A 78-year-old community-dwelling woman is seen at a primary care clinic after falling at home yesterday without injury. She has hypertension treated with lisinopril-hydrochlorothiazide, reports lightheadedness when standing, takes 14 seconds on the Timed Up and Go test, and states her hallway has no nightlight. Which interventions should the nurse include in an individualized fall-prevention plan? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
The CDC STEADI framework directs nurses to screen, assess modifiable risk factors, and implement targeted interventions. For a community-dwelling older adult with a recent fall, orthostatic symptoms, polypharmacy, prolonged Timed Up and Go, and identified home hazards, the plan should include requesting a provider-led medication review, referring to an evidence-based strength and balance program, and modifying home environmental risks. Interventions that independently alter medication timing, recommend assistive devices without proper assessment and fitting, or modify dietary sodium without provider input exceed nursing scope or require further evaluation. Each intervention should target a specific identified risk factor rather than applying blanket restrictions.
Clinical Reasoning The CDC STEADI framework directs nurses to screen, assess modifiable risk factors, and implement targeted interventions. For a community-dwelling older adult with a recent fall, orthostatic symptoms, polypharmacy, prolonged Timed Up and Go, and identified home hazards, the plan should include requesting a provider-led medication review, referring to an evidence-based strength and balance program, and modifying home environmental risks. Interventions that independently alter medication timing, recommend assistive devices without proper assessment and fitting, or modify dietary sodium without provider input exceed nursing scope or require further evaluation. Each intervention should target a specific identified risk factor rather than applying blanket restrictions.
Option Review
Incorrect — Changing antihypertensive timing to bedtime without provider evaluation is outside nursing scope and may increase nocturnal fall risk. The nurse should instead request a formal medication review to identify and modify fall-risk-increasing medications.
Correct — STEADI guidelines call for a structured medication review when fall-risk-increasing drugs are identified. The provider can evaluate whether the diuretic or antihypertensive contributes to orthostatic hypotension and adjust the regimen accordingly.
Correct — Evidence-based programs such as Tai Chi or Otago improve strength and balance and reduce falls in community-dwelling older adults. This directly addresses the prolonged Timed Up and Go result.
Incorrect — Prescribing an assistive device requires gait assessment, proper fitting, and training by a qualified clinician. Advising universal walker use without evaluation may create a new fall hazard and does not address the underlying causes.
Incorrect — Increasing dietary sodium to manage orthostatic hypotension requires provider evaluation, especially in a client with hypertension. Unsupervised sodium modification could worsen blood pressure control and increase cardiovascular risk.
Correct — Home hazard modification is a core STEADI component. Installing automatic nightlights addresses the identified environmental risk and improves visibility during nighttime trips to the bathroom.
Sources
12026 NCLEX-RN Test Plan
2CDC: STEADI Older Adult Fall Prevention
3CDC: Preventing Falls and Hip Fractures
A 78-year-old community-dwelling woman presents to a primary care clinic after an uncomplicated fall at home. She reports orthostatic lightheadedness, takes an antihypertensive diuretic, has a prolonged Timed Up and Go test, and lacks nighttime lighting in her hallway.