Which patients should the nurse be concerned about regarding nonadherence to prescribed medication regimens?
1. A 70-year-old hypertensive male patient who has a prescription for a diuretic and is complaining that his medication is keeping him up all night
2. A 30-year-old college student who has a prescription for birth control pills and tells the nurse she has had breakthrough bleeding this past cycle
3. A 45-year-old diabetic who has a prescription for insulin and whose blood sugar is within the normal range
4. A 57-year-old day laborer who has a prescription for Lipitor for high cholesterol and a prescription card for a free health clinic
5. An 18-year-old male with a prescription for an acne medication that must be taken 4 times a day
Correct Answer: 1,5
Rationale 1: This patient has been taking his diuretic in the evening instead of in the morning and is most likely experiencing increased urination at night that is disrupting his sleep. Adverse side effects are common causes for nonadherence.
Rationale 2: Birth control pills often cause midcycle bleeding. This does not raise any red flags for nonadherence.
Rationale 3: The fact that this diabetic patient's blood sugar is within the normal range may be evidence that the patient is taking insulin as directed.
Rationale 4: The means to pay for medication (free clinic prescription card) decreases the patient's risk for nonadherence.
Rationale 5: One of the most common reasons for nonadherence is forgetting a dose, particularly with drugs that must be taken more than twice a day.
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