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NCLEX RN Exam Bank: Substance Use Disorders,
Withdrawal, Relapse Prevention & Support
Table of Contents
Subtopic 1: Recognition and Management of Acute Withdrawal Symptoms....................... 2
Subtopic 2: Relapse Triggers, Coping Mechanisms & Behavioral Interventions ................ 10
Subtopic 3: Pharmacologic Therapies for Substance Use Disorders ................................ 19
Subtopic 4: Nursing Care in Detoxification Units ........................................................... 28
Subtopic 5: Substance Use and Comorbid Mental Health Disorders ............................... 37
Subtopic 6: Pregnancy, Neonatal Effects & Perinatal Management of Substance Use
Disorders ................................................................................................................... 46
Subtopic 7: Pharmacologic Management of Substance Use Disorders ............................ 54
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Subtopic 1: Recognition and Management of Acute
Withdrawal Symptoms
Question 1
A patient with a history of chronic alcohol use is admitted for detoxification. Which of the
following symptoms is most concerning and requires immediate intervention?
A. Nausea and vomiting
B. Tremors in hands
C. Visual hallucinations
D. Headache
Correct Answer: C. Visual hallucinations
Rationale: Visual hallucinations are a sign of alcohol withdrawal delirium (delirium
tremens), which is a medical emergency. Tremors, nausea, and headaches are common
but less severe symptoms of withdrawal.
Question 2
A patient undergoing opioid withdrawal is likely to experience which of the following
symptoms?
A. Euphoria and sedation
B. Hypothermia and bradycardia
C. Yawning, rhinorrhea, and muscle aches
D. Confusion and hallucinations
Correct Answer: C. Yawning, rhinorrhea, and muscle aches
Rationale: These are hallmark symptoms of opioid withdrawal, which is uncomfortable but
not typically life-threatening.
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Question 3
Which medication is commonly used to manage symptoms of alcohol withdrawal?
A. Methadone
B. Lorazepam
C. Naltrexone
D. Disulfiram
Correct Answer: B. Lorazepam
Rationale: Benzodiazepines like lorazepam are first-line agents for managing alcohol
withdrawal due to their ability to reduce the risk of seizures and delirium tremens.
Question 4
Which assessment tool is most appropriate for monitoring alcohol withdrawal symptoms?
A. PHQ-9
B. GAD-7
C. CIWA-Ar
D. CAGE
Correct Answer: C. CIWA-Ar
Rationale: The Clinical Institute Withdrawal Assessment for Alcohol—Revised (CIWA-Ar)
scale is used to assess and monitor alcohol withdrawal symptoms in a clinical setting.
Question 5
Which electrolyte abnormality is most concerning during acute alcohol withdrawal?
A. Hypomagnesemia
B. Hyperkalemia
C. Hypernatremia
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D. Hypocalcemia
Correct Answer: A. Hypomagnesemia
Rationale: Hypomagnesemia can increase the risk of seizures and cardiac arrhythmias in
alcohol withdrawal and must be corrected promptly.
Question 6
A nurse is caring for a patient withdrawing from cocaine. Which of the following is an
expected symptom?
A. Diaphoresis and hallucinations
B. Depression and hypersomnia
C. Hypertension and hyperreflexia
D. Bradycardia and confusion
Correct Answer: B. Depression and hypersomnia
Rationale: Cocaine withdrawal often presents with "crash" symptoms such as fatigue,
hypersomnia, and depression.
Question 7
Which of the following is the most appropriate nursing action when managing a patient with
opioid withdrawal?
A. Restrict all fluids
B. Administer prescribed clonidine
C. Place patient on seizure precautions
D. Encourage complete bed rest
Correct Answer: B. Administer prescribed clonidine
NCLEX RN Exam Bank: Substance Use Disorders,
Withdrawal, Relapse Prevention & Support
Table of Contents
Subtopic 1: Recognition and Management of Acute Withdrawal Symptoms....................... 2
Subtopic 2: Relapse Triggers, Coping Mechanisms & Behavioral Interventions ................ 10
Subtopic 3: Pharmacologic Therapies for Substance Use Disorders ................................ 19
Subtopic 4: Nursing Care in Detoxification Units ........................................................... 28
Subtopic 5: Substance Use and Comorbid Mental Health Disorders ............................... 37
Subtopic 6: Pregnancy, Neonatal Effects & Perinatal Management of Substance Use
Disorders ................................................................................................................... 46
Subtopic 7: Pharmacologic Management of Substance Use Disorders ............................ 54
, 2
Subtopic 1: Recognition and Management of Acute
Withdrawal Symptoms
Question 1
A patient with a history of chronic alcohol use is admitted for detoxification. Which of the
following symptoms is most concerning and requires immediate intervention?
A. Nausea and vomiting
B. Tremors in hands
C. Visual hallucinations
D. Headache
Correct Answer: C. Visual hallucinations
Rationale: Visual hallucinations are a sign of alcohol withdrawal delirium (delirium
tremens), which is a medical emergency. Tremors, nausea, and headaches are common
but less severe symptoms of withdrawal.
Question 2
A patient undergoing opioid withdrawal is likely to experience which of the following
symptoms?
A. Euphoria and sedation
B. Hypothermia and bradycardia
C. Yawning, rhinorrhea, and muscle aches
D. Confusion and hallucinations
Correct Answer: C. Yawning, rhinorrhea, and muscle aches
Rationale: These are hallmark symptoms of opioid withdrawal, which is uncomfortable but
not typically life-threatening.
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Question 3
Which medication is commonly used to manage symptoms of alcohol withdrawal?
A. Methadone
B. Lorazepam
C. Naltrexone
D. Disulfiram
Correct Answer: B. Lorazepam
Rationale: Benzodiazepines like lorazepam are first-line agents for managing alcohol
withdrawal due to their ability to reduce the risk of seizures and delirium tremens.
Question 4
Which assessment tool is most appropriate for monitoring alcohol withdrawal symptoms?
A. PHQ-9
B. GAD-7
C. CIWA-Ar
D. CAGE
Correct Answer: C. CIWA-Ar
Rationale: The Clinical Institute Withdrawal Assessment for Alcohol—Revised (CIWA-Ar)
scale is used to assess and monitor alcohol withdrawal symptoms in a clinical setting.
Question 5
Which electrolyte abnormality is most concerning during acute alcohol withdrawal?
A. Hypomagnesemia
B. Hyperkalemia
C. Hypernatremia
, 4
D. Hypocalcemia
Correct Answer: A. Hypomagnesemia
Rationale: Hypomagnesemia can increase the risk of seizures and cardiac arrhythmias in
alcohol withdrawal and must be corrected promptly.
Question 6
A nurse is caring for a patient withdrawing from cocaine. Which of the following is an
expected symptom?
A. Diaphoresis and hallucinations
B. Depression and hypersomnia
C. Hypertension and hyperreflexia
D. Bradycardia and confusion
Correct Answer: B. Depression and hypersomnia
Rationale: Cocaine withdrawal often presents with "crash" symptoms such as fatigue,
hypersomnia, and depression.
Question 7
Which of the following is the most appropriate nursing action when managing a patient with
opioid withdrawal?
A. Restrict all fluids
B. Administer prescribed clonidine
C. Place patient on seizure precautions
D. Encourage complete bed rest
Correct Answer: B. Administer prescribed clonidine
