A nurse manager is presenting information to the nursing staff regarding the appropriate use of client restraints. Which of the following should the nurse include? (Select all that apply.)
The provider should renew the prescription for restraints every 48 hr.
The nurse should pad the bony prominences.
The nurse should tie the restraints using a square knot.
The nurse should remove the restraints every 2 hr.
The provider's prescription should include the type of restraint to use.
Correct Answer : B,D,E
A. The provider should renew the prescription for restraints every 24 hours, not 48 hours.
B. Padding bony prominences helps prevent skin breakdown and pressure injuries.
C. Restraints should be tied using a quick-release knot, not a square knot, to allow for rapid removal in an emergency.
D. Removing the restraints every 2 hours allows for circulatory assessment, skin care, and range of motion exercises.
E. The provider's prescription should specify the type of restraint to ensure proper and appropriate use.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["92"]
Explanation
- Pulse pressure is the difference between systolic and diastolic blood pressure.
- The client's pulse pressure is 132 - 40 = 92 mm Hg.
Correct Answer is C
Explanation
A. Tilted head position facilitates drainage into the nasolacrimal duct, not necessarily into the eye.
B. Washing away exudate is not necessary before administering eye drops.
C. Using aseptic technique to drop medication into the conjunctival sac ensures proper delivery of the medication to the eye.
D. Dropping medication onto the cornea can cause discomfort and may not effectively reach the eye.
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