An ambulatory client is admitted to the extended care facility with a diagnosis of Alzheimer's disease. In using a fall assessment tool, the nurse knows that which one of the following is the greatest indicator of risk for falls?

a. Confusion
b. Impaired judgement
c. Sensory deficit
d. History of falls


D
According to the fall assessment tool, the greatest indicator of risk for falls is a history of falls.
According to the fall assessment tool, the second leading risk factor for falls is confusion.
According to the fall assessment tool, impaired judgement is the fourth leading risk factor for falls.
According to the fall assessment tool, sensory deficit is the fifth leading risk factor for falls.

Nursing

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