— 基本照護與舒適 · MEDIUM · SATA —
一位病人有高跌倒風險。哪些護理措施是適當的？（選所有適合的）
A client is at high risk for falls. Which nursing actions are appropriate? (Select all that apply.)
- AKeep the call light within reach✓ 正解將呼叫鈴置於觸手可及之處
- BPlace the client in a room far from the nurses' station將病人安置在遠離護理站的病房
- CEncourage the use of non-slip socks✓ 正解鼓勵使用防滑襪
- DCheck the client frequently (hourly rounds)✓ 正解頻繁評估病人（每小時巡房）
- EApply soft physical restraints to keep them seated使用軟性身體約束帶以維持坐姿
— Explanation · 中文詳解 —
高跌倒風險病人的照護是一項綜合性的安全策略。核心原則是「預防勝於治療」。呼叫鈴隨手可得讓病人感到安全且能即時求助；防滑襪提供摩擦力，減少因地面濕滑造成的跌倒；頻繁查房（Hourly rounds）能主動發現病人的需求（如廁、口渴），減少病人自行下床的衝動。將病人移至離護理站遠的房間會增加監視困難。束縛（Restraints）是為了保護病人免受傷害的最後手段，不能僅為了防跌而濫用，必須有明確醫囑。
Appropriate nursing actions for a client at high risk for falls include keeping the call light within reach, encouraging the use of non-slip socks, and performing frequent hourly rounds. These strategies promote safety by facilitating immediate assistance, improving traction, and proactively addressing client needs to prevent unsupervised ambulation.