A charge nurse is observing a newly licensed nurse care for a client who is at risk for falls. Which of the following findings should the nurse identify as a risk factor for falls?

Choice A: This is incorrect because maintaining the client on bed rest can increase the risk of complications such as pneumonia, thromboembolism, or pressure ulcers. The nurse should encourage early ambulation and frequent position changes to promote healing and prevent complications.

Choice B: This is correct because repositioning the client can help relieve pressure and discomfort from the incision site. The nurse should assist the client to change positions every 2 hours and use pillows or splints to support the incision.

Choice C: This is incorrect because applying a warm, moist compress to the incision area can interfere with wound healing and increase the risk of infection. The nurse should keep the incision site clean and dry and follow the provider's orders for dressing changes.

Choice D: This is incorrect because administering an additional dose of pain medication is not necessary when the client reports a pain level of 2 on a scale of 0 to 10. The nurse should monitor the client's pain level and administer pain medication as prescribed and as needed.

Choice A reason: Staying nearby can provide comfort and support is not an appropriate response, as it does not acknowledge or validate the partner's feelings of grief and loss. The nurse should listen empathetically and encourage the partner to express their emotions.

Choice B reason: I can understand your feelings of sadness is an appropriate response, as it shows empathy and compassion for the partner's situation and allows them to feel heard and understood.

Choice C reason: I will be positive and optimistic for you is not an appropriate response, as it implies that the partner's feelings are negative or inappropriate and that they need to be changed or fixed. The nurse should respect and accept the partner's feelings without judging or minimizing them.

Choice D reason: You should try to be strong for him is not an appropriate response, as it places pressure and expectations on the partner and discourages them from showing their true feelings. The nurse should support and empower the partner without imposing their own values or beliefs.