# Stage 1 — Recognize cues. Review the 2045 nursing note. Highlight the findings that require follow-up before the nurse administers the scheduled basal insulin. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=513803&lang=en > language: en > subject: Adverse Effects/Contraindications/Interactions > category: PPT ## Question Stage 1 — Recognize cues. Review the 2045 nursing note. Highlight the findings that require follow-up before the nurse administers the scheduled basal insulin. Nurses' Notes 2045 — The client is a 68-year-old woman with type 2 diabetes and stage 3 chronic kidney disease. Her pneumonia is improving. She ate about 25 percent of dinner. Capillary glucose fell from 102 mg/dL at 1600 to 78 mg/dL at 2030. The 2100 medication administration record lists insulin degludec 24 units subcutaneously and insulin glargine 20 units subcutaneously as active. She denies sweating, tremor, palpitations, or confusion, is alert and oriented, has BP 126/72 mm Hg and HR 78/min, and states, "I use degludec at home, but I have never taken both long-acting insulins together." ## Explanation The two active basal-insulin orders are an unresolved discrepancy. Reduced intake, a falling glucose value, and chronic kidney disease increase concern for hypoglycemia if both doses are given. ## In-depth explanation Quick answer Follow up on the two active basal-insulin orders before giving either dose, while considering the falling glucose, reduced intake, and kidney impairment. Why this is correct Medication reconciliation compares the verified regimen with current orders and resolves unintended discrepancies. Insulin is high-alert, and its glucose-lowering effect can become unsafe when duplicate therapy, reduced intake, or renal impairment is present. Easy analogy or mental picture Think of the medication list as a railway switch: two basal-insulin orders point two trains onto one track. The analogy only identifies the need to stop and verify; it does not determine the correct replacement dose. Memory hook Two basal orders + less intake + falling glucose = pause and reconcile. NCLEX decision rule When two active orders could duplicate a high-alert medication, do not guess which one is intended. Assess the client, compare the verified medication sources, and clarify the orders before administration. Why the other choices are wrong Stable vital signs and absence of symptoms do not prove that giving both doses is safe. Pneumonia improvement and orientation are relevant to the overall assessment but do not resolve the medication discrepancy.References 1AHRQ MATCH Toolkit, Chapter 5Medication reconciliation workflow 2ISMP High-Alert Medications in Acute CareInsulin safety ## Clinical scenario Clinical practice guide Verify the medication history, current orders, last administration time, glucose trend, oral intake, symptoms, and renal function before resolving a possible duplicate insulin order. ## Related questions - [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=en) - [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=en) - [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=en) - [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. Before the next do…](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=en) - [A client with bipolar disorder has been taking lithium carbonate 600 mg orally three times…](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=en) - [A nurse is monitoring a client receiving a continuous IV heparin infusion for pulmonary em…](https://mymerci.kr/pages/nclex_q.php?qn_id=363988&lang=en) - [A nurse is preparing to initiate a weight-based continuous IV unfractionated heparin infus…](https://mymerci.kr/pages/nclex_q.php?qn_id=364107&lang=en) - [A nurse is providing discharge teaching to a 65-year-old client newly prescribed warfarin …](https://mymerci.kr/pages/nclex_q.php?qn_id=364872&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=513803&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=513803&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=513803&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=513803&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=513803&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. Always follow current clinical guidelines and your institution’s protocols._