The question bank is the fastest way to start, but PMHNP Helper also includes board-review planning, student resources, and plain-English guidance for psychiatric nurse practitioner students who are still learning the exam landscape.
A 79-year-old woman with a history of major depressive disorder, generalized anxiety disorder, insomnia, chronic pain, and osteoporosis is evaluated by the PMHNP following her third fall in six months, the most recent resulting in a wrist fracture. Her current psychiatric medications include mirtazapine 30 mg at bedtime, lorazepam 0.5 mg twice daily, trazodone 50 mg at bedtime, and gabapentin 300 mg three times daily. She also takes amlodipine 5 mg daily and hydrochlorothiazide 25 mg daily for hypertension. She reports morning drowsiness, occasional dizziness when standing, and unsteady gait. The PMHNP evaluates the relationship between her medication regimen and fall risk. Which of the following most accurately describes the fall risk assessment for this patient?
Explanation
Psychotropic polypharmacy is a major independent risk factor for falls in the elderly. Benzodiazepines have the strongest evidence linking them to falls and fractures. Sedating antidepressants, gabapentin, and antihypertensives compound the risk through additive sedation, impaired psychomotor function, and orthostatic hypotension. Comprehensive medication review is a primary fall prevention strategy in geriatric patients.
Key Takeaway
In geriatric patients with recurrent falls, comprehensive medication review is essential; benzodiazepines are the strongest independent psychotropic risk factor for falls, and polypharmacy with multiple sedating agents creates cumulative fall risk through additive sedation and orthostatic hypotension.