A nurse on a medical-surgical unit is planning care for a client who has dementia and a history of wandering. Which of the following actions should the nurse plan to implement?
Explanation & Rationale
A. Use chemical restraints at bedtime is incorrect. Chemical restraints should not be used routinely to prevent wandering. They are only appropriate for managing severe agitation or behaviors that pose immediate danger, and their use carries significant risks and ethical concerns. B. Encourage participation in activities that provide excessive stimulation is incorrect. Overstimulation can increase agitation and confusion in clients with dementia, potentially worsening wandering or behavioral issues. Activities should be calming, structured, and appropriate to the client’s cognitive abilities. C. Use a bed alarm is correct. Bed or chair alarms alert staff when a client attempts to leave the bed or chair unassisted, providing a non-restrictive safety measure to prevent wandering and falls. This intervention supports client safety while maintaining autonomy. D. Move client to a double room is incorrect. Placing a client with dementia in a double room may increase confusion and agitation due to environmental overstimulation. Single rooms are generally preferred to reduce triggers for wandering and disruptive behaviors.