— 安全與感染控制 · EASY · MCQ —
下列哪項護理行為顯示護理師具備正確的老年人跌倒預防知識？
Which of the following actions by a nurse demonstrates appropriate knowledge of fall prevention for an elderly client?
- AEncourage the client to get up quickly to maintain blood pressure鼓勵病人快速起身以維持血壓
- BKeep the bed in the highest position for easy access將病床保持在最高位置以便接觸
- CKeep the call light within the client's reach✓ 正解將呼叫鈴置於病人可觸及之處
- DRestrain the client if they attempt to walk alone若病人試圖獨自行走則約束病人
— Explanation · 中文詳解 —
跌倒預防的核心在於減少環境風險並確保病人能獲得即時協助。高齡病人常因平衡感下降、視力減退或藥物影響導致跌倒，護理師應採取主動式預防。正確答案為維持呼叫鈴（call light）在可及範圍，這能讓病人在需要協助時（如上廁所）能及時呼叫，避免因急迫而自行下床。其他選項均違反跌倒預防的安全原則，應予以避免。
Keeping the call light within the client's reach demonstrates appropriate fall prevention by ensuring the client can easily request assistance, thereby reducing the urge to ambulate unsafely. Other actions such as rapid position changes, keeping the bed high, or using restraints increase fall risks or violate safety principles.
✦ 台美臨床差異
在美國臨床環境中，床欄（side rails）的使用規範極為嚴格，過度使用被視為約束，因此「床維持最低位」與「呼叫鈴隨手可得」是預防跌倒的標準程序，而非僅是照護建議。