# A nurse is assessing a 28-year-old client admitted to the emergency department with suspected opioid withdrawal. Which assessment finding would be most indicative of opioid withdrawal syndrome? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543428 > language: ko > subject: Mental Health ## 문제 A nurse is assessing a 28-year-old client admitted to the emergency department with suspected opioid withdrawal. Which assessment finding would be most indicative of opioid withdrawal syndrome? ## 보기 1. Constricted pupils and decreased respiratory rate 2. Dilated pupils and increased heart rate **✔ 정답** 3. Euphoria and increased appetite 4. Sedation and slurred speech **정답: 2** ## 해설 Opioid withdrawal presents with sympathetic activation: dilated pupils and tachycardia are classic signs, opposite to intoxication. Other options describe intoxication effects. ## 심화 해설 Understanding Opioid Withdrawal Pathophysiology When you assess a client with suspected opioid withdrawal, recognizing the underlying neurobiology helps you anticipate the clinical picture. Opioid receptors, particularly the mu-receptors, are abundant in the locus coeruleus, a region of the brainstem that regulates autonomic functions. Chronic opioid use suppresses the firing of noradrenergic neurons in this area. When the opioid is abruptly removed, a rebound phenomenon occurs: there is a surge in norepinephrine release. This excessive noradrenergic activity drives the hallmark sympathetic nervous system signs of withdrawal [1]. Breaking Down the Clinical Signs The Clinical Opiate Withdrawal Scale (COWS), a validated tool for assessing withdrawal severity, directly measures the physiological manifestations of this noradrenergic storm [1]. The correct answer, dilated pupils and increased heart rate, reflects two key measurable signs. Pupillary dilation, or mydriasis, occurs because the surge of norepinephrine stimulates alpha-1 receptors on the radial muscle of the iris, causing it to contract. Simultaneously, the increased sympathetic outflow to the sinoatrial node elevates the heart rate, a finding objectively scored on the COWS as a resting pulse rate above a baseline threshold [1]. Why the Other Options Are Incorrect The remaining options describe clinical states that are either opposite to withdrawal or indicative of opioid intoxication. - Constricted pupils and decreased respiratory rate are classic signs of acute opioid intoxication, not withdrawal. Opioid agonism at the mu-receptor stimulates the parasympathetic Edinger-Westphal nucleus, leading to pinpoint pupils, and depresses the brainstem respiratory centers, causing bradypnea. - Euphoria and increased appetite can be associated with the initial reinforcing effects of opioid use or with recovery from withdrawal, but they are not the objective, measurable signs of the acute noradrenergic rebound that defines the withdrawal syndrome as measured by a scale like the COWS [1]. - Sedation and slurred speech are central nervous system depressant effects that align with opioid intoxication or overdose, standing in direct contrast to the central nervous system hyperarousal state of withdrawal. Clinical Application of the COWS Assessment In practice, a nurse uses a structured tool like the COWS to move beyond a subjective report and quantify the withdrawal syndrome. The scale assigns points for objective findings, including an elevated resting pulse rate and pupil size. A finding of dilated pupils would contribute a specific score, and a heart rate consistently above 100 bpm would add further points, helping to categorize the withdrawal severity as mild, moderate, or severe [1]. This objective scoring directly guides pharmacologic intervention decisions, such as the need for and dosing of opioid agonist therapy. The reliability and validity of such scales, as demonstrated in translation studies, are critical because they ensure that the clinical signs you are observing—like pupil size and heart rate—are consistently linked to the underlying construct of withdrawal severity across different patient populations [1].References (research sources) - [1]Reliability and Validity Study of the Turkish Version of the Clinical Opiate Withdrawal Scale.Research articleAltintoprak AE, Evren EC, Aydemir Ö, Yapici Eslek A, Can Y, Mutlu E, Tokuçoğlu L, Deveci A, Coşkunol H. (2015) · DOI: 10.5152/npa.2015.7169 ## 임상 시나리오 Opioid Withdrawal AssessmentRecognizing the Noradrenergic Storm The key driver of withdrawal is a rebound norepinephrine surge in the locus coeruleus when opioids are stopped. This creates a hyperadrenergic state. Use the COWS tool to objectively score severity. Look for mydriasis (dilated pupils) and a resting pulse rate above the patient's baseline, often over 100 bpm. CautionDo not mistake withdrawal for intoxication. Intoxication presents with central nervous system depression: miosis (pinpoint pupils), bradypnea, and sedation. ## 핵심 개념 - **Locus Coeruleus** — A brainstem region rich in noradrenergic neurons that regulate autonomic function; its rebound hyperactivity causes withdrawal symptoms. - **Mydriasis** — Pupillary dilation caused by norepinephrine stimulating the iris radial muscle, a key sign of opioid withdrawal. - **Clinical Opiate Withdrawal Scale (COWS)** — A validated tool used to assess the severity of opioid withdrawal by measuring objective signs like pulse rate and pupil size. - **Noradrenergic Storm** — The surge in norepinephrine release following abrupt opioid cessation, driving sympathetic nervous system activation. - **Mu-receptors** — Opioid receptors in the brain whose chronic suppression leads to physical dependence and a withdrawal syndrome when stimulation stops. ## 같은 주제 문제 - [A nurse in the emergency department is assessing a 28-year-old client with suspected opioi…](https://mymerci.kr/pages/nclex_q.php?qn_id=543427) - [A nurse is caring for a client with opioid use disorder who is experiencing withdrawal sym…](https://mymerci.kr/pages/nclex_q.php?qn_id=543429) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._