A nurse is monitoring a patient who abuses alcohol for signs of alcohol withdrawal. Which of the following would alert the nurse to the potential for delirium tremors (DTs)?

Appeared in: Uttarakhand CHO - 2021

Explanation

Delirium tremens (DTs) is the most severe form of alcohol withdrawal, characterized by profound autonomic hyperactivity.
This hyperactivity manifests as hypertension (high blood pressure), tachycardia, fever, and diaphoresis.
The classic triad of DTs includes severe confusion or delirium (changes in level of consciousness), vivid hallucinations (often visual or tactile), and extreme agitation.
The onset of DTs is typically 48 to 96 hours after the last alcoholic drink, making this a critical period for intensive monitoring.

Why Other Options Were Wrong

Option B: This option includes hypotension (low blood pressure), which is contrary to the signs of DTs. While ataxia and vomiting can occur during alcohol withdrawal, the presence of hypotension makes this choice incorrect for DTs.
Option C: Muscular rigidity is not a characteristic feature of DTs. The typical presentation involves coarse tremors and severe psychomotor agitation. Stupor is also less common than a state of hyper-alertness and delirium.
Option D: Similar to option B, this choice incorrectly lists hypotension. Although coarse hand tremors and agitation are hallmark signs of alcohol withdrawal, the presence of hypotension rules out DTs, which are defined by a hyperdynamic state (hypertension).

Related Visual

Clinical Relevance

Nursing practice connection: Use the key finding related to Signs and Symptoms of Delirium Tremens (Alcohol Withdrawal) to guide bedside assessment, documentation, and the next nursing action.
Delirium tremens is a medical emergency with a mortality rate as high as 20% if left untreated, often due to complications like respiratory failure, arrhythmias, or pneumonia.
Nurses must use a standardized tool, such as the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar), to systematically assess for withdrawal symptoms and guide timely pharmacological intervention, typically with benzodiazepines.
A priority nursing action is the administration of thiamine before any glucose-containing IV fluids to prevent Wernicke's encephalopathy, a serious neurological complication of chronic alcohol abuse.

How to Approach the Question

Identify the core clinical concept: The question asks for signs of the most severe form of alcohol withdrawal, which is Delirium Tremens (DTs).
Recall the key pathophysiology of DTs: It is a state of extreme central nervous system and autonomic hyperactivity resulting from the abrupt cessation of alcohol.
Analyze the options based on this pathophysiology. Look for a cluster of symptoms that reflects this hyperactive, delirious state.
Evaluate Option A: Hypertension (autonomic hyperactivity), changes in LOC (delirium), and hallucinations are the classic triad of DTs. This aligns perfectly with the pathophysiology.
Systematically eliminate other options: Options B and D include hypotension, which is the direct opposite of the expected autonomic response. Option C includes muscular rigidity, which is not a typical sign. Therefore, these options can be confidently ruled out.

Concept Tested & Keywords

Concept Tested: Signs and Symptoms of Delirium Tremens (Alcohol Withdrawal)
Stem keywords: alcohol withdrawal, delirium tremors, DTs, signs
Lead-in keywords: alert the nurse, potential for
Negative lead-in flag: false

Question ID

QYoH78u9q6X1yI5BOxlbYB

Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 891-893, 2564-2566

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 4228-4230

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