A nurse is assessing a client who is experiencing acute amphetamine toxicity. Which of the following findings should the nurse expect?

A. "This medication may cause me to experience a metallic taste in my mouth.": Lorazepam is a benzodiazepine and does not commonly cause a metallic taste. This statement reflects a misunderstanding of common adverse effects associated with the medication.

B. "This medication can cause my potassium level to decrease.": Lorazepam does not affect electrolyte levels such as potassium. Monitoring potassium is not typically necessary with this medication, so this statement is inaccurate.

C. "This medication can cause drowsiness.": Drowsiness is a common side effect of lorazepam due to its sedative properties. Understanding this effect helps the client anticipate and manage daytime sleepiness and avoid activities requiring alertness, demonstrating correct comprehension of teaching.

D. "This medication may cause me to lose weight.": Lorazepam is not associated with weight loss. Clients should be informed about the expected side effects, and weight changes are not typical with this medication, making this statement incorrect.

Rationale:

• Pressured speech: The client demonstrates rapid, loud, and nonstop speech, characteristic of mania. Pressured speech reflects heightened energy, distractibility, and decreased need for rest, all typical of a manic episode. It is not a primary symptom of psychosis, although severe psychotic agitation can sometimes alter speech.

• Hallucinations: The client reports seeing a person who is not present and interacting with them, which is a hallmark of psychosis. These perceptual disturbances indicate impaired reality testing. Hallucinations are less common in purely manic states unless mania is accompanied by psychotic features. Here, the client’s persistent visual hallucinations support a diagnosis of psychosis.

• Disorganized thought process: The client exhibits disorganized and tangential speech, reflecting difficulty organizing thoughts. Disorganization is characteristic of psychotic disorders due to impaired reality testing and cognitive processing. It can also appear in mania, particularly when the client exhibits distractibility, racing thoughts, and pressured speech.

• Lack of sleep: The client has gone at least 2 days without sleeping, a classic sign of mania. Decreased need for sleep with preserved energy is typical in manic episodes. Sleep deprivation alone does not indicate psychosis unless accompanied by hallucinations or delusions.

• Excessive spending habits: The client exhibits impulsive financial behavior, giving away large sums of money and overspending. This risk-taking and poor judgment are hallmark features of mania. Such behaviors are less commonly associated with psychosis unless delusions drive them.