DAVIS'S DRUG GUIDE FOR NURSES
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1
Drug Reference
Vancomycin — Glycopeptide antibiotic — Evidence-Based
Practice and Pharmacotherapeutics (Therapeutic drug
monitoring / Monitoring).
Stem (2–4 sentences)
A 68-year-old man with MRSA bacteremia is ordered
vancomycin 1 g IV q12h. Today before the 3rd dose his trough
drawn 30 minutes before the dose is 22 mcg/mL and serum
creatinine increased from 0.9 to 1.6 mg/dL over 48 hours. He is
afebrile, BP 120/76 mmHg, HR 86. What is the nurse’s best
action?
,A. Administer the prescribed dose and document the trough
result.
B. Hold the dose and notify the prescriber to consider dosing
change/level review.
C. Give half the dose now and repeat the trough 30 minutes
later.
D. Proceed with dose and order a repeat trough immediately
after infusion.
Correct answer: B
Rationale — Correct (B)
A trough of 22 mcg/mL with rising creatinine indicates
supratherapeutic exposure and renal function decline; holding
and notifying prescriber for dose adjustment or interval
extension prevents nephrotoxicity and accumulation. Evidence-
based practice requires therapeutic drug monitoring and
dosage modification when troughs exceed recommended
targets. Vancomycin is renally cleared; prompt clinician
notification is priority.
Rationale — Incorrect
A. Unsafe — administering with high trough and worsening
creatinine risks toxicity.
C. Incomplete/unsafe — arbitrary dose reduction without
prescriber/level guidance risks under/over-treatment; retesting
should follow protocol.
D. Incorrect timing — trough is meant to be pre-dose; repeating
,a trough after infusion is not useful for pre-dose monitoring and
delays action.
Teaching point: Hold vancomycin with high troughs and
worsening renal function; notify prescriber promptly.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Evidence-Based Practice and
Pharmacotherapeutics].
2
Drug Reference
Clopidogrel — P2Y12 ADP receptor blocker (antiplatelet) —
Pharmacogenomics (CYP2C19 metabolism).
Stem
A 59-year-old woman with a recent PCI is prescribed clopidogrel
75 mg daily. Her chart indicates prior genetic testing showing
she is a CYP2C19 poor metabolizer. Labs: Hgb 13 g/dL, platelets
220,000/µL. What is the nurse’s best action when preparing
patient education and medication reconciliation?
A. Explain clopidogrel will be less effective and notify the
prescriber to consider an alternative antiplatelet.
B. Encourage adherence because drug effect is independent of
genetics.
C. Suggest doubling the clopidogrel dose to overcome reduced
metabolism.
, D. Advise the patient to take clopidogrel only on procedure
days.
Correct answer: A
Rationale — Correct (A)
CYP2C19 poor metabolizers convert clopidogrel less effectively
to its active metabolite, reducing antiplatelet effect and
increasing thrombotic risk post-PCI. Evidence-based
pharmacogenomics recommends prescriber consideration of
alternative agents (e.g., prasugrel or ticagrelor) in poor
metabolizers. Nurse’s role includes patient education and
prompt prescriber notification.
Rationale — Incorrect
B. Factually incorrect — genetics affect clopidogrel activation.
C. Unsafe — doubling dose is not recommended and can
increase bleeding risk without improving activation.
D. Incorrect instruction — clopidogrel requires daily dosing;
intermittent dosing is ineffective.
Teaching point: CYP2C19 poor metabolizers may need alternate
antiplatelet therapy; notify prescriber.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Pharmacogenomics].
3
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1
Drug Reference
Vancomycin — Glycopeptide antibiotic — Evidence-Based
Practice and Pharmacotherapeutics (Therapeutic drug
monitoring / Monitoring).
Stem (2–4 sentences)
A 68-year-old man with MRSA bacteremia is ordered
vancomycin 1 g IV q12h. Today before the 3rd dose his trough
drawn 30 minutes before the dose is 22 mcg/mL and serum
creatinine increased from 0.9 to 1.6 mg/dL over 48 hours. He is
afebrile, BP 120/76 mmHg, HR 86. What is the nurse’s best
action?
,A. Administer the prescribed dose and document the trough
result.
B. Hold the dose and notify the prescriber to consider dosing
change/level review.
C. Give half the dose now and repeat the trough 30 minutes
later.
D. Proceed with dose and order a repeat trough immediately
after infusion.
Correct answer: B
Rationale — Correct (B)
A trough of 22 mcg/mL with rising creatinine indicates
supratherapeutic exposure and renal function decline; holding
and notifying prescriber for dose adjustment or interval
extension prevents nephrotoxicity and accumulation. Evidence-
based practice requires therapeutic drug monitoring and
dosage modification when troughs exceed recommended
targets. Vancomycin is renally cleared; prompt clinician
notification is priority.
Rationale — Incorrect
A. Unsafe — administering with high trough and worsening
creatinine risks toxicity.
C. Incomplete/unsafe — arbitrary dose reduction without
prescriber/level guidance risks under/over-treatment; retesting
should follow protocol.
D. Incorrect timing — trough is meant to be pre-dose; repeating
,a trough after infusion is not useful for pre-dose monitoring and
delays action.
Teaching point: Hold vancomycin with high troughs and
worsening renal function; notify prescriber promptly.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Evidence-Based Practice and
Pharmacotherapeutics].
2
Drug Reference
Clopidogrel — P2Y12 ADP receptor blocker (antiplatelet) —
Pharmacogenomics (CYP2C19 metabolism).
Stem
A 59-year-old woman with a recent PCI is prescribed clopidogrel
75 mg daily. Her chart indicates prior genetic testing showing
she is a CYP2C19 poor metabolizer. Labs: Hgb 13 g/dL, platelets
220,000/µL. What is the nurse’s best action when preparing
patient education and medication reconciliation?
A. Explain clopidogrel will be less effective and notify the
prescriber to consider an alternative antiplatelet.
B. Encourage adherence because drug effect is independent of
genetics.
C. Suggest doubling the clopidogrel dose to overcome reduced
metabolism.
, D. Advise the patient to take clopidogrel only on procedure
days.
Correct answer: A
Rationale — Correct (A)
CYP2C19 poor metabolizers convert clopidogrel less effectively
to its active metabolite, reducing antiplatelet effect and
increasing thrombotic risk post-PCI. Evidence-based
pharmacogenomics recommends prescriber consideration of
alternative agents (e.g., prasugrel or ticagrelor) in poor
metabolizers. Nurse’s role includes patient education and
prompt prescriber notification.
Rationale — Incorrect
B. Factually incorrect — genetics affect clopidogrel activation.
C. Unsafe — doubling dose is not recommended and can
increase bleeding risk without improving activation.
D. Incorrect instruction — clopidogrel requires daily dosing;
intermittent dosing is ineffective.
Teaching point: CYP2C19 poor metabolizers may need alternate
antiplatelet therapy; notify prescriber.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Pharmacogenomics].
3
