AIIMS Delhi NO- 2019
Mental Health Nursing
Easy
A patient came to emergency with alcohol withdrawal symptoms. What symptoms will you observe?
Appeared in: AIIMS Delhi NO- 2019
Explanation
- Tremor, sweating (diaphoresis), and restlessness are the classic triad of early or minor alcohol withdrawal.
- These symptoms typically appear within 6 to 12 hours after a significant reduction or cessation of alcohol intake.
- They are caused by autonomic nervous system hyperactivity as the brain rebounds from the chronic depressive effects of alcohol.
- This cluster of symptoms is a primary indicator used in assessment tools like the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) to gauge withdrawal severity and guide treatment.
Why Other Options Were Wrong
- Option B: Fever is a sign of severe alcohol withdrawal, specifically Delirium Tremens (DTs), which is a medical emergency that typically occurs 48-96 hours after the last drink. The question asks for general symptoms, and the other options represent the more common, earlier stage.
- Option C: Rhinorrhea (a runny nose) is a characteristic symptom of opioid withdrawal, not alcohol withdrawal. While hypertension and sweating are common in alcohol withdrawal, the presence of rhinorrhea makes this option incorrect.
- Option D: Lacrimation (excessive tearing) is another classic sign of opioid withdrawal. Furthermore, a deep coma is not a symptom of withdrawal, which is a state of hyperexcitability. Coma would suggest severe intoxication, a post-seizure state, or another acute neurological event.
Related Visual
Clinical Relevance
- Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Clinical manifestations of Alcohol Withdrawal Syndrome (AWS) in acute care settings.
- Prompt recognition of early withdrawal symptoms using a standardized scale like CIWA-Ar is a critical nursing responsibility. It allows for timely intervention with benzodiazepines to prevent progression to life-threatening complications like seizures and Delirium Tremens.
- Nurses must prioritize administering thiamine (Vitamin B1) before or along with glucose infusions in patients with chronic alcoholism. This prevents the precipitation of Wernicke's encephalopathy, a severe neurological disorder.
- Providing a safe, quiet, and low-stimulus environment is a key nursing intervention to decrease patient agitation, reduce the risk of injury, and minimize hallucinations.
How to Approach the Question
- First, identify the core clinical concept from the stem: the signs and symptoms of alcohol withdrawal.
- The question asks you to identify a cluster of symptoms you would observe. This requires recognizing the most common initial presentation.
- Evaluate each option by comparing it to the known pathophysiology of alcohol withdrawal. Recall that withdrawal is a state of CNS hyperexcitability.
- Option A (Tremor, sweating, restlessness) lists the hallmark signs of early autonomic hyperactivity.
- Analyze the distractors. Option B includes fever, a sign of severe, later-stage withdrawal (DTs). Options C and D include rhinorrhea and lacrimation, which are classic signs of opioid withdrawal, not alcohol withdrawal.
- Select the option that contains the most accurate and characteristic grouping of symptoms for the initial phase of alcohol withdrawal.
Concept Tested & Keywords
- Concept Tested: Clinical manifestations of Alcohol Withdrawal Syndrome (AWS)
- Stem keywords: alcohol withdrawal, symptoms, emergency
- Lead-in keywords: What symptoms will you observe
- Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.
- Negative lead-in flag: false
Question ID
QL_l8a4sKP_3b5w7j2nHha
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 4228-4230, 4252-4254
E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 p. 136-138
Practise the full AIIMS Delhi NO- 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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