A nurse is caring for a client who has been brought into an emergency department of a large hospital. The client's family state that the client "took some kind of drugs." The client is dizzy, has recently vomited, and is experiencing paranoia, yelling, "Stay away from me! You are going to kill me!" The client alternates yelling with mumbling and gesturing. Their eyes are darting back and forth as they are talking to the wall. The nurse should suspect the client has used which of the following substances?
Anabolic steroids
Opioids
Stimulants
Hallucinogens
The Correct Answer is D
D. The client's symptoms, including paranoia, perceptual disturbances (such as seeing things that aren't there), erratic behavior, and disorientation, are consistent with the effects of hallucinogens. Hallucinogens are a class of drugs that alter perception, mood, and cognitive processes.
A. Anabolic steroids are synthetic variations of the male sex hormone testosterone. They are primarily used to promote muscle growth and enhance athletic performance.
B Opioids are a class of drugs that include prescription pain relievers, such as oxycodone and morphine, as well as illegal drugs like heroin.
C. Stimulants, such as cocaine and amphetamines, can cause symptoms such as paranoia, agitation, and hallucinations, particularly at high doses or with chronic use. However, the client's symptoms of darting eyes, paranoia, yelling, mumbling, and gesturing are more suggestive of hallucinogen use rather than stimulant use.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
D. Tardive dyskinesia (TD) is a side effect of long-term use of first-generation antipsychotic medications, such as those commonly used to treat schizophrenia. It is characterized by involuntary, repetitive movements of the face, tongue, lips, and other parts of the body.
A. Impaired ability to regulate body temperature is more commonly associated with conditions such as heatstroke or certain neurological disorders affecting the hypothalamus, and it typically presents with symptoms such as fever or hypothermia.
B. Extrapyramidal symptoms encompass a range of movement disorders caused by dysfunction of the extrapyramidal system, which includes the basal ganglia.
C. Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening side effect of antipsychotic medications, characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction.
Correct Answer is C
Explanation
C. Reinforcing teaching with vulnerable clients about strategies to prevent illness and promote health is the most immediate and direct action the nurse can take. Education empowers
individuals to make informed decisions about their health and well-being, potentially preventing illness and reducing the need for healthcare services.
A. This action focuses on improving access to care but may not directly address the immediate health needs of vulnerable clients.
B. Protecting the rights and well-being of clients without housing is important, but it may take time to implement legislative changes and see the effects.
D. While advocating for policy change and advising elected officials on the needs of vulnerable populations is important for systemic change, it may not directly address the immediate health needs of vulnerable clients
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