A nurse is considering placing wrist restraints on a client who has cognitive deficits and has pulled out their IV catheter. Before using wrist restraints, which of the following actions must the nurse take first?

Obtain a prescription for restraints from the provider.

Document the indications for using wrist restraints.

Explain the procedure to the client and their family.

Attempt less restrictive alternatives.

Answer and Explanation

The Correct Answer is D

A.   While a prescription may be necessary, attempting less restrictive alternatives should be the first action.
B.   Documentation is important but should not precede attempting less restrictive alternatives.
C.   Education about the use of restraints is important but should follow attempts at less restrictive alternatives.
D.   The nurse should exhaust all possible alternatives to restraints before considering their use, in line with the principle of least restrictive intervention.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

A. Social workers typically assist with psychosocial issues, resource management, and support services. While important, they may not have the specialized skills required for teaching eating utensil use.

B. Occupational therapists specialize in helping individuals regain the ability to perform activities of daily living, including eating, after injuries such as traumatic brain injury.
C. Speech-language pathologists focus on communication and swallowing disorders.

While they may be involved in therapy for clients with traumatic brain injury, their primary focus is not on teaching utensil use.
D. Physical therapists focus on mobility, strength, and function. While they may assist with overall rehabilitation after a traumatic brain injury, they are not specifically trained in teaching eating skills.

A. Allow the client to hear running water while attempting to void. B. Provide the client a bedpan while lying supine. C. Encourage fluid intake up to 1,000 mL daily. D. Insert an indwelling urinary catheter and connect it to gravity drainage.

Correct Answer is C

Explanation

A. While this technique can sometimes be helpful, it's not the first-line intervention for postoperative urinary retention. Encouraging fluids is a more fundamental step.

B. Lying supine may make it more difficult for the client to void. Sitting upright or ambulating to the bathroom may be more effective.
C. Encouraging fluids helps maintain adequate urine output, which is essential for preventing urinary retention after surgery. Dehydration can worsen the difficulty voiding.
D. Catheterization should be considered only after other interventions to promote voiding have been attempted and failed, as it carries the risk of infection and discomfort.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is considering placing wrist restraints on a client who has cognitive deficits and has pulled out their IV catheter. Before using wrist restraints, which of the following actions must the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a traumatic brain injury and needs to relearn how to use eating utensils. The nurse should refer the client to which of the following members of the interprofessional team?

Correct Answer is B

Explanation

A nurse is caring for a client who is 6 hr postoperative following abdominal surgery and is having difficulty voiding. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

A nurse is caring for a client who has an extracellular fluid volume deficit. Which of the following findings should the nurse expect?

A nurse is caring for a client who was recently diagnosed with a terminal illness. The client tells the nurse, "I am looking forward to seeing my grandchildren grow up." The nurse should identify that the client is experiencing which of the following stages of grief?

A nurse is preparing to transfer a client to the radiology department using a wheelchair. Which of the following actions should the nurse take?

A nurse is teaching a client about stress management techniques. Which of the following client statements indicates an understanding of the teaching?

A nurse is teaching a client about logrolling while in bed. Which of the following information should the nurse include in the teaching?

A nurse is completing discharge teaching about ostomy care with a client who has a new stoma. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

A nurse is caring for a postoperative client. Which of the following findings indicate the client may be actively bleeding?

A nurse is considering placing wrist restraints on a client who has cognitive deficits and has pulled out their IV catheter. Before using wrist restraints, which of the following actions must the nurse take first?