A nurse manager is observing an AP applying wrist restraints for a client. Which of the following actions should the nurse identify as an indication that the AP understands the procedure?

The nurse can insert one finger between the client's wrist and the restraint.

The padding of the restraints is against the client's bony prominences.

The AP ties the straps of the restraints in a double knot.

The AP ties the restraints to the side rails

Answer and Explanation

The Correct Answer is B

Answer: B. The padding of the restraints is against the client's bony prominences.

A. The nurse can insert one finger between the client's wrist and the restraint.
The proper guideline is that the nurse should be able to insert two fingers between the client's wrist and the restraint. This ensures the restraint is snug but not too tight, which helps prevent impaired circulation and skin breakdown.

B. The padding of the restraints is against the client's bony prominences.
This is the correct practice. The padding of the restraints should always be applied to protect the client’s skin and prevent injury, particularly over bony prominences where the risk of pressure sores or skin breakdown is higher.

C. The AP ties the straps of the restraints in a double knot.
A double knot should not be used because it can make it difficult to quickly release the restraint in an emergency. A quick-release knot should always be used to ensure the restraint can be removed easily and promptly if needed.

D. The AP ties the restraints to the side rails.
Restraints should never be tied to movable parts like side rails, as raising or lowering the side rails could cause injury. Restraints should be secured to a part of the bed frame that does not move to prevent harm to the client.

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Correct Answer is A

Explanation

A. Propranolol is a beta-blocker medication commonly used to treat hypertension, angina, and certain heart rhythm disorders. However, it is contraindicated in clients with a history of asthma or other obstructive airway diseases due to its potential to cause bronchoconstriction and exacerbate respiratory symptoms.

B. Migraines:
Propranolol is actually commonly used for the prophylactic treatment of migraines, particularly in individuals with frequent or severe migraines. It helps reduce the frequency and severity of migraine attacks by blocking the release of certain chemicals in the brain.

C. Glaucoma:
Propranolol can be used in the treatment of glaucoma, particularly when other treatments have been ineffective. It works by reducing intraocular pressure, which can help prevent vision loss associated with glaucoma.

D. Depression:
Propranolol is not contraindicated in clients with depression. In fact, it may sometimes be used off-label to manage certain symptoms of anxiety or performance anxiety. However, it is important to monitor clients with depression closely when prescribing propranolol, as it may interact with other medications used to treat depression or worsen certain depressive symptoms.

A. I don't take naps throughout the day." B. I have a small snack and take a bath before going to bed each day." C. I go to bed and get up routinely at the same time each day." D. I watch tevision until I fall asleep at night."

Correct Answer is D

Explanation

A) "I don't take naps throughout the day": This statement indicates a good sleep habit, as avoiding daytime naps can help promote better sleep at night.
B) "I have a small snack and take a bath before going to bed each day": This statement suggests a bedtime routine, which can be beneficial for promoting relaxation and signaling the body that it's time to sleep.
C) "I go to bed and get up routinely at the same time each day": Consistency in sleep schedule is an essential aspect of healthy sleep habits, as it helps regulate the body's internal clock and promotes better sleep quality.
D) "I watch television until I fall asleep at night": This statement indicates a poor sleep habit. Screen time before bedtime, especially from devices like televisions, computers, or smartphones, can interfere with the body's natural sleep-wake cycle and make it harder to fall asleep. The blue light emitted by screens can suppress the production of melatonin, a hormone that regulates sleep, leading to difficulty falling asleep and poor sleep quality. Therefore, this statement suggests a need for further teaching about avoiding screen time before bedtime to promote better sleep hygiene.

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A nurse manager is observing an AP applying wrist restraints for a client. Which of the following actions should the nurse identify as an indication that the AP understands the procedure?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions?

Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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