A 68-year-old client with type 2 diabetes and stage 3 chronic kidney disease ate 25% of dinner. Glucose fell from 102 mg/dL at 1600 to 78 mg/dL at 2030. The 2100 MAR lists insulin degludec 24 units and insulin glargine 20 units as active; the client reports using degludec at home but never both long-acting insulins together. Place the nursing actions in order from the immediate bedside safety check through administration of the clarified single basal-insulin regimen.
Ordered Response
Choose your responses, then check the answer.
Explanation
Assess the client first, verify the discrepancy from reliable medication sources, communicate the complete situation, confirm and document the authorized regimen, and only then administer the clarified dose with continued monitoring.
Quick answer Use the sequence assess → compare → communicate → confirm/document → administer/monitor.
Why this is correct The bedside assessment identifies immediate instability. Source comparison defines the discrepancy. The prescriber and pharmacist then receive the data needed to resolve it, after which the authorized single regimen can be documented and administered safely.
Easy analogy or mental picture Think of closing a five-link chain. Skipping a link leaves either the client unassessed, the discrepancy unverified, or the final order undocumented. The chain does not imply that every medication issue has the same urgency.
NCLEX decision rule Assessment comes before a nonemergency medication decision, and medication administration comes only after the intended high-alert order is clear and authorized.
Why the other choices are wrong Calling before gathering the current glucose and medication-source data produces an incomplete handoff. Administering before clarification risks duplicate exposure. Documentation belongs after an authorized decision, not before it.
References
1AHRQ MATCH Toolkit, Chapter 5Comparison, resolution, documentation, communication
Closed-loop insulin-order clarificationSequence current assessment, source comparison, complete communication, authorized documentation, and safe administration without inventing a dose conversion.