A nurse is planning care for a client who has a gambling disorder. Which of the following actions should the nurse include in the plan of care?

A. An assistive personnel reapplies a soft limb restraint on a client after assisting them to the bathroom: Reapplying a soft limb restraint in itself does not necessarily require an incident report. However, the application must follow proper protocols, and the nurse should ensure that the assistive personnel are trained and following the correct procedures.
B. An assistive personnel applies physical restraints on a client who is aggressive: Physical restraints should only be applied with a physician's order and in accordance with facility policies. If restraints are applied without proper authorization or protocol, an incident report must be completed.
C. An assistive personnel tells the provider that a client is making other clients feel unsafe: Reporting concerns to the provider about a client's behavior is part of proper communication and does not require an incident report.
D. An assistive personnel provides 1:1 monitoring for a client who is reporting thoughts of self-harm: This is an appropriate and necessary intervention for a client at risk of self-harm. It does not require an incident report, as the staff member is performing their duty to ensure the safety of the client.

A. Day time naps should actually be discouraged. Napping during the day can disrupt the client's sleep-wake cycle, increasing nighttime wakefulness and worsening the confusion and wandering associated with sundowning.

B. Installing locks out of the client's direct line of vision, such as at the very top or very bottom of exit doors, is a highly effective safety strategy. Because clients with Alzheimer's disease typically look at eye level for doorknobs and locks, this placement prevents them from easily opening exit doors and wandering outside unnoticed.

C. Placing the mattress directly on the floor is a safety intervention to reduce fall injuries for a client who rolls out of bed, but it does not prevent or stop the behavioral action of nighttime wandering itself.

D. Throw rugs present a major safety hazard and should be entirely removed from the home. Even with rubber backing, they create uneven surfaces that increase the risk of tripping and falling for a client navigating a dark environment.