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?

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.