A nurse is assessing a client during a follow-up at a health clinic. The client reports that they struggle to take antipsychotic medication on a regular basis. Which of the following actions should the nurse take to improve medication adherence?

Choice A reason:
An apology from the client for their prior behavior, while it may be a positive step towards recovery, does not necessarily indicate that they have regained control over their actions or that they no longer pose a risk to themselves or others. The decision to discontinue restraints should be based on current behavior and risk assessment rather than past actions.

Choice B reason:
The primary goal of using physical restraints is to prevent harm to the patient or others when less restrictive interventions are not effective. If the client demonstrates control over their actions, it suggests that they are no longer at immediate risk of harm, and therefore, discontinuing restraints could be considered³⁴⁵. This aligns with guidelines that advocate for restraint use to be continually assessed and reduced or discontinued as soon as possible.

Choice C reason:
While a request to be released from restraints indicates a desire for freedom, it does not provide enough information about the client's current mental state or risk of harm. The healthcare team must assess whether the client's condition has improved to a point where restraints are no longer necessary.

Choice D reason:
Signing a behavioral contract is a positive step towards establishing trust and setting expectations for behavior. However, it is not an immediate indication that the client can safely have restraints removed. The effectiveness of such contracts depends on the individual's ability to understand and adhere to the agreed-upon behaviors.

Choice A reason:
Placing the client in a reclining chair is not a recommended intervention for managing wandering behavior. While it might seem like a way to keep the client stationary, it does not address the underlying issue of wandering and can lead to discomfort or pressure sores if the client remains in the chair for extended periods.

Choice B reason:
Installing sensor devices on outside doors is an effective intervention. These devices can alert caregivers when the client attempts to leave the house, thereby preventing wandering and potential falls. This measure enhances safety by providing immediate notification of the client's movements.

Choice C reason:
Positioning the mattress on the floor can help prevent injuries from falls. If the client rolls out of bed, the risk of injury is minimized because the fall distance is significantly reduced. This is a practical solution for clients who are prone to falling out of bed.

Choice D reason:
Encouraging physical activity prior to bedtime can be beneficial for overall health but may not be the best strategy for managing nighttime wandering. Physical activity should be balanced and not too close to bedtime, as it can sometimes lead to increased alertness rather than promoting sleep.

Choice E reason:
Putting locks at the top of doors is a useful safety measure. Clients with Alzheimer's disease may not notice or be able to reach locks placed higher up, which can prevent them from wandering outside unsupervised. This intervention helps ensure the client's safety by restricting access to potentially dangerous areas.