Patient Safety, Mobility, and Body Mechanics
This domain tests how you keep a patient free from injury during transfers, ambulation, and daily care. The NCT 2023 outline frames it around three behaviors: recognizing risk before something happens, choosing the least restrictive intervention that actually works, and protecting your own body while you do it. Items are scenario stems that ask for the first or best action, so read for the detail that changes the answer - a specific drug, a recent fall, a new diagnosis.
Fall risk
Risk rises with age over 65, a fall in the past year, sedatives, diuretics, orthostatic hypotension, confusion, sensory or gait impairment, and tethers such as IV tubing and catheters. Standard interventions: bed locked and in the lowest position, call light and personal items within reach, non-skid footwear, a clear path to the bathroom, and rounding that is performed and documented rather than assumed. If a patient falls, do not move or lift them: stay, call for help, do a head-to-toe check, and document objective findings. The incident report goes to risk management; it is not filed in the medical record.
Restraints
A restraint needs a current provider order for a specific safety problem, after less restrictive measures fail, and never for punishment or staff convenience. Release, reposition, and assess skin, circulation, and range of motion at least every two hours under most policies, offering fluids, food, and toileting each time.
Body mechanics
Wide base, back straight, load close, lift with the legs, pivot the feet instead of twisting the spine. Use a gait belt for assisted transfers and a mechanical lift for anyone who cannot bear weight.
Worked example. A 78-year-old admitted after a fall at home takes furosemide and asks to walk to the bathroom at 0200. Best first action? Assist him: non-skid footwear, gait belt, and walk alongside rather than handing him a walker and pointing down the hall. Recent fall plus diuretic plus nocturia plus an unfamiliar dark room makes unassisted ambulation the highest-risk option, and gathering more data is not required when the risk is already explicit.
Traps: charting care before you give it; trusting a patient who says he feels fine; skipping the incident report because nobody was hurt; applying a restraint and then obtaining the order.