Egans Ch 40 AEROSOL DRUG THERAPY Flashcard

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What best defines an aerosol?____ A) Suspension of liquid droplets in a gas B) Suspension of particulate matter in a gas C) Molecular water dispersed throughout a carrier gas D) Suspension of liquid or solid particles in a gas

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Suspension of liquid or solid particles in a gas

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terms list

Suspension of liquid or solid particles in a gas

With what devices are therapeutic aerosols generated?____ 1. Atomizers 2. Nebulizers 3. Humidifiers 4. Soft mist inhalers

1, 2, and 4 only

The mass of aerosol particles produced by a nebulizer in a given unit time best describes which quality of the aerosol?____ A) Stability B) Density C) Output D) Deposition

Output

What describes the mass of drug leaving the mouthpiece of a nebulizer as aerosol?____ A) Single dose B) Emitted dose C) Multiple dose D) Output dose

B) Emitted dose

What is a common method to measure aerosol particle size?____ A) Scan B) Gravimetric C) Cascade impaction D) Penetration studies

C) Cascade impaction

What measure is used to identify the particle diameter, which corresponds to the most typical settling behavior of an aerosol?____ A) Mean mass velocity coefficient (MMVC) B) Logarithmic standard diameter (LSD) C) Mean mass aerodynamic diameter (MMAD) D) Geometric standard deviation (GSD)

C) Mean mass aerodynamic diameter (MMAD)

What measure is used to describe the variability of particle diameters in an aerosol?____ A) MMVC B) LSD C) MMAD D) GSD

D) GSD

Most nebulizers used in respiratory care produce which type of aerosol suspension?____ A) Monodisperse B) Microaerosol C) Heterodisperse D) Macroaerosol

C) Heterodisperse

What is the retention of aerosol particles resulting from contact with the respiratory tract mucosa called?____ A) Stability B) Density C) Penetration D) Deposition

D) Deposition

What factors affect pulmonary deposition of an aerosol?____ 1. Size of the particles 2. Shape and motion of the particles 3. Physical characteristics of the airways 4. Class of medication being delivered

1, 2, and 3 only

What is the primary mechanism for deposition of large, high-mass particles (>5 μm) in the respiratory tract?____ A) Inertial impaction B) Sedimentation C) Diffusion D) Brownian motion

A) Inertial impaction

What will increase aerosol deposition by inertial impaction? 1. High-velocity gas flow 2. Variable or irregular passages 3. Turbulent gas flow 4. Particles of high mass

2 and 3 only

Where do most aerosol particles in the 5- to 10-μm range deposit?____ A) Alveoli B) Bronchioles C) Central airways D) Upper airways

D) Upper airways

What is the primary mechanism for central airway deposition of particles in the 1- to 5-μm range?____ A) Impaction B) Sedimentation C) Diffusion D) Brownian motion

B) Sedimentation

Where do most aerosol particles in the 1- to 5-μm range deposit?____ A) Alveoli B) Bronchioles C) Central airways D) Upper airways

C) Central airways

What are techniques that will increase aerosol deposition by sedimentation in the lungs?____ A) High inspiratory flow B) Short inspiratory time C) 10-sec breath-hold D) Short expiratory time

C) 10-sec breath-hold

Which term describes the primary mechanism for deposition of small particles?____ A) Hygroscopic condensation B) Gravity sedimentation C) Brownian diffusion D) Inertial impaction

C) Brownian diffusion

What is the primary fate of inhaled aerosol particles that are between 1 and 0.5 μm?____ A) Most are cleared during exhalation. B) Most deposit in the central airways. C) Most deposit in the upper airways. D) Most deposit in the alveoli.

A) Most are cleared during exhalation.

What aerosols would have the highest rate of deposition by diffusion?____ A) MMAD of 0.1 µm B) MMAD of 3.0 µm C) MMAD of 10.0 µm D) MMAD of 50.0 µm

A) MMAD of 0.1 µm

Where do most aerosol particles that are less than 3 μm deposit?____ A) Alveoli B) Bronchioles C) Central airways D) Upper airways

A) Alveoli

A physician wants to deliver a therapeutic aerosol to the upper airway (nose, larynx, trachea). To help ensure maximum deposition in this area, you would select an aerosol generator with an MMAD in what range? A) 5 to 50 µm B) 2 to 5 µm C) 1 to 3 µm D) Less than 1 µm

A) 5 to 50 µm

A physician wants to deliver a therapeutic aerosol to the central and lower airways. To help ensure maximum deposition in this area, you would select an aerosol generator with an MMAD in what range?____ A) 5 to 20 µm B) 2 to 5 µm C) 1 to 3 µm D) Less than 1 µm

B) 2 to 5 µm

A physician wants to deliver a therapeutic aerosol to the lung parenchyma (alveolar region). To help ensure maximum deposition in this area, you would select an aerosol generator with an MMAD in what range?____ A) 5 to 20 µm B) 2 to 5 µm C) 1 to 3 µm D) Less than 1 µm

D) Less than 1 µm

What is the process by which aerosol suspension changes over time?____ A) Evaporation B) Deposition C) Aging D) Sublimation

C) Aging

What changes in aerosol suspensions happens over time?____ A) Liquid aerosol particles can shrink (evaporation) or grow (water absorption). B) The rate of particle growth is directly proportional to particle size. C) Small water-based particles tend to shrink when exposed to dry gas. D) Aerosols of water-soluble salts tend to grow in a humidified environment.

B) The rate of particle growth is directly proportional to particle size.

As hygroscopic aerosol particles enter the respiratory tract, what do they tend to do?____ A) Decrease in size because of the absorption of molecular water. B) Increase in size because of the absorption of molecular water. C) Increase in size because of the evaporation of molecular water. D) Decrease in size because of the evaporation of molecular water.

B) Increase in size because of the absorption of molecular water.

What is the primary hazard of aerosol drug therapy?____ A) Adverse drug reactions B) Pulmonary infection C) Airway reactivity D) Drug reconcentration

A) Adverse drug reactions

To minimize the risk of infection associated with aerosol drug therapy, what should you do?____ 1. Sterilize nebulizers between patients. 2. Frequently replace in-use units. 3. Rinse nebulizers with sterile water.

1, 2, and 3

What drugs or drug categories have been associated with increased airway resistance and bronchospasm during aerosol administration?____ 1. Steroids 2. Albuterol 3. Acetylcysteine 4. Antibiotics

1, 3, and 4 only

To monitor a patient for the possibility of reactive bronchospasm during aerosol drug therapy, what should you do?____ 1. Measure pre- and postpeak flow and/or percentage forced expiratory volume in 1 second (%FEV1). 2. Auscultate for adventitious breath sounds. 3. Carefully observe the patient's response. 4. Communicate with the patient during therapy.

1, 2, 3, and 4

A patient with chronic bronchitis is receiving heated water aerosol treatments through a jet nebulizer four times daily to aid in mobilizing retained secretions. After each treatment, you note a dramatic increase in the magnitude of coarse crackles heard on auscultation. What recommendations would you make to the physician? A) Discontinue the heated water aerosol treatments. B) Switch to a higher-density aerosol (e.g., ultrasonic). C) Add coughing and postural drainage to the therapy. D) Consider prior treatment with a bronchodilator.

C) Add coughing and postural drainage to the therapy.

What are the types of drug aerosol delivery systems?____ 1. Dry powder inhalers (DPIs) 2. Small-volume jet nebulizers 3. Metered dose inhalers (MDIs) 4. Spinning disk nebulizers

1, 2 and 3

What is the preferred method for delivering bronchodilators to spontaneously breathing and intubated, ventilated patients?____ A) Dry powder inhaler B) Small-volume jet nebulizer C) Metered dose inhaler D) Hand-bulb atomizer

C) Metered dose inhaler

Immediately after firing, the aerosol particles produced by most metered dose inhalers are approximately how large?____ A) 1 µm B) 5 µm C) 20 µm D) 35 µm

D) 35 µm

Each actuation of a typical metered dose inhaler delivers approximately what output volume?____ A) 10 to 30 mcl B) 30 to 100 mcl C) 10 to 30 ml D) 30 to 100 ml

B) 30 to 100 mcl

What does most of the spray generated by the majority of metered dose inhalers consist of?____ A) Active drug B) Propellant C) Surfactant agents D) Water solution

B) Propellant

Approximately what range of drug dosages can be provided with each firing of a metered dose inhaler?____ A) 5 to 50 mg B) 50 to 100 mg C) 5 to 50 mcg D) 50 mcg to 5 mg

D) 50 mcg to 5 mg

A typical metered dose inhaler produces what particle distributions? A) 2 to 6-µm mean mass aerodynamic diameter (MMAD) B) 1- to 3-µm MMAD C) 6- to 9-µm MMAD D) Less than 1-µm MMAD

A) 2 to 6-µm mean mass aerodynamic diameter (MMAD)

When fired inside the mouth, what percentage of the drug dose delivered by a simple metered dose inhaler (MDI) deposits in the oropharynx?____ A) Approximately 20% B) Approximately 40% C) Approximately 60% D) Approximately 80%

D) Approximately 80%

When using a metered dose inhaler without a holding chamber or a spacer, the patient should be instructed to fire the device at what point? A) Immediately before beginning a slow inspiration B) Immediately after beginning a slow exhalation C) Immediately after beginning a slow inspiration D) Immediately before beginning a slow exhalation

C) Immediately after beginning a slow inspiration

What should the patient exhale to before inspiration and actuation of a metered dose inhaler? a. total lung capacity b. residual volume c. functional residual capacity d. expiratory reserve volume

c. functional residual capacity

To ensure delivery of the proper drug dosage with a metered dose inhaler, what must be done before its use?____ 1. The canister valve stem should be cleaned with a pin. 2. The canister should be warmed to hand or body temperature. 3. The canister should be vigorously shaken.

2 and 3

What groups of patients are most likely to have difficulty using a simple metered dose inhaler for aerosol drug therapy?____ 1. Patients in acute distress 2. Infants and young children 3. Elderly persons

1, 2 and 3

What agents has been associated with increased intraocular pressure?____ A) Anticholinergics B) Epinephrine C) Beta-2 agonists D) Antibiotics

A) Anticholinergics

To decrease the likelihood of an opportunistic yeast or fungal infection associated with metered dose inhaler (MDI) steroids, what would you recommend that a patient does?____ 1. Cut in half the number of puffs or treatments. 2. Use a spacer or holding chamber. 3. Rinse the mouth after each treatment

2 and 3

What is a potential limitation of breath-actuated dosing systems?____ A) Increased pharyngeal impaction. B) Less effective lung deposition. C) High flows necessary for actuation. D) Requires accessory equipment.

C) High flows necessary for actuation.

For what type of patient would you recommend against using a breath-actuated metered dose inhaler (MDI) as the sole bronchodilator delivery system?____ A) Patient likely to develop acute severe bronchospasm B) Stable elderly patient on maintenance bronchodilator therapy C) Teenage asthmatic who refuses to use a holding chamber D) Patient who cannot coordinate MDI firing with inhalation

A) Patient likely to develop acute severe bronchospasm

What are the beneficial effects of using a holding chamber with a metered dose inhaler (MDI)?____ 1. Reduction in oropharyngeal aerosol deposition 2. Decrease in need for hand-breath coordination 3. Elimination of medication waste

1 and 2

What is the key difference between a metered dose inhaler (MDI) holding chamber and a spacer?____ A) Larger enclosed space B) One-way inspiratory valve C) Heated chamber D) Series of baffles

B) One-way inspiratory valve

After actuating a metered dose inhaler with a holding chamber, what should the patient be instructed to do?____ A) Take a large breath and hold it for at least 5 sec. B) Continue to breathe through the device for three breaths. C) Immediately exhale as fast and as much as possible. D) Take one quick breath and remove the holding chamber.

B) Continue to breathe through the device for three breaths.

What devices would you select to deliver an aerosolized bronchodilator to a young child?____ A) Metered dose inhaler (MDI) and spacer B) MDI, holding chamber, and mask C) MDI and holding chamber D) Dry powder inhaler

B) MDI, holding chamber, and mask

What are the advantages of the dry powder inhaler (DPI) drug delivery systems?____ 1. Low relative cost 2. No propellants required 3. No hand-breath coordination necessary 4. Unaffected by humidity

1, 2 and 3

What does proper use of a dry powder inhaler (DPI) require that the patient be able to do?____ A) Generate inspiratory flows of 60 L/min or higher. B) Exhale forcibly through the device before drug delivery. C) Inhale slowly (<0.5 L/sec) and perform a breath-hold. D) Coordinate firing of the DPI with inspiration.

A) Generate inspiratory flows of 60 L/min or higher.

What devices depend on the patient's inspiratory effort to dispense the dose? A) Small-volume jet nebulizers B) Metered dose inhaler C) Dry powder inhaler D) Soft mist inhaler

C) Dry powder inhaler

What would be the correct instructions for a patient being taught proper use of a dry powder inhaler?____ 1. Place mouthpiece 4 cm from mouth 2. Exhale slowly to FRC 3. Inhale slowly (<30 L/min) 4. Repeat until dose is used up

2 and 4

What patient group(s) is/are the use of a dry powder inhaler (DPI) for bronchodilator administration recommended?____ 1. Infants and children younger than 5 years 2. Patients with an acute bronchospastic episode 3. Patients requiring maintenance therapy

3 only

Exhalation into what device can result in loss of drug delivery?____ A) Small-volume jet nebulizers B) Metered dose inhaler C) Dry powder inhaler D) Ultrasonic nebulizer

C) Dry powder inhaler

What small-volume jet nebulizer design features affect its performance?____ 1. Position 2. Residual volume 3. Baffles 4. Reservoirs

1, 2, 3 and 4

What source gas characteristics affect the performance of small-volume jet nebulizers?____ 1. Humidity 2. Flow 3. Pressure 4. Viscosity

1, 2 and 3

What drug formulation characteristics affect the performance of small-volume jet nebulizers?____ 1. Homogeneity 2. Surface tension 3. Viscosity 4. Potency

1, 2 and 3

What is the average amount of dead volume in a small-volume jet nebulizer after the device runs dry?____ A) 0.1 ml B) 0.5 to 2.2 ml C) 2.0 to 4.0 ml D) Less than 0.1 ml

B) 0.5 to 2.2 ml

During aerosol drug delivery using a small-volume jet nebulizer (SVN) set at 8 L/min input flow, a patient asks that the head of the bed be lowered to a semi-Fowler's position. Immediately after doing so, you observe a significant drop in SVN aerosol output, despite there being at least 3 ml of solution left in the reservoir. What would you do to correct this problem? A) Add 1 to 2 ml more diluent to the nebulizer reservoir. B) Increase the nebulizer input flow to 10 to 12 L/min. C) Reposition the patient so that the SVN is more upright. D) Decrease the nebulizer input flow to 3 to 4 L/min.

C) Reposition the patient so that the SVN is more upright.

You increase the fill volume from 2 to 4 ml in a small-volume jet nebulizer being used to administer a bronchodilator agent with an aerosol. What effect will this have on the amount of drug delivered?____ A) No effect B) Increase C) Decrease D) More waste

B) Increase

What happens as the pressure or flow delivered through a small-volume jet nebulizer gets higher?____ 1. Treatment time becomes shorter. 2. Particle size becomes smaller. 3. Aerosol output becomes greater.

1, 2 and 3

What is the effect of aerosol particles entrained into a warm and fully saturated gas stream?____ 1. Treatment time becomes shorter. 2. Particle size becomes smaller. 3. Aerosol output becomes greater.

1, 2 and 3. (INCREASE IN SIZES)

What the optimal technique for using a small-volume jet nebulizer (SVN) for aerosol drug delivery?____ 1. SVNs are less technique- and device-dependent. 2. Slow inspiration improves SVN aerosol deposition. 3. Deep breathing or breath-holding improves SVN deposition. 4.Use of a mouthpiece or mask provides similar results.

1, 2 and 4

In mouth-breathing adult patients, what factor(s) is/are crucial in determining whether to use a mask or mouthpiece for aerosol drug delivery with a small-volume jet nebulizer?____ A) Clinician experience B) Drug concentration C) Patient preference and comfort D) Brand of small-volume jet nebulizer

C) Patient preference and comfort

Normally, when using a 50-psi flowmeter to drive a small-volume jet nebulizer, to what should you set the flow?____ A) 2 to 4 L/min B) 4 to 6 L/min C) 6 to 10 L/min D) 8 to 10 L/min

C) 6 to 10 L/min

To decrease the dead space volume of a small-volume jet nebulizer during drug administration, what should you do?____ A) Decrease the nebulizer flow. B) Turn the nebulizer upside-down. C) Continue treatment until nebulizer begins to sputter. D) Increase the nebulizer flow.

C) Continue treatment until nebulizer begins to sputter.

To minimize a patient's infection risk between drug treatments with a small-volume jet nebulizer (SVN), what would you do?____ A) Rinse the SVN with sterile water; air dry. B) Carefully repackage the SVN in its wet state. C) Rinse the SVN with tap water; run until dry. D) Throw out the SVN after every treatment.

A) Rinse the SVN with sterile water; air dry.

A patient with an acute exacerbation of asthma is not responding to the standard dose and frequency of an aerosolized bronchodilator and is now receiving small-volume jet nebulizer (SVN) therapy every 30 min. What would you recommend to the patient's physician at this time? A) Discontinue the aerosolized bronchodilator. B) Increase the frequency of SVN therapy to every 10 min. C) Consider continuous nebulization of the drug. D) Add more diluent to the SVN to extend treatment time.

C) Consider continuous nebulization of the drug.

What is the major problem with using large volume nebulizers for continuous aerosol drug therapy?____ A) Decreased pulmonary deposition B) Drug reconcentration and toxicity C) Frequent interruption of therapy D) Greater waste of drug

B) Drug reconcentration and toxicity

A physician has ordered the antiviral agent ribavirin (Virazole) to be administered by aerosol to an infant with bronchiolitis. What device would you recommend in this situation?____ A) Hydrodynamic (Babbington) nebulizer B) Small-particle aerosol generator (SPAG) C) Ultrasonic (piezoelectric) nebulizer D) Large-volume heated jet nebulizer

B) Small-particle aerosol generator (SPAG)

Through what does the small-particle aerosol generator (SPAG) produce a small monodisperse aerosol?____ A) Aerosol impaction by sequential baffling B) Particle evaporation in a glass drying chamber C) Use of an inert liquefied gas propellant D) Aerosol generation using vibrational energy

B) Particle evaporation in a glass drying chamber

What drugs present the greatest exposure risks for health care workers?____ 1. Albuterol (Proventil) 2. Pentamidine (NebuPent) 3. Ribavirin (Virazole) 4. Acetylcysteine (Mucomyst)

2 and 3

What are the side effects of environmental exposure to ribavirin or pentamidine aerosols?____ 1. Bronchospasm 2. Skin rashes 3. Conjunctivitis 4. Tachyphylaxis

1, 2 and 3

What method(s) can be used to minimize the harmful effects of environmental exposure to ribavirin or pentamidine aerosols?____ 1. Use an isolation booth or tent with HEPA filtered exhaust. 2. Have health care personnel wear a HEPA filtered mask. 3. Use a negative pressure room with adequate air exchange.

1, 2 and 3

What happens when a solution is being aerosolized by an ultrasonic nebulizer?____ 1. The solute concentration decreases. 2. The temperature of the solution increases. 3. The solute concentration increases. 4. The temperature of the solution decreases.

2 and 3

What makes small-volume ultrasonic drug delivery systems different from their large-volume counterparts?____ 1. They do not use a couplant compartment. 2. Drugs are placed directly on the transducer. 3. Battery power is available on some units. 4. Patient flow, not a blower, carries the aerosol.

1, 2 and 3

What are the advantages of small-volume ultrasonic nebulizers for drug delivery 1. Greater respirable drug mass 2. Less dead space and waste 3. Increased mobility 4. Decreased cost

1, 2 and 3

What is the average mean mass aerodynamic diameter (MMAD) generated by the vibrating mesh nebulizers?____ A) 1 to 2 µm B) 2 to 3 µm C) 3 to 4 µm D) 5 to 6 µm

B) 2 to 3 µm

In selecting the appropriate aerosol drug delivery device for a given patient, what must you consider?____ 1. Available drug formulation(s) 2. Desired site of deposition 3. Patient's characteristics 4. Patient's preference

2 and 4

For maintenance administration of bronchodilators to an adult patient with adequate inspiratory flow, what aerosol drug delivery devices would you recommend?____ 1. Pressurized metered dose inhaler (pMDI) 2. Small-volume jet nebulizer 3. Dry powder inhaler 4. pMDI and holding chamber

3 and 4

What aerosol drug delivery devices would you recommend against using with a toddler or small child?____ 1. Metered dose inhaler (MDI) 2. Small-volume jet nebulizer 3. Dry powder inhaler 4. MDI, holding chamber, and mask

1 and 2

On the average, what percentage of an aerosol drug delivery device's output actually deposits in the lungs?____ A) Less than 10% B) 10% C) 20% D) 30%

B) 10%

What are the factors associated with reduced pulmonary deposition of aerosolized drugs?____ 1. Mechanical ventilation 2. Artificial airways 3. Poor patient technique 4. Mouth breathing

1, 2 and 3

What are the possible complications associated with the selection of an aerosol drug delivery device?____ 1. Underdosing or overdosing because of improper technique 2. Overhydration or fluid imbalances 3. Adverse effects of the specific drug agent 4. Environmental contamination or caregiver exposure

1, 3 and 4

A semiconscious patient with inadequate spontaneous ventilation requires aerosol drug administration. What approach would you recommend?____ A) Large-volume continuous nebulizer B) Small-volume jet nebulizer (SVN) C) SVN with delivery by intermittent positive-pressure breathing D) Metered dose inhaler and holding chamber

C) SVN with delivery by intermittent positive-pressure breathing

To assess the effectiveness of a particular aerosol delivery device selection, what would you evaluate?____ 1. Patient's technique in using the device 2. Patient's response to and compliance with procedure 3. Objective measures of improvement (e.g., peak flow)

1, 2 and 3

What would you recommend as initial therapy for a patient admitted to the emergency department with acute airway obstruction (wheezing, cough, dyspnea, peak expiratory flow rate [PEFR] <60% predicted)?____ 1. Assess dose-response of metered dose inhaler (MDI) albuterol (up to 12 puffs). 2. Provide up to three small-volume jet nebulizer (SVN) treatments with albuterol every 20 min. 3. Immediately begin continuous albuterol therapy at 15 mg/hr.

1 and 2

What does indications for assessment of patient's response to bronchodilator therapy include? 1. Confirm whether the therapy works as intended. 2. Individualize the dose, frequency, or type of medication. 3. Help follow the patient's status during long-term therapy. 4. Quantify the degree of bronchial hyperresponsiveness.

1, 2 and 3

What does appropriate documentation when conducting point-of-care assessment of a patient's response to bronchodilator therapy include?____ 1. Medication type, dose, and time received 2. Vital signs, breath sounds, and pulmonary function test measures 3. Patient's progress and ability to self-assess symptoms 4. Blood levels of the bronchodilator agent

1, 2 and 3

What does proper use of a soft mist inhaler require that the patient be able to do?____ A) Generate inspiratory flows of 60 L/min or higher. B) Exhale forcibly through the device before drug delivery. C) Requires hand-breath coordination on the part of the patient. D) Connect the device to the proper gas source.

C) Requires hand-breath coordination on the part of the patient.

In addition to bedside pulmonary function test measures, what other components of patient assessment are useful in evaluating bronchodilator therapy?____ 1. Patient interview and observation 2. Measurement of vital signs 3. Chest auscultation 4. Arterial blood gas analysis and oximetry

1, 2, 3 and 4

When assessing a patient's response to bronchodilator therapy, you notice a decrease in wheezing accompanied by an overall decrease in the intensity of breath sounds. What has happened?____ A) Increasing airway obstruction B) Improving ventilation/perfusion ratio (V/Q) C) Decreasing airway obstruction D) Deteriorating oxygenation

A) Increasing airway obstruction

When assessing a patient's response to bronchodilator therapy, you notice a decrease in wheezing accompanied by an overall increase in the intensity of breath sounds. What has happened?____ A) Increasing airway obstruction B) Improving C) Decreasing airway obstruction D) Deteriorating oxygenation

C) Decreasing airway obstruction

What best describes a proper a dose-response assessment of a metered dose inhaler (MDI) bronchodilator? A) Give 4 puffs one after the other, wait 1 min, repeat up to 16 puffs. The best dose is the highest dose given without side effects. B) Give 4 puffs spaced 1 to 2 min apart; repeat up to 12 puffs with continued improvement. The best dose provides maximum subjective relief and the highest peak expiratory flow rate (PEFR) without side effects. C) Give 12 puffs 1 min apart; repeat every 20 min until maximum relief of symptoms is achieved without side effects. D) Give 2 puffs 1 to 2 min apart; repeat up to 6 puffs with continued improvement. The best dose provides maximum subjective relief and the highest PEFR without side effects.

B) Give 4 puffs spaced 1 to 2 min apart; repeat up to 12 puffs with continued improvement. The best dose provides maximum subjective relief and the highest peak expiratory flow rate (PEFR) without side effects.

In a dose-response assessment of a patient's response to a metered dose inhaler bronchodilator, when would you stop increasing the dose?____ 1. When the peak expiratory flow rate improves less than 10% to 15% 2. When tachycardia occurs 3. When tremors are evident 4. When 6 to 8 puffs are delivered

1, 2 and 3

An asthmatic patient in severe distress with wheezing and dyspnea is admitted to the emergency department and started on albuterol via small-volume jet nebulizer. What approaches would you recommend to assess this therapy for this patient?____ 1. Perform arterial blood gas analysis. 2. Continuously monitor the SpO2. 3. Assess breath sounds and vital signs before and after each treatment. 4. Measure peak expiratory flow rate or forced expiratory volume in 1 sec before and after each treatment.

1, 2, 3 and 4

An asthmatic patient in severe distress with wheezing and dyspnea is admitted to the emergency department. After a conducting a full assessment and obtaining a pretreatment baseline, you start the patient on albuterol with a small-volume jet nebulizer. You should continue assessing and documenting all appropriate variables before and after each treatment until what point?____ A) The patient's symptoms are relieved or the peak expiratory flow rate (PEFR)/forced expiratory volume in 1 second (FEVl) exceeds 70% of "personal best." B) The patient's wheezing disappears and the intensity of breath sounds decreases. C) The patient's symptoms are relieved or the PEFR/FEVl returns to the predicted normal. D) The patient's SpO2 is above 90% and the PEFR/FEVl returns to the predicted normal.

A) The patient's symptoms are relieved or the peak expiratory flow rate (PEFR)/forced expiratory volume in 1 second (FEVl) exceeds 70% of "personal best."

After initially conducting a pre- and post-bronchodilator assessment on a stable asthmatic patient admitted to the hospital, how often would you recommend reassessment of peak expiratory flow rate/forced expiratory volume in 1 second?____ A) With each treatment B) Twice daily C) Once per day D) Every other day

B) Twice daily

What schedule of peak expiratory flow rate assessment would you recommend for a home care asthmatic patient?____ A) 1 to 2 times daily (on rising and at bedtime) B) Once per day (on rising or at bedtime) C) 3 to 4 times daily (on rising, noon, 4 to 7 PM, bedtime) D) 1 to 2 times daily (at noon and around bedtime)

C) 3 to 4 times daily (on rising, noon, 4 to 7 PM, bedtime)

For a hospitalized patient who will require ongoing maintenance bronchodilator therapy after discharge, what should your end goal be?____ A) Complete relief of all patient symptoms B) Normal airflow and cessation of therapy C) Effective self-administration of the drug D) Peak expiratory flow rate that exceeds 70% of "personal best"

C) Effective self-administration of the drug

What factor(s) is/are most crucial in developing an effective program of aerosol drug self-administration in an adult patient requiring maintenance of bronchodilator therapy?____ A) Proper device selection B) Well-written brochures C) Reliable peak expiratory flow rate meter D) Good patient education

D) Good patient education

What patient skills are necessary to ensure effectiveness of drug administration via the aerosol route?____ 1. Ability to keep track of dosing requirements 2. Understanding of the methods and goals of therapy 3. Ability to recognize undesirable side effects

1, 2 and 3

What is the best way to confirm that an asthmatic outpatient can properly self-manage a newly prescribed aerosol drug therapy? A) Have the patient describe the proper procedural steps. B) Have the patient provide a repeat or return demonstration. C) Have the patient take a written or oral quiz on technique. D) Have the patient maintain detailed treatment logs.

B) Have the patient provide a repeat or return demonstration.

After administering 12 puffs of metered dose inhaler (MDI) albuterol to an acutely ill asthmatic patient in the emergency department, assessment indicates no significant improvement in symptoms. What should you now recommend?____ A) Switch over to high-dose MDI steroids. B) Discontinue the bronchodilator therapy. C) Use continuous bronchodilator therapy. D) Switch over to an anticholinergic agent.

C) Use continuous bronchodilator therapy.

What is the recommended dosage for continuous bronchodilator therapy (CBT)?____ 1 A) 0.5 mg/hr B) 5.0 mg/hr C) 15.0 mg/hr D) 50.0 mg/hr

C) 15.0 mg/hr

What is the most reliable indicator of a change in airway resistance due to bronchodilator administration during mechanical ventilation?____

What are the indications of an adverse drug response during continuous bronchodilator therapy?____ 1. Decreased consciousness 2. Worsening tachycardia 3. Vomiting 4. Palpitations

2, 3 and 4

To provide an extra margin of safety during continuous bronchodilator therapy (CBT), what should you recommend be monitored?____ 1. Eosinophil count 2. Serum potassium levels 3. Electrocardiogram

2 and 3

What device-related factors have a major effect on pressurized metered dose inhaler (MDI) delivery of aerosolized drugs during mechanical ventilation?____ 1. MDI propellant formula 2. Type of spacer or adapter used 3. Position of spacer in circuit 4. Timing of MDI actuation

2, 3 and 4

What circuit-related factors have a major effect on metered dose inhaler delivery of aerosolized drugs during mechanical ventilation? 1. Endotracheal tube size 2. Type of humidifier 3. Relative humidity 4. Temperature

1,2 and 3

What ventilator-related factors have a major effect on metered dose inhaler delivery of aerosolized drugs during mechanical ventilation?____ 1. Mode of support 2. Presence of positive end expiratory pressure 3. VT 4. Inspiratory wave form

1, 2 and 3

On the average, what is the range of the actual pulmonary deposition of small-volume jet nebulizer aerosolized drugs in intubated patients receiving mechanical ventilation?____ A) 1.5% to 3.0% B) 3.5% to 6.0% C) 6.5% to 9.0% D) 9.5% to 15.0%

A) 1.5% to 3.0%

What would you recommend to optimize drug delivery with a small-volume jet nebulizer (SVN) to an intubated, mechanically ventilated patient?____ 1. Increase dose to compensate for decreased delivery. 2. Adjust ventilator volume or pressure limit for added flow. 3. Disconnect or bypass heated humidifier system. 4. Turn off flow-by or continuous-flow while nebulizing.

1,2 and 3

A patient on mechanical ventilation was given 4 puffs of albuterol 5 min ago through a metered dose inhaler (MDI) and holding chamber placed 18 in from the circuit's airway connector. The patient continues to exhibit clinical signs of increased airway resistance but has demonstrated no apparent side effects from the drug. What would you recommend at this time?____ A) Discontinue the albuterol and switch to a systemic bronchodilator. B) Repeat administration until the desired response is achieved. C) Remove the circuit-holding chamber and repeat MDI actuation. D) Move the MDI closer to the patient's airway and repeat use.

B) Repeat administration until the desired response is achieved.

When using a chamber-style adapter with a metered dose inhaler (MDI) to deliver a bronchodilator to a patient receiving mechanical ventilation, with what would you coordinate MDI firing? A) Beginning of inspiration B) Beginning of exhalation C) End of inspiration D) Middle of inspiration

A) Beginning of inspiration

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