A nurse is caring for a client who has a history of alcohol use disorder and has been hospitalized for detoxification. The nurse enters the room and finds the client shouting in a terrified voice, “Get these bugs off of me!” Which of the following responses by the nurse is appropriate?

Choice A reason: Acknowledging the client’s fear without validating the hallucination (delirium tremens from alcohol withdrawal) is therapeutic. It validates emotions, builds trust, and allows de-escalation, addressing the psychological distress of the withdrawal process, making this the appropriate response. Choice B reason: Asking about the bugs may reinforce the hallucination, increasing distress in delirium tremens. It does not address the client’s fear or provide reassurance, making it less effective than acknowledging their emotional state. Choice C reason: Assuring the bugs are harmless dismisses the client’s distress and may not de-escalate the situation. Hallucinations in alcohol withdrawal are terrifying, requiring emotional validation over minimization, making this choice inappropriate. Choice D reason: Stating it’s part of withdrawal is factual but lacks empathy and may not address immediate fear. It risks alienating the client, as it does not validate their experience, making it less appropriate than acknowledging their fear.