The nurse reviews the client's test results.

Exhibits

For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the client.

Rationale:

• Opioid intoxication. The client was found unresponsive with a needle in the left antecubital space, suggesting recent intravenous drug use. The administration of naloxone, an opioid antagonist, further supports opioid intoxication as the likely condition. Additionally, the client presents with decreased level of consciousness, respiratory depression (respiratory rate of 10/min), and decreased bowel sounds, all of which are classic signs of opioid intoxication.
• Pupil characteristics
  The client’s pupils are miotic (constricted), which is a hallmark sign of opioid intoxication due to the drug’s effect on the parasympathetic nervous system. Opioids, particularly heroin and prescription narcotics, cause pinpoint pupils, which can help differentiate opioid intoxication from other conditions that may cause altered mental status.

Rationale for Incorrect Options:

• Opioid withdrawal is characterized by symptoms such as agitation, dilated pupils, diarrhea, and tachycardia, none of which are present in this client. Instead, the client exhibits signs of central nervous system depression rather than hyperactivity, making withdrawal unlikely.
• Hallucinogen intoxication typically presents with hallucinations, paranoia, agitation, and altered sensory perception. The client’s presentation does not include these findings, making hallucinogen intoxication an unlikely cause.
• Alcohol intoxication is associated with slurred speech, ataxia, and confusion, but the client’s history indicates only one beer was consumed, which is not enough to cause such profound central nervous system depression. The presence of a needle and response to naloxone further support opioid intoxication rather than alcohol intoxication.
• Alcohol withdrawal presents with symptoms such as tremors, tachycardia, hypertension, and agitation. The client is instead experiencing respiratory depression and sedation, which are inconsistent with alcohol withdrawal.

A. "If I keep gaining weight, I will be miserable." Expressing anxiety about weight gain reflects a lack of emotional readiness and acceptance regarding the physical changes that accompany pregnancy.
B. "I cannot believe I got pregnant. We really weren't even trying to have a baby." Indicating surprise suggests a lack of preparation for the emotional and practical aspects of pregnancy. This reflects that the client may not have fully accepted the reality of the situation.
C. "I understand that hormonal changes can cause me to be happy one minute and sad the next." Recognizing and accepting the emotional fluctuations that can occur during pregnancy due to hormonal changes indicates a level of emotional preparation for the journey ahead.
D. "This baby will totally change my lifestyle, and I am not sure I am ready for all of this." Acknowledging the impact of having a baby on lifestyle is important, but expressing uncertainty suggests that the client may still be struggling with the implications of becoming a parent.