Complete Fundamentals of Nursing CA Practice Test 2025

The primary responsibility of a nurse when a patient falls is to assess the patient for injuries and report the incident. This is crucial because the immediate priority in any fall situation is to ensure the safety and well-being of the patient. Assessing the patient involves checking for any signs of injury, such as fractures, bruises, or other trauma, and monitoring vital signs to detect any changes that could indicate serious complications.

Reporting the incident is equally important as it ensures that proper documentation takes place and facilitates any necessary follow-up actions, such as further assessments or notification of the healthcare team. This process helps to maintain patient safety standards, provides data for quality improvement processes, and allows for a better understanding of the fall's circumstances, which can be vital for preventing future incidents.

While explaining the incident to the family, administering pain relief, and cleaning the area may be part of the overall response, they fall secondary to the immediate assessment and reporting responsibilities. Ensuring the patient's physical condition is stable and properly documented addresses both immediate care needs and long-term safety considerations.