Nursing 401 Exam #2 ~ Withdrawal,
SBIRT, & Substance Use Disorders
Exam Questions and Answers
Attach to opioid receptors in the brain, spinal cord, and GI tract and block transmission
of pain - Answer-How do opioids work?
Give euphoric feeling, numb emotional pain, acute relief of psych issues; addictive,
memory deficit, hallucinations/delusions, paranoia, worsening of mental health,
sedation, constipation, resp depression - Answer-What are the pros and cons of opioid
use?
Clinical Opioid Withdrawal Scale (COWS) - Answer-Tool used to assess withdrawal
from opioids
Can ensure safety, conduct withdrawal checks, administer pharmacological
replacement therapy, *prevent TD's if alcohol withdrawal* - Answer-Why is medically
assisted withdrawal (MAW) better than going it alone?
Scored 0-4 or 5 for each parameter; 5-12 = Mild, 13-24 = Moderate, 25-36 = Moderately
severe, 37+ = Severe withdrawal - Answer-How does COWS scoring work?
Tachycardia, sweating, restlessness, dilated pupils, bone/joint aches, runny nose,
tearing, GI upset, diarrhea, tremors, yawning, goosebumps/pilorection - Answer-
Objective symptoms of opioid withdrawal
Room with good lighting, normal = 3 - Answer-How should pupils be assessed during
opioid withdrawal checks?
Tongue or abdomen - Answer-Where can muscle twitching/tremors be observed
objectively?
Have patient in observable area 5 minutes before BP measurement - Answer-How to
prevent patient running in place to raise BP during opioid withdrawal checks
Nausea-crackers, ginger ale, tea, flat warm coke; muscle aches-hot shower, warm
compress, Tylenol; anxiety-distraction, relaxation and talk therapy - Answer-What are
the subjective symptoms of opioid withdrawal and some interventions for relief?
Zofran, Phenergan PO or suppository; not IM r/t "rush" feeling - Answer-PRN meds
given for nausea during opioid withdrawal
, Vistaril or Atarax; avoid benzodiazepines - Answer-PRN meds given for anxiety,
lacrimation, and rhinorrhea during opioid withdrawal
Trazadone - Answer-PRN med given for insomnia during opioid withdrawal
Tylenol (*unless esophageal varices or ulcers r/t alcohol use*), NSAIDs/ibuprofen -
Answer-PRN meds given for myalgias during opioid withdrawal
Kaopectate preferred, avoid Lomotil because of desired sedative effect - Answer-PRN
meds given for diarrhea during opioid withdrawal
Narcan - Answer-Emergency med for respiratory depression (larger dose) and post-op
recovery (smaller dose)
Methadone - Answer-Medication given as substitution for opioids during withdrawal,
especially pregnant mothers, gives more predictable outcome in fetus
Clonidine - Answer-PRN med given for elevated BP during opioid withdrawal
Suboxone (buprenorphine/Narcan) or Subutex (buprenorphine only) - Answer-Meds
given for long-term reduction of opioid cravings; curb cravings without producing "high"
or dangerous SE's, block other opioids, lower abuse potential
Vivitrol - Answer-Long-term med for opioid AND alcohol dependence, binds with opioid
receptors without the high
Fetus experiences withdrawal 2-3 times more intensely than mother-->methadone
makes withdrawal safer - Answer-How does withdrawal affect the fetus if the patient is
pregnant?
Alcohol, benzodiazepines, barbiturates - Answer-The 3 types of sedative-hypnotics
6-12 hrs=minor symptoms, insomnia, shakiness, GI upset, mild anxiety, HA,
diaphoresis, palpitations, anorexia; 12-24 hrs=alcoholic hallucinosis; 24-48
hrs=withdrawal seizures; 48-72 hrs=delirium (DTs), disorientation, tachycardia, low
fever, agitation - Answer-Outline the symptoms of alcohol withdrawal by # of hours after
cessation of use
Lasts 3-5 days, peak at 48 hours - Answer-Typical length of alcohol withdrawal and time
of peak
Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA) - Answer-Tool used
to assess alcohol withdrawal as often as every 30 min
