DRUGS ACTING ON ANS
b. acetylcholinesterase and MAO.
1.When describing the functions of the ANS,
which would the instructor include?
a. Maintenance of balance and posture
b. Maintenance of the special senses
c. Regulation of integrated internal body
functions
d. Coordination of peripheral and central nerve
pathways
2. The ANS differs from other systems in the
CNS in that it
a. uses only peripheral pathways.
b. affects organs and muscles via a two-neuron
system.
c. uses a unique one-neuron system.
d. bypasses the CNS in all of its actions.
3. If you suspect that a person is very stressed
and is experiencing a sympathetic stress
reaction, you would expect to find
a. increased bowel sounds and urinary output.
b. constricted pupils and warm, flushed skin.
c. slow heart rate and decreased systolic blood
pressure.
d. dilated pupils and elevated systolic blood
pressure
4. The nurse determines that the beta2-
receptors in the SNS have been stimulated by
which finding?
a. Increased heart rate
b. Increased myocardial contraction
c. Bronchial dilation
d. Uterine contraction
5. Once a postganglionic receptor site has been
stimulated, the neurotransmitter must be
broken down immediately. The sympathetic
system breaks down postganglionic
neurotransmitters by using
a. liver enzymes and acetylcholinesterase.
c. COMT and liver enzymes.
d. MAO and COMT
6. The parasympathetic nervous system, in
most situations, opposes the actions of the
SNS, allowing the ANS to
a. generally have no effect.
b. maintain a fine control over internal
homeostasis.
c. promote digestion.
d. respond to stress most effectively.
7. Cholinergic neurons, those using ACh as
their neurotransmitter, would be least likely to
be found in
a. motor nerves on skeletal muscles.
b. preganglionic nerves in the sympathetic and
parasympathetic systems.
c. postganglionic nerves in the parasympathetic
system.
d. the adrenal medulla.
8. Stimulation of the parasympathetic nervous
system would cause
a. slower heart rate and increased GI secretions.
b. faster heart rate and urinary retention.
c. vasoconstriction and bronchial dilation.
d. pupil dilation and muscle paralysis
SELECT ALL THAT APPLY
1. The SNS
a. is called the thoracolumbar system.
b. is called the fight-or-flight system.
c. is called the craniosacral system.
d. uses ACh as its sole neurotransmitter.
e. uses epinephrine as its sole
neurotransmitter.
f. is active during a stress reaction.
2. The sympathetic system uses
catecholamines at the postganglionic
 receptors. Which are considered
catecholamines? a. Urinary retention and pupil constriction
b. Hypotension and slow heart rate
a. Dopamine c. Personality changes and increased appetite
b. Norepinephrine d. Cardiac arrhythmias and difficulty urinating
c. ACh
d. Epinephrine
e. MAO 5. Adverse effects associated with adrenergic
f. Serotonin agonists are related to the generalized
stimulation of the SNS and could include
ADRENERGIC
a. slowed heart rate.
b. constriction of the pupils.
1. The instructor determines that teaching c. hypertension.
about adrenergic drugs has been successful d. increased GI secretions.
when the class identifies the drugs as also
being called 6. A patient has elected to take an OTC cold
preparation that contains phenylephrine. The
a. sympatholytic agents. nurse would advise the patient not to take
b. cholinergic agents. that drug if the patient has
c. sympathomimetic agents.
d. anticholinergic agents. a. thyroid or CV disease.
b. a cough and runny nose.
2. The adrenergic agent of choice for treating c. chronic obstructive pulmonary disease.
the signs and symptoms of allergic rhinitis is d. hypotension

a. norepinephrine.
b. phenylephrine.
SELECT ALL THAT APPLY
c. dobutamine.
d. dopamine 1. Isoproterenol is a nonspecific beta-
agonist. The nurse might expect to
3. An adrenergic agent being used to treat administer this drug for which
shock infiltrates into the tissue with IV condition?
administration. Which action by the nurse
would be most appropriate? a. Preterm labor
b. Bronchospasm
a. Watch the area for any signs of necrosis, and c. Cardiac standstill
report it to the physician. d. Shock
b. Notify the physician, and decrease the rate of e. Heart block in transplanted hearts
infusion. f. Heart failure
c. Remove the IV, and prepare phentolamine for
administration to the area. 2. A nurse would question the order for
d. Apply ice, and elevate the arm. an adrenergic agonist for a patient
who is also receiving which of the
4. Phenylephrine, an alpha-specific agonist, is following?
found in many cold and allergy preparations.
The nurse instructs the patient to be alert for
which adverse effects?
 a. Anticholinergic drugs d. Shock states and bronchospasm
b. Halogenated hydrocarbon
anesthetics The beta-blocker of choice for a patient who is
c. Beta-blockers hypertensive and has angina is
d. Benzodiazepines
e. MAOIs a. nadolol.
f.TCAs b. propranolol.
c. timolol.
d. carteolol.
Adrenergic Antagonists
A nurse would question an order for beta1-
selective adrenergic blocker for a patient with
1.Adrenergic blocking drugs, because of their
clinical effects, are also known as a. cardiac arrhythmias.
b. hypertension.
a. anticholinergics. c. cardiogenic shock.
b. sympathomimetics. d. open-angle glaucoma.
c. parasympatholytics.
d. sympatholytics. A smoker who is being treated for
hypertension with a beta-blocker is most likely
The nurse would anticipate administering receiving a.
drugs that generally block all adrenergic
receptor sites to treat a nonspecific beta-blocker.
b. an alpha1-specific beta-blocker.
a. allergic rhinitis. c. beta- and alpha-blockers.
b. COPD. d. a beta1-specific blocker.
c. cardiac-related conditions.
d. premature labor. You would caution a patient who is taking an
adrenergic blocker
Phentolamine (Regitine), an alpha-adrenergic
blocker, is most frequently used a. to avoid exposure to infection
b. to stop the drug if he or she experiences flu-
a. to prevent cell death after extravasation of like symptoms.
intravenous dopamine or norepinephrine. c. that it can be dangerous to stop the drug
b. to treat COPD in patients with hypertension abruptly.
or arrhythmias. d. to avoid exposure to the sun
c. to treat hypertension and BPH in male
patients.
d. to block bronchoconstriction during acute SELECT ALL THAT APPLY
asthma attacks.

A patient with which conditions would most A nurse would question an order for a beta-
likely be prescribed an alpha1-selective adrenergic blocker if the patient was also
adrenergic blocking agent? receiving what other drugs?

a. COPD and hypotension a. Clonidine

b. Hypertension and BPH b. Ergot alkaloids
c. Erectile dysfunction and hypotension c. Aspirin
d. NSAIDs
e. Triptans
f. Epinephrine
The beta-adrenergic blocker propranolol is
approved for a wide variety of uses. Which of
the following are approved indications?
a. Migraine headaches
b. Stage fright
c. Bronchospasm
d. Reinfarction after an MI
e. Erectile dysfunction
f. Hypertension
CHOLINERGIC AGONIST
Indirect-acting cholinergic agents
a. react with acetylcholine receptor sites on the
membranes of effector cells
b. react chemically with acetylcholinesterase to
increase acetylcholine concentrations.
c. are used to increase bladder tone and urinary
excretion.
d. should be given with food to slow absorption.
A patient is to receive pilocarpine. The nurse
understands that this drug would be most
likely used to treat which of the following?
a. Myasthenia gravis
b. Neurogenic bladder
c. Sjögren disease dry mouth
d. Alzheimer disease
A patient with myasthenia gravis is no longer
able to swallow. Which of the following would
the nurse expect the physician to order?
a. Rivastigmine
b. Memantine
c. Pyridostigmine
d. Edrophonium
Alzheimer disease is marked by a progressive
loss of memory and is associated with
a. degeneration of dopamine-producing cells in
the basal ganglia.
b. loss of acetylcholine-producing neurons and
their target neurons in the CNS..
c. loss of acetylcholine receptor sites in the
parasympathetic nervous system.
d. increased levels of acetylcholinesterase in the
CNS.
The nurse would expect to administer
donepezil to a patient with Alzheimer disease
who
a. cannot remember family members’ names.
b. is mildly inhibited and can still follow medical
dosing regimens.
c. is able to carry on normal activities of daily
living.
d. has memory problems and would benefit
from once-a-day dosing.
Adverse effects associated with the use of
cholinergic drugs include

Myasthenia gravis is treated with indirect- a. constipation and insomnia.

acting cholinergic agents that b. diarrhea and urinary urgency.
c. tachycardia and hypertension.
a. lead to accumulation of acetylcholine in the d. dry mouth and tachycardia.
synaptic cleft.
b. block the GI effects of the disease, allowing Nerve gas is an irreversible
for absorption. acetylcholinesterase inhibitor that can cause
c. directly stimulate the remaining muscle paralysis and death. An antidote to
acetylcholine receptors. such an agent is
d. can be given only by injection because of
problems associated with swallowing. a. atropine.
b. propranolol.
c. pralidoxime.
d. neostigmine
SELECT ALL THAT APPLY
A nurse is explaining myasthenia gravis to a
family. Which of the following points would be
included in the explanation?
a. It is thought to be an autoimmune disease.
b. It is associated with destruction of
acetylcholine receptor sites.
c. It is best treated with potent antibiotics.
d. It is a chronic and progressive muscular
disease.
e. It is caused by demyelination of the nerve
fiber.
f. Once diagnosed, it has a 5-year survival rate.
A nurse would question an order for a
cholinergic drug if the patient was also taking
which drugs?
a. Theophylline
b. NSAIDs
c. Cephalosporin
d. Atropine
e. Propranolol
f. Memantine
ANTICHOLINERGIC AGENTS
Anticholinergic drugs are used
a. to allow the sympathetic system to become
more dominant.
b. to block the parasympathetic system, which
is commonly hyperactive.
c. as the drugs of choice for treating ulcers.
d. to stimulate GI activity.
Atropine and scopolamine work by blocking
a. nicotinic receptors only.
b. muscarinic and nicotinic receptors.
c. muscarinic receptors only.
d. adrenergic receptors to allow cholinergic
receptors to dominate.
Which of the following suggestions would the
nurse make to help a patient who is receiving
an anticholinergic agent reduce the risks
associated with decreased sweating?
a. Covering the head and using sunscreen
b. Ensuring hydration and temperature control
c. Changing position slowly and protecting from
the sun
d. Monitoring for difficulty swallowing and
breathing
Which of the following would the nurse be
least likely to include when developing a
teaching plan for a patient who is receiving an
anticholinergic agent?
a. Encouraging the patient to void before dosing
b. Setting up a bowel program to deal with
constipation
c. Encouraging the patient to use sugarless
lozenges to combat dry mouth
d. Performing exercises to increase the heart
rate
SELECT ALL THAT APPLY
A nurse would expect atropine to be used for
which of the following?
a. To depress salivation
b. To dry up bronchial secretions .
c. To increase the heart rate
d. To promote uterine contractions
e. To treat myasthenia gravis
f. To treat Alzheimer disease
Remembering that anticholinergics block the
effects of the parasympathetic nervous
system, the nurse would question an order for
an anticholinergic drug for patients with which
conditions?
 The hypothalamus maintains internal
a. Ulcerative colitis homeostasis and could be considered the
b. Asthma master endocrine gland because
c. Bradycardia a. it releases stimulating hormones that cause
d. Inner ear imbalance endocrine glands to produce their hormones.
e. Glaucoma b. no hormone-releasing gland responds unless
f. Prostatic hyperplasia stimulated by the hypothalamus.
c. it secretes releasing hormones that are an
important part of the HPA.
DRUGS ACTING ON d. it regulates temperature control and arousal
ENDOCRINE SYSTEM as well as hormone release.

The posterior lobe of the pituitary gland

Which of the following best describes
aldosterone?
a. It causes the loss of sodium and water from
the renal tubules.
b. It is under direct hormonal control from the
hypothalamus.
c. It is released into the bloodstream in
response to angiotensin I.
d. It is released into the bloodstream in
response to high potassium levels.
When explaining the role of ADH to a group of
students, which fact would the instructor
include?
a. It is produced by the anterior pituitary.
b. It causes the retention of water by the
kidneys.
c. It is released by the hypothalamus.
d. It causes the retention of sodium by the
kidneys.
The endocrine glands
a. form part of the communication system of
the body.
b. cannot be stimulated by hormones
circulating in the blood.
c. cannot be viewed as integrating centers of
reflex arcs.
d. are only controlled by the hypothalamus.
a. secretes a number of stimulating hormones.
b. produces endorphins to modulate pain
perception.
c. has no function that has yet been identified.
d. stores ADH and oxytocin, which are produced
in the hypothalamus.
After teaching a group of students about the
negative feedback system, identification of
which of the following as an example would
indicate that the students have understood the
teaching?
a. Growth hormone control
b. Prolactin control
c. Melanocyte-stimulating hormone control
d. Thyroid hormone control.
Internal body homeostasis and
communication are regulated by
a. the cardiovascular and respiratory systems.
b. the nervous and cardiovascular systems.
c. the endocrine and nervous systems.
d. the endocrine and cardiovascular systems
SELECT ALL THAT APPLY
Hormones exert their influence on human cells
by influencing which of the following?

a. Enzyme-controlled reactions
b. Messenger RNA
c. Lysosome activity
d. Transcription RNA
e. Cellular DNA
f. Cyclic AMP activity
The specific criteria that define a hormone
would include which of the following?
a. It is produced in small amounts.
b. It is secreted directly into the bloodstream.
c. It is slowly metabolized in the liver and lungs.
d. It reacts with a specific receptor set on a
target cell.
e. A mechanism is always available to
immediately destroy it.
f. It can change a cell’s basic function.
Some endocrine glands do not respond to the
HPA. These glands include the
a. thyroid gland.
b. ovaries.
c. parathyroid glands.
d. adrenal cortex.
e. endocrine pancreas.
f. GI gastrin-secreting cells
HYPOTHALAMIC AND PITITUARY GLAND
Hypothalamic hormones are normally present
in small amounts. When used therapeutically,
their main indication is
a. diagnosis of endocrine disorders and
treatment of specific cancers.
b. treatment of multiple endocrine disorders.
c. treatment of CNS-related abnormalities.
d. treatment of autoimmune-related problems.
Somatropin (Nutropin and others) is a
genetically engineered GH that is used
a. to diagnose hypothalamic failure.
b. to treat precocious puberty.
c. in the treatment of children with growth
failure.
d. to stimulate pituitary response.
GH deficiencies
a. occur only in children.
b. always result in dwarfism.
c. are treated only in children because GH is
usually produced only until puberty.
d. can occur in adults as well as children.
Patients who are receiving GH replacement
therapy must be monitored closely. Routine
follow-up examinations would include
a. a bowel program to deal with constipation.
b. tests of thyroid function and glucose
tolerance.
c. a calorie check to control weight gain.
d. tests of adrenal hormone levels.
Acromegaly and gigantism are both conditions
related to excessive secretion of
a. thyroid hormone.
b. melanin-stimulating hormone.
c. growth hormone.
d. oxytocin.
Diabetes insipidus is a relatively rare disease
characterized by
a. excessive secretion of ADH.
b. renal damage.
c. the production of large amounts of dilute
urine containing no glucose.
d. insufficient pancreatic activity.
Treatment with ADH preparations is associated
with adverse effects, including
a. constipation and paralytic ileus.
b. cholecystitis and bile obstruction.
c. nocturia and bedwetting.
d. “hangover” symptoms, including headache,
sweating, and tremors.
A patient who is receiving an ADH preparation
for diabetes insipidus may need instruction in
administering the drug
a. PO or IM.
b. PO or intranasally.
c. PR or PO.
d. intranasally or by dermal patch.
SELECT ALL THAT APPLY
Octreotide (Sandostatin) would be the drug of
choice in the treatment of acromegaly in a
client with which factors?
a. Diabetes
b. Gallbladder disease
c. Adrenal insufficiency
d. Hypothalamic lesions
e. Intolerance to other therapies
f. Age older than 18 years
A father brought his 15-year-old son to the
endocrine clinic because the boy was only 5 ft
tall. He wanted his son to receive GH therapy
because short stature would be a detriment to
his success as an adult. The boy would be
considered for this therapy under which of the
following circumstances?
a. If he were against the use of cadaver parts
b. If his epiphyses were closed
c. If his GH levels were very low
d. If he were also diabetic
e. If he had chronic renal failure
f. If he had hypothyroidism
ADRENOCORTICOID AGENTS
Adrenocortical agents are widely used
a. to cure chronic inflammatory disorders.
b. for short-term treatment to relieve
inflammation.
c. for long-term treatment of chronic disorders.
d. to relieve minor aches and pains and to make
people feel better.
If a nurse was asked to explain the adrenal
medulla to a patient, it would be appropriate
for him or her to tell that patient that it
a. is the outer core of the adrenal gland.
b. is the site of production of aldosterone and
corticosteroids.
c. is actually a neural ganglion of the SNS.
d. consists of three layers of cells that produce
different hormones.
Glucocorticoids are hormones that
a. are released in response to high glucose
levels.
b. help regulate electrolyte levels.
c. help regulate water balance in the body.
d. promote the preservation of energy through
increased glucose levels, protein breakdown,
and fat formation.
Diurnal rhythm in a person with a regular sleep
cycle would show
a. high levels of ACTH during the night while
sleeping.
b. rising levels of corticosteroids throughout the
day.
c. peak levels of ACTH and corticosteroids early
in the morning.
d. hypothalamic stimulation to release CRH
around noon.
Patients who have been receiving
corticosteroid therapy for a prolonged period
and suddenly stop the drug will experience an
adrenal crisis because their adrenal glands will
not be producing any adrenal hormones. Your
assessment of a patient for the possibility of
adrenal crisis may include
a. physiological exhaustion, shock, and fluid
shift.
b. acne development and hypertension.
c. water retention and increased speed of
healing.
d. hyperglycemia and water retention.
A patient is started on a regimen of prednisone
because of a crisis in her ulcerative colitis.
Nursing care of this patient would need to
include
a. immunizations to prevent infections.
b. increased calories to deal with metabolic
changes.
c. fluid restriction to decrease water retention.
d. administration of the drug around 8 or 9 AM
to mimic normal diurnal rhythm.
A patient who is taking corticosteroids is at
increased risk for infection and should
a. be protected from exposure to infections and
invasive procedures.
b. take antiinflammatory agents regularly
throughout the day.
c. receive live virus vaccine to protect him or
her from infection.
d. be at no risk if elective surgery is needed.
Mineralocorticoids are used to maintain
electrolyte balance in situations of adrenal
insufficiency. Mineralocorticoids
a. are usually given alone.
b. can be given only IV.
c. are always given in conjunction with
appropriate glucocorticoids.
d. are separate in their function from the
glucocorticoids
SELECT AL THAT APPLY
Patients who are taking corticosteroids would
be expected to report which findings?
a. Weight gain .
b. Round or “moon face” appearance
c. Feeling of well-being
d. Weight loss
e. Excessive hair growth
f. Fragile skin
Corticosteroid hormones are released during a
sympathetic stress reaction. They would cause
which actions?
a. Increase blood volume
b. Cause the release of glucose for energy
c. Increase the rate of protein production
d. Block the effects of the inflammatory and
immune systems
e. Store glucose to preserve energy
f. Block protein production to save energy
THYROID AND PARATHYROID
AGENTS
The thyroid gland produces the thyroid
hormones triiodothyronine (T3) and
tetraiodothyronine (T4), which are dependent
on the availability of
a. iodine produced in the liver.
b. iodine found in the diet.
c. iron absorbed from the GI tract.
d. PTH to promote iodine binding.
The thyroid gland is dependent on the
hypothalamic–pituitary axis for regulation.
Increasing the levels of thyroid hormone (by
taking replacement thyroid hormone) would
a. increase hypothalamic release of TRH.
b. increase pituitary release of TSH.
c. suppress hypothalamic release of TRH.
d. stimulate the thyroid gland to produce more
T3 and T4.
Goiter, or enlargement of the thyroid gland, is
usually associated with
a. hypothyroidism.
b. iodine deficiency.
c. hyperthyroidism.
d. underactive thyroid tissue.
SELECT ALL THAT APPLY
Thyroid replacement therapy is indicated for
the treatment of
A patient who is receiving a bisphosphonate
a. obesity.
for the treatment of postmenopausal
b. myxedema.
osteoporosis should be taught
c. Graves disease.
d. Cushing disease.
a. to also take vitamin D, calcium, and hormone
replacement.
Assessing a patient’s knowledge of his or her
b. to restrict fluids as much as possible.
thyroid replacement therapy would show good
c. to take the drug before any food for the day
understanding if the patient stated,
with a full glass of water.
d. to stay upright for at least 30 minutes after
a. “My wife may use some of my drug since she
taking the drug.
wants to lose weight.”
e. to take the drug with meals to avoid GI
b. “I should only need this drug for about 3
upset.
months.”
f. to avoid exercise to prevent bone fractures.
c. “I can stop taking this drug as soon as I feel
like my old self.”
Hypothyroidism is a common and often
d. “I should call if I experience unusual
missed disorder. Signs and symptoms of
sweating, weight gain, or chills and fever.”
hypothyroidism include
Administration of propylthiouracil would
a. increased body temperature.
include giving the drug
b. thickening of the tongue.
c. bradycardia.
a. once a day in the morning.
d. loss of hair.
b. around the clock to assure therapeutic
e. excessive weight loss.
levels.
f. oily skin
c. once a day at bedtime to decrease adverse
effects.
d. if the patient is experiencing slow heart rate,
skin rash, or excessive bleeding. AGENTS TO CONTROL BLOOD
GLUCOSE LEVELS
The parathyroid glands produce PTH, which is
important in the body as Currently, the medical management of
diabetes mellitus is aimed at
a. a modulator of thyroid hormone.
b. a regulator of potassium. a. controlling caloric intake.
c. a regulator of calcium. b. increasing exercise levels.
d. an activator of vitamin D. c. regulating blood glucose levels.
d. decreasing fluid loss.
Which should NOT be used for the treatment
of postmenopausal osteoporosis? The HbA1c blood test is a good measure of
overall glucose control because
a. risedronate
b. alendronate a. it reflects the level of glucose after a meal.
c. zoledronic acid
d. parathyroid hormone
b. fasting for 8 hours before the test ensures
accuracy.
c. it reflects a 3-month average glucose level in
the body.
d. the test can be affected by the glucose
challenge.
A patient with hyperglycemia will often
present with
a. polyuria, polydipsia, and polyphagia.
b. polycythemia, polyuria, and polyphagia.
c. polyadenitis, polyuria, and polydipsia.
d. polydipsia, polycythemia, and polyarteritis.
The long-term alterations in fat, carbohydrate,
and protein metabolism associated with
diabetes mellitus result in
a. obesity.
b. thickening of the capillary basement
membrane.
c. chronic obstructive pulmonary disease.
d. lactose intolerance.
Insulin is available in several forms or
suspensions, which differ in their
a. effects on the pancreas.
b. onsets and durations of action.
c. means of administration.
d. tendencies to cause adverse effects.
Which would be the first choice for a newly
diagnosed client with diabetes mellitus type II
who does not have any other health
problems?
a. Canagliflozin
b. Liraglutide
c. Pioglitazone
d. Metformin
Miglitol differs from the sulfonylureas in that it
a. greatly stimulates pancreatic insulin release.
b. greatly increases the sensitivity of insulin
receptor sites.
c. delays the absorption of glucose, leading to
lower glucose levels.
d. cannot be used in combination with other
antidiabetic agents.
Teaching subjects for the patient with diabetes
should include
a. diet and exercise changes that are needed.
b. the importance of avoiding exercise and
eating one meal a day.
c. protection from exposure to any infection
and avoiding tiring activities.
d. avoiding pregnancy and taking hygiene
measures
SELECT ALL THAT APPLY
Treatment of diabetes may include which?
a. Replacement therapy with insulin
b. Control of glucose absorption through the GI
tract
c. Drugs that stimulate insulin release or
increase sensitivity of insulin receptor sites
d. Surgical clearing of the capillary basement
membranes
e. Slowing of gastric emptying
f. Diet and exercise programs
A client is recently diagnosed with diabetes. In
reviewing his past history, which would be
early indicators of the problem?
a. Lethargy
b. Fruity-smelling breath
c. Boundless energy
d. Weight loss
e. Increased sweating
f. Getting up often at night to go to the
bathroom
QUIZ ON ANS AND ENDO
CHOLINERGIC RECEPTORS
1. Diabetes may be associated with
mainly insulin resistance with 9. What type of drug are
some insulin deficiency to mainly IIpratropium and Tiotropium
an insulin secretory defect with Bromide?
insulin resistance
CHOLINERGIC ANTAGONISTS
TYPE 2
10. Which condition results from
2. What type of drugs are Albuterol over secretion of growth
and Metaproterenol? hormone?

ADRENERGIC AGONISTS ACROMEGALY

3. Carbachol is what type of drug? 11. TRUE OR FALSE. Nicotinic

receptors are found in
CHOLINERGIC AGONIST autonomic ganglia.
Neurotransmuscular junction
4. What effect does Methyldopa and the adrenal medulla.
have?
TRUE
DECREAS BLOOD PRESSURE
12. Which drug may be prescribed
5. What receptor does Clonidine to treat hypothyroidism?
act on?
LEVOTHYROXINE
ALPHA 2
13. Lack of ADH causes diabetes
6. TRUE OR FALSE. Epinephrine insipidus. This drug may be
produces the alpha 1 and beta 1 prescribed to combat the
or 2 effects disorder.

TRUE DESOMOPRESSIN

7. What type of drugs are the
following? Atenolol,
Metroprolol, Esmolol
BETA SELECTIVE ANTAGONISTS
8. What receptors are involved in
the Parasympathetic division?
14. This drug acts as a synthetic T4
hormone
LEVOTHYROXINE
15. Lack of glucocorticoids with
primary causes would be
attributed to which condition?
ADDISON’S
16. This drug inhibits/slows the IODINE
digestion of sugars in the
digestive tract 24. The nurse realizes that
cholinergic drugs mimic the
GLUCOSIDASE INHIBITOR parasympathetic
neurotransmitter
17. The sodium glucose co-
transporter is a _____ and its ACETYLCHOLINE
function is to ____
25. When the client is prescribed
ANTI-DIABETIC, glipizide (Glucotrol), the nurse
DECREASE AMOUNT OF knows that side effect/ adverse
GLUCOSE REABSORBED BY effect include
KIDNEY
TACHYCARDIA
18. Which drug would be
administered to help uterus 26. A client is to receive insulin prior
contract after delivery of a baby? to breakfast, and breakfast tray
delivery is variable. The nurse
OXYTOCIN (PITOCIN) know that ____ insulin should
not be administered until the bf
19. What effects does Clonidine tray has arrived and the client is
have? ready to eat

Decrease Blood pressure HUMALOG (LISPRO)

20. Clonidine is what type of drug? 27. Effective in the immediate

management of the comatose,
ALPHA AGONIST hypoglycemic patient

21. What effects does Propanolol GLUCAGON INJECTION –

have? SUBCUTANEOUS OR
INTRAMUSCULAR
VASODILATION
28. Causes of hypoglycemia in a
22. The ____ division of the ANS is diabetic patient
said to function during “rest and
digest” Insulin overdosage, delay in
eating, unusual physical activity
PARASYMPATHETIC
29. Biguanide – oral hypoglycemic
23. Thyroid hormones contains the drug
element
METFORMIN (GLUCOPHAGE)

30. Second generation sulfonylurea
GLIPIZIDE (GLUCOTROL)
Drugs Acting on the Cardiovascular
System
CHECK YOUR UNDERSTANDING
Answers to the questions in this chapter can be
found in Answers to Check Your Understanding
Questions
MULTIPLE CHOICE Select the best answer.
1. When describing heart valves to a group of
students, would the instructor include?
a. The closing of the AV valves is what is solely
responsible for heart sounds.
b. Small muscles attached to the AV valves are
responsible for opening and closing the valves.
c. The aortic valve opens when the pressure in
the left ventricle becomes greater than the
aortic pressure.
d. The valves leading to the great vessels are
called the cuspid valves.
2. In the heart,
a. the ventricles will not contract unless they
are stimulated by action potentials arising from
the SA node.
b. fibrillation of the atria will cause blood
pressure to fall to zero.
c. spontaneous depolarization of the muscle
membrane can occur in the absence of nerve
stimulation.
d. the muscle can continue to contract for a
long period of time in the absence of oxygen.
3. The activity of the heart depends on both
the inherent properties of the cardiac muscle
cells and the activity of the autonomic nerves
to the heart. Therefore,
a. cutting all of the autonomic nerves to the
heart produces a decrease in resting heart rate.
b. blocking the parasympathetic nerves to the
heart decreases the heart rate.
c. stimulating the sympathetic nerves to the
heart increases the time available to fill the
ventricles during diastole.
d. the heart rate will increase in cases of
dehydration, which will lead to less filling time.
4. A heart transplantation patient has no nerve
connections to the transplanted heart. In such
an individual, one would expect to find
a. a slower-than-normal resting heart rate.
b. atria that contract at a different rate than
ventricles.
c. an increase in heart rate during emotional
stress.
d. inability to exercise because there is no way
to increase heart rate.
5. When describing heart valves to a group of
students, would the instructor include?
a. Blood that has a high amount of oxygen
enters the left atrium.
b. Blood that has a high amount of oxygen
enters the right ventricle.
c. The highest pressure is found in the right
ventricle of the heart.
d. The mitral valve allows for bidirectional blood
flow.
6. Cardiac cells differ from skeletal muscle cells
in that
a. they contain actin and myosin.
b. they possess automaticity and conductivity.
c. calcium must be present for muscle
contraction to occur.
d. they do not require oxygen to survive.
7. Clinically, dysrhythmias, or arrhythmias,
may cause
a. altered cardiac output that could affect all
cells.
b. changes in capillary filling pressures.
c. alterations in osmotic pressure.
d. valvular dysfunction.
8. A client is brought to the emergency room
with a suspected myocardial infarction. The
client is upset because he had just had an ECG
in his doctor’s office and it was fine. The
explanation of this common phenomenon
would include the fact that
a. the ECG only reflects changes in cardiac
output.
b. the ECG is not a very accurate test.
c. the ECG only measures the flow of electrical
current through the heart.
d. the ECG is not related to the heart problems.
9. Blood flow to the myocardium differs from
blood flow to the rest of the cells of the body in
that
a. blood perfuses the myocardium during
systole.
b. blood flow is determined by many local
factors, including buildup of acid.
c. blood perfuses the myocardium during
diastole.
d. oxygenated blood flows to the myocardium
via veins.
MULTIPLE RESPONSE Select all that apply.
1. During diastole, which would occur?
a. Opening of the AV valves
b. Relaxation of the myocardial muscle
c. Flow of blood from the atria to the ventricles
d. Contraction of the ventricles
e. Closing of the semilunar valves
f. Filling of the coronary arteries
2. The sympathetic nervous system would be
expected to have which effects?
a. Stimulates the heart to beat faster
b. Speeds conduction through the AV node
c. Causes the heart muscle to contract harder
d. Slows conduction through the AV node
e. Decreases overall vascular volume
f. Increases total peripheral resistance
Drugs Affecting Blood Pressure
CHECK YOUR UNDERSTANDING
MULTIPLE CHOICE Select the best answer.
1. Baroreceptors are the most important factor
in controlling fast changes in BP. Baroreceptors
a. are evenly distributed throughout the body
to maintain pressure in the system.
b. sense pressure and immediately send that
information to the medulla in the brain.
c. are directly connected to the sympathetic
nervous system.
d. are as sensitive to oxygen levels as to
pressure changes.
2. Essential hypertension is the most commonly
diagnosed form of high BP. Essential
hypertension is
a. caused by a tumor in the adrenal gland.
b. associated with no known cause.
c. related to renal disease
d. caused by liver dysfunction.
3. Hypertension is associated with
a. loss of vision.
b. strokes.
c. atherosclerosis.
d. all of the above.
4. The stepped-care approach to the treatment
of hypertension includes
a. lifestyle modification, including exercise, diet,
and decreased smoking and alcohol intake.
b. use of a diuretic, beta-blocker, or ACE
inhibitor to supplement lifestyle changes.
c. a combination of antihypertensive drug
classes to achieve desired control.
d. all of the above.
5. ACE inhibitors work on the renin–
angiotensin system to prevent the conversion
of angiotensin I to angiotensin II. Because this
blocking occurs in the cells in the lung, which is
usually the site of this conversion, the use of
ACE inhibitors often results in
a. spontaneous pneumothorax.
b. pneumonia.
c. unrelenting cough.
d. respiratory depression.
6. A client taking an ACE inhibitor is scheduled
for surgery. Because this medication may be
dangerous in the setting of general anesthesia,
the nurse should
a. stop the drug without discussing with the
providers.
b. alert the provider caring for the patient, and
mark the client’s chart prominently.
2. The renin–angiotensin system is associated
c. cancel the surgery and consult with the with which?
prescriber.
a. Intense vasoconstriction and BP elevation
d. monitor fluid levels and make sure the fluids
are restricted before surgery. b. Blood flow through the kidneys

c. Production of surfactant in the lungs

7. A patient who is hypertensive becomes
pregnant. Which is the safest medication for
this patient?
a. An angiotensin II receptor blocker
b. An ACE inhibitor
d. Release of aldosterone from the adrenal
cortex
e. Retention of sodium and water in the kidneys
f. Liver production of fibrinogen

c. A beta-blocker Agents for Treating Heart Failure

d. A calcium-channel blocker

8. Droxidopa, an antihypotensive drug, should CHECK YOUR UNDERSTANDING

be used
MULTIPLE CHOICE
a. only with patients who are confined to bed.
b. in the treatment of acute shock. Select the best answer.

c. in patients with known pheochromocytoma. 1. A nurse assessing a patient with HF would

d. to treat orthostatic hypotension in patients expect to find
whose lives are impaired by the disorder.
a. cardiac arrest.
MULTIPLE RESPONSE Select all that apply.
b. congestion of blood vessels.
1. Pressure within the vascular system is
c. an MI.
determined by which?
d. a pulmonary embolism.
a. Peripheral resistance
2. Calcium is needed in the cardiac muscle
b. Stroke volume
a. to break apart actin–myosin bridges.
c. Sodium load
b. to activate troponin.
d. Heart rate
c. to promote contraction via sliding.
e. Total intravascular volume
d. to maintain the electrical rhythm.
f. Rate of erythropoietin release
3. When assessing a patient with right-sided
HF, the nurse would expect to find edema
a. in gravity-dependent areas.
b. in the hands and fingers.
c. around the eyes.
d. when the patient is lying down.
4. ACE inhibitors and other vasodilators are
used in the early treatment of HF. They act to
a. decrease workload on the heart by lowering
preload and afterload.
b. increase arterial pressure and perfusion.
c. cause pooling of the blood and decreased
venous return to the heart.
d. increase the release of aldosterone and
improve fluid balance.
5. A nurse is preparing to administer a
prescribed cardiac glycoside to a patient based
on the understanding that this group of drugs
acts in which way?
a. They block the sympathetic nervous system.
b. They block the renin–angiotensin system.
c. They block the parasympathetic influence on
the heart muscle.
d. They affect intracellular calcium levels in the
heart muscle
6. A nurse would instruct a patient taking
Lanoxin (digoxin) for the treatment of HF to
take which action?
a. Make up any missed doses the next day.
b. Report changes in heart rate.
c. Avoid exposure to the sun.
d. Switch to generic tablets if less expensive.
7. A nurse is about to administer Lanoxin to a
patient whose apical pulse is 48 beats/min. He
or she should
a. administer the drug and notify the prescriber
that the heart rate is low.
b. retake the pulse in 15 minutes and give the
drug if the pulse has not changed.
c. retake the pulse in 1 hour and withhold the
drug if the pulse is still less than 60 beats/min.
d. withhold the drug and notify the prescriber
that the heart rate is below 60 beats/min.
8. How does ivabradine (Corlanor) work in the
body?
a. Blocks beta-receptors to slow the heart rate
b. Slows influx of calcium to decrease force of
contraction
c. Slows influx of calcium and relaxes blood
vessels
d. Reduces heart rate by inhibiting action
potentials at the SA node
MULTIPLE RESPONSE Select all that apply.
1. HF occurs when the heart fails to pump
effectively. Which could cause HF?
a. Coronary artery disease
b. Chronic hypertension
c. Cardiomyopathy
d. Fluid overload.
e. Pneumonia
f. Cirrhosis b. alter blood flow to the kidney.

c. cause new arrhythmias.

2. A client develops left-sided HF after an MI. d. cause electrolyte disturbances.

Which would the nurse expect to find during
3. Lidocaine is a class Ib antiarrhythmic. Which
the client assessment?
is correct regarding its mechanism of action?
a. Orthopnea
a. It primarily blocks potassium influx.
b. Polyuria
b. It primarily blocks beta receptors.
c. Tachypnea
c. It primarily blocks calcium influx.
d. Dyspnea
d. It primarily blocks sodium influx.
e. Blood-tinged sputum
4. Ibutilide (Corvert) is a class III antiarrhythmic
f. Swollen ankles drug that is used for

a. sedation during electrocardioversion.

Antiarrhythmic Agents b. conversion of recent-onset AF and flutter.

c. treatment of life-threatening ventricular

arrhythmias.

CHECK YOUR UNDERSTANDING d. treatment of arrhythmias complicated by HF.

5. The drug of choice for the treatment of a
MULTIPLE CHOICE Select the best answer.
supraventricular tachycardia associated with
1. Cardiac contraction and relaxation are Wolff-Parkinson-White syndrome is
controlled by
a. digoxin.
a. a specific area in the brain.
b. verapamil.
b. the sympathetic nervous system.
c. lidocaine.
c. the autonomic nervous system.
d. adenosine.
d. action potential and electrical conduction
6. A patient who is receiving an antiarrhythmic
arising within the heart.
drug needs
2. Antiarrhythmic drugs alter the action
a. constant cardiac monitoring until stabilized.
potential of the cardiac cells. Because they
b. frequent blood tests, including drug levels.
alter the action potential, antiarrhythmic drugs
often c. an antidepressant to deal with psychological
depression.
a. cause HF.
d. dietary changes to prevent irritation of the
heart muscle.
7. A patient is brought into the emergency
room with a potentially life threatening
ventricular arrhythmia. Immediate treatment
might include
a. a loading dose of digoxin.
b. injection of quinidine.
c. bolus and titrated doses of lidocaine
d. loading dose of propafenone.
8. A client stabilized on quinidine for the
regulation of AF would be cautioned to avoid
which foods?
a. Potassium-rich foods
b. Foods containing tyrosine
c. High-sodium–containing foods
d. Foods that alkalinize the urine
MULTIPLE RESPONSE Select all that apply.
1. The conduction system of the heart includes
which structures?
a. The SA node
b. The sinuses of Valsalva
c. The atrial bundles
d. The Purkinje fibers
e. The coronary sinus
f. The bundle of His
2. Arrhythmias or dysrhythmias can be caused
by which situations?
a. Lack of oxygen to the heart muscle cells
b. Acidosis near a cell
c. Structural damage in the conduction pathway
through the heart
d. Vasodilation in the myocardial vascular bed
e. Thyroid hormone imbalance
f. Electrolyte imbalances
Antianginal Agents
CHECK YOUR UNDERSTANDING
MULTIPLE CHOICE Select the best answer.
1. Coronary artery disease results in
a. an imbalance in cardiac muscle oxygen supply
and demand.
b. delivery of blood to the heart muscle during
systole.
c. increased pulse pressure.
d. a decreased workload on the heart.
2. Angina
a. causes death of heart muscle cells.
b. is pain due to lack of oxygen to myocardial
cells.
c. cannot occur at rest.
d. is not treatable.
3. Nitrates are commonly used antianginal
drugs that act to
a. increase the preload on the heart.
b. increase the afterload on the heart.
c. dilate coronary vessels to increase the
delivery of oxygen through those vessels.
d. decrease venous return to the heart,
decreasing the myocardial workload.
4. Calcium channel blockers are effective in
treating angina because they
a. prevent any CV exercise, preventing strain on
the heart.
b. block strong muscle contractions, causing
vasodilation.
c. alter the electrolyte balance of the heart,
preventing arrhythmias.
d. increase the heart rate, making it more
efficient.
5. A nurse would question an order for which
drug if the patient was also receiving
verapamil?
a. Oral contraceptives
b. Cyclosporine
c. Digoxin
d. Barbiturate anesthetics
6. Prinzmetal angina occurs as a result of
a. electrolyte imbalance.
b. a spasm of a coronary vessel.
c. decreased venous return to the heart.
d. a ventricular arrhythmia.
MULTIPLE RESPONSE Select all that apply.
1. Treating angina involves modifying factors
that could decrease myocardial oxygen
consumption. It could be expected that this
might include
a. weight loss.
b. use of nitrates.
c. use of angiotensin-converting enzyme
inhibitors.
d. activity modification.
e. use of a piperazine acetamide agent.
f. use of a calcium channel blocker.
2. An acute myocardial infarction is usually
associated with which conditions?
a. Permanent injury to the heart muscle
b. Potentially serious arrhythmias
c. Pain
d. The development of hypertension
e. Loss of consciousness
f. A feeling of anxiety
3. When describing the action of antianginal
drugs to a patient, which would the nurse
include?
a. Decrease the workload on the heart
b. Increase the supply of oxygen to the heart
c. Change the metabolic pathway in the heart
muscle to remove the need for oxygen
d. Restore the supply-and-demand balance of
oxygen in the heart
e. Decrease venous return to the heart
f. Alter the coronary artery filling pathway
4. A client who has nitroglycerin to avert an
acute anginal attack would need to be taught
a. to take five or six tablets and then seek
medical help if no relief occurs.
b. to buy the tablets in bulk to decrease the
cost.
c. to protect tablets from light and humidity.
d. to store the tablets in a clearly marked, clear
container in open view.
e. to use the nitroglycerin before an event or
activity that will most likely precipitate an
anginal attack.
f. to discard them if they do not fizzle when
placed under the tongue
Lipid-Lowering Agents
CHECK YOUR UNDERSTANDING
MULTIPLE CHOICE
Select the best answer.
1. Which way that the body uses cholesterol
stated by a community group indicates that
the group has understood teaching about
cholesterol?
a. The production of water-soluble vitamins
b. The formation of steroid hormones
c. The mineralization of bones
d. The development of dental plaques
2. The formation of atheromas in blood vessels
precedes the signs and symptoms of
a. hepatitis.
b. CAD.
c. diabetes mellitus.
d. chronic obstructive pulmonary disease
(COPD).
3. Hyperlipidemia is considered to be
a. a normal finding in adult males.
b. related to stress levels.
c. a treatable CAD risk factor.
d. a side effect of cigarette smoking.
4. The bile acid sequestrants
a. are absorbed into the liver.
b. take several weeks to show an effect.
c. have no associated adverse effects.
d. prevent bile salts from being reabsorbed.
5. HMG–CoA reductase inhibitors work in the
a. process of bile secretion.
b. process of cholesterol formation in the cell.
c. intestinal wall to block fat absorption.
d. kidney to block fat excretion.
6. Which would the nurse include when
teaching a patient about HMG–CoA reductase
inhibitors?
a. The patient will not have a heart attack.
b. The patient will not develop CAD.
c. The patient might develop cataracts as a
result.
d. The patient might stop absorbing fat-soluble
vitamins.
7. Which would the nurse expect the
healthcare provider to prescribe for a patient
who has high lipid levels and cannot take
fibrates or HMG–CoA reductase inhibitors?
a. Nicotine
b. Vitamin C
c. PCSK9 inhibitor
d. Nitrates
8. Which would alert the nurse to suspect that
a patient receiving HMG–CoA reductase
inhibitors is developing rhabdomyolysis?
a. Flatulence and abdominal bloating
b. Increased bleeding and bruising
c. The development of cataracts and blurred
vision
d. Muscle pain and weakness
MULTIPLE RESPONSE Select all that apply.
1. A bile acid sequestrant is the drug of choice
for a client who has which conditions?
a. A high LDL concentration
b. A high triglyceride concentration
c. Biliary obstruction
d. Vitamin K deficiency
e. A high HDL concentration
f. Intolerance to statins
2. Teaching a client who is prescribed an HMG–
CoA reductaseinhibitor to treat high
cholesterol and high lipid levels should include
which information?
a. The importance of exercise
b. The need for dietary changes to alter
cholesterol levels
c. That taking a statin will allow a full,
unrestricted diet
d. That drug therapy is always needed when
these levels are elevated
e. The importance of controlling blood pressure
and blood glucose levels
f. That stopping smoking may also help to lower
lipid levels
Drugs Affecting Blood Coagulation
CHECK YOUR UNDERSTANDING
MULTIPLE CHOICE Select the best answer.
1. Blood coagulation is a complex reaction that
involves
a. vasoconstriction, platelet aggregation, and
plasminogen action.
b. vasodilation, platelet aggregation, and
activation of the clotting cascade.
c. vasoconstriction, platelet aggregation, and
conversion of prothrombin to thrombin.
d. vasodilation, platelet inhibition, and action of
the intrinsic and extrinsic clotting cascades.
2. Warfarin, an oral anticoagulant, acts
a. to directly prevent the conversion of
prothrombin to thrombin.
b. to decrease the production of vitamin K
clotting factors in the liver.
c. as a catalyst in the conversion of plasminogen
to plasmin.
d. immediately, so it is the drug of choice in
emergency situations.
3. Heparin reacts to prevent the conversion of
prothrombin to thrombin. Heparin
a. is available in oral and parenteral forms.
b. takes about 72 hours to have a therapeutic
effect.
c. has its effects reversed with the
administration of protamine sulfate.
d. has its effects reversed with the injection of
vitamin K.
4. The low-molecular-weight heparin of choice
for preventing DVT after hip replacement
therapy is
a. heparin.
b. betrixaban.
c. fondaparinux.
d. enoxaparin.
5. A thrombolytic agent would be most
indicated for which circumstance?
a. CVA within the last 2 months
b. Acute MI within the last 3 hours
c. Recent, serious GI bleeding
d. Obstetric delivery
6. Which is true of warfarin?
a. Side effects include increased risk of clotting.
b. Therapy may take multiple days of dosing to
become therapeutic.
c. It works by inhibiting activation of factor X.
d. It is only administered IV.
MULTIPLE RESPONSE Select all that apply.
1. Hageman factor is known to activate which?
a. The clotting cascade
b. The anticlotting process
c. The inflammatory response
d. Platelet aggregation
e. Thromboxane A2
f. Troponin coupling
2. Plasminogen is converted to plasmin, a clot-
dissolving substance, by which?
a. Nicotine
b. Hageman factor
c. Tenecteplase
d. Pyrogens
e. Thrombin
f. Christmas factor
3. Antiplatelet drugs block the aggregation of
platelets and keep vessels open. These drugs
would be useful in which circumstances?
a. Maintaining the patency of grafts
b. Decreasing the risk of fatal MI
c. Preventing reinfarction after MI
d. Dissolving a PE and improving oxygenation
e. Decreasing damage in a subarachnoid bleed
f. Preventing thromboembolic strokes
4. Evaluating a client who is taking an
anticoagulant for blood loss would usually
include assessing for which conditions?
a. The presence of petechiae
b. Bleeding gums while brushing the teeth
c. Dark-colored urine
d. Yellow color to the sclera or skin
e. The presence of ecchymotic areas
f. Loss of hair
Drugs Used to Treat Anemias
CHECK YOUR UNDERSTANDING
MULTIPLE CHOICE.
Select the best answer.
1. After teaching a group of students about
RBC production, the instructor determines that
the teaching was effective when the group
states that the rate of RBC production is
controlled by
a. iron.
b. folic acid.
c. erythropoietin.
d. vitamin B12.
2. RBCs must be continually produced by the
body because
a. the iron within the RBC wears out and must
be replaced.
b. RBCs cannot maintain themselves and wear
out.
c. RBCs are continuously entering and being lost
from the GI tract.
d. RBCs are processed into bile salts and must
be replaced.
3. Which would the nurse include in the
teaching plan when describing all types of
anemia to a patient?
a. A decreased number of or abnormal RBCs
b. A lack of iron in the body
c. A lack of vitamin B12 in the body
d. An excessive number of platelets
4. Megaloblastic anemia is a result of
insufficient folic acid or vitamin B12, affecting
which?
a. White blood cell production
b. Vegetarians
c. Rapidly turning over cells
d. Slow-growing cells
5. The nurse would expect the physician to
prescribe epoetin alfa (Epogen) as the drug of
choice
a. for acute blood loss during surgery.
b. to replace blood loss from traumatic injury.
c. for treatment of anemia during lactation.
d. for treatment of anemia associated with
renal failure.
6. A patient with anemia who is given iron
salts could expect to show a therapeutic
increase in hematocrit
a. within 72 hours.
b. within 2 to 3 weeks.
c. within 6 to 10 months.
d. within 1 to 2 weeks.
7. To ensure maximum absorption, a nurse
instructs a patient receiving oral iron therapy
to avoid taking the iron with
a. protein.
b. antibiotics.
c. fats.
d. antiplatelet medications.
8. After teaching a patient with pernicious
anemia about vitamin B12 therapy, which
patient statement would indicate that the
teaching was successful?
a. “I can take this pill with breakfast.”
b. “I should take this pill at bedtime.”
c. “I need to inject this drug subcutaneously
every day.”
d. “I need to inject this drug IM every 5 to 10
days.”
MULTIPLE RESPONSE Select all that apply.
1. Clients are often given iron pills by their
clinic. Instructions in giving these pills should
include
a. taking the drug with milk to avoid GI
problems.
b. the potential for constipation.
c. keeping these potentially toxic pills away
from children.
d. taking the drug with antacids to alleviate GI
upset.
e. having periodic blood tests to evaluate the
drug effect.
f. being aware that stools may be colored green.
2. In a healthy person, little iron is needed on a
daily basis. Loss of iron is associated with
which conditions?
a. Heavy menstrual flow
b. Bile duct obstruction
c. Internal bleeding
d. Penetrating traumatic injury
e. Bone marrow suppression
f. Alcoholic cirrhosis
Drugs Acting on the Renal System

CHECK YOUR UNDERSTANDING
.MULTIPLE CHOICE
Select the best answer.
1. During severe exertion, a man may lose up
to 4 L of hypotonic sweat per hour. This loss
would result in
a. decreased plasma volume.
b. decreased plasma osmolarity.
c. decreased circulating levels of ADH.
d. return of body fluid balance to normal after
ingestion of 100 mL of water.
2. Urine passes through the ureter by
a. osmosis.
b. air pressure.
c. filtration.
d. peristalsis.
3. When describing renal reabsorption to a
group of students, the instructor would
identify it as the movement of which?
a. Substances from the renal tubule into the
blood
b. Substances from the blood into the renal
tubule
c. Water that is increased in the absence of ADH
d. Sodium occurring only in the proximal tubule
4. Considering the functions of the kidney, if a
patient lost kidney function, a nurse would
expect to see
a. increased red blood cell count.
b. decreased fluid volume.
c. low blood potassium.
d. variability in control of blood pressure.
5. Blood flow to the nephron differs from blood
flow to other tissues in that
a. the venous system is not involved in blood
flow around the nephron.
b. there are no capillaries in the nephron
allowing direct flow from the artery to the vein.
c. efferent and afferent arterioles allow for
autoregulation of blood flow.
d. the capillary bed has a fenestrated
membrane to allow passage of fluid and small
particles.
6. Concentration and dilution of urine are
controlled by
a. afferent arterioles.
b. the renin–angiotensin–aldosterone system.
c. aldosterone release.
d. the countercurrent mechanism.
7. Women tend to have more problems with
bladder infections than men because
a. women have Escherichia coli in the urinary
tract.
b. women have a short urethra, making access
to the bladder easier for bacteria.
c. the prostate gland secretes a substance that
protects men from bladder infections.
d. women’s urine is more acidic, encouraging
the growth of bladder bacteria.
MULTIPLE RESPONSE Select all that apply.
1. Considering the metabolic functions of the
kidneys, renal failure would be expected to
cause which conditions?
a. Anemia
b. Loss of calcium regulation
c. Urea buildup on the skin
d. Respiratory alkalosis
e. Metabolic acidosis
f. Changes in the function of blood cells
2. During severe diarrhea, there is a loss of
water, bicarbonate, and sodium from the GI
tract. Physiological compensation for this
would probably include which conditions?
a. Increased alveolar ventilation
b. Decreased hydrogen ion secretion by the
renal tubules
c. Decreased urinary excretion of sodium and
water
d. Increased renin secretion
e. Increased hydrogen ion secretion by the renal
tubules
f. Increased ADH levels
3. Maintenance of blood pressure is important
in maintaining the fragile nephrons. Reflex
systems that work to ensure blood flow to the
kidneys include
a. the renin–angiotensin–aldosterone system
causing vasoconstriction.
b. baroreceptor monitoring of the renal artery.
c. aldosterone release secondary to angiotensin
stimulation.
d. ADH release in response to decreased blood
volume with increased osmolarity.
e. release of erythropoietin.
f. local response of the afferent arterioles
Diuretic Agents
CHECK YOUR UNDERSTANDING
MULTIPLE CHOICE Select the best answer.
1. Most diuretics act in the body to cause
a. loss of calcium.
b. loss of sodium.
c. retention of potassium.
d. retention of chloride.
2. Diuretics cause a loss of fluid volume in the
body. The drop in volume activates
compensatory mechanisms to restore the determine the need to regularly monitor
volume, including which?

a. suppression of ADH release and stimulation a. Sodium levels

of the countercurrent mechanism.
b. Bone marrow function
b. suppression of aldosterone release and
increased ADH release. c. Calcium levels

c. activation of the renin–angiotensin–
aldosterone system with increased ADH and
aldosterone.
d. stimulation of the countercurrent mechanism
with reflex drop in renin release.
d. Potassium levels
6. When developing the plan of care for a
patient with hyperaldosteronism, the nurse
would expect the physician to prescribe which
agent?

a. Spironolactone

3. Thiazide diuretics are considered mild b. Furosemide

diuretics because c. Hydrochlorothiazide
a. they block the sodium pump in the loop of d. Acetazolamide
Henle.

b. they cause loss of sodium and chloride but

little water.
c. they do not cause fluid rebound when they
work in the kidneys.
d. they have little or no effect on electrolyte
levels.
4. The nurse would anticipate an order for a
loop diuretic as the drug of choice for a patient
with
7. A patient with severe glaucoma who is
about to undergo eye surgery would benefit
from a decrease in intraocular fluid. This is
often best accomplished by giving the patient
a. a loop diuretic.
b. a thiazide diuretic.
c. a carbonic anhydrase inhibitor.
d. an osmotic diuretic.

a. hypertension 8. The nurse would instruct a patient receiving

a loop diuretic to report
b. septic shock.
a. yellow vision.
c. pulmonary edema.
b. weight loss of 1 lb/d.
d. fluid retention of pregnancy.
c. muscle cramping.
5. When providing care to a patient who is
receiving a loop diuretic, the nurse would d. increased urination.

MULTIPLE RESPONSE Select all that apply.
1. Diuretics are currently recommended for the
treatment of which conditions?
a. Hypertension
b. Renal disease
c. Obesity
d. Severe liver disease
e. Fluid retention of pregnancy
f. Heart failure
2. Routine nursing care of a client receiving a
diuretic would include which interventions?
a. Daily weighing
b. Tight fluid restrictions
c. Periodic electrolyte evaluations
d. Monitoring of urinary output
e. Regular IOP testing
f. Teaching the patient to report muscle
cramping
Drugs Affecting the Urinary Tract and the
Bladder
CHECK YOUR UNDERSTANDING
MULTIPLE CHOICE Select the best answer.
1. When describing methylene blue to a
patient, the nurse should explain that it is a
urinary tract anti-infective that acts by
a. interfering with bacterial cell wall formation.
b. interfering with bacterial cell division.
c. alkalinizing the urine, which kills bacteria.
d. acidifying the urine, which kills bacteria.
2. The antibiotic of choice for a patient with
cystitis who has great difficulty following
medical regimens is
a. penicillin.
b. fosfomycin.
c. ciprofloxacin.
d. nitrofurantoin.
3. Urinary tract antispasmodics block the pain
and discomfort associated with spasm in the
smooth muscle of the urinary tract. The
numerous adverse effects associated with
these drugs are related to
a. their blockade of sympathetic beta-receptors.
b. their stimulation of cholinergic receptors.
c. their stimulation of sympathetic receptors.
d. their blockade of cholinergic receptors.
4. When planning the care for an older male
patient diagnosed with BPH, which two types
of drugs would the nurse most likely expect the
physician to prescribe?
a. Alpha-adrenergic blockers and anticholinergic c. tamsulosin.
drugs
d. terazosin.
b. Alpha-adrenergic blockers and testosterone
production blockers
8. After bladder surgery, many patients
c. Anticholinergic drugs and alpha-adrenergic
stimulators experience burning, urgency, frequency, and
pain related to urinary tract irritation. Such
d. Testosterone production stimulators and patients would benefit from treatment with
adrenal androgens
a. methylene blue.

b. fosfomycin.
5. The drug of choice for treatment of BPH in a
man with known hypertension might be c. phenazopyridine.

d. flavoxate.
a. doxazosin.

b. dutasteride.

c. finasteride. MULTIPLE RESPONSE Select all that apply

1. In evaluating a client for the presence of a

d. propranolol.
bladder infection, one would expect to find
reports of which conditions?

6. Before administering a drug for the a. Frequency of urination

treatment of BPH, the nurse should ensure that
a. the patient has had a prostate examination, b. Painful urination
including measurement of the PSA level. c. Edema of the fingers and hands
b. the patient has not had a vasectomy. d. Urgency of urination
c. the patient is still sexually active. e. Feelings of abdominal bloating
d. the patient is hypertensive. f. Itching, scaly skin

7. A male who is concerned about his hair loss 2. Important educational points for clients with
and who is being treated for BPH might prefer cystitis include which information?
treatment with
a. Avoidance of bubble baths
a. doxazosin.
b. Voiding immediately after sexual intercourse
b. finasteride. c. Always wiping from back to front
d. Avoidance of foods high in alkaline ash

e. Tight fluid restriction

f. Always wiping from front to back