A nurse is caring for a client who has a new prescription for a protective safety restraint. Which of the following actions should the nurse take?

A. Choose the most restrictive type of restraint that will fit the client: Restraint use follows the principle of least restriction. The least restrictive device that ensures safety should always be selected to preserve client autonomy and reduce complications such as agitation, decreased circulation, or psychological distress. Choosing the most restrictive option increases the risk of harm and violates best practice guidelines. B. Assess skin integrity under the restraint once per day: Clients in restraints require frequent monitoring, including assessment of skin integrity, circulation, and neurovascular status at least every 2 hours or according to facility policy. Assessing only once per day is insufficient and increases the risk of pressure injuries, impaired circulation, and nerve damage. C. Attach the restraint securely to the side rail when the client is in bed: Restraints should be secured to the bed frame, not the side rails. Side rails move when raised or lowered, which can cause injury or accidental tightening of the restraint. Securing to the immovable bed frame ensures consistent positioning and reduces injury risk. D. Secure the restraint with an easy-to-release tie: Restraints should be secured using a quick-release knot or buckle that allows rapid removal in case of emergency. This method ensures client safety by permitting immediate release during situations such as respiratory distress or fire, while still maintaining appropriate security during use.