitoring for neuropsychiatric symptoms?
A. Nicotine replacement therapy (patch 21 mg/day)
B. Bupropion SR 150 mg BID starting 1-2 weeks before quit date
C. Varenicline 0.5 mg daily titrated to 1 mg BID, a partial alpha-4 beta-2 nicotinic agonist
[CORRECT]
D. Clonidine 0.1 mg BID as off-label adjunct
Correct Answer: C
Rationale: Varenicline is a partial agonist at the alpha-4 beta-2 nicotinic receptor that reduces craving and attenuates the
rewarding effects of smoking. It has the highest abstinence rates of the single-agent pharmacotherapies but carries an FDA
warning for neuropsychiatric symptoms (mood changes, suicidal ideation) requiring monitoring. Bupropion is also effective
but contraindicated with seizure/eating disorder history. NRT is safe and effective but less so as monotherapy. The patient
should also be referred to 1-800-QUIT-NOW for behavioral counseling.
Q9: A 23-year-old male presents with cyclic vomiting, abdominal pain, and reports that hot
showers reliably relieve his symptoms. He admits to chronic daily cannabis use. Which syndrome
is MOST likely, and what is the recommended first-line treatment?
A. Opioid withdrawal syndrome; treat with buprenorphine
B. Cannabis hyperemesis syndrome; first-line is cessation of cannabis use with supportive care (IV
fluids, antiemetics) [CORRECT]
C. Alcoholic ketoacidosis; treat with IV dextrose and thiamine
D. Cyclic vomiting syndrome; treat with tricyclic antidepressants
Correct Answer: B
Rationale: Cannabis hyperemesis syndrome (CHS) presents with cyclic vomiting, abdominal pain, and pathognomonic
relief from hot showers or baths in chronic daily cannabis users. The definitive treatment is cessation of cannabis use, which
resolves symptoms over days to weeks. Supportive care during acute episodes includes IV fluids, electrolyte correction, and
antiemetics (haloperidol or topical capsaicin have shown benefit). Traditional antiemetics like ondansetron are often
ineffective. Continued cannabis use perpetuates the syndrome.
Q10: A 41-year-old patient with long-term alprazolam use (4 mg/day for 5 years) abruptly stops
taking the medication. She presents with severe anxiety, tremors, and a witnessed tonic-clonic
seizure. Which pharmacological management is MOST appropriate for benzodiazepine
withdrawal?
A. Convert to an equivalent dose of diazepam and taper by 10% per week [CORRECT]
B. Begin phenytoin for seizure prophylaxis long-term
C. Administer naloxone to reverse benzodiazepine toxicity
D. Prescribe disulfiram for aversion therapy
Correct Answer: A
Rationale: Sedative-hypnotic-anxiolytic withdrawal can be life-threatening (seizures, delirium). The standard management
is to convert the patient's current benzodiazepine to a long-acting equivalent (diazepam) and taper gradually at ~10% per
week to minimize withdrawal symptoms and seizure risk. Abrupt discontinuation is contraindicated. Phenytoin is not used
for benzodiazepine withdrawal seizures. Naloxone reverses opioids, not benzodiazepines. Disulfiram is for AUD. The 10%
weekly taper is the Wilkes NSG 526 standard for safe benzodiazepine discontinuation.
Wilkes University | Passan School of Nursing | Rated A Guide - Verified Answers Page 4
Wilkes University | Passan School of Nursing
NSG 526 Exam 3 ( Update)
Clinical Modalities in Advanced Psychiatric Mental Health Nursing Practice
Rated A Guide | Verified Answers | 75-Question Comprehensive Examination
Total Questions 75 Multiple Choice
Cognitive Distribution ~25% Recall | ~55% Application | ~20% Analysis
Question Style ~70% Scenario-Based | ~20% Direct Recall | ~10% Clinical Judgment
Sections 6 (SUD | Child/Adolescent | Geriatric | Emergencies | Forensic | Integrated)
Aligned With 2026-2027 Wilkes NSG 526 Curriculum & APNA Competencies
Examination Instructions: Select the SINGLE BEST answer for each question. Each question includes the correct
answer and a comprehensive rationale reflecting advanced psychiatric-mental health nursing clinical reasoning,
evidence-based practice, and Wilkes University NSG 526 (2026-2027) curriculum competencies. Rationales integrate
psychopharmacology, therapeutic modalities, safety/legal/ethical frameworks, and interprofessional collaboration.
Section 1: Substance Use Disorders and Addiction Medicine (Q1-Q15)
Q1: A 47-year-old male presents to his PMHNP for an annual physical. He reports drinking 4-5
beers nightly on weekdays and 8-10 on weekend nights. The PMHNP initiates universal screening
per USPSTF Grade B recommendation. Which screening instrument is MOST appropriate to
identify alcohol use disorder in this primary care setting?
A. CAGE-AID, because it screens for both alcohol and drug use simultaneously
B. AUDIT-C, because it is a brief 3-item tool validated for unhealthy alcohol use in primary care
[CORRECT]
C. SMAST-G, because it is the geriatric-specific screening tool of choice
D. DAST-10, because it detects drug use disorders with high sensitivity
Correct Answer: B
Rationale: The USPSTF (Grade B) recommends universal screening for unhealthy alcohol use in adults 18+ in primary
care. AUDIT-C, a 3-item validated version of the AUDIT, is ideal for brief primary care encounters and detects hazardous
drinking with strong sensitivity. CAGE-AID screens for both alcohol and drug use but is less sensitive for early problem
drinking. SMAST-G is reserved for geriatric populations, and DAST-10 targets drug use only, not alcohol. Wilkes NSG 526
(2026-2027) emphasizes universal alcohol screening with AUDIT-C as the first-line tool in adult primary care.
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,NSG 526 Exam 3 (2026/2027 Update) - Wilkes University Clinical Modalities in Advanced Psychiatric Mental Health Nursing Practice
Q2: A 52-year-old female with alcohol use disorder (AUD) is admitted for inpatient withdrawal
management. Her CIWA-Ar score is 22. The PMHNP orders symptom-triggered lorazepam. Which
CIWA-Ar domain assesses the patient's report of 'feeling bugs crawling on my skin'?
A. Tremor
B. Tactile disturbances [CORRECT]
C. Auditory disturbances
D. Headache, fullness in head
Correct Answer: B
Rationale: The CIWA-Ar (Clinical Institute Withdrawal Assessment-Alcohol Revised) includes 10 domains:
nausea/vomiting, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual
disturbances, headache/fullness in head, and orientation. Tactile disturbances specifically assess paresthesias and the
sensation of bugs crawling (formication), which are classic alcohol withdrawal phenomena. Tremor is motor-based;
auditory/visual disturbances involve hallucinations in those respective modalities. A CIWA-Ar score of 22 indicates severe
withdrawal requiring inpatient benzodiazepine management.
Q3: A 61-year-old male with chronic alcohol use disorder presents with acute onset confusion,
ataxia, and nystagmus. Which intervention is MOST critical to administer BEFORE intravenous
glucose?
A. Intravenous haloperidol for agitation
B. Intravenous thiamine (vitamin B1) [CORRECT]
C. Oral naltrexone to reduce craving
D. Sublingual lorazepam for tremor
Correct Answer: B
Rationale: This patient presents with the classic triad of Wernicke's encephalopathy: confusion, ataxia, and
ophthalmoplegia/nystagmus. Thiamine MUST be administered BEFORE glucose to prevent precipitation or worsening of
Wernicke's encephalopathy. Glucose metabolism consumes thiamine, and giving dextrose first can accelerate thiamine
depletion and lead to irreversible Korsakoff syndrome (anterograde/retrograde amnesia with confabulation). Haloperidol
and lorazepam do not address the underlying thiamine deficiency. Naltrexone is for AUD maintenance, not acute
management.
Q4: A 38-year-old female with alcohol use disorder has completed medical detoxification and is
being discharged to outpatient treatment. She has normal liver function and no contraindications.
She reports strong alcohol cravings. Which pharmacotherapy is MOST appropriate to reduce both
craving and the rewarding effects of alcohol?
A. Disulfiram 250 mg PO daily, which produces aversion through acetaldehyde accumulation
B. Naltrexone 50 mg PO daily or 380 mg IM monthly, an opioid antagonist that reduces craving and
blocks euphoria [CORRECT]
C. Acamprosate 666 mg PO TID, which normalizes glutamatergic activity post-detox
D. Topiramate 200 mg PO daily, which modulates GABA and glutamate
Correct Answer: B
Rationale: Naltrexone (oral 50 mg daily or IM Vivitrol 380 mg monthly) is an opioid antagonist that reduces alcohol
craving and blocks the rewarding/euphoric effects of alcohol, supporting abstinence. Disulfiram causes aversion through
acetaldehyde accumulation but requires adherence and motivation. Acamprosate is most useful post-detox for craving
reduction but does not block euphoria. Topiramate is off-label. For a patient with normal liver function and prominent
craving, naltrexone is first-line per Wilkes NSG 526 AUD pharmacotherapy guidelines.
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,NSG 526 Exam 3 (2026/2027 Update) - Wilkes University Clinical Modalities in Advanced Psychiatric Mental Health Nursing Practice
Q5: A 29-year-old male with opioid use disorder (OUD) presents requesting treatment. He has been
using heroin IV daily and his last use was 8 hours ago. He is experiencing mild withdrawal (COWS
~10). The PMHNP initiates buprenorphine-naloxone. What is the BEST pharmacological rationale
for choosing buprenorphine over methadone for this patient?
A. Buprenorphine is a full mu agonist and therefore more effective for severe withdrawal
B. Buprenorphine is a partial mu agonist with a ceiling effect on respiratory depression, reducing
overdose risk and allowing office-based prescribing [CORRECT]
C. Methadone cannot be used because the patient has only mild withdrawal
D. Buprenorphine requires daily OTP visits which increases structure and accountability
Correct Answer: B
Rationale: Buprenorphine is a partial mu-opioid agonist with a ceiling effect on respiratory depression, making it safer in
overdose and divertible less than full agonists. It can be prescribed in office-based settings by waivered providers (and under
recent MAT Act changes, by any DEA-registered prescriber). Methadone is a full mu agonist requiring daily OTP (Opioid
Treatment Program) dosing. Buprenorphine induction requires the patient to be in mild-moderate withdrawal (COWS ≥8) to
avoid precipitated withdrawal. The partial agonist property is the key pharmacological advantage for safety.
Q6: A 34-year-old patient with opioid use disorder is being transitioned to extended-release
naltrexone (Vivitrol) IM. Which requirement is ESSENTIAL before initiating this medication?
A. The patient must have a COWS score of at least 12 to confirm withdrawal
B. The patient must be opioid-free for 7-10 days and pass a naloxone challenge to avoid
precipitated withdrawal [CORRECT]
C. The patient must be enrolled in a federally licensed Opioid Treatment Program
D. The patient must be co-prescribed a benzodiazepine for anxiety
Correct Answer: B
Rationale: Extended-release naltrexone (Vivitrol) is a mu-opioid antagonist that requires complete opioid detoxification
prior to initiation. Patients must be opioid-free for 7-10 days and ideally pass a naloxone challenge test; otherwise, the
antagonist will precipitate severe acute withdrawal. Unlike buprenorphine or methadone, naltrexone does not require OTP
enrollment. Co-prescribing benzodiazepines is generally avoided in OUD. The opioid-free period is the critical safety gate.
Q7: A 44-year-old male with chronic cocaine use disorder presents to the ED with acute
intoxication. Vitals: HR 132, BP 178/104, T 39.2°C, agitated and paranoid. The patient is diaphoretic
with muscle rigidity. Which management approach is MOST appropriate?
A. Administer haloperidol IM as first-line for cocaine-induced agitation
B. Administer IV lorazepam and initiate active cooling measures for hyperthermia [CORRECT]
C. Administer buprenorphine for cocaine craving reduction
D. Administer naloxone to reverse cocaine toxicity
Correct Answer: B
Rationale: Acute cocaine intoxication produces sympathomimetic toxicity: tachycardia, hypertension, hyperthermia,
agitation, and psychosis. First-line management is supportive care with IV benzodiazepines (lorazepam) to reduce agitation,
lower HR/BP, and prevent seizures, plus active cooling for hyperthermia. Antipsychotics like haloperidol are second-line
because they can worsen hyperthermia, lower seizure threshold, and contribute to rigidity. There are no FDA-approved
medications for cocaine use disorder; buprenorphine treats opioids, not stimulants. Naloxone reverses opioids, not cocaine.
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, NSG 526 Exam 3 (2026/2027 Update) - Wilkes University Clinical Modalities in Advanced Psychiatric Mental Health Nursing Practice
Q8: A 55-year-old female wishes to quit smoking. She has smoked 1 pack/day for 30 years. She
has a history of depression but no seizures. Per USPSTF Grade A recommendation, the PMHNP
offers both behavioral counseling and pharmacotherapy. Which medication has the HIGHEST
efficacy for smoking cessation but requires monitoring for neuropsychiatric symptoms?
A. Nicotine replacement therapy (patch 21 mg/day)
B. Bupropion SR 150 mg BID starting 1-2 weeks before quit date
C. Varenicline 0.5 mg daily titrated to 1 mg BID, a partial alpha-4 beta-2 nicotinic agonist
[CORRECT]
D. Clonidine 0.1 mg BID as off-label adjunct
Correct Answer: C
Rationale: Varenicline is a partial agonist at the alpha-4 beta-2 nicotinic receptor that reduces craving and attenuates the
rewarding effects of smoking. It has the highest abstinence rates of the single-agent pharmacotherapies but carries an FDA
warning for neuropsychiatric symptoms (mood changes, suicidal ideation) requiring monitoring. Bupropion is also effective
but contraindicated with seizure/eating disorder history. NRT is safe and effective but less so as monotherapy. The patient
should also be referred to 1-800-QUIT-NOW for behavioral counseling.
Q9: A 23-year-old male presents with cyclic vomiting, abdominal pain, and reports that hot
showers reliably relieve his symptoms. He admits to chronic daily cannabis use. Which syndrome
is MOST likely, and what is the recommended first-line treatment?
A. Opioid withdrawal syndrome; treat with buprenorphine
B. Cannabis hyperemesis syndrome; first-line is cessation of cannabis use with supportive care (IV
fluids, antiemetics) [CORRECT]
C. Alcoholic ketoacidosis; treat with IV dextrose and thiamine
D. Cyclic vomiting syndrome; treat with tricyclic antidepressants
Correct Answer: B
Rationale: Cannabis hyperemesis syndrome (CHS) presents with cyclic vomiting, abdominal pain, and pathognomonic
relief from hot showers or baths in chronic daily cannabis users. The definitive treatment is cessation of cannabis use, which
resolves symptoms over days to weeks. Supportive care during acute episodes includes IV fluids, electrolyte correction, and
antiemetics (haloperidol or topical capsaicin have shown benefit). Traditional antiemetics like ondansetron are often
ineffective. Continued cannabis use perpetuates the syndrome.
Q10: A 41-year-old patient with long-term alprazolam use (4 mg/day for 5 years) abruptly stops
taking the medication. She presents with severe anxiety, tremors, and a witnessed tonic-clonic
seizure. Which pharmacological management is MOST appropriate for benzodiazepine
withdrawal?
A. Convert to an equivalent dose of diazepam and taper by 10% per week [CORRECT]
B. Begin phenytoin for seizure prophylaxis long-term
C. Administer naloxone to reverse benzodiazepine toxicity
D. Prescribe disulfiram for aversion therapy
Correct Answer: A
Rationale: Sedative-hypnotic-anxiolytic withdrawal can be life-threatening (seizures, delirium). The standard management
is to convert the patient's current benzodiazepine to a long-acting equivalent (diazepam) and taper gradually at ~10% per
week to minimize withdrawal symptoms and seizure risk. Abrupt discontinuation is contraindicated. Phenytoin is not used
for benzodiazepine withdrawal seizures. Naloxone reverses opioids, not benzodiazepines. Disulfiram is for AUD. The 10%
weekly taper is the Wilkes NSG 526 standard for safe benzodiazepine discontinuation.
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