Physical & Chemical Restraints

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Physical & Chemical Restraints - Quiz

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

    Correct Answer
    B. No – this is appropriate treatment for alcohol withdrawal
    Explanation
    This is not a chemical restraint because the administration of Lorazepam 1 mg IV every 6 hours is a standard and appropriate treatment for alcohol withdrawal. Chemical restraint refers to the use of medication for the purpose of controlling a person's behavior or restricting their freedom, typically without their consent or against their will. In this case, the medication is being used to manage symptoms of alcohol withdrawal and is part of a recognized treatment protocol.

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  • 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).

    Correct Answer
    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).
    Explanation
    Physical restraints may be appropriate for this patient because alternatives have been tried and failed, and getting out of bed without help is contraindicated. However, it is important to evaluate other factors such as her medications (Morphine PCA) and possible contributing factors like hypoxemia or hypercarbia by checking ABG and H&H levels.

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  • 3. 

    What kind of restraint would be considered for this patient?

    • A.

      Medical – Surgical

    • B.

      Violent / Self-Destructive Restraint

    Correct Answer
    A. Medical – Surgical
    Explanation
    This patient would require medical-surgical restraint. Medical-surgical restraints are used to ensure the safety and well-being of patients who may pose a risk to themselves or others due to their medical condition or surgical procedure. These restraints are typically used to prevent patients from pulling out medical devices, tubes, or lines, or from engaging in self-destructive or violent behavior. By using medical-surgical restraints, healthcare providers can protect the patient from harm and provide the necessary care and treatment.

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  • 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

    Correct Answer
    A. Daily with a progress note addressing the reason for on-going need for restraint
    Explanation
    The physician must evaluate this patient daily with a progress note addressing the reason for on-going need for restraint. This is important to ensure that the patient's condition is monitored closely and any changes or improvements are documented. It also allows the physician to assess the necessity of continuing the use of restraints and make any necessary adjustments to the treatment plan. Regular evaluation and documentation are crucial in ensuring the patient's safety and well-being.

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  • 5. 

    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

    Correct Answer
    B. Violent / Self – Destructive Behavior Restraints
    Explanation
    The set of restraint standards that are in effect for this patient are Violent / Self – Destructive Behavior Restraints. This is because the patient is exhibiting aggressive and threatening behavior, which poses a risk to themselves and others. The use of hard limb restraints and the administration of Haldol, a medication used to manage agitation and aggression, further supports the need for this type of restraint.

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  • 6. 

    How often must orders for physical restraints be renewed for this patient?

    • A.

      Daily

    • B.

      Every 8 hours

    • C.

      Every 4 hours

    • D.

      Weekly

    Correct Answer
    C. Every 4 hours
    Explanation
    Physical restraints are used to restrict a patient's movement to ensure their safety or the safety of others. The need for physical restraints must be regularly assessed and documented. Renewing orders for physical restraints every 4 hours indicates that the patient's condition is being closely monitored and that the healthcare team is actively evaluating the need for continued use of restraints. This frequent renewal ensures that restraints are not unnecessarily prolonged and that the patient's well-being is prioritized.

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  • 7. 

    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

    Correct Answer
    A. Within 1 hour after application (ED physician’s evaluation is sufficient) and every 8 hours thereafter
  • 8. 

    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

    Correct Answer
    A. Medical – Surgical
    Explanation
    The use of soft wrist restraints for Patrick, a 70-year-old male with severe COPD who fights the ventilator and de-saturates, is considered a medical-surgical restraint. This type of restraint is used to ensure patient safety and prevent harm, such as accidental extubation or self-extubation. It is not intended to control violent or self-destructive behavior, but rather to protect the patient's well-being during their recovery from surgery.

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  • 9. 

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

    • A.

      Yes

    • B.

      No

    Correct Answer
    B. No
    Explanation
    The given answer is "No" because a Lorazepam infusion is not considered a chemical restraint. Chemical restraints refer to the use of medication to control a person's behavior or restrict their movement, typically for the purpose of discipline or convenience. However, a Lorazepam infusion is a form of medication used for its sedative and anxiolytic properties, often administered to treat anxiety, insomnia, or seizures. While it can have a sedating effect, it is not specifically used as a means of restraint.

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  • 10. 

     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

    Correct Answer
    C. With the daily assessment. A progress note addressing the on-going need for restraint is required
    Explanation
    The face-to-face evaluation by the physician is required for this patient with the daily assessment. This means that the physician needs to evaluate the patient in person on a daily basis and provide a progress note addressing the ongoing need for restraint. This suggests that the patient may require physical or chemical restraints, and the physician needs to assess their condition regularly to determine if the restraint is still necessary.

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  • 11. 

    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

    Correct Answer
    B. No – it is considered continuation of usual treatment
    Explanation
    The correct answer is "No - it is considered continuation of usual treatment." This means that when Haldol is prescribed intramuscularly (IM) in the hospital due to the patient's NPO (nothing by mouth) status, it is not considered a chemical restraint. Instead, it is seen as a continuation of the patient's usual treatment. This suggests that the patient was already receiving Haldol orally at home, and the IM administration is just a temporary adjustment due to the NPO status.

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  • 12. 

    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

    Correct Answer
    C. It depends upon the precipitating behavior that requires the restraint
    Explanation
    The correct answer is "It depends upon the precipitating behavior that requires the restraint." This means that whether the restraints are considered Medical-Surgical or Violent/Self-Destructive depends on the specific behavior that necessitates the use of restraints. The question does not provide enough information to determine the type of restraints needed.

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  • 13. 

    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

    Correct Answer
    D. A and c are both correct
    Explanation
    The correct answer is "a and c are both correct." This means that both statements "An order is good for each episode of restraints; from initiation until successful release" and "If restraints have been removed unsuccessfully and the patient needs to be restrained again, a new order is needed" are true. This implies that a new order is required if restraints are removed unsuccessfully and the patient needs to be restrained again, and that an order remains valid for each episode of restraints until the patient is successfully released from them.

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  • 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

    Correct Answer
    B. No, not unless it is provided as a telephone order from their supervising physician
    Explanation
    The correct answer is "No, not unless it is provided as a telephone order from their supervising physician." This means that PA, NP, CNM, or CNS are not allowed to order restraint unless it is specifically authorized by their supervising physician through a telephone order. This indicates that these healthcare professionals do not have the authority to independently order restraint measures and must rely on the direction and approval of their supervising physician in such cases.

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  • 15. 

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

    • A.

      Yes

    • B.

      No

    Correct Answer
    A. Yes
    Explanation
    The explanation for the correct answer "Yes" is that order authentication for telephone orders for restraints must be completed in 24 hours, which is a shorter timeframe compared to other orders. This suggests that there is a specific requirement for prompt authentication of telephone orders for restraints, emphasizing the need for timely processing and verification.

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