DAVIS'S DRUG GUIDE FOR NURSES
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1
Drug Reference: Warfarin — Vitamin K antagonist
(anticoagulant) — Pharmacogenomics & Drug Interactions
Stem: A 68-year-old man with atrial fibrillation is started on
warfarin 5 mg nightly. His baseline labs: INR 1.0, creatinine 1.0
mg/dL. He reports a family history of excessive bleeding with
"thin blood" on his maternal side. The provider orders a one-
time loading dose with plan for INR check in 3 days. Which
action best reflects application of pharmacogenomic-informed
safe prescribing?
A. Administer the ordered loading dose and check INR in 3 days.
,B. Hold warfarin and obtain CYP2C9 and VKORC1 genotype
testing before first dose.
C. Give half the ordered dose (2.5 mg) and check INR at 24–48
hours.
D. Start the ordered dose and give oral vitamin K
prophylactically to limit bleeding.
Correct Answer: C
Rationale — Correct: Starting at a lower initial dose (2.5 mg) in
a patient with possible genetic sensitivity (family history of
increased warfarin sensitivity) is a pragmatic, safety-focused
approach while awaiting genotype results or early INR.
Pharmacogenomic variants (CYP2C9, VKORC1) can increase
warfarin sensitivity and bleeding risk; lower dosing with early
INR monitoring (24–48 hours) prevents overshoot.
Rationale — Incorrect:
A. Unsafe — full loading dose risks rapid INR elevation if the
patient is a sensitive metabolizer.
B. Impractical and delaying therapy — genotype testing may
take days; holding anticoagulation without bridging increases
thromboembolism risk.
D. Inappropriate — prophylactic vitamin K negates
anticoagulation and defeats therapeutic intent; not a safe
prevention strategy.
Teaching point: Consider genetics; start low and monitor INR
early when sensitivity suspected.
,Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Pharmacogenomics].
2
Drug Reference: Insulin regular (IV infusion) — Short-acting
insulin — Medication Errors: Improving Practices and Patient
Safety
Stem: A newly hired nurse is assigned a patient on IV regular
insulin infusion for DKA. The electronic infusion pump order
reads: “insulin infusion 0.1 units/kg/hr.” The nurse is preparing
to calculate the infusion rate for a 70-kg man. What is the
nurse's best action before starting the infusion?
A. Calculate and program the pump using 7 units/hr and start
the infusion.
B. Ask another nurse to verify the weight and calculation
(independent double-check).
C. Round the rate to 6 units/hr to account for pump variability
and start.
D. Call pharmacy to request a premixed insulin bag at the
calculated rate.
Correct Answer: B
Rationale — Correct: Independent double-check of high-alert
medication calculations (weight-based insulin infusions) is a
recognized safety practice to prevent medication errors.
Verification of the weight and calculation before starting
, reduces risk of insulin overdose or underdose.
Rationale — Incorrect:
A. Starting without verification risks calculation error.
C. Arbitrary rounding may underdose; pump accuracy should be
assured, not compensated for with guesswork.
D. Delaying therapy by waiting for pharmacy premix may be
unsafe in DKA; however, calling pharmacy is appropriate if there
is uncertainty — but the priority is verification first.
Teaching point: Use independent double-checks for high-alert,
weight-based insulin infusions.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Medication Errors: Improving
Practices and Patient Safety].
3
Drug Reference: Vancomycin — Glycopeptide antibiotic —
Detecting and Managing Adverse Drug Reactions
Stem: A patient receiving IV vancomycin over 60 minutes
develops flushing, hypotension (BP 88/54 mmHg), and pruritus
during infusion. The nurse notes the infusion is halfway
complete. What is the priority nursing action?
A. Stop the infusion immediately and notify the prescriber.
B. Slow the infusion rate to finish over 2 more hours and
monitor.
C. Give IV diphenhydramine and allow the infusion to continue
19TH EDITION
• AUTHOR(S)APRIL HAZARD
VALLERAND; CYNTHIA SANOSKI
TEST BANK
1
Drug Reference: Warfarin — Vitamin K antagonist
(anticoagulant) — Pharmacogenomics & Drug Interactions
Stem: A 68-year-old man with atrial fibrillation is started on
warfarin 5 mg nightly. His baseline labs: INR 1.0, creatinine 1.0
mg/dL. He reports a family history of excessive bleeding with
"thin blood" on his maternal side. The provider orders a one-
time loading dose with plan for INR check in 3 days. Which
action best reflects application of pharmacogenomic-informed
safe prescribing?
A. Administer the ordered loading dose and check INR in 3 days.
,B. Hold warfarin and obtain CYP2C9 and VKORC1 genotype
testing before first dose.
C. Give half the ordered dose (2.5 mg) and check INR at 24–48
hours.
D. Start the ordered dose and give oral vitamin K
prophylactically to limit bleeding.
Correct Answer: C
Rationale — Correct: Starting at a lower initial dose (2.5 mg) in
a patient with possible genetic sensitivity (family history of
increased warfarin sensitivity) is a pragmatic, safety-focused
approach while awaiting genotype results or early INR.
Pharmacogenomic variants (CYP2C9, VKORC1) can increase
warfarin sensitivity and bleeding risk; lower dosing with early
INR monitoring (24–48 hours) prevents overshoot.
Rationale — Incorrect:
A. Unsafe — full loading dose risks rapid INR elevation if the
patient is a sensitive metabolizer.
B. Impractical and delaying therapy — genotype testing may
take days; holding anticoagulation without bridging increases
thromboembolism risk.
D. Inappropriate — prophylactic vitamin K negates
anticoagulation and defeats therapeutic intent; not a safe
prevention strategy.
Teaching point: Consider genetics; start low and monitor INR
early when sensitivity suspected.
,Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Pharmacogenomics].
2
Drug Reference: Insulin regular (IV infusion) — Short-acting
insulin — Medication Errors: Improving Practices and Patient
Safety
Stem: A newly hired nurse is assigned a patient on IV regular
insulin infusion for DKA. The electronic infusion pump order
reads: “insulin infusion 0.1 units/kg/hr.” The nurse is preparing
to calculate the infusion rate for a 70-kg man. What is the
nurse's best action before starting the infusion?
A. Calculate and program the pump using 7 units/hr and start
the infusion.
B. Ask another nurse to verify the weight and calculation
(independent double-check).
C. Round the rate to 6 units/hr to account for pump variability
and start.
D. Call pharmacy to request a premixed insulin bag at the
calculated rate.
Correct Answer: B
Rationale — Correct: Independent double-check of high-alert
medication calculations (weight-based insulin infusions) is a
recognized safety practice to prevent medication errors.
Verification of the weight and calculation before starting
, reduces risk of insulin overdose or underdose.
Rationale — Incorrect:
A. Starting without verification risks calculation error.
C. Arbitrary rounding may underdose; pump accuracy should be
assured, not compensated for with guesswork.
D. Delaying therapy by waiting for pharmacy premix may be
unsafe in DKA; however, calling pharmacy is appropriate if there
is uncertainty — but the priority is verification first.
Teaching point: Use independent double-checks for high-alert,
weight-based insulin infusions.
Citation: Vallerand, A. H., & Sanoski, C. (2025). Davis's Drug
Guide for Nurses (19th ed.). [Medication Errors: Improving
Practices and Patient Safety].
3
Drug Reference: Vancomycin — Glycopeptide antibiotic —
Detecting and Managing Adverse Drug Reactions
Stem: A patient receiving IV vancomycin over 60 minutes
develops flushing, hypotension (BP 88/54 mmHg), and pruritus
during infusion. The nurse notes the infusion is halfway
complete. What is the priority nursing action?
A. Stop the infusion immediately and notify the prescriber.
B. Slow the infusion rate to finish over 2 more hours and
monitor.
C. Give IV diphenhydramine and allow the infusion to continue
