Pharmacology An Introduction 7Th Edition By Henry Hitner

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Sample Test

Chapter 03

Geriatric Pharmacology

Multiple Choice Questions

1. In comparison to the members of other age groups, members of the geriatric population are:
A. less likely to consume drugs.
B. more likely to experience the adverse effects of a drug.
C. less likely to suffer from toxicity.
D. more likely to benefit from the therapeutic effects of the drug.

Drug use increases with increasing age, and the number of drugs consumed in the geriatric population averages between three and four drugs per individual. Both the nature and frequency of adverse drug reactions increase with age.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Understand
CAAHEP: I.C.7. Describe the normal function of each body system
CAAHEP: I.C12. Identify quality assurance practices in healthcare
Difficulty: 2 Medium
Learning Outcome: 03.01

2. Identify an accurate statement about the use of drugs in the elderly.
A. Elderly people tend to use less drugs than people in other age groups.
B. Elderly people are less likely than people from other age groups to experience adverse drug reactions.
C. Compared to people from other age groups, elderly people account for the highest percentage of drug prescriptions per year.
D. Compared to people from other age groups, elderly people are more able to eliminate drugs from their bodies.

Compared to other age groups, the geriatric population accounts for the highest percentage of drug prescriptions per year.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Understand
CAAHEP: I.C.9.b. Analyze pathology for each body system including treatment modalities
Difficulty: 2 Medium
Learning Outcome: 03.01

3. Which of the following changes takes place as a person ages?
A. The amount of blood pumped by the heart per minute increases.
B. The size of several body organs decreases.
C. The frequency and nature of adverse reactions to drugs decreases.
D. The efficiency with which the liver metabolizes drugs increases.

The size of most body organs decreases with age and, therefore, there are fewer cells to carry out organ functions.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Understand
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 2 Medium
Learning Outcome: 03.01

4. Which of the following changes in aging people tends to slow down the rate of drug absorption and the onset of drug action?
A. A decrease in the amount of gastric acid secreted
B. An increase in intestinal motility
C. An increase in blood flow to the intestinal tract
D. A decrease in the percentage of adipose tissue in the body

With age there is a decrease in blood flow to the intestinal tract, reduced intestinal absorptive surface area, a decrease in gastric acid secretion, and a decrease in intestinal motility. These changes tend to slow the rate of drug absorption and the onset of drug action.

5. Dr. Hampton administers the same dose of a certain water-soluble drug to two of his patients, Nathaniel, who is 65 years of age, and Mark, who is 25 years of age. Which of the following is most likely going to happen?
A. Most of the drug in Nathaniel’s body will get deposited in the body organs that have a high fat content, away from the liver and kidneys.
B. The drug will be more widely distributed in Nathaniel’s body than it will be in Mark’s body.
C. Nathaniel will experience a more intense pharmacological drug effect than Mark will experience.
D. The concentration of the drug in Mark’s blood plasma will be higher than the concentration of the drug in Nathaniel’s blood plasma.

In the bodies of older people, water-soluble drugs will have less body fluid in which to dissolve and are less widely distributed out to the organs with high fat content. This produces higher plasma drug levels and greater pharmacological effects when compared to the same dosage of drug administered to a younger adult.

ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications
Blooms: Apply
CAAHEP: I.C.10. Identify CLIA waived tests associated with common diseases
CAAHEP: I.C.9.b. Analyze pathology for each body system including treatment modalities
Difficulty: 3 Hard
Learning Outcome: 03.02

6. Equal doses of a certain fat-soluble drug are administered to two individuals, John, who is 20 years old and Eric, who is 70 years old. Which of the following is most likely to happen based on the information provided in this scenario?
A. A greater percentage of the drug in John’s body will get diverted away from the liver and kidneys than the percentage of the drug in Eric’s body.
B. Eric’s body will be able to eliminate the drug much faster than John’s body will be able to eliminate it.
C. The drug will get more widely distributed to various organs in John’s body than it will get distributed to the organs in Eric’s body.
D. The drug will have a longer half-life in Eric’s body than it will have in John’s body.

The drug will have a longer half-life in Eric’s body than it will have in John’s body. The percentage of body fat increases with age. This causes lipid-soluble drugs to be more widely distributed to the body organs that have a high fat content, such as adipose tissue and muscle, and away from the liver and kidneys. Since the liver and kidneys are responsible for drug metabolism and excretion, any diversion from them will slow elimination of the drug from the body. The drug will then have a longer half-life and duration of action.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Analyze
CAAHEP: I.C.9.b. Analyze pathology for each body system including treatment modalities
Difficulty: 3 Hard
Learning Outcome: 03.02

7. Why do fat-soluble drugs have a longer half-life and duration of action in the elderly?
A. Because they get diverted away from the liver and kidneys
B. Because they dissolve faster in the fluids of the body
C. Because they are less widely distributed to the other organs in the body
D. Because they are instantly metabolized as soon as they are ingested

The percentage of body fat increases with age. This causes lipid-soluble drugs to be more widely distributed to the body organs that have a high fat content, such as adipose tissue and muscle, and away from the liver and kidneys. Since the liver and kidneys are responsible for drug metabolism and excretion, any diversion from them will slow elimination of the drug from the body. The drug will then have a longer half-life and duration of action.

8. Ken, a 60-year-old, has been taking daily doses of certain fat-soluble drugs. Identify an accurate statement about how these drugs will get distributed in Ken’s body.
A. Most of the drugs will dissolve into the body fluids.
B. The drugs will be distributed to the body organs that have a high content of adipose tissue.
C. The drugs will be directly diverted to the liver and kidneys.
D. Most of the drugs will dissolve into the blood plasma.

The percentage of body fat (adipose tissue) increases with age. This causes lipid-soluble drugs to be more widely distributed to the body organs that have a high fat content, such as adipose tissue and muscle (modest fat content, but large mass), and away from the liver and kidneys. Since the liver and kidneys are responsible for drug metabolism and excretion, any diversion from them will slow elimination of the drug from the body.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Apply
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 3 Hard
Learning Outcome: 03.02

9. Which of the following may contribute to drug toxicity in the geriatric population?
A. Increased activity of liver enzymes
B. Stable creatinine levels
C. Reduced production of plasma proteins
D. Leukopenia

The concentration of plasma proteins, mainly albumin, decreases with age. Since most drugs are bound to some extent to plasma proteins and it is only the concentration of “free drug” that produces the pharmacological effect, any decrease in plasma proteins and plasma protein drug binding will increase the amount of free or unbound drug and, therefore, the intensity of the drug effect.

ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications
Blooms: Understand
CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use
Difficulty: 1 Easy
Learning Outcome: 03.02

10. An elderly man has been taking an adult-strength dose of the topical steroid hydrocortisone for the past four weeks. He has developed thin skin and stria along his back, which are physical indications of toxicity. Which of the following might have led to the toxic effects of the steroid?
A. A reduction in the amount of the drug absorbed by the intestine
B. A buildup of the drug in the adipose tissues
C. An increase in the metabolic activity of the liver
D. An increase in the rate at which the drug is excreted by the kidneys

ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications
Blooms: Analyze
CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use
Difficulty: 3 Hard
Learning Outcome: 03.02

11. Arthur, a 70-year-old, and Kevin, a 24-year-old, are given the same dose of a certain water-soluble drug X. When Dr. Robinson examines samples of their blood plasma, he finds that the concentration of X in Arthur’s system is much higher than the concentration of X in Kevin’s system. Why is Arthur’s blood plasma more concentrated with drug X than Kevin’s blood plasma?
A. Because elderly people have a lower percentage of total body water than younger people do
B. Because elderly people have more lean body mass than younger people do
C. Because elderly people have less adipose tissue than younger people do
D. Because elderly people have less intestinal absorptive surface area than younger people do

The percentage of lean body mass (muscle) and the percentage of total body water decrease with age. If one thinks of the body as a big beaker filled with 35 liters of fluid and a drug dose dumped into the beaker, there will be a certain concentration of drug per liter. As the percentage of water decreases, the same dose will produce a higher concentration of drug in the beaker. The same thing occurs in the body. As one becomes older, the same dosage of drug given to a younger adult will produce a higher drug concentration in the elderly.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Analyze
CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 3 Hard
Learning Outcome: 03.02

12. The enzymes that are most affected by the process of aging are those that play a role in _____ drugs.
A. oxidizing
B. reducing
C. chelating
D. alkylating

The age-related decreases in liver blood flow and production of some drug microsomal metabolizing enzymes (DMMS) reduce the rate of drug metabolism. The enzymes that are most affected appear to be the enzymes that oxidize drugs, referred to as the mixed-function oxidase system.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Apply
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 2 Medium
Learning Outcome: 03.03

13. Which of the following age-related changes is responsible for the decrease in the rate of drug metabolism in elderly patients?
A. The increase in the production of drug microsomal metabolizing enzymes
B. The reduction in renal blood flow
C. The decrease in liver blood flow
D. The increase in the concentration of plasma proteins

The age-related decreases in liver blood flow and production of some drug microsomal metabolizing enzymes (DMMS) reduce the rate of drug metabolism.

14. The drug morphine has a high first-pass metabolism. What change in the dosage of morphine would have to be made if the drug were to be administered to an elderly patient?
A. A higher dose of morphine should be administered.
B. The same dose of morphine that would be administered to a younger patient should be administered.
C. The drug morphine should not be administered to a patient above the age of 60.
D. A lower dose of morphine should be administered.

Drugs that normally undergo first-pass metabolism are not as extensively metabolized during the first pass through the liver. This allows a greater amount of drug to be absorbed, an example of increased bioavailability.

ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications
Blooms: Analyze
CAAHEP: I.C.11.b. Identify the classifications of medications including desired effects
Difficulty: 3 Hard
Learning Outcome: 03.03

15. Which of the following pharmacokinetic processes is most affected by the reduction of renal blood flow with age?
A. Drug absorption
B. Drug metabolism
C. Drug distribution
D. Drug excretion

The reduction of renal blood flow with age has a significant effect on the renal elimination of drugs. Renal excretion is probably the most important pharmacokinetic process that is affected by age.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Understand
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 1 Easy
Learning Outcome: 03.03

16. How would John, an elderly patient who smokes and consumes alcohol, tolerate an adult-strength dose of actively oxidized medication in comparison to Rick, an elderly patient who neither smokes nor drinks?
A. John would not be able to metabolize the drug, whereas Rick would be able to metabolize it.
B. Rick would be able to metabolize the drug in the same amount of time as John would be able to metabolize it.
C. John would be able to metabolize the drug at a faster rate than Rick would be able to metabolize it.
D. Rick’s body would absorb a lesser amount of the drug than John’s body would absorb.

John would be able to metabolize the drug at a faster rate than Rick would be able to metabolize it. Factors such as smoking, alcohol consumption, and the administration of certain drugs may cause microsomal enzyme induction, which will increase the rate of drug metabolism.

ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications
Blooms: Analyze
CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use
CAAHEP: I.C.9.b. Analyze pathology for each body system including treatment modalities
Difficulty: 3 Hard
Learning Outcome: 03.03

17. Harry, a 70-year-old, and Ben, a 28-year-old, are taking the same dose of a certain drug that needs to undergo oxidation in their bodies. How will the drug metabolism in Harry’s body differ from that in Ben’s body?
A. The rate at which the drug will be metabolized in Harry’s body will be much faster than the rate at which it will be metabolized in Ben’s body.
B. A greater amount of the drug will be absorbed by Ben’s body than it will be absorbed by Harry’s body.
C. The duration of drug action in Ben’s body will be longer than the duration of drug action in Harry’s body.
D. The pharmacological effects of the drug will be experienced for a longer duration of time in Harry’s body than they will be experienced in Ben’s body.

In general, the rate of drug metabolism decreases with age, although there is much variability. The pharmacological effects of drugs requiring oxidation, the benzodiazepines (diazepam, Valium) for example, are usually prolonged with age.

ABHES: 2.a. List all body systems, their structure and functions
ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications
Blooms: Analyze
CAAHEP: I.C.9.b. Analyze pathology for each body system including treatment modalities
Difficulty: 3 Hard
Learning Outcome: 03.03

18. Who among the following is most likely to have the lowest rate of drug metabolism?
A. 62-year-old Edward, whose liver is showing symptoms of poor blood circulation
B. 30-year-old Estella, who is following a protein-rich diet
C. 21-year-old Fabiola, who often consumes alcohol when she goes out
D. 60-year-old John, who smokes occasionally

The age-related decreases in liver blood flow and production of some drug microsomal metabolizing enzymes (DMMS) reduce the rate of drug metabolism. Other factors such as smoking, alcohol consumption, and the administration of certain drugs, all of which may cause microsomal enzyme induction, will increase the rate of drug metabolism.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Analyze
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 3 Hard
Learning Outcome: 03.03

19. Drugs are mainly eliminated from the body by _____.
A. sweating
B. renal excretion
C. enterohepatic recycling
D. regurgitation

Drugs are eliminated from the body mainly by renal excretion and gastrointestinal elimination.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Remember
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 1 Easy
Learning Outcome: 03.03

20. A decrease in renal function is associated with:
A. an increase in the rate of drug excretion.
B. an increase in the duration of the drug action.
C. a decrease in the intensity of the drug action.
D. a decrease in the rate of drug metabolism.

Age-related decreases in renal function and blood flow slow the rate of drug excretion and increase the duration and intensity of drug action.

21. Which of the following physiological changes in an elderly patient lowers the rate of drug metabolism?
A. An increase in the flow of blood to the liver
B. A decrease in the production of enzymes that oxidize drugs
C. An increase in renal blood flow
D. A decrease in the percentage of adipose tissue in the body

22. A decrease in the size of the liver is directly associated with a(n):
A. increase in the rate of drug absorption.
B. decrease in the rate of drug excretion.
C. increase in the rate at which the drug is distributed through the body.
D. decrease in the rate of drug metabolism.

Decreased liver blood flow, liver organ size, and enzyme concentrations decrease the rate of drug metabolism and increase the duration and intensity of drug action.

23. How would one expect the plasma creatinine levels in a person’s body to change with age?
A. Slightly decrease with age
B. Remain unchanged
C. Dramatically decrease with age
D. Increase with age

The plasma concentration of creatinine increases with age and renal disease and reflects the effects of age and disease to decreased renal function.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Apply
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 2 Medium
Learning Outcome: 03.03

24. A patient having multiple chronic diseases can expect:
A. an increase in the consequences of a drug’s action.
B. a decrease in the consequences of a drug’s action.
C. no change in the consequences of a drug’s action.
D. all of these.

Reduction of organ function decreases the ability of organs to metabolize and eliminate drugs. Consequently, the actions and adverse effects of most drugs are increased. The consequences of disease on drug action increase as the number of diseases in any one individual increase.

ABHES: 6.d. Properly utilize Physician’s Desk Reference (PDR), drug handbook and other drug references to identify a drug’s classification, usual dosage, usual side effects, and contraindications
Blooms: Understand
CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use
Difficulty: 1 Easy
Learning Outcome: 03.04

25. Which of the following factors can affect drug metabolism by reducing the efficiency with which organs function?
A. Genetics
B. Nutritional deficiency
C. Disease
D. All of these

An adequate diet is important in relation to liver function and the ability to metabolize drugs. The major chronic diseases of aging—hypertension, coronary artery disease, diabetes, cancer, and many others—all have effects that reduce vital organ function, especially of the heart, liver, and kidneys. Reduction of organ function decreases the ability of these organs to metabolize and eliminate drugs.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Apply
CAAHEP: IV.P.1. Instruct a patient according to patient’s special dietary needs
Difficulty: 2 Medium
Learning Outcome: 03.04

26. Adequate nutrition in elderly patients is important for synthesizing drug-metabolizing enzymes. The body produces these enzymes from foods that are high in:
A. fat.
B. protein.
C. carbohydrate.
D. sugar.

Protein intake is important for the synthesis of drug-metabolizing enzymes.

ABHES: 2.d.ii. Educate patients regarding proper diet and nutrition guidelines
Blooms: Analyze
CAAHEP: IV.P.1. Instruct a patient according to patient’s special dietary needs
Difficulty: 3 Hard
Learning Outcome: 03.04

27. Who among the following is most likely to experience an impaired drug response caused by the lack of adequate nutrition?
A. A comatose patient on TPN
B. A patient living with his or her family members
C. A nursing home patient
D. A physically active senior citizen

Many of the elderly live alone or in unfamiliar surroundings such as nursing homes. The desire, ability, and affordability to prepare well-balanced meals are often lacking. An adequate diet is important in relation to liver function and the ability to metabolize drugs.

ABHES: 2.d.ii. Educate patients regarding proper diet and nutrition guidelines
Blooms: Apply
CAAHEP: IV.P.1. Instruct a patient according to patient’s special dietary needs
Difficulty: 2 Medium
Learning Outcome: 03.04

28. In relation to their medications, why is it important for elderly patients to increase their dietary protein intake?
A. To maintain appropriate albumin levels
B. To increase serum potassium levels
C. To lower serum triglyceride levels
D. To maintain serum calcium levels

Lack of adequate protein intake lowers the concentration of plasma proteins, especially albumin, which is necessary for plasma protein drug binding.

ABHES: 2.d.ii. Educate patients regarding proper diet and nutrition guidelines
Blooms: Analyze
CAAHEP: IV.C.1.c. Describe dietary nutrients including protein
Difficulty: 3 Hard
Learning Outcome: 03.04

29. Lack of adequate protein intake in elderly people:
A. leads to a lower concentration of plasma proteins.
B. leads to an increase in the synthesis of drug metabolizing enzymes.
C. leads to an increase in the rate of drug metabolism.
D. leads to a decrease in the intensity of drug action.

Lack of adequate protein intake lowers the concentration of plasma proteins, especially albumin, necessary for plasma protein drug binding.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Understand
CAAHEP: IV.C.1.c. Describe dietary nutrients including protein
Difficulty: 2 Medium
Learning Outcome: 03.04

30. Which of the following proteins plays an important role in plasma protein drug binding?
A. Albumin
B. Myoglobin
C. Hemoglobin
D. Myosin

Lack of adequate protein intake lowers the concentration of plasma proteins, especially albumin, necessary for plasma protein drug binding.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Remember
CAAHEP: IV.C.1.c. Describe dietary nutrients including protein
Difficulty: 1 Easy
Learning Outcome: 03.04

31. The term used to describe the situation that involves multiple drug prescriptions is _____.
A. pharmacotherapy
B. polypharmacy
C. therapeutic duplication
D. monotherapy

The term polypharmacy is used to describe the situation that involves multiple drug prescriptions.

ABHES: 2.c. Identify diagnostic and treatment modalities as they relate to each body system
Blooms: Remember
CAAHEP: I.C.9.b. Analyze pathology for each body system including treatment modalities
Difficulty: 1 Easy
Learning Outcome: 03.05

32. One way to improve compliance for a patient with arthritis would be to:
A. encourage the patient to take medication on an empty stomach.
B. suggest not using child safety caps on medication bottles.
C. encourage the patient to read medication information literature.
D. allow the patient to identify the drugs he requires on his own.

Many elderly patients have difficulty swallowing large capsules. In addition, they often cannot get the lid off the drug container. There are easy-to-open lids for the elderly, available upon request.

ABHES: 9.j. Make adaptations with patients with special needs
Blooms: Understand
CAAHEP: V.C.6.c. Define coaching a patient as it relates to compliance with treatment plan
Difficulty: 1 Easy
Learning Outcome: 03.05

33. An elderly patient was on medication for diabetes and hypertension before suffering a heart attack. Her cardiologist gave her thorough directions on taking her new heart medications. What would be a probable outcome of this situation?
A. No change in patient compliance
B. A slight improvement in patient compliance
C. A substantial increase in patient compliance
D. A decrease in patient compliance

Elderly patients often have difficulty understanding and remembering what the drug is and exactly why it was prescribed. The confusion is increased in those who already have problems with memory, who live alone, and who are not provided with sufficient time for instruction and training on the proper procedures for drug administration.

ABHES: 9.j. Make adaptations with patients with special needs
Blooms: Apply
CAAHEP: V.C.6.c. Define coaching a patient as it relates to compliance with treatment plan
Difficulty: 2 Medium
Learning Outcome: 03.05

34. Which of the following would most likely be a chief complaint from elderly patients taking omeprazole capsules?
A. Dosing frequency
B. Dietary restrictions
C. Difficulty swallowing
D. Small size

Many elderly patients have difficulty swallowing large capsules.

ABHES: 9.j. Make adaptations with patients with special needs
Blooms: Analyze
CAAHEP: V.C.6.c. Define coaching a patient as it relates to compliance with treatment plan
Difficulty: 3 Hard
Learning Outcome: 03.05

35. One approach that can be used to facilitate decisions and enhance compliance when explaining medications to an elderly patient is to:
A. provide current pharmaceutical literature.
B. speak loudly.
C. use proper medical terminology.
D. display appropriate demeanor.

The attitude and demeanor of the person providing drug prescribing instructions are sometimes the key ingredients to successful drug compliance.

Chapter 05

Autonomic Nervous System

Multiple Choice Questions

1. Identify an accurate statement about the autonomic nervous system (ANS).
A. The ANS is under one’s conscious control.
B. The ANS is composed of nerves that innervate smooth and cardiac muscle.
C. The ANS is regulated by the cerebral cortex.
D. The ANS is composed of nerves that innervate skeletal muscles.

The ANS is composed of nerves that innervate cardiac and smooth muscle (involuntary) of the internal organs and glands.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Understand
CAAHEP: I.C.5. Identify the anatomical location of major organs in each body system
Difficulty: 2 Medium
Learning Outcome: 05.01

2. The two structures that directly regulate visceral nerves are:
A. the hypothalamus and the pituitary gland.
B. the pituitary gland and the medulla oblongata.
C. the pituitary gland and the pineal gland.
D. the hypothalamus and the medulla oblongata.

The visceral nerves, which are not under conscious control, are regulated by the hypothalamus and the medulla oblongata.

3. Identify a difference between visceral nerves and somatic nerves.
A. The somatic nerves innervate involuntary muscles, whereas the visceral nerves innervate voluntary muscles.
B. The visceral nerves are not under voluntary control, whereas the somatic nerves are under voluntary control.
C. Visceral nerves are regulated by the cerebral cortex, whereas somatic nerves are regulated by the medulla oblongata.
D. Somatic nerves innervate the muscles of the heart, whereas visceral nerves innervate the skeletal muscles.

The somatic nerves are under the conscious, or voluntary, control of the cerebral cortex. The visceral nerves are not under conscious control and are regulated by the hypothalamus and the medulla oblongata.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Analyze
CAAHEP: I.C.1. Describe structural organization of the human body
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 3 Hard
Learning Outcome: 05.01

4. The somatic nerves are the branches of the cranial and spinal motor nerves that:
A. innervate skeletal muscle.
B. are not under one’s voluntary control.
C. are regulated by the hypothalamus and the medulla oblongata.
D. innervate the cardiac muscles and the smooth muscles of the internal organs and glands.

The somatic nerves are the branches of the cranial and spinal motor nerves that innervate skeletal muscle (voluntary).

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Understand
CAAHEP: I.C.1. Describe structural organization of the human body
Difficulty: 2 Medium
Learning Outcome: 05.01

5. Another name for the autonomic nervous system is:
A. the somatic nervous system.
B. the sensory nervous system.
C. the visceral nervous system.
D. the spinal nervous system.

The visceral nerves are commonly referred to as the autonomic nervous system (ANS).

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Understand
CAAHEP: I.C.1. Describe structural organization of the human body
Difficulty: 1 Easy
Learning Outcome: 05.01

6. The special property that allows cardiac and smooth muscles to initiate their own contractions is known as:
A. autorhythmicity.
B. biorhythmicity.
C. tachycardia.
D. bradycardia.

Cardiac and smooth muscles are involuntary muscles that are found in the walls of the internal organs and glands. They possess a special property, known as autorhythmicity, which allows them to initiate their own contractions.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Remember
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 1 Easy
Learning Outcome: 05.02

7. Identify a difference between parasympathetic nerves and sympathetic nerves.
A. Parasympathetic nerves are more active during periods of intense stress, whereas sympathetic nerves are more active during periods of rest.
B. Parasympathetic nerves originate from the brain and the spinal cord, whereas sympathetic nerves originate from the thoracic and lumbar spinal nerves.
C. Parasympathetic nerves innervate blood vessels, whereas sympathetic nerves innervate skeletal muscles.
D. Parasympathetic nerves release the neurotransmitter adrenaline, whereas sympathetic nerves release the neurotransmitter acetylcholine.

The nerves of the parasympathetic division (also known as the craniosacral division) originate from the brain (cranial nerves 3, 7, 9, and 10) and spinal cord (sacral nerves S2 to S4). The nerves of the sympathetic division (known as the thoracolumbar division) originate from the thoracic and lumbar spinal nerves (T1 to L3).

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Analyze
CAAHEP: I.C.1. Describe structural organization of the human body
Difficulty: 3 Hard
Learning Outcome: 05.03

8. During an anatomical class, Dr. Hales removes the heart of a frog and places it in a beaker of oxygenated Ringer’s solution. He then instructs his health care trainees to observe how the muscles of the frog’s heart continue to contract even without external stimulation. What property of the muscles of the heart is Dr. Hales asking his students to observe?
A. Autorhythmicity
B. Bradycardia
C. Tachycardia
D. Biorhythmicity

Involuntary muscles are found in the walls of the internal organs and glands and possess a special property, autorhythmicity, which allows them to initiate their own contractions.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Apply
CAAHEP: I.C.5. Identify the anatomical location of major organs in each body system
Difficulty: 3 Hard
Learning Outcome: 05.02

9. The function of the autonomic nervous system is to regulate the rate of:
A. cardiac muscle contractions.
B. skeletal muscle contractions.
C. striated muscle contractions.
D. sensory conduction.

One of the functions of the autonomic nervous system is to regulate the rate of cardiac muscle contractions.

10. _____ is the term used to describe the situation where the nerves arising from the two separate divisions of the autonomic nervous system innervate and alternatively increase and decrease the activity of a particular organ.
A. Single autonomic innervation
B. Dual autonomic innervation
C. Autorhythmicity
D. Homeostasis

Generally, each visceral organ receives a nerve from each division of the autonomic nervous system. One division usually increases the activity of a particular organ while the other decreases the activity. This is referred to as dual autonomic innervation.

11. If the heart of a frog was placed in a petri dish filled with oxygenated Ringer’s solution, what other chemical would be essential to make it contract?
A. Norepinephrine
B. Acetylcholine
C. Serotonin
D. None

This process of autorhythmicity can be demonstrated by removing the heart or a piece of intestine from a frog, placing the organ in oxygenated Ringer’s solution, and observing the contractions that occur without any stimulation.

12. Identify an accurate statement about the autonomic nervous system (ANS).
A. The ANS is under one’s conscious control.
B. The ANS is composed of nerves that innervate the skeletal muscles.
C. The ANS is regulated by the cerebral cortex.
D. The ultimate purpose of the ANS is to maintain homeostasis in the body.

The ANS functions to regulate the rate at which the internal organs and glands of the body work, either increasing or decreasing their activity. In this way, homeostasis, the normal balance among the body’s internal organs, can be maintained.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Apply
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 2 Medium
Learning Outcome: 05.02

13. _____ refers to the normal state of balance among the body’s internal organs.
A. Repolarization
B. Homeodynamics
C. Homeostasis
D. Euvolemia

Homeostasis refers to the normal state of balance among the body’s internal organs.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Remember
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 1 Easy
Learning Outcome: 05.02

14. An increase in blood pressure is associated with a(n):
A. decrease in sympathetic activity.
B. increase in parasympathetic activity.
C. decrease in parasympathetic activity.
D. increase in sympathetic activity.

Blood pressure is controlled by either increasing sympathetic activity to cause vasoconstriction or decreasing sympathetic activity to cause vasodilation.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Apply
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 2 Medium
Learning Outcome: 05.03

15. Identify an accurate statement about the parasympathetic division of the autonomic nervous system.
A. The nerves of the parasympathetic division originate from the brain and spinal cord.
B. The sacral nerves of the parasympathetic division supply the internal organs and glands of the head.
C. Most blood vessels receive parasympathetic innervation.
D. The parasympathetic division is less active during periods of rest and restoration of body energy stores.

The nerves of the parasympathetic division (also known as the craniosacral division) originate from the brain (cranial nerves 3, 7, 9, and 10) and spinal cord (sacral nerves S2 to S4).

16. The thoracic nerves of the sympathetic division of the autonomic nervous system:
A. supply the lower portion of the abdominal cavity and the pelvic cavity.
B. decrease the activity of the heart during the fight or flight reaction.
C. supply the internal organs of the head, thoracic cavity, and upper abdominal cavity.
D. originate from the sacral region of the spinal cord.

The thoracic nerves supply the internal organs and glands of the head, thoracic cavity, and upper abdominal cavity.

17. The activation of the parasympathetic division will not directly reduce:
A. gastrointestinal motility.
B. blood pressure.
C. urinary motility.
D. skeletal muscle contraction.

Each of the internal organs and glands receives a nerve from each division of the parasympathetic division. There are exceptions; for example, most blood vessels do not receive parasympathetic innervation. In this situation, blood pressure is controlled by either increasing sympathetic activity to cause vasoconstriction or decreasing sympathetic activity to cause vasodilation.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Analyze
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 3 Hard
Learning Outcome: 05.03

18. Patients undergoing a chemical stress test at a doctor’s office could expect to receive an injection of which neurotransmitter?
A. Epinephrine
B. Acetylcholine
C. Serotonin
D. Dopamine

Patients undergoing a chemical stress test at a doctor’s office could expect to receive an injection of epinephrine. The neurotransmitter epinephrine triggers physiological changes in the body in response to stressful and emergency situations; it activates the sympathetic nervous system.

ABHES: 2.c. Identify diagnostic and treatment modalities as they relate to each body system
Blooms: Analyze
CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use
Difficulty: 3 Hard
Learning Outcome: 05.03

19. A parasympathetic stimulating medication would be good for which condition?
A. Hypertension
B. Constipation
C. Diarrhea
D. Conjuctivitis

The parasympathetic nerves increase body functions such as digestion and elimination of waste products (urination, defecation).

ABHES: 2.a. List all body systems, their structure and functions
ABHES: 2.c. Identify diagnostic and treatment modalities as they relate to each body system
Blooms: Analyze
CAAHEP: I.C.11.a. Identify the classifications of medications including indications for use
Difficulty: 2 Medium
Learning Outcome: 05.03

20. A patient with tachycardia, an abnormally rapid heartbeat, is experiencing:
A. parasympathetic activation.
B. parasympathetic inhibition.
C. sympathetic activation.
D. sympathetic inhibition.

Sympathetic stimulation increases heart rate and the force of myocardial contractions. It also allows for more air exchange in the lungs.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Apply
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 2 Medium
Learning Outcome: 05.03

21. What physiological changes take place in the body during the fight or flight reaction?
A. The heart rate decreases.
B. The activity of the gastrointestinal tract increases.
C. The breathing rate decreases.
D. The force of myocardial contractions increases.

During the fight or flight reaction, the sympathetic division increases the activity of certain organs to allow a greater expenditure of energy for both physical and mental exertion. For example, sympathetic stimulation increases heart rate and the force of myocardial contraction; also bronchodilation allows for more air exchange in the lungs. At the same time, there is a decrease in the activity of the organs whose functions are not required for the fight or flight reaction. For example, activity of the gastrointestinal and urinary tracts is inhibited.

22. While Alice is mowing her lawn, she sees a big snake slithering out from under some flower pots. In response to the sudden threat of danger, Alice’s heart rate increases, and she begins to breathe rapidly. Which of the following neurotransmitters is primarily responsible for triggering these physical reactions in Alice’s body?
A. Dopamine
B. Acetylcholine
C. Epinephrine
D. Somatostatin

During the fight or flight reaction, the adrenal medulla releases epinephrine (also known as adrenaline) and some norepinephrine into the blood. These neurotransmitters then act as hormones and travel to all sympathetic receptor sites producing intense sympathetic stimulation.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Apply
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 3 Hard
Learning Outcome: 05.03

23. What is the main chemical released by the adrenal medulla in response to sympathetic stimulation?
A. Norepinephrine
B. Acetylcholine
C. Dopamine
D. Epinephrine

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Apply
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 2 Medium
Learning Outcome: 05.03

24. Which of the following neurotransmitters is released by the adrenal medulla during the fight or flight reaction?
A. Serotonin
B. Dopamine
C. Adrenaline
D. Acetylcholine

During the fight or flight reaction, the adrenal medulla releases epinephrine (also known as adrenaline) and some norepinephrine into the blood.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Remember
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 1 Easy
Learning Outcome: 05.03

25. How do parasympathetic nerves differ from sympathetic nerves?
A. Parasympathetic nerves innervate blood vessels, whereas sympathetic nerves do not.
B. Parasympathetic nerves are less active than sympathetic nerves during periods of rest.
C. Parasympathetic nerves cannot be individually stimulated, whereas sympathetic nerves can.
D. Parasympathetic nerves do not release the neurotransmitter norepinephrine, whereas sympathetic nerves do.

In the parasympathetic nervous system, the neurotransmitter released at both the ganglia and the postganglionic nerve endings is acetylcholine (ACH). In sympathetic nerves, the neurotransmitter released at the ganglia is also ACH, but at the postganglionic nerve endings, it is norepinephrine (NE).

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Analyze
CAAHEP: I.C.5. Identify the anatomical location of major organs in each body system
Difficulty: 3 Hard
Learning Outcome: 05.04

26. The neurotransmitter common to both preganglionic nerve fibers in the sympathetic and parasympathetic nervous system is:
A. norepinephrine.
B. acetylcholine.
C. epinephrine.
D. serotonin.

The neurotransmitter released from preganglionic nerve fibers at the autonomic ganglion of both divisions is acetylcholine (ACH).

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Analyze
CAAHEP: I.C.1. Describe structural organization of the human body
Difficulty: 3 Hard
Learning Outcome: 05.04

27. Which of the following effects results from parasympathetic stimulation?
A. Mydriasis
B. An increase in heart rate
C. An increase in gastrointestinal motility
D. Bronchodilation

The motility of the gastrointestinal tract increases in response to parasympathetic stimulation.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Remember
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 1 Easy
Learning Outcome: 05.03

28. Which of the following is a difference between acetylcholine and epinephrine?
A. Acetylcholine is released from the adrenal gland, whereas epinephrine is released from the preganglionic fibers of parasympathetic nerves.
B. Acetylcholine produces the effects of parasympathetic stimulation, whereas epinephrine produces the effects of sympathetic stimulation.
C. Acetylcholine is released by adrenergic nerves, whereas epinephrine is released by cholinergic nerves.
D. Acetylcholine binds with adrenergic receptors, whereas epinephrine binds with muscarinic receptors.

The effects of parasympathetic stimulation are produced by the release of acetylcholine, which binds to the cholinergic receptors. The effects of sympathetic stimulation are produced by the release of norepinephrine from adrenergic nerve endings and also by epinephrine (EPI) released from the adrenal medulla.

29. In the ANS, neurons that emerge from the central nervous system form the _____.
A. postganglionic nerve fiber
B. preganglionic nerve fiber
C. autonomic ganglion
D. neuroglia

In the ANS, neurons that emerge from the central nervous system form the preganglionic nerve fiber.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Remember
CAAHEP: I.C.1. Describe structural organization of the human body
Difficulty: 1 Easy
Learning Outcome: 05.04

30. Identify an accurate statement about acetylcholine.
A. Acetylcholine is produced in the adrenal gland.
B. Acetylcholine is released at the postganglionic nerve endings of sympathetic nerves.
C. Acetylcholine is released at both the ganglia and the postganglionic nerve endings of parasympathetic nerves.
D. Acetylcholine is the predominant neurotransmitter that is released during the fight or flight reaction.

In the parasympathetic nervous system, the neurotransmitter released at both the ganglia and the postganglionic nerve endings is acetylcholine (ACH).

31. Which of the following statements is true of the effects of sympathetic stimulation on the body?
A. It decreases the rate at which the heart contracts and relaxes.
B. It increases the rate of atrioventricular conduction.
C. It stimulates the urinary bladder to contract.
D. It causes the pupils of the eyes to constrict.

An increase in the heart rate and atrioventricular conduction are some of the effects of sympathetic stimulation.

32. A high rate of sympathetic nerve firing is most likely to result in _____.
A. bronchoconstriction
B. vasoconstriction
C. miosis
D. vasodilation

A high rate of sympathetic nerve firing results in vasoconstriction. Vasoconstriction increases blood pressure but reduces blood flow.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Remember
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 1 Easy
Learning Outcome: 05.04

33. How do muscarinic receptors differ from nicotinic receptors?
A. Muscarinic receptors are located on the cell membranes of the visceral organs and glands, whereas nicotinic receptors are located on the cell membranes of skeletal muscles and at the ganglia of nerves.
B. Muscarinic receptors are cholinergic receptors, whereas nicotinic receptors are adrenergic receptors.
C. Muscarinic receptors are stimulated by acetylcholine released from preganglionic nerve endings, whereas nicotinic receptors are stimulated by acetylcholine released from postganglionic nerve endings.
D. Muscarinic receptors are somatic, whereas nicotinic receptors are autonomic.

Muscarinic receptors are located on the cell membranes of the visceral organs and glands. Nicotinic-nerve receptors are located at both the parasympathetic and sympathetic ganglia. Nicotinic-muscle receptors are located on the cell membranes of skeletal muscle and are stimulated by ACH from somatic nerve endings to contract skeletal muscle.

34. The receptors that are located at both the parasympathetic and sympathetic ganglia, which are stimulated by the acetylcholine released from preganglionic nerve endings to conduct impulses across the autonomic ganglia to the postganglionic fibers of both autonomic divisions, are known as _____.
A. nicotinic-muscle receptors
B. nicotinic-nerve receptors
C. muscarinic receptors
D. adrenergic receptors

Nicotinic-nerve receptors are located at both the parasympathetic and sympathetic ganglia and are stimulated by the acetylcholine released from preganglionic nerve endings to conduct impulses across the autonomic ganglia to the postganglionic fibers of both autonomic divisions.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Remember
CAAHEP: I.C.5. Identify the anatomical location of major organs in each body system
Difficulty: 1 Easy
Learning Outcome: 05.05

35. Which of the following neurotransmitters is released by the postganglionic neurons in the sympathetic division of the autonomic nervous system?
A. Acetylcholine
B. Norepinephrine
C. Serotonin
D. Dopamine

In the sympathetic division, the postganglionic neurons release norepinephrine, which stimulates the adrenergic receptors.

ABHES: 2.a. List all body systems, their structure and functions
Blooms: Remember
CAAHEP: I.C.7. Describe the normal function of each body system
Difficulty: 1 Easy
Learning Outcome: 05.05

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Pharmacology An Introduction 7Th Edition By Henry Hitner – Test Bank

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