# A nurse is caring for a client with Parkinson's disease who has been experiencing frequent falls. Which nursing intervention should be the priority to ensure client safety?

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> subject: Adult Health

## 문제

A nurse is caring for a client with Parkinson's disease who has been experiencing frequent falls. Which nursing intervention should be the priority to ensure client safety?

## 보기

1. Remove all throw rugs and ensure adequate lighting in walkways **✔ 정답**
2. Encourage the client to walk quickly to maintain momentum
3. Provide a wheelchair for all mobility needs
4. Schedule physical therapy sessions twice weekly

**정답: 1**

## 해설

Environmental modifications like removing throw rugs and ensuring adequate lighting are the priority safety intervention for Parkinson's disease clients at risk for falls, as they directly address immediate hazards. Other options are either dangerous (encouraging quick walking), overly restrictive (wheelchair for all mobility), or not immediate (physical therapy).

## 심화 해설

Understanding the Priority: Environmental Safety in Parkinson's Disease

The correct answer is to remove all throw rugs and ensure adequate lighting in walkways. For a client with Parkinson's disease (PD) experiencing frequent falls, the immediate priority is modifying the environment to eliminate hazards. Parkinson's disease causes progressive motor symptoms—including bradykinesia, rigidity, and postural instability—that directly increase fall risk. Because most falls in persons with Parkinson's (PwPs) occur in the home or its immediate surroundings, a home safety assessment and hazard removal are the most direct and effective first-line nursing interventions to prevent injury [1].

Why Environmental Modification is the Priority

The primary goal for a client with a known fall history is immediate risk reduction. A novel home-based telerehabilitation program targeting fall prevention demonstrated that a key component of care involves a "virtual home tour" to identify and mitigate environmental fall hazards [2]. This aligns with the nursing process: before addressing mobility training or activity scheduling, the nurse must first ensure the physical environment is safe. Throw rugs are a classic tripping hazard, and poor lighting exacerbates the visual-spatial deficits and gait freezing common in PD. Removing these hazards provides an immediate safety net.

Analysis of Incorrect Options

- Option 2: Encourage the client to walk quickly to maintain momentum. This is contraindicated. While clients with PD may experience festination (a rapid, shuffling gait), intentionally encouraging speed without addressing postural control or environmental safety drastically increases the risk of losing balance and falling. Safety management evidence emphasizes controlled, deliberate movements, not speed .

- Option 3: Provide a wheelchair for all mobility needs. This is a restrictive and inappropriate intervention that promotes deconditioning and loss of independence. Maintaining mobility is crucial in PD management to prevent contractures and preserve function. A wheelchair should not be the default response to falls; rather, the focus should be on safe ambulation strategies.

- Option 4: Schedule physical therapy sessions twice weekly. While physical therapy is an essential component of long-term fall prevention and mobility management in PD, it is not the immediate priority. A referral addresses the underlying motor impairments over time but does not eliminate the fall hazard present in the client's home right now. The nurse must first ensure the environment is safe before the client engages in therapeutic exercises.

Integrating Evidence into Clinical Judgment

Systematic review evidence for safety management in PD reinforces that a structured process of identifying and mitigating environmental risks is fundamental to preventing falls and ensuring patient well-being . The telehealth studies further validate that direct observation and modification of the home setting are feasible and central to fall prevention programs [1,2]. From an NCLEX-RN perspective, this question tests the ability to prioritize an intervention that provides an immediate, direct solution to a safety threat, which always takes precedence over long-term restorative or educational interventions. The nurse's role is to act on modifiable risk factors in the physical environment first, thereby creating a safe space for all subsequent therapeutic activities.References (research sources)

- [1]A Novel Home-Based Telerehabilitation Program Targeting Fall Prevention in Parkinson Disease: A Preliminary Trial.Research articleAfshari M, Hernandez AV, Joyce JM, Hauptschein AW, Trenkle KL, Stebbins GT, Goetz CG. (2024) · DOI: 10.1212/cpj.0000000000200246

- [2]Participant and Provider Perspectives on a Novel Virtual Home Safety Program for Fall Prevention in Parkinson's Disease.Research articleAfshari M, Dharmadhikari SP, Palakuzhy VG, Hernandez AV, Hauptschein AW, Goetz CG. (2025) · DOI: 10.3390/jcm14145031

## 임상 시나리오

Fall Prevention in Parkinson's DiseaseImmediate Environmental Safety Interventions
The priority nursing action for a client with Parkinson's disease and frequent falls is environmental hazard modification. Remove all throw rugs and ensure adequate lighting in walkways to create an immediate safety net.

Most falls occur in the home environment. A home safety assessment targeting tripping hazards and visual-spatial deficits is the most direct intervention to prevent injury before addressing mobility training.

CautionDo not encourage the client to walk quickly to maintain momentum. This contradicts safety principles for bradykinesia and postural instability, significantly increasing fall risk. Avoid routine wheelchair use, which promotes deconditioning.

## 핵심 개념

- **Bradykinesia** — Slowness of movement, a cardinal symptom of Parkinson's disease that impairs gait and increases fall risk.
- **Postural Instability** — Impaired balance and coordination, often leading to retropulsion and falls, typically occurring in later stages of Parkinson's disease.
- **Nursing Priority** — The most critical intervention based on immediate safety needs, following the hierarchy of physiological safety before addressing other concerns.
- **Environmental Hazard Modification** — A first-line fall prevention strategy involving removal of tripping hazards like rugs and ensuring adequate lighting to compensate for sensory deficits.
- **Freezing of Gait** — A sudden, brief inability to move the feet forward despite the intention to walk, commonly triggered by environmental factors like doorways or poor lighting.

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