TEST BANK FOR INTRODUCTION TO CLINICAL PHARMACOLOGY 9TH EDITION BY VISOVSKY

Chapter 08: Drugs Affecting theRenal/Urinary and Cardiovascular Problems Visovsky: Introduction to Clinical Pharmacology, 9th Edition MULTIPLE CHOICE 1. Which body system works with the renal/urinary system to maintain fluid balance and remove waste products from the body? a. Biliary system b. Cardiovascular system c. Central nervous system d. Gastrointestinal system ANS: B The renal/urinary system works together with the cardiovascular system to maintain adequate circulation to all parts of the body. The interactions between these two systems help maintain fluid balance, delivery of nutrients, and removal of waste products from cells, tissues, and organs. Most drugs that affect one system have an effect on the functioning of the other system. DIF: Cognitive Level: Remembering REF: p. 126 2. Which category of diuretic drugs exerts its mechanism of action in the collecting duct? a. Loop diuretics b. Thiazide diuretics c. Potassium-sparing diuretics d. Thiazide-like sulfonamide diuretics ANS: C Loop diuretics work in the ascending limb of the Loop of Henle. Thiazide diuretics and thiazide-like diuretics work at the end of the ascending loop of Henle and the beginning of the distal convoluted tubule. Only the potassium-sparing diuretics work at the collecting duct. DIF: Cognitive Level: Understanding REF: p. 126 3. How do thiazide and thiazide-like diuretic drugs reduce high blood pressure? a. Reducing blood volume and relaxing vascular smooth muscle b. Increasing potassium excretion and slowing heart contractions c. Releasing sodium from cellular storage sites and preventing heart block d. Reducing the thirst response and increasing the amount of urine the bladder can hold ANS: A Blood pressure is maintained by fluid volume in circulation, the force of heart contractions, and the constriction of blood vessels that provide resistance. All diuretics help lower blood pressure by reducing the amount of fluid (volume) in the blood. Thiazide and thiazide-like diuretics also relax blood vessel smooth muscle, which decrease vascular resistance to blood flow. The reduced volume and decreased resistance result in lower blood pressure. TEST BANK FOR INTRODUCTION TO CLINICAL PHARMACOLOGY 9TH EDITION BY VISOVSKY NURSINGTB.COM TEST BANK FOR INTRODUCTION TO CLINICAL PHARMACOLOGY 9TH EDITION BY VISOVSKY N U R S I N G T B . C O M DIF: Cognitive Level: Understanding REF: p. 126 4. Which precaution is most important for the LPN/VN to teach a patient newly prescribed to take 10 mg of amiloride (Midamor) orally daily? a. “Avoid the use of salt substitutes.” b. “Avoid aspirin and aspirin-containing products.” c. “Eat plenty of bananas and oranges to prevent complications.” d. “Report a decrease in hearing to your healthcare provider immediately. ANS: A Amiloride is a potassium-sparing diuretic, and patients can develop dangerously high blood potassium levels while taking this drug. They must avoid extra potassium. Salt substitutes contain high levels of potassium and so do bananas and citrus fruits. Amiloride does not interact with aspirin or aspirin-containing drugs. DIF: Cognitive Level: Applying REF: p. 129 5. Which health problem is a potential side effect or adverse reaction of any class of diuretic drug? a. Dehydration b. Heart failure c. Blurred vision d. Urinary tract infection ANS: A Diuretics work by increasing the excretion of water through urination. When water loss is excessive, dehydration of the circulatory system or even the whole body can occur. Diuretic therapy actually helps improve the symptoms of heart failure and do not cause blurred vision. Although a urinary tract infection can occur in a patient taking a diuretic, the drug is not the direct cause. DIF: Cognitive Level: Understanding REF: p. 129 6. Which statement made by a patient taking a loop diuretic indicates the need for more teaching? a. “Since I work nights, I take my drug when I first wake up rather than in the morning.” b. “If my hearing decreases, I will notify my healthcare provider.” c. “I make sure to space my fluid intake evenly throughout the day.” d. “When I travel by car, I always skip my diuretic that day.” ANS: D Although taking the time to urinate while traveling is inconvenient, the patient needs to understand that the drug must be taken every day. Often, patients are told to take the drug in the morning; it should be taken at the time furthest away from when the patient usually goes to bed so there is less interference with his or her normal sleep patterns. Spacing fluid intake evenly throughout the day helps prevent dehydration. Loop diuretics can cause hearing loss and the patient should notify the healthcare provider if this develops even though his or her health problem may require that the drug be continued. TEST BANK FOR INTRODUCTION TO CLINICAL PHARMACOLOGY 9TH EDITION BY VISOVSKY NURSINGTB.COM N U R S I N G T B . C O M DIF: Cognitive Level: Applying REF: p. 130 7. Why is it important to warn a patient prescribed to take finasteride (Proscar) for benign prostatic hyperplasia to wear a condom when having sex with a pregnant woman or one who could become pregnant? a. The drug contains a hormone that can greatly increase the risk for having twins when absorbed by a pregnant woman. b. The drug can be absorbed by the pregnant woman and cause birth defects in the fetus. c. The drug reduces local immunity and increases the risk for transmitting HIV. d. The drug increases the risk for vaginal infections in pregnant women. ANS: B The drug is a synthetic hormone that can be absorbed through the skin and mucous membranes. When the fetus is exposed, birth defects are possible. The drug does not increase the risk for any type of infection development or transmission. The drug does not increase the risk for having twins. DIF: Cognitive Level: Understanding REF: p. 131 8. How does phenazopyridine help reduce the symptoms of a bladder infection (cystitis)? a. Increasing the strength of the bladder contraction b. Changing the color and the smell of the urine c. Killing off the bacteria causing the infection d. Reducing the irritation of the bladder ANS: D The drug is a bladder anesthetic that reduces the irritation of the bladder (which causes pain and the sensation of needing to urinate immediately). Phenazopyridine is not an antibiotic and cannot kill or cure a urinary tract infection. Although it does turn the urine a deep orange-red color, this alone does not reduce symptoms. The drug does not increase the strength of bladder contractions, which would only worsen some of the symptoms. DIF: Cognitive Level: Understanding REF: p. 130 9. You are teaching a patient about drug therapy for hyperlipidemia. Which statement made by the patient indicates that more teaching is needed? a. “I am so thankful that my high cholesterol has been cured by this drug.” b. “I always try to drink just about the same amount of fluid that I urinate each day.” c. “I have been taking this drug just before I go to bed so that it has the greatest effect.” d. “I will keep regular appointments with my healthcare provider to assess for any organ complications.” ANS: A TEST BANK FOR INTRODUCTION TO CLINICAL PHARMACOLOGY 9TH EDITION BY VISOVSKY NURSINGTB.COM N U R S I N G T B . C O M Drugs for hyperlipidemia do not cure the high cholesterol blood levels; they only help control the problem. If the patient stops taking the drug, blood cholesterol levels will increase. The drugs do not increase urine output or the risk for dehydration. Drinking as much fluid as gets urinated each day is a good practice for anyone. Taking some of the drugs, especially the statins before bed is good because the body’s production of cholesterol generally occurs at night. DIF: Cognitive Level: Applying REF: p. 135 10. Why are “statins” avoided during pregnancy and breast-feeding? a. These drugs cause hypotension in the fetus and infant. b. These drugs are associated with development of autism. c. They lower cholesterol levels in the fetus and infant. d. They can lead to miscarriage and early pregnancy loss. ANS: C Statins can be dangerous to use during pregnancy because cholesterol is important for normal brain development. If taken during pregnancy, statins can lower the cholesterol levels in the fetus, which results in brain deformities. DIF: Cognitive Level: Knowing REF: p. 135 11. A patient who has been taking atorvastatin for 6 months reports that he has stopped exercising because his muscles and joints are always so sore. What is the nurse’s best action? a. Document the report as the only action. b. Assess the patient’s range of joint motion. c. Hold the drug and notify the healthcare provider immediately. d. Suggest that the patient continue to exercise but take aspirin an hour before starting. ANS: C Muscle weakness and joint soreness can signal the serious condition of muscle breakdown known as rhabdomyolysis. It may also be a mild issue. Only the healthcare provider will know whether the patient needs to discontinue the drug completely or continue the drug. Therefore, the best action is to notify the healthcare provider of this new and potentially serious complication. DIF: Cognitive Level: Applying REF: p. 135 12. Which precaution is most important to teach patients who are taking any “statin” drug? a. “Eat plenty of bananas and oranges to prevent low blood potassium levels.” b. “Avoid using aspirin or any aspirin-containing products and drugs.” c. “Be sure to take this drug right before you eat a high fat meal.” d. “Avoid drinking alcohol and taking acetaminophen.”