Question

At the beginning of your shift, you notice that a client's restraint is tied too tightly. The client is struggling to free herself from the restraint. You should:

A. get the nurse in charge at once.
B. loosen the restraint and tie it correctly.
C. cut the strap to remove the restraint quickly.
D. apply a different type of restraint.

Answer 1

When a client's restraint is too tight, you should loosen and correctly re-tie the restraint to ensure safety and comfort, and then notify the nurse in charge.

Step-by-step explanation:

When you notice that a client's restraint is tied too tightly and the client is struggling, you should first assess the situation to ensure there is no immediate danger to the client's health. If the restraint is affecting the client's circulation or causing distress, you should loosen the restraint and tie it correctly.

The priority is to ensure the client's safety and comfort. After addressing the immediate concern, you should then get the nurse in charge to inform them of the situation and to evaluate whether the restraint is necessary or needs adjusting. Cutting the strap may be too drastic unless other attempts to remove the restraint have failed or there is an emergency. It is also not advisable to apply a different type of restraint without first consulting with the nurse or doctor in charge.