— 安全與感染控制 · MEDIUM · SATA —
護理師評估病人的跌倒風險，哪些發現會增加其跌倒機率？（選所有適合的）
A nurse is assessing a client for fall risk. Which findings increase the client's risk for falling? (Select all that apply.)
- AAge 75 years✓ 正解75歲
- BHistory of recent orthostatic hypotension✓ 正解近期有姿勢性低血壓病史
- CCurrent prescription for a sedative✓ 正解目前處方鎮靜劑
- DAmbulation with a walker使用助行器行走
- ERecent visual impairment✓ 正解近期視力障礙
— Explanation · 中文詳解 —
跌倒風險評估（Fall risk assessment）是 NCLEX 的重要考點，通常使用 Morse Fall Scale 等工具。老年、姿位性低血壓（orthostatic hypotension）、鎮靜藥物（如 benzodiazepines）與視力障礙皆會顯著影響病人的平衡感與反應時間，進而增加跌倒風險。護理師應針對這些危險因子採取預防性措施，如輔助行走、定時巡視（rounding）及環境調整。
Risk factors for falls include advanced age, history of orthostatic hypotension, current use of sedatives, and recent visual impairment, as these conditions affect balance, alertness, and environmental awareness. Using a walker properly typically decreases fall risk rather than increasing it.