A nurse is assisting in the admission of a client to an inpatient mental health facility. For each finding, click to specify if the finding is consistent with opioid, stimulant, or hallucinogen intoxication. Each finding may be consistent with more than 1 substance or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row.

• Paranoia: Stimulant intoxication, such as from cocaine or methamphetamine, often causes heightened alertness, suspiciousness, and paranoia. Hallucinogens can also alter perception and cognition, leading to paranoid ideation. Paranoia is not characteristic of opioid intoxication. • Sedation: Opioid intoxication commonly produces CNS depression, resulting in drowsiness, lethargy, and decreased responsiveness. Sedation is a hallmark feature of opioid use and helps differentiate opioids from stimulants and hallucinogens, which typically cause increased arousal. • Seizures: Seizures can occur with high doses or toxicity of stimulants due to CNS overstimulation and excitotoxicity. Hallucinogens may also precipitate seizures in susceptible individuals. Opioid intoxication rarely causes seizures unless in combination with other substances. • Dilated pupils: Pupillary dilation (mydriasis) is a classic effect of stimulant intoxication from increased sympathetic activity. Hallucinogens, such as LSD or psilocybin, also cause mydriasis due to their effects on the autonomic nervous system. • Tachycardia: Stimulants increase catecholamine release, leading to tachycardia. Hallucinogens can also increase heart rate by stimulating the sympathetic nervous system. Opioids generally cause bradycardia or normal heart rate unless hypoxia is present. • Hypertension: Elevated blood pressure is common with stimulant use due to increased sympathetic activity. Hallucinogens can also cause transient hypertension. Opioids typically lower blood pressure through CNS depression and vasodilation. • Pinpoint pupils: Miosis, or pinpoint pupils, is a classic sign of opioid intoxication. It results from parasympathetic stimulation via the Edinger-Westphal nucleus. Stimulants and hallucinogens usually cause normal or dilated pupils rather than constriction.