1
HESI Exit Exam Study Guide:
Substance Use Disorder, Withdrawal
& Relapse Prevention
Table of Contents
Subtopic 1: Alcohol Withdrawal Syndrome & Detox Nursing Care...................2
Subtopic 2: Opioid Withdrawal Management & Nursing Priorities...................9
Subtopic 3: Sedative-Hypnotic Withdrawal & Benzodiazepine Taper Protocols
.......................................................................................................................16
Subtopic 4: Stimulant (Cocaine, Methamphetamine) Withdrawal & Nursing
Interventions..................................................................................................23
Subtopic 5: Cannabis & Hallucinogen Withdrawal – Clinical Implications &
Supportive Care.............................................................................................31
Subtopic 6: Medication-Assisted Treatment (MAT) Protocols – Nursing
Considerations for Methadone, Buprenorphine & Naltrexone........................38
Subtopic 7: Dual Diagnosis – Managing Co-occurring Mental Health and
Substance Use Disorders...............................................................................45
Subtopic 8: Withdrawal Protocols in Emergency & Acute Settings................52
Subtopic 9: Pharmacologic Management in Recovery and Maintenance.......59
Subtopic 10: Dual Diagnosis and Co-Occurring Mental Health Conditions.....66
, 2
Subtopic 1: Alcohol Withdrawal Syndrome &
Detox Nursing Care
1. A nurse is caring for a patient who is 12 hours post-admission for alcohol
detox. Which symptom would be most concerning and require immediate
attention?
A. Mild tremors
B. Nausea
C. Hallucinations
D. Insomnia
Correct Answer: C. Hallucinations
Rationale: Hallucinations at this stage may indicate the onset of alcohol
withdrawal delirium (delirium tremens), a medical emergency. Early
intervention is crucial to prevent progression.
2. Which medication is commonly administered to prevent seizures during
alcohol withdrawal?
A. Haloperidol
B. Lorazepam
C. Naloxone
D. Buspirone
Correct Answer: B. Lorazepam
Rationale: Benzodiazepines like lorazepam are first-line agents to prevent
withdrawal seizures and reduce the risk of delirium tremens during alcohol
detoxification.
3. What lab value is most critical to monitor during acute alcohol withdrawal?
A. Hemoglobin
B. Platelet count
, 3
C. Magnesium
D. LDL cholesterol
Correct Answer: C. Magnesium
Rationale: Hypomagnesemia is common in alcoholics and can exacerbate
withdrawal symptoms including seizures. Monitoring and correcting this is
essential.
4. A patient in alcohol withdrawal reports visual hallucinations and confusion.
What should the nurse do first?
A. Reassure the patient they are safe
B. Notify the healthcare provider immediately
C. Provide distraction techniques
D. Administer acetaminophen
Correct Answer: B. Notify the healthcare provider immediately
Rationale: Visual hallucinations and confusion are signs of severe withdrawal;
prompt medical attention is needed to initiate or escalate pharmacologic
treatment.
5. What is the priority nursing diagnosis for a patient undergoing alcohol
withdrawal?
A. Risk for loneliness
B. Risk for injury
C. Impaired social interaction
D. Disturbed body image
Correct Answer: B. Risk for injury
Rationale: Seizures, hallucinations, and confusion place the patient at high
risk for injury during withdrawal, making this the top priority.
6. Which of the following is a CIWA-Ar scale used for?
, 4
A. To assess readiness for relapse prevention therapy
B. To assess the severity of alcohol withdrawal symptoms
C. To measure liver function
D. To monitor long-term sobriety
Correct Answer: B. To assess the severity of alcohol withdrawal symptoms
Rationale: The Clinical Institute Withdrawal Assessment for Alcohol-Revised
(CIWA-Ar) is a validated tool to guide treatment decisions during withdrawal.
7. Which of the following findings should alert the nurse to escalating
withdrawal severity?
A. Bradycardia
B. Hypertension and diaphoresis
C. Hypotension and hypothermia
D. Elevated blood glucose
Correct Answer: B. Hypertension and diaphoresis
Rationale: These are hallmark signs of autonomic hyperactivity during
withdrawal and can indicate worsening condition.
8. What is the main goal during the first 72 hours of alcohol withdrawal
treatment?
A. Prevent complications such as seizures and delirium tremens
B. Counsel the patient on relapse prevention
C. Provide nutritional counseling
D. Establish long-term sobriety
Correct Answer: A. Prevent complications such as seizures and delirium
tremens
Rationale: The early phase of withdrawal is critical for preventing life-
threatening complications.
HESI Exit Exam Study Guide:
Substance Use Disorder, Withdrawal
& Relapse Prevention
Table of Contents
Subtopic 1: Alcohol Withdrawal Syndrome & Detox Nursing Care...................2
Subtopic 2: Opioid Withdrawal Management & Nursing Priorities...................9
Subtopic 3: Sedative-Hypnotic Withdrawal & Benzodiazepine Taper Protocols
.......................................................................................................................16
Subtopic 4: Stimulant (Cocaine, Methamphetamine) Withdrawal & Nursing
Interventions..................................................................................................23
Subtopic 5: Cannabis & Hallucinogen Withdrawal – Clinical Implications &
Supportive Care.............................................................................................31
Subtopic 6: Medication-Assisted Treatment (MAT) Protocols – Nursing
Considerations for Methadone, Buprenorphine & Naltrexone........................38
Subtopic 7: Dual Diagnosis – Managing Co-occurring Mental Health and
Substance Use Disorders...............................................................................45
Subtopic 8: Withdrawal Protocols in Emergency & Acute Settings................52
Subtopic 9: Pharmacologic Management in Recovery and Maintenance.......59
Subtopic 10: Dual Diagnosis and Co-Occurring Mental Health Conditions.....66
, 2
Subtopic 1: Alcohol Withdrawal Syndrome &
Detox Nursing Care
1. A nurse is caring for a patient who is 12 hours post-admission for alcohol
detox. Which symptom would be most concerning and require immediate
attention?
A. Mild tremors
B. Nausea
C. Hallucinations
D. Insomnia
Correct Answer: C. Hallucinations
Rationale: Hallucinations at this stage may indicate the onset of alcohol
withdrawal delirium (delirium tremens), a medical emergency. Early
intervention is crucial to prevent progression.
2. Which medication is commonly administered to prevent seizures during
alcohol withdrawal?
A. Haloperidol
B. Lorazepam
C. Naloxone
D. Buspirone
Correct Answer: B. Lorazepam
Rationale: Benzodiazepines like lorazepam are first-line agents to prevent
withdrawal seizures and reduce the risk of delirium tremens during alcohol
detoxification.
3. What lab value is most critical to monitor during acute alcohol withdrawal?
A. Hemoglobin
B. Platelet count
, 3
C. Magnesium
D. LDL cholesterol
Correct Answer: C. Magnesium
Rationale: Hypomagnesemia is common in alcoholics and can exacerbate
withdrawal symptoms including seizures. Monitoring and correcting this is
essential.
4. A patient in alcohol withdrawal reports visual hallucinations and confusion.
What should the nurse do first?
A. Reassure the patient they are safe
B. Notify the healthcare provider immediately
C. Provide distraction techniques
D. Administer acetaminophen
Correct Answer: B. Notify the healthcare provider immediately
Rationale: Visual hallucinations and confusion are signs of severe withdrawal;
prompt medical attention is needed to initiate or escalate pharmacologic
treatment.
5. What is the priority nursing diagnosis for a patient undergoing alcohol
withdrawal?
A. Risk for loneliness
B. Risk for injury
C. Impaired social interaction
D. Disturbed body image
Correct Answer: B. Risk for injury
Rationale: Seizures, hallucinations, and confusion place the patient at high
risk for injury during withdrawal, making this the top priority.
6. Which of the following is a CIWA-Ar scale used for?
, 4
A. To assess readiness for relapse prevention therapy
B. To assess the severity of alcohol withdrawal symptoms
C. To measure liver function
D. To monitor long-term sobriety
Correct Answer: B. To assess the severity of alcohol withdrawal symptoms
Rationale: The Clinical Institute Withdrawal Assessment for Alcohol-Revised
(CIWA-Ar) is a validated tool to guide treatment decisions during withdrawal.
7. Which of the following findings should alert the nurse to escalating
withdrawal severity?
A. Bradycardia
B. Hypertension and diaphoresis
C. Hypotension and hypothermia
D. Elevated blood glucose
Correct Answer: B. Hypertension and diaphoresis
Rationale: These are hallmark signs of autonomic hyperactivity during
withdrawal and can indicate worsening condition.
8. What is the main goal during the first 72 hours of alcohol withdrawal
treatment?
A. Prevent complications such as seizures and delirium tremens
B. Counsel the patient on relapse prevention
C. Provide nutritional counseling
D. Establish long-term sobriety
Correct Answer: A. Prevent complications such as seizures and delirium
tremens
Rationale: The early phase of withdrawal is critical for preventing life-
threatening complications.
