A nurse is supervising an assistive personnel (AP) who is caring for a client who is at risk for falls. For which of the following actions by the AP should the nurse intervene?

A. Raises all four side rails on the client's bed: Raising all four side rails can create a restraint situation, increasing the risk of entrapment or injury. Current safety guidelines recommend using only two side rails and employing other fall-prevention strategies instead. B. Locks the wheels on the client's bed: This is a standard safety measure. Locking the wheels ensures the bed does not move when the client attempts to sit up or get out of bed, reducing fall risk. This is an appropriate safety measure for clients at risk for falls. C. Assists the client to the bathroom every 2 hr: Regularly assisting the client to the bathroom reduces the likelihood of unassisted ambulation, which can prevent falls. Scheduled toileting is a recommended intervention for fall prevention. D. Clears furniture from the path leading to the bathroom: Removing obstacles ensures a clear walking path and minimizes tripping hazards. Removing environmental hazards, such as clutter, loose rugs, or excess furniture, creates a clear, safe pathway for the client and reduces the risk of tripping.