The PMHNP is evaluating a 47-year-old man admitted to the substance abuse facility where she is rounding. His pulse is 105 and he is sweating. He has bilateral hand tremors and is nauseated, restless, and agitated. He says he has not slept in 24 hours. What is his most likely diagnosis?
Opioid withdrawal
Alcohol withdrawal
Sedative, hypnotic, or anxiolytic withdrawal
Stimulant withdrawal
The Correct Answer is B
Choice A reason: Opioid withdrawal typically presents with symptoms such as muscle aches, diarrhea, rhinorrhea, and yawning. While restlessness and insomnia may occur, tremors and autonomic instability (e.g., elevated pulse and sweating) are more characteristic of alcohol withdrawal.
Choice B reason: Alcohol withdrawal is marked by autonomic hyperactivity (elevated pulse, sweating), tremors, nausea, agitation, and insomnia. These symptoms match the clinical presentation described. If untreated, it can progress to delirium tremens, which includes hallucinations and seizures.
Choice C reason: Sedative, hypnotic, or anxiolytic withdrawal (e.g., benzodiazepines) can resemble alcohol withdrawal but typically includes more pronounced anxiety, irritability, and risk of seizures. However, the classic signs of autonomic hyperactivity and tremors are more strongly associated with alcohol withdrawal.
Choice D reason: Stimulant withdrawal often includes fatigue, depression, increased appetite, and sleep disturbances. It does not typically present with tremors, autonomic instability, or nausea, making it less likely in this case.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Smoking is a well-established risk factor for oral and oropharyngeal cancers, but its contribution to the increasing incidence has declined due to public health efforts and reduced smoking rates. It remains a significant cause but not the primary driver of the recent rise.
Choice B reason: Air pollution is associated with respiratory and cardiovascular diseases, but it is not a recognized major contributor to oropharyngeal cancers. There is no strong epidemiological link between air pollution and the rising incidence of these cancers.
Choice C reason: Human papillomavirus (HPV), particularly HPV-16, has emerged as the leading cause of the increasing incidence of oropharyngeal cancers, especially among younger adults who do not smoke. HPV-related cancers tend to affect the tonsils and base of the tongue and are biologically distinct from those caused by tobacco and alcohol.
Choice D reason: Alcohol is a known risk factor for oral cancers, especially when combined with tobacco use. However, like smoking, its role in the rising incidence is secondary to HPV, which has become the predominant etiological factor in recent years.
Correct Answer is B
Explanation
Choice A reason: This describes internal validity, which assesses whether the observed effect is due to the intervention and not confounding variables. It does not address generalizability.
Choice B reason: External validity refers to the extent to which study findings can be generalized beyond the specific sample used. If the sample accurately reflects the broader population, the results are more likely to apply in real-world settings, enhancing external validity.
Choice C reason: A p-value of 0.1 suggests that the results are not statistically significant at the conventional threshold of 0.05. It does not relate to external validity, which is about generalizability, not statistical significance.
Choice D reason: Peer-reviewed publication indicates that the research has undergone expert scrutiny, but it does not guarantee external validity. Generalizability depends on study design and sample characteristics, not publication status.
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