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HESI Specialty Exam Bank: Substance Use Disorder Withdrawal
& Relapse Prevention Questions & Rationales
Table of Contents
Subtopic 1: Recognition and Assessment of Withdrawal Symptoms in Substance Use
Disorders ..................................................................................................................... 2
Subtopic 2: Pharmacologic Management of Withdrawal ................................................ 10
Subtopic 3: Nursing Care Priorities in the Withdrawal Phase .......................................... 19
Subtopic 4: Complications During Withdrawal and Emergency Interventions .................. 28
Subtopic 5: Motivational Interviewing and Stages of Change .......................................... 37
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Subtopic 1: Recognition and Assessment of Withdrawal
Symptoms in Substance Use Disorders
Question 1:
A patient admitted for alcohol detoxification begins to show tremors, diaphoresis, and
anxiety 8 hours after their last drink. What is the most appropriate nursing intervention?
A. Encourage fluid intake and monitor vitals every 8 hours
B. Administer benzodiazepines as prescribed and initiate CIWA protocol
C. Place the patient on a cardiac monitor for suspected myocardial infarction
D. Initiate a no-stimulation protocol and keep the lights off
Correct answer: B
Rationale: Alcohol withdrawal typically begins 6–12 hours after cessation. Benzodiazepines
reduce the risk of seizures and DTs. The CIWA protocol helps monitor withdrawal severity.
Question 2:
Which of the following symptoms is most concerning for progression to delirium tremens
(DTs) in a patient withdrawing from alcohol?
A. Headache and restlessness
B. Insomnia and nausea
C. Hallucinations and severe agitation
D. Bradycardia and pinpoint pupils
Correct answer: C
Rationale: Hallucinations and agitation are hallmark signs of DTs, a life-threatening alcohol
withdrawal complication. It requires immediate medical attention.
Question 3:
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A nurse is caring for a patient withdrawing from opioids. Which symptom is expected during
the initial 12–24 hours of withdrawal?
A. Respiratory depression
B. Yawning and lacrimation
C. Euphoria and drowsiness
D. Visual hallucinations
Correct answer: B
Rationale: Early opioid withdrawal symptoms include yawning, lacrimation, rhinorrhea,
and piloerection. Respiratory depression is associated with opioid intoxication, not
withdrawal.
Question 4:
A patient withdrawing from benzodiazepines is at risk for which serious complication?
A. Hypertension
B. Coma
C. Seizures
D. Delirium tremens
Correct answer: C
Rationale: Benzodiazepine withdrawal can cause life-threatening seizures, particularly if
the drug was taken at high doses or for a prolonged period.
Question 5:
Which finding in a patient undergoing methamphetamine withdrawal requires immediate
reassessment?
A. Fatigue and hypersomnia
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B. Cravings and irritability
C. Suicidal ideation
D. Increased appetite
Correct answer: C
Rationale: Suicidal ideation is a medical emergency. Methamphetamine withdrawal often
includes depression and risk for suicide, requiring immediate psychiatric evaluation.
Question 6:
What tool is most appropriate for assessing severity of alcohol withdrawal?
A. Beck Depression Inventory
B. GAD-7 Scale
C. Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar)
D. CAGE Questionnaire
Correct answer: C
Rationale: CIWA-Ar quantifies the severity of alcohol withdrawal and guides medication
administration. The CAGE tool screens for alcohol use disorder but is not for acute
withdrawal.
Question 7:
A client in opioid withdrawal presents with piloerection, dilated pupils, and muscle aches.
Which medication should the nurse anticipate administering?
A. Flumazenil
B. Clonidine
C. Lorazepam
D. Methadone
HESI Specialty Exam Bank: Substance Use Disorder Withdrawal
& Relapse Prevention Questions & Rationales
Table of Contents
Subtopic 1: Recognition and Assessment of Withdrawal Symptoms in Substance Use
Disorders ..................................................................................................................... 2
Subtopic 2: Pharmacologic Management of Withdrawal ................................................ 10
Subtopic 3: Nursing Care Priorities in the Withdrawal Phase .......................................... 19
Subtopic 4: Complications During Withdrawal and Emergency Interventions .................. 28
Subtopic 5: Motivational Interviewing and Stages of Change .......................................... 37
, 2
Subtopic 1: Recognition and Assessment of Withdrawal
Symptoms in Substance Use Disorders
Question 1:
A patient admitted for alcohol detoxification begins to show tremors, diaphoresis, and
anxiety 8 hours after their last drink. What is the most appropriate nursing intervention?
A. Encourage fluid intake and monitor vitals every 8 hours
B. Administer benzodiazepines as prescribed and initiate CIWA protocol
C. Place the patient on a cardiac monitor for suspected myocardial infarction
D. Initiate a no-stimulation protocol and keep the lights off
Correct answer: B
Rationale: Alcohol withdrawal typically begins 6–12 hours after cessation. Benzodiazepines
reduce the risk of seizures and DTs. The CIWA protocol helps monitor withdrawal severity.
Question 2:
Which of the following symptoms is most concerning for progression to delirium tremens
(DTs) in a patient withdrawing from alcohol?
A. Headache and restlessness
B. Insomnia and nausea
C. Hallucinations and severe agitation
D. Bradycardia and pinpoint pupils
Correct answer: C
Rationale: Hallucinations and agitation are hallmark signs of DTs, a life-threatening alcohol
withdrawal complication. It requires immediate medical attention.
Question 3:
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A nurse is caring for a patient withdrawing from opioids. Which symptom is expected during
the initial 12–24 hours of withdrawal?
A. Respiratory depression
B. Yawning and lacrimation
C. Euphoria and drowsiness
D. Visual hallucinations
Correct answer: B
Rationale: Early opioid withdrawal symptoms include yawning, lacrimation, rhinorrhea,
and piloerection. Respiratory depression is associated with opioid intoxication, not
withdrawal.
Question 4:
A patient withdrawing from benzodiazepines is at risk for which serious complication?
A. Hypertension
B. Coma
C. Seizures
D. Delirium tremens
Correct answer: C
Rationale: Benzodiazepine withdrawal can cause life-threatening seizures, particularly if
the drug was taken at high doses or for a prolonged period.
Question 5:
Which finding in a patient undergoing methamphetamine withdrawal requires immediate
reassessment?
A. Fatigue and hypersomnia
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B. Cravings and irritability
C. Suicidal ideation
D. Increased appetite
Correct answer: C
Rationale: Suicidal ideation is a medical emergency. Methamphetamine withdrawal often
includes depression and risk for suicide, requiring immediate psychiatric evaluation.
Question 6:
What tool is most appropriate for assessing severity of alcohol withdrawal?
A. Beck Depression Inventory
B. GAD-7 Scale
C. Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar)
D. CAGE Questionnaire
Correct answer: C
Rationale: CIWA-Ar quantifies the severity of alcohol withdrawal and guides medication
administration. The CAGE tool screens for alcohol use disorder but is not for acute
withdrawal.
Question 7:
A client in opioid withdrawal presents with piloerection, dilated pupils, and muscle aches.
Which medication should the nurse anticipate administering?
A. Flumazenil
B. Clonidine
C. Lorazepam
D. Methadone
