The nurse is assisting in the care of a client in an inpatient mental health facility. For which of the following manifestations of withdrawal is the client at risk? Select the 4 manifestations of withdrawal for which the client is at risk.

A. Diaphoresis: Sweating is a common manifestation of opioid and stimulant withdrawal. The client’s recent heroin and methamphetamine use puts them at risk for autonomic hyperactivity, including diaphoresis. B. Anxiety: Anxiety is a frequent symptom during withdrawal from both opioids and stimulants. The client’s agitation and fear of worsening withdrawal indicate heightened risk for emotional and psychological distress. C. Insomnia: Sleep disturbances, including difficulty falling or staying asleep, are common during withdrawal from substances such as heroin and methamphetamine. Insomnia contributes to fatigue and irritability during the withdrawal period. D. Slurred speech: Slurred speech is more indicative of acute intoxication, central nervous system depressant effects, or neurological impairment rather than withdrawal symptoms. It is not expected in opioid or stimulant withdrawal. E. Hyperreflexia: Increased reflexes can occur during stimulant withdrawal or opioid withdrawal due to central nervous system hyperactivity. The client’s restlessness and autonomic manifestations suggest this risk. F. Hypothermia: Withdrawal typically causes hyperthermia or temperature instability rather than hypothermia. Low body temperature is not a typical manifestation in opioid or stimulant withdrawal.