The caregiver of a client with Alzheimer's disease reports to the nurse that often the client will suddenly become angry during meals and nothing seems to calm him down. The nurse teaches the caregiver to use distraction techniques. Which response would be best to teach as an example of this technique?

Choice A reason: Mild delirium involves acute confusion and impaired judgment due to cerebral dysfunction, often from metabolic or infectious causes. Accompanying the client ensures safety, as disorientation increases wandering or injury risk. Supervision mitigates risks from altered cognition while allowing mobility, supporting cerebral recovery without exacerbating confusion.

Choice B reason: Restricting the client to the unit may increase agitation, as delirium’s neurochemical imbalances, like acetylcholine deficiency, heighten restlessness. While safety is critical, blanket restriction ignores the potential benefits of supervised movement, which can reduce stress and improve cerebral perfusion, making this less appropriate than supervised accompaniment.

Choice C reason: Assessing motives may clarify intent but delays addressing immediate safety in delirium, where confusion stems from cerebral dysfunction, such as hypoxia or electrolyte imbalance. The client’s impaired judgment requires supervision over exploration of motives, as disorientation increases risk of harm, making this a secondary action.

Choice D reason: Allowing an unsupervised walk is unsafe in delirium, as acute cognitive impairment from neurotransmitter imbalances or metabolic disturbances increases wandering or injury risk. Without supervision, the client may become disoriented or lost, exacerbating cerebral stress. Accompanied walks better balance safety and mobility in this condition.

Choice A reason: Valproic acid does not typically require thyroid function tests, as it primarily affects liver metabolism via glucuronidation and mitochondrial pathways. Thyroid dysfunction is not a common side effect, unlike with lithium, which impacts thyroid hormone synthesis. This instruction is irrelevant, as valproic acid’s toxicity risks are hepatic, not thyroid-related.

Choice B reason: Expecting a gradual decrease in valproic acid dosage is incorrect, as it is titrated to therapeutic levels for conditions like seizures or bipolar disorder, based on serum levels (50–100 mcg/mL). Dosage adjustments depend on efficacy, not routine reduction, as stable neural excitability is needed, making this scientifically inaccurate.

Choice C reason: Taking aspirin for pain with valproic acid is risky, as both inhibit platelet function, increasing bleeding risk via synergistic effects on prostaglandin synthesis. Valproic acid’s hepatic metabolism also raises hepatotoxicity concerns, making aspirin inappropriate. Alternative analgesics like acetaminophen are safer, rendering this instruction incorrect.

Choice D reason: Valproic acid requires regular liver function monitoring, as it is hepatically metabolized and can cause hepatotoxicity, particularly in the first 6 months, due to mitochondrial dysfunction and oxidative stress. Elevated liver enzymes or rare fulminant hepatitis necessitate early detection to prevent liver failure, making this a critical instruction.