When explaining risk assessment, the nurse would indicate that ...

[Beheh]

When explaining risk assessment, the nurse would indicate that the highest priority for admission to hospital-based care is
 
  a. safety of self and others.
  b. confusion and disorientation.
  c. withdrawal from harmful substances.
  d. medical illness complicating a psychiatric disorder.

Question 2

A patient was restrained after assaulting a staff member. Which nursing measure has priority?
 
  a. Monitor the patient every 30 minutes.
  b. Maintain constant supervision of the patient.
  c. Administer a sedating medication after applying the restraints.
  d. Distract the patient at frequent intervals while restraints are in use.

[SomethingSomething]

Answer to Question 1

A
The highest priority is safety. In the other situations, threats to safety might or might not exist.

Answer to Question 2

B
Restrained patients must be constantly observed, with documentation of physical safety and comfort interventions occurring at 15-minute intervals. Medication may be administered, but this is not the priority action. Distraction is not an effective technique to use when a patient is in restraints, because minimal stimulation is preferred.