A nurse on a medical-surgical unit has received a report on four clients. Which of the following clients should the nurse assign to the RN?

Choice A rationale
A patient who experiences postural hypotension is at a higher risk for falls. Postural hypotension, or a sudden drop in blood pressure upon standing, can cause dizziness and increase the likelihood of falling. This condition is common in older adults and those with certain medical conditions.
Choice B rationale
A patient who is experiencing nausea from chemotherapy is not necessarily at a higher risk for falls. While nausea can cause discomfort and weakness, it does not directly contribute to an increased risk of falling. Other factors, such as medication side effects or balance issues, are more significant in fall risk assessment.
Choice C rationale

A patient who has already fallen twice is at a higher risk for future falls. A history of falls is a strong predictor of subsequent falls, as it may indicate underlying issues such as balance problems, muscle weakness, or environmental hazards.
Choice D rationale
A patient who is older than 50 years old is not automatically at a higher risk for falls. While age is a factor, the risk significantly increases for individuals over 65 years old. Other factors, such as medical conditions and medication use, play a more critical role in fall risk assessment.
Choice E rationale
A patient who is transferred to long-term care is at a higher risk for falls. The transition to a new environment can be disorienting, and patients may be unfamiliar with their surroundings. Additionally, long-term care patients often have multiple health issues that contribute to an increased fall risk.

Choice A rationale
Providing an opportunity for team members to ask questions is important for effective communication and teamwork, but it is not the primary action to verify the correct patient, procedure, and surgery. This action is more related to ensuring that all team members are on the same page and can clarify any doubts, but it does not directly verify the patient’s identity and procedure.
Choice B rationale
Discussing personal matters unrelated to the surgery is incorrect and unprofessional. It does not contribute to verifying the correct patient, procedure, and surgery. This action can lead to distractions and potential errors in patient care.
Choice C rationale
Reviewing the surgical instruments and equipment is important for ensuring that the necessary tools are available and functioning properly, but it does not directly verify the patient’s identity and procedure. This action is more related to the preparation and readiness of the surgical team.
Choice D rationale
Confirming the patient’s identity and procedure is the correct action to verify the correct patient, procedure, and surgery. This involves verifying the patient’s identity using at least two identifiers, confirming the procedure with the patient or their representative, and ensuring that the correct procedure is on the schedule. This step is crucial to prevent wrong-site, wrong- procedure, and wrong-patient surgeries.