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NCLEX · Substance Use and Dependencies

A client experiencing opioid withdrawal asks when they should expect symptoms to peak. What is the most accurate response for heroin/short-acting opioid withdrawal?

Correct answer

Symptoms peak 36-72 hours after the last dose for short-acting opioids (heroin, oxycodone); earlier onset (6-24 hours) with peak at 36-72 hours; symptoms resolve within 5-7 days

  1. A Immediately upon the last dose
  2. B Symptoms peak 36-72 hours after the last dose for short-acting opioids (heroin, oxycodone); earlier onset (6-24 hours) with peak at 36-72 hours; symptoms resolve within 5-7 days
  3. C Symptoms peak at 2 weeks
  4. D Opioid withdrawal has no predictable timeline

Why this is the answer

OPIOID WITHDRAWAL TIMELINE: Depends on the opioid type: SHORT-ACTING (heroin, oxycodone, hydrocodone): Onset 6-24 hours; Peak 36-72 hours; Resolution 5-7 days; LONG-ACTING (methadone): Onset 36-48 hours; Peak 72-96 hours; Resolution 2-3 weeks; SYMPTOMS: Early: yawning, lacrimation, rhinorrhea, diaphoresis; Peak: severe myalgias, nausea, vomiting, diarrhoea, abdominal cramps, gooseflesh (piloerection), anxiety, insomnia, severe drug craving; MEDICAL SIGNIFICANCE: Opioid withdrawal is RARELY life-threatening in healthy adults (unlike alcohol withdrawal which can cause fatal seizures); however, dehydration from vomiting/diarrhoea can be dangerous; TREATMENT: Methadone or buprenorphine (opioid agonist therapy); clonidine (autonomic symptoms); antiemetics; antidiarrhoeal; comfort measures.
Source: NCLEX-PN PS — Substance Use, Opioid Withdrawal Timeline

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