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NCLEX · Substance Use and Dependencies

A client in the emergency department is suspected to have taken a large dose of benzodiazepines. Which finding confirms significant toxicity?

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Correct answer

Respiratory depression (slow, shallow breathing), hypotension, excessive sedation progressing to stupor or coma — respiratory depression is the most life-threatening manifestation of benzodiazepine overdose

  1. A Respiratory depression (slow, shallow breathing), hypotension, excessive sedation progressing to stupor or coma — respiratory depression is the most life-threatening manifestation of benzodiazepine overdose
  2. B Hyperthermia and rigidity
  3. C Pupil dilation (mydriasis)
  4. D Tachycardia and agitation

Why this is the answer

BENZODIAZEPINE TOXICITY vs INTOXICATION: BENZODIAZEPINE CNS DEPRESSANT effects are dose-dependent: Therapeutic dose: anxiolysis, sedation; Toxic dose: respiratory depression, hypotension, excessive sedation → stupor → coma; RESPIRATORY DEPRESSION is the primary life threat — CNS depression suppresses the respiratory drive;

Vital sign pattern: Low RR (may be <8); shallow breaths; SpO2 declining; hypotension; bradycardia or tachycardia.

Key finding: MIOSIS (pinpoint pupils) is associated with OPIOID overdose; Benzodiazepines typically cause NORMAL to SLIGHTLY CONSTRICTED pupils.

Treatment: Supportive (airway management, oxygen, positioning); FLUMAZENIL (romazicon) is the SPECIFIC ANTIDOTE for benzodiazepine overdose; however, flumazenil use is controversial and not always recommended (can precipitate seizures in benzodiazepine-dependent patients).

Distinguish from: Opioid overdose (also respiratory depression + miosis) vs. stimulant overdose (tachycardia, hyperthermia, dilated pupils) vs. alcohol withdrawal (agitation, tremors, seizures).

Source: NCLEX-PN Test Plan: Psychosocial — Substance Use, Benzodiazepine Toxicity

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About this topic: Substance Use and Dependencies

Substance use questions cover signs of intoxication and withdrawal for alcohol, opioids, stimulants and sedatives, the priority of safety during withdrawal, and the therapeutic approach to dependency. This is one of 8 PN: Psychosocial Integrity questions on substance use and dependencies, each with a full explanation on a single study page.

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