Which of the following would the nurse recognize as signs of alcohol withdrawal?
Select all that apply.

Choice A reason: Relaxed inhibitions, increased appetite, and distorted perceptions are more characteristic of cannabis intoxication rather than stimulants. Cannabis use often leads to increased appetite ("the munchies") and perceptual distortions, but stimulants typically suppress appetite and increase alertness.

Choice B reason: Depersonalization, dilated pupils, and visual hallucinations are more consistent with hallucinogen intoxication such as LSD or PCP. While stimulants can cause dilated pupils, the presence of depersonalization and hallucinations points more toward hallucinogens rather than stimulants.

Choice C reason: Slurred speech, unsteady gait, and impaired concentration are typical of alcohol intoxication or sedative-hypnotic use. These substances depress the central nervous system, leading to impaired motor coordination and speech, which are not features of stimulant intoxication.

Choice D reason: Hyperactivity, talkativeness, and euphoria are hallmark signs of stimulant intoxication. Stimulants such as cocaine, amphetamines, and methamphetamine increase dopamine and norepinephrine activity, leading to heightened energy, excessive talking, and feelings of intense pleasure or euphoria. These behaviors directly reflect the pharmacologic effects of stimulants on the central nervous system.

Choice A reason: A supportive approach may be helpful in many therapeutic relationships, but with narcissistic personality disorder, it can inadvertently reinforce manipulative or grandiose behaviors. These clients often exploit supportive interactions to maintain control.

Choice B reason: A cheerful approach may be perceived as insincere or patronizing by clients with narcissistic traits. They may dismiss or devalue the nurse’s efforts, making this approach ineffective.

Choice C reason: A friendly approach can blur professional boundaries. Clients with narcissistic personality disorder may manipulate friendliness to gain special treatment or attention, which undermines therapeutic goals.

Choice D reason: A matter-of-fact approach is the most effective. It maintains professional boundaries, avoids feeding into the client’s grandiosity, and provides clear, consistent communication. This approach helps the nurse remain neutral and objective, which is essential in managing narcissistic behaviors.