Full Download Integrated Cardiopulmonary Pharmacology 3rd Edition Colbert Test Bank
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Sample-Test-bank-For-Integrated-Cardiopulmonary-Pharmacology-3rd-Edition-by-Bruce-J.-Colbert.doc
Answer Key
Chapter 1
Multiple Choice
1. B
Rationale:
Therapeutics is defined as the study of drugs used to cure, treat, and prevent disease. Pharmacotherapy
combines the terms “pharmacology” and “therapeutics.” Disease management refers to a collective
management of all aspects of the patient’s disease, not just pharmacotherapy.
2. C
Rationale:
Although drugs are derived from a variety of sources, such as plant and animal sources, the majority of
drugs today are synthetic. It is predicted that in the future many drugs will be genetically bioengineered.
3. D
Rationale:
CDER is a specialized program (not an agency) within the FDA. The CDC and the NIH are not responsible
for drug testing and approval.
4. D
Rationale:
Phase IV studies, also known as “postmarketing studies,” are performed after a drug is already on the
market. This phase attempts to see if rare or serious adverse effects that were not detected prior to drug
approval have occurred.
5. C
Rationale:
The PDR and AHFS are sources for drug information and are not involved in establishing or regulating drug
standards. The USP’s role usually begins after the FDA approves a drug for the market. Once USP standards
are established and official, they are enforceable by the FDA.
6. B
Rationale:
The chemical name describes the structure of the drug and serves as a point of reference to manufacture the
drug but is not used to name the drug. The trade or brand name of a drug is used by the original
manufacturer to market the drug.
7. D
Rationale:
ADRs are defined as unintended side effects that can be mild, or severe and life threatening.
Hypersensitivity is one example of an ADR. Teratogenicity refers to a drug’s potential to damage a fetus in
utero when administered to a pregnant woman.
8. B
Rationale:
The first-pass effect describes drugs that are administered by mouth that go to the liver first and undergo
metabolic changes before reaching the systemic circulation.
9. D
Rationale:
Page 1 of 7
Enteral routes of drug absorption are via the gastrointestinal tract and include oral, sublingual, nasogastric
tube, and rectal routes.
10. A
Rationale:
The first-pass effect explains why a smaller dose of the same drug given via IV produces a similar response
to a larger dose given PO. After absorption, a drug given orally must pass through the liver before reaching
the systemic circulation. In the liver, the drug undergoes metabolic changes that inactivate some of the drug.
Bioavailability measures the amount of drug that was absorbed into the systemic circulation; it can be
affected by the route of administration as well as many other factors.
11. A
Rationale:
Although sublingual and transdermal are convenient and are becoming more popular, they are not the most
common. The inhalation route is not the most common and convenient because it requires the use of a
device to create and deliver micron-sized aerosol particles to the lungs.
12. C
Rationale:
Malnourished patients have less serum albumin; therefore, more drug is free within the bloodstream to cause
a higher blood level of the active drug, which leads to a greater drug response.
13. C
Rationale:
Water-soluble drugs have an increased effect in patients with larger water compartments. Additive effect
describes the sum of the effects of two drugs given together.
14. B
Rationale:
The liver’s microsomal drug oxidation system, the cytochrome P-450 system, is responsible for
metabolizing rifampin. However, the liver enzymes that break down this drug are induced, or increased in
activity.
15. D
Rationale:
Drugs are eliminated after metabolism in feces, urine, or through the skin or pulmonary system. Some drugs
are excreted unchanged in the urine.
16. D
Rationale:
Potency is a term used to describe the amount of drug required to produce a desired response. Whereas
affinity refers to the tendency of a drug to combine with a receptor. How a drug is cleared from the body is
referred to as elimination.
17. B
Rationale:
Excretion of drugs through the kidneys is not affected by drug oxidation, which occurs in the process of
metabolism of a drug in the liver.
18. D
Rationale:
Just because a drug is occupying a receptor site does not guarantee that it will produce a therapeutic effect.
19. C
Rationale:
An agonist activates the receptor and causes a greater response. An antagonist can combine at the receptor
site but does not cause activation.
20. B
Rationale:
Tolerance explains why an increased amount of a drug is needed to produce the same effect because of
receptor adaptation. Desensitization is the term used for diminished responsiveness that occurs over time,
whereas dependence refers to a physiologic or psychologic need. Therapeutic index is the ratio between the
Page 2 of 7
Sample-Test-bank-For-Integrated-Cardiopulmonary-Pharmacology-3rd-Edition-by-Bruce-J.-Colbert.doc
minimum effective dose and the average maximum tolerated dose. A low therapeutic index would therefore
cause more adverse effect.
21. A
Rationale:
PO refers to the oral route of administration. QID is a medical abbreviation meaning four times daily.
22. C
Rationale:
Only intravenous injections completely bypass the absorption step because they enter the bloodstream
directly.
23. B
Rationale:
A steady state of drug concentration will occur if a regulated, consistent dosage is given as a continuous
infusion rather than an intermittent intravenous dose, which causes peaks and troughs in the drug
concentration.
24. D
Rationale:
Tolerance of a drug occurs due to receptor adaptation, which occurs over time and with repeated use of a
particular drug.
25. D
Rationale:
Treatment for drug overdose may include the administration of emetics, adsorbents and antidotes depending
on the type of drug and amount of time after exposure.
True/False
1. False
Rationale:
Although herbals have been used for years and were forerunners of many current medications, the FDA
considers them dietary supplements.
2. False
Rationale:
Drug potency refers to an amount of drug required to produce a desired response. If the reaction of two
drugs given together causes one drug to have no direct effect but increases the response of the other drug,
the interaction is referred to as “potentiation.”
3. True
Rationale:
The inhalation route is a form of topical delivery because the inhaled drug is deposited directly onto the
mucous lining of the airways; however, it is absorbed systemically.
4. True
Rationale:
A bolus dose gives peaks and troughs in drug concentrations.
5. False
Rationale:
Selectivity for a specific site or receptor makes a drug more useful.
6. False
Rationale:
Fat-soluble drugs have an increased effect in patients with more fat..
7. True
Rationale:
Drugs must be water soluble in order to be excreted from the body as urine, feces, or sweat.
8. False
Page 3 of 7
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THE bird picture book proved indeed a great joy to May, as Billy had
thought it would, and many were the hours she spent poring over it
during the long winter days when bad weather kept her indoors. She
was quick to learn the names of the pictured birds she did not
already know by sight, and eager to find out all about them. The
Vicar could give her more information than anyone else. All she
learnt from him she repeated to Billy.
Such was indeed the case. Within one week there was a great
transformation scene. The wind changed from north-east to south-
west, a gentle rain fell on the frost-dried earth; then the rain ceased,
sunshine came, and the soft stir of awakening life.
At last all the seeds were in the ground. The garden at Rowley
Cottage, with its trim, smooth beds, was a picture of neatness. The
gardens in the allotment field were in a like condition. And now there
was a lull in the gardening.
Billy thought the seeds were slow in growing, but his grandfather
assured him that they were doing all right.
"But how can you tell, Grandfer?" the little boy inquired. "You can't
see them."
"No, Billy," William Brown answered; "I can't see them, but I've faith
as to what's going on underground. I've seen too many springtimes
to doubt that."
And all right they were. One morning William Brown announced, at
breakfast, that the turnips and parsnips were showing above the
ground. Before going to school Billy had a look at them. What tiny
plants they were! After that, other vegetables, such as carrots, beets,
and onions, were not long in appearing, and, once above ground,
they grew apace.
"John Dingle took the prize for marrows at the vegetable show last
year," William Brown remarked.
"Yes, he told me," Billy answered, adding; "He says he should like
one of us boys to win the prize this year. We both mean to try."
Harold was weeding in his father's garden when Billy arrived at the
allotment field Billy examined his marrow plant, which seemed in just
the same flourishing condition as his own, and then went in search of
May, who had wandered off to the river. He found her on the river's
bank. She turned a bright, happy face to him as he approached, and,
with her finger on her lip, whispered—
"Aren't they sweet little things?" whispered May. "Oh, look, there's
their father! What a hurry he's in!"
Sure enough there he was, running along the bank towards his
family. Suddenly he dived off into the river. There was a great flutter
for a moment or two, then father, mother, and baby dip-chicks had all
disappeared under the overhanging bank.
"They saw us," said May regretfully. "Now they'll hide till we're gone."
"Better come away from the water," advised Billy; "you might fall in."
"Oh, I'm ever so careful!" the little girl assured him. "I do love the
river; don't you? And it's so happy to-day! Listen how it laughs and
sings! That's because it's fine weather and the sun shines. Back in
the winter it was different—so dark and deep. Billy, it must be very
wise, mustn't it? for it's come such a long, long way, from up in the
Dartmoor hills. It's going right on to the sea. Mr. Singleton told me.
He comes here sometimes, and we listen to the river together. Oh,
look, look! What's that? There, up in the sky! And what a funny
noise, Billy!"
Billy's eyes followed the direction of the little girl's pointing finger, and
saw an aeroplane coming towards them, high in the sky. It looked
like a great bird in the distance, but he recognised it as an aeroplane
at a glance, for he had frequently seen them pass over London.
Though he knew there was little likelihood of this one being an
enemy, his heart throbbed fast at the sight of it. He explained to May
what it was; then Harold rushed up to them in a great state of
excitement.
"It's a biplane," said Billy, rather proud of his knowledge. "I've seen
several like it before. How fast it's going! And can't we hear its
engines working plainly! That's the funny noise you spoke of, May.
Buzz-z-z-z!"
May drew a deep sigh. She was watching the aeroplane with
breathless interest, her colour coming and going fitfully. It was
momentarily growing more and more like a bird as it sailed away.
When at last it was lost to view the children left the allotment field
and hurried back to the village. Every one had been out to watch.
The aeroplane was the talk of the place, and indeed of the
neighbourhood, for days.
CHAPTER XI.
GRANNY SURPRISES BILLY.
"I'M come to tea, mother," announced Mrs. Dingle, one hot August
afternoon, as she entered the kitchen at Rowley Cottage, where Mrs.
Brown stood ironing at a table near the open window. "I shan't be in
your way, shall I? Here, you rest a bit, and let me take on your irons."
"No, thank you," Mrs. Brown answered. "You were never a good
hand at ironing starchery, Elizabeth, and I can't bear to see it done
badly. I'm doing Billy's collars—such a lot there are! This hot weather
a collar rarely lasts him more than a day."
"I suppose he makes a lot of extra work for you," remarked Mrs.
Dingle, seating herself and taking off her hat.
"You suppose?" said her mother tartly. "As if you didn't know, when
you've a boy of your own! By the way, I believe May and Harold are
about here somewhere."
"To give him his due, he's been a great help during the fruit-picking,"
she allowed. "All his spare time out of school hours during the
summer he's spent in the garden, and now it's holidays he's there
from morning till night. Did he show you his marrow—the one he is
going to cut for the show?"
"Mother, have you noticed any alteration in May lately? No? Oh, I
have, and her father too! She's far less dreamy and more interested
in things in general than she used to be. The other day we were
surprised to find she's really beginning to learn to read."
"Yes, mother; yes, indeed! It seems it was Billy who taught her her
letters. Don't you remember how much time she spent with him after
his illness?"
"Of course! But I never paid much attention to them—they used to sit
on the settle by the fire, looking at the pictures in some story books
he has and talking in whispers. And he taught her then? Yes? Well, I
never!"
"She can read short words now," Mrs. Dingle said, with a tremble of
joyfulness in her voice. "Fancy! Oh, I think it's marvellous—
marvellous! It's been such a trouble to John and me that our little
maid should be so different from others."
"I always said she was only backward!" cried Mrs. Brown
triumphantly.
"Mr. Singleton says if you can interest her in anything she can learn
all about it quicker than most children," she said eagerly; "but if you
can't it's impossible to teach her or to chain her attention. She got
interested in Billy's books because there are such wonderful stories
in them, and that made her want to learn to read. Then Billy began to
teach her—he says it wasn't so very difficult; but I don't think he quite
realises what a great matter it is—that it shows our darling's intellect
is less clouded than we thought. Oh, mother, I don't feel now that I
shall fear for the child any more! Her school-teacher's most hopeful
about her, and I—oh, I'm grateful to God from the bottom of my
heart!"
Mrs. Brown changed her iron for a hotter one, and went on ironing
silently.
"I'm not sorry now we had to have him here," she admitted, then
added: "As boys go, he's better than most; and I'll say this for him,
he never answers me back."
"He's a dear boy!" declared Mrs. Dingle. "I often think how his poor
mother must have loved him. Ah, here is May!"
"Yes," replied her grandmother; "by the time they've been in and
washed their hands tea will be ready."
"All right, mother," Mrs. Dingle answered; "I haven't put one more
spoonful than you told me to."
The conversation was mostly about the flower, fruit, and vegetable
show which was to be held in the Vicarage grounds that day week.
There was to be a prize for the prettiest bunch of wild flowers, for
which May intended to compete. Billy said he would help her gather
the flowers, but she shook her head.
"No one must help me," she said, "or it wouldn't be fair."
"Our marrows will grow a lot more in a week," remarked Billy. "I do
hope one of us will get the prize, Harold."
"You mean you hope you will get it," laughed Harold.
"I meant what I said," Billy replied. "Grandfer says your marrow is a
better shape than mine," he continued, "and that will be taken into
consideration. I went around and looked at all the marrows in the
allotment gardens yesterday, and there wasn't one to beat yours,
though I did see one that came near doing it."
"Is that the Gibbs who was had up for poaching last winter?" inquired
Mrs. Brown. "Yes. I should have thought he was too idle to have a
garden."
William Brown read the letter he had expected first, then opened the
other, and glanced through it quickly. It seemed to be of a startling
nature, for he turned very red and uttered an exclamation of
amazement. Then he read the letter a second time, very slowly and
carefully, his face exceedingly grave. After that he thought a while.
"Why, Billy," he said at length, "you never told me your mother had
an uncle in Scotland."
"I didn't know she had," Billy answered; "that is, I remember her
telling me she had an uncle, but she'd lost sight of him and didn't
know if he was living or dead. I think she said he was a sea captain."
"Exactly. This letter is from the master of the Institution where you
stopped in London. He'd had a letter from a Captain Foster, who
says he's your mother's uncle. Captain Foster, who has left the sea
and is now living in Glasgow, has only lately learnt of your mother's
sad death, and he and his wife, who are a childless couple, are
willing to give you a home and do the best they can for you. It's a
good offer, Billy, but—well, I don't want to part with you, my boy."
"And I don't want to leave you, Grandfer!" cried Billy. "I—I—oh, it's
not to be thought of, is it?"
"I don't know," William Brown said doubtfully; "maybe this Captain
Foster can do more for you than I can. Dear me, this is most
upsetting! I think I'd better go in and tell Maria, and hear what she
has to say."
Left alone, the little boy perched himself on the edge of a wheel-
barrow to consider the situation. Would he, indeed, be called upon to
leave the home he had learnt to love? The thought that he might be
wrung his heart.
"If it rests with Granny I shall have to go," he told himself sadly; "she
will be only too glad to get rid of me—she never wanted me here."
His eyes filled with tears as he looked around the garden. How he
loved it! What happy days he had spent here with Grandfer and May!
He had been looking forward to many more such happy days, but
now, perhaps, he would be sent far away. Suddenly he jumped off
the wheel-barrow, and hurried towards the house. He would not be
kept in suspense; he would find out what was to become of him at
once.
Arrived at the back door Billy stopped, his heart sinking despairingly.
From the kitchen came the sound of Mrs. Brown's voice, loud and
indignant.
"Oh, dear, she's in a temper," thought the little boy. "Perhaps I'd
better keep out of her sight."
But he was so anxious that he could not help lingering to listen. Then
he had a most wonderful surprise.
Billy's heart gave a bound of joy. Then Granny was against sending
him away! It was amazing, but true. He rushed into the kitchen, his
eyes a-sparkle, his face aglow with delight. Mrs. Brown appealed to
him immediately.
"No!" Billy cried; "No, no, no! I—I, oh, the thought of it was dreadful!"
"It was," William Brown agreed. "I was only putting it to you, Maria,
that this Captain Foster might be able to do more for Billy than I can,
and—"
"And I tell you I don't believe it!" interrupted his wife. "Billy's cut out
for a gardener, and he's in his right place. I daresay this Captain
Foster would want to send him to sea. You write and tell him we can't
give the boy up."
"Now I know what to do," William Brown remarked, adding: "We shall
all sleep the better for having decided this matter to-night."
CHAPTER XII.
CONCLUSION.
WILLIAM BROWN wrote to Captain Foster that same night, and the
first thing after breakfast the following morning Billy hastened to the
village and posted the letter. Then he went into the post office, where
he found Mr. and Mrs. Dingle in earnest conversation, both looking
unusually grave.
"Oh, Billy," the latter began, "poor Harold's in trouble. He went to look
at his marrow before breakfast and found it gone."
"Yes," she assented, "stolen! Oh, it's really too bad! We've told the
policeman what's happened, but it's most improbable he'll be able to
find the thief. The marrow must have been taken during the night."
"Yes," agreed John Dingle, "for it was all right last evening—I saw it
myself after dusk."
Billy explained. When he had finished his tale Mrs. Dingle looked at
her husband meaningly, and said—
"There! Now what did I say, John? Didn't I tell you mother was
growing fond of Billy?"
"Yes, you certainly did," he answered, "and this proves you were
right. You're glad to remain at Rowley Cottage, Billy?"
"Oh, Uncle John, I don't know what I should have felt if Granny had
said I must go! Of course I knew Grandfer wouldn't want me to go,
but I was so afraid Granny would. You can't imagine how glad I was
to hear she didn't like the idea of my going! She was quite upset
about it. I am so glad, so glad!"
After a little further conversation Billy left to return home. He had not
gone far from the village when he heard, someone shouting, and,
looking back, saw Harold running after him. He stopped immediately.
Billy nodded.
"I'm so sorry," he said simply, his voice full of sympathy; "it's a great
shame!"
"I'd give a great deal to know for certain who's had it!" Harold cried
fiercely. "I suspect that fellow Gibbs, and I believe father does too,
though he doesn't like to say so. Gibbs believes his marrow will be
the best exhibited at the show now, but he'll be mistaken! He doesn't
know about yours, and we must take care he doesn't!"
"If mine gets the prize we'll divide the money," said Billy. "Five
shillings it'll be, won't it?"
"Of course I do! Half-a-crown each will be worth having, won't it?"
The boys were walking on side by side now. There was a brief
silence, then Harold suddenly exclaimed—
"You're a real brick, Billy. I've always been nasty to you about your
gardening tools, and begrudged your having them—you must have
seen it, yet you lent me your hand-fork when I broke mine, and—oh,
it's been too mean of me! I'm sure if someone had stolen your
marrow and I thought I was going to get the prize I shouldn't offer to
divide it with you—at least, I don't think I should—"
"Oh, I expect you would!" Billy broke in. "Anyway, if I win the prize we
go shares, mind! That's agreed."
The fields on the slope of the hill behind Rowley Cottage were now
golden with corn as tall as the boys themselves, and ripening fast
under the kisses of the hot August sun. The boys raced down the
narrow foot-track behind each other, through the orchard, and into
the garden. There they found William Brown whistling light-heartedly
as he weeded his asparagus bed. He heard of the loss Harold had
had with much concern.
"I can't tell you how sorry I am, Harold," he said; "it's a great
disappointment for you. We must watch that Billy's marrow doesn't
go in the same way."
Billy's marrow was put on a stall with a lot of others. The boys had
the satisfaction of seeing, at a glance, that it was the best marrow
there, for shape, colour, and size. An ill-kept, sullen-looking man who
was standing near saw this, too. He shot a scowling look from one
boy to the other, and moved away.
Gibbs had slunk out of the tent and disappeared. He did not return
when the exhibits were being judged, nor did he come near the show
again. Apparently his whole interest in it had gone.
The show opened at two o'clock. It was well attended, nearly every
one in the parish being present. Mrs. Brown, who seldom left home,
was there under the escort of her husband and Billy. She was in high
good humour, for Billy's marrow had won the prize; and when she
came to the stall on which the wild flowers were being exhibited,
there, in the centre, was a beautiful bouquet bearing a card on which
was written: "First Prize—May Dingle." She felt, as she said, quite
proud to be connected with two prize-winners.
The prizes were distributed by the Vicar. Next day all the vegetable
exhibits, by agreement of the exhibitors, were packed carefully and
sent off as a gift to the Fleet, whilst the flowers were returned to their
owners. May gave her bouquet to her grandmother, and for several
days it graced the round table in the middle of the parlour at Rowley
Cottage.
Corn harvest was now commencing. Billy took great interest in
Farmer Turpin's "reaper and binder," which he thought the most
marvellous piece of machinery there could possibly be. One day it
arrived to cut the corn in the fields near Rowley Cottage, and he
spent hours in watching it as it worked, gathering the corn into a
sheaf and cutting the stalks and tying them, then throwing the sheaf
out on the ground, and going through the same programme
continuously as it went on. Billy followed it till he was tired, then sat
down on a big stone near the gateway leading into the road, and
watched it from there.
"Well met!"
The next instant he was shaking hands with Tom Turpin, back on
leave from France again.
"Is there room for two on that stone?" asked the young soldier, and,
Billy assenting eagerly, they sat down together. "I arrived home the
day before yesterday," he continued, his blue eyes looking lovingly
across the valley to Mount Farm on the opposite hill. "I can tell you
it's good to be home, my boy! How beautiful everything is! 'The
pastures are clothed with flocks; the valleys also are covered with
corn; they shout for joy, they also sing.' This is a blessed land, Billy.
Where I have come from there will be no harvest—all is desolation
and ruin. Here there is plenty, and oh, the peacefulness of it all!"
There was a note of sadness in Tom's voice, whilst his eyes had a
wistful expression in them. For a minute his face was clouded, then it
cleared, and he went on—
"So I've heard," smiled Tom Turpin; "your grandfather says you've
done a lot of real hard work."
"Thanks to your tools!" exclaimed Billy. "I couldn't have done half so
much without them. I've taken great care of them, Mr. Turpin; they
are as bright as bright!"
"You seem remarkably 'fit,' Billy," he said; "you're rather different now
from the timid little chap I remember. You've grown a couple of
inches, I should say, and your face is almost as brown as mine. You
look happy, too."
"I am happy," Billy said earnestly. "When mother was killed I never
thought I should be happy again; but, oh, I am! And things which
used to frighten me don't frighten me any longer now. I pray your
prayer, 'Be not Thou far from me, O Lord,' and that helps me to be
brave—you understand."
"I love being here," Billy continued; "I love the hills, and the river, and
the woods, and, most of all, I love Grandfer's garden. It was so
wonderful in the spring to see everything coming to life. You see I
was never in the country, in the spring, before this year. I suppose
that's why I thought it so wonderful. Everything—the river, the
woods, the grasses in the fields, seemed to be whispering—always
saying the same!"
THE END.
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