Nutrition And Diet Therapy 8th Ed By Whitney – Test Bank

Nutrition And Diet Therapy 8th Ed By Whitney – Test Bank

Chapter 15 – Medications, Diet-Drug Interactions, and Herbal Supplements

Answer, K/A, page(s) K = knowledge question; A = application question

True/False

T K 413 1. A high-fiber diet and regular exercise may prevent the need for laxatives.

T K 414 2. Although many medications can cause nausea, it usually subsides after the first few doses.

T K 421 3. The National Center for Complementary and Alternative Medicine is one of the many institutes that make up the National Institutes of Health.

F K 421 4. The adverse effects of herbs are required to be listed on supplement labels.

F K 421 5. There are no known interactions between herbal supplements and medications.

F K 422 6. Health practitioners do not need to be aware of patients’ use of complementary and alternative therapies.

Nutrition in Practice – Complementary and Alternative Therapies

T K 427 7. An example of guided imagery is when person tries to reverse the disease process by using mental pictures.

F K 426 8. Naturopathic medicine is based on the theory that “like cures like.”

T K 425 9. CAM is used as a marketing ploy and is utilized by unscrupulous sellers of worthless treatments.

T K 425 10. Physicians who practice integrative medicine may refer patients for complementary therapies while continuing to provide standard treatments.

Multiple Choice

a K 411 1. Aspirin is an example of:

1. an OTC drug.
2. a generic drug.
3. an herbal product.
4. a prescription drug.

b K 411 2. Which of the following is a true statement about OTC drugs?

1. They have no side effects.
2. Some were once prescription drugs.
3. They do not interact with other medications.
4. They are the same as generic drugs.

a K 412 3. Problems with medications can be reported to the FDA via:

1. the MedWatch website.
2. the DSHEA website.
3. the NCCAM website.
4. the USDA website.

c K 412 4. Which population group is most prone to drug-drug interactions?

1. infants
2. children
3. the elderly
4. the disabled

d K 412 5. Medication errors may be the result of any of the following except:

1. improper dosages.
2. misinterpretation of the physician’s order.
3. confusion of drugs with similar names.
4. bar code scanning systems.

c K 412 6. Populations with increased vulnerability to the adverse effects of drugs include all of the following except:

1. elderly people.
2. pregnant women.
3. middle-aged women.
4. children.

c K 413 7. Which of the following is a medical abbreviation that is prohibited on clinical documentation?

1. q.i.d.
2. mcg
3. IU
4. mg

a K 421 8. Which of the following is true about dietary supplements?

1. They can be marketed without studies to document their effectiveness and safety.
2. They are always hazardous.
3. The amount actually present in the product always equals the amount stated on the label.
4. They are approved by the FDA.

a A 413 9. Which of the following practices can help to reduce the likelihood of the adverse effects of drugs?

1. Request a complete list of all medications and dietary supplements that a patient is taking.
2. Ensure that more than one doctor is overseeing each patient’s medication use.
3. Encourage patients to use multiple pharmacies so that more than one pharmacist can monitor their prescriptions.
4. Tell patients that most side effects are temporary and to wait a few days before calling the doctor.

c K 421 10. According to the DSHEA:

1. herbal supplements must be approved by the FDA.
2. manufacturers of herbal supplements must provide evidence of a product’s safety.
3. the FDA must show that a supplement is unsafe before it can stop the sale of an herbal supplement.
4. manufacturers of herbal supplements may make claims about the prevention or treatment of specific diseases.

c K 421 11. Consistency in herbal supplements is not guaranteed because:

1. no manufacturers have attempted to standardize them.
2. they are natural substances, so there can be no consistency.
3. growing conditions can affect the plants’ chemical composition.
4. the active ingredient in an herb must be isolated to be effective.

b K 421 12. Yohimbe has been linked to:

1. liver damage.
2. heart arrhythmias.
3. sexual dysfunction.
4. hypertension.

c K 421 13. The most common adverse effects of herbs include:

1. breathing difficulties.
2. renal failure, seizures, and heart palpitations.
3. nausea, vomiting, and diarrhea.
4. heart attack or stroke.

a K 422 14. Which herb has been found to inhibit the action of oral contraceptives?

1. St. John’s wort
2. garlic
3. ginseng
4. kava

d K 421 15. Concerns about the use of herbal supplements include all of the following except:

1. contamination with toxic metals.
2. adulteration with synthetic drugs.
3. lack of consistency in ingredients.
4. cost compared to benefit.

a K 421-422 16. Which herb can raise the likelihood of bleeding when used in conjunction with anticoagulant drugs?

1. ginseng
2. ephedra
3. kava
4. valerian

b K 420 17. Which herb is often used for the prevention and treatment of nausea and motion sickness?

1. ginseng
2. ginger
3. kava
4. valerian

c K 420, 421 18. Which herb has been linked to liver damage?

1. ginseng
2. gingko
3. kava
4. garlic

c K 421-422 19. Which herb can intensify the action of warfarin (Coumadin)?

1. kava
2. saw palmetto
3. garlic
4. echinacea

a K 414 20. Unintentional weight gain can result from the use of:

1. antidepressant medications.
2. antihypertensive medications.
3. sedatives.
4. antinausea medications.

a K 414 21. Megestrol acetate is a/an:

1. appetite enhancer.
2. weight-loss drug.
3. antidepressant.
4. pain reliever.

a K 414 22. Which of the following types of drugs may cause unintentional weight gain?

1. antipsychotics
2. antiretrovirals
3. antinauseants
4. antibiotics

d K 414 23. All of the following types of drugs can cause nutrient malabsorption except:

1. antineoplastic drugs.
2. antiretroviral drugs.
3. NSAIDs.
4. antiemetics.

b K 415 24. Medications that reduce stomach acid may impair the absorption of:

1. vitamin C.
2. vitamin B₁₂.
3. glucose.
4. all nutrients.

a K 414-415 25. Why is it recommended that tetracycline be taken on an empty stomach at least two hours before or after consuming dairy products?

1. Tetracycline and calcium will bind to each other, reducing the absorption of both.
2. Too much tetracycline will be absorbed and blood levels will be too high.
3. The combination of tetracycline and calcium will cause tooth enamel to discolor.
4. Too much calcium will be absorbed and blood levels will be too high.

c K 414 26. The medications most likely to cause nutrient malabsorption are those that:

1. lower blood glucose.
2. control high blood pressure.
3. damage the intestinal mucosa.
4. slow gastric emptying.

b K 416 27. Which of the following can bind with medications and reduce their absorption?

1. lactose
2. phytates
3. protein
4. garlic

b K 417 28. Which of the following foods has been shown to raise blood levels of a variety of medications?

1. bananas
2. grapefruit juice
3. tomato juice
4. oranges

a K 416 29. Anticonvulsant medications may increase levels of enzymes that metabolize all of these vitamins except:

1. vitamin A.
2. folate.
3. vitamin D.
4. vitamin K.

a K 416 30. Methotrexate interferes with the metabolism of:

1. folate.
2. iron.
3. vitamin B₁₂.
4. calcium.

b K 418 31. Supplements of _____ are usually given to patients receiving the antituberculosis drug isoniazid.

1. iron
2. vitamin B₆
3. vitamin B₁₂
4. folate

a K 417 32. Grapefruit juice affects drug absorption by:

1. increasing blood concentration of some drugs.
2. decreasing blood concentration of some drugs.
3. inactivating certain drugs.
4. altering the action of certain drugs.

b K 417 33. The drug warfarin is structurally similar to:

1. vitamin C.
2. vitamin K.
3. vitamin D.
4. vitamin E.

a K 417 34. Which of the following side effects might be expected from long-term use of corticosteroids?

1. weight gain, muscle wasting, bone loss, hyperglycemia
2. weight loss, hypertension, bone loss, hypoglycemia
3. weight gain, high cholesterol, bone loss, hypoglycemia
4. weight loss, muscle wasting, kidney failure, hyperglycemia

c K 417 35. Individuals using warfarin are advised to:

1. avoid all foods containing vitamin K.
2. take a vitamin K supplement.
3. consume consistent amounts of vitamin K daily.
4. avoid green, leafy vegetables.

b K 418 36. An individual taking INH should also take supplements of:

1. folate.
2. vitamin B₆.
3. vitamin B₁₂.
4. iron.

b A 418 37. People taking MAO inhibitors should restrict their intake of:

1. tomato sauce.
2. cheddar cheese.
3. cottage cheese.
4. white wine.

d A 418 38. Which food should not be eaten in a tyramine-controlled diet?

1. tomatoes
2. liver
3. cucumbers
4. pork sausage

a K 418 39. People taking MAO inhibitors should avoid foods containing:

1. tyramine.
2. phenylalanine.
3. tryptophan.
4. starch.

c K 418 40. People taking lithium are advised to maintain a consistent intake of _____ from day to day in order to maintain a stable blood level of lithium.

1. calcium
2. zinc
3. sodium
4. alcohol

b K 421 41. One of the problems with determining the effectiveness of an herbal remedy is:

1. the lack of a consistent supply of herbs.
2. the fact that different samples of an herb can have different chemical compositions.
3. inconsistent labeling of supplements.
4. differing opinions about the best method for testing herbs.

Case Study Questions

Use the following case study to answer questions 42-47.

Jose Salazar has been hospitalized following a motor vehicle accident. He has several broken bones, including his left jaw, two ribs on the left side, and a compound fracture of his left leg. According to his medical record, he is 47 years old, his height is 5’9”, and his weight is 171 pounds. During the course of his hospital stay, he was diagnosed with a heart arrhythmia. His current medications include lovastatin to lower his cholesterol, an MAO inhibitor to treat depression, and an analgesic to treat his pain. Mr. Salazar’s wife also reports that he takes several herbal products including, yohimbe, kava kava, valerian, and St. John’s wort.

b A 417-418 42. Before leaving the hospital, Mr. Salazar will need nutrition education on:

1. how to use a blender.
2. food-medication interactions.
3. food safety.
4. weight loss.

a A 418 43. In order to avoid a food-medication interaction with his MAO inhibitor, Mr. Salazar will need to avoid drinking:

1. beer.
2. cola beverages.
3. tea.
4. grapefruit juice.

b A 417 44. Because Mr. Salazar is taking lovastatin, he should be counseled to avoid:

1. apple juice.
2. grapefruit juice.
3. green leafy vegetables.
4. milk.

b K 422 45. Mr. Salazar will be discharged with analgesic medications to control his pain. Which herbal products should he be advised to quit taking because of the potential for interaction?

1. yohimbe and valerian
2. kava kava and valerian
3. St. John’s wort and yohimbe
4. valerian and St. John’s wort

a K 421 46. Which herbal product taken by Mr. Salazar may be causing his heart arrhythmia?

1. yohimbe
2. kava kava
3. St. John’s wort
4. valerian

a A 413 47. What advice should be given to Mr. Salazar regarding his use of herbal products?

1. Each time he visits his physician, he should bring a list of all prescription medications and herbal products he regularly takes.
2. He should look up the side effects of each herbal product he takes so he can be aware of them.
3. He should never take more than one herbal product at a time.
4. Herbal products should never be taken at the same time he takes his prescription medications.

Nutrition in Practice – Complementary and Alternative Therapies

d K 425 48. The popularity of CAM can be explained by all of the following except:

1. consumers’ interest in self-help measures.
2. the noninvasive nature of CAM therapies.
3. the tendency of CAM practitioners to spend more time with patients.
4. growing evidence of the effectiveness of CAM.

c K 425, 427 49. The one characteristic that all alternative therapies have in common is:

1. their effectiveness.
2. research as to their safety.
3. a lack of evidence about their effectiveness.
4. the absence of any interactions or effects with mainstream medical care.

b K 426 50. Which of the following forms of alternative medicine proposes that a person’s “life force” can foster self-healing?

1. homeopathic medicine
2. naturopathic medicine
3. bioelectrical medicine
4. chiropractic medicine

b K 426 51. Which of the following is a form of traditional Chinese medicine?

1. bioelectromagnetic therapy
2. acupuncture
3. chiropractic
4. therapeutic touch

a K 425 52. A common biologically based therapy is the use of:

1. dietary supplements and herbal products.
2. chiropractic medicine.
3. massage therapy.
4. aromatherapy.

a K 425, 426 53. Which of the following alternative therapies involves the alleged curative power of “energy”?

1. qi gong
2. massage therapy
3. biofeedback training
4. faith healing

d K 428 54. Concerns about the use of CAM by consumers include all of the following except:

1. consumers may assume that all CAM therapies are safe.
2. the use of CAM therapies may delay the use of reliable treatments.
3. most CAM therapies are not regulated or monitored.
4. CAM therapies are more expensive than traditional medical care.

Nursing Exam Review Questions

c A 417 55. The nurse recognizes that a patient placed on the anticoagulant drug warfarin will need:

1. supplements of vitamin K.
2. a high-kcalorie diet.
3. education regarding diet-drug interactions.
4. education regarding increasing iron intake.

c K 418 56. A patient is taking an MAO inhibitor and is on a tyramine-controlled diet. Which of the following foods should be avoided?

1. American cheese
2. peanuts
3. mushrooms
4. spinach

Essay

412-413 1. Describe which types of individuals are at high risk for adverse effects from medications.

414 2. What are three general ways in which diet and drugs can interact?

414 3. Discuss the ways in which drugs can affect food intake.

420-422 4. Describe how you would counsel a patient who is taking herbal supplements to treat a medical condition.

Case Study Essay Questions

Ernest Hare is a 75-year-old retired railroad engineer. He has a history of myocardial infarction, hypertension, congestive heart failure, and anxiety. His medications include warfarin, simvastatin, Lopressor, lorazepam, and Lasix. In addition to these prescription drugs, Mr. Hare takes garlic tablets and St. John’s wort.

1. As a health professional, what steps should you take to determine if any of the medications and supplements Mr. Hare is taking has the potential for diet-drug or drug-drug interactions?
2. Do any of the drugs Mr. Hare is taking prevent him from safely consuming grapefruit? If so, which ones and why?
3. Which medication that Mr. Hare is taking interacts with vitamin K? How does this interaction occur?
4. How should Mr. Hare be counseled regarding his vitamin K intake?
5. Could either of the dietary supplements Mr. Hare is taking interact with his prescription medications? If so, which ones and why?

Answers:

1. To prevent diet-drug interactions, first list the types and amounts of over-the-counter drugs, prescription drugs, and dietary supplements that the patient uses on a regular basis. Look up each drug in a drug reference and make a note of:

• The appropriate method of administration (twice daily or at bedtime, for example).
• How the drug should be administered with respect to foods, beverages, and specific nutrients (for example, take on an empty stomach, take with food, do not take with milk, or do not drink alcoholic beverages while using the medication).
• How the drug should be used with respect to other medications.
• The side effects that may influence food intake (nausea and vomiting, diarrhea, constipation, or sedation, for example) or nutrient needs (interference with nutrient absorption or metabolism, for example).

A similar process can be used to review the dietary supplements that a person is taking.

2. Yes. Grapefruit should not be consumed when taking simvastatin. Compounds in grapefruit juice (or whole grapefruit) have been found to inhibit or inactivate enzymes that metabolize a number of different drugs, including simvastatin. As a result of the reduced enzyme action, blood levels of the drugs increase, leading to stronger physiological effects. The effect of the grapefruit juice lasts for a substantial period after the juice is consumed.
3. Warfarin interacts with vitamin K. The two are structurally similar. Warfarin acts by blocking the enzyme that activates vitamin K, thereby preventing the synthesis of blood-clotting factors. The amount of warfarin prescribed is dependent, in part, on how much vitamin K is in the diet. If vitamin K consumption from foods or supplements changes substantially, it can alter the effect of the drug.
4. Individuals using warfarin are advised to consume similar amounts of vitamin K daily to keep warfarin activity stable. The dietary sources highest in vitamin K are green leafy vegetables such as spinach, kale, Brussels sprouts, collard greens, and mustard greens. A registered dietitian can provide individualized guidance.
5. Both St. John’s wort and garlic can interact with the warfarin Mr. Hare is taking. They enhance the activity of warfarin.

Matching

d

426

1. acupuncture

a. healing methods based on the belief that illnesses can be healed by manipulating energy fields that purportedly surround and penetrate the body.

b. a practice based on the theory substances believed to cause certain symptoms are prescribed for curing the same symptoms, but are given in extremely diluted amounts.

c. an alternative medical system based on the unproven theory that spinal manipulation can restore health.

d. a therapy that involves inserting thin needles into the skin at specific anatomical points, allegedly to correct disruptions in the flow of energy within the body.

e. a technique in which individuals are trained to gain voluntary control of certain physiological processes, such as skin temperature or brain wave activity, to help reduce stress and anxiety.

f. therapies that involve the unconventional use of electric or magnetic fields to cure illness.

f

426

2. bioelectrical therapies

e

426

3. biofeedback

a

426

4. biofield therapies

c

426

5. chiropractic

b

426

6. homeopathic medicine