The nurse is preparing a teaching plan for a client who is in the implementation step of the teaching plan. Which of the following actions should the nurse take?

Choice A rationale
Ensuring that the patient has been adequately monitored is important, but it is not the first step when considering the use of restraints. The nurse should first explore alternative interventions.
Choice B rationale
Proceeding with the application of restraints without considering alternatives can lead to unnecessary use of restraints, which can cause physical and psychological harm to the patient.
Choice C rationale
Exploring alternative interventions to address the patient’s behavior is the first step. Restraints should only be used as a last resort when other interventions have failed.
Choice D rationale
Obtaining verbal consent from the patient’s family is important, but it is not the first step. The nurse should first explore alternative interventions.

Choice A rationale
A client who has dysphagia should be seen first because dysphagia can lead to serious complications such as aspiration, choking, and pneumonia. Immediate assessment and intervention are necessary to ensure the client’s airway is protected and to prevent potential respiratory distress.
Choice B rationale
A client who asks about community resources is important, but this is not an urgent need. This client can be seen after addressing more immediate clinical concerns.

Choice C rationale
A client who will require oxygen at home needs proper planning and education, but this can be addressed after ensuring the immediate safety of clients with urgent needs.
Choice D rationale
A client who wants a priest to visit while they are in the hospital is a valid request, but it is not an urgent clinical need. This can be arranged after addressing clients with more immediate health concerns.