a.  Explain the medication reconciliation process
b.  Analyze the client scenario for any omissions, additions, or duplications of medications and discuss the implications to the client.
c.  Analyze the client scenario for potential risks associated with the clients current condition and currently prescribed home medications 
d.  Identify potential drug interaction and prioritize the drug interactions that are most concerning to you.
e.  Identify actions that the nurse should implement and provide a reason for each action.

1.  Mr. H. is being admitted with a broken hip due to falling at home and will be having surgery the next morning.  Past medical history includes hypertension and Type 2 diabetes. Allergies: Penicillin.  The home medication list is provided to the nurse and includes the following medications:
a.  Metoprolol 25 mg PO daily
b.  Atenolol 50 mg PO daily
c.  Garlic 1000 mg PO daily
d.  Metformin 500 mg PO twice daily
e.  Aspirin 81 mg PO daily
2.  The admitting orders include the following medication orders:
a.  Continue all home medications except metformin
b.  Insulin subcutaneous based on sliding scale B
 i.  Blood sugar <150= 0 units  ii.  Blood sugar 151-175= 2 units  iii.  Blood sugar 176-200=3 units  iv.  Blood sugar 201-225=4 units  v.  Blood sugar 226-250=5 units  vi.  Blood sugar 251-300= 6 unites  vii.  Blood sugar > 300= notify healthcare provider
c.  Enoxaparin 40 mg subcutaneous daily, first dose tomorrow following surgery  
d.  Piperacillin/tazobactam 3 gram/0.375 gram IV every 6 hours, first dose 30 minutes prior to surgery