,A nurse is caring for a client who speaks a different b. Request the services of an interpreter to determine the clients
language wishes
than the nurse. The clients
partner tells the nurse that the client would like to go
home
against medical advice (AMA). Which of the actions
should the nurse take?
a. Discharge the client and notify the health care provider
b. Request the services of an interpreter to determine the
clients
wishes
c. Have the client's partner sign an AMA form
d. Ask the partner to reiterate the consequences of
leaving AMA
to the client
A nurse at long term care facility is reviewing the plan of b. Assist the client with range of motion exercises of the hands
care
who has a prescription for
mitten restraints. Which of the following tasks should the
nurse
assign to assistive personnel?
a. Evaluate the need client
b. Assist the client with range of motion exercises of the
hands
c. Determine the circulation status
d. Instruct the client's family about purpose mitten
restraint
8.A nurse in an acute mental health facility is caring for an b. Plan to remove the restraints as soon as the clients is calm
adolescent who is exhibiting
destructive behavior. Which of the following actions
should the
nurse take after applying
physical restraints to the client?
a. Monitor the client's range of motion every 60 min.
b. Plan to remove the restraints as soon as the clients is
calm
c. Offer the clients nutritious snack every 4 hr.
d. Ensure that the procedure has signed a prescription for
restrain within 48 hr.
, A nurse in a mental health facility receives a change of 1. A client placed in restraints for aggressive behavior
shift
report on 4 clients. Which of the
following clients should the nurse plan to assess first?
1. A client placed in restraints for aggressive behavior
2. A new limited client presents history of 4.5kg weight
loss in
the past two
months
3. Client is receiving a PRN dose of haloperidol two
hours ago
for increased
anxiety
4. Client will receive his first ECT treatment today
A nurse on a mental health unit is caring for a client who Check the client's status every hour.
is
in restraints. Which of the
following actions should the nurse take?
-Check the client's status every hour.
-Document the client's behavior leading to the initiation
of
restraints.
-Obtain written consent by the client for the placement
of the
restraints.
-Release the client's restraints every 4 hr.
A nurse is caring of a client who is confused and is trying a. Remove the restraints from the client's wrists every 2 hr.
to
pull out their IV catheter. After
attempting other measures to prevent the client from
self-harm,
the nurse places wrist
restraints on the client. Which of the following actions
should
the nurse take?
a. Remove the restraints from the client's wrists every 2 hr.
b. Fasten the restrains ties to the bed's side rail
c. Contact the provide within 48 hr. to obtain a
prescription for
the restrain
d. Check that one finger will fit between the client's wrist
and
the restraints
The nurse delegates a task to an AP and the AP refuses to Report the AP to the risk manager
complete the assigned
task. Which of the following actions should the nurse
take?
language wishes
than the nurse. The clients
partner tells the nurse that the client would like to go
home
against medical advice (AMA). Which of the actions
should the nurse take?
a. Discharge the client and notify the health care provider
b. Request the services of an interpreter to determine the
clients
wishes
c. Have the client's partner sign an AMA form
d. Ask the partner to reiterate the consequences of
leaving AMA
to the client
A nurse at long term care facility is reviewing the plan of b. Assist the client with range of motion exercises of the hands
care
who has a prescription for
mitten restraints. Which of the following tasks should the
nurse
assign to assistive personnel?
a. Evaluate the need client
b. Assist the client with range of motion exercises of the
hands
c. Determine the circulation status
d. Instruct the client's family about purpose mitten
restraint
8.A nurse in an acute mental health facility is caring for an b. Plan to remove the restraints as soon as the clients is calm
adolescent who is exhibiting
destructive behavior. Which of the following actions
should the
nurse take after applying
physical restraints to the client?
a. Monitor the client's range of motion every 60 min.
b. Plan to remove the restraints as soon as the clients is
calm
c. Offer the clients nutritious snack every 4 hr.
d. Ensure that the procedure has signed a prescription for
restrain within 48 hr.
, A nurse in a mental health facility receives a change of 1. A client placed in restraints for aggressive behavior
shift
report on 4 clients. Which of the
following clients should the nurse plan to assess first?
1. A client placed in restraints for aggressive behavior
2. A new limited client presents history of 4.5kg weight
loss in
the past two
months
3. Client is receiving a PRN dose of haloperidol two
hours ago
for increased
anxiety
4. Client will receive his first ECT treatment today
A nurse on a mental health unit is caring for a client who Check the client's status every hour.
is
in restraints. Which of the
following actions should the nurse take?
-Check the client's status every hour.
-Document the client's behavior leading to the initiation
of
restraints.
-Obtain written consent by the client for the placement
of the
restraints.
-Release the client's restraints every 4 hr.
A nurse is caring of a client who is confused and is trying a. Remove the restraints from the client's wrists every 2 hr.
to
pull out their IV catheter. After
attempting other measures to prevent the client from
self-harm,
the nurse places wrist
restraints on the client. Which of the following actions
should
the nurse take?
a. Remove the restraints from the client's wrists every 2 hr.
b. Fasten the restrains ties to the bed's side rail
c. Contact the provide within 48 hr. to obtain a
prescription for
the restrain
d. Check that one finger will fit between the client's wrist
and
the restraints
The nurse delegates a task to an AP and the AP refuses to Report the AP to the risk manager
complete the assigned
task. Which of the following actions should the nurse
take?
