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 & Pharmacotherapeutics
Stem: A 62-year-old man is admitted after an acute MI. Orders
include metoprolol 25 mg PO twice daily. Current vitals: BP
110/68 mmHg, HR 64 bpm, SpO₂ 98% on room air. He has a
history of COPD (uses albuterol PRN). Which action should the
nurse take before administering metoprolol?
A. Give the dose; his BP and HR are acceptable after MI.
B. Hold the dose and call the prescriber because HR is
borderline low.
C. Administer and monitor respiratory status because COPD
increases beta-blocker risk.
,D. Administer half the dose because older adults require dose
reduction post-MI.
Correct answer: A
Rationale — Correct (A): Evidence supports early initiation of β-
blocker therapy after MI when hemodynamically stable to
reduce mortality. His HR (64 bpm) and BP (110/68 mmHg) are
within acceptable ranges for starting metoprolol. Nursing
implication: administer and monitor BP/HR.
Rationale — Incorrect:
B. HR 64 bpm is not low enough to routinely hold β-blocker
post-MI; holding without prescriber input may withhold
guideline therapy.
C. While nonselective beta-blockers increase bronchospasm
risk, metoprolol is β₁-selective and usually safe; monitor but do
not withhold for COPD alone.
D. Dose adjustments are individualized; arbitrary halving is not
guideline-based and could underdose therapy.
Teaching point: Begin β-blocker post-MI if hemodynamically
stable; monitor BP and HR.
Citation: Vallerand, A. H., & Sanoski, C. (2024). Davis's Drug
Guide for Nurses (19th ed.). [Metoprolol — Evidence-Based
Practice & Pharmacotherapeutics].
,2)
Drug Reference: Warfarin — Vitamin K Antagonist —
Pharmacogenomics
Stem: A 54-year-old woman with new atrial fibrillation is to
start warfarin. Her initial INR after 3 days on the starting dose is
1.1. She has a known CYP2C9 *1/*3 genotype and VKORC1
variant associated with warfarin sensitivity. What is the nurse’s
best action?
A. Increase the dose because the INR is subtherapeutic.
B. Continue the dose and reassess INR in 48 hours due to
genotype-related slower response.
C. Hold the warfarin and request alternative anticoagulation
because of genetic risk.
D. Double the dose once to achieve therapeutic INR faster.
Correct answer: B
Rationale — Correct (B): Pharmacogenomic variants (CYP2C9,
VKORC1) can alter warfarin metabolism and sensitivity —
patients with these variants often require lower stable doses
and may show delayed INR response. The safe action is to
continue current dosing and reassess INR per protocol rather
than escalating dose rapidly.
Rationale — Incorrect:
A. Increasing dose risks overshoot and bleeding given genotype
predicts sensitivity.
C. Genetic variants do not automatically contraindicate
, warfarin; management is dose adjustment and monitoring.
D. Doubling dose risks serious bleeding once INR rises; not safe.
Teaching point: Use genotype information to guide dosing and
frequent INR monitoring to avoid overshoot.
Citation: Vallerand, A. H., & Sanoski, C. (2024). Davis's Drug
Guide for Nurses (19th ed.). [Warfarin — Pharmacogenomics].
3)
Drug Reference: Regular Insulin (IV infusion) — Short-Acting
Insulin — Medication Errors: Improving Practices & Patient
Safety
Stem: In the ICU a nurse prepares an insulin infusion for a
patient with DKA. The electronic medication administration
record (eMAR) shows an order for “insulin 0.1 units/kg/hr IV.”
The patient weighs 120 kg; the unit's standard protocol requires
pharmacy double-check. The nurse is alone and ready to hang
the infusion. What should the nurse do?
A. Prepare and start the infusion—this is routine; document
later.
B. Start the infusion after visually verifying the dose with
another nurse during shift change.
C. Hold initiating the infusion and request the required
pharmacy or second-nurse double-check now.
D. Ask the charge nurse later whether a double-check is
needed, then proceed.
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1)
Drug Reference: Metoprolol — Beta₁-Selective Adrenergic
Blocker — Evidence-Based Practice & Pharmacotherapeutics
Stem: A 62-year-old man is admitted after an acute MI. Orders
include metoprolol 25 mg PO twice daily. Current vitals: BP
110/68 mmHg, HR 64 bpm, SpO₂ 98% on room air. He has a
history of COPD (uses albuterol PRN). Which action should the
nurse take before administering metoprolol?
A. Give the dose; his BP and HR are acceptable after MI.
B. Hold the dose and call the prescriber because HR is
borderline low.
C. Administer and monitor respiratory status because COPD
increases beta-blocker risk.
,D. Administer half the dose because older adults require dose
reduction post-MI.
Correct answer: A
Rationale — Correct (A): Evidence supports early initiation of β-
blocker therapy after MI when hemodynamically stable to
reduce mortality. His HR (64 bpm) and BP (110/68 mmHg) are
within acceptable ranges for starting metoprolol. Nursing
implication: administer and monitor BP/HR.
Rationale — Incorrect:
B. HR 64 bpm is not low enough to routinely hold β-blocker
post-MI; holding without prescriber input may withhold
guideline therapy.
C. While nonselective beta-blockers increase bronchospasm
risk, metoprolol is β₁-selective and usually safe; monitor but do
not withhold for COPD alone.
D. Dose adjustments are individualized; arbitrary halving is not
guideline-based and could underdose therapy.
Teaching point: Begin β-blocker post-MI if hemodynamically
stable; monitor BP and HR.
Citation: Vallerand, A. H., & Sanoski, C. (2024). Davis's Drug
Guide for Nurses (19th ed.). [Metoprolol — Evidence-Based
Practice & Pharmacotherapeutics].
,2)
Drug Reference: Warfarin — Vitamin K Antagonist —
Pharmacogenomics
Stem: A 54-year-old woman with new atrial fibrillation is to
start warfarin. Her initial INR after 3 days on the starting dose is
1.1. She has a known CYP2C9 *1/*3 genotype and VKORC1
variant associated with warfarin sensitivity. What is the nurse’s
best action?
A. Increase the dose because the INR is subtherapeutic.
B. Continue the dose and reassess INR in 48 hours due to
genotype-related slower response.
C. Hold the warfarin and request alternative anticoagulation
because of genetic risk.
D. Double the dose once to achieve therapeutic INR faster.
Correct answer: B
Rationale — Correct (B): Pharmacogenomic variants (CYP2C9,
VKORC1) can alter warfarin metabolism and sensitivity —
patients with these variants often require lower stable doses
and may show delayed INR response. The safe action is to
continue current dosing and reassess INR per protocol rather
than escalating dose rapidly.
Rationale — Incorrect:
A. Increasing dose risks overshoot and bleeding given genotype
predicts sensitivity.
C. Genetic variants do not automatically contraindicate
, warfarin; management is dose adjustment and monitoring.
D. Doubling dose risks serious bleeding once INR rises; not safe.
Teaching point: Use genotype information to guide dosing and
frequent INR monitoring to avoid overshoot.
Citation: Vallerand, A. H., & Sanoski, C. (2024). Davis's Drug
Guide for Nurses (19th ed.). [Warfarin — Pharmacogenomics].
3)
Drug Reference: Regular Insulin (IV infusion) — Short-Acting
Insulin — Medication Errors: Improving Practices & Patient
Safety
Stem: In the ICU a nurse prepares an insulin infusion for a
patient with DKA. The electronic medication administration
record (eMAR) shows an order for “insulin 0.1 units/kg/hr IV.”
The patient weighs 120 kg; the unit's standard protocol requires
pharmacy double-check. The nurse is alone and ready to hang
the infusion. What should the nurse do?
A. Prepare and start the infusion—this is routine; document
later.
B. Start the infusion after visually verifying the dose with
another nurse during shift change.
C. Hold initiating the infusion and request the required
pharmacy or second-nurse double-check now.
D. Ask the charge nurse later whether a double-check is
needed, then proceed.
