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newSchoolWorks.com › VoTechWorks › Health & Personal Services › Practical Nursing (LPN) › Pharmacology for Practical Nursing › Lesson 11
HLT-LPN37-02 · Lesson 11 · 15 clock hours · demo

Patient Teaching, Medication Reconciliation, and Special Populations

Objective. The student will conduct a medication reconciliation interview using a structured tool and deliver an individualized medication teaching session adapted for a patient from a special population (pediatric, geriatric, or pregnant).

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed clinician in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.

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Why Medication Reconciliation Matters

Medication errors are among the most common and preventable patient safety events in health care. Medication reconciliation is the formal process of comparing a patient's current home medication list with the medications ordered during a new episode of care—such as hospital admission, transfer, or discharge. As an LPN, you support this process by gathering an accurate home medication history, documenting it on a structured form, and flagging discrepancies to the supervising nurse or provider. A discrepancy might be a missing home medication, a duplicate drug, a dose difference, or an interaction. Early detection protects patients from serious harm.

Conducting a Structured Reconciliation Interview

Approach the patient in a quiet, private setting. Use open-ended questions to start: "Tell me all the medicines you take at home, including vitamins, supplements, and anything you buy without a prescription." Then use closed questions to confirm details: name, dose, how often, last dose taken, and why the drug was prescribed. Ask specifically about over-the-counter products, herbal remedies, inhalers, patches, drops, and injections because patients often do not think of these as "medications."

Record every item on the reconciliation form in real time. When you have the complete list, compare it against the simulated admission orders. Flag any of the following:

Report every discrepancy immediately to the charge nurse or provider. Never assume a discrepancy is intentional.

Physiologic Differences in Special Populations

Pediatric Patients

Children are not small adults. Drug doses for pediatric patients are calculated by body weight (milligrams per kilogram) and sometimes by body surface area. Absorption, distribution, metabolism, and excretion differ significantly by age and organ maturity. Neonates and infants have immature liver enzyme systems, which slows drug metabolism. Liquid formulations are used most often because young children cannot swallow tablets. Caregivers—not the child—receive most of the teaching. Confirm that the caregiver understands how to measure a liquid dose accurately (oral syringe, not a kitchen spoon), how often to give the drug, and when to call the provider.

Geriatric Patients

Older adults commonly take multiple medications simultaneously—a situation called polypharmacy. Age-related changes increase drug sensitivity and the risk of adverse effects:

Fall risk is a critical safety concern. Many drugs—including sedatives, opioids, antihypertensives, and certain antidepressants—increase the risk of falls. When teaching an elderly patient, use large print, simple sentences, and a pill organizer demonstration if appropriate. Teach-back is essential to confirm understanding.

Pregnant Patients

Some drugs cross the placenta and may harm the developing fetus. Historically, drugs were classified into pregnancy risk categories (A, B, C, D, X) to communicate teratogenic risk; you may see this system referenced in older references and packaging. The FDA moved to a new labeling system (the Pregnancy and Lactation Labeling Rule), but the concept of teratogenicity—the potential for a drug to cause fetal abnormality—remains central. The LPN's role is to reinforce the provider's instructions: take only medications approved by the prenatal provider, report any new symptoms promptly, and never stop a prescribed drug without guidance, because untreated illness also poses risk to mother and fetus. Folic acid supplementation early in pregnancy is a standard teaching point.

Patient Teaching with the Teach-Back Method

Effective medication teaching follows a structured sequence:

1. Assess what the patient already knows.

2. Teach using plain language—avoid medical jargon. Say "blood thinner" before you say "anticoagulant."

3. Use visual aids—a printed handout reinforces spoken instruction.

4. Check understanding with teach-back: ask the patient or caregiver to explain the information in their own words. Example: "I want to make sure I explained this clearly. Can you show me how you would measure one dose?"

5. Clarify and re-teach any point the patient cannot recall or demonstrates incorrectly.

6. Document that teaching was provided and the patient or caregiver demonstrated understanding.

Teach-back is not a test of the patient; it is a test of how well you taught. If the patient cannot recall a key point, rephrase and try again. Aim for three essential messages per session: what the drug is for, how to take it correctly, and what warning signs to report.

Safety First: Key Points for Practice

Key terms8

Medication reconciliationA systematic process of comparing a patient's current home medication list with medications ordered at a transition of care to identify and resolve discrepancies.
DiscrepancyAny difference between a patient's home medication list and a new set of orders, including omissions, additions, dose differences, or duplications.
PolypharmacyThe concurrent use of multiple medications by one patient, common in older adults, which increases the risk of drug interactions and adverse effects.
Weight-based dosingCalculating a drug dose in milligrams per kilogram of body weight, the standard approach for pediatric patients to account for size variability.
TeratogenicityThe potential of a substance to cause structural or functional abnormalities in a developing fetus when a pregnant patient is exposed to it.
Teach-back methodA patient education technique in which the clinician asks the patient or caregiver to restate or demonstrate key information in their own words to confirm understanding.
Creatinine clearanceA measure of kidney filtration function used to assess whether the kidneys can adequately eliminate renally cleared drugs, often reduced in older adults.
Polypharmacy fall riskThe increased likelihood of a fall in geriatric patients taking multiple medications, especially those that cause sedation, orthostatic hypotension, or dizziness.

Worked examples3

1. A child weighs 22 kg. The provider orders amoxicillin 40 mg/kg/day divided every 8 hours. The suspension available is 250 mg/5 mL. How many milliliters will you prepare for each dose?
  1. Step 1 – Calculate total daily dose: 40 mg/kg/day × 22 kg = 880 mg/day.
  2. Step 2 – Divide into three doses (every 8 hours = 3 doses per day): 880 mg ÷ 3 = approximately 293 mg per dose.
  3. Step 3 – Set up a proportion using the available concentration (250 mg per 5 mL): 250 mg / 5 mL = 293 mg / X mL.
  4. Step 4 – Solve for X: X = (293 × 5) ÷ 250 = 1465 ÷ 250 = 5.86 mL, rounded to 5.9 mL per dose per facility rounding policy.
Answer: Approximately 5.9 mL per dose every 8 hours. Document and teach the caregiver to use an oral syringe and measure to the 5.9 mL mark.
2. During a reconciliation interview, a patient reports taking metoprolol 25 mg twice daily at home. The admission order reads metoprolol 50 mg once daily. What is the discrepancy, and what is your next action?
  1. Step 1 – Identify the discrepancy type: the home regimen is 25 mg twice daily (total 50 mg/day); the order is 50 mg once daily (same total daily dose, but different frequency and individual dose).
  2. Step 2 – Recognize this is a dosing-frequency discrepancy that requires provider clarification—the drugs may be different formulations (immediate release vs. extended release) or it may be an ordering error.
  3. Step 3 – Document the discrepancy clearly on the reconciliation form with the patient's stated home regimen and the ordered regimen.
  4. Step 4 – Report the discrepancy to the charge nurse or provider immediately; do not administer either version until the order is clarified.
Answer: This is a dose-frequency discrepancy. Document and report to the provider before administering any dose. Do not assume the change is intentional.
3. A patient's caregiver is learning to give a liquid antibiotic at home. The dose is 7.5 mL. The caregiver says she will use a teaspoon. What teaching is needed, and how does a teaspoon compare to 7.5 mL?
  1. Step 1 – Recall the standard conversion: 1 teaspoon = approximately 5 mL.
  2. Step 2 – A household teaspoon can hold anywhere from about 3 mL to 7 mL depending on the spoon—it is not an accurate measure.
  3. Step 3 – Calculate that 7.5 mL is 1.5 teaspoons; even if the caregiver tried to measure 1.5 teaspoons with a kitchen spoon, the result would be inaccurate.
  4. Step 4 – Teach the caregiver to use the oral dosing syringe that comes with the medication, fill it to the 7.5 mL line, and administer it directly into the child's cheek slowly.
Answer: A household teaspoon is not accurate for medication. Instruct the caregiver to use only the supplied oral syringe drawn to exactly 7.5 mL, and demonstrate and confirm with teach-back.

The math in this lesson2

Learners compute a 40 mg/kg/day pediatric dose for 22 kg, split it into three, and find 5.9 mL per dose.
7.RP.2N-Q.1
Brush up in the math halls at newSchoolWorks.com:
In class: Students practice a structured medication reconciliation interview with a classmate acting as a patient who takes multiple home medications; they document findings on a standard reconciliation form and identify discrepancies against a simulated admission order. · Lecture and discussion: physiologic differences in pediatric (weight-based dosing, liquid formulations), geriatric (polypharmacy, renal/hepatic decline, fall risk), and pregnant patients (pregnancy risk categories concept, teratogenicity) that alter pharmacotherapy and LPN teaching. · Students prepare and deliver a five-minute teach-back session for an assigned drug and patient profile (e.g., warfarin for an elderly patient or amoxicillin suspension for a pediatric patient's caregiver) using plain language, a printed handout, and the teach-back method; peers evaluate with a rubric.
Materials: Medication reconciliation form; simulated admission orders; patient teaching rubric; teach-back handout templates; pharmacology textbook chapters on special populations
Check: Peer and instructor evaluation of teach-back session using rubric; student must score satisfactory or above on all three rubric domains (accuracy, plain language, teach-back confirmation) to pass.

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

Pharmacological and Parenteral Therapies
1. An LPN is conducting a medication reconciliation interview with a newly admitted patient. The patient mentions she takes an herbal supplement every morning. Which action by the LPN is most appropriate?
Pharmacological and Parenteral Therapies
2. When comparing a patient's home medication list with the admission orders, the LPN notices that a blood pressure medication the patient takes daily at home is not listed in the admission orders. This finding is best described as which type of discrepancy?
Health Promotion and Maintenance
3. A nurse is teaching an elderly patient about a new medication. The patient says, "I understand." Which action best confirms that the patient actually understands the instructions?
Pharmacological and Parenteral Therapies
4. An LPN is preparing to teach a caregiver about a liquid antibiotic for a 2-year-old child. Which instruction is most important regarding dose measurement?
Pharmacological and Parenteral Therapies
5. Which physiologic change associated with aging most directly increases the risk that a renally cleared drug will accumulate to toxic levels in an older adult?
Pharmacological and Parenteral Therapies
6. A caregiver of a pediatric patient asks, 'Can I give the liquid medicine with a regular spoon?' The nurse explains that a household teaspoon equals approximately how many milliliters?
Health Promotion and Maintenance
7. An LPN is teaching a pregnant patient about medication safety. Which statement by the nurse is most accurate?
Safety and Infection Control
8. An elderly patient is admitted taking eight different medications. During teaching, the LPN identifies that three of those medications are associated with increased fall risk. Which action is the priority?
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