— 安全與感染控制 · EASY · MCQ —
下列哪位病人最需要評估潛在安全隱患？
Which client should the nurse assess for potential safety hazards?
- AClient who is alert and oriented意識清楚且定向力完整的病人
- BClient who is reading a book正在閱讀書籍的病人
- CClient who is sitting quietly in a chair安靜坐在椅子上的病人
- DClient with confusion and history of falls✓ 正解有混淆狀態且有跌倒病史的病人
— Explanation · 中文詳解 —
認知功能受損（Confusion）加上過往病史（History of falls）是跌倒風險極高的組合。這類病人因判斷力欠缺，無法遵從安全指導，必須採取高度防護措施（如離床警報器、持續監測）。其他選項病人皆表現穩定，風險較低。
A client with confusion and a history of falls presents the highest risk for injury because cognitive impairment compromises judgment and the ability to follow safety instructions. Unlike stable or alert clients, this individual requires heightened precautions such as bed alarms and continuous monitoring to prevent falls.
✦ 台美臨床差異
美台評估工具雖一致，但台灣在照護這類病人時，常需結合家屬陪同以共同維護安全。