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一位老年人因差點跌倒而住院。針對每個線索或介入措施，選擇最佳的分類。

Matrix

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	Individual fall-risk cue個別跌倒風險線索	Tailored prevention intervention量身訂製的預防介入措施	Reassessment or escalation trigger重新評估或升級處置觸發條件
Dizziness begins after standing following a recent antihypertensive dose increase近期增加抗高血壓藥物劑量後，站立時開始出現頭暈
Urinary urgency, lower-extremity weakness, and unfamiliarity with the walker occur together尿急、下肢無力及對助行器不熟悉同時出現
Schedule assisted toileting at the client’s high-risk times and keep the call light and walker within reach在個案的高風險時段安排協助如廁，並將呼叫鈴和助行器放在可及範圍內
Request medication review and practice supervised transfers and walker use with the client要求藥物審查，並與個案練習在監督下轉位及使用助行器
Repeated symptomatic blood-pressure drops occur despite sitting first and rising with assistance儘管先坐起並在協助下起身，仍反覆出現有症狀的血壓下降
A near fall is followed by new unilateral weakness, confusion, syncope, or suspected injury差點跌倒後出現新的單側無力、意識混亂、暈厥或疑似損傷

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相同主題的下一題A circulating nurse leads the final time-out for an operative procedure. Complete the safe…本題收錄於此題庫[전통+신유형] NCLEX LEVEL UP 패키지KRW 79,000

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