A nurse is caring for a client who has delirium. Which of the following findings should the nurse expect?

Choice A reason: A client who is hearing command hallucinations should be prioritized first because command hallucinations can be particularly dangerous. These hallucinations can involve voices instructing the client to harm themselves or others. Immediate assessment and intervention are crucial to ensure the client's safety and to prevent potential harm. The nurse needs to address the client's safety concerns and implement necessary precautions.

Choice B reason: A client verbalizing ideas of reference, which involve misinterpreting events or remarks as having personal significance, may experience distress and paranoia. While these symptoms require attention and management, they do not typically pose an immediate risk to the client's or others' safety. The nurse should monitor and support the client but prioritize more urgent safety concerns first.

Choice C reason: A client using neologisms, or creating new words that are not understood by others, indicates a thought disorder. While this is a significant symptom that requires intervention, it does not typically pose an immediate risk to safety. The nurse should evaluate the client's communication and thought processes and provide appropriate care.

Choice D reason: A client demonstrating clang associations, which involve linking words based on sound rather than meaning, also indicates a thought disorder. This symptom requires attention, but it does not usually pose an immediate threat to the client's or others' safety. The nurse should assess the client's condition and provide appropriate interventions but prioritize more urgent safety concerns first.

Choice A reason: A decrease in appetite is not a typical effect of starting a nicotine transdermal system. In fact, individuals may experience an increase in appetite and potential weight gain after quitting smoking, as nicotine acts as an appetite suppressant. It is important for clients to be aware of this potential change so they can plan healthy eating habits and manage their weight effectively.

Choice B reason: Nicotine replacement therapy, including the nicotine transdermal system, is designed to help minimize symptoms of nicotine withdrawal. These symptoms can include cravings, irritability, anxiety, and difficulty concentrating. By providing a controlled release of nicotine, the transdermal system helps reduce the intensity of withdrawal symptoms and supports the quitting process.

Choice C reason: It is unrealistic to expect clients to stop smoking immediately after starting a nicotine transdermal system. The goal of nicotine replacement therapy is to gradually reduce dependence on nicotine while managing withdrawal symptoms. Clients are often encouraged to set a quit date and use the transdermal system as part of a comprehensive plan to stop smoking over time.

Choice D reason: Applying a new patch every 4 hours is incorrect and impractical. Nicotine transdermal patches are typically designed to be worn for 16 to 24 hours, depending on the specific product. Clients should follow the manufacturer's instructions and their healthcare provider's guidance for the proper use of the patch, usually replacing it once a day.