— 基本照護與舒適 · EASY · MCQ —
護理師協助一位步態不穩的高齡病人，採取哪項措施最能預防跌倒？
A nurse is assisting an elderly client who is unsteady on their feet. What is the most appropriate action to prevent falls?
- AApply physical restraints to keep the client in bed應用身體約束具將病人固定在床上
- BInstruct the client to call for help before getting up指導病人在起身前呼叫協助
- CKeep the bed in the lowest position with wheels locked✓ 正解將床置於最低位置並鎖定輪子
- DPlace the client in a room far from the nursing station將病人安置在遠離護理站的房間
— Explanation · 中文詳解 —
對於步態不穩的高齡病人，防跌（Fall prevention）是照護的核心。預防跌倒需結合環境安全與行為介入。將床位降至最低是為了在病人不慎墜床時，縮短墜落高度，降低受傷程度。雖然呼叫協助很重要，但物理性環境調整（如鎖輪、低床位）提供的是第一層即時保護。護理師應評估病人的認知能力，採取適當的環境保護措施。
Fall prevention is central in caring for unsteady older adults. It combines environmental safety and behavioral interventions. Lowering the bed reduces fall distance if the patient slides off. Although calling for help is important, physical environmental adjustments (low bed, locked wheels) provide the first immediate layer of protection. Tailor measures to the patient's cognitive ability.