A nurse is assisting with the care of a client who has delirium. The client is disoriented and restless. Which of the following conditions should the nurse identify as a risk factor for delirium?

Choice A reason: Reversibility is a preschool (3-5) belief, not school-age (6-12), where permanence is grasped. Scientifically, this mismatches developmental grief stages, as school-age children understand death’s finality, making this less expected in an older sibling’s response.

Choice B reason: Alienating from peers is common in school-age grief, as sadness or guilt isolates them socially. Scientifically, this aligns with developmental psychology, where peer withdrawal reflects processing loss inwardly, a typical reaction to a sibling’s terminal illness.

Choice C reason: Bad behavior causing death is magical thinking, typical of preschoolers, not school-age kids who reason logically. Scientifically, this regresses below their cognitive stage, making it less likely than social withdrawal in grief responses.

Choice D reason: Regression (e.g., bedwetting) occurs more in younger children under stress, less in school-age. Scientifically, older kids cope via isolation or questions, not developmental backsliding, making this less characteristic than peer alienation in this age group.

Choice A reason: Instructing another nurse to record risks errors; the receiving nurse must document directly for accuracy. Scientifically, this violates chain-of-command and transcription protocols, as firsthand recording ensures fidelity to the provider’s intent, reducing miscommunication in medication orders.

Choice B reason: Asking for spelling clarifies the medication, preventing errors like sound-alikes (e.g., Celexa vs. Celebrex). Scientifically, this aligns with safety standards, as precise identification ensures correct drug administration, critical in telephone orders where auditory mistakes are common.

Choice C reason: Withholding until signed delays care; telephone orders allow immediate action with later signature (e.g., 24-48 hours). Scientifically, this contradicts urgent care needs, as timely treatment outweighs procedural lag, provided documentation and verification are complete.

Choice D reason: Recording date and time establishes a legal timeline, ensuring accountability and sequence of care. Scientifically, this is mandatory in telephone orders, supporting traceability and adherence to protocols, critical for auditing and patient safety in medication administration.

Choice E reason: Read-back confirmation verifies accuracy, reducing errors in verbal orders. Scientifically, this is evidence-based, as it ensures the provider’s intent matches the nurse’s record, safeguarding against misheard doses or drugs, a key step in safe prescribing practices.