A nurse is collecting data from a client who has substance use disorder and reports recently taking opioids.
Which of the following findings should the nurse identify as a manifestation of opioid intoxication?
Tachycardia
Mental alertness
Hyperreflexia
Pinpoint pupils
The Correct Answer is D
d. Pinpoint pupils.
Explanation:
Opioid intoxication is characterized by various signs and symptoms, including central nervous system depression. One common manifestation of opioid intoxication is pinpoint pupils (miosis), which is caused by the effect of opioids on the pupillary constrictor muscles. The pupils become constricted and appear as small dots, hence the term "pinpoint."
The other options are not typical manifestations of opioid intoxication. Tachycardia (rapid heart rate) is more commonly associated with stimulant use rather than opioids. Mental alertness is typically reduced in cases of opioid intoxication, as opioids cause sedation and CNS depression. Hyperreflexia (exaggerated reflexes) is not a typical finding in opioid intoxication; instead, it may occur in withdrawal from certain substances such as alcohol or benzodiazepines.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A nurse caring for a client who is receiving total parenteral nutrition should identify that a serum calcium level of 12.5 mg/dL indicates a possible complication of this therapy. Total parenteral nutrition can result in electrolyte imbalances, including hypercalcemia (high levels of calcium in the blood).
The other laboratory results are within normal ranges and do not indicate a complication of total parenteral nutrition.
b) A BUN level of 16 mg/dL is within the normal range.
c) A serum potassium level of 4.6 mEq/L is within the normal range.
d) A WBC count of 8,000/mm³ is within the normal range.
Correct Answer is B
Explanation
b. Seizure pads
Explanation:
The nurse should place seizure pads in the client's room when admitting a client with bacterial meningitis. Bacterial meningitis is an infection that affects the meninges, the protective membranes covering the brain and spinal cord. It can cause inflammation and swelling of the brain, leading to an increased risk of seizures.
Seizure pads are specifically designed to provide a cushioning and protective barrier between the client's head and the hard surface, reducing the risk of injury during a seizure. They are placed on the bed or matress to help prevent head trauma or other injuries that may occur if a seizure occurs.
Now, let's discuss why the other options are not necessary for the client with bacterial meningitis:
a. Oral irrigating device:
An oral irrigating device is not necessary for a client with bacterial meningitis. Bacterial meningitis primarily affects the central nervous system and does not require oral care interventions. The focus of care for these clients is on managing the infection, monitoring vital signs, and providing supportive care.
c. Sterile gloves:
While sterile gloves are commonly used in healthcare settings, they are not specifically required for the care of a client with bacterial meningitis. Standard precautions, including the use of non-sterile gloves, are sufficient for providing care to these clients. Sterile gloves are typically used for invasive procedures or when there is a need to maintain a sterile field.
d. Tongue blade:
A tongue blade is not necessary for the care of a client with bacterial meningitis. Tongue blades are typically used for oral assessments or when examining the throat, which are not directly related to the management or treatment of bacterial meningitis. The focus of care for these clients is on infection control, monitoring for complications, and providing comfort and support.
In summary, when admitting a client with bacterial meningitis, the nurse should prioritize placing seizure pads in the client's room to ensure their safety during potential seizure activity.

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