Alcohol Withdrawal & Delirium Tremens NCLEX Quiz

1. A patient at high risk for delirium tremens is admitted. Which preventive nursing intervention is most important?

Keep the room brightly lit and stimulating

Provide frequent reorientation and a calm, supportive environment

Restrict all visitors and communication

Administer sedatives routinely every 2 hours

2. The mortality rate of untreated delirium tremens is significant. What is the approximate mortality range if DTs progresses without intervention?

1-5%

5-10%

10-15%

20-35%

3. Which assessment finding indicates the patient is progressing toward severe alcohol withdrawal and potential delirium tremens?

Stable vital signs with mild tremor

Hallucinations, hypertension, hyperthermia, and severe diaphoresis

Fatigue and decreased appetite

Mild anxiety and insomnia only

4. A patient in alcohol withdrawal develops a temperature of 104°F (40°C), severe agitation, and rigidity. Which complication is most likely?

Sepsis from concurrent infection

Neuroleptic malignant syndrome from antipsychotic use

Delirium tremens with hyperthermia

Thyroid storm

5. Thiamine supplementation is essential in alcohol withdrawal. What is the primary reason for early thiamine administration?

To prevent Wernicke-Korsakoff syndrome

To reduce tremors directly

To enhance benzodiazepine metabolism

To restore normal liver function

6. A patient with alcohol withdrawal is receiving lorazepam IV. Which laboratory value should be monitored to assess for a major complication of prolonged benzodiazepine use?

Liver function tests (AST, ALT)

Glucose levels

Respiratory function and blood gas

Renal function (BUN, creatinine)

7. Which symptom cluster best differentiates delirium tremens from simple alcohol withdrawal?

Tremor and mild anxiety only

Visual or tactile hallucinations, autonomic instability, and disorientation

Headache and mild nausea

Increased appetite and insomnia

8. A patient with chronic alcohol use is admitted for surgery. Which prophylactic measure is recommended to prevent alcohol withdrawal and delirium tremens?

Abrupt cessation of all alcohol immediately

Slow tapering of alcohol or benzodiazepine substitution preoperatively

High-dose antipsychotics started immediately

Increased sedation only during the operative period

9. True or False: Alcohol withdrawal syndrome can be safely managed at home with outpatient support if the patient has a strong social support network.

True

False

10. Alcohol withdrawal can trigger autonomic hyperactivity. Which mechanism best explains this physiological response?

Loss of GABA inhibition and excess glutamate activity

Decreased dopamine production in the brain

Elevated acetylcholine levels throughout the CNS

Reduced serotonin reuptake in synapses

11. A patient with a 20-year history of heavy alcohol use is admitted to the ICU 12 hours after last drink. Which finding is most consistent with early alcohol withdrawal?

Tremors, diaphoresis, tachycardia, and anxiety

Seizures, hyperthermia, and hallucinations

Bradycardia, hypotension, and lethargy

Miosis, respiratory depression, and pinpoint pupils

12. Which medication should be avoided in a patient with acute alcohol withdrawal because it may precipitate or worsen hallucinations?

Thiamine (vitamin B1)

Antipsychotics as monotherapy without benzodiazepines

Magnesium sulfate

Folic acid

13. The Clinical Institute Withdrawal Assessment (CIWA-Ar) scale is used to monitor alcohol withdrawal severity. A score above which value indicates severe withdrawal?

5

10

15

20

14. A patient on day 2 of alcohol withdrawal develops a generalized seizure. Which nursing action is the priority?

Administer oxygen and protect airway

Immediately give IV lorazepam

Place patient in four-point restraints

Call for stat psychiatric consultation

15. Which electrolyte imbalance is most commonly associated with severe alcohol withdrawal and increases seizure risk?

Hyperkalemia

Hypocalcemia

Hypomagnesemia

Hypernatremia

16. A patient in acute alcohol withdrawal is experiencing hallucinations and disorientation. Which vital sign abnormality would you expect?

Hypotension and bradycardia

Hypertension and tachycardia

Hypothermia and slow respirations

Normal vital signs with neurological changes only

17. Which medication is the first-line agent for managing alcohol withdrawal and preventing progression to delirium tremens?

Naltrexone

Benzodiazepines (lorazepam or diazepam)

Antipsychotics (haloperidol)

Beta-blockers (propranolol)

18. Delirium tremens (DTs) is the most severe form of alcohol withdrawal. Which timeframe marks the typical onset of DTs?

12 to 24 hours after last drink

24 to 48 hours after last drink

48 to 96 hours after last drink

7 to 10 days after last drink

19. When does alcohol withdrawal syndrome typically begin after the last drink?

Within 1 to 2 hours

Within 6 to 24 hours

Within 48 to 72 hours

After 1 week

Alcohol Withdrawal Quiz: Can You Prevent DTs?