A 68-year-old client with type 2 diabetes and stage 3 chronic kidney disease had simultaneous 2100 orders for insulin degludec and insulin glargine. Neither dose was given until the prescriber and pharmacist clarified the discrepancy and documented one adjusted basal regimen. Review the subsequent glucose, intake, symptoms, and medication-list trend. Select the best interpretation and ongoing plan.
Trend
Choose your responses, then check the answer.
Explanation
The duplicate order was removed through an authorized clarification, one adjusted basal regimen was administered, and glucose remained above 70 mg/dL without symptoms. Continued monitoring and a clearly reconciled discharge plan are appropriate.
Quick answer The client is stable without hypoglycemia after the duplicate order was resolved. Continue the single reconciled regimen, monitoring, and transition-of-care teaching.
Why this is correct The outcome is supported by stable mentation, absence of hypoglycemia symptoms, glucose values above 70 mg/dL, improved intake, and a single authorized basal order. Reconciliation is complete only when the final regimen is documented and communicated across the next transition.
Easy analogy or mental picture After fixing a wrong route, check both the traveler and the map: the client must remain stable, and the medication list must show one clear path. The analogy does not set an individual glucose target.
Memory hook Good outcome = stable client + one clear regimen + closed-loop handoff.
NCLEX decision rule Evaluate both physiologic response and system correction. A normal value alone is not enough if the duplicate order or discharge list remains unresolved.
Why the other choices are wrong The trend does not show hypoglycemia or clinical deterioration, so rescue treatment and emergency escalation are not indicated. Restarting both basal orders recreates the original hazard.
References
1ADA Standards of Care in Diabetes—2026, Hospital CareHypoglycemia prevention and plan review
2AHRQ MATCH Toolkit, Chapter 5Documented and communicated reconciliation
Post-clarification outcome evaluationJudge both physiologic stability and whether the duplicate order was removed, documented, monitored, and prevented from carrying into discharge.