Nclexrn Quiz: Substance Use And Withdrawal Care

What this quiz covers

This quiz focuses on Substance Use And Withdrawal Care, giving you a quick way to practice the rules, question types, and explanations that matter most for Nclexrn.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

Question 1

1. Place the client on continuous cardiac and pulse oximetry monitoring, initiate seizure precautions, and administer prescribed benzodiazepine per protocol (correct answer)
2. Provide extensive education about Alcoholics Anonymous meeting schedules
3. Request a prescription for nicotine gum to address restlessness
4. Collect a detailed dietary recall to address electrolyte abnormalities

Explanation: This question tests nursing interventions and clinical judgment related to substance use, addressing delirium tremens in alcohol withdrawal. The priority concern is the client's confusion, severe tremors, hallucinations, fever, tachycardia, hypertension, and hypokalemia, indicating high mortality risk. Placing on monitoring, seizure precautions, and administering benzodiazepines is the best choice as it stabilizes autonomic hyperactivity, referencing vital signs and disorientation. AA education is long-term; nicotine gum irrelevant; dietary recall secondary. The underlying principle of care in substance use scenarios is aggressive symptom management to prevent seizures and cardiovascular collapse. Electrolyte replacement supports recovery. A transferable nursing strategy is to orient frequently and reduce stimuli in hallucinating clients.

Question 2

1. Glucose 56 mg/dL (normal 70–110) (correct answer)
2. Mild tremors and anxiety
3. Blood pressure 150/86 mm Hg
4. History of alcohol use disorder

Explanation: This question tests nursing interventions and clinical judgment related to substance use, addressing acute complications in alcohol use disorder. The priority concern is the client's anxiety, mild tremors, tachycardia, hypertension, and hypoglycemia, with risk for seizures or altered mental status. The glucose of 56 mg/dL requires immediate attention as alcoholics are prone to hypoglycemia, exacerbating withdrawal. Tremors and anxiety are expected; blood pressure elevated but secondary; history not acute. The underlying principle of care in substance use scenarios is correcting metabolic derangements promptly. Glucose administration follows thiamine to prevent encephalopathy. A transferable nursing strategy is to check blood glucose routinely in withdrawing clients and treat per protocol.

Question 3

1. Request a prescription for disulfiram and provide medication teaching
2. Administer naloxone and prepare for rapid sequence intubation
3. Obtain a detailed timeline of alcohol intake and complete a full substance-use screening tool
4. Institute seizure precautions and administer the prescribed benzodiazepine per alcohol-withdrawal protocol (correct answer)

Explanation: This question tests nursing interventions and clinical judgment related to substance use, specifically recognizing and managing alcohol withdrawal syndrome. The priority concern is the client's symptoms of diaphoresis, anxiety, tremors, nausea, insomnia, tachycardia, hypertension, and electrolyte imbalances, indicating severe alcohol withdrawal with risk for seizures and delirium tremens. Instituting seizure precautions and administering benzodiazepines per protocol is the best choice because the client's elevated heart rate, blood pressure, and low magnesium and potassium levels increase seizure risk, requiring immediate stabilization. Requesting disulfiram is incorrect as it is for aversion therapy post-detox, not acute withdrawal; obtaining a timeline is important but not immediate; naloxone is for opioids, not alcohol, which is a common misconception in mixed substance cases. The underlying principle of care in substance use scenarios is to prioritize physiological stability and prevent life-threatening complications like seizures or cardiovascular events. Additionally, electrolyte correction and thiamine administration are essential to avoid Wernicke-Korsakoff syndrome. A transferable nursing strategy is to use standardized tools like CIWA-Ar for ongoing assessment and symptom-triggered interventions in withdrawal management.

Question 4

1. Temperature 38.6°C (101.5°F) with severe agitation and tachycardia (correct answer)
2. Report of not sleeping for 2 days
3. Potassium 4.0 mEq/L within normal range
4. Client statement that staff are "trying to poison me"

Explanation: This question tests nursing interventions and clinical judgment related to substance use, identifying critical signs in stimulant intoxication. The priority concern is the client's insomnia, diaphoresis, jaw clenching, paranoia, fever, tachycardia, and hypertension, signaling severe toxicity. The temperature of 38.6°C with agitation and tachycardia requires immediate attention as it indicates hyperthermia and risk for cardiac arrhythmia or rhabdomyolysis. Insomnia is expected; normal potassium is not urgent; paranoia is concerning but secondary to vital sign instability. The underlying principle of care in substance use scenarios is to address hyperadrenergic crises promptly to prevent organ damage. Cooling measures and benzodiazepines may be needed. A transferable nursing strategy is to monitor for dehydration and electrolyte shifts in prolonged stimulant use.

Question 5

1. Blood pressure 188/104 mm Hg with new-onset hallucinations and disorientation (correct answer)
2. Sodium 132 mEq/L with mild headache
3. History of alcohol use disorder for more than 10 years
4. Client reports poor sleep since admission

Explanation: This question tests nursing interventions and clinical judgment related to substance use, specifically identifying severe alcohol withdrawal complications. The priority concern is the client's confusion, visual hallucinations, agitation, fever, tachycardia, hypertension, and hyponatremia, suggesting delirium tremens. The blood pressure of 188/104 mm Hg with hallucinations requires immediate attention as it indicates autonomic hyperactivity and risk for stroke or seizures. Mild hyponatremia with headache is less urgent; long history is a risk factor but not acute; poor sleep is common but not critical. The underlying principle of care in substance use scenarios is to recognize escalating symptoms like delirium for prompt intervention. Benzodiazepines and supportive care are key to prevent mortality. A transferable nursing strategy is to monitor vital signs frequently and use scales like CIWA-Ar to guide treatment in withdrawal.

Question 6

1. Start intravenous fluids at a keep-vein-open rate and wait for the provider to evaluate the client
2. Place the client in a low-stimulation environment and encourage sleep
3. Obtain consent for substance-use treatment and initiate referral paperwork
4. Administer naloxone per protocol and provide ventilatory support while preparing for possible repeat dosing (correct answer)

Explanation: This question tests nursing interventions and clinical judgment related to substance use, responding to opioid overdose. The priority concern is the client's cyanosis, bradypnea, hypoxia, bradycardia, hypotension, pinpoint pupils, and unresponsiveness, indicating severe respiratory depression. Administering naloxone with ventilatory support is the best choice as it reverses effects quickly, addressing the low saturation and rate. IV fluids alone ignore reversal; consent delays emergency care; low stimulation is insufficient for apnea. The underlying principle of care in substance use scenarios is rapid antidote administration in life-threatening overdoses. Preparation for intubation may be needed if no response. A transferable nursing strategy is to train laypersons in naloxone use for community overdose prevention.

Question 7

1. Request an order for naloxone to keep at the bedside for withdrawal symptoms
2. Encourage the client to ambulate in the hallway to reduce anxiety
3. Obtain a detailed family history of substance use disorders
4. Administer thiamine as prescribed before giving glucose-containing fluids or nutrition (correct answer)

Explanation: This question tests nursing interventions and clinical judgment related to substance use, preventing complications in alcohol withdrawal. The priority concern is the client's tremors, anxiety, tachycardia, hypertension, and hypomagnesemia, with risk for Wernicke's encephalopathy. Administering thiamine before glucose is the best choice as it prevents neurological damage, supported by the vital signs and low magnesium. Ambulation increases fall risk; family history is not immediate; naloxone is for opioids. The underlying principle of care in substance use scenarios is nutritional supplementation to counter deficiencies from chronic alcohol use. Benzodiazepines address symptoms separately. A transferable nursing strategy is to routinely give thiamine, folate, and multivitamins in alcohol use disorder admissions.

Question 8

1. Offer nicotine patch therapy to reduce agitation
2. Ask security to apply restraints immediately without further assessment
3. Complete a full head-to-toe physical assessment before addressing behavior
4. Attempt verbal de-escalation, ensure adequate staff support, and maintain a safe distance with an exit route (correct answer)

Explanation: This question tests nursing interventions and clinical judgment related to substance use, de-escalating stimulant-induced agitation. The priority concern is the client's refusal of care, shouting, throwing objects, tachycardia, hypertension, hostility, and paranoia, posing safety risks. Attempting verbal de-escalation with staff support and safe positioning is the best choice as it prevents escalation, per the vital signs and behavior. Immediate restraints bypass least-restrictive options; full assessment risks safety; nicotine patch is unrelated. The underlying principle of care in substance use scenarios is non-confrontational approaches in psychotic states. Medications like antipsychotics may follow if needed. A transferable nursing strategy is to document behaviors and interventions for legal protection in behavioral crises.

Question 9

1. Teach coping strategies for cravings and offer nicotine replacement therapy options such as patch plus short-acting gum or lozenge (correct answer)
2. Administer naloxone and observe for withdrawal symptoms
3. Institute seizure precautions for the first 72 hours after quitting nicotine
4. Request a prescription for benzodiazepines to prevent relapse

Explanation: This question tests nursing interventions and clinical judgment related to substance use, supporting sustained nicotine cessation. The priority concern is the client's cravings and weight gain one week post-quitting heavy smoking, with motivation but frustration. Teaching coping strategies and offering combined NRT is the best choice as it addresses symptoms and prevents relapse, per the stable vital signs. Naloxone is for opioids; seizure precautions unnecessary for nicotine; benzodiazepines inappropriate. The underlying principle of care in substance use scenarios is multimodal therapy for addiction management. Behavioral techniques like exercise help with weight concerns. A transferable nursing strategy is to follow up regularly and adjust plans based on progress.

Question 10

1. Request a prescription for nicotine patch to reduce sedation
2. Provide counseling about medication-assisted treatment options and schedule follow-up appointments
3. Obtain a comprehensive social history including housing and employment
4. Apply supplemental oxygen, stimulate the client, and prepare to administer naloxone per protocol if respirations decline further (correct answer)

Explanation: This question tests nursing interventions and clinical judgment related to substance use, preventing progression in opioid intoxication. The priority concern is the client's sleepiness, bradypnea, hypoxia, bradycardia, pinpoint pupils, and responsiveness only to voice, risking full overdose. Applying oxygen, stimulating, and preparing naloxone is the best choice as it maintains ventilation, per the low rate and saturation. Counseling is later; social history non-urgent; nicotine patch irrelevant. The underlying principle of care in substance use scenarios is early intervention to avoid respiratory arrest. Stimulation techniques like sternal rub can temporize. A transferable nursing strategy is to teach harm reduction, like not using alone, to prevent overdoses.

Question 11

1. Continue routine vital signs every 8 hours because symptoms are mild
2. Initiate a standardized alcohol-withdrawal assessment and administer prescribed medication based on the score (correct answer)
3. Obtain a complete family history of substance use disorders
4. Request a prescription for methadone to prevent withdrawal-related discomfort

Explanation: This question tests nursing interventions and clinical judgment related to substance use, specifically early alcohol withdrawal requiring systematic assessment and treatment. The priority concern is that this client with heavy daily alcohol use is showing early withdrawal signs (anxiety, tremors, nausea, elevated vital signs) 8 hours after last drink, requiring immediate standardized assessment to guide medication administration and prevent progression. Initiating standardized withdrawal assessment and administering medication based on scores (B) is the best choice because it provides objective measurement of withdrawal severity and ensures appropriate benzodiazepine dosing to prevent complications. Continuing routine vital signs (A) dangerously underestimates withdrawal risks, obtaining family history (C) delays urgent treatment, and methadone (D) is for opioid not alcohol withdrawal. The underlying principle is that alcohol withdrawal severity can progress rapidly, and standardized assessment tools (like CIWA-Ar) guide evidence-based treatment to prevent seizures and delirium tremens. The transferable nursing strategy is to use validated withdrawal assessment tools immediately upon recognizing early symptoms, reassess frequently, and administer medications based on objective scores rather than subjective judgment.

Question 12

1. Administer naloxone per protocol and support ventilation as needed (correct answer)
2. Obtain a urine drug screen before giving any medications
3. Place the client in a quiet room and dim the lights to reduce stimulation
4. Request a prescription for methadone to prevent withdrawal symptoms

Explanation: This question tests nursing interventions and clinical judgment related to substance use, specifically opioid overdose management. The priority concern is respiratory depression (rate 6/min, O2 sat 82%) with classic opioid overdose signs (pinpoint pupils, unresponsiveness) requiring immediate reversal to prevent respiratory arrest and death. Administering naloxone and supporting ventilation (A) is the best choice because it directly reverses opioid-induced respiratory depression and restores adequate oxygenation within minutes. Obtaining a urine drug screen (B) wastes precious time when the clinical presentation is clear, placing in a quiet room (C) ignores the life-threatening respiratory depression, and methadone (D) would worsen the overdose as it's an opioid agonist, not an antagonist. The underlying principle is that opioid overdose causes potentially fatal respiratory depression that requires immediate reversal with naloxone, an opioid antagonist, while supporting ventilation. The transferable nursing strategy is to recognize the opioid overdose triad (respiratory depression, pinpoint pupils, decreased consciousness), administer naloxone immediately, and monitor for re-sedation as naloxone's duration is shorter than most opioids.

Question 13

1. The client reports generalized muscle aches and yawning
2. Respiratory rate decreases to 8/min with oxygen saturation 88% on room air (correct answer)
3. The client requests to leave the emergency department to go home
4. The client reports nausea and abdominal cramping

Explanation: This question tests nursing interventions and clinical judgment related to substance use, specifically post-naloxone monitoring after opioid overdose reversal. The priority concern is that the client's respiratory rate has decreased to 8/min with hypoxia (O2 sat 88%), indicating re-sedation as naloxone's effects wear off while longer-acting opioids remain in the system. Respiratory depression recurring after naloxone (B) requires immediate attention because it indicates opioid effects are outlasting the antagonist, risking respiratory arrest. Muscle aches and yawning (A) are expected opioid withdrawal symptoms from naloxone, requesting to leave (C) is concerning but not immediately life-threatening, and nausea/cramping (D) are also expected withdrawal symptoms. The underlying principle is that naloxone has a shorter duration (30-90 minutes) than most opioids, requiring continuous monitoring for re-sedation and potential need for repeat doses or continuous infusion. The transferable nursing strategy is to monitor post-naloxone patients closely for at least 2-4 hours, watching for return of respiratory depression, and being prepared to administer additional naloxone doses as needed.

Question 14

1. Place the client in a quiet room with dim lighting to reduce stimulation
2. Collect a urine toxicology screen before initiating any treatment
3. Request a prescription for buprenorphine-naloxone and begin induction teaching
4. Administer naloxone immediately per protocol and support ventilation with a bag-valve mask (correct answer)

Explanation: This question tests nursing interventions and clinical judgment related to substance use, focusing on acute opioid overdose reversal. The priority concern is the client's unresponsiveness, shallow breathing, low oxygen saturation, bradycardia, hypotension, pinpoint pupils, and respiratory acidosis, signaling opioid-induced respiratory depression. Administering naloxone immediately and supporting ventilation is the best choice as it rapidly reverses opioid effects, addressing the life-threatening hypoventilation and low saturation. Collecting a urine toxicology screen delays care, which is a misconception that testing must precede treatment; buprenorphine is for maintenance, not acute overdose; a quiet room is unsuitable for respiratory compromise. The underlying principle of care in substance use scenarios is to ensure airway, breathing, and circulation stability first in overdoses. Supportive measures like oxygen and monitoring for renarcotization are crucial due to naloxone's short half-life. A transferable nursing strategy is to prepare for precipitated withdrawal and have repeat doses ready while educating on harm reduction.

Question 15

1. Administer prescribed thiamine before giving glucose-containing fluids or nutrition (correct answer)
2. Ask the provider to prescribe disulfiram to prevent relapse
3. Obtain a repeat blood alcohol level to determine the severity of withdrawal
4. Encourage the client to ambulate in the hallway to reduce anxiety

Explanation: This question tests nursing interventions and clinical judgment related to substance use, specifically early alcohol withdrawal with risk for Wernicke's encephalopathy. The priority concern is that this client with chronic alcohol use is at high risk for thiamine deficiency, and administering glucose without thiamine first can precipitate Wernicke's encephalopathy, a medical emergency causing confusion, ataxia, and eye movement abnormalities. Administering thiamine before glucose (A) is the best choice because it prevents this irreversible neurological complication while addressing the borderline low glucose safely. Disulfiram (B) is contraindicated during withdrawal, repeat alcohol levels (C) don't guide withdrawal treatment, and encouraging ambulation (D) could be unsafe with potential ataxia and doesn't address the thiamine deficiency. The underlying principle is that chronic alcohol use depletes thiamine stores, and glucose administration increases thiamine demand, potentially triggering Wernicke's encephalopathy if thiamine isn't replaced first. The transferable nursing strategy is to always administer thiamine before or with glucose in any patient with alcohol use disorder, regardless of withdrawal severity, to prevent permanent neurological damage.

Question 16

1. Administer naloxone and monitor for recurrent respiratory depression
2. Teach coping strategies and initiate nicotine replacement therapy per clinic protocol (correct answer)
3. Obtain an electrocardiogram before discussing any treatment options
4. Request a prescription for disulfiram to reduce nicotine cravings

Explanation: This question tests nursing interventions and clinical judgment related to substance use, specifically nicotine withdrawal management. The priority concern is the client's nicotine withdrawal symptoms (cravings, irritability, insomnia, difficulty concentrating) that began 2 days after cessation, which can lead to relapse without appropriate support. Teaching coping strategies and initiating nicotine replacement therapy (B) is the best choice because it addresses withdrawal symptoms, reduces cravings, and supports successful cessation through evidence-based interventions. Naloxone (A) is for opioid overdose and irrelevant here, obtaining an ECG (C) is unnecessary with normal vital signs and no cardiac symptoms, and disulfiram (D) is for alcohol use disorder, not nicotine dependence. The underlying principle is that nicotine withdrawal, while not life-threatening, requires prompt symptom management and behavioral support to prevent relapse and promote successful cessation. The transferable nursing strategy is to recognize nicotine withdrawal symptoms, provide immediate coping strategies, initiate replacement therapy when appropriate, and offer ongoing support throughout the cessation process.

Question 17

1. Approach with a calm, nonthreatening stance, set clear limits, and call for assistance to maintain safety (correct answer)
2. Begin motivational interviewing about readiness to stop using methamphetamine
3. Ask the provider to prescribe disulfiram to reduce cravings
4. Obtain a full sleep history and teach sleep hygiene strategies

Explanation: This question tests nursing interventions and clinical judgment related to substance use, specifically acute methamphetamine intoxication with escalating aggression. The priority concern is the client's paranoid, threatening behavior with sympathetic overstimulation (tachycardia, hypertension, hyperthermia) creating immediate danger to self, staff, and other patients requiring de-escalation and safety measures. Approaching calmly, setting limits, and calling for assistance (A) is the best choice because it prioritizes safety while using therapeutic communication to prevent violence and prepare for potential physical intervention if needed. Starting motivational interviewing (B) is inappropriate during acute intoxication with paranoia, disulfiram (C) is for alcohol not stimulants, and teaching sleep hygiene (D) ignores the immediate safety threat. The underlying principle is that stimulant-induced paranoia and aggression require immediate safety interventions, including team response, before any therapeutic interventions can be attempted. The transferable nursing strategy is to maintain a calm demeanor, ensure adequate backup is available, use clear and simple communication, respect personal space, and be prepared to implement emergency protocols if verbal de-escalation fails.

Question 18

1. Collect a urine specimen for toxicology screening before initiating treatment
2. Administer naloxone per protocol and provide bag-valve-mask ventilation with supplemental oxygen (correct answer)
3. Request a prescription for buprenorphine to begin maintenance therapy in the emergency department
4. Place the client in a quiet, low-stimulation environment and reorient as needed

Explanation: This question tests nursing interventions and clinical judgment related to substance use, specifically severe opioid overdose with respiratory acidosis. The priority concern is profound respiratory depression (rate 7/min, O2 sat 84%) with respiratory acidosis (pH 7.28, PaCO2 58) indicating inadequate ventilation and imminent respiratory arrest requiring immediate reversal and ventilatory support. Administering naloxone and providing bag-valve-mask ventilation (B) is the best choice because it simultaneously reverses opioid effects and corrects hypoxemia/hypercapnia through assisted ventilation. Collecting urine for toxicology (A) delays life-saving treatment, starting buprenorphine (C) would worsen the overdose as it's a partial opioid agonist, and placing in a quiet environment (D) ignores the critical respiratory failure. The underlying principle is that severe opioid overdose with respiratory acidosis requires both pharmacological reversal with naloxone and mechanical ventilatory support to prevent death from hypoxic brain injury. The transferable nursing strategy is to recognize that severe respiratory depression may require ventilatory support beyond naloxone alone, especially when acidosis is present, and to provide assisted ventilation while administering the antidote.

Question 19

1. Encourage oral fluids and offer a high-calorie meal to restore nutrition
2. Use calm verbal de-escalation, maintain safety, and reduce environmental stimulation (correct answer)
3. Ask the provider for a nicotine patch to address cravings and irritability
4. Complete a detailed psychosocial assessment and develop a long-term relapse-prevention plan

Explanation: This question tests nursing interventions and clinical judgment related to substance use, specifically methamphetamine intoxication management. The priority concern is the client's acute agitation, paranoia, and aggressive behavior combined with sympathetic overstimulation (tachycardia, hypertension, elevated CK) that poses immediate safety risks to self and others. Using calm verbal de-escalation, maintaining safety, and reducing environmental stimulation (B) is the best choice because it addresses the immediate behavioral crisis while avoiding physical confrontation that could escalate violence. Encouraging oral fluids and meals (A) ignores the acute behavioral emergency, nicotine patches (C) are irrelevant to methamphetamine intoxication, and completing a detailed assessment (D) is premature when the client is acutely agitated and paranoid. The underlying principle is that stimulant intoxication causes hypervigilance, paranoia, and potential violence requiring immediate de-escalation and environmental management before any other interventions. The transferable nursing strategy is to approach stimulant-intoxicated clients calmly, reduce sensory stimulation, maintain safe distances, and use verbal techniques while having backup readily available for safety.

Question 20

1. Implement seizure precautions and administer prescribed benzodiazepine therapy for severe withdrawal (correct answer)
2. Obtain a complete dietary recall and request a nutrition consult
3. Ask the provider to start disulfiram before discharge to promote abstinence
4. Collect a repeat blood alcohol level to confirm the diagnosis of withdrawal

Explanation: This question tests nursing interventions and clinical judgment related to substance use, specifically severe alcohol withdrawal (delirium tremens). The priority concern is that this client is experiencing delirium tremens (confusion, hallucinations, severe autonomic instability, hyperthermia) 24 hours after last drink, which carries a 5-15% mortality risk if untreated. Implementing seizure precautions and administering benzodiazepines (A) is the best choice because it addresses the life-threatening withdrawal syndrome, prevents seizures, and reduces mortality through GABA receptor activation. Obtaining dietary recall (B) ignores the medical emergency, disulfiram (C) is contraindicated during acute withdrawal and could be dangerous, and collecting repeat alcohol levels (D) is unnecessary as withdrawal diagnosis is clinical, not based on blood alcohol content. The underlying principle is that delirium tremens is a medical emergency requiring immediate benzodiazepine therapy, seizure precautions, and intensive monitoring to prevent death from autonomic instability or seizures. The transferable nursing strategy is to recognize severe withdrawal symptoms (confusion, hallucinations, vital sign instability), implement safety measures immediately, and administer benzodiazepines per protocol while correcting electrolyte imbalances.