Alcohol Withdrawal Orders



Name____________________

Employee #_______________

Date____________________

CIWA (Alcohol Withdrawal Orders)

Post Quiz

1. A patient who is on the Alcohol Withdrawal Orders must be assessed for symptoms

of withdrawal by:

a. Assigned RN who has been trained to use the alcohol withdrawal orders and

CIWA-Ar assessment.

b. The nursing supervisor

c. The assigned nurse

d. The charge nurse

2. You have been assigned a patient who transferred from the ICU today. He has

been in the ICU for 2 days following a MVA and has a broken femur. The doctor

wrote transfer orders and included the alcohol withdrawal orders. The patient scores

14 on the CIWA-Ar scale. How much Ativan would you give?

a. None

b. 1 mg IV/PO

c. 4 mg IV/PO

d. 2 mg IV/PO

3. During the admission assessment of a patient, he tells you that he does drink

alcohol and usually drinks a pint of vodka per day. What other information do you

need from this patient?

a. The day and time of his last drink of alcohol.

b. Information about seizures during a period of alcohol withdrawal in the past.

c. Any information concerning difficulty during a period of alcohol withdrawal

in the past.

d. All of the above

4. A total score of 22 on the CIWA-Ar scale indicates that the patient:

a. Does not need medication

b. Is having severe withdrawal symptoms

c. Is having mild withdrawal symptoms

d. Is having moderate withdrawal symptoms

5. How often must you monitor a patient who has a CIWA-Ar score of less than 8?

a. Every hour x 4 consecutively, then every 4 hours

b. Every 30 minutes

c. Every 15 minutes

d. Every 8 hours

6. Your patient has a high anion gap, elevated serum ketones, and a BS of 149. You call the physician to report that the patient is showing symptoms of:

a. Diabetic ketoacidosis

b. Metabolic alkalosis

c. Alcoholic ketoacidosis

d. Respiratory acidosis

7. What types of problems might be seen with alcohol withdrawal?

a. Delirium tremors

b. Seizures

c. Anxiety

d. Vomiting

e. Hallucinations

f. All of the above

8. The DT’s are a life threatening complication that is treated with:

a. D5NS

b. 25 ml of 50% glucose IVP stat

c. Romazicon 1 ml IV slow push every 2 – 3 minutes until desired response is

obtained.

d. Sedatives, antihypertensive medication, antiseizure medication, and life support measures PRN.

9. In addition to the CIWA-Ar assessment score, what additional monitoring does a

patient who is withdrawing from alcohol and on the alcohol withdrawal order set

require:

a. Pulse oximetry

b. Vital signs at least every 4 hours

c. Sedation score every 4 hours and every dose of lorezapam (Ativan)

d. All of the above

10. What scale is used to assess the sedation level of the patient?

a. RASS Scale

b. Conscious Sedation Assessment Scale

c. Aldrete Scale

d. Glascow Coma Scale

11. Where is the sedation scale located in EPIC?

       a. Head to Toe doc flow sheet

       b. Vital Signs doc flow sheet

       c. Daily Cares/Safety doc flow sheet

d. Intake and Output doc flow sheet

12. When can the CIWA-Ar assessment be discontinued:

a. When CIWA-Ar is less than 8 for 72 hours

b. When CIWA-Ar is less than 15 for 72 hours

c. When CIWA-Ar is less than 20 for 72 hours

d. The CIWA-Ar is continued as long as the patient is in the hospital.

True or False

______ 13. A patient with a history of previous seizures during alcohol withdrawal has a 70% chance of seizures reoccurring during alcohol withdrawal.

______14. When the neurotransmitter GABA binds to the GABA receptor, it allows chloride into the intracellular space which decreases neural activity.

_____15. The goal of the administration of Ativan to a patient in alcohol withdrawal is to keep the patient at a sedation of RASS -4 to -5.

_____16. Thiamine 100mg is given within the first 4 hours or admission to alleviate the symptoms of Wernicke-Korsakoff syndrome.

_____17. If you have administered 6 mg of Ativan in 2 hours or CIWA-Ar score > 9 on more than 2 consecutive assessments, call the physician.

_____18. Continuous Ativan drips for alcohol withdrawal are used on all units.

_____19. DTs during alcohol withdrawal are annoying for the patient and cause insignificant results.

_____20. You have just received orders for the Universal Alcohol Withdrawal on your patient. You should obtain orders to place the patient on continuous pulse oximetry and cardiac monitoring.

_____21. A patient on the alcohol withdrawal protocol who is over sedated may be given Naloxone.

Answer Key Alcohol Withdrawal Orders Quiz

1. a

2. d

3. d

4. b

5. a

6. c

7. f

8. d

9. d

10. a

11. b

12. a

13. T

14. T

15. F

16. T

17. T

18. F

19. F

20. T

21. F

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