The nurse is considering the use of restraints for a client. In which

The nurse is considering the use of restraints for a client. In which situation can the nurse apply restraints to a client?

1. Client wanders around the care area.
2. Client is picking at the access site for intravenous infusion of chemotherapy.
3. Client needed to use the bathroom and waited for help but didn’t want to soil the bed and fell while attempting to walk to the bathroom.
4. Client does not want to stay in bed but wants to sit in the lounge with others.

ANSWER

Correct Answer: 2
Rationale 1: Restraints cannot be used for the convenience of the care staff.
Rationale 2: In this situation, the client’s actions could hinder his or her health status and a restraint would be indicated.
Rationale 3: This situation would not call for the client to be restrained. The care staff needs to be more attentive to the client’s needs.
Rationale 4: This client would not be a candidate for restraints.