A nurse is applying a belt restraint to a client who has become physically aggressive. Which of the following actions should the nurse take?
Apply the restraint under the client's clothes.
Tie the restraint to the railing of the client's bed.
Place the client in a sitting position.
Ensure the restraint is placed across the client's chest.
The Correct Answer is C
a. Applying the restraint under the client's clothes: Restraints should be applied over the client's clothes to avoid direct skin contact and reduce the risk of skin irritation or injury.
b. Tying the restraint to the railing of the client's bed: Restraints should not be tied to bed rails or any other fixed objects. This can increase the risk of injury to the client and should be avoided.
c. Placing the client in a sitting position is appropriate when applying a belt restraint, as it helps prevent respiratory compromise and allows the client to maintain a safer and more comfortable posture.
d. A belt restraint should be placed around the client's waist, not across the chest, to avoid restricting breathing.

Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Observing the client during and after meals is crucial for monitoring their eating behaviors, identifying any signs of bingeing or purging, and assessing their overall progress in managing their eating disorder. By closely observing the client, the nurse can provide immediate support and intervention if necessary and help prevent or address any potentially harmful behaviors. Instructing the client about effective coping strategies is valuable in helping them develop healthier ways to manage stress and emotions. However, this instruction can be more effective once the nurse has observed the client's behaviors and identified specific areas where coping strategies are needed.
Suggesting that the client assist with meal planning can be a helpful step in empowering them to take ownership of their eating habits and make healthier choices. However, before involving the client in meal planning, it is important to first assess their current eating behaviors and address any immediate concerns or risks.
Referring the client to a support group for individuals with eating disorders is a beneficial step in providing ongoing support and community. However, this referral can be made once the nurse has established a baseline understanding of the client's behaviors and needs.
Observing the client during and after meals is crucial for monitoring their eating behaviors, identifying any signs of bingeing or purging, and assessing their overall progress in managing their eating disorder. By closely observing the client, the nurse can provide immediate support and intervention if necessary and help prevent or address any potentially harmful behaviors. Instructing the client about effective coping strategies is valuable in helping them develop healthier ways to manage stress and emotions. However, this instruction can be more effective once the nurse has observed the client's behaviors and identified specific areas where coping strategies are needed.
Suggesting that the client assist with meal planning can be a helpful step in empowering them to take ownership of their eating habits and make healthier choices. However, before involving the client in meal planning, it is important to first assess their current eating behaviors and address any immediate concerns or risks.
Referring the client to a support group for individuals with eating disorders is a beneficial step in providing ongoing support and community. However, this referral can be made once the nurse has established a baseline understanding of the client's behaviors and needs.

Correct Answer is C
Explanation
Explanation:
Bleach is an effective disinfectant for blood spills and is recommended by healthcare guidelines for its ability to kill a broad range of microorganisms, including bloodborne pathogens such as human immunodeficiency virus (HIV). To prepare a bleach solution, the nurse can mix 1-part bleach with 10 parts water. This diluted bleach solution can be used to clean and disinfect the overbed table surfaces that have been contaminated with blood.
A- Chlorhexidine is an antiseptic commonly used for skin preparation before invasive procedures, but it is not the ideal choice for disinfecting surfaces or objects after a blood spill.
B- Isopropyl alcohol is effective for disinfecting small surfaces, but it may not be as effective as bleach for blood spills, particularly in the context of bloodborne pathogens like HIV.
D- Hydrogen peroxide can be used as a disinfectant, but it may not be as effective as bleach in eliminating bloodborne pathogens from surfaces.
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