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    Ati 0926 Beg Med Surg Proctored Exam Cms Equivalent

    Which of the following assessments is most appropriate for evaluating a client's risk of falls due to impaired mobility?

    Explanation & Rationale

    A. The Braden Scale: This tool is designed to assess a client’s risk for pressure injury by evaluating factors like sensory perception, activity, and moisture. While useful in skin care planning, it does not measure mobility in relation to fall risk. B. The Mini-Mental State Examination: This screening tool evaluates cognitive status, including memory, orientation, and attention. Although cognition affects fall risk, the MMSE does not specifically measure mobility or gait performance. C. The Timed Up and Go Test: This test directly evaluates mobility and balance by timing how long it takes a client to rise from a chair, walk a short distance, and return. It is one of the most appropriate and widely used assessments for predicting fall risk related to impaired mobility. D. The Glasgow Coma Scale: This tool is used to assess a client’s level of consciousness and neurological function, particularly after head trauma. It does not evaluate mobility, balance, or gait, making it unsuitable for fall risk assessment.

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