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NCLEX · Substance Use Disorders

A client is admitted for alcohol withdrawal. Which symptom indicates the MOST life-threatening progression of withdrawal?

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Correct answer

Delirium tremens (DTs) — characterised by confusion, agitation, hallucinations, hyperthermia, and autonomic instability (tachycardia, hypertension, diaphoresis); can progress to seizures and death if untreated

  1. A Nausea and vomiting
  2. B Delirium tremens (DTs) — characterised by confusion, agitation, hallucinations, hyperthermia, and autonomic instability (tachycardia, hypertension, diaphoresis); can progress to seizures and death if untreated
  3. C Insomnia and irritability
  4. D Mild tremors

Why this is the answer

Alcohol withdrawal progression: MILD (6-12 hours): Tremors, anxiety, nausea, diaphoresis, palpitations; MODERATE (12-48 hours): Same plus headache, vomiting, transient hallucinations (often visual/auditory), seizures (peak 24-48 hours); SEVERE — DELIRIUM TREMENS (48-96 hours): Life-threatening; disorientation and confusion; agitation; auditory, visual, tactile hallucinations; severe autonomic instability (fever to 104°F+, HR>120, BP crisis); seizures.

Without treatment: DT mortality is 5-15%.

With treatment: <1%.

Treatment: IV benzodiazepines (lorazepam, diazepam) — first-line; thiamine IV before any glucose (prevents Wernicke's encephalopathy); fluid/electrolyte replacement (hypomagnesemia, hypokalemia common); beta-blockers or clonidine for autonomic symptoms; CIWA-Ar scale monitors symptom severity to guide benzodiazepine dosing.

Source: NCLEX-RN Test Plan: Psychosocial — Substance Use, Alcohol Withdrawal Progression

Practice more questions

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About this topic: Substance Use Disorders

Substance use disorder questions cover intoxication and withdrawal syndromes, delirium tremens, the CIWA assessment, medications used in detox and recovery, and the nurse's non-judgemental approach. This is one of 7 RN: Psychosocial Integrity questions on substance use disorders, each with a full explanation on a single study page.

New to this exam? Our NCLEX exam guide explains the format, scoring, and how to prepare.

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