DAVIS'S DRUG GUIDE FOR NURSES
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1)
Drug Reference: Codeine — Opioid analgesic —
Pharmacogenomics & Patient/Family Teaching
Stem: A 6-year-old child (weight 22 kg) post-tonsillectomy has
an order for oral codeine for pain. The nurse notes in the chart
that the child has a family history of "rapid metabolizer"
reactions to medications. Vital signs: T 37.1°C, HR 98, RR 18,
SpO₂ 97% on room air. Which action should the nurse take
before administering codeine?
A. Administer the ordered dose and monitor respiratory rate
every 30 minutes.
,B. Hold the codeine and consult the prescriber about an
alternative analgesic.
C. Give half the ordered dose and instruct parents to report any
drowsiness.
D. Administer the dose and obtain a capillary blood glucose 1
hour later.
Correct Answer: B
Rationale — Correct (B): Codeine is metabolized to morphine
via CYP2D6; in pediatric patients who are ultra-rapid
metabolizers there is risk of respiratory depression. The safest
nursing action is to hold and consult for an alternative analgesic
(e.g., acetaminophen or nonopioid), per pharmacogenomics
guidance. This aligns with Davis's recommendations to avoid
codeine in rapid metabolizers and in post-tonsillectomy
children.
Rationale — Incorrect:
A. Monitoring alone is unsafe — ultra-rapid metabolism can
cause sudden life-threatening respiratory depression; avoid
giving codeine.
C. Partial dosing still risks excessive conversion to morphine;
dose reduction is unreliable for genetic variability.
D. Blood glucose is irrelevant to opioid pharmacogenomics and
will not prevent respiratory depression.
Teaching Point: Avoid codeine in known or suspected ultra-
rapid CYP2D6 metabolizers.
,Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). Pharmacogenomics.
2)
Drug Reference: Clopidogrel — P2Y₁₂ ADP receptor antagonist
— Pharmacogenomics & Drug Interactions
Stem: A 62-year-old patient with recent percutaneous coronary
intervention is to start clopidogrel 75 mg daily. The patient is
also on omeprazole 20 mg daily for GERD. Labs: CBC normal.
Which intervention reflects best evidence-based
pharmacotherapeutic practice?
A. Continue both medications; no interaction risk of clinical
significance.
B. Substitute pantoprazole for omeprazole and start clopidogrel
as ordered.
C. Stop clopidogrel and request warfarin instead.
D. Increase clopidogrel dose to 150 mg for 2 weeks then return
to 75 mg.
Correct Answer: B
Rationale — Correct (B): Omeprazole inhibits CYP2C19, which
converts clopidogrel to its active metabolite; coadministration
reduces antiplatelet effect. Evidence suggests using a PPI with
less CYP2C19 inhibition (e.g., pantoprazole) or timing
separation. Substituting pantoprazole preserves GERD therapy
while minimizing interaction.
, Rationale — Incorrect:
A. Incorrect—there is a clinically relevant interaction that may
reduce clopidogrel efficacy and increase stent thrombosis risk.
C. Warfarin is not an appropriate substitute for antiplatelet
therapy after PCI.
D. Dose escalation lacks evidence, may increase bleeding
without restoring antiplatelet activation in poor metabolizers.
Teaching Point: Avoid omeprazole with clopidogrel; prefer
pantoprazole when PPI needed.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). Drug Interactions;
Pharmacogenomics.
3)
Drug Reference: Insulin — Rapid-acting insulin analogue (e.g.,
lispro) — Medication Errors: Improving Practices & Patient
Teaching
Stem: A newly admitted adult with type 1 diabetes has an
order: lispro 6 units subcutacutely at 0900 for pre-breakfast
glucose of 240 mg/dL. The unit uses both U-100 insulin pens
and U-500 vials on the same floor. Which nursing action best
prevents a medication-error risk before giving insulin?
A. Draw the dose with a U-500 syringe because the patient is
hyperglycemic.
B. Verify the insulin type and device with another RN and
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1)
Drug Reference: Codeine — Opioid analgesic —
Pharmacogenomics & Patient/Family Teaching
Stem: A 6-year-old child (weight 22 kg) post-tonsillectomy has
an order for oral codeine for pain. The nurse notes in the chart
that the child has a family history of "rapid metabolizer"
reactions to medications. Vital signs: T 37.1°C, HR 98, RR 18,
SpO₂ 97% on room air. Which action should the nurse take
before administering codeine?
A. Administer the ordered dose and monitor respiratory rate
every 30 minutes.
,B. Hold the codeine and consult the prescriber about an
alternative analgesic.
C. Give half the ordered dose and instruct parents to report any
drowsiness.
D. Administer the dose and obtain a capillary blood glucose 1
hour later.
Correct Answer: B
Rationale — Correct (B): Codeine is metabolized to morphine
via CYP2D6; in pediatric patients who are ultra-rapid
metabolizers there is risk of respiratory depression. The safest
nursing action is to hold and consult for an alternative analgesic
(e.g., acetaminophen or nonopioid), per pharmacogenomics
guidance. This aligns with Davis's recommendations to avoid
codeine in rapid metabolizers and in post-tonsillectomy
children.
Rationale — Incorrect:
A. Monitoring alone is unsafe — ultra-rapid metabolism can
cause sudden life-threatening respiratory depression; avoid
giving codeine.
C. Partial dosing still risks excessive conversion to morphine;
dose reduction is unreliable for genetic variability.
D. Blood glucose is irrelevant to opioid pharmacogenomics and
will not prevent respiratory depression.
Teaching Point: Avoid codeine in known or suspected ultra-
rapid CYP2D6 metabolizers.
,Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). Pharmacogenomics.
2)
Drug Reference: Clopidogrel — P2Y₁₂ ADP receptor antagonist
— Pharmacogenomics & Drug Interactions
Stem: A 62-year-old patient with recent percutaneous coronary
intervention is to start clopidogrel 75 mg daily. The patient is
also on omeprazole 20 mg daily for GERD. Labs: CBC normal.
Which intervention reflects best evidence-based
pharmacotherapeutic practice?
A. Continue both medications; no interaction risk of clinical
significance.
B. Substitute pantoprazole for omeprazole and start clopidogrel
as ordered.
C. Stop clopidogrel and request warfarin instead.
D. Increase clopidogrel dose to 150 mg for 2 weeks then return
to 75 mg.
Correct Answer: B
Rationale — Correct (B): Omeprazole inhibits CYP2C19, which
converts clopidogrel to its active metabolite; coadministration
reduces antiplatelet effect. Evidence suggests using a PPI with
less CYP2C19 inhibition (e.g., pantoprazole) or timing
separation. Substituting pantoprazole preserves GERD therapy
while minimizing interaction.
, Rationale — Incorrect:
A. Incorrect—there is a clinically relevant interaction that may
reduce clopidogrel efficacy and increase stent thrombosis risk.
C. Warfarin is not an appropriate substitute for antiplatelet
therapy after PCI.
D. Dose escalation lacks evidence, may increase bleeding
without restoring antiplatelet activation in poor metabolizers.
Teaching Point: Avoid omeprazole with clopidogrel; prefer
pantoprazole when PPI needed.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). Drug Interactions;
Pharmacogenomics.
3)
Drug Reference: Insulin — Rapid-acting insulin analogue (e.g.,
lispro) — Medication Errors: Improving Practices & Patient
Teaching
Stem: A newly admitted adult with type 1 diabetes has an
order: lispro 6 units subcutacutely at 0900 for pre-breakfast
glucose of 240 mg/dL. The unit uses both U-100 insulin pens
and U-500 vials on the same floor. Which nursing action best
prevents a medication-error risk before giving insulin?
A. Draw the dose with a U-500 syringe because the patient is
hyperglycemic.
B. Verify the insulin type and device with another RN and
