A nurse is making a home visit to an older adult woman who was recently discharged home from the hospital with a new prescription. The nurse notes that a serum drug level drawn the day be-fore was subtherapeutic. What will the nurse do next?

Question

a. Ask the patient if she has difficulty swal-lowing pills.
b. Count the pills in the prescription bottle.
c. Notify the provider to request more fre-quent dosing.
d. Request an order for renal function tests.

Answer 1

B
Intentional nonadherence is common and may occur because older adult patients are not con-vinced that drugs are needed or that the dose prescribed is correct. Counting the pills would be an appropriate first step as the nurse determines the cause of the low serum drug level, because it provides information about adherence. If the pill count is correct and the patient has taken the drug as prescribed, other causes may have to be investigated. If it is clear that the patient has not been taking enough of the medication, asking about her ability to swallow may be a good fol-low-up question. The last two options would be steps to discuss with the provider if the patient is taking the medication as prescribed.