Question 1

Which of the following best describes a proper a dose-response assessment of a metered-dose inhaler (MDI) bronchodilator?

Accepted Answer

A) Give 4 puffs one after the other, wait 1 minute, repeat up to 16 puffs. The best dose is the highest dose given without side effects. 
B) Give 4 puffs spaced 1 to 2 minutes 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 minute apart; repeat every 20 minutes until maximum relief of symptoms is achieved without side effects. 
D) Give 2 puffs 1 to 2 minutes apart; repeat up to 6 puffs with continued improvement. The best dose provides maximum subjective relief and the highest PEFR without side effects. 
A) Give 4 puffs one after the other, wait 1 minute, repeat up to 16 puffs. The best dose is the highest dose given without side effects. 
B) Give 4 puffs spaced 1 to 2 minutes 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 minute apart; repeat every 20 minutes until maximum relief of symptoms is achieved without side effects. 
D) Give 2 puffs 1 to 2 minutes apart; repeat up to 6 puffs with continued improvement. The best dose provides maximum subjective relief and the highest PEFR without side effects.

Question 2

Which of the following is the effect of aerosol particles entrained into a warm and fully saturated gas stream?

Accepted Answer

A) no effect 
B) increase in size 
C) decrease in size 
D) increase in number 
A) no effect 
B) increase in size 
C) decrease in size 
D) increase in number

Question 3

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?

Accepted Answer

A) 5 to 20 $\mu$m 
B) 2 to 5 $\mu$m 
C) 1 to 3 $\mu$m 
D) less than 1 $\mu$m 
A) 5 to 20 $\mu$m 
B) 2 to 5 $\mu$m 
C) 1 to 3 $\mu$m 
D) less than 1 $\mu$m

Question 4

Which of the following will increase aerosol deposition by inertial impaction?
I.high-velocity gas flow
II.variable or irregular passages
III.turbulent gas flow
IV.particles of high mass

Accepted Answer

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

Question 5

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 minutes. Which of the following would you recommend to the patient's physician at this time?

Accepted Answer

A) Discontinue the aerosolized bronchodilator. 
B) Increase the frequency of SVN therapy to every 10 minutes. 
C) Consider continuous nebulization of the drug. 
D) Add more diluent to the SVN to extend treatment time. 
A) Discontinue the aerosolized bronchodilator. 
B) Increase the frequency of SVN therapy to every 10 minutes. 
C) Consider continuous nebulization of the drug. 
D) Add more diluent to the SVN to extend treatment time.

Question 6

Where do most aerosol particles in the 5- to 10-$\mu$m range deposit?

Accepted Answer

A) alveoli 
B) bronchioles 
C) central airways 
D) upper airways 
A) alveoli 
B) bronchioles 
C) central airways 
D) upper airways

Question 7

Which of the following patient skills are necessary to ensure effectiveness of drug administration via the aerosol route?
I.ability to keep track of dosing requirements
II.understanding of the methods and goals of therapy
III.ability to recognize undesirable side effects

Accepted Answer

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

Question 8

What is the primary mechanism for central airway deposition of particles in the 1- to 5-$\mu$m range?

Accepted Answer

A) impaction 
B) sedimentation 
C) diffusion 
D) Brownian motion 
A) impaction 
B) sedimentation 
C) diffusion 
D) Brownian motion

Question 9

What is the major problem with using large-volume nebulizers for continuous aerosol drug therapy?

Accepted Answer

A) decreased pulmonary deposition 
B) drug reconcentration and toxicity 
C) frequent interruption of therapy 
D) greater waste of drug 
A) decreased pulmonary deposition 
B) drug reconcentration and toxicity 
C) frequent interruption of therapy 
D) greater waste of drug

Question 10

In mouth-breathing adult patients, which of the following factors is crucial in determining whether to use a mask or mouthpiece for aerosol drug delivery with a small-volume jet nebulizer?

Accepted Answer

A) clinician experience 
B) drug concentration 
C) patient preference and comfort 
D) brand of small-volume jet nebulizer 
A) clinician experience 
B) drug concentration 
C) patient preference and comfort 
D) brand of small-volume jet nebulizer

Question 11

What is the average amount of dead volume in a small-volume jet nebulizer after the device runs dry?

Accepted Answer

A) 0.1 ml 
B) 0.5 to 3.0 ml 
C) 2.0 to 4.0 ml 
D) less than 0.1 ml 
A) 0.1 ml 
B) 0.5 to 3.0 ml 
C) 2.0 to 4.0 ml 
D) less than 0.1 ml

Question 12

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?

Accepted Answer

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. 
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.

Question 13

As hygroscopic aerosol particles enter the respiratory tract, what do they tend to do?

Accepted Answer

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 
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

Question 14

Drug aerosol delivery systems include all of the following except:

Accepted Answer

A) dry powder inhalers (DPIs) 
B) small-volume jet nebulizers 
C) metered-dose inhalers (MDIs) 
D) spinning disk nebulizers 
A) dry powder inhalers (DPIs) 
B) small-volume jet nebulizers 
C) metered-dose inhalers (MDIs) 
D) spinning disk nebulizers

Question 15

Factors associated with reduced pulmonary deposition of aerosolized drugs include all of the following except:

Accepted Answer

A) mechanical ventilation 
B) artificial airways 
C) poor patient technique 
D) mouth breathing 
A) mechanical ventilation 
B) artificial airways 
C) poor patient technique 
D) mouth breathing

Question 16

All of the following device-related factors have a major effect on pressurized metered-dose inhaler (MDI) delivery of aerosolized drugs during mechanical ventilation except:

Accepted Answer

A) MDI propellant formula 
B) type of spacer or adapter used 
C) position of spacer in circuit 
D) timing of MDI actuation 
A) MDI propellant formula 
B) type of spacer or adapter used 
C) position of spacer in circuit 
D) timing of MDI actuation

Question 17

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. Which of the following is most likely?

Accepted Answer

A) increasing airway obstruction 
B) improving $\dot { V } / \dot { Q }$ 
C) decreasing airway obstruction 
D) deteriorating oxygenation 
A) increasing airway obstruction 
B) improving $\dot { V } / \dot { Q }$ 
C) decreasing airway obstruction 
D) deteriorating oxygenation

Question 18

What is the primary mechanism for deposition of large, high-mass particles (greater than 5 $\mu$m) in the respiratory tract?

Accepted Answer

A) inertial impaction 
B) sedimentation 
C) diffusion 
D) Brownian motion 
A) inertial impaction 
B) sedimentation 
C) diffusion 
D) Brownian motion

Question 19

Which of the following is false about changes in aerosol suspensions over time?

Accepted Answer

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. 
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.

Question 20

Which of the following aerosol drug delivery devices would you recommend against using with a toddler or small child?
I.metered-dose inhaler (MDI)II.small-volume jet nebulizer
III.dry powder inhaler
IV.MDI, holding chamber, and mask

Accepted Answer

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

Exam 36: Aerosol Drug Therapy

Which of the following best describes a proper a dose-response assessment of a metered-dose inhaler (MDI) bronchodilator?

Which of the following is the effect of aerosol particles entrained into a warm and fully saturated gas stream?

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?

Which of the following will increase aerosol deposition by inertial impaction? I.high-velocity gas flow II.variable or irregular passages III.turbulent gas flow IV.particles of high mass

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 minutes. Which of the following would you recommend to the patient's physician at this time?

Where do most aerosol particles in the 5- to 10- μ\muμ m range deposit?

Which of the following patient skills are necessary to ensure effectiveness of drug administration via the aerosol route? I.ability to keep track of dosing requirements II.understanding of the methods and goals of therapy III.ability to recognize undesirable side effects

What is the primary mechanism for central airway deposition of particles in the 1- to 5- μ\muμ m range?

What is the major problem with using large-volume nebulizers for continuous aerosol drug therapy?

In mouth-breathing adult patients, which of the following factors is crucial in determining whether to use a mask or mouthpiece for aerosol drug delivery with a small-volume jet nebulizer?

What is the average amount of dead volume in a small-volume jet nebulizer after the device runs dry?

As hygroscopic aerosol particles enter the respiratory tract, what do they tend to do?

Drug aerosol delivery systems include all of the following except:

Factors associated with reduced pulmonary deposition of aerosolized drugs include all of the following except:

All of the following device-related factors have a major effect on pressurized metered-dose inhaler (MDI) delivery of aerosolized drugs during mechanical ventilation except:

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. Which of the following is most likely?

What is the primary mechanism for deposition of large, high-mass particles (greater than 5 μ\muμ m) in the respiratory tract?

Which of the following is false about changes in aerosol suspensions over time?

Which of the following aerosol drug delivery devices would you recommend against using with a toddler or small child? I.metered-dose inhaler (MDI)II.small-volume jet nebulizer III.dry powder inhaler IV.MDI, holding chamber, and mask

History of Respiratory Care

Quality and Evidence-Based Respiratory Care

Patient Safety, Communication, and Record Keeping

Principles of Infection Control

Ethical and Legal Implications of Practice

Physical Principles of Respiratory Care

Computer Applications in Respiratory Care

The Respiratory System

The Cardiovascular System

Ventilation

Gas Exchange and Transport

Solutions, Body Fluids, and Electrolytes

Acid-Base Balance

Regulation of Breathing

Bedside Assessment of the Patient

Interpretation of Clinical Laboratory Data

Interpreting the Electrocardiogram

Analysis and Monitoring of Gas Exchange

Pulmonary Function Testing

A Review of Thoracic Imaging

Nutrition Assessment

Pulmonary Infections

Obstructive Lung Disease: Copd, Asthma, and Related Diseases

Interstitial Lung Disease

Pleural Diseases

Pulmonary Vascular Disease

Acute Lung Injury, Pulmonary Edema, and Multiple System Organ

Lung Cancer

Neuromuscular and Other Diseases of the Chest Wall

Disorders of Sleep

Neonatal and Pediatric Respiratory Disorders

Airway Pharmacology

Airway Management

Emergency Cardiovascular Life Support

Humidity and Bland Aerosol Therapy

Storage and Delivery of Medical Gases

Medical Gas Therapy

Lung Expansion Therapy

Bronchial Hygiene Therapy

Respiratory Failure and the Need for Ventilatory Support

Mechanical Ventilators

Physiology of Ventilatory Support

Initiating and Adjusting Ventilatory Support

Noninvasive Positive Pressure Ventilation

Monitoring and Management of the Patient in the Intensive Care Unit

Discontinuing Ventilatory Support

Neonatal and Pediatric Respiratory Care

Patient Education and Health Promotion

Cardiopulmonary Rehabilitation

Respiratory Care in Alternative Settings

Filters

Where do most aerosol particles in the 5- to 10- $\mu$ m range deposit?

What is the primary mechanism for central airway deposition of particles in the 1- to 5- $\mu$ m range?

What is the primary mechanism for deposition of large, high-mass particles (greater than 5 $\mu$ m) in the respiratory tract?