Question

A nurse on an acute care unit is caring for a client following a total hip arthroplasty. The client is confused, is moving his leg into positions that could dislocate the new hip joint, and he repeatedly attempts to get out of bed. After determining that restraint application is indicated, which of the following actions should the nurse take? (Select all that apply)

a. secure the restraint to the frame of the bed
b. get a prescription for restraints from the provider
c. have a family member sign the consent
d. use a sqaure knot to secure the restraints
e. ensure that only one finger can be inserted between the restraint and the client

Answer 1

When restraining a confused client following a total hip arthroplasty, the nurse should secure the restraint to the bed frame, get a prescription for restraints, and ensure appropriate tightness.

Step-by-step explanation:

When determining that restraint application is indicated for a confused client following a total hip arthroplasty, the nurse should take the following actions:

1. Secure the restraint to the frame of the bed: This prevents the client from moving his leg into positions that could dislocate the new hip joint.
2. Get a prescription for restraints from the provider: The use of restraints requires a prescription from a healthcare provider to ensure that it is medically necessary.
3. Ensure that only one finger can be inserted between the restraint and the client: This ensures that the restraint is not too tight and allows for circulation and comfort.