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Pharmacology: An Introduction 7th Edition Hitner Nagle Test Bank

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Pharmacology: An Introduction 7th Edition Hitner Nagle Test Bank

  • ISBN:9780073513812

 

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Pharmacology: An Introduction 7th Edition Hitner Nagle Test Bank

  • ISBN:9780073513812

 

 

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Chapter 08

Drugs Affecting the Autonomic Ganglia

 

 

Multiple Choice Questions

  1. Identify the neurotransmitter found at the autonomic ganglia that stimulates the nicotinic-neural (Nn) receptors.
    A. Serotonin
    B.  Epinephrine
    C.  Acetylcholine
    D.  Dopamine

Acetylcholine is the neurotransmitter at the autonomic ganglia that normally stimulates the nicotinic-neural (Nn) receptors.

 

ABHES: 2.a
Blooms: Remember
CAAHEP: I.C.5
Difficulty: 1 Easy
Learning Outcome: 08.01

  1. What were the receptors at the autonomic ganglia known as prior to the discovery of the neurotransmitter acetylcholine (ACH)?
    A. Serotonin receptors
    B.  Nicotinic receptors
    C.  Epinephrine receptors
    D.  Dopamine receptors

Before the discovery of ACH, nicotine was found to stimulate the autonomic ganglia. Hence, the receptors at the ganglia were known as nicotinic receptors. Currently, they are more specifically classified as the nicotinic-neural (Nn) receptors.

 

ABHES: 2.a
Blooms: Remember
CAAHEP: I.C.2
Difficulty: 1 Easy
Learning Outcome: 08.01

 

 

  1. Identify a consequence of sympathetic stimulation by the use of nicotine products.
    A. Heart rate will increase.
    B.  Blood pressure will decrease.
    C.  GI activity will decrease.
    D.  All of these are correct.

Sympathetic stimulation usually predominates in the cardiovascular system, while parasympathetic stimulation predominates in the gastrointestinal tract. Consequently, after smoking, there is usually an increase in heart rate, blood pressure, and GI activity.

 

ABHES: 2.a
Blooms: Understand
CAAHEP: I.C.5
Difficulty: 1 Easy
Learning Outcome: 08.01

  1. Nicotine gum (Nicorette) has been classified as _____ by the FDA.
    A. Pregnancy Category A
    B.  Pregnancy Category B
    C.  Pregnancy Category C
    D.  Pregnancy Category D

Nicotine has been shown to be harmful to the fetus. Consequently, tobacco and the use of nicotine substitutes should be avoided during pregnancy. These drugs are classified as Pregnancy Category D by the FDA.

 

ABHES: 2.b
ABHES: 6.e
Blooms: Understand
CAAHEP: I.C.12
CAAHEP: IX.P.8
Difficulty: 1 Easy
Learning Outcome: 08.02

 

 

  1. What is the reason for the contraindication of ganglionic blockers in patients with glaucoma?
    A. Ganglionic blockers have a mydriatic effect that increases intraocular pressure.
    B.  Ganglionic blockers have a mydriatic effect that decreases intraocular fluid.
    C.  Ganglionic blockers have a miotic effect that increases intraocular pressure.
    D.  None of these are correct.

The adverse effects of the ganglionic blockers are caused by excessive blockade of the autonomic ganglia. Ganglionic blockers are contraindicated in patients with glaucoma because the mydriatic effect increases intraocular pressure.

 

ABHES: 2.b
Blooms: Understand
CAAHEP: 1.C.9
Difficulty: 1 Easy
Learning Outcome: 08.03

  1. Varenicline, which is used in the treatment of smoking cessation, is sold under the trade name _____.
    A. Zyban
    B.  Commit
    C.  Chantix
    D.  Wellbutrin

Varenicline, which is used in the treatment of smoking cessation, is sold under the trade name Chantix. It is available as 0.5- and 1-mg tablets. It blocks the effect of nicotine on the central nervous system receptors.

 

ABHES: 6.d
Blooms: Understand
CAAHEP: I.C.11
Difficulty: 1 Easy
Learning Outcome: 08.02

 

 

  1. A patient who was recently put on a smoking cessation treatment plan complains of throat irritation. This adverse effect is most likely caused by the use of _____.
    A. Nicorette
    B.  Nicotrol NS
    C.  Chantix
    D.  Zyban

This adverse effect is most likely caused by the use of Nicotrol NS. The common adverse effects of oral inhalers and nasal sprays include local mouth and throat irritation, minor breathing difficulties, and disturbances in the gastrointestinal tract.

 

ABHES: 6.d
Blooms: Apply
CAAHEP: I.C.11
Difficulty: 2 Medium
Learning Outcome: 08.02

  1. A patient complains of weakness, dizziness, and feelings of faintness when standing up. Using your knowledge on ganglionic stimulants and blockers, determine the probable cause of these adverse effects based on the patient’s medication profile.
    A. Mecamylamine
    B.  Bupropion
    C.  Varenicline
    D.  None of the above

Mecamylamine is a potent ganglionic blocker that can cause orthostatic hypotension and significant depression of the cardiovascular system. Symptoms of low blood pressure include weakness, dizziness, and feelings of faintness.

 

ABHES: 6.d
Blooms: Apply
CAAHEP: I.C.11
Difficulty: 2 Medium
Learning Outcome: 08.03

 

 

  1. A patient’s wife is concerned that her husband is overusing Nicorette 4-mg nicotine gum. She would like to confirm how many pieces he can use in a day. In this scenario, the dosage should be limited to _____.
    A. 20 pieces per day
    B.  10 pieces per day
    C.  30 pieces per day
    D.  50 pieces per day

Nicotine gum (Nicorette) is available as 2 mg (limited to 30 pieces/day) and 4 mg (limited to 20 pieces/day).

 

ABHES: 6.d
Blooms: Apply
CAAHEP: I.C.11
Difficulty: 2 Medium
Learning Outcome: 08.02

  1. Implementing a treatment plan that includes mecamylamine is indicative of a diagnosis of _____.
    A. smoking addiction
    B.  severe hypertension
    C.  depression
    D.  constipation

The only ganglionic blocker currently available for chronic use is mecamylamine (Inversine). Mecamylamine is mainly used for the treatment of severe hypertension when other drugs have not been effective.

 

ABHES: 6.d
Blooms: Apply
CAAHEP: I.C.11
Difficulty: 2 Medium
Learning Outcome: 08.03

 

 

  1. Implementing a treatment plan that includes mecamylamine requires monitoring the patient for:
    A. suicidal ideation.
    B.  depression of the cardiovascular system.
    C.  mental depression.
    D.  neuropsychiatric effects such as hostility.

Mecamylamine is a potent ganglionic blocker that can cause orthostatic hypotension and significant depression of the cardiovascular system. The patient should be observed for signs of low blood pressure, slow heart rate, and respiratory difficulties.

 

ABHES: 6.d
Blooms: Apply
CAAHEP: I.C.12
Difficulty: 2 Medium
Learning Outcome: 08.03

  1. Implementing a treatment plan that includes ganglionic blocking drugs and vasodilators could lead to a drug interaction resulting in _____.
    A. additive anticholinergic effects
    B.  additive vasodilating effects
    C.  antagonism of anticholinergic effects
    D.  additive antiadrenergic effects

Vasodilators interact with ganglionic blocking drugs and cause an additive vasodilating effect that produces hypotension and possible cardiovascular collapse.

 

ABHES: 6.d
Blooms: Apply
CAAHEP: I.C.11
Difficulty: 2 Medium
Learning Outcome: 08.04

 

 

  1. One of the similarities between ganglionic stimulants and ganglionic blockers is that both:
    A. increase a person’s craving for nicotine.
    B.  can be used to treat severe hypertension.
    C.  have little clinical use.
    D.  can be used to treat hypotension.

As a drug class, drugs that stimulate autonomic ganglia have little clinical use. However, for individuals who want to quit the tobacco habit, there are nicotine-containing preparations that substitute tobacco. The clinical use of ganglionic blockers is limited and mainly indicated for the treatment of severe hypertension.

 

ABHES: 6.d
Blooms: Analyze
CAAHEP: I.C.11
Difficulty: 3 Hard
Learning Outcome: 08.01

  1. Differentiating between the adverse effects of Nicorette and Nicoderm CQ, you determine that the use of Nicorette can result in all of the following adverse effects except:
    A. taste disturbances.
    B.  jaw soreness.
    C.  nausea.
    D.  nervousness.

Nicoderm CQ and other nicotine replacement transdermal patches can cause soreness at the patch site, changes in taste, GI disturbances, and nervousness. Nicorette and other nicotine gum and lozenges can cause taste disturbances, mouth and jaw soreness, and GI disturbances such as nausea and heartburn.

 

ABHES: 6.d
Blooms: Analyze
CAAHEP: I.C.11
Difficulty: 3 Hard
Learning Outcome: 08.01

 

 

  1. What is the main effect of ganglionic blockers on the gastrointestinal system?
    A. Increased blood pressure
    B.  Decreased intestinal secretions
    C.  Increased urination
    D.  Decreased cardiac output

The use of ganglionic blockers results in a combination of anticholinergic and antiadrenergic effects, which usually include decreased GI activity (dry mouth and constipation), visual disturbances (mydriasis and cycloplegia), decreased cardiovascular function (hypotension and decreased cardiac output), and decreased genitourinary function (urinary retention and impotency).

 

ABHES: 6.d
Blooms: Analyze
CAAHEP: I.C.11
Difficulty: 3 Hard
Learning Outcome: 08.03

  1. When integrating a smoking cessation treatment with Nicotrol Inhaler, the inhaler should be used with caution because:
    A. it may cause nervousness.
    B.  it is not compatible with other nicotine drug preparations.
    C.  it may cause minor breathing difficulties.
    D.  it can desensitize adrenergic receptors.

Nicotine inhalers, such as Nicotrol Inhaler, and nasal sprays may cause local mouth and throat irritation, minor breathing difficulties, and disturbances in the gastrointestinal tract.

 

ABHES: 6.d
Blooms: Analyze
CAAHEP: I.C.12
Difficulty: 3 Hard
Learning Outcome: 08.02

 

 

  1. When selecting bupropion for treatment of smoking cessation, it is important to differentiate between bupropion and the nicotine replacement products. Which of the following statements is true of bupropion?
    A. It is an antidepressant drug.
    B.  It has an adverse effect profile that includes insomnia, dry mouth, and gastrointestinal (GI) disturbances.
    C.  It is available as 25-, 50-, 75-, and 150-mg tablets.
    D.  All of the above statements are correct.

Bupropion is sold under the trade names Wellbutrin and Zyban. It is an antidepressant drug used to reduce nicotine cravings, and it is available as 25-, 50-, 75-, and 150-mg tablets and 150-mg sustained-release tablets.

 

ABHES: 6.d
Blooms: Analyze
CAAHEP: I.C.11
Difficulty: 3 Hard
Learning Outcome: 08.02

  1. Integrating a cholinergic drug into the existing treatment plan of a patient already taking a ganglionic blocking drug could result in a drug interaction characterized by:
    A. additive anticholinergic effect of ganglionic blockade on the gastrointestinal and urinary tracts.
    B.  additive vasodilating effect to produce hypotension and cardiovascular collapse.
    C.  antagonism of anticholinergic effect of ganglionic blockade on the gastrointestinal and urinary tracts.
    D.  additive antiadrenergic effect that leads to hypotension and cardiovascular collapse.

Cholinergic drugs interact with ganglionic blocking drugs causing antagonism of the anticholinergic effect of ganglionic blockade, especially on the gastrointestinal and urinary tracts.

 

ABHES: 6.d
Blooms: Analyze
CAAHEP: I.C.11
Difficulty: 3 Hard
Learning Outcome: 08.04

 

 

  1. Which of the following can result from prescribing a nicotine replacement product for a patient while the patient continues to indulge in smoking cigarettes?
    A. Toxic doses of nicotine in the body
    B.  Ganglionic blockade
    C.  Decreased respiratory function
    D.  All of the above

Frequently, smokers will use nicotine replacement therapy (NRT) products but continue to smoke or chew tobacco. This can lead to nicotine toxicity. At toxic doses, ACH and nicotine desensitize both Nn (nicotinic-neural) and Nm (skeletal muscle) receptors and can act like ganglionic blockers and block both ganglionic and skeletal neuromuscular transmission. This blockade can result in respiratory paralysis and death.

 

ABHES: 6.d
Blooms: Analyze
CAAHEP: I.C.11
Difficulty: 3 Hard
Learning Outcome: 08.02

  1. Selection of ganglionic blockers for the treatment of severe hypertension in males can lead to _____.
    A. increased urination
    B.  increased intestinal secretions
    C.  impotence
    D.  hostility

The major effects of treating severe hypertension with ganglionic blockers are hypotension, bradycardia, decreased intestinal secretions and motility, and reduced urination. It can also cause impotence in males.

 

ABHES: 6.d
Blooms: Analyze
CAAHEP: I.C.11
Difficulty: 3 Hard
Learning Outcome: 08.03

 

 

  1. Two weeks after beginning treatment for smoking cessation, Joe visits a physician and complains of having suicidal tendencies and feeling mentally depressed. Which of the following is a most likely reason for this occurrence?
    A. Joe is not taking his medication regularly and has reverted to smoking to satisfy his craving for nicotine.
    B.  The acetylcholine in Joe’s body is at toxic levels, impairing his neuromuscular function.
    C.  Joe is consuming tobacco to overcome the effects of nicotine withdrawal.
    D.  The treatment for Joe’s condition involves a drug preparation known as varenicline.

Varenicline is a drug that is claimed to block nicotine receptors in the brain to prevent nicotine from exerting its full effects. The most common adverse effects of varenicline are nausea, vomiting, constipation, and headaches. In addition, psychiatric disturbances, mental depression, and suicidal ideation have been reported.

 

ABHES: 6.d
Blooms: Apply
CAAHEP: I.C.11
Difficulty: 3 Hard
Learning Outcome: 08.02

  1. When a patient is administered mecamylamine, what are the signs that a nurse or medical assistant should watch out for in the patient?
    A. Bradycardia
    B.  Taste disturbances
    C.  Jaw soreness
    D.  Nervousness

When a patient is administered mecamylamine, the patient should be observed for signs of low blood pressure, slow heart rate (bradycardia), and respiratory difficulties.

 

ABHES: 6.d
Blooms: Remember
CAAHEP: I.C.11
Difficulty: 1 Easy
Learning Outcome: 08.03

 

 

  1. Which of the following can cause a sudden drop in blood pressure or orthostatic hypotension for a patient being treated with mecamylamine?
    A. A change in body position
    B.  A sudden decrease in dosage of mecamylamine
    C.  A pre-existing condition such as mental depression
    D.  A temporary stoppage in the delivery of the drug

When a patient is administered mecamylamine, the patient should be careful when changing body position since this can cause orthostatic hypotension.

 

ABHES: 6.d
Blooms: Remember
CAAHEP: I.C.11
Difficulty: 1 Easy
Learning Outcome: 08.03

  1. How does mecamylamine differ from other ganglionic blockers such as trimethaphan?
    A. Unlike other ganglionic blockers, mecamylamine is unavailable for clinical use.
    B.  Unlike other ganglionic blockers, mecamylamine is unavailable for chronic use.
    C.  Unlike other ganglionic blockers, mecamylamine is almost completely absorbed after oral administration.
    D.  Unlike other ganglionic blockers, mecamylamine is administered intravenously rather than through the gastrointestinal tract.

The first ganglionic blockers that were discovered (hexamethonium, pentolinium, and trimethaphan) possessed a quaternary ammonium ion. Quaternary ammonium ions are permanently charged molecules and are poorly absorbed from the GI tract. Mecamylamine, another ganglionic blocker, is not a quaternary ion and is almost completely absorbed after oral administration.

 

ABHES: 6.d
Blooms: Analyze
CAAHEP: I.C.11
Difficulty: 3 Hard
Learning Outcome: 08.03

 

 

  1. The profound vasodilation caused by the pharmacologic action of mecamylamine is primarily due to the:
    A. ganglionic stimulation of sympathetic ganglia.
    B.  ganglionic stimulation of parasympathetic ganglia.
    C.  ganglionic blockade of sympathetic ganglia.
    D.  ganglionic blockade of parasympathetic ganglia.

The pharmacologic action of mecamylamine is mainly due to ganglionic blockade of sympathetic ganglia, which causes profound vasodilation.

 

ABHES: 6.d
Blooms: Understand
CAAHEP: I.C.11
Difficulty: 2 Medium
Learning Outcome: 08.03

  1. Which of the drug classes interact with ganglionic blocking drugs to produce an antagonism of antiadrenergic effect?
    A. Adrenergic drugs
    B.  Adrenergic blocking drugs
    C.  Cholinergic drugs
    D.  Anticholinergic drugs

Adrenergic drugs interact with ganglionic blocking drugs to produce an antagonism of antiadrenergic effect of ganglionic blockade, especially on the cardiovascular system.

 

ABHES: 6.d
Blooms: Understand
CAAHEP: I.C.11
Difficulty: 2 Medium
Learning Outcome: 08.04

 

 

  1. _____ interact with ganglionic blocking drugs to produce an additive antiadrenergic effect.
    A. Adrenergic drugs
    B.  Adrenergic blocking drugs
    C.  Cholinergic drugs
    D.  Anticholinergic drugs

Adrenergic blocking drugs interact with ganglionic blocking drugs to produce an additive antiadrenergic effect resulting in hypotension and possible cardiovascular collapse.

 

ABHES: 6.d
Blooms: Understand
CAAHEP: I.C.11
Difficulty: 2 Medium
Learning Outcome: 08.04

  1. The class of drugs that interact with ganglionic blocking drugs to produce additive anticholinergic effect is _____.
    A. adrenergic drugs
    B.  adrenergic blocking drugs
    C.  cholinergic drugs
    D.  anticholinergic drugs

The class of drugs that interact with ganglionic blocking drugs to produce additive anticholinergic effect is anticholinergic drugs.

 

ABHES: 6.d
Blooms: Understand
CAAHEP: I.C.11
Difficulty: 2 Medium
Learning Outcome: 08.04

 

 

  1. _____ interact with ganglionic blocking drugs to produce hypotension and possible cardiovascular collapse.
    A. Adrenergic drugs
    B.  Vasodilator drugs
    C.  Cholinergic drugs
    D.  Anticholinergic drugs

Vasodilator drugs interact with ganglionic blocking drugs to produce hypotension and possible cardiovascular collapse.

 

ABHES: 6.d
Blooms: Understand
CAAHEP: I.C.11
Difficulty: 2 Medium
Learning Outcome: 08.04

  1. Angelo, a chain smoker, is prescribed 4-mg pieces of nicotine gum with a limit of 14 pieces per day to help him deal with the effects of nicotine withdrawal. What is the maximum dosage of nicotine that can be administered in a day?
    A. 28 mg/day
    B.  40 mg/day
    C.  46 mg/day
    D.  56 mg/day

The maximum dosage is 56 mg/day. Multiply the dosage per piece by the maximum number of pieces that can be consumed in a day. 4 mg/piece ´ 14 piece/day = 56 mg/day

 

ABHES: 6.b
Blooms: Apply
CAAHEP: II.C.2
Difficulty: 3 Hard
Learning Outcome: 08.02

 

 

  1. A physician prescribes 20 mg/day of nicotine for Robert as part of nicotine-replacement therapy. The dosage can be administered in the form of nicotine lozenges (available as 2-mg and 4-mg lozenges) or nicotine gum (available as 2-mg and 4-mg pieces of gum). What is the appropriate combination of gum and lozenges required to administer the required dosage?
    A. Four 2-mg lozenges and three 4-mg pieces of gum
    B.  Two 2-mg lozenges and seven 2-mg pieces of gum
    C.  Five 2-mg lozenges and five 4-mg pieces of gum
    D.  One 4-mg lozenge and three 4-mg pieces of gum

The appropriate combination of gum and lozenges required to administer the required dosage is four 2-mg lozenges and three 4-mg pieces of gum.

 

ABHES: 6.b
Blooms: Apply
CAAHEP: II.C.2
Difficulty: 3 Hard
Learning Outcome: 08.02

  1. Both bupropion and varenicline impact the central nervous system (CNS). However, bupropion differs from varenicline in that it:
    A. blocks nicotine receptors in the brain.
    B.  blocks acetylcholine receptors in the brain.
    C.  reduces the CNS effects of nicotine toxicity.
    D.  reduces the CNS effects of nicotine withdrawal.

Bupropion is an antidepressant that affects mood and is claimed to reduce the CNS effects of nicotine withdrawal. Varenicline is a drug that is claimed to block nicotine receptors in the brain to prevent nicotine from exerting its full effects.

 

ABHES: 6.d
Blooms: Analyze
CAAHEP: I.C.11
Difficulty: 3 Hard
Learning Outcome: 08.02

 

 

  1. Both bupropion and varenicline impact the central nervous system (CNS) in the treatment of smoking cessation. However, varenicline differs from bupropion in that it:
    A. blocks nicotine receptors in the brain.
    B.  stimulates nicotine receptors in the brain.
    C.  reduces the CNS effects of nicotine toxicity.
    D.  reduces the CNS effects of nicotine withdrawal.

Bupropion is an antidepressant that affects mood and is claimed to reduce the CNS effects of nicotine withdrawal. Varenicline is a drug that is claimed to block nicotine receptors in the brain to prevent nicotine from exerting its full effects.

 

ABHES: 6.d
Blooms: Analyze
CAAHEP: I.C.11
Difficulty: 3 Hard
Learning Outcome: 08.02

  1. Which of the following systems is predominantly stimulated by nicotine action on parasympathetic nerves?
    A. The endocrine system
    B.  The cardiovascular system
    C.  The gastrointestinal system
    D.  The renal system

Individuals who use tobacco absorb nicotine, which produces ganglionic stimulation that increases both sympathetic and parasympathetic activity. However, sympathetic stimulation usually predominates in the cardiovascular system, while parasympathetic stimulation predominates in the gastrointestinal tract.

 

ABHES: 2.a
Blooms: Remember
CAAHEP: I.C.5
Difficulty: 1 Easy
Learning Outcome: 08.01

 

 

  1. Nicotine stimulates sympathetic nerves predominantly in the _____.
    A. endocrine system
    B.  cardiovascular system
    C.  gastrointestinal system
    D.  renal system

Individuals who use tobacco absorb nicotine, which produces ganglionic stimulation that increases both sympathetic and parasympathetic activity. However, sympathetic stimulation usually predominates in the cardiovascular system, while parasympathetic stimulation predominates in the gastrointestinal tract.

 

ABHES: 2.a
Blooms: Remember
CAAHEP: I.C.5
Difficulty: 1 Easy
Learning Outcome: 08.01