# The nurse compares the electronic health record before discharge. Which action is the priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=513809&lang=en  
> language: en  
> subject: Continuity of Care  
> category: MOC

## Question

The nurse compares the electronic health record before discharge. Which action is the priority?

History

Vitals

Labs

Orders

Notes

Rheumatoid arthritis is controlled with methotrexate 15 mg by mouth every Tuesday. The client brought the labeled bottle, and the community pharmacy confirms the same schedule.

BP 124/70 mm Hg, HR 76/min, RR 16/min, temperature 36.8 C. The client is alert and ready for discharge.

WBC 6,800/mm3, hemoglobin 12.7 g/dL, platelets 238,000/mm3, creatinine 0.9 mg/dL.

Discharge medication: methotrexate 15 mg by mouth once daily, first dose tomorrow.

The client says, "I have always taken all 6 tablets together on Tuesday, never every day." No documentation explains a frequency change.

1

Give the printed discharge list and ask the client to follow it exactly.

✕

2

Remove methotrexate from the discharge list without contacting the prescriber.

✕

3

Pause discharge medication teaching and clarify the methotrexate frequency with the prescriber and pharmacist.

✕

4

Tell the client to skip the next Tuesday dose and begin the daily schedule afterward.

✕

## Explanation

The verified home regimen is once weekly, while the discharge order says once daily. The nurse should stop the transition process and resolve the high-risk frequency discrepancy before teaching or administration.

## In-depth explanation

Quick answer
Pause the discharge process and reconcile the weekly-versus-daily methotrexate discrepancy.

Why this is correct
The interview, labeled bottle, and pharmacy record agree on 15 mg every Tuesday, but the discharge order changes the frequency to daily without an explained clinical reason. DailyMed identifies once-weekly dosing for rheumatoid arthritis; an unintended daily schedule can cause severe toxicity.

Easy analogy or mental picture
Treat the discharge list like a flight plan. If three verified sources point to Tuesday but the final plan says every day, the plane does not leave until the route is reconciled.

Memory hook
Weekly drug written daily: stop the transition and close the discrepancy.

NCLEX decision rule
At a care transition, compare the best possible medication history with the new orders. Do not teach, administer, delete, or improvise around an unexplained high-risk discrepancy.

Why the other choices are wrong
Printing the list validates an unsafe schedule. Deleting a prescribed drug or inventing a temporary schedule exceeds the nurse's authority and leaves the discrepancy unresolved.References
1AHRQ MATCH ToolkitMedication reconciliation at transitions of care
2DailyMed: Methotrexate TabletsOnce-weekly dosing for rheumatoid arthritis

## Clinical scenario

Medication-transition check
Compare the client interview, labeled containers, pharmacy fill history, and discharge orders. Resolve every unexplained difference before providing the final medication list.

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