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concept of nursing 1

Safety Lesson 2

QuestionAnswer
Who may require a temporary restraint? - A patient who is at risk for falls when nonrestrictive measures have failed. - A confused patient who may interrupt prescribed therapy, such as a nasogastric tube. - A patient who may be a risk to self or others.
A hospitalized elderly patient is disoriented to time and place, and the NAP reports the patient has been pulling at the indwelling catheter. The nurse replaced the Foley catheter an hour ago after the patient pulled it out. --
After a focused assessment of the patient, the nurse determines the use of restraints is appropriate. Which action should the nurse take next? Have the NAP stay with the patient and call the health care provider.
The nurse and NAP are applying extremity restraints to a patient. Which action, if made by the NAP, would require correction? The NAP attached the restraint to the side rail of the bed.
The NAP is reviewing with the nurse how to apply a belt restraint. Which statement, if made by the NAP, indicates further teaching is necessary? I should place the belt restraint around the chest or abdomen.
Which of the following would be a correct action of the NAP in regard to the application of restraints? The NAP removes one restraint at a time for a patient who has violent behavior.
The nurse has applied extremity restraints on a patient. What should the nurse assess on a regular basis? -Skin integrity and range of motion. -Pulse and temperature of restrained body part. -Readiness for discontinuation of restraint. -That IV catheter remains uninterrupted.
Why are most health care agencies no longer using vest (jacket) restraints? Because they have been associated with fatal injuries.
Created by: Lightnning54
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