The emergency department (ED) nurse is caring for a client who arrives with altered mental status, slurred speech, pinpoint pupils, bradypnea, and hypotension. The nurse is concerned that this client is experiencing
The emergency department (ED) nurse is caring for a client who arrives with altered mental status, slurred speech, pinpoint pupils, bradypnea, and hypotension. The nurse is concerned that this client is experiencing
A. alcohol intoxication.
[21%]
B. alcohol withdrawal.
[7%]
C. cocaine intoxication.
[15%]
D. opioid intoxication.
[57%]
Statistics
Subject/Lesson
Subject
Mental Health
Lesson
Substance Abuse and other dependencies
Client Need
Test Plan
Reduction of Risk Potential
Related Topic
Potential for Alterations in Body Systems
Item Type
Item Type
Analysis
Explanation
Choice D is correct. The client is showing signs of opiate intoxication. Pinpoint pupils, slurred speech, inattention, lethargy, psychomotor retardation, and impaired memory, judgment, and social function characterize opiate intoxication. Changes to vitals include hypotension, decreased heart rate, reduced temperature, and bradypnea are expected.
Choice A is incorrect. Alcohol intoxication is characterized by unsteady gait/balance, nystagmus, flushed face, sedation, impaired judgment, uninhibited behavior, talkativeness, slurred speech, impaired memory, and irritability. Alcohol intoxication does not feature pinpoint pupils.
Choice B is incorrect. Irritability, tremors, altered mental status, diaphoresis, nystagmus, and life-threatening seizure activity are manifestations associated with alcohol withdrawal. Pinpoint pupils are not a feature of alcohol withdrawal.
Choice C is incorrect. Cocaine intoxication is characterized by pupil dilation, increased or decreased heart rate and blood pressure, chills, nausea/vomiting, sweating, pacing, psychomotor agitation, visual or tactile hallucinations, and hyper-vigilance.
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2 Key Topics
Substance abuse
13.4 Substance Use & Family Systems
Additional Info
✓ Opioid intoxication may be life-threatening because the individual may experience bradypnea, leading to respiratory arrest.
✓ The treatment for opioid intoxication is immediate administration of naloxone. Naloxone may be administered subcutaneously, intravenously, or intranasally.
✓ Opioid intoxication may cause an individual to experience cool and clammy skin, pinpoint pupils, lethargy, slurred speech, and bradypnea.
