A nurse is assisting in the care for a client who is exhibiting a depressed mood one week before the start of their menstrual cycle. When collecting data, the nurse should identify that the client is exhibiting manifestations consistent with which of the following disorders?

A. Increased cheerfulness, increased energy, helping other nurses on the shift. While mood changes can sometimes indicate a problem, increased cheerfulness and willingness to help others are not specific red flags for substance use disorder. Substance use is more commonly associated with erratic behavior, frequent absences, or medication discrepancies.
B. Increased irritability towards supervisors, outspokenness regarding work issues, increased attendance at staff meetings. Frustration with workplace issues and increased engagement in staff meetings do not necessarily indicate substance use disorder. Behavioral concerns related to substance use often include impaired judgment, frequent errors, or missing narcotics.
C. Volunteering for overtime on a continual basis, avoiding having a witness to wasting narcotics, needing to be alone in the medication room when preparing medications. Consistently seeking extra shifts, avoiding witnesses when handling narcotics, and needing to be alone while preparing medications suggest possible drug diversion. These behaviors align with common patterns seen in healthcare professionals struggling with substance use disorders.
D. Crying, sharing personal details of relationship problems, monopolizing conversations. Emotional distress and oversharing personal issues may indicate stress or burnout rather than substance use disorder. Substance use concerns are more closely tied to inconsistent work performance, medication discrepancies, and altered behavior related to drug access.

A. Stimulants. Stimulant intoxication typically causes increased energy, agitation, tachycardia, and paranoia, but it does not usually induce hallucinations to the extent described. While severe stimulant use (e.g., methamphetamine or cocaine) can cause paranoia, the significant perceptual disturbances and visual hallucinations suggest a different category of drugs.
B. Opioids. Opioid intoxication generally leads to central nervous system depression, respiratory depression, pinpoint pupils, and sedation rather than paranoia, hallucinations, and erratic behavior. The described symptoms do not align with opioid use.
C. Hallucinogens. Hallucinogen use, such as LSD or PCP, can cause altered perception, paranoia, visual hallucinations, and erratic behavior. The client’s symptoms—paranoia, visual disturbances, mumbling, and gesturing—are characteristic of hallucinogen intoxication, making this the most likely cause.
D. Anabolic steroids. Anabolic steroid use can lead to mood swings, aggression, and psychotic symptoms in some cases, but it does not typically cause acute hallucinations, paranoia, or perceptual disturbances. The symptoms described do not fit anabolic steroid use.