Safety and Infection Control Practice Question

Question

The nurse is caring for a client in the emergency department and is focused on fall prevention scenario 3. Which nursing action is most appropriate?

Answer choices

1. A. Delay assessment until the next scheduled round if the client is not calling for help.
2. B. Delegate the clinical assessment and nursing judgment to assistive personnel.
3. C. Place high-risk clients near the nurses' station and keep call light and belongings within reach.
4. D. Document the concern without notifying the appropriate provider or care team member when escalation is needed.

Correct Answer

C. Place high-risk clients near the nurses' station and keep call light and belongings within reach.

Explanation

The priority action for fall prevention is to place high-risk clients near the nurses' station and keep call light and belongings within reach. NCLEX-style prioritization favors safety, assessment, appropriate delegation, timely escalation, and client-centered teaching.

Question details

• Difficulty: medium
• Domain: Safety and Infection Control
• Objective: fall prevention

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