DAVIS'S DRUG GUIDE FOR NURSES
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1
Drug Reference
Pharmacogenomics — Pharmacogenomics — Nursing
Implications & Monitoring
Clinical stem
A 62-year-old patient with metastatic breast cancer is
prescribed tamoxifen. Her chart notes she is a known CYP2D6
poor metabolizer on prior genetic testing. Which nursing action
is most appropriate before administering tamoxifen?
A. Proceed with usual tamoxifen dosing; educate about hot
flashes.
B. Hold medication and notify the prescriber to consider
alternative therapy or dose adjustment.
,C. Administer medication and request serum drug level in 24
hours.
D. Recommend addition of a CYP3A4 inhibitor to increase active
metabolite formation.
Correct answer: B
Rationale — Correct (B)
Tamoxifen’s effectiveness depends on conversion by CYP2D6 to
active metabolites; poor metabolizers may have reduced
therapeutic effect. The nurse should hold or at least notify the
prescriber to consider alternatives or genotype-guided therapy.
Davis emphasizes using pharmacogenomic data to guide drug
selection and dosing for safety and efficacy.
Rationale — Incorrect
A: Unsafe — proceeding ignores genotype-related reduced
efficacy and risks ineffective therapy.
C: Serum tamoxifen levels do not reliably reflect active
metabolite formation and treating without prescriber input is
inappropriate.
D: Adding a CYP3A4 inhibitor won’t increase CYP2D6-mediated
activation and may cause harmful interactions.
Teaching point: Use pharmacogenomic results (e.g., CYP2D6) to
guide drug choice or adjust therapy.
Citation: Vallerand, A. H., & Sanoski, C. (2026). Davis's Drug
Guide for Nurses (19th ed.). Pharmacogenomics.
,2
Drug Reference
Medication Errors: Improving Practices and Patient Safety —
Nursing Implications & Monitoring
Clinical stem
During a busy shift, a nurse prepares to administer an IV
medication but the patient’s MAR shows two similar drug
names (look-alike). The patient has a new allergy documented
to penicillin. What is the nurse’s priority action before
administration?
A. Give the med but double-check the allergy band first.
B. Verify the drug via two-patient identifiers and check the
electronic MAR + medication monograph; if uncertain, withhold
and clarify with prescriber/pharmacy.
C. Call pharmacy only if the patient reacts after administration.
D. Ask the unit secretary which medication the prescriber likely
intended.
Correct answer: B
Rationale — Correct (B)
Davis emphasizes preventing medication errors by verifying
orders, using two identifiers, consulting drug references, and
clarifying ambiguous orders before administration. With look-
alike names and an allergy present, withholding and clarifying is
safest.
, Rationale — Incorrect
A: Incomplete — allergy must be confirmed and drug identity
clarified before administration.
C: Reactive rather than preventive — waiting for reaction risks
harm.
D: Unit secretary is not an authoritative clinical resource for
clarifying medication orders.
Teaching point: Always verify ambiguous orders with
prescriber/pharmacy before giving medications.
Citation: Vallerand, A. H., & Sanoski, C. (2026). Davis's Drug
Guide for Nurses (19th ed.). Medication Errors: Improving
Practices and Patient Safety.
3
Drug Reference
Detecting and Managing Adverse Drug Reactions — Adverse
Reactions & Monitoring
Clinical stem
A 45-year-old patient started on a new antibiotic 48 hours ago
now reports new-onset wheezing, urticaria, and hypotension
(BP 84/50 mm Hg). Which is the nurse’s priority action?
A. Administer the next antibiotic dose as scheduled and call the
prescriber.
B. Immediately stop the antibiotic, call for rapid
response/medical emergency, and prepare to administer
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1
Drug Reference
Pharmacogenomics — Pharmacogenomics — Nursing
Implications & Monitoring
Clinical stem
A 62-year-old patient with metastatic breast cancer is
prescribed tamoxifen. Her chart notes she is a known CYP2D6
poor metabolizer on prior genetic testing. Which nursing action
is most appropriate before administering tamoxifen?
A. Proceed with usual tamoxifen dosing; educate about hot
flashes.
B. Hold medication and notify the prescriber to consider
alternative therapy or dose adjustment.
,C. Administer medication and request serum drug level in 24
hours.
D. Recommend addition of a CYP3A4 inhibitor to increase active
metabolite formation.
Correct answer: B
Rationale — Correct (B)
Tamoxifen’s effectiveness depends on conversion by CYP2D6 to
active metabolites; poor metabolizers may have reduced
therapeutic effect. The nurse should hold or at least notify the
prescriber to consider alternatives or genotype-guided therapy.
Davis emphasizes using pharmacogenomic data to guide drug
selection and dosing for safety and efficacy.
Rationale — Incorrect
A: Unsafe — proceeding ignores genotype-related reduced
efficacy and risks ineffective therapy.
C: Serum tamoxifen levels do not reliably reflect active
metabolite formation and treating without prescriber input is
inappropriate.
D: Adding a CYP3A4 inhibitor won’t increase CYP2D6-mediated
activation and may cause harmful interactions.
Teaching point: Use pharmacogenomic results (e.g., CYP2D6) to
guide drug choice or adjust therapy.
Citation: Vallerand, A. H., & Sanoski, C. (2026). Davis's Drug
Guide for Nurses (19th ed.). Pharmacogenomics.
,2
Drug Reference
Medication Errors: Improving Practices and Patient Safety —
Nursing Implications & Monitoring
Clinical stem
During a busy shift, a nurse prepares to administer an IV
medication but the patient’s MAR shows two similar drug
names (look-alike). The patient has a new allergy documented
to penicillin. What is the nurse’s priority action before
administration?
A. Give the med but double-check the allergy band first.
B. Verify the drug via two-patient identifiers and check the
electronic MAR + medication monograph; if uncertain, withhold
and clarify with prescriber/pharmacy.
C. Call pharmacy only if the patient reacts after administration.
D. Ask the unit secretary which medication the prescriber likely
intended.
Correct answer: B
Rationale — Correct (B)
Davis emphasizes preventing medication errors by verifying
orders, using two identifiers, consulting drug references, and
clarifying ambiguous orders before administration. With look-
alike names and an allergy present, withholding and clarifying is
safest.
, Rationale — Incorrect
A: Incomplete — allergy must be confirmed and drug identity
clarified before administration.
C: Reactive rather than preventive — waiting for reaction risks
harm.
D: Unit secretary is not an authoritative clinical resource for
clarifying medication orders.
Teaching point: Always verify ambiguous orders with
prescriber/pharmacy before giving medications.
Citation: Vallerand, A. H., & Sanoski, C. (2026). Davis's Drug
Guide for Nurses (19th ed.). Medication Errors: Improving
Practices and Patient Safety.
3
Drug Reference
Detecting and Managing Adverse Drug Reactions — Adverse
Reactions & Monitoring
Clinical stem
A 45-year-old patient started on a new antibiotic 48 hours ago
now reports new-onset wheezing, urticaria, and hypotension
(BP 84/50 mm Hg). Which is the nurse’s priority action?
A. Administer the next antibiotic dose as scheduled and call the
prescriber.
B. Immediately stop the antibiotic, call for rapid
response/medical emergency, and prepare to administer
