A 57-year-old woman with type 2 diabetes mellitus comes to the physician for a follow-up examination. She previously had been compliant with her diet and medication but has had a 5-kg (11-lb) weight gain since the last visit 6 months ago. She reports that she often misses doses of her metformin. Her hemoglobin A1c is 9.8%. Which of the following is the most appropriate course of action?
AAdd glyburide to the medication regimen
BStop metformin and begin an insulin regimen
CSchedule more frequent follow-up visits
DRefer the patient to an endocrinologist
ERefer the patient to a dietician
A 34-year-old man presents to the local clinic with a 2 month history of midsternal chest pain following meals. He has a past medical history of hypertension. The patient takes lisinopril daily. He drinks 4–5 cans of 12 ounce beer daily, and chews 2 tins of smokeless tobacco every day. The vital signs are currently stable. Physical examination shows a patient who is alert and oriented to person, place, and time. Palpation of the epigastric region elicits mild tenderness. Percussion is normoresonant in all 4 quadrants. Murphy’s sign is negative. Electrocardiogram shows sinus rhythm with no acute ST segment or T wave changes. The physician decides to initiate a trial of omeprazole to treat the patient’s gastroesophageal reflux disease. How can the physician most effectively assure that this patient will adhere to the medication regimen?
AInstruct the patient to purchase a weekly pill organizer
BHave the patient repeat back to the physician the name of the medication, dosage, and frequency
CProvide the patient with details of the medication on a print-out
DContact the pharmacist because they can explain the details more thoroughly
ETell the patient to write the medication name, dosage, and frequency on their calendar at home
A 56-year-old man presents to the family medicine office since he has been having difficulty keeping his blood pressure under control for the past month. He has a significant medical history of hypertension, coronary artery disease, and diabetes mellitus. He has a prescription for losartan, atenolol, and metformin. The blood pressure is 178/100 mm Hg, the heart rate is 92/min, and the respiratory rate is 16/min. The physical examination is positive for a grade II holosystolic murmur at the left sternal border. He also has diminished sensation in his toes. Which of the following statements is the most effective means of communication between the doctor and the patient?
A“What is causing your blood pressure to be elevated?”
B“Have you been taking your medications as prescribed?”
C“Would you like us to consider trying a different medication for your blood pressure?”
D“You are taking your medications as prescribed, aren’t you?”
E“Why are you not taking your medication?”
+ 3 more in the PDF
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