# 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.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=513808&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

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.

| Time | Data |
| --- | --- |
| 2030 | Glucose 78 mg/dL; 25 percent of dinner eaten; two 2100 basal-insulin orders remain active; client is asymptomatic |
| 2105 | Neither basal dose administered; prescriber and pharmacist notified; glucose 82 mg/dL; client remains asymptomatic |
| 2130 | Insulin degludec order discontinued; one adjusted insulin glargine order documented and administered |
| 2300 | Glucose 92 mg/dL; no sweating, tremor, palpitations, confusion, or change in mental status |
| 0600 | Glucose 110 mg/dL; client ate 60 percent of breakfast; one basal-insulin order remains active |

Q1. How is the client responding after the discrepancy was resolved?

Developing progressive hypoglycemia despite intervention
Stable without hypoglycemia after the duplicate order was removed
Developing severe hyperglycemia from withholding all insulin

Q2. Which ongoing plan is appropriate?

Restart both basal-insulin orders at the next scheduled time
Stop glucose monitoring because the client has no symptoms
Continue the single reconciled regimen, monitoring, and discharge-list verification
Treat immediately with 15 g glucose despite values above 70 mg/dL and no symptoms

## 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.

## In-depth explanation

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

## Clinical scenario

Post-clarification outcome evaluation
Judge both physiologic stability and whether the duplicate order was removed, documented, monitored, and prevented from carrying into discharge.

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