Question 1

What measure is used to identify the particle diameter, which corresponds to the most typical settling behavior of an aerosol?

Accepted Answer

A)  Mean mass velocity coefficient (MMV
C)  
B)  Logarithmic standard diameter (LS
D)  
C)  Mean mass aerodynamic diameter (MMA
D)  
D)  Geometric standard deviation (GS
D)  
A)  Mean mass velocity coefficient (MMV
C)  
B)  Logarithmic standard diameter (LS
D)  
C)  Mean mass aerodynamic diameter (MMA
D)  
D)  Geometric standard deviation (GS
D)

Question 2

Before inspiration and actuation of a metered dose inhaler, the patient should exhale to which of the following?

Accepted Answer

A)  Total lung capacity 
B)  Residual volume 
C)  Functional residual capacity 
D)  Expiratory reserve volume 
A)  Total lung capacity 
B)  Residual volume 
C)  Functional residual capacity 
D)  Expiratory reserve volume

Question 3

Which of the following are true about a solution that 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.

Accepted Answer

A) 1 and 2 only 
B) 2 and 3 only 
C) 2 and 4 only 
D) 3 and 4 only 
A) 1 and 2 only 
B) 2 and 3 only 
C) 2 and 4 only 
D) 3 and 4 only

Question 4

Factors associated with reduced pulmonary deposition of aerosolized drugs include which of the following?
1) Mechanical ventilation
2) Artificial airways
3) Poor patient technique
4) Mouth breathing

Accepted Answer

A) 1 and 3 only 
B) 1, 2, and 3 only 
C) 3 and 4 only 
D) 2, 3, and 4 only 
A) 1 and 3 only 
B) 1, 2, and 3 only 
C) 3 and 4 only 
D) 2, 3, and 4 only

Question 5

For a hospitalized patient who will require ongoing maintenance bronchodilator therapy after discharge, what should your end goal be?

Accepted Answer

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" 
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"

Question 6

What is the average mean mass aerodynamic diameter (MMAD) generated by the vibrating mesh nebulizers?

Accepted Answer

A)  1 to 2 µm 
B)  2 to 3 µm 
C)  3 to 4 µm 
D)  5 to 6 µm 
A)  1 to 2 µm 
B)  2 to 3 µm 
C)  3 to 4 µm 
D)  5 to 6 µm

Question 7

What schedule of peak expiratory flow rate assessment would you recommend for a home care asthmatic patient?

Accepted Answer

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) 
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)

Question 8

Normally, when using a 50-psi flowmeter to drive a small-volume jet nebulizer, to what should you set the flow?

Accepted Answer

A)  2 to 4 L/min 
B)  4 to 6 L/min 
C)  6 to 10 L/min 
D)  8 to 10 L/min 
A)  2 to 4 L/min 
B)  4 to 6 L/min 
C)  6 to 10 L/min 
D)  8 to 10 L/min

Question 9

What is the best way to confirm that an asthmatic outpatient can properly self-manage a newly prescribed aerosol drug therapy?

Accepted Answer

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. 
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.

Question 10

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 11

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

Accepted Answer

A)  Change in slope of the expiratory flow-volume curve 
B)  Difference between peak airway and plateau pressures 
C)  Change in peak expiratory flow during passive exhalation 
D)  Difference between plateau and baseline (PEEP) pressures 
A)  Change in slope of the expiratory flow-volume curve 
B)  Difference between peak airway and plateau pressures 
C)  Change in peak expiratory flow during passive exhalation 
D)  Difference between plateau and baseline (PEEP) pressures

Question 12

Exhalation into which device can result in loss of drug delivery?

Accepted Answer

A)  Small-volume jet nebulizers 
B)  Metered dose inhaler 
C)  Dry powder inhaler 
D)  Ultrasonic nebulizer 
A)  Small-volume jet nebulizers 
B)  Metered dose inhaler 
C)  Dry powder inhaler 
D)  Ultrasonic nebulizer

Question 13

For maintenance administration of bronchodilators to an adult patient with adequate inspiratory flow, which of the following 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

Accepted Answer

A) 1 or 2 only 
B) 2 or 3 only 
C) 2 or 4 only 
D) 3 or 4 only 
A) 1 or 2 only 
B) 2 or 3 only 
C) 2 or 4 only 
D) 3 or 4 only

Question 14

What is the primary mechanism for deposition of large, high-mass particles (>5 µm) 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 15

Which of the following small-volume jet nebulizer design features affect its performance?
1) Position
2) Residual volume
3) Baffles
4) Reservoirs

Accepted Answer

A) 1, 2, and 3 only 
B) 2 and 4 only 
C) 3 and 4 only 
D) 1, 2, 3, and 4 
A) 1, 2, and 3 only 
B) 2 and 4 only 
C) 3 and 4 only 
D) 1, 2, 3, and 4

Question 16

Which of the following 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.

Accepted Answer

A) 1, 2, and 3 only 
B) 2 and 4 only 
C) 3 and 4 only 
D) 1 and 2 only 
A) 1, 2, and 3 only 
B) 2 and 4 only 
C) 3 and 4 only 
D) 1 and 2 only

Question 17

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. Which of the following recommendations would you make to the physician?

Accepted Answer

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. 
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.

Question 18

Which of the following 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.

Accepted Answer

A) 1 or 2 only 
B) 1 or 3 only 
C) 2 or 3 only 
D) 1, 2, and 3 
A) 1 or 2 only 
B) 1 or 3 only 
C) 2 or 3 only 
D) 1, 2, and 3

Question 19

To decrease the dead space volume of a small-volume jet nebulizer during drug administration, what should you do?

Accepted Answer

A)  Decrease the nebulizer flow. 
B)  Turn the nebulizer upside-down. 
C)  Continue treatment until nebulizer begins to sputter. 
D)  Increase the nebulizer flow. 
A)  Decrease the nebulizer flow. 
B)  Turn the nebulizer upside-down. 
C)  Continue treatment until nebulizer begins to sputter. 
D)  Increase the nebulizer flow.

Question 20

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.

Accepted Answer

A) 1 and 2 only 
B) 1 and 3 only 
C) 2 and 3 only 
D) 1, 2, and 3 
A) 1 and 2 only 
B) 1 and 3 only 
C) 2 and 3 only 
D) 1, 2, and 3

Exam 39: Aerosol Drug Therapy

What measure is used to identify the particle diameter, which corresponds to the most typical settling behavior of an aerosol?

Before inspiration and actuation of a metered dose inhaler, the patient should exhale to which of the following?

Which of the following are true about a solution that 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.

Factors associated with reduced pulmonary deposition of aerosolized drugs include which of the following? 1) Mechanical ventilation 2) Artificial airways 3) Poor patient technique 4) Mouth breathing

For a hospitalized patient who will require ongoing maintenance bronchodilator therapy after discharge, what should your end goal be?

What is the average mean mass aerodynamic diameter (MMAD) generated by the vibrating mesh nebulizers?

What schedule of peak expiratory flow rate assessment would you recommend for a home care asthmatic patient?

Normally, when using a 50-psi flowmeter to drive a small-volume jet nebulizer, to what should you set the flow?

What is the best way to confirm that an asthmatic outpatient can properly self-manage a newly prescribed aerosol drug therapy?

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

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

Exhalation into which device can result in loss of drug delivery?

For maintenance administration of bronchodilators to an adult patient with adequate inspiratory flow, which of the following 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

What is the primary mechanism for deposition of large, high-mass particles (>5 µm) in the respiratory tract?

Which of the following small-volume jet nebulizer design features affect its performance? 1) Position 2) Residual volume 3) Baffles 4) Reservoirs

To decrease the dead space volume of a small-volume jet nebulizer during drug administration, what should you do?

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.

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