A nurse is assisting with planning in-service training for staff members about manifestations of opioid use. Which of the following manifestations should the nurse include when discussing opioid intoxication? (Select all that apply.)

Opioid intoxication occurs when excessive amounts of opioid substances depress the central nervous system, leading to potentially life-threatening respiratory and cardiovascular effects. Medications such as Morphine sulfate act on mu-opioid receptors, producing analgesia but also CNS and respiratory depression when used in high doses. Recognizing clinical manifestations of opioid intoxication is essential for early intervention and prevention of respiratory failure. Nurses must differentiate intoxication signs from opioid withdrawal symptoms, which present differently. Rationale: A. Bradycardia is a common manifestation of opioid intoxication due to central nervous system depression and increased parasympathetic tone. Opioids suppress sympathetic outflow, leading to a slowed heart rate. This cardiovascular effect often accompanies respiratory depression and decreased level of consciousness in overdose situations. B. Hypotension occurs in opioid intoxication as a result of vasodilation and histamine release, along with decreased sympathetic nervous system activity. These effects reduce peripheral vascular resistance and can lead to dizziness, fainting, or poor tissue perfusion. Monitoring blood pressure is essential in clients suspected of opioid overdose. C. Enlarged pupils are incorrect because opioid intoxication typically causes miosis, or pinpoint pupils, due to stimulation of the parasympathetic nervous system. Dilated pupils are more commonly associated with stimulant intoxication or opioid withdrawal rather than overdose. D. Sedation is a hallmark sign of opioid intoxication due to depression of the central nervous system. Clients may present with drowsiness, lethargy, or decreased responsiveness, progressing to coma in severe cases. This occurs because opioids suppress brainstem activity and cortical arousal pathways. E. Rhinorrhea is not associated with opioid intoxication but is a classic symptom of opioid withdrawal. Withdrawal leads to autonomic hyperactivity, which results in symptoms such as runny nose, sweating, yawning, and agitation. These findings are opposite to the CNS depression seen in intoxication.