UNDERSTANDING PHARMACOLOGY FOR ESSENTIALS MEDICATION SAFETY CHAPTER 1-28 TESTBANK BY WORKMAN & LACHARITY
Chapter1: Drug Therapyfor Heart
... [Show More] Failure
MULTIPLE CHOICE BASIC
CONCEPTS
1. Whatdoes the term “afterload” mean?
a. The amount ofbloodentering the left ventricle that must bepumped outof the heart
b
.
The peripheral resistanceof the arterialsystem, including meanarterialpressure
c. The abilityof the living muscle fibers of the heart to contractand pumpblood
d
.
The percentageofbloodpumped out of the heart witheachheartbeat
ANS: B
Afterload is the pressure in the aorta that the left ventricle must overcome before blood can movefrom it
into the aorta. Mean arterial pressure (MAP) is also the pressure that the left ventricle must overcome to
move blood from the left ventricle into the aorta during contraction (afterload). Afterload increases
because of increased peripheral resistance usually as a result of high blood pressure.
DIF: Cognitive Level: Remembering REF: p. 274
2. What is the mostcommon causeofheart failure?
a. High blood pressure
b
.
Low blood pressure
c. Defective heart valves
d
.
Defective coronaryarteries
ANS: A
Most heart failure is caused by hypertension. Other causes of heart failure include myocardial
infarction, coronary artery disease, cardiomyopathy, substance abuse (alcohol and illicit or prescribed
drugs), heart valve disease, congenital defects, cardiac infections and inflammations,and conditions that
increasecardiac outputand energydemands such as sepsis.
DIF: Cognitive Level: Remembering REF: p. 278
3. What is the mainphysiologicalproblem in most types of heart failure?
a. Overstretching of the right ventriclesothat too much blood leaves the heart
b
.
Overstretching of the right ventriclesothat too little blood leaves the heart
c. Overstretching of the left ventricleso that too muchblood leaves the heart
d
.
Overstretching of the left ventricleso that too little blood leaves theheart
ANS: D
The muscle of the left ventricle becomes overstretched. When any muscle is overstretched, its
contraction is weaker. Whenthe muscles of the left ventricleare overstretched or flabbyand the
contraction is weak, too much blood remains in the left ventricle, and more blood arriving fromthe left
atrium is added to it. This overstretches the muscle more and continues to weaken contractions, leading
to heart failure.
DIF: Cognitive Level: Remembering REF: p. 274
4. Which symptom occurs with only pure right-sided heart failure and does not occur withpure
left-sided heart failure?
a. Confusion
b
.
Shortness ofbreath
c. Decreasedafterload
d
.
Swelling in the ankles and legs
ANS: D
When the right ventricle contracts poorly, signs and symptoms of peripheral congestion occur (Box 17-2
in text)suchas weight gain, swelling in the legs, jugular vein distention (Figure 17-4in text), and increased
blood pressure.
DIF: Cognitive Level: Remembering REF: p.276, Box 17-2
5. Whichstatement aboutdrug therapy forheart failure is true?
a. The drugs work onlydirectlyon the heart muscle.
b
.
Drug therapy improves heart function butdoes not cure heart failure.
c. Whenheart function returns tonormal, the drugtherapycanbestopped.
d
.
Drug therapy forheart failure does not work when thepatient continues tosmoke.
ANS: B
Drug therapy only improves heart function; drugs do not cure heart failure. Because the damageto the
heart muscle is not reversible, the only realcure for heart failure is aheart transplant.
DIF: Cognitive Level: Remembering REF: p. 277
6. What is acommonside effectofhydralazine (Apresoline) therapy forheart failure?
a. Tachycardia
b
.
High bloodpressure
c. Constipation
d
.
Difficultysleeping
ANS: A
Commonsideeffects ofhydralazine includetachycardiaandsalt retention.DIF:
Cognitive Level: Remembering REF: p. 280
7. How should sublingualnitroglycerin tablets forheart failure be taken?
a. Ona full stomach
b
.
Onanemptystomach
c. Dissolved under the tongue
d
.
Placedunder a patchon thechest
ANS: C
Sublingual means to place the drug under the tongue. Remind patients that sublingual
nitroglycerinshould be kept in placeuntil dissolved.
DIF: Cognitive Level: Remembering REF: p. 281
8. What is the mechanism ofaction forcardiac glycosides?
a. Slowingthe heart rate and increasing the forceof the heart muscle contraction
b
.
Increasing the heart rate and decreasing the force of theheart muscle contraction
c. Directly relaxingblood vessel muscles anddecreasing afterload
d
.
Directlyconstricting blood vessel muscles andincreasing afterload
ANS: A
Cardiac glycosides area class ofdrugs that improve heart failure byslowingdown aheart ratethat is too
fast, allowing more time for the left ventricle to fill. They also work on the muscle fibers in the heartand
increase the force of each heartbeat (contractility).
DIF: Cognitive Level: Remembering REF: pp. 281-282
9. What is the mostcommonside effectofcardiac glycosidedrugs forheart failure therapy?
a. Abdominalcrampingand constipation
b
.
Heart rhythm disturbances
c. High blood pressure
d
.
Skinrashes
ANS: B
The most common side effects of digoxin (Lanoxin), a cardiac glycoside, are heart rhythm disturbances
thatarerelated todigoxintoxicity. Othercommonsideeffects to watchfor includefatigue, bradycardia
(slow heart rate less than 60 beats/min), anorexia (loss of appetite), nausea,and vomiting.
DIF: Cognitive Level: Remembering REF: p. 282
10. Whichdrug forheart failure is acommonpositive inotrope?
a. Amiloride (Midamor)
b
.
Nesiritide(Natrecor)
c. Captopril (Capoten)
d
.
Dobutamine (Dobutrex)
ANS: D
Dobutamine (Dobutrex) is apositive inotrope.This drug is a heart pumpdrug that makes theheart muscle
contract more forcefully. It alsorelaxes bloodvessels sobloodcanflow better.
DIF: Cognitive Level: Remembering REF: p. 285
11. Whenare vasodilator drugs usuallyprescribed forheart failure?
a. Whenangiotensin-converting enzyme (ACE) inhibitors cannotbetaken
b
.
When venous dilation is also needed
c. Whenbetablockers are also being taken
d
.
Whenheart failure is improving
ANS: A
Vasodilators act directly on the peripheral arteries, causing them to dilate, which leads to decreased
blood pressureand workload ontheheart. Whenpatients cannot take ACE inhibitorsorangiotensin II
receptor blockers, vasodilators are often prescribed [Show Less]