| Course | NU263CL Medical-Surgical Nursing III Clinical |
|---|---|
| Unit | Unit 5 |
| Paper type | Medication reconciliation exercise |
| Length | About 850 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BSN (prelicensure) |
| Updated | October 2026 |
Free sample paper for NU263CL Unit 5
Twelve Rows at the Door of the ICU: A Medication Reconciliation Exercise for a Composite 73-Year-Old Woman Moving to Step-Down After Four Days on a Ventilator, Finding Three Unintended Differences and Two Drugs Whose Reason Had Ended
[Student Name]
Purdue University Global
NU263CL: Medical-Surgical Nursing III Clinical
Unit 5 Medication Reconciliation Exercise
[Instructor Name]
[Date]
The patient is composite; drug names are real but doses are bracketed, every change belongs to the prescriber, and the student's role was to compare and report.
Sources for the Home List
Home medications were confirmed from three sources: her pharmacy's fill history, the bottles her son brought in and a phone call with her son, who manages her pillbox. Medication histories taken at admission are often incomplete or wrong, so more than one source is used (Tam et al., 2005).
The Twelve Rows
Each row shows the home medication, the transfer order and the finding.
1. Metoprolol succinate [50] mg daily, taken to slow the heart rate in atrial fibrillation. Transfer: none. Finding: unintended omission. It was held in the ICU when she was on vasopressors, and never restarted.
2. Apixaban [5] mg every twelve hours, her stroke-prevention anticoagulant. Transfer: heparin subcutaneous for clot prevention. Finding: unintended. Her stroke-prevention anticoagulant was replaced with a prophylactic dose that does not protect her from stroke from atrial fibrillation.
3. Levothyroxine [75] mcg daily. Transfer: levothyroxine [75] mcg daily. Matches.
4. Atorvastatin [40] mg nightly. Transfer: none. Finding: unintended omission.
5. Tiotropium inhaler daily for COPD. Transfer: ipratropium nebulizer every six hours. Finding: intended substitution in the ICU; the plan should state whether to return to her home inhaler.
6. Lisinopril [20] mg daily. Transfer: held. Finding: intended, because of kidney injury; restart criteria should be written.
7. Insulin glargine [18] units nightly at home. Transfer: insulin glargine [24] units nightly. Finding: a dose that changed meaning. The ICU converted her insulin infusion to [24] units while she was on continuous tube feeding; she is now eating little by mouth.
8. Pantoprazole IV daily. Transfer: continued. Home: none. Finding: reason expired. It was started for stress ulcer prevention while she was ventilated.
9. Quetiapine [25] mg at bedtime. Transfer: continued. Home: none. Finding: reason expired. It was started for ICU delirium, which has resolved.
10. Acetaminophen as needed. Transfer: as needed. Matches.
11. Heparin for clot prevention. Transfer: continued. Finding: see row 2.
12. Vitamin D daily. Transfer: none. Finding: low-priority omission.
Three of the differences came from the same moment: a crisis in the ICU when medicines were stopped for good reasons that were never revisited.
Why ICU Transfers Lose Medications
Medications for chronic conditions are often stopped during an ICU stay for good reasons, and then not restarted. A large study found that patients admitted to the ICU were more likely than others to have chronic medications unintentionally discontinued at discharge, including anticoagulants, statins and other drugs (Bell et al., 2011). Transfer out of the ICU is the moment to catch them.
One Message, Ranked by Harm
The student and assigned nurse sent one message to the transferring provider, ranked by potential harm:
1. Row 2: apixaban replaced by prophylactic heparin; she has atrial fibrillation and is unprotected from stroke. Please review anticoagulation plan.
2. Row 7: glargine increased to [24] units during tube feeding; she is now eating less than half her meals. Risk of overnight hypoglycemia. Please review dose.
3. Row 1: metoprolol not restarted; heart rate [104] this morning. Please consider restarting.
4. Rows 8 and 9: pantoprazole and quetiapine started in ICU; reasons may have ended. Please review.
5. Row 4: atorvastatin not restarted.
Outcome
The provider restarted apixaban and stopped prophylactic heparin, reduced glargine to [14] units, restarted metoprolol at a lower dose and atorvastatin, stopped quetiapine and planned to stop pantoprazole the next day.
How the Student and Nurse Divided the Work
The student built the twelve-row comparison and confirmed the home list with the son. The nurse reviewed each row, decided which findings to send and when, and spoke with the provider. The student's role was to compare and flag, not to decide which differences were intended. That division matters: a student can find a missing metoprolol, but only the prescriber can decide whether it should be restarted, and at what dose after a week of low pressures.
Why Expired Reasons Are Easy to Miss
Drugs started for a temporary reason, such as stress ulcer prevention on a ventilator or delirium in the ICU, look like ordinary orders on a transfer list. Nothing on the order says the reason has ended. Unless someone asks why each drug was started, these medicines can follow a patient home and add side effects and costs for no benefit.
Teaching Her Son
Her son will manage her pillbox at home, so the final list was reviewed with him line by line, including which drugs were stopped and why, and which were new.
What I Learned
Reconciliation is not checking whether doses match; it is asking why each difference exists and whether that reason still applies (Harding et al., 2023).
References
Bell, C. M., Brener, S. S., Gunraj, N., Huo, C., Bierman, A. S., Scales, D. C., Bajcar, J., Zwarenstein, M., & Urbach, D. R. (2011). Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases. JAMA, 306(8), 840-847. https://doi.org/10.1001/jama.2011.1206
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.
Tam, V. C., Knowles, S. R., Cornish, P. L., Fine, N., Marchesano, R., & Etchells, E. E. (2005). Frequency, type and clinical importance of medication history errors at admission to hospital: A systematic review. Canadian Medical Association Journal, 173(5), 510-515. https://doi.org/10.1503/cmaj.045311
Reading the NU 263CL Unit 5 instructions
Unit 5 often asks students to reconcile a patient's medications at a transition of care, such as admission, transfer or discharge. Prompts usually want the home medication list built from reliable sources, a side-by-side comparison with current orders, each difference classified as intended or unintended, a communication to the prescriber and reflection on why discrepancies occur. Instructors look for more than one source for the home list, attention to drugs started for temporary reasons, recognition of dose changes that no longer fit the patient's situation and a prioritized message. The student's role is to compare and report, not to change orders. Exercises usually fill three to four pages, citing research on reconciliation errors.
Inside the NU263CL Unit 5 example
The exercise names three sources for the home list, citing a review of medication history errors. Twelve numbered rows follow, each comparing home and transfer and giving a finding, with the highlighted sentence on how three differences came from one ICU moment and a margin note on that single cause. A section explains why ICU transfers lose medications, citing a large study of unintentional discontinuation. One message ranked by harm follows, with a margin note. The outcome reports the provider's changes. Sections explain how the student and nurse divided the work, why expired reasons are easy to miss and how the son was taught, ending with what the student learned.
Where the points sit in the NU263CL Unit 5 rubric
Reconciliation rubrics in NU 263CL commonly reward an accurate home list, a complete comparison, correct classification of differences, prioritized communication, understanding of why errors happen and appropriate scope. List credit depends on more than one source. Comparison credit goes to every medication being matched or flagged. Classification credit is earned by separating intended changes from unintended ones and noticing doses that changed meaning. Communication credit rewards a single message ranked by potential harm. Understanding credit requires linking omissions to ICU care. Scope credit goes to the student comparing and reporting rather than deciding. Exercises that catch drugs whose reason has ended usually earn the highest marks. Clear presentation, often as a numbered list or table, also counts.
Common NU263CL Unit 5 mistakes, and how to avoid them
Reconciliation exercises often lose marks by trusting a single home list, such as an old record, without confirming it. Another frequent error is assuming every difference was intended because a provider wrote the order. Some students miss doses that were right in one setting but wrong in another, like insulin set for tube feeding. Others send a long unranked list. Confirm the home list from several sources, compare every line, classify each difference, ask why each new drug was started and whether that reason still applies, rank findings by harm and leave decisions to the prescriber. Teach whoever manages medications at home from the final list.
Get an NU263CL Unit 5 example written to your instructions
Admission, transfer or discharge; a supplied list or one built from a case; a table or a narrative: reconciliation exercises vary on all three counts. Upload the Unit 5 case and instructions exactly as posted, with the rubric and any category terms the course uses, and every difference gets sorted and explained, doses bracketed. First custom sample free; ready in 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU263CL Unit 5 questions, answered
Where can I find a free NU263CL Unit 5 sample paper?
This page holds the full NU263CL Unit 5 medication reconciliation exercise for a composite woman leaving intensive care, with twelve rows, ranked findings and three sources. A reconciliation from your own transfer patient can be organized the same way.
Why are medications lost at ICU transfer in NU263CL Unit 5 terms?
Chronic drugs are often stopped in the ICU for good reasons and not restarted, and a large study found ICU patients were more likely to have them unintentionally discontinued.
What does a reason that has ended mean?
A drug started for a temporary purpose, such as stress ulcer prevention on a ventilator, that may no longer be needed after transfer.
How should findings be sent to the prescriber?
In one message, ranked by potential harm, so the most dangerous differences are read first.
What is the student's role in reconciliation?
To build the home list, compare it with orders and report differences. Decisions about restarting or stopping drugs belong to the prescriber.