A nurse is applying a belt restraint to a client who has become physically aggressive. Which of the following actions should the nurse take?
Apply the restraint under the client's clothes.
Tie the restraint to the railing of the client's bed.
Place the client in a sitting position.
Ensure the restraint is placed across the client's chest.
The Correct Answer is C
a. Applying the restraint under the client's clothes: Restraints should be applied over the client's clothes to avoid direct skin contact and reduce the risk of skin irritation or injury.
b. Tying the restraint to the railing of the client's bed: Restraints should not be tied to bed rails or any other fixed objects. This can increase the risk of injury to the client and should be avoided.
c. Placing the client in a sitting position is appropriate when applying a belt restraint, as it helps prevent respiratory compromise and allows the client to maintain a safer and more comfortable posture.
d. A belt restraint should be placed around the client's waist, not across the chest, to avoid restricting breathing.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Among the given options, 240 mL (8 oz) of hot cocoa typically contains the least amount of caffeine. While the exact caffeine content can vary depending on the brand and preparation method, hot cocoa is generally considered to have a lower caffeine content compared to brewed green tea, instant coffee, or cola soft drinks.
However, it's worth noting that hot cocoa may still contain a small amount of caffeine, although significantly less than the other options mentioned.
Correct Answer is D
Explanation
Explanation
D. Muscle cramps
Hyponatremia is a condition characterized by low levels of sodium in the blood. Sodium plays a crucial role in maintaining fluid balance and nerve and muscle function. When sodium levels are low, it can lead to imbalances in fluid levels and cause muscle cramps and weakness.
Constipation in (option A) is incorrect because it is more commonly associated with other conditions such as dehydration or electrolyte imbalances like hypercalcemia.
Blurred vision in (option B) is not a typical finding in hyponatremia. Visual disturbances may occur in severe cases, but they are not a consistent symptom.
Hypertension (high blood pressure) in (option C) is not typically associated with hyponatremia. In fact, hyponatremia can sometimes lead to low blood pressure (hypotension) due to the fluid imbalances it causes.
Therefore, the nurse should expect muscle cramps (option D) as a finding in a client with hyponatremia due to the disruption of fluid balance and its impact on muscle function.
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