為了預防高齡病人跌倒，護理師應將哪些護理措施納入照護計畫？(選所有適合的)
Which of the following interventions should a nurse include in the plan of care to prevent falls for an older adult client? (Select all that apply.)
- AKeep the bed in the lowest position✓ 正解將病床保持在最低位置
- BEncourage the client to get up quickly when dizzy鼓勵病人在頭暈時快速起身
- COrient the client to the environment upon admission✓ 正解在病人入院時協助其熟悉環境
- DKeep the call light within reach✓ 正解確保呼叫鈴在病人伸手可及之處
- EApply physical restraints to prevent wandering應用身體約束帶以防止病人遊走
預防跌倒的照護計畫應包含環境準備與病人教育。將病床降至最低、確保呼叫鈴隨手可及、入院時進行環境熟悉（orientation）以減少病人對環境的陌生感，均為標準措施。鼓勵病人快速起身會引發姿勢性低血壓（orthostatic hypotension），增加跌倒風險。約束（restraints）則非預防跌倒的手段，反會增加病人的掙扎與受傷機率。
A fall-prevention plan of care should include both environmental preparation and patient education. Keeping the bed at the lowest position, ensuring that the call light is within reach, and orienting the client to the environment on admission to reduce unfamiliarity are all standard measures. Encouraging the client to get up quickly precipitates orthostatic hypotension and increases the risk of falls. Restraints are not a means of preventing falls and may instead provoke struggling and increase the risk of injury.