護理師為跌倒高風險病人進行安全評估，下列哪些發現需要立即介入？（選所有適合的）
A nurse is conducting a safety assessment for a client at risk for falls. Which findings require immediate intervention? (Select all that apply.)
- AThe call light is out of reach✓ 正解呼叫鈴超出觸及範圍
- BThe bed is kept in the lowest position病床保持在最低位置
- CThe floor is cluttered with personal items✓ 正解地板上堆積個人物品
- DThe client's shoes are non-slip病人的鞋子具有防滑功能
- EThe bed wheels are unlocked✓ 正解病床輪未上鎖
跌倒預防的核心在於移除環境障礙物與確保病人能隨時尋求協助。護理師需評估環境的『可近性（Accessibility）』與『穩定性（Stability）』。呼叫鈴不在手邊會導致病人因急於下床而跌倒；動線障礙物會增加絆倒風險；床輪未鎖定則會在病人移位時造成床鋪滑動。此類環境因素屬於可立即修正的安全威脅，護理師應在巡視時優先排除，以落實 Fall Precautions 規範。
Fall prevention centers on removing environmental hazards and ensuring that the client can summon help at any time. The nurse must assess the environment for accessibility and stability. A call light that is out of reach may prompt the client to attempt to get out of bed and fall; clutter in the walking path increases the risk of tripping; unlocked bed wheels allow the bed to shift during transfer. These environmental factors are immediately correctable safety threats that the nurse should remove during rounds in order to implement Fall Precautions.