下列哪些護理措施適合用於預防病人跌倒？（選所有適合的）
Which nursing actions are appropriate to prevent a client from falling? (Select all that apply.)
- AKeeping the bed in the lowest position✓ 正解將病床保持在最低位置
- BPlacing the call light within the client's reach✓ 正解將呼叫鈴放在病人可觸及之處
- CEncouraging the client to get up independently for exercise鼓勵病人獨立起身運動
- DKeeping the floor clear of clutter and cords✓ 正解保持地面整潔，無雜物與電線
- EApplying physical restraints to all elderly clients對所有老年病人使用身體約束
預防跌倒（Fall Prevention）是住院護理的黃金法則。護理措施應以「減低風險、環境安全、適當輔助」為核心。保持病床低位與確保呼叫鈴在伸手可及處，能有效預防病人因急於下床而摔倒。此外，保持環境明亮與地面淨空亦是預防絆倒的關鍵。約束（Restraint）則應被視為最後手段，僅在病人有生命安全疑慮時使用，絕非預防跌倒的常規手段。
Fall prevention is a golden rule of inpatient nursing care. Interventions should focus on 'reducing risk, ensuring a safe environment, and providing appropriate assistance.' Keeping the bed in the lowest position and ensuring the call light is within reach effectively prevent falls caused by the client's hurried attempts to get out of bed. Maintaining a well-lit, clutter-free environment is also key to preventing trips. Restraints should be viewed as a last resort, used only when there is concern for the client's life, and never as a routine method of fall prevention.
美國醫院對於約束的使用有嚴格的聯邦法律規範（CMS regulations），護理師必須有明確的醫師醫囑，且需定時評估約束必要性與病人皮膚完整性。