CNA Restraint Use and Alternatives to Restraints — Questions and Answers
Question 1: Under federal OBRA regulations, a physical restraint may only be applied to a resident when:
- The nurse aide believes the resident is a fall risk
- It is ordered by a physician and used as a last resort after alternatives have failed (Correct answer)
- The resident's family requests it for safety
- The facility is short-staffed and cannot monitor the resident closely
Correct answer: It is ordered by a physician and used as a last resort after alternatives have failed
OBRA regulations require a physician's order for physical restraints, and restraints must be the least restrictive intervention used only after alternatives have been tried and documented. Family requests or staffing issues are not acceptable justifications.
Question 2: A resident is in a vest restraint. How often should the nurse aide check on and release the restraint according to standard practice?
- Once per shift
- Only when the resident calls for help
- At least every two hours, with repositioning and range of motion offered (Correct answer)
- Every 15 minutes
Correct answer: At least every two hours, with repositioning and range of motion offered
Residents in restraints must be monitored at least every two hours. The nurse aide must release the restraint, reposition the resident, provide range of motion exercises, offer toileting, and observe skin condition to prevent complications such as pressure injuries, poor circulation, and muscle contracture.
Question 3: Which of the following is considered an alternative to physical restraints that the care team should attempt first?
- Tying the resident's hands together to prevent removal of tubes
- Placing the resident in a low bed with floor mats and a bed alarm (Correct answer)
- Locking the resident's wheelchair wheels at all times
- Removing the call light so the resident does not try to get up independently
Correct answer: Placing the resident in a low bed with floor mats and a bed alarm
Restraint alternatives include bed alarms, low beds with floor mats, increased supervision, activity engagement, addressing unmet needs (pain, toileting), and environmental modifications. These must be tried and documented before a restraint order is sought.
Question 4: A nurse aide ties a bed sheet across a resident's lap to prevent her from sliding out of the wheelchair without a physician order. This is:
- Acceptable because the aide is acting in the resident's best interest
- Acceptable if the family has verbally agreed
- A form of illegal physical restraint that must be reported (Correct answer)
- Acceptable as long as the aide checks on the resident every hour
Correct answer: A form of illegal physical restraint that must be reported
Any device that restricts a resident's freedom of movement without a physician's order constitutes an unauthorized physical restraint, regardless of intent. This is a violation of OBRA regulations and the resident's rights, and must be reported immediately.
Question 5: While a resident is in a torso restraint, the nurse aide observes the resident is struggling to breathe. The nurse aide should:
- Document the observation and report it at the end of the shift
- Tighten the restraint so the resident cannot struggle as much
- Remove or loosen the restraint immediately and call the nurse (Correct answer)
- Ask the resident to calm down and breathe slowly
Correct answer: Remove or loosen the restraint immediately and call the nurse
Respiratory distress is a life-threatening restraint complication. The nurse aide must immediately loosen or remove the restraint to restore breathing and call the nurse. Restraints must never impair breathing, and any sign of respiratory compromise requires immediate action.
Question 6: Which of the following statements about side rails on a resident's bed is correct?
- Raising all four side rails on a full bed is a routine safety measure with no regulatory concern
- Side rails raised to prevent a resident from getting out of bed can be considered a physical restraint (Correct answer)
- Side rails are never considered restraints as long as a doctor orders them
- Side rails may be raised at any time without documentation if the resident seems confused
Correct answer: Side rails raised to prevent a resident from getting out of bed can be considered a physical restraint
When side rails are used to prevent a resident from voluntarily leaving the bed, they may legally qualify as a physical restraint under OBRA guidelines. Their use must be assessed, ordered, and documented just like any other restraint device.
CNA Restraint Use and Alternatives to Restraints
Under federal OBRA regulations, a physical restraint may only be applied to a resident when: