Which of the following fall prevention strategies should the nurse perform on all hospitalized patients? (Select all that apply.)
a. Conduct hourly rounds.
b. Provide the patient regular toileting.
c. Assess the patient's comfort needs.
d. Evaluate the effectiveness of pain medication.
A, B, C
A recent study shows that hourly nurse rounds are an effective strategy for reducing falls. Combining hourly rounds with activities such as regular toileting and assessing the patient's comfort needs manages those factors that often prompt patients to get out of bed without assistance. In the hospital setting, a variety of fall risk factor screening tools are available. Because multiple risk factors for falls are known, no single assessment tool is sensitive and specific for analyzing fall risk.
You might also like to view...
An older client is experiencing mouth pain rated 4 on a 10-point pain scale. What action should the nurse take?
1. Medicate the client with a prescribed narcotic analgesic. 2. Carefully inspect the client's mouth, teeth, and tongue. 3. Ask the client if they have ever had mouth pain for any reason. 4. Instruct the client to begin rinsing the mouth with an isotonic solution.
Which of the following is true of Maslow's basic need of self-actualization?
a. Once self-actualization is achieved, it is never lost. b. Elderly people outgrow the need for self-expression and self-development. c. Most people achieve self-actualization after all other needs are met. d. People use their abilities to the fullest extent possible and are true to their nature.
Why is there generally a continuing education requirement for the nursing assistant?
What will be an ideal response?
A negative contraction stress test is one in which:
a. No contractions are seen b. There are late decelerations with > 50% of the contractions seen c. There are no fetal heart rate late decelerations with the contractions d. There is one fetal heart rate deceleration seen