The nurse is assessing a client who reports using cocaine several times in the past week. Which observations should the nurses expect on assessment?

A. Hallucinations and delusions: While chronic or high-dose cocaine use can occasionally lead to psychotic symptoms, hallucinations and delusions are not typical acute signs. They are more likely in severe intoxication or in individuals with underlying psychiatric disorders, making them less common in routine assessment of recent use. B. Lethargy and depression: Lethargy and depressive symptoms are more characteristic of the cocaine withdrawal phase rather than acute use. During withdrawal, the central nervous system experiences decreased dopamine activity, leading to fatigue, anhedonia, and low mood. C. Bradycardia and bradypnea: Cocaine is a potent stimulant that increases sympathetic nervous system activity. Bradycardia and bradypnea reflect central nervous system depression, which is opposite the expected physiologic effects of cocaine. D. Stimulation and dilated pupils: Cocaine acutely increases norepinephrine, dopamine, and serotonin levels, producing central nervous system stimulation. Observable effects include increased alertness, restlessness, tachycardia, hypertension, hyperactivity, and mydriasis (dilated pupils). These are hallmark signs of stimulant intoxication.