# Review the discharge timeline and determine how the nurse should manage the medication discrepancy before the client leaves the hospital. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=393509&lang=en > language: en > subject: Continuity of Care > category: MOC ## Question Review the discharge timeline and determine how the nurse should manage the medication discrepancy before the client leaves the hospital. | Time | Data | | --- | --- | | 0800 | Pharmacy-verified home list: insulin glargine 24 units subcutaneously nightly. The client confirms this was the dose used before admission. | | 0900 | Inpatient medication record: insulin glargine 12 units nightly while oral intake was reduced. | | 1030 | New discharge prescription: insulin glargine 18 units nightly. Draft after-visit summary still lists both 12 units and 24 units as active. | | 1100 | The client asks, Which dose do I take tonight? Final discharge teaching has not started. | Q1. What does the timeline reveal? The inpatient dose automatically becomes the discharge dose An unresolved medication discrepancy exists across transition documents The client should select the dose that was used longest Q2. What should the nurse do before completing discharge teaching? Teach all three doses and let the client decide at home Choose the 12-unit dose because it is the lowest Clarify the intended regimen with the prescriber and pharmacist and correct all discharge documents Q3. Which finding best shows that medication reconciliation is complete? One consistent regimen appears on the prescription and after-visit summary, and the client explains it correctly by teach-back The conflicting lists remain attached so the clinic can review them later The client signs the discharge form without explaining the regimen ## 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. ## In-depth explanation 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 ## Clinical scenario Transition of care An 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. ## Key concepts - **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. ## Related questions - [A nurse is transferring an older adult from a hospital to a long-term care facility. 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