A Client Is Becoming Increasingly Restless,and the Nurse Is Concerned

Multiple Choice

A client is becoming increasingly restless,and the nurse is concerned that the client may fall out of bed.After obtaining a health care provider's order for a chest restraint,the nurse applies the restraint to the client.What MUST the nurse document concerning this situation?

A) client age,diagnosis,and time restraint is applied
B) generic name of restraint,where applied,and estimated time it will remain in place
C) reason for restraint,type of restraint used,time of placement,and condition of skin
D) name of prescribing health care provider,type of restraint,and time applied