A nurse is applying soft limb restraints to a child who is acting aggressively toward staff. Which of the following actions should the nurse take?
Tie the restraints to the side rails of the child's bed.
Request that the provider renew the prescription for restraints every 48 hr.
Secure the restraints with a quick-release knot.
Assess the child every 4 hr while in restraints.
The Correct Answer is C
A. Tying restraints to the side rails poses a risk of injury to the child and is not a recommended practice.
B. Renewing the prescription for restraints every 48 hours is important, but it does not directly address the proper application of restraints.
C. Securing restraints with a quick-release knot allows for quick removal in case of emergency and is the correct method for applying restraints.
D. Assessing the child every 4 hours while in restraints is important, but it does not address the proper application of restraints.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Temperature within normal range may indicate the absence of infection, but it does not specifically indicate effectiveness of treatment for glomerulonephritis.
B. Absence of pain with voiding is a positive sign but does not directly indicate the effectiveness of treatment for glomerulonephritis.
C. Clear urine indicates resolution of hematuria, a common symptom of acute poststreptococcal glomerulonephritis, suggesting treatment effectiveness.
D. Odorless urine is a general characteristic of urine and does not specifically indicate the effectiveness of treatment for glomerulonephritis.
Correct Answer is C
Explanation
A. Warming goat's milk before feeding does not address the issue of nutritional adequacy or suitability for the infant's age.
B. Soy milk may not be appropriate for a 10-month-old infant and may not adequately address nutritional needs.
C. Correct. Commercially prepared formula is recommended for infants who are not breastfeeding and provides essential nutrients necessary for growth and development.
D. Reinitiating breastfeeding may not be feasible or appropriate in this situation if the parent has chosen to feed the infant goat milk.
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