Integrated Cardiopulmonary Pharmacology 3rd Edition by Bruce J. Colbert – Test Bank
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Sample
Test
Chapter 3
MULTIPLE CHOICE
Choose the one
alternative that best completes the statement or answers the question.
1. All of the
following explain the function of the somatic nervous system except:
a. Skeletal muscle
movement.
b. Conduction of
sensory information.
c. Involuntary
control.
d. Voluntary movement.
2. The sympathetic
system causes which of the following effects?
a. Bronchoconstriction
b. Increased digestion
c. Decreased heart
rate
d. Bladder relaxation
3. The ANS regulates
all the following body functions except:
a. Digestion.
b. Skeletal muscle
movement.
c. Cardiac muscle
control.
d. Blood vessel
constriction.
4. Bronchodilation is
achieved by using which of the following classifications of drugs?
I. Parasympatholytic
II. Sympatholytics
III. Adrenergic
agonists
a. I and II
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b. II and III
c. I and III
d. I, II, and III
5. The peripheral
nervous system is composed of all the following except:
a. Afferent and
efferent nerves.
b. Brain and spinal
nerves.
c. Sympathetic and
parasympathetic branches.
d. The somatic and
autonomic nervous systems.
6. The somatic nervous
system is responsible for:
a. Skeletal muscle
movement.
b. Cardiac muscle
control.
c. The digestive
process.
d. Involuntary muscle
control.
7. Which statement
best explains the control of the parasympathetic and sympathetic systems?
a. The parasympathetic
and sympathetic systems work independently of each other to regulate autonomic
control.
b. The sympathetic
system is in primary autonomic control.
c. The parasympathetic
and sympathetic systems work in a coordinated, opposite fashion to maintain
balance.
d. The parasympathetic
system is the dominant controller.
8. The system
responsible for a rise in heart rate and blood pressure when your instructor
announces a surprise quiz is the:
a. Central.
b. Parasympathetic.
c. Somatic.
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d. Sympathetic.
9. The systems
responsible for maintaining coordination between bronchodilation and
bronchoconstriction are the:
a. Parasympathetic and
sympathetic.
b. Somatic and
autonomic.
c. Peripheral and
autonomic.
d. Autonomic and
sympathetic.
10. Which of the
following cannot be considered part of a two-junction system?
a. The somatic nervous
system
b. The norepinephrine
neurotransmitter
c. Postganglia
d. The autonomic
nervous system
11. Norepinephrine is
found at the terminal end of which of the following nerve fibers?
a. Preganglionic
junction of the sympathetic system
b. Postganglionic
junction of the sympathetic system
c. Preganglionic
junction of the parasympathetic system
d. Postganglionic
junction of the parasympathetic system
12. The primary action
of neurotransmitters takes place at the:
a. Neuroeffector site.
b. Presynaptic neuron.
c. Postsynaptic
neuron.
d. Nerve axon.
13. In a situation of
stress, any of the following receptors may be stimulated except:
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a. Adrenergic.
b. Muscarinic.
c. Nicotinic.
d. Beta.
14. If you apply the
alpha-adrenergic agent phenylephrine topically, which of the following occurs?
a. Swollen vessels
constrict.
b. Blood pressure
decreases.
c. Heart rate
decreases.
d. Respiratory rate
increases.
15. A physician has
just written an order for atropine to be administered to a patient for which
you are caring. This parasympatholytic drug would cause all the following
except:
a. Bronchodilation.
b. Dry secretions.
c. Bradycardia.
d. Vasoconstriction.
16. Receptors that
bind with acetylcholine can be referred to as:
I. Cholinergic.
II. Adrenergic.
III. Muscarinic.
IV. Nicotinic.
a. I and II
b. I and III
c. I, II, and III
d. I, III, and IV
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17. Receptors that
bind with norepinephrine are referred to as:
I. Adrenergic.
II. Alpha.
III. Beta.
IV. Muscarinic.
a. I and II
b. I, II, and III
c. I and IV
d. II, III, and IV
18. Stimulation of
dopamine receptors causes which of the following?
a. Increased heart
rate
b. Relaxation of renal
arteries
c. Constriction of
peripheral blood vessels
d. Bronchodilation
19. The primary action
of sympathomimetics is to:
a. Stimulate
acetylcholine.
b. Block acetylcholine.
c. Stimulate
norepinephrine.
d. Block
norepinephrine.
20. The name of the
parasympathetic neurotransmitter is:
a. Acetylcholine.
b. Cholinesterase.
c. Norepinephrine.
d. Adrenalin.
21. Drugs that
antagonize the sympathetic response would be classified as all of the following
except:
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a. Antiadrenergics.
b. Sympatholytics.
c. Beta blockers.
d. Muscarinics.
22. Beta1 stimulation
mainly affects the:
a. Heart.
b. Blood vessels.
c. Airways.
d. Skeleton and
muscles.
23. Beta2 stimulation
results in:
a. Bronchospasm.
b. Bronchodilation.
c. Vasoconstriction.
d. Vasodilation.
24. A drug that is
classified as a beta blocker would cause which of the following effects?
a. Vasodilation
b. Increased heart
rate
c. Increased
respirations
d. Bronchoconstriction
25. Drugs that
antagonize or block the parasympathetic response are referred to as:
a. Antiadrenergics.
b. Cholinergics.
c.
Parasympathomimetics.
d. Parasympatholytics.
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26. When a drug
stimulates a receptor, it can be classified as all the following except:
a. Direct acting.
b. An agonist.
c. Sympathomimetic.
d. Parasympatholytic.
27. Agents that
inhibit the enzyme acetylcholinesterase cause which of the following effects on
the PNS?
a. Bradycardia and
hypotension
b. Overstimulation of
the sympathetic branch of the PNS
c. None
d. Bronchodilation
28. Elimination of
norepinephrine at the synaptic cleft is accomplished by which of the following
mechanisms?
I. Reuptake
II. Metabolization by
AChE
III. Metabolization by
MAO
IV. Metabolization by
COMT
a. I and II
b. I and III
c. I, II, and III
d. I, III, and IV
29. Adrenergic agents
that are considered catecholamines include all the following except:
a. Dobutamine.
b. Epinephrine.
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c. Phenylephrine.
d. Dopamine.
30. Sympathomimetic
drugs include all of the following except:
a. Isoproterenol.
b. Propranolol.
c. Albuterol.
d. Phenylephrine.
TRUE/FALSE
Write ‘T’ if the statement
is true and ‘F’ if the statement is false.
______ 1. Efferent
neurons convey impulses from the brain along motor pathways to smooth muscle
and glands.
______ 2. Stimulation
of a resting nerve occurs when a chemical neurotransmitter travels along the
nerve fiber.
______ 3. The somatic
nervous system involves nerve transmission from a presynaptic neuron to a
postsynaptic neuron.
______ 4. Nicotinic
receptors are found in both the parasympathetic and sympathetic nervous
systems.
______ 5. The
neurotransmitter in the postsynaptic junction of the parasympathetic nervous
system is norepinephrine.
______ 6.
Acetylcholine is inactivated by the enzyme monoamine oxidase (MAO).
______ 7.
Acetylcholine binds with muscarinic receptors in the parasympathetic nervous
system.
______ 8. Once
released, norepinephrine is immediately broken down by the enzyme monoamine
oxidase (MAO).
______ 9. Beta
blockers are classified as sympatholytics.
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______ 10. Adrenergic
receptors are found primarily in the smooth muscle of blood vessels, cardiac
muscle, and the airways.
FILL-IN-THE-BLANK
Write the word or
phrase that best completes each statement.
1. The CNS is
comprised of the ____________ and the ____________.
2. Information sent
from the brain travels along motor pathways known as ____________.
3. The flow of
information toward the brain is referred to as “sensory,” or ________________,
input.
4. The branch of the
ANS responsible for fight-or-flight reactions is the ________________ branch.
5. The action of the
parasympathetic neurotransmitter acetylcholine is terminated by
________________.
6. Drugs that
antagonize the sympathetic response are known as ________________ or
________________.
7. The branch of the
ANS responsible for maintaining a homeostatic environment is the ____________
branch.
8. The type of
adrenergic receptor found in the smooth muscle of airways is ________________.
9. The action of
norepinephrine is terminated by a process called ________________.
10. Catecholamines are
adrenergic agents such as ________________.
11. Sympathomimetic
drugs are used for ________________ or ________________.
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12. The general effect
of sympatholytic drugs is to ________________ the effects of the sympathetic
system.
13. The general effect
of sympathomimetic drugs is to ________________ the effects of the sympathetic
system.
14. A
parasympatholytic drug would cause a/an ____________in heart rate and cause the
bronchial airways to ____________.
15. A sympatholytic
drug would cause a/an ____________in heart rate and cause the bronchial airways
to ____________.
SHORT ANSWER
Answer the following
questions or statements.
1. How do muscarinic
and nicotinic receptor sites differ?
2. What ANS division
needs to be blocked to cause bronchial smooth muscle dilation?
3. What ANS division
needs to be stimulated to cause bronchial smooth muscle dilation?
4. How is
norepinephrine regulated at postsynaptic adrenergic receptors?
5. What are adrenergic
blockers?
Chapter 4
MULTIPLE CHOICE
Choose the one
alternative that best completes the statement or answers the question.
1. Advantages of
delivering aerosolized drugs via inhalation include all of the following
except:
a. Smaller drug
dosage.
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b. Quick drug
response.
c. Variable dosage.
d. fewer side effects.
2. If an aerosol
particle cannot navigate around a branching of the airway and is deposited onto
the oncoming airway wall, it has been affected by:
a. Deposition.
b. Inertial impaction.
c. Stability.
d. Penetration.
3. Aerosol deposition
is defined as:
a. Particles falling
out of suspension.
b. The depth to which
the aerosol particles reach within the lungs.
c. The velocity at
which the aerosol particles travel.
d. The ability of an
aerosol particle to stay in suspension.
4. Drugs delivered by
the inhalation route are affected by which of the following factors?
I. The properties of
the drug being aerosolized
II. The device used to
generate the aerosol
III. The
characteristics of the airway
IV. The breathing
pattern of the patient
a. I and II
b. I, III, and IV
c. II, III, and IV
d. I, II, III, and IV
5. Which of the
following devices is the most capable of creating very stable aerosols?
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a. DPI
b. MDI
c. SVN
d. USN
6. The best deposition
into the lower airways is achieved with aerosol particles of which size?
a. >10 microns
b. 5 to 10 microns
c. 1 to 5 microns
d. <1 micron
7. In order for nasal
sprays to deposit in the nasal cavity, the particle size should be:
a. >10 microns
b. 5 to 10 microns
c. 1 to 5 microns
d. <1 micron
8. Aerosol penetration
is defined as:
a. The removal of the
particles from suspension.
b. The depth to which
the aerosol particles reach within the lungs.
c. The velocity at
which the aerosol particles travel.
d. The ability of an
aerosol particle to stay in suspension.
9. If the optimal
breathing pattern is followed with an inspiratory breath hold, the result is:
a. Minimal inertial
impaction of aerosol particles.
b. Maximum penetration
of aerosol particles.
c. Deposition of very
small, stable particles onto the lung tissue.
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d. Laminar flow of the
carrier gas.
10. All except which
of the following are advantages of using a spacer or a holding chamber?
a. It increases the
flow rate of the aerosol particles as they move through the spacer.
b. It allows the
patient to direct the flow of aerosol into and through the oral cavity.
c. It aids in
coordinating activating the device and taking a breath.
d. It allows time to
vaporize the aerosol particle to the point of 1 to 5 microns.
11. Which of the
following factors will improve aerosol particle size and increase aerosol
delivery to the patient?
I. Flow rates of 6–8
liters/min
II. A dead volume of
3–6 ml
III. A fill volume of
4–6 ml
a. I and II
b. I and III
c. II and III
d. I, II and III
12. If a spacer is not
available for use with an MDI, how should you instruct the patient to use the
inhaler?
a. Place the inhaler
between your teeth and bite down before depressing the canister.
b. Hold the MDI 3 to 4
centimeters away from your open mouth before depressing the canister.
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c. Place the inhaler
mouthpiece inside your mouth as far as possible before depressing the canister.
d. The inhaler should
never be used without a spacer or holding device.
13. When taking
several medications with an MDI, the patient should be instructed to take which
drug first?
a. Cromolyn sodium
b. Vanceril
c. Azmacort
d. Albuterol
14. You are called to
the ICU to give a stat bronchodilator treatment to a comatose patient. Which of
the following devices would be most appropriate for this patient?
a. An MDI with a
holding chamber
b. A DPI
c. An SVN with a mask
d. A BAN with a
mouthpiece
15. The recommended
procedure to follow when using an SVN during mechanical ventilation includes
all of the following except:
a. Use a flow rate of
30 lpm
b. Place the nebulizer
30 cm back from the patient wye
c. Turn on the flow-by
or flow trigger
d. Use a tidal volume
of 500 cc when possible
16. The nebulizer that
is most efficient in reducing the amount of wasted medication during exhalation
is:
a. An MDI.
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b. An SVN.
c. A BAN.
d. A DPI.
17. Patients who are
prescribed inhaled corticosteroids should be instructed to do which of the
following to prevent an opportunistic oral infection?
a. Have routine throat
cultures to detect an oral infection.
b. Use prophylactic
antifungal medication.
c. Decrease the dosage
if signs of infection occur.
d. Rinse the mouth and
throat with mouthwash or water after inhalation of the corticosteroid.
18. Which of the
following devices would be suitable for the delivery of medications, such as
bronchodilators, via the inhalation route?
I. A BAN AeroGen
II. An MDI with a
holding chamber
III. An LVN HEART
IV. A DPI
a. I, II, and III
b. I, II, and IV
c. I, III, and IV
d. I, II, III, and IV
19. While treating a 3-year-old
patient at a hospital clinic, you are asked to select an aerosol device for
bronchodilator therapy at home. The most appropriate device for this patient
is:
a. A bulb nebulizer.
b. A dry powder
inhaler.
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c. An MDI with a
spacer.
d. An MDI.
20. You are called to
instruct a patient about the proper procedure for using an MDI. You would
instruct the patient to activate the medication in the inhaler:
a. Just before
inspiration.
b. Just as inspiration
has begun.
c. At the end of
exhalation.
d. After inhaling as
deeply as possible.
21. While on a routine
home visit, a patient informs you that he has not used his MDI for 2 weeks and
asks if the medication is still good. You should tell the patient to:
a. Discard the MDI
canister.
b. Use the MDI as
instructed.
c. Prime the valve
before use.
d. Call his physician
for help.
22. You are called to
the emergency room to administer a bronchodilator to a patient diagnosed with
status asthmaticus. EMS gave her two treatments with an SVN prior to her
arrival in the ER. What device would you recommend?
a. An MDI with a
spacer
b. A DPI
c. A BAN
d. A HEART nebulizer
23. Side effects of
continuous nebulization of albuterol include all except which of the following?
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a. Hypoglycemia
b. Tachycardia
c. Arrhythmia
d. Hypokalemia
24. DPIs deliver
aerosolized medication to the lungs by:
a. Mixing the drug
with a propellant.
b. Using an internal
power source.
c. Requiring the patient
to generate sufficient inspiratory flow rates.
d. Using an external
gas source.
25. If the inspiratory
time is prolonged to improve aerosol delivery during mechanical ventilation,
the respiratory therapist must monitor the patient for which of the following?
a. Bronchospasm
b. Auto-PEEP
c. Increased
secretions
d. Decreased
oxygenation
TRUE/FALSE
Write ‘T’ if the
statement is true and ‘F’ if the statement is false.
______ 1. The majority
of an aerosolized drug does not deposit in the lungs, even under optimal
conditions.
______ 2. The
inhalation route of drug administration delivers a precise dose of medication
to the lungs with each aerosol treatment.
3. Smaller doses of
drug administered via the inhalation route are effective because there is no
first-pass effect in the GI tract.
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______ 4. Medicated
aerosol refers to a suspension of a liquid or solid drug in a carrier gas.
______ 5. Aerosol
particles that are 10 to 15 microns deposit in the large bronchi.
______ 6. The gas
powering a nebulizer during aerosol therapy should be set at a flow rate of 10
to 12 lpm.
______ 7. Penetration
refers to an aerosol particle falling out of suspension as it travels through
the tracheobronchial tree.
______ 8. Rapid inspiratory
flows cause aerosol particles to deposit higher in the respiratory tract.
______ 9. An aerosol
particle that is smaller than 0.5 microns will penetrate to the lower airways
where it is needed.
______ 10. The
difference between a spacer and a holding chamber is that there is a one-way
valve within a holding chamber.
______ 11. SVNs are
the most efficient type of nebulizer for delivering aerosolized medication to
the lungs.
______ 12. An
inspiratory hold after a slow, deep inspiration will optimize penetration and
deposition of aerosol particles within the lungs.
______ 13. When
administering a spontaneous aerosol treatment with an SVN, a mouthpiece is
recommended for better deposition than with a mask.
______ 14. A DPI
contains liquid aerosol particles that are released when the device is
activated.
______ 15. The AARC
guidelines recommend that when you use SVNs during mechanical ventilation, they
should be changed every other day.
FILL-IN-THE-BLANK
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Write the word or
phrase that best completes each statement.
1. A slow inspiration
produces more ____________ flow and improves penetration of aerosol particles.
2. The category of
drugs that desensitize the allergic response and prevents asthma is
____________.
3. Mucolytics can be
administered by nebulization and by ____________.
4. Propellant-based
delivery devices called ________________ create very stable aerosols capable of
reaching the lower airways.
5. One factor that
determines the depth of penetration of an aerosol particle is the
________________.
6. Aerosol particles
are measured in ________________.
7. One factor that
determines an aerosol particle’s size is the ________________.
8. Adding diluent to a
nebulizer along with the medication ________________ the amount of drug that is
nebulized.
9. Newer propellants
used in MDIs are ________________.
10. A nebulizer that
is designed for continuous nebulization bronchodilator therapy is
________________.
11. Patients using
DPIs must be able to generate inspiratory flow rates of at least
________________.
12. Heated and
humidified gas in ventilator circuits cause aerosol particles to
________________ in size.
13. A nebulizer should
be placed ________________ back from the patient wye of the ventilator circuit.
14. A breath-actuated
nebulizer is capable of delivering a dose that is____________ times greater
than with continuous nebulization.
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15. When delivering
aerosolized drugs by SVN to mechanically ventilated patients, the respiratory
therapist should adjust the flow rate to ____________ and the tidal volume to
____________.
SHORT ANSWER
Answer the following
questions or statements.
1. Explain why a slow
inspiration improves aerosol medication delivery within the lungs.
2. State a clinical
condition that would require delivery of medicated aerosols to the upper
airway.
3. What are the
advantages of SVNs?
4. List the guidelines
for patient selection for DPI use.
5. What factors affect
aerosol deposition in mechanically ventilated patients?
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