DAVIS'S DRUG GUIDE FOR NURSES
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1
Drug Reference
Pharmacogenomics — Topic Guidance — Pharmacogenomics
section
Stem (NCLEX-level)
A 62-year-old male with atrial fibrillation is scheduled to start
warfarin. His genotype report returned as **CYP2C9 3/3 and
VKORC1 –1639AA. He has normal renal and hepatic labs. Which
nursing action is most appropriate when planning initial
anticoagulation management?
A. Administer standard warfarin initiation dose and plan INR
monitoring in 3 days.
B. Hold warfarin; contact prescriber to consider a substantially
,lower starting dose and more frequent INR checks.
C. Substitute with low-molecular-weight heparin without
consulting genetics results.
D. Begin warfarin at double the usual dose because genotype
delays metabolism.
Correct answer: B
Rationale — Correct (B)
CYP2C9 *3/*3 and VKORC1 –1639AA predict greatly increased
warfarin sensitivity and reduced metabolism, so a lower initial
dose and more frequent INR monitoring are required. Nursing
role includes recognizing pharmacogenomic results and
communicating dose adjustment and monitoring plans to the
prescriber for safety.
Rationale — Incorrect
A. Standard dosing risks supratherapeutic INR and bleeding;
waiting 3 days is insufficient for high-risk genotype.
C. Substituting LMWH ignores that warfarin may still be
indicated and requires prescriber decision; not a nursing
autonomous action.
D. Doubling dose is dangerous—genotype indicates reduced
clearance and increased sensitivity, not faster metabolism.
Teaching point: Pharmacogenomic variants (CYP2C9, VKORC1)
often require dose reduction and closer INR monitoring.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Pharmacogenomics section].
,2
Drug Reference
Medication Errors: Improving Practices and Patient Safety —
Medication Errors section
Stem (NCLEX-level)
During a busy night shift, a nurse discovers an insulin syringe
labeled “100 units/mL” prepared at the bedside for
administration at 0700 to a patient with type 1 diabetes. The
patient is asleep and blood glucose is 58 mg/dL. What is the
nurse’s priority action?
A. Administer half the prepared dose and notify the provider.
B. Hold insulin, treat hypoglycemia per protocol, and report the
near-miss per policy.
C. Wake patient and encourage carbohydrate intake before
giving the insulin.
D. Discard the syringe and document that the dose was
omitted.
Correct answer: B
Rationale — Correct (B)
A blood glucose of 58 mg/dL indicates hypoglycemia; holding
insulin and treating hypoglycemia immediately is priority.
Because an insulin dose was prepared at bedside (a safety
breach), the nurse must treat, stabilize, then report the near-
miss to improve safety.
, Rationale — Incorrect
A. Administering any insulin during hypoglycemia is unsafe.
C. Waking patient to eat could be acceptable if awake and able,
but immediate treatment per hypoglycemia protocol (e.g., 15 g
fast-acting carbohydrate or D50 IV if symptomatic) is priority.
D. Discarding without treating the hypoglycemia or reporting
the safety issue is inadequate.
Teaching point: Prioritize treating hypoglycemia; then report
and analyze medication safety near-misses.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Medication Errors section].
3
Drug Reference
Detecting and Managing Adverse Drug Reactions — Detecting
and Managing Adverse Drug Reactions section
Stem (NCLEX-level)
A patient receiving vancomycin IV develops flushing,
hypotension (BP 86/50 mmHg), and pruritus during the
infusion. Which immediate nursing action is most appropriate?
A. Stop the infusion, assess airway/breathing, and notify the
prescriber.
B. Slow the infusion rate and document the adverse effect.
C. Give diphenhydramine PO and continue infusion at same
rate.
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1
Drug Reference
Pharmacogenomics — Topic Guidance — Pharmacogenomics
section
Stem (NCLEX-level)
A 62-year-old male with atrial fibrillation is scheduled to start
warfarin. His genotype report returned as **CYP2C9 3/3 and
VKORC1 –1639AA. He has normal renal and hepatic labs. Which
nursing action is most appropriate when planning initial
anticoagulation management?
A. Administer standard warfarin initiation dose and plan INR
monitoring in 3 days.
B. Hold warfarin; contact prescriber to consider a substantially
,lower starting dose and more frequent INR checks.
C. Substitute with low-molecular-weight heparin without
consulting genetics results.
D. Begin warfarin at double the usual dose because genotype
delays metabolism.
Correct answer: B
Rationale — Correct (B)
CYP2C9 *3/*3 and VKORC1 –1639AA predict greatly increased
warfarin sensitivity and reduced metabolism, so a lower initial
dose and more frequent INR monitoring are required. Nursing
role includes recognizing pharmacogenomic results and
communicating dose adjustment and monitoring plans to the
prescriber for safety.
Rationale — Incorrect
A. Standard dosing risks supratherapeutic INR and bleeding;
waiting 3 days is insufficient for high-risk genotype.
C. Substituting LMWH ignores that warfarin may still be
indicated and requires prescriber decision; not a nursing
autonomous action.
D. Doubling dose is dangerous—genotype indicates reduced
clearance and increased sensitivity, not faster metabolism.
Teaching point: Pharmacogenomic variants (CYP2C9, VKORC1)
often require dose reduction and closer INR monitoring.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Pharmacogenomics section].
,2
Drug Reference
Medication Errors: Improving Practices and Patient Safety —
Medication Errors section
Stem (NCLEX-level)
During a busy night shift, a nurse discovers an insulin syringe
labeled “100 units/mL” prepared at the bedside for
administration at 0700 to a patient with type 1 diabetes. The
patient is asleep and blood glucose is 58 mg/dL. What is the
nurse’s priority action?
A. Administer half the prepared dose and notify the provider.
B. Hold insulin, treat hypoglycemia per protocol, and report the
near-miss per policy.
C. Wake patient and encourage carbohydrate intake before
giving the insulin.
D. Discard the syringe and document that the dose was
omitted.
Correct answer: B
Rationale — Correct (B)
A blood glucose of 58 mg/dL indicates hypoglycemia; holding
insulin and treating hypoglycemia immediately is priority.
Because an insulin dose was prepared at bedside (a safety
breach), the nurse must treat, stabilize, then report the near-
miss to improve safety.
, Rationale — Incorrect
A. Administering any insulin during hypoglycemia is unsafe.
C. Waking patient to eat could be acceptable if awake and able,
but immediate treatment per hypoglycemia protocol (e.g., 15 g
fast-acting carbohydrate or D50 IV if symptomatic) is priority.
D. Discarding without treating the hypoglycemia or reporting
the safety issue is inadequate.
Teaching point: Prioritize treating hypoglycemia; then report
and analyze medication safety near-misses.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Medication Errors section].
3
Drug Reference
Detecting and Managing Adverse Drug Reactions — Detecting
and Managing Adverse Drug Reactions section
Stem (NCLEX-level)
A patient receiving vancomycin IV develops flushing,
hypotension (BP 86/50 mmHg), and pruritus during the
infusion. Which immediate nursing action is most appropriate?
A. Stop the infusion, assess airway/breathing, and notify the
prescriber.
B. Slow the infusion rate and document the adverse effect.
C. Give diphenhydramine PO and continue infusion at same
rate.
