— 照護管理 · EASY · MCQ —
護理師照護一位有跌倒病史的病人，哪項行動是確保安全的第一優先？
A nurse is caring for a client with a history of falls. Which action is the priority to ensure safety?
- AKeep the bed in the lowest position保持病床處於最低位置
- BPlace a sign indicating fall risk on the door在門上放置跌倒風險警示牌
- CAssist the client with all ambulation協助病人進行所有行走活動
- DOrient the client to the call light✓ 正解教導病人使用呼叫鈴
— Explanation · 中文詳解 —
跌倒預防的核心在於減少無人協助的移動。指導病人使用呼叫鈴是避免其冒險下床的最有效方式。雖然降低病床、標示警示與協助行動均為跌倒預防措施，但若病人不知道如何求助，這些措施的效果將大打折扣，故優先順序最高。
Orienting the client to the call light is the priority safety intervention because it empowers the client to request assistance before attempting to move independently. While lowering the bed and using warning signs are important environmental modifications, they are less effective if the client does not know how to summon help when feeling unsteady or needing to ambulate.
✦ 台美臨床差異
美國醫院廣泛使用跌倒預防監測警報器（bed alarm）；台灣常見以床欄與家屬陪同為主。