DAVIS'S DRUG GUIDE FOR NURSES
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1
Drug Reference
Metoprolol — Beta₁-Selective Adrenergic Blocker — Evidence-
Based Practice and Pharmacotherapeutics
Stem
A 68-year-old male with chronic ischemic heart disease is
ordered metoprolol succinate 50 mg PO daily. His current BP is
92/56 mm Hg, HR 48 bpm, and he reports dizziness when
standing. Serum potassium 4.6 mEq/L, creatinine 1.1 mg/dL.
Which is the nurse’s best action?
A. Hold the metoprolol and notify the prescriber to discuss dose
reduction or discontinuation.
,B. Administer the dose and recheck blood pressure and heart
rate in 30 minutes.
C. Give half the dose (25 mg) now and schedule follow-up vitals
in 1 hour.
D. Give the dose with a 250 mL fluid bolus to increase blood
pressure.
Correct answer: A
Rationales
A (Correct): Symptomatic hypotension and bradycardia are
contraindications to administering a beta-blocker per evidence-
based HF/ischemic heart disease guidelines; holding the dose
and notifying the prescriber to reassess therapy is safest. Beta-
blockers can worsen hypotension/bradycardia and precipitate
syncope.
B: Giving the dose risks worsening bradycardia and
hypotension; monitoring after administration is inappropriate
when baseline vitals are unsafe.
C: Arbitrary dose reduction by the nurse is unsafe without
prescriber approval and still risks adverse effects.
D: Administering fluids without prescriber/assessment is
inappropriate—dizziness is likely medication-related, and fluids
may not correct beta-blocker–induced bradycardia.
Teaching point: Hold beta-blockers for symptomatic
hypotension or heart rate <50 bpm; notify prescriber.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
,Guide for Nurses (19th ed.). [Evidence-Based Practice and
Pharmacotherapeutics].
2
Drug Reference
Clopidogrel — Antiplatelet Agent — Pharmacogenomics
Stem
A 58-year-old woman is prescribed clopidogrel 75 mg PO daily
after a drug-eluting stent. The chart notes she is a poor
CYP2C19 metabolizer. Platelets are within normal limits, no
bleeding. What is the nurse’s best action when preparing
discharge teaching?
A. Teach that clopidogrel may not be effective and inform
prescriber about genotype for alternative therapy.
B. Reinforce strict adherence to clopidogrel and advise
immediate reporting of any bleeding.
C. Suggest taking an extra dose if chest pain occurs to enhance
antiplatelet effect.
D. Advise stopping clopidogrel on her own if she experiences
bruising.
Correct answer: A
Rationales
A (Correct): Pharmacogenomic evidence shows CYP2C19
poor metabolizers have less active metabolite formation and
, reduced clopidogrel efficacy; nurse should educate patient and
notify prescriber to consider alternatives (e.g., prasugrel or
ticagrelor) per pharmacogenomics guidance.
B: While adherence and bleeding education are important,
this misses the essential safety issue of reduced drug
effectiveness in poor metabolizers.
C: Taking extra doses is dangerous and will not overcome
genetic loss of activation; it risks harm.
D: Stopping an antiplatelet without prescriber input after
stent placement risks thrombosis; the nurse should direct the
patient to consult prescriber.
Teaching point: CYP2C19 poor metabolizers may have reduced
clopidogrel response—notify prescriber.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Pharmacogenomics].
3
Drug Reference
Regular Insulin — Short-Acting Insulin — Medication Errors:
Improving Practices and Patient Safety
Stem
A hospitalized client’s MAR shows "insulin 10 units subcut at
0730". The nurse finds morning fingerstick glucose 48 mg/dL;
the client is alert but sweating. Breakfast tray is delayed by 45
minutes. What is the immediate nursing action?
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1
Drug Reference
Metoprolol — Beta₁-Selective Adrenergic Blocker — Evidence-
Based Practice and Pharmacotherapeutics
Stem
A 68-year-old male with chronic ischemic heart disease is
ordered metoprolol succinate 50 mg PO daily. His current BP is
92/56 mm Hg, HR 48 bpm, and he reports dizziness when
standing. Serum potassium 4.6 mEq/L, creatinine 1.1 mg/dL.
Which is the nurse’s best action?
A. Hold the metoprolol and notify the prescriber to discuss dose
reduction or discontinuation.
,B. Administer the dose and recheck blood pressure and heart
rate in 30 minutes.
C. Give half the dose (25 mg) now and schedule follow-up vitals
in 1 hour.
D. Give the dose with a 250 mL fluid bolus to increase blood
pressure.
Correct answer: A
Rationales
A (Correct): Symptomatic hypotension and bradycardia are
contraindications to administering a beta-blocker per evidence-
based HF/ischemic heart disease guidelines; holding the dose
and notifying the prescriber to reassess therapy is safest. Beta-
blockers can worsen hypotension/bradycardia and precipitate
syncope.
B: Giving the dose risks worsening bradycardia and
hypotension; monitoring after administration is inappropriate
when baseline vitals are unsafe.
C: Arbitrary dose reduction by the nurse is unsafe without
prescriber approval and still risks adverse effects.
D: Administering fluids without prescriber/assessment is
inappropriate—dizziness is likely medication-related, and fluids
may not correct beta-blocker–induced bradycardia.
Teaching point: Hold beta-blockers for symptomatic
hypotension or heart rate <50 bpm; notify prescriber.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
,Guide for Nurses (19th ed.). [Evidence-Based Practice and
Pharmacotherapeutics].
2
Drug Reference
Clopidogrel — Antiplatelet Agent — Pharmacogenomics
Stem
A 58-year-old woman is prescribed clopidogrel 75 mg PO daily
after a drug-eluting stent. The chart notes she is a poor
CYP2C19 metabolizer. Platelets are within normal limits, no
bleeding. What is the nurse’s best action when preparing
discharge teaching?
A. Teach that clopidogrel may not be effective and inform
prescriber about genotype for alternative therapy.
B. Reinforce strict adherence to clopidogrel and advise
immediate reporting of any bleeding.
C. Suggest taking an extra dose if chest pain occurs to enhance
antiplatelet effect.
D. Advise stopping clopidogrel on her own if she experiences
bruising.
Correct answer: A
Rationales
A (Correct): Pharmacogenomic evidence shows CYP2C19
poor metabolizers have less active metabolite formation and
, reduced clopidogrel efficacy; nurse should educate patient and
notify prescriber to consider alternatives (e.g., prasugrel or
ticagrelor) per pharmacogenomics guidance.
B: While adherence and bleeding education are important,
this misses the essential safety issue of reduced drug
effectiveness in poor metabolizers.
C: Taking extra doses is dangerous and will not overcome
genetic loss of activation; it risks harm.
D: Stopping an antiplatelet without prescriber input after
stent placement risks thrombosis; the nurse should direct the
patient to consult prescriber.
Teaching point: CYP2C19 poor metabolizers may have reduced
clopidogrel response—notify prescriber.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Pharmacogenomics].
3
Drug Reference
Regular Insulin — Short-Acting Insulin — Medication Errors:
Improving Practices and Patient Safety
Stem
A hospitalized client’s MAR shows "insulin 10 units subcut at
0730". The nurse finds morning fingerstick glucose 48 mg/dL;
the client is alert but sweating. Breakfast tray is delayed by 45
minutes. What is the immediate nursing action?
