Review the discharge timeline and determine how the nurse should manage the medication discrepancy before the client leaves the hospital.
Trend
Choose your responses, then check the answer.
Explanation
The three different insulin glargine doses are an unresolved medication discrepancy, not a cue for the nurse to choose a dose independently. Before discharge, pause final teaching and clarify the intended regimen with the responsible prescriber and pharmacist. Update the prescription and after-visit summary so the client receives one consistent medication list, then use teach-back and confirm follow-up and whom to contact for problems. Medication reconciliation is complete only when discrepancies are resolved and the accurate plan moves forward across the transition.
Trend to recognize The medication story diverges as the client approaches discharge: the verified home dose, temporary inpatient dose, prescription, and after-visit summary do not agree.
Priority response Stop the transition long enough to clarify the intended regimen with the prescriber and pharmacist. Correct the documents before teaching from them or sending them to the next care setting.
Completion evidence Compare, resolve, consolidate, teach back: one accurate list must leave with the client.
Why the alternatives fail The smallest, largest, or most recent dose is not automatically correct. Giving all versions to the client transfers rather than resolves the risk. Waiting for a later clinic visit leaves a high-alert medication discrepancy active at home.
Source
1AHRQ MATCH Medication Reconciliation Toolkit
2AHRQ Transitions of Care
32026 NCLEX-RN Test Plan
Transition of careAn older adult is medically stable after treatment for pneumonia. The nurse compares the best possible medication history, inpatient medication administration record, discharge prescription, and after-visit summary before teaching the client.
anion gap closure — Reduction of AG below 12; primary DKA resolution endpoint.
dextrose addition — Adding D5/D10 to fluids when glucose under 200 to allow insulin to continue.
subcutaneous transition — Switch to long-acting basal plus rapid-acting; overlap IV insulin by 1-2 hours.