Wrist restraints have been prescribed for a client who is constantly pulling at his gastrostomy tube. Which of the following findings does the nurse, developing a care plan, recognize as unexpected outcomes related to the use of restraints?
A. The client is agitated.
B. The skin under the restraint is red.
C. The client's left hand is pale and cold.
D. The client verbalizes the reason for the restraints.
E. The client is unable to reach the gastrostomy tube with his hands.
F. The client slips his hand from its restraint and pulls at his gastrostomy tube.
Ans:
A. The client is agitated.
B. The skin under the restraint is red.
C. The client's left hand is pale and cold.
F. The client slips his hand from its restraint and pulls at his gastrostomy tube.
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