NURS 430 EXAM 1 QUESTIONS WITH 100%
ACCURATE ANSWERS
An 18-year-old female patient is brought to the emergency department due to drug overdose. Which of
the following routes of administration is the most desirable for administering the antidote for the drug
overdose?
A. Intramuscular.
B. Subcutaneous.
C. Transdermal.
D. Oral.
E. Intravenous. - Accurate answers E. Intravenous.
The intravenous route of administration is the most desirable because it results in achievement of
therapeutic plasma levels of the antidote rapidly.
KR2250 is an investigational cholesterol-lowering agent. KR2250 has a high molecular weight and is
extensively bound to albumin. KR2250 will have a(n) _______________ apparent volume of distribution
(Vd).
A. High
B. Low
C. Extremely high
D. Normal - Accurate answers B. Low
Because of its high molecular weight and high protein binding, KR2250 will be effectively trapped within
the plasma (vascular) compartment and will have a low apparent volume of distribution.
A 40-year-old male patient (70 kg) was recently diagnosed with infection involving methicillin-resistant
S. aureus. He received 2000 mg of vancomycin as an IV loading dose. The peak plasma concentration of
vancomycin was 28.5 mg/L. The apparent volume of distribution is:
A. 1 L/kg
B. 7 L/kg
C. 10 L/kg
D. 14 L/kg
E. 70 L/kg - Accurate answers A. 1 L/kg
Vd = dose/C = 2000 mg/28.5 mg/L = 70.1 L. Because the patient is 70 kg, the apparent volume of
distribution in L/kg will be approximately 1 L/kg (70.1 L/70 kg).
A 55-year-old woman is brought to the emergency department because of seizures. She has a history of
renal disease and currently undergoes dialysis. She receives an intravenous infusion of antiseizure Drug
X. Which of the following is likely to be observed with use of Drug X in this patient in terms of the half
life and dosing as compared to a normal patient?
,A. Half life increase, dosage increase
B. Half life decrease, dosage decrease
C. Half life increase, dosage same
D. Half life increase, dosage decrease
E. Half life same, dosage same - Accurate answers D. Half life increase, dosage decrease
Because the patient has a renal disorder, she may not be able to excrete the drug effectively. Therefore,
the half-life of Drug X will be prolonged. As the half-life is prolonged, the dosage must be reduced so the
patient will not have serious toxic effects of Drug X.
A 64-year-old female patient (60 kg) is treated with experimental Drug A for type 2 diabetes. Drug A is
available as tablets with an oral bioavailability of 90%. If the Vd is 2 L/kg and the desired steady-state
plasma concentration is 3.0 mg/L, which of the following is the most appropriate oral loading dose of
Drug A?
A. 6 mg
B. 6.66 mg
C. 108 mg
D. 360 mg
E. 400 mg - Accurate answers E. 400 mg
For oral dosing, loading dose = [(Vd) × (desired steady-state plasma concentration)/F]. The Vd in this
case is corrected to the patient's weight is 120 L. The F value is 0.9 (because bioavailability is 90%, that
is, 90/100 = 0.9). Thus, loading dose = (120 L × 3.0 mg/L)/0.9 = 400 mg.
A 74-year-old man was admitted to the hospital for treatment of heart failure. He received 160 mcg of
digoxin intravenously, and the plasma digoxin level was 0.4 ng/mL. If the desired plasma concentration
of digoxin for optimal therapeutic activity in heart failure is 1.2 ng/mL, and the patient has an estimated
Vd of 400 L, calculate the additional dose of digoxin needed for this patient to achieve the desired
plasma concentration.
A. 128 mcg
B. 160 mcg
C. 320 mcg
D. 480 mcg
E. 640 mcg - Accurate answers C. 320 mcg
The additional dosage of digoxin needed to achieve the desired plasma concentration can be calculated
using the equation Vd (C2 - C1). C1 is the current plasma concentration (0.4 ng/mL) and C2 is the desired
plasma concentration (1.2 ng/mL). Therefore, the additional dosage of digoxin is [400 L × (1.2 - 0.4)
ng/mL)] = 320 mcg.
Which of the following best describes how a drug that acts as an agonist at the A subtype of GABA
receptors affects signal transduction in a neuron?
A. Activation of this receptor subtype alters transcription of DNA in the nucleus of the neuron.
,B. Activation of this receptor subtype opens ion channels that allow sodium to enter cells and increases
the chance of generating an action potential.
C. Activation of this receptor subtype opens ion channels that allow chloride to enter cells and decreases
the chance of generating an action potential.
D. Activation of this receptor subtype results in G protein activation and increased intracellular second
messenger levels. - Accurate answers C. Activation of this receptor subtype opens ion channels
that allow chloride to enter cells and decreases the chance of generating an action potential.
The GABA-A receptor is a ligand-gated ion channel selective for chloride. Agonists for the GABA-A
receptor increase opening of channels, resulting in chloride entry into the neuron, hyperpolarization,
and decreased action potential events.
If 1 mg of lorazepam produces the same anxiolytic response as 10 mg of diazepam, which is correct?
A. Lorazepam is more potent than is diazepam.
B. Lorazepam is more efficacious than is diazepam.
C. Lorazepam is a full agonist, and diazepam is a partial agonist.
D. Lorazepam is a better drug to take for anxiety than is diazepam. - Accurate answers A.
Lorazepam is more potent than is diazepam.
A drug that causes the same effect at a lower dose is more potent. B and C are incorrect because
without information about the maximal effect of these drugs, no conclusions can be made about efficacy
or intrinsic activity. D is incorrect because the maximal response obtained is often more important than
the amount of drug needed to achieve it.
If 10 mg of oxycodone produces a greater analgesic response than does aspirin at any dose, which is
correct?
A. Oxycodone is more efficacious than is aspirin.
B. Oxycodone is less potent than is aspirin.
C. Aspirin is a full agonist, and oxycodone is a partial agonist.
D. Oxycodone and aspirin act on the same drug target. - Accurate answers A. Oxycodone is more
efficacious than is aspirin
Drugs with greater response at maximally effective concentrations are more efficacious than drugs with
a lower maximal response. Choice B is incorrect since no information is given about the half maximal
concentrations of either drug. Choices C and D are incorrect since it is not known if both drugs bind to
the same receptor population.
In the presence of propranolol, a higher concentration of epinephrine is required to elicit full
antiasthmatic activity. Propranolol has no effect on asthma symptoms. Which is correct regarding these
medications?
A. Epinephrine is less efficacious than is propranolol.
B. Epinephrine is a full agonist, and propranolol is a partial agonist.
C. Epinephrine is an agonist, and propranolol is a competitive antagonist.
D. Epinephrine is an agonist, and propranolol is a noncompetitive antagonist. - Accurate answers C.
Epinephrine is an agonist, and propranolol is a competitive antagonist.
, Since propranolol decreases the effect of epinephrine but the inhibition can be overcome by giving a
higher dose of epinephrine, propranolol must be a competitive antagonist. If D were correct, even very
high concentrations of epinephrine would not be able to elicit a maximal effect in the presence of
propranolol. Since propranolol has no effect by itself, A and B are incorrect.
In the presence of picrotoxin, diazepam is less efficacious at causing sedation, regardless of the dose.
Picrotoxin has no sedative effect, even at the highest dose. Which of the following is correct regarding
these agents?
A. Picrotoxin is a competitive antagonist.
B. Picrotoxin is a noncompetitive antagonist.
C. Diazepam is less efficacious than is picrotoxin.
D. Diazepam is less potent than is picrotoxin. - Accurate answers B. Picrotoxin is a noncompetitive
antagonist.
Since picrotoxin decreases the maximal effect of diazepam regardless of the diazepam dose, it is a
noncompetitive antagonist. Picrotoxin has no efficacy alone, so C is incorrect. No information is provided
about potency of either drug.
Haloperidol, chlorpromazine, and clozapine are antipsychotic medications that bind to the D2 subtype of
dopamine receptors, with a binding affinity of haloperidol > chlorpromazine > clozapine. Which
statement would have to be correct to conclude that the mechanism of antipsychotic effects for these
drugs is via binding to D2 receptors?
A. Haloperidol should have the lowest potency of the three antipsychotic drugs.
B. D2 receptor binding should also be related to the potency of these drugs in causing Parkinson's-like
adverse effects.
C. A positive correlation should exist between the affinity of these drugs to bind to D2 receptors and
their potency for antipsychotic actions.
D. Clozapine would have to be more potent than chlorpromazine for decreasing psychosis. - Accurate
answers C. A positive correlation should exist between the affinity of these drugs to bind to D2
receptors and their potency for antipsychotic actions.
To conclude that the mechanism of antipsychotic effect for these drugs is via binding to D2 receptors,
there should be a positive correlation between the affinity of the drugs for D2 receptors and their
potency for antipsychotic actions. Haloperidol should have the highest antipsychotic potency and
clozapine the lowest. There is no guarantee the therapeutic effects and adverse effects are mediated by
the same receptor population; therefore, a different correlation may exist for the adverse effects and D2
receptor affinity.
If there were spare β1-adrenergic receptors on cardiac muscle cells, which statement would be correct?
A. The number of spare β1-adrenergic receptors determines the size of the maximum effect of the
agonist epinephrine.
B. Spare β1 adrenergic receptors make the cardiac tissue less sensitive to epinephrine.
C. A maximal effect of epinephrine is seen when only a portion of β1 adrenergic receptors are occupied.
ACCURATE ANSWERS
An 18-year-old female patient is brought to the emergency department due to drug overdose. Which of
the following routes of administration is the most desirable for administering the antidote for the drug
overdose?
A. Intramuscular.
B. Subcutaneous.
C. Transdermal.
D. Oral.
E. Intravenous. - Accurate answers E. Intravenous.
The intravenous route of administration is the most desirable because it results in achievement of
therapeutic plasma levels of the antidote rapidly.
KR2250 is an investigational cholesterol-lowering agent. KR2250 has a high molecular weight and is
extensively bound to albumin. KR2250 will have a(n) _______________ apparent volume of distribution
(Vd).
A. High
B. Low
C. Extremely high
D. Normal - Accurate answers B. Low
Because of its high molecular weight and high protein binding, KR2250 will be effectively trapped within
the plasma (vascular) compartment and will have a low apparent volume of distribution.
A 40-year-old male patient (70 kg) was recently diagnosed with infection involving methicillin-resistant
S. aureus. He received 2000 mg of vancomycin as an IV loading dose. The peak plasma concentration of
vancomycin was 28.5 mg/L. The apparent volume of distribution is:
A. 1 L/kg
B. 7 L/kg
C. 10 L/kg
D. 14 L/kg
E. 70 L/kg - Accurate answers A. 1 L/kg
Vd = dose/C = 2000 mg/28.5 mg/L = 70.1 L. Because the patient is 70 kg, the apparent volume of
distribution in L/kg will be approximately 1 L/kg (70.1 L/70 kg).
A 55-year-old woman is brought to the emergency department because of seizures. She has a history of
renal disease and currently undergoes dialysis. She receives an intravenous infusion of antiseizure Drug
X. Which of the following is likely to be observed with use of Drug X in this patient in terms of the half
life and dosing as compared to a normal patient?
,A. Half life increase, dosage increase
B. Half life decrease, dosage decrease
C. Half life increase, dosage same
D. Half life increase, dosage decrease
E. Half life same, dosage same - Accurate answers D. Half life increase, dosage decrease
Because the patient has a renal disorder, she may not be able to excrete the drug effectively. Therefore,
the half-life of Drug X will be prolonged. As the half-life is prolonged, the dosage must be reduced so the
patient will not have serious toxic effects of Drug X.
A 64-year-old female patient (60 kg) is treated with experimental Drug A for type 2 diabetes. Drug A is
available as tablets with an oral bioavailability of 90%. If the Vd is 2 L/kg and the desired steady-state
plasma concentration is 3.0 mg/L, which of the following is the most appropriate oral loading dose of
Drug A?
A. 6 mg
B. 6.66 mg
C. 108 mg
D. 360 mg
E. 400 mg - Accurate answers E. 400 mg
For oral dosing, loading dose = [(Vd) × (desired steady-state plasma concentration)/F]. The Vd in this
case is corrected to the patient's weight is 120 L. The F value is 0.9 (because bioavailability is 90%, that
is, 90/100 = 0.9). Thus, loading dose = (120 L × 3.0 mg/L)/0.9 = 400 mg.
A 74-year-old man was admitted to the hospital for treatment of heart failure. He received 160 mcg of
digoxin intravenously, and the plasma digoxin level was 0.4 ng/mL. If the desired plasma concentration
of digoxin for optimal therapeutic activity in heart failure is 1.2 ng/mL, and the patient has an estimated
Vd of 400 L, calculate the additional dose of digoxin needed for this patient to achieve the desired
plasma concentration.
A. 128 mcg
B. 160 mcg
C. 320 mcg
D. 480 mcg
E. 640 mcg - Accurate answers C. 320 mcg
The additional dosage of digoxin needed to achieve the desired plasma concentration can be calculated
using the equation Vd (C2 - C1). C1 is the current plasma concentration (0.4 ng/mL) and C2 is the desired
plasma concentration (1.2 ng/mL). Therefore, the additional dosage of digoxin is [400 L × (1.2 - 0.4)
ng/mL)] = 320 mcg.
Which of the following best describes how a drug that acts as an agonist at the A subtype of GABA
receptors affects signal transduction in a neuron?
A. Activation of this receptor subtype alters transcription of DNA in the nucleus of the neuron.
,B. Activation of this receptor subtype opens ion channels that allow sodium to enter cells and increases
the chance of generating an action potential.
C. Activation of this receptor subtype opens ion channels that allow chloride to enter cells and decreases
the chance of generating an action potential.
D. Activation of this receptor subtype results in G protein activation and increased intracellular second
messenger levels. - Accurate answers C. Activation of this receptor subtype opens ion channels
that allow chloride to enter cells and decreases the chance of generating an action potential.
The GABA-A receptor is a ligand-gated ion channel selective for chloride. Agonists for the GABA-A
receptor increase opening of channels, resulting in chloride entry into the neuron, hyperpolarization,
and decreased action potential events.
If 1 mg of lorazepam produces the same anxiolytic response as 10 mg of diazepam, which is correct?
A. Lorazepam is more potent than is diazepam.
B. Lorazepam is more efficacious than is diazepam.
C. Lorazepam is a full agonist, and diazepam is a partial agonist.
D. Lorazepam is a better drug to take for anxiety than is diazepam. - Accurate answers A.
Lorazepam is more potent than is diazepam.
A drug that causes the same effect at a lower dose is more potent. B and C are incorrect because
without information about the maximal effect of these drugs, no conclusions can be made about efficacy
or intrinsic activity. D is incorrect because the maximal response obtained is often more important than
the amount of drug needed to achieve it.
If 10 mg of oxycodone produces a greater analgesic response than does aspirin at any dose, which is
correct?
A. Oxycodone is more efficacious than is aspirin.
B. Oxycodone is less potent than is aspirin.
C. Aspirin is a full agonist, and oxycodone is a partial agonist.
D. Oxycodone and aspirin act on the same drug target. - Accurate answers A. Oxycodone is more
efficacious than is aspirin
Drugs with greater response at maximally effective concentrations are more efficacious than drugs with
a lower maximal response. Choice B is incorrect since no information is given about the half maximal
concentrations of either drug. Choices C and D are incorrect since it is not known if both drugs bind to
the same receptor population.
In the presence of propranolol, a higher concentration of epinephrine is required to elicit full
antiasthmatic activity. Propranolol has no effect on asthma symptoms. Which is correct regarding these
medications?
A. Epinephrine is less efficacious than is propranolol.
B. Epinephrine is a full agonist, and propranolol is a partial agonist.
C. Epinephrine is an agonist, and propranolol is a competitive antagonist.
D. Epinephrine is an agonist, and propranolol is a noncompetitive antagonist. - Accurate answers C.
Epinephrine is an agonist, and propranolol is a competitive antagonist.
, Since propranolol decreases the effect of epinephrine but the inhibition can be overcome by giving a
higher dose of epinephrine, propranolol must be a competitive antagonist. If D were correct, even very
high concentrations of epinephrine would not be able to elicit a maximal effect in the presence of
propranolol. Since propranolol has no effect by itself, A and B are incorrect.
In the presence of picrotoxin, diazepam is less efficacious at causing sedation, regardless of the dose.
Picrotoxin has no sedative effect, even at the highest dose. Which of the following is correct regarding
these agents?
A. Picrotoxin is a competitive antagonist.
B. Picrotoxin is a noncompetitive antagonist.
C. Diazepam is less efficacious than is picrotoxin.
D. Diazepam is less potent than is picrotoxin. - Accurate answers B. Picrotoxin is a noncompetitive
antagonist.
Since picrotoxin decreases the maximal effect of diazepam regardless of the diazepam dose, it is a
noncompetitive antagonist. Picrotoxin has no efficacy alone, so C is incorrect. No information is provided
about potency of either drug.
Haloperidol, chlorpromazine, and clozapine are antipsychotic medications that bind to the D2 subtype of
dopamine receptors, with a binding affinity of haloperidol > chlorpromazine > clozapine. Which
statement would have to be correct to conclude that the mechanism of antipsychotic effects for these
drugs is via binding to D2 receptors?
A. Haloperidol should have the lowest potency of the three antipsychotic drugs.
B. D2 receptor binding should also be related to the potency of these drugs in causing Parkinson's-like
adverse effects.
C. A positive correlation should exist between the affinity of these drugs to bind to D2 receptors and
their potency for antipsychotic actions.
D. Clozapine would have to be more potent than chlorpromazine for decreasing psychosis. - Accurate
answers C. A positive correlation should exist between the affinity of these drugs to bind to D2
receptors and their potency for antipsychotic actions.
To conclude that the mechanism of antipsychotic effect for these drugs is via binding to D2 receptors,
there should be a positive correlation between the affinity of the drugs for D2 receptors and their
potency for antipsychotic actions. Haloperidol should have the highest antipsychotic potency and
clozapine the lowest. There is no guarantee the therapeutic effects and adverse effects are mediated by
the same receptor population; therefore, a different correlation may exist for the adverse effects and D2
receptor affinity.
If there were spare β1-adrenergic receptors on cardiac muscle cells, which statement would be correct?
A. The number of spare β1-adrenergic receptors determines the size of the maximum effect of the
agonist epinephrine.
B. Spare β1 adrenergic receptors make the cardiac tissue less sensitive to epinephrine.
C. A maximal effect of epinephrine is seen when only a portion of β1 adrenergic receptors are occupied.
