Question 1

Which of the following methods is acceptable for delivering a drug via a pMDI to an intubated neonate receiving mechanical ventilation?

Accepted Answer

A)  In-line with the ventilator 
B)  Through a resuscitation bag 
C)  Through a T-piece 
D)  In-line with a spacer 
A)  In-line with the ventilator 
B)  Through a resuscitation bag 
C)  Through a T-piece 
D)  In-line with a spacer B

Question 2

Where in the ventilator circuit should a pMDI be placed to improve efficiency of aerosol delivery?

Accepted Answer

A)  Near the ventilator before the humidifier than in the inspiratory limb near the Y 
B)  The inspiratory limb near the Y 
C)  30 cm from the heated humidifier 
D)  In the expiratory limb 
A)  Near the ventilator before the humidifier than in the inspiratory limb near the Y 
B)  The inspiratory limb near the Y 
C)  30 cm from the heated humidifier 
D)  In the expiratory limb B

Question 3

The respiratory therapist is administering a standard nebulizer with a mask to a 2-year-old child. The mask is being held away from the child's face ("blow-by") due to crying. What should the RT consider doing to improve aerosol lung deposition?

Accepted Answer

A)  Hold the mask close to the face to minimize the leak. 
B)  Change the aerosol to a pMDI. 
C)  Change the aerosol mask to a breath-enhanced nebulizer. 
D)  Ask the mother of the child to hold the mask and continue "blow-by" therapy. 
A)  Hold the mask close to the face to minimize the leak. 
B)  Change the aerosol to a pMDI. 
C)  Change the aerosol mask to a breath-enhanced nebulizer. 
D)  Ask the mother of the child to hold the mask and continue "blow-by" therapy. C

Question 4

The respiratory therapist verifies an order to administer albuterol 1.25 mg to a 2-kg infant. Why does this dose have the same safety and efficacy profile as a 2.5-mg dose in the adult?

Accepted Answer

A)  The deposition efficiency in the infant results in a similar lung dose per kg of the adult patient. 
B)  The liver of the infant metabolizes 95% of the drug. Therefore, the lung deposition is similar to that of the adult. 
C)  Albuterol targets only a minimal number of beta-2 receptors in the infant's airways. 
D)  The infant gets a higher lung dose, but it does not produce side effects. 
A)  The deposition efficiency in the infant results in a similar lung dose per kg of the adult patient. 
B)  The liver of the infant metabolizes 95% of the drug. Therefore, the lung deposition is similar to that of the adult. 
C)  Albuterol targets only a minimal number of beta-2 receptors in the infant's airways. 
D)  The infant gets a higher lung dose, but it does not produce side effects.

Question 5

Why are pass-over humidifiers preferred over pneumatic nebulizer humidifiers?

Accepted Answer

A)  Pass-over humidifiers produce smaller particles and have a greater output. 
B)  The fraction of inspired oxygen (FiO2) used with pass-over humidifiers is easier to control. 
C)  Pass-over humidifiers transmit fewer pathogens than pneumatic nebulizers. 
D)  Pass-over humidifiers have a smaller residual volume than pneumatic nebulizers. 
A)  Pass-over humidifiers produce smaller particles and have a greater output. 
B)  The fraction of inspired oxygen (FiO2) used with pass-over humidifiers is easier to control. 
C)  Pass-over humidifiers transmit fewer pathogens than pneumatic nebulizers. 
D)  Pass-over humidifiers have a smaller residual volume than pneumatic nebulizers.

Question 6

A conventional jet nebulizer with a dead volume of 1 mL is filled with a 3-mL solution of albuterol. What percent of the medication is available for nebulization?

Accepted Answer

A)  33% 
B)  50% 
C)  75% 
D)  100% 
A)  33% 
B)  50% 
C)  75% 
D)  100%

Question 7

In order to guarantee the same performance of the nebulizer after repeated use, what should be suggested to the user?

Accepted Answer

A)  Rinse with vinegar and air dry. 
B)  Rinse with sterile water and dry with a clean paper towel. 
C)  Rinse with a mixture of vinegar and sterile water and air dry. 
D)  Rinse with sterile water and air dry. 
A)  Rinse with vinegar and air dry. 
B)  Rinse with sterile water and dry with a clean paper towel. 
C)  Rinse with a mixture of vinegar and sterile water and air dry. 
D)  Rinse with sterile water and air dry.

Question 8

Which of the following functions are served by spacer and holding chambers in conjunction with pMDIs?
I. Reduction in oropharyngeal deposition of drug
II. Elimination of the "cold Freon effect"
III. Improvement in lower respiratory tract deposition
IV. Decrease in treatment time without sacrificing efficacy

Accepted Answer

A)  I and III only 
B)  II and IV only 
C)  I, II, and III only 
D)  I, III, and IV only 
A)  I and III only 
B)  II and IV only 
C)  I, II, and III only 
D)  I, III, and IV only

Question 9

Pneumatic nebulizers operate according to which of the following physical tenets?

Accepted Answer

A)  Venturi principle 
B)  Bernoulli principle 
C)  Law of continuity 
D)  Law of conservation of energy 
A)  Venturi principle 
B)  Bernoulli principle 
C)  Law of continuity 
D)  Law of conservation of energy

Question 10

By what percentage can breath holding increase particle deposition in the lungs?

Accepted Answer

A)  5% 
B)  10% 
C)  15% 
D)  20% 
A)  5% 
B)  10% 
C)  15% 
D)  20%

Question 11

How can a patient avoid the problem of terminating inhalation when a plume from a pressurized metered-dose inhaler (pMDI) impacts the oropharynx?

Accepted Answer

A)  Hold the pMDI closer the mouth. 
B)  Use a valved holding chamber. 
C)  Depress the nozzle only half the full distance. 
D)  Instruct the patient to inspire a short, rapid breath. 
A)  Hold the pMDI closer the mouth. 
B)  Use a valved holding chamber. 
C)  Depress the nozzle only half the full distance. 
D)  Instruct the patient to inspire a short, rapid breath.

Question 12

Which of the following suggestions will have the most significant impact on the inhaled dose of medications with nebulizers?

Accepted Answer

A)  Increasing the flow rate powering the nebulizer 
B)  Terminating the treatment prior to "sputter" 
C)  Adding 6 inches of tubing on the expiratory side of the nebulizer 
D)  Using breath-enhanced nebulizers 
A)  Increasing the flow rate powering the nebulizer 
B)  Terminating the treatment prior to "sputter" 
C)  Adding 6 inches of tubing on the expiratory side of the nebulizer 
D)  Using breath-enhanced nebulizers

Question 13

Why should pMDIs containing steroids in particular be used with a valved holding chamber?

Accepted Answer

A)  To provide better lung deposition 
B)  To increase the dose of the medication 
C)  To enable the patient to take a deeper breath 
D)  To reduce the risk of oral thrush 
A)  To provide better lung deposition 
B)  To increase the dose of the medication 
C)  To enable the patient to take a deeper breath 
D)  To reduce the risk of oral thrush

Question 14

The physician in the emergency department is attending to a 12-year-old child who has an exacerbation of asthma. The physician asks the therapist to recommend a medication that has a synergistic effect with beta-2 agonists during asthma exacerbations. Which of the following medications should the therapist recommend?

Accepted Answer

A)  Montelukast 
B)  Ipratropium bromide 
C)  Fluticasone 
D)  Triamcinolone 
A)  Montelukast 
B)  Ipratropium bromide 
C)  Fluticasone 
D)  Triamcinolone

Question 15

When a conventional jet nebulizer is operated at a flow of 10 L/min versus 5 L/min, what should the respiratory therapist expect?

Accepted Answer

A)  The particle size gets larger. 
B)  The particle size gets smaller. 
C)  The particle size remains stable. 
D)  The nebulizer will nebulize the full dose more slowly. 
A)  The particle size gets larger. 
B)  The particle size gets smaller. 
C)  The particle size remains stable. 
D)  The nebulizer will nebulize the full dose more slowly.

Question 16

An aerosol treatment is being administered via a jet nebulizer. After 8 minutes the nebulizer starts "sputtering." What should the therapist do at this point?

Accepted Answer

A)  Tap the nebulizer cup until no more mist is produced. 
B)  Terminate the treatment at this time. 
C)  Allow the nebulizer to continue the treatment for 2 more minutes. 
D)  Add more diluent to the nebulizer cup. 
A)  Tap the nebulizer cup until no more mist is produced. 
B)  Terminate the treatment at this time. 
C)  Allow the nebulizer to continue the treatment for 2 more minutes. 
D)  Add more diluent to the nebulizer cup.

Question 17

For which of the following types of patients would using a dry powder inhaler (DPI) for medication delivery likely be contraindicated?

Accepted Answer

A)  A 4-year-old child 
B)  A patient with COPD 
C)  A teenager able to generate an inspiratory flow of 40 L/minute 
D)  An 11-year-old diagnosed with stable asthma 
A)  A 4-year-old child 
B)  A patient with COPD 
C)  A teenager able to generate an inspiratory flow of 40 L/minute 
D)  An 11-year-old diagnosed with stable asthma

Question 18

Which of the following nebulizers should be suggested to improve lung dose in patients undergoing invasive mechanical ventilation?

Accepted Answer

A)  Jet nebulizer 
B)  Ultrasonic nebulizer 
C)  Breath-actuated nebulizer 
D)  Vibrating mesh nebulizer 
A)  Jet nebulizer 
B)  Ultrasonic nebulizer 
C)  Breath-actuated nebulizer 
D)  Vibrating mesh nebulizer

Question 19

The therapist receives an order to administer a bronchodilator in-line to an infant receiving mechanical ventilation. The order also indicates that the nebulizer must not significantly increase the patient's delivered tidal volume. Which of the following aerosol delivery devices should the therapist select?
I. Vibrating mesh nebulizer
II. pMDI
III. Jet nebulizer
IV. Ultrasonic nebulizer

Accepted Answer

A)  II and III only 
B)  I, II, and IV only 
C)  I, III, and IV only 
D)  III and IV only 
A)  II and III only 
B)  I, II, and IV only 
C)  I, III, and IV only 
D)  III and IV only

Question 20

An 18-month-old patient brought to the emergency department is exhibiting signs and symptoms consistent with an acute asthma episode and is administered a beta-2 agonist to which the patient does not respond favorably. Which of the following conditions could be responsible for this patient's problem?

Accepted Answer

A)  Aspiration of a foreign object 
B)  Croup 
C)  Bronchiolitis 
D)  Pneumonia 
A)  Aspiration of a foreign object 
B)  Croup 
C)  Bronchiolitis 
D)  Pneumonia

Exam 11: Aerosols and Administration of Inhaled Medications

Which of the following methods is acceptable for delivering a drug via a pMDI to an intubated neonate receiving mechanical ventilation?

Where in the ventilator circuit should a pMDI be placed to improve efficiency of aerosol delivery?

The respiratory therapist is administering a standard nebulizer with a mask to a 2-year-old child. The mask is being held away from the child's face ("blow-by") due to crying. What should the RT consider doing to improve aerosol lung deposition?

The respiratory therapist verifies an order to administer albuterol 1.25 mg to a 2-kg infant. Why does this dose have the same safety and efficacy profile as a 2.5-mg dose in the adult?

Why are pass-over humidifiers preferred over pneumatic nebulizer humidifiers?

A conventional jet nebulizer with a dead volume of 1 mL is filled with a 3-mL solution of albuterol. What percent of the medication is available for nebulization?

In order to guarantee the same performance of the nebulizer after repeated use, what should be suggested to the user?

Pneumatic nebulizers operate according to which of the following physical tenets?

By what percentage can breath holding increase particle deposition in the lungs?

How can a patient avoid the problem of terminating inhalation when a plume from a pressurized metered-dose inhaler (pMDI) impacts the oropharynx?

Which of the following suggestions will have the most significant impact on the inhaled dose of medications with nebulizers?

Why should pMDIs containing steroids in particular be used with a valved holding chamber?

When a conventional jet nebulizer is operated at a flow of 10 L/min versus 5 L/min, what should the respiratory therapist expect?

An aerosol treatment is being administered via a jet nebulizer. After 8 minutes the nebulizer starts "sputtering." What should the therapist do at this point?

For which of the following types of patients would using a dry powder inhaler (DPI) for medication delivery likely be contraindicated?

Which of the following nebulizers should be suggested to improve lung dose in patients undergoing invasive mechanical ventilation?

Fetal Lung Development

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