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 C
Explanation
C. This response politely declines the client's request while explaining the reason behind it, which is hospital policy. It maintains professionalism and boundaries.
A nurses should not provide their home address to clients, as it can compromise their privacy and potentially lead to boundary violations or safety concerns.
B. It is important for the nurse to respond to the client's request for personal information in a professional and appropriate manner.
D. It is important for nurses to communicate boundaries firmly but respectfully, without causing unnecessary distress to the client.
Correct Answer is B
Explanation
B. Experiencing cyberbullying can have significant negative effects on an adolescent's mental health and well-being. Addressing cyberbullying promptly is crucial to ensuring the client's safety and mental health.
A. Journaling their feelings about their sister's death suggests that they are actively processing their emotions, which can be a healthy coping mechanism.
C. Addressing dietary habits and providing education on healthy eating is important but it may not be as urgent as addressing issues such as cyberbullying or mental health concerns.
D. While supporting the client with managing their allergies is important, it may not be the priority for immediate intervention compared to issues such as cyberbullying or mental health concerns.
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