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A
PAWS does not exist — all withdrawal symptoms resolve within a week
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B
PAWS involves prolonged neurological symptoms (anxiety, sleep disturbance, mood instability, cognitive difficulties, reduced stress tolerance) that can persist for weeks to months after acute withdrawal resolves — understanding PAWS helps clients recognize it and not mistake it for relapse
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C
PAWS only occurs with opioid withdrawal
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D
PAWS is treated with benzodiazepines indefinitely
Why this is the answer
POST-ACUTE WITHDRAWAL SYNDROME (PAWS) — also called protracted withdrawal — is a second phase of withdrawal symptoms that emerge after the acute withdrawal phase resolves. CLINICAL PRESENTATION for alcohol (and other CNS depressants): Anxiety and irritability; sleep disturbances (insomnia, vivid dreams); mood instability, depression; cognitive difficulties (brain fog, difficulty concentrating, memory problems); reduced ability to handle stress; fatigue; strong cravings; TIMELINE: Can persist from weeks to 2 years depending on severity and duration of use; symptoms are typically episodic (good days and bad days) rather than constant; MECHANISM: Long-term alcohol use causes neuroadaptation (the brain's chemistry and structure change); acute withdrawal represents the overcorrection when alcohol is removed; PAWS reflects the slower process of the brain re-regulating its neurotransmitter systems to baseline; WHY IT MATTERS FOR RECOVERY: PAWS symptoms are a major trigger for relapse — clients feel the discomfort and may use substances to relieve it; clients who don't know about PAWS may interpret symptoms as mental illness or permanent damage, leading to hopelessness; NURSING TEACHING: Normalize PAWS as expected and temporary; identify coping strategies (exercise, sleep hygiene, stress management); connect to peer support; PAWS does NOT require benzodiazepines (risk of cross-dependence); non-pharmacological management is preferred; SSRIs and naltrexone may help some symptoms.
Source: NCLEX-RN Test Plan: Psychosocial — Substance Use, PAWS