The Nurse Is Caring for a Patient in Restraints

The nurse is caring for a patient in restraints. Which essential information will the nurse document in the patient's medical record to provide safe care? (Select all that apply.)

A) One family member has gone to lunch.
B) Patient is placed in bilateral wrist restraints at 0815.
C) Bilateral radial pulses present, 2+, hands warm to touch
D) Straps with quick-release buckle attached to bed side rails
E) Attempts to distract the patient with television are unsuccessful.
F) Released from restraints, active range-of-motion exercises completed