Physical & Chemical Restraints

15 Questions | Total Attempts: 649

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Physical & Chemical Restraints

Required for all physicians and allied health staff members with the exception of: Telemedicine physicians, Dermatologists, Pathologists, Radiologists, and Department of Obstetrics


Questions and Answers
  • 1. 
    Case Scenario # 1:  Mr. Jones is a 47 year old with a long history of alcohol abuse.  He is placed on the Alcohol Withdrawal protocol with Lorazepam 1 mg IV every 6 hours as needed for anxiety or agitation. Is this a chemical restraint?
    • A. 

      Yes

    • B. 

      No – this is appropriate treatment for alcohol withdrawal

  • 2. 
    Case Scenario # 2:  Mrs. Smith is an 87 year old admitted for a fractured hip.  Her past medical history is unremarkable.  Her only routine home medications are Aspirin 81 mg twice weekly, Lasix 20 mg PO daily, Digoxin 0.25 mg PO daily, KCl 20 mEq daily.  She has undergone a hemiarthroplasty and it is post operative day two.  She is on Morphine PCA.  The RN calls to report that the patient is agitated and confused, trying to get out of bed, pushing staff away and is pulling out her IV, her Foley catheter, and her JP drain.  Staff have attempted to reorient her, have provided warm blankets and contacted her grand-daughter to sit with her but to no avail.   Are physical restraints appropriate for this patient?
    • A. 

      Yes

    • B. 

      No

    • C. 

      Maybe - because alternatives have been tried and failed and getting out of bed is contraindicated without help. However, other things to evaluate are her medications (Morphine PCA) and other possible contributing factors (e.g. check ABG and H&H to evaluate possible hypoxemia or hypercarbia).

  • 3. 
    What kind of restraint would be considered for this patient?
    • A. 

      Medical – Surgical

    • B. 

      Violent / Self-Destructive Restraint

  • 4. 
    When must the physician evaluate this patient?
    • A. 

      Daily with a progress note addressing the reason for on-going need for restraint

    • B. 

      Every 8 hours

    • C. 

      Weekly

  • 5. 
    Which of the following is a true statement about Medical- Surgical physical restraint orders?
    • A. 

      An order is good for each episode of restraints; from initiation until successful release.

    • B. 

      Orders must be renewed daily

    • C. 

      If restraints have been removed unsuccessfully and the patient needs to be restrained again, a new order is needed.

    • D. 

      A and c are both correct

  • 6. 
    Case Scenario # 3:  John is a 22 year old brought into ED by friends after taking an unknown quantity of various prescription drugs and alcohol.  He is belligerent and aggressive.  He kicked an ER Tech and is threatening the staff with his IV pole.  The physician authorizes hard limb restraints x 4 and Haldol 5 mg IV push x one dose. Which set of restraint standards are in effect for this patient?
    • A. 

      Medical – Surgical Restraints

    • B. 

      Violent / Self – Destructive Behavior Restraints

  • 7. 
    How often must orders for physical restraints be renewed for this patient?
    • A. 

      Daily

    • B. 

      Every 8 hours

    • C. 

      Every 4 hours

    • D. 

      Weekly

  • 8. 
    When is the face – to – face evaluation by the physician required for this patient?
    • A. 

      Within 1 hour after application (ED physician’s evaluation is sufficient) and every 8 hours thereafter

    • B. 

      Within 1 hour after application (ED physician’s evaluation is sufficient) and daily thereafter

    • C. 

      Daily

  • 9. 
    Case Scenario #4:  Patrick is a 70 year old male who has just undergone an open cholecystectomy.  He has a history of severe COPD and is transferred to the ICU post-op on a ventilator.  When unsedated, he fights the ventilator and de-saturates.  Soft wrist restraints are ordered.  Is this Medical – Surgical Restraint or Violent / Self-Destructive Restraint?
    • A. 

      Medical – Surgical

    • B. 

      Violent / Self – Destructive

  • 10. 
    He is on a Lorazepam infusion.  Is this considered a chemical restraint?
    • A. 

      Yes

    • B. 

      No

  • 11. 
     When is the face – to – face evaluation by the physician required for this patient?
    • A. 

      Within 12 hours

    • B. 

      Weekly

    • C. 

      With the daily assessment. A progress note addressing the on-going need for restraint is required

  • 12. 
    Case Scenario # 5:  Mrs. Jones is 70 years old, admitted to the hospital from the Gardens with acute cholecystitis.  She has chronic dementia with multiple psychotropic drugs noted on the Admission Medication Reconciliation which includes Haldol 5 mg PO every HS.   When Haldol is prescribed IM in the hospital due to NPO status, does this constitute a chemical restraint?
    • A. 

      Yes

    • B. 

      No – it is considered continuation of usual treatment

  • 13. 
    If physical restraints are required for this patient, would they be considered Medical – Surgical or Violent / Self-Destructive Restraints?
    • A. 

      Medical – Surgical

    • B. 

      Violent / Self-Destructive

    • C. 

      It depends upon the precipitating behavior that requires the restraint

  • 14. 
    Is the PA, NP, CNM, or CNS allowed to order restraint?
    • A. 

      Yes

    • B. 

      No, not unless it is provided as a telephone order from their supervising physician

  • 15. 
    Order authentication for telephone orders for restraints must be completed in 24 hours----a shorter timeframe than other orders.
    • A. 

      Yes

    • B. 

      No

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