DAVIS'S DRUG GUIDE FOR NURSES
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1
Drug Reference
Evidence synthesis (multiple drugs; class varies) — Evidence-
Based Practice and Pharmacotherapeutics — Nursing
Implications & Monitoring
Clinical stem
A 68-year-old man with osteoarthritis asks you which analgesic
is “best” after you reviewed several trials. His comorbidities:
chronic kidney disease stage 3 (eGFR 45 mL/min/1.73m²), heart
failure (EF 35%), and a history of GI bleed. You note a
randomized trial showing modest pain reduction with an NSAID
,but with increased renal and GI events in older adults. What is
the most appropriate nursing recommendation?
A. Advise starting a nonselective NSAID for maximal pain relief
and schedule follow-up in 1 week.
B. Recommend acetaminophen scheduled dosing and discuss
nonpharmacologic measures; avoid routine NSAIDs.
C. Start a COX-2 selective NSAID (celecoxib) to reduce GI risk
and monitor renal function.
D. Prescribe naproxen and add a proton pump inhibitor (PPI) to
prevent GI bleeding.
Correct answer: B
Rationale — Correct (B)
Acetaminophen is first-line for older adults with osteoarthritis
when NSAID risks (CKD, HF, prior GI bleed) are present. This
aligns with evidence-based pharmacotherapeutics: minimize
harm while providing analgesia and combine with
nonpharmacologic measures (exercise, PT). Scheduled dosing
with monitoring for hepatotoxicity (if risk factors) and
reassessment is appropriate.
Rationales — Incorrect
A. Nonselective NSAIDs increase risk of renal injury and
exacerbate heart failure in this patient; not appropriate as first
choice.
C. COX-2 inhibitors reduce GI bleeding risk but still increase
cardiovascular and renal risk; not safer for HF/CKD.
,D. Adding a PPI reduces GI risk but does not remove renal or HF
risks of NSAIDs and is inferior to choosing a safer analgesic.
Teaching point: Prefer acetaminophen and nonpharmacologic
pain management when NSAID risks exist.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Evidence-Based Practice and
Pharmacotherapeutics].
2
Drug Reference
Codeine (example) — Opioid analgesic (prodrug) —
Pharmacogenomics — Patient/Family Teaching & Nursing
Implications
Clinical stem
A 2-day-old neonate born to a mother who breastfeeds
received codeine postpartum. The infant is now lethargic with
shallow respirations and O₂ saturation 88%. The newborn’s
mother reports she took codeine as prescribed. Which
pharmacogenomic explanation most likely explains the infant’s
condition and the nurse’s priority action?
A. The infant is an ultrarapid CYP2D6 metabolizer causing
increased activation of morphine; hold breastfeeding and notify
provider.
B. The infant is a CYP3A4 poor metabolizer leading to
accumulation of codeine; observe and reassess in 6 hours.
, C. The mother is a CYP2D6 poor metabolizer causing low
morphine levels; advise increased codeine dose.
D. The infant has immature renal clearance causing codeine
accumulation; continue breastfeeding and monitor.
Correct answer: A
Rationale — Correct (A)
Ultrarapid CYP2D6 metabolism in the mother can convert more
codeine to morphine, leading to higher morphine levels in
breast milk and neonatal respiratory depression. Nursing
priority: stop maternal codeine, hold breastfeeding, support
airway/oxygen, and notify prescriber—immediate safety action.
Rationales — Incorrect
B. CYP3A4 poor metabolism does not explain high morphine
exposure from codeine; delaying action is unsafe.
C. A CYP2D6 poor metabolizer would produce less morphine—
would not cause neonatal respiratory depression; increasing
dose would be dangerous.
D. While neonatal elimination is immature, the likely cause here
is maternal ultrarapid conversion; continuing breastfeeding risks
further exposure.
Teaching point: CYP2D6 ultrarapid metabolism can cause life-
threatening morphine exposure in breastfed infants.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Pharmacogenomics].
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1
Drug Reference
Evidence synthesis (multiple drugs; class varies) — Evidence-
Based Practice and Pharmacotherapeutics — Nursing
Implications & Monitoring
Clinical stem
A 68-year-old man with osteoarthritis asks you which analgesic
is “best” after you reviewed several trials. His comorbidities:
chronic kidney disease stage 3 (eGFR 45 mL/min/1.73m²), heart
failure (EF 35%), and a history of GI bleed. You note a
randomized trial showing modest pain reduction with an NSAID
,but with increased renal and GI events in older adults. What is
the most appropriate nursing recommendation?
A. Advise starting a nonselective NSAID for maximal pain relief
and schedule follow-up in 1 week.
B. Recommend acetaminophen scheduled dosing and discuss
nonpharmacologic measures; avoid routine NSAIDs.
C. Start a COX-2 selective NSAID (celecoxib) to reduce GI risk
and monitor renal function.
D. Prescribe naproxen and add a proton pump inhibitor (PPI) to
prevent GI bleeding.
Correct answer: B
Rationale — Correct (B)
Acetaminophen is first-line for older adults with osteoarthritis
when NSAID risks (CKD, HF, prior GI bleed) are present. This
aligns with evidence-based pharmacotherapeutics: minimize
harm while providing analgesia and combine with
nonpharmacologic measures (exercise, PT). Scheduled dosing
with monitoring for hepatotoxicity (if risk factors) and
reassessment is appropriate.
Rationales — Incorrect
A. Nonselective NSAIDs increase risk of renal injury and
exacerbate heart failure in this patient; not appropriate as first
choice.
C. COX-2 inhibitors reduce GI bleeding risk but still increase
cardiovascular and renal risk; not safer for HF/CKD.
,D. Adding a PPI reduces GI risk but does not remove renal or HF
risks of NSAIDs and is inferior to choosing a safer analgesic.
Teaching point: Prefer acetaminophen and nonpharmacologic
pain management when NSAID risks exist.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Evidence-Based Practice and
Pharmacotherapeutics].
2
Drug Reference
Codeine (example) — Opioid analgesic (prodrug) —
Pharmacogenomics — Patient/Family Teaching & Nursing
Implications
Clinical stem
A 2-day-old neonate born to a mother who breastfeeds
received codeine postpartum. The infant is now lethargic with
shallow respirations and O₂ saturation 88%. The newborn’s
mother reports she took codeine as prescribed. Which
pharmacogenomic explanation most likely explains the infant’s
condition and the nurse’s priority action?
A. The infant is an ultrarapid CYP2D6 metabolizer causing
increased activation of morphine; hold breastfeeding and notify
provider.
B. The infant is a CYP3A4 poor metabolizer leading to
accumulation of codeine; observe and reassess in 6 hours.
, C. The mother is a CYP2D6 poor metabolizer causing low
morphine levels; advise increased codeine dose.
D. The infant has immature renal clearance causing codeine
accumulation; continue breastfeeding and monitor.
Correct answer: A
Rationale — Correct (A)
Ultrarapid CYP2D6 metabolism in the mother can convert more
codeine to morphine, leading to higher morphine levels in
breast milk and neonatal respiratory depression. Nursing
priority: stop maternal codeine, hold breastfeeding, support
airway/oxygen, and notify prescriber—immediate safety action.
Rationales — Incorrect
B. CYP3A4 poor metabolism does not explain high morphine
exposure from codeine; delaying action is unsafe.
C. A CYP2D6 poor metabolizer would produce less morphine—
would not cause neonatal respiratory depression; increasing
dose would be dangerous.
D. While neonatal elimination is immature, the likely cause here
is maternal ultrarapid conversion; continuing breastfeeding risks
further exposure.
Teaching point: CYP2D6 ultrarapid metabolism can cause life-
threatening morphine exposure in breastfed infants.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Pharmacogenomics].
