# 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.

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> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

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.

Contact the prescriber and pharmacist with the discrepancy, current glucose, intake, renal function, and last-dose information.

Administer the clarified single basal-insulin dose and continue glucose monitoring as ordered.

Check point-of-care glucose and assess for adrenergic and neuroglycopenic symptoms.

Document the clarified regimen and the authorized discontinuation of the duplicate order.

Compare the verified home-medication list, active inpatient orders, and medication-administration record.

## 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.

## In-depth explanation

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.

Memory hook
A-C-C-C-A: Assess, Compare, Communicate, Confirm, Administer.

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
2MARQUIS2 StudyBest-practice medication reconciliation

## Clinical scenario

Closed-loop insulin-order clarification
Sequence current assessment, source comparison, complete communication, authorized documentation, and safe administration without inventing a dose conversion.

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