A Client in the Intensive Care Unit Is Combative and Pulling

question 13

Multiple Choice

A client in the intensive care unit is combative and pulling at the endotracheal tube,which must remain in place.After applying soft hand restraints to protect the client's airway,which action should the nurse take next?

• A) Notify the primary healthcare provider.
• B) Notify the family of the need for restraints.
• C) Reassess the need for the restraints in 8 hours.
• D) Document the application of restraints in the chart.

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Definitions:

Effective Reinforcer

A stimulus that, when presented after a behavior, significantly increases the likelihood of that behavior occurring again in the future.

Cognitive Dissonance

A psychological discomfort experienced when holding two or more conflicting beliefs, values, or attitudes typically leading to a change in beliefs or behaviors to reduce the discomfort.

Social Learning Theory

A theory that suggests people can learn new behaviors and information through observing others, emphasizing the importance of modeling, imitation, and social reinforcement.

Imitation and Modeling

The act of mimicking the behavior, gestures, or speech of others as a method of learning, often a key process in the development of social skills and behaviors.