A nurse is providing teaching to an assistive personnel (AP) about the application of wrist restraints to a client. Which of the following instructions should the nurse include in the teaching?<\/p>\n\n\n\n
A.
Secure the client’s restraints with a square knot<\/p>\n\n\n\n
B.
Attach the restraints to the fixed portion of the frame of the client’s bed<\/p>\n\n\n\n
C.
Remove the client’s restraints every 2 hours<\/p>\n\n\n\n
D.
Allow 1 fingerbreadth between the restraint and the client’s wrists<\/p>\n\n\n\n
The Correct Answer and Explanation is :<\/mark><\/strong><\/p>\n\n\n\n The correct answer is B. Attach the restraints to the fixed portion of the frame of the client’s bed<\/strong>.<\/p>\n\n\n\n A. Secure the client’s restraints with a square knot<\/strong> Using a square knot to secure restraints is not recommended because it is not considered a safe or effective method for securing restraints. Instead, restraints should be secured with a quick-release tie that allows for easy removal in case of an emergency. A square knot may be difficult to untie quickly and could potentially hinder prompt response if the client needs urgent assistance.<\/p>\n\n\n\n B. Attach the restraints to the fixed portion of the frame of the client’s bed<\/strong> This is the correct approach. Restraints should be attached to the fixed part of the bed frame, not to moveable parts like side rails or other adjustable components. Attaching restraints to a fixed part of the bed frame ensures that the restraints remain secure and that the client cannot accidentally disengage them. This approach also helps to prevent the client from being able to pull the restraint loose or cause additional injury.<\/p>\n\n\n\n C. Remove the client’s restraints every 2 hours<\/strong> It is essential to remove restraints periodically to assess the client’s comfort, circulation, and skin integrity. However, the exact interval for removal should be based on the client’s condition and the facility’s policies, which may recommend more frequent or less frequent checks. In many cases, restraints are removed every 1 to 2 hours to ensure the client’s safety and well-being. The specific timing can vary depending on the client’s needs and should always be tailored to the individual case.<\/p>\n\n\n\n D. Allow 1 fingerbreadth between the restraint and the client’s wrists<\/strong> Allowing only 1 fingerbreadth between the restraint and the client’s wrist might not provide sufficient space to prevent injury or skin damage. It is generally recommended to allow enough space to comfortably fit two fingers to ensure that the restraint is not too tight and does not compromise circulation. The proper space helps prevent skin breakdown and ensures that the restraint is applied without causing undue discomfort or harm.<\/p>\n\n\n\n In summary, when applying wrist restraints, it is crucial to attach them to a fixed part of the bed frame (option B), ensure that they are properly adjusted to avoid skin damage, and periodically check and remove the restraints as needed according to the client’s needs and facility guidelines.<\/p>\n","protected":false},"excerpt":{"rendered":" A nurse is providing teaching to an assistive personnel (AP) about the application of wrist restraints to a client. Which of the following instructions should the nurse include in the teaching? A.Secure the client’s restraints with a square knot B.Attach the restraints to the fixed portion of the frame of the client’s bed C.Remove the […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-137184","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/137184","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=137184"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/137184\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=137184"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=137184"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=137184"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}Explanation:<\/h3>\n\n\n\n