A nurse is caring for a client who is confused and has a prescription for wrist restraints. Which of the following actions should the nurse take?

Request a prescription renewal from the provider every 36 hr.

Make sure two fingers fit under the restraints.

Check the client's range of motion every 6 hr.

Secure the restraints with a square knot.

Answer and Explanation

The Correct Answer is B

A. Restraint prescriptions typically need to be renewed at least every 24 hours, not every 36 hours, to comply with regulatory standards.

B. Ensuring that two fingers fit under the restraints is essential to confirm that they are not too tight, allowing for circulation and comfort while still securing the client.

C. Checking the client's range of motion should occur more frequently than every 6 hours; ideally, it should be assessed more regularly to prevent complications.

D. Restraints should be secured using a quick-release knot, not a square knot, to ensure they can be removed easily in an emergency.

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Free Nursing Study Resources

Correct Answer is D,E,A,C,B

Explanation

Begin by setting up a clean, dry surface above waist level to ensure sterility (Step D). Remove the dust cover and set up the sterile kit (Step E). Open the sterile kit's flaps in order, starting with the outermost (Steps A and C), and finally the innermost flap (Step B) while keeping distance to prevent contamination.

A. Gathering the client's personal belongings B. Closing the client's eyes C. Washing the client's face D. Removing the client's dentures from their mouth

Correct Answer is D

Explanation

A. Gathering personal belongings is appropriate for safekeeping or distribution to family members.

B. Closing the client’s eyes is part of respectful postmortem care.

C. Washing the client’s face is a standard part of preparing the body for viewing.

D. Dentures are typically left in place to maintain facial structure and present a natural appearance for family visitation.

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A nurse is caring for a client who is confused and has a prescription for wrist restraints. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to set up a sterile field to change a sterile dressing on a client's abdominal wound. Identify the sequence of steps the nurse should take. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Correct Answer is D,E,A,C,B

Explanation

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Correct Answer is D

Explanation

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