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Difficulty: HardUse of Restraints and Safety Devices

A 78-year-old client admitted with urosepsis becomes increasingly restless and makes repeated attempts to disconnect their intravenous (IV) line. The healthcare provider issues a prescription stating, "Soft wrist restraints PRN for agitation." The registered nurse (RN) hands the restraint equipment to the practical nurse (PN) and delegates the application. Which action demonstrates the PN's correct understanding of restraint protocols?

  1. Refuse the delegated task and inform the registered nurse that PRN prescriptions for any type of restraint are legally invalid.Answer
  2. B
    Accept the delegated task and ensure the restraint straps are anchored to the movable side rails using quick-release knots.
  3. C
    Withhold the physical restraints but request a prescription for a sedative, as chemical restraints must always be attempted first.
  4. D
    Proceed with the application, as sudden confusion is a normal baseline change for clients of advanced age experiencing infection.

Answer

The PN must refuse the delegated task and inform the registered nurse that PRN prescriptions for any type of restraint are legally invalid.
The correct answer accurately reflects strict legal and ethical guidelines regarding client safety: PRN (as needed) prescriptions for restraints are strictly prohibited under all circumstances. Restraints require a specific, time-limited order based on a face-to-face evaluation by the provider. The PN must recognize this invalid order and appropriately advocate for the client by refusing to implement it.

Step-by-Step Solution

1
Evaluate the provider's prescription for restraints.
The prescription is written as a PRN (as needed) order.
Federal regulations and facility policies dictate that physical and chemical restraints require a specific, time-limited provider order.
2
Determine the legality and safety of the PRN order.
PRN orders for restraints are universally prohibited in all clinical settings.
Restraints restrict a client's freedom and carry high risks of injury; therefore, they require a current, situational assessment by the provider, not an open-ended PRN order.
3
Decide on the appropriate response to the RN's delegation.
The PN must decline the delegation.
A nurse cannot legally implement an invalid or unsafe order. The PN has a duty to advocate for client safety and adhere to legal scope of practice by refusing the task.

Key Concept

Restraint Prescriptions and Legal Boundaries
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Topics

Use of Restraints and Safety Devices

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