A nurse is caring for a client who has an alcohol use disorder. Which of the following manifestations should the nurse expect the client to have during withdrawal?

Choice A reason: Fatigue is not a primary symptom of acute alcohol withdrawal. Chronic alcohol use depresses the central nervous system, and withdrawal causes hyperexcitability, leading to symptoms like agitation or anxiety, not lethargy. Fatigue may occur in post-withdrawal recovery or co-occurring conditions like depression, but it is not a hallmark of acute withdrawal syndrome. Choice B reason: Rapid speech is associated with manic episodes or stimulant intoxication, not alcohol withdrawal. Withdrawal causes neurological hyperactivity, manifesting as anxiety, irritability, or confusion, but not typically rapid speech. Disorganized speech may occur in severe cases like delirium tremens, but rapid speech is not a characteristic symptom. Choice C reason: Seizures are a critical manifestation of alcohol withdrawal, typically occurring 12–48 hours after cessation. Chronic alcohol suppresses GABA activity, and abrupt cessation causes a rebound increase in excitatory glutamate, leading to neuronal hyperexcitability. This can result in tonic-clonic seizures, requiring urgent intervention with benzodiazepines to prevent complications like status epilepticus. Choice D reason: Hand tremors are a common early symptom of alcohol withdrawal, appearing within 6–12 hours. They result from autonomic hyperactivity due to decreased GABA inhibition and increased glutamate activity. While significant, tremors are less severe than seizures, which are a medical emergency, making seizures the priority manifestation to expect.