A confused client on a ventilator was restrained to prevent him ...

[Shelles]

A confused client on a ventilator was restrained to prevent him from pulling out his endotracheal tube. Which of the following could be a possible alternative measure that the nurse could use to avoid the use of the restraints?
 
  1. Orient the client to the environment and explain the need for the endotracheal tube.
  2. Provide a trained sitter to continuously supervise the client.
  3. Camouflage the endotracheal tube with stockinette dressing.
  4. Promote relaxation techniques.

Question 2

A nurse in the emergency department (ED) of a community hospital notes that an unusually high number of clients have presented in the ED with flulike symptoms,
 
  abdominal pain, nausea, vomiting, bloody diarrhea, hematemesis and itching of the hands, fore-arms, and head. The nurse is concerned with bioterrorism, reports this to the supervisor, and sus-pects an outbreak of:
  1. Botulism
  2. Anthrax
  3. Plague
  4. Smallpox

[Silverbeard98]

Answer to Question 1

ANS: 2
A trained sitter can prevent the client from pulling out the endotracheal tube. The client is con-fused and does not understand. The endotracheal tube cannot be camouflaged effectivelythe client feels it more than sees it. Because the client is confused, it may be very difficult to com-municate relaxation techniques so that the client has an understanding.

Answer to Question 2

ANS: 2
The symptoms of the clients all point to an endemic outbreak of anthrax.