A nurse is caring for a client who has constricted pupils, delayed reflexes, and decreased blood pressure. The nurse should identify that these findings are potential manifestations of which of the following?
Cannabis withdrawal
Opioid intoxication
Amphetamine intoxication
Alcohol withdrawal
The Correct Answer is B
A. Cannabis withdrawal typically presents with symptoms such as irritability, anxiety, insomnia, decreased appetite, and physical discomfort, but not constricted pupils, delayed reflexes, and decreased blood pressure.
B. Opioid intoxication can cause constricted pupils (miosis), delayed reflexes, and decreased blood pressure, among other symptoms such as respiratory depression, drowsiness, and altered mental status.
C. Amphetamine intoxication typically presents with symptoms such as dilated pupils, increased blood pressure, tachycardia, agitation, and hallucinations, but not constricted pupils, delayed reflexes, and decreased blood pressure.
D. Alcohol withdrawal typically presents with symptoms such as tremors, anxiety, agitation, hallucinations, increased heart rate and blood pressure, but not constricted pupils, delayed reflexes, and decreased blood pressure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A.
A. "Reporting the incident to Adult Protective Services" is crucial when there are signs of elder abuse or neglect. This action ensures that appropriate interventions are initiated to protect the client.
B. "Interviewing the client with his adult child present" may not allow the client to speak freely, especially if the adult child is the perpetrator or involved in the abuse. Confidentiality and safety are essential considerations.
C. "Telling the client he must answer every assessment question" can be intimidating and may not facilitate open communication, especially in situations involving abuse.
D. "Advising the client to consult a social worker" may be appropriate after reporting the incident to Adult Protective Services, but it is not the initial action to take when abuse is suspected. Reporting to authorities is the priority to ensure the client's safety.
Correct Answer is B
Explanation
A. Constipation can occur as a side effect of TPN due to decreased bowel motility, but it is not typically considered a serious complication.
B. Respiratory depression can occur as a complication of TPN, particularly if the solution contains high concentrations of dextrose or if the client has underlying respiratory issues.
C. Hypotension can occur as a complication of TPN if the solution is administered too rapidly, leading to fluid overload, but it is less common than respiratory depression.
D. Electrolyte imbalance, particularly hyperglycemia and hypertriglyceridemia, is a common complication of TPN, but it is less likely to cause immediate respiratory depression compared to other complications such as fluid overload.
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