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NCLEX · Substance Use Disorders

A client in alcohol withdrawal is being monitored using the CIWA-Ar scale. What does a rising CIWA-Ar score indicate?

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Correct answer

Worsening withdrawal severity — a rising score indicates escalating symptoms and the need for more aggressive treatment (typically benzodiazepine dosing) to prevent progression to seizures or delirium tremens

  1. A Worsening withdrawal severity — a rising score indicates escalating symptoms and the need for more aggressive treatment (typically benzodiazepine dosing) to prevent progression to seizures or delirium tremens
  2. B Improvement in withdrawal symptoms
  3. C Successful detoxification
  4. D The client is ready for discharge

Why this is the answer

CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised): A validated 10-item scale that quantifies alcohol withdrawal severity.

Items: Nausea/vomiting, tremor, sweating, anxiety, agitation, tactile/auditory/visual disturbances, headache, orientation.

Scoring: Higher score = more severe withdrawal; guides symptom-triggered benzodiazepine dosing; RISING SCORE = worsening — requires more aggressive treatment; WITHDRAWAL PROGRESSION (if untreated): Tremors/anxiety (6-12h) → hallucinations (12-24h) → seizures (24-48h) → delirium tremens (48-96h, life-threatening).

Treatment: Benzodiazepines (lorazepam, diazepam, chlordiazepoxide) are first-line — symptom-triggered dosing based on CIWA score; thiamine (B1) BEFORE glucose (prevents Wernicke encephalopathy); fluid/electrolyte management; quiet environment.

Delirium tremens: Medical emergency with high mortality if untreated — confusion, severe autonomic instability, hallucinations; nursing role: assess with CIWA, administer benzodiazepines per protocol, monitor for escalation, ensure safety, give thiamine.

Source: NCLEX-RN Psychosocial — Substance Use, CIWA-Ar Scale

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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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