RN Nursing · Substance Use Disorders · Practice question
A nurse is caring for a client who has been brought to the emergency department and is experiencing acute fentanyl toxicity. The nurse should expect to observe which of the following adverse effects in this client?
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Hypertension
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Elevated heart rate
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Tachypnea
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Pupillary dilation
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✓
None of the above
Answer & explanation
Correct: None of the above
Acute fentanyl toxicity, as with all opioid overdoses, produces a characteristic toxidrome that is the opposite of the distractors listed. Fentanyl acts on mu-opioid receptors in the central nervous system, causing respiratory depression (not tachypnea), hypotension (not hypertension), bradycardia (not elevated heart rate), and miosis — pinpoint pupillary constriction (not dilation). The Edinger-Westphal nucleus is stimulated by opioids, producing miosis through parasympathetic activation of the pupillary sphincter. The classic opioid overdose triad is coma, miosis, and respiratory depression. Hypertension and tachycardia are findings associated with opioid withdrawal, not toxicity — the body's adrenergic rebound when opioids are removed. Tachypnea is also a withdrawal finding. Pupillary dilation occurs with stimulants, anticholinergics, or sympathomimetics. Because none of the first four options — hypertension, elevated heart rate, tachypnea, or pupillary dilation — correctly describes opioid toxicity findings, 'none of the above' is the correct answer. Treatment of fentanyl toxicity includes naloxone administration and respiratory support.
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