Ch36

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  1. Which of the following best defines an aerosol?

    A.suspension of liquid droplets in a gas
    B.molecular water dispersed throughout a carrier gas
    C.suspension of liquid or solid particles in a gas
    D.suspension of particulate matter in a gas
    C.suspension of liquid or solid particles in a gas
    (this multiple choice question has been scrambled)
  2. With which of the following devices are therapeutic aerosols generated?

    1.atomizers
    2. nebulizers
    3.humidifiers
    A.1 and 2
    B.1 and 3
    C.2 and 3
    D.1, 2, and 3
    A.1 and 2
    (this multiple choice question has been scrambled)
  3. The mass of aerosol particles produced by a nebulizer in a given unit time best describes which quality of the aerosol?

    A.deposition
    B.output
    C.stability
    D.density
    B.output
    (this multiple choice question has been scrambled)
  4. Which of the following 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
    (this multiple choice question has been scrambled)
  5. Which of the following is a common method to measure aerosol particle size?

    A.cascade impaction
    B.scan
    C.gravimetric
    D.penetration studies
    A.cascade impaction
    (this multiple choice question has been scrambled)
  6. What measure is used to identify the particle diameter, which corresponds to the most typical settling behavior of an aerosol?

    A.logarithmic standard diameter (LSD)
    B.geometric standard deviation (GSD)
    C.mean mass velocity coefficient (MMVC)
    D.mean mass aerodynamic diameter (MMAD)
    D.mean mass aerodynamic diameter (MMAD)
    (this multiple choice question has been scrambled)
  7. What measure is used to describe the variability of particle diameters in an aerosol?

    A.MMAD
    B.MMVC
    C.LSD
    D.GSD
    D.GSD
    (this multiple choice question has been scrambled)
  8. Most nebulizers used in respiratory care produce which type of aerosol suspension?

    A.macroaerosol
    B.heterodisperse
    C.monodisperse
    D.microaerosol
    B.heterodisperse
    (this multiple choice question has been scrambled)
  9. What is the retention of aerosol particles resulting from contact with the respiratory tract mucosa called?

    A.density
    B.stability
    C.deposition
    D.penetration
    C.deposition
    (this multiple choice question has been scrambled)
  10. Which of the following 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
    A.1 and 2
    B.2 and 3
    C.1 and 3
    D.1, 2, and 3
    D.1, 2, and 3
    (this multiple choice question has been scrambled)
  11. What is the primary mechanism for deposition of large, high-mass particles (greater than 5 mm) in the respiratory tract?

    A.Brownian motion
    B.sedimentation
    C.inertial impaction
    D.diffusion
    C.inertial impaction
    (this multiple choice question has been scrambled)
  12. Which of the following 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
    A.2, 3, and 4
    B.2 and 3
    C.1, 3, and 4
    D.1, 2, 3, and 4
    B.2 and 3
    (this multiple choice question has been scrambled)
  13. Where do most aerosol particles in the 5- to 10-mm range deposit?

    A.alveoli
    B.central airways
    C.bronchioles
    D.upper airways
    D.upper airways
    (this multiple choice question has been scrambled)
  14. What is the primary mechanism for central airway deposition of particles in the 1- to 5-mm range?

    A.Brownian motion
    B.diffusion
    C.impaction
    D.sedimentation
    D.sedimentation
    (this multiple choice question has been scrambled)
  15. Where do most aerosol particles in the 1- to 5-mm range deposit?

    A.upper airways
    B.bronchioles
    C.central airways
    D.alveoli
    C.central airways
    (this multiple choice question has been scrambled)
  16. Which of the following techniques will increase aerosol deposition by sedimentation in the lungs?

    A.short expiratory time
    B.short inspiratory time
    C.10-second breath-hold
    D.high inspiratory flow
    C.10-second breath-hold
    (this multiple choice question has been scrambled)
  17. What term describes the primary mechanism for deposition of small particles?

    A.Brownian diffusion
    B.inertial impaction
    C.hygroscopic condensation
    D.gravity sedimentation
    A.Brownian diffusion
    (this multiple choice question has been scrambled)
  18. What is the primary fate of inhaled aerosol particles that are between 1 and 0.5 mm?

    A.Most deposit in the upper airway.
    B.Most deposit in the alveoli.
    C.Most deposit in the central airways.
    D.Most are cleared during exhalation.
    D.Most are cleared during exhalation.
    (this multiple choice question has been scrambled)
  19. Which of the following aerosols would have the highest rate of deposition by diffusion?

    A.MMAD of 3.0 mm
    B.MMAD of 50.0 mm
    C.MMAD of 0.1 mm
    D.MMAD of 10.0 mm
    C.MMAD of 0.1 mm
    (this multiple choice question has been scrambled)
  20. Where do most aerosol particles that are less than 3 mm deposit?

    A.central airways
    B.alveoli
    C.upper airways
    D.bronchioles
    B.alveoli
    (this multiple choice question has been scrambled)
  21. 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.1 to 3 mm
    B.2 to 5 mm
    C.less than 1 mm
    D.5 to 50 mm
    D.5 to 50 mm
    (this multiple choice question has been scrambled)
  22. 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 mm
    B.less than 1 mm
    C.1 to 3 mm
    D.2 to 5 mm
    D.2 to 5 mm
    (this multiple choice question has been scrambled)
  23. 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.less than 1 mm
    B.1 to 3 mm
    C.5 to 20 mm
    D.2 to 5 mm
    A.less than 1 mm
    (this multiple choice question has been scrambled)
  24. What is the process by which aerosol suspension changes over time?

    A.aging
    B.deposition
    C.evaporation
    D.sublimation
    A.aging
    (this multiple choice question has been scrambled)
  25. Which of the following is false about changes in aerosol suspensions over time?

    A.The rate of particle growth is directly proportional to particle size
    B.Aerosols of water-soluble salts tend to grow in a humidified environment.
    C.Liquid aerosol particles can shrink (evaporation) or grow (water absorption).
    D.Small water-based particles tend to shrink when exposed to dry gas.
    A.The rate of particle growth is directly proportional to particle size
    (this multiple choice question has been scrambled)
  26. As hygroscopic aerosol particles enter the respiratory tract, what do they tend to do?


    A.decrease in size because of the evaporation 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 absorption of molecular water
    B.increase in size because of the absorption of molecular water
    (this multiple choice question has been scrambled)
  27. What is the primary hazard of aerosol drug therapy?

    A.untoward drug reactions
    B.pulmonary infection
    C.airway reactivity
    D.drug reconcentration
    A.untoward drug reactions
    (this multiple choice question has been scrambled)
  28. 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.
    A.1 and 3
    B.1, 2, and 3
    C.1 and 2
    D.2 and 3
    B.1, 2, and 3
    (this multiple choice question has been scrambled)
  29. All of the following drugs or drug categories have been associated with increased airway resistance and bronchospasm during aerosol administration except:

    A.albuterol
    B.acetylcysteine
    C.steroids
    D.antibiotics
    A.albuterol
    (this multiple choice question has been scrambled)
  30. To monitor a patient for the possibility of reactive bronchospasm during aerosol drug therapy, what should you do?


    1.Measure pre- and post-peak 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.
    A.1 and 3
    B.1, 3, and 4
    C.2, 3, and 4
    D.1, 2, 3, and 4
    D.1, 2, 3, and 4
    (this multiple choice question has been scrambled)
  31. 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?

    A.Switch to a higher-density aerosol (e.g., ultrasonic).
    B.Add coughing and postural drainage to the therapy.
    C.Consider prior treatment with a bronchodilator.
    D.Discontinue the heated water aerosol treatments.
    B.Add coughing and postural drainage to the therapy.
    (this multiple choice question has been scrambled)
  32. Drug aerosol delivery systems include all of the following except:

    A.metered-dose inhalers (MDIs)
    B.spinning disk nebulizers
    C.small-volume jet nebulizers
    D.dry powder inhalers (DPIs)
    B.spinning disk nebulizers
    (this multiple choice question has been scrambled)
  33. What is the preferred method for delivering bronchodilators to spontaneously breathing and intubated, ventilated patients?

    A.small-volume jet nebulizer
    B.hand-bulb atomizer
    C.dry powder inhaler
    D.metered-dose inhaler
    D.metered-dose inhaler
    (this multiple choice question has been scrambled)
  34. Immediately after firing, the aerosol particles produced by most metered-dose inhalers are about how large?

    A.35 mm
    B.5 mm
    C.1 mm
    D.20 mm
    A.35 mm
    (this multiple choice question has been scrambled)
  35. Each firing of a typical metered-dose inhaler delivers about what output volume?

    A.10 to 30 ml
    B.10 to 30 ml
    C.30 to 100 ml
    D.30 to 100 ml
    C.30 to 100 ml
    (this multiple choice question has been scrambled)
  36. Most of the spray generated by the majority of metered-dose inhalers consists of which of the following?

    A.active drug
    B.propellant
    C.water solution
    D.surfactant agents
    B.propellant
    (this multiple choice question has been scrambled)
  37. About 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.50 mg to 5 mg
    D.5 to 50 mg
    C.50 mg to 5 mg
    (this multiple choice question has been scrambled)
  38. Which of the following particle distributions is produced by a typical metered-dose inhaler?

    A.6- to 9-mm MMAD
    B.less than 1-mm MMAD
    C.1- to 3-mm MMAD
    D.2 to 6-mm mean mass aerodynamic diameter (MMAD)
    D.2 to 6-mm mean mass aerodynamic diameter (MMAD)
    (this multiple choice question has been scrambled)
  39. When fired inside the mouth, what percentage of the drug dose delivered by a simple metered-dose inhaler (MDI) deposits in the oropharynx?

    A.about 60%
    B.about 20%
    C.about 80%
    D.about 40%
    C.about 80%
    (this multiple choice question has been scrambled)
  40. 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 inspiration
    C.immediately after beginning a slow exhalation
    D.immediately before beginning a slow exhalation
    B.immediately after beginning a slow inspiration
    (this multiple choice question has been scrambled)
  41. Before inspiration and actuation of a metered-dose inhaler, the patient should exhale to which of the following?

    A.residual volume
    B.functional residual capacity
    C.total lung capacity
    D.expiratory reserve volume
    B.functional residual capacity
    (this multiple choice question has been scrambled)
  42. To ensure delivery of the proper drug dosage with a metered-dose inhaler, which of the following 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.
    A.2 and 3
    B.1 and 3
    C.1 and 2
    D.1, 2, and 3
    A.2 and 3
    (this multiple choice question has been scrambled)
  43. Which of the following 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
    A.1 and 2
    B.1, 2, and 3
    C.2 and 3
    D.1 and 3
    B.1, 2, and 3
    (this multiple choice question has been scrambled)
  44. Which of the following agents has been associated with increased intraocular pressure?

    A.b2-agonists
    B.epinephrine
    C.antibiotics
    D.anticholinergics
    D.anticholinergics
    (this multiple choice question has been scrambled)
  45. 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 do?

    1.Cut in half the number of puffs or treatments.
    2.Use a spacer or holding chamber.
    3.Rinse the mouth after each treatment.
    A.1, 2, and 3
    B.1 and 3
    C.1 and 2
    D.2 and 3
    D.2 and 3
    (this multiple choice question has been scrambled)
  46. What is a potential limitation of flow-triggered metered-dose inhaler devices?


    A.increased pharyngeal impaction
    B.high flows necessary for actuation
    C.less effective lung deposition
    D.requires accessory equipment
    B.high flows necessary for actuation
    (this multiple choice question has been scrambled)
  47. For which of the following patients would you recommend against using a flow-triggered metered-dose inhaler (MDI) as the sole bronchodilator delivery system?

    A.patient who cannot coordinate MDI firing with inhalation
    B.stable elderly patient on maintenance bronchodilator therapy
    C.teenage asthmatic who refuses to use a holding chamber
    D.patient likely to develop acute severe bronchospasm
    D.patient likely to develop acute severe bronchospasm
    (this multiple choice question has been scrambled)
  48. Which of the following are 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
    A.1 and 2
    B.1, 2, and 3
    C.2 and 3
    D.1 and 3
    A.1 and 2
    (this multiple choice question has been scrambled)
  49. The key difference between a metered-dose inhaler (MDI) holding chamber and a spacer is that the holding chamber incorporates which of the following?

    A.larger enclosed space
    B.one-way inspiratory valve
    C.series of baffles
    D.heated chamber
    B.one-way inspiratory valve
    (this multiple choice question has been scrambled)
  50. After actuating a metered-dose inhaler with a holding chamber, what should the patient be instructed to do?

    A.Immediately exhale as fast and as much as possible.
    B.Take a large breath and hold it for at least 5 seconds.
    C.Continue to breathe through the device for three breaths.
    D.Take one quick breath and remove the holding chamber.
    C.Continue to breathe through the device for three breaths.
    (this multiple choice question has been scrambled)
  51. Which of the following devices would you select to deliver an aerosolized bronchodilator to a young child?

    A.MDI, holding chamber, and mask
    B.MDI and holding chamber
    C.dry power inhaler
    D.metered-dose inhaler (MDI) and spacer
    A.MDI, holding chamber, and mask
    (this multiple choice question has been scrambled)
  52. Advantages of the dry power inhaler (DPI) drug delivery systems include all of the following except:

    A.low relative cost
    B.unaffected by humidity
    C.no hand–breath coordination necessary
    D.no propellants required
    B.unaffected by humidity
    (this multiple choice question has been scrambled)
  53. Proper use of a dry power inhaler (DPI) requires that the patient be able to do which of the following?

    A.coordinate firing of the DPI with inspiration
    B.inhale slowly (less than 0.5 L/sec) and perform a breath-hold
    C.generate inspiratory flows of 60 L/min or higher
    D.exhale forcibly through the device before drug delivery
    C.generate inspiratory flows of 60 L/min or higher
    (this multiple choice question has been scrambled)
  54. Which of the following devices depends on the patient’s inspiratory effort to dispense the dose?

    A.ultrasonic nebulizer
    B.metered-dose inhaler
    C.dry power inhaler
    D.small-volume jet nebulizers
    C.dry power inhaler
    (this multiple choice question has been scrambled)
  55. Which of the following would be correct instructions for a patient being taught proper use of a dry power inhaler?

    1.Place mouthpiece 4 cm from mouth.
    2.Exhale slowly to FRC.
    3.Inhale slowly (less than 30 L/min).
    4.Repeat until dose is used up.
    A.1, 2, 3, and 4
    B.2 and 4
    C.1, 2, and 3
    D.3 and 4
    B.2 and 4
    (this multiple choice question has been scrambled)
  56. For which of the following patient groups is use of a dry power inhaler (DPI) for bronchodilator administration NOT recommended?

    1.infants and children younger than 5 years
    2.patients with an acute bronchospastic episode
    3.patients requiring maintenance therapy
    A.2 and 3
    B.1, 2, and 3
    C.1 and 3
    D.1 and 2
    D.1 and 2
    (this multiple choice question has been scrambled)
  57. Exhalation into which device can result in loss of drug delivery?

    A.dry power inhaler
    B.ultrasonic nebulizer
    C.metered-dose inhaler
    D.small-volume jet nebulizers
    A.dry power inhaler
    (this multiple choice question has been scrambled)
  58. Which of the following small-volume jet nebulizer design features affect its performance?

    1.position
    2.residual volume
    3.baffles
    4.reservoirs
    A.2 and 4
    B.1, 2, 3, and 4
    C.3 and 4
    D.1, 2, and 3
    B.1, 2, 3, and 4
    (this multiple choice question has been scrambled)
  59. All of the following source gas characteristics affect the performance of small-volume jet nebulizers except:

    A.pressure
    B.flow
    C.humidity
    D.viscosity
    D.viscosity
    (this multiple choice question has been scrambled)
  60. All of the following drug formulation characteristics affect the performance of small-volume jet nebulizers except:

    A.viscosity
    B.surface tension
    C.potency
    D.homogeneity
    C.potency
    (this multiple choice question has been scrambled)
  61. What is the average amount of dead volume in a small-volume jet nebulizer after the device runs dry?

    A.less than 0.1 ml
    B.0.1 ml
    C.2.0 to 4.0 ml
    D.0.5 to 2.2 ml
    D.0.5 to 2.2 ml
    (this multiple choice question has been scrambled)
  62. 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.Increase the nebulizer input flow to 10 to 12 L/min.
    B.Add 1 to 2 ml more diluent to the nebulizer reservoir.
    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.
    (this multiple choice question has been scrambled)
  63. 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.more waste
    B.no effect
    C.increase
    D.decrease
    C.increase
    (this multiple choice question has been scrambled)
  64. 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.
    A.1 and 2
    B.1, 2, and 3
    C.2 and 3
    D.1 and 3
    B.1, 2, and 3
    (this multiple choice question has been scrambled)
  65. Which of the following is the effect of aerosol particles entrained into a warm and fully saturated gas stream?

    A.no effect
    B.increase in number
    C.increase in size
    D.decrease in size
    C.increase in size
    (this multiple choice question has been scrambled)
  66. Which of the following is false about the optimal technique for using a small-volume jet nebulizer (SVN) for aerosol drug delivery?

    A.Slow inspiration improves SVN aerosol deposition.
    B.Deep breathing or breath-holding improves SVN deposition.
    C.SVNs are less technique- and device-dependent.
    D.Use of a mouthpiece or mask provides similar results.
    B.Deep breathing or breath-holding improves SVN deposition.
    (this multiple choice question has been scrambled)
  67. 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?

    A.drug concentration
    B.patient preference and comfort
    C.brand of small-volume jet nebulizer
    D.clinician experience
    B.patient preference and comfort
    (this multiple choice question has been scrambled)
  68. Normally, when using a 50-psi flowmeter to drive a small-volume jet nebulizer, to what should you set the flow?

    A.6 to 10 L/min
    B.2 to 4 L/min
    C.4 to 6 L/min
    D.8 to 10 L/min
    A.6 to 10 L/min
    (this multiple choice question has been scrambled)
  69. To decrease the VDS 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.Increase the nebulizer flow
    D.continue treatment until nebulizer begins to sputter
    D.continue treatment until nebulizer begins to sputter
    (this multiple choice question has been scrambled)
  70. To minimize a patient’s infection risk between drug treatments with a small-volume jet nebulizer (SVN), what would you do?


    A.Throw out the SVN after every treatment
    B.Rinse the SVN with sterile water; air dry.
    C.Carefully repackage the SVN in its wet state.
    D.Rinse the SVN with tap water; run until dry.
    B.Rinse the SVN with sterile water; air dry.
    (this multiple choice question has been scrambled)
  71. 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?


    A.Add more diluent to the SVN to extend treatment time.
    B.Consider continuous nebulization of the drug.
    C.Discontinue the aerosolized bronchodilator.
    D.Increase the frequency of SVN therapy to every 10 minutes.
    B.Consider continuous nebulization of the drug.
    (this multiple choice question has been scrambled)
  72. What is the major problem with using large-volume nebulizers for continuous aerosol drug therapy?

    A.greater waste of drug
    B.drug reconcentration and toxicity
    C.frequent interruption of therapy
    D.decreased pulmonary deposition
    B.drug reconcentration and toxicity
    (this multiple choice question has been scrambled)
  73. A physician has ordered the antiviral agent ribavirin (Virazole) to be administered by aerosol to an infant with bronchiolitis. Which of the following devices would you recommend in this situation?

    A.small-particle aerosol generator (SPAG)
    B.large-volume heated jet nebulizer
    C.hydrodynamic (Babbington) nebulizer
    D.ultrasonic (piezoelectric) nebulizer
    A.small-particle aerosol generator (SPAG)
    (this multiple choice question has been scrambled)
  74. The small-particle aerosol generator (SPAG) produces a small monodisperse aerosol through which of the following?

    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
    (this multiple choice question has been scrambled)
  75. When using a small-particle aerosol generator (SPAG) to administer ribavirin (Virazole) to an infant, which pair of flow settings is correct?

    Nebulizer    Drying Chamber
    A.5L/min          5L/min
    B.4L/min          8L/min
    C.8L/min          4L/min
    D.8L/min          8L/min
    D.   8L/min          8L/min
    (this multiple choice question has been scrambled)
  76. What serious problems associated with the delivery of ribavirin (Virazole) using the small-particle aerosol generator (SPAG)?

    1.caregiver exposure to the drug aerosol
    2.drug reconcentration in the drying
    3.chamber drug precipitation in ventilator circuits
    A.1 and 3
    B.1 and 2
    C.2 and 3
    D.1, 2, and 3
    A.1 and 3
    (this multiple choice question has been scrambled)
  77. This problem of ribavirin (Virazole) aerosol precipitation causing malfunction of ventilator circuits can be overcome by which of the following?

    1.Placing a one-way valve between the small-particle aerosol generator (SPAG) and the circuit
    2.Placing a HEPA filter proximal to the exhalation valve
    3.Decreasing the SPAG’s total flow to below 10 L/min
    A.2 and 3
    B.1 and 2
    C.1, 2, and 3
    D.1 and 3
    B.1 and 2
    (this multiple choice question has been scrambled)
  78. 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.
    A.2 and 3
    B.2 and 4
    C.3 and 4
    D.1 and 2
    A.2 and 3
    (this multiple choice question has been scrambled)
  79. Which of the following make 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.
    A.1, 2, and 3
    B.3 and 4
    C.2 and 4
    D.1, 2, 3, and 4
    D.1, 2, 3, and 4
    (this multiple choice question has been scrambled)
  80. Advantages of small-volume ultrasonic nebulizers for drug delivery include all of the following except:

    A.less dead space and waste
    B.greater respirable drug mass
    C.increased mobility
    D.decreased cost
    D.decreased cost
    (this multiple choice question has been scrambled)
  81. What is the average mean mass aerodynamic diameter (MMAD) generated by the vibrating mesh nebulizers?

    A.2 to 3 mm
    B.3 to 4 mm
    C.1 to 2 mm
    D.5 to 6 mm
    A.2 to 3 mm
    (this multiple choice question has been scrambled)
  82. 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 characteristics4.patient’s preference
    A.1, 2, 3, and 4
    B.2 and 4
    C.1 and 3
    D.1 and 2
    B.2 and 4
    (this multiple choice question has been scrambled)
  83. 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
    A.2 or 4
    B.1 or 2
    C.2 or 3
    D.3 or 4
    D.3 or 4
    (this multiple choice question has been scrambled)
  84. Which of the following 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
    A.3 and 4
    B.2 and 4
    C.1 and 2
    D.1 and 3
    C.1 and 2
    (this multiple choice question has been scrambled)
  85. On the average, what percentage of an aerosol drug delivery device’s output actually deposits in the lungs?

    A.30%
    B.10%
    C.less than 10%
    D.20%
    B.10%
    (this multiple choice question has been scrambled)
  86. Factors associated with reduced pulmonary deposition of aerosolized drugs include all of the following except:

    A.poor patient technique
    B.artificial airways
    C.mouth breathing
    D.mechanical ventilation
    C.mouth breathing
    (this multiple choice question has been scrambled)
  87. Possible complications associated with the selection of an aerosol drug delivery device include all of the following except:


    A.overhydration or fluid imbalances
    B.environmental contamination or caregiver exposure
    C.underdosing or overdosing because of improper technique
    D.adverse effects of the specific drug agent
    A.overhydration or fluid imbalances
    (this multiple choice question has been scrambled)
  88. A semiconscious patient with inadequate spontaneous ventilation requires aerosol drug administration. Which of the following approaches would you recommend?

    A.metered-dose inhaler and holding chamber
    B.small-volume jet nebulizer (SVN)
    C.SVN with delivery by intermittent positive-pressure breathing
    D.large-volume continuous nebulizer
    C.SVN with delivery by intermittent positive-pressure breathing
    (this multiple choice question has been scrambled)
  89. 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)
    A.2 and 3
    B.1, 2, and 3
    C.1 and 3
    D.1 and 2
    B.1, 2, and 3
    (this multiple choice question has been scrambled)
  90. 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] less than 60% predicted)?

    1.Assess dose-response of metered-dose inhaler (MDI)
    2.albuterol (up to 12 puffs).
    3.Provide up to three small-volume jet nebulizer (SVN) treatments with albuterol every 20 minutes.
    4.Immediately begin continuous albuterol therapy at 15 mg/hr.
    A.2 or 3
    B.1 or 3
    C.1, 2, and 3
    D.1 or 2
    D.1 or 2
    (this multiple choice question has been scrambled)
  91. Indications for assessment of patient’s response to bronchodilator therapy include all of the following except to:

    A.individualize the dose, frequency, or type of medication
    B.help follow the patient’s status during long-term therapy
    C.quantify the degree of bronchial hyperresponsiveness
    D.confirm whether the therapy works as intended
    C.quantify the degree of bronchial hyperresponsiveness
    (this multiple choice question has been scrambled)
  92. Appropriate documentation when conducting point-of-care assessment of a patient’s response to bronchodilator therapy includes all of the following except:

    A.blood levels of the bronchodilator agent
    B.vital signs, breath sounds, and pulmonary function test measures
    C.medication type, dose, and time received
    D.patient’s progress and ability to self-assess symptoms
    A.blood levels of the bronchodilator agent
    (this multiple choice question has been scrambled)
  93. Which of the following is false about the use of the peak expiratory flow rate (PEFR) in assessing a patient’s response to bronchodilator therapy?

    A.The peak flow measure is effort and volume dependent.
    B.PEFR and lab spirometry forced vital capacity values may correlate poorly.
    C.Some peak flowmeters are more accurate and reliable than others.
    D.PEFR is the standard for determining bronchodilator response.
    D.PEFR is the standard for determining bronchodilator response.
    (this multiple choice question has been scrambled)
  94. 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 chest
    3.auscultation
    4.arterial blood gas analysis and oximetry
    A.1, 2, 3, and 4
    B.2 and 3
    C.1, 3, and 4
    D.2, 3, and 4
    A.1, 2, 3, and 4
    (this multiple choice question has been scrambled)
  95. 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. Which of the following is most likely?

    A.deteriorating oxygenation
    B.improving ventilation/perfusion ratio ()
    C.decreasing airway obstruction
    D.increasing airway obstruction
    D.increasing airway obstruction
    (this multiple choice question has been scrambled)
  96. 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?

    A.increasing airway obstruction
    B.decreasing airway obstruction
    C.deteriorating oxygenation
    D.improving
    B.decreasing airway obstruction
    (this multiple choice question has been scrambled)
  97. Which of the following 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 minute, repeat up to 16 puffs. The best dose is the highest dose given without side effects.
    B.Give 12 puffs 1 minute apart; repeat every 20 minutes until maximum relief of symptoms is achieved without side effects.
    C.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.
    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.
    C.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.
    (this multiple choice question has been scrambled)
  98. 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 <10% to 15%
    2.when tachycardia occurs
    3.when tremors are evident
    4.when 6 to 8 puffs are delivered
    A.1, 2, 3, and 4
    B.2, 3, and 4
    C.1, 3, and 4
    D.1, 2, and 3
    D.1, 2, and 3
    (this multiple choice question has been scrambled)
  99. 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. Which of the following 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 second before and after each treatment.
    A.1, 2, 3, and 4
    B.1 and 2
    C.1, 3, and 4
    D.2, 3, and 4
    A.1, 2, 3, and 4
    (this multiple choice question has been scrambled)
  100. 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 wheezing disappears, and the intensity of breath sounds decreases.
    B.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.”
    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.
    B.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.”
    (this multiple choice question has been scrambled)
  101. 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.once per day
    B.every other day
    C.twice daily
    D.with each treatment
    C.twice daily
    (this multiple choice question has been scrambled)
  102. What schedule of peak expiratory flow rate assessment would you recommend for a home care asthmatic patient?

    A.once per day (on rising or at bedtime)
    B.3 to 4 times daily (on rising, noon, 4 to 7 PM, bedtime)
    C.1 to 2 times daily (at noon and around bedtime)
    D.1 to 2 times daily (on rising and at bedtime)
    B.3 to 4 times daily (on rising, noon, 4 to 7 PM, bedtime)
    (this multiple choice question has been scrambled)
  103. For a hospitalized patient who will require ongoing maintenance bronchodilator therapy after discharge, what should your end goal be?

    A.effective self-administration of the drug
    B.normal airflow and cessation of therapy
    C.peak expiratory flow rate that exceeds 70% of “personal best”
    D.complete relief of all patient symptoms
    A.effective self-administration of the drug
    (this multiple choice question has been scrambled)
  104. Which of the following factors is most crucial in developing an effective program of aerosol drug self-administration in an adult patient requiring maintenance bronchodilator therapy?

    A.reliable peak expiratory flow rate meter
    B.well-written brochures
    C.proper device selection
    D.good patient education
    D.good patient education
    (this multiple choice question has been scrambled)
  105. Which of the following 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
    A.2 and 3
    B.1, 2, and 3
    C.1 and 3
    D.1 and 2
    B.1, 2, and 3
    (this multiple choice question has been scrambled)
  106. 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 take a written or oral quiz on technique.
    B.Have the patient provide a repeat or return demonstration.
    C.Have the patient maintain detailed treatment logs.
    D.Have the patient describe the proper procedural steps.
    B.Have the patient provide a repeat or return demonstration.
    (this multiple choice question has been scrambled)
  107. 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. Which of the following would you now recommend?

    A.Discontinue the bronchodilator therapy.
    B.Use continuous bronchodilator therapy.
    C.Switch over to high-dose MDI steroids.
    D.Switch over to an anticholinergic agent.
    B.Use continuous bronchodilator therapy.
    (this multiple choice question has been scrambled)
  108. What is the recommended dosage for continuous bronchodilator therapy (CBT)?

    A.50.0 mg/hr
    B.15.0 mg/hr
    C.0.5 mg/hr
    D.5.0 mg/hr
    B.15.0 mg/hr
    (this multiple choice question has been scrambled)
  109. A physician orders continuous bronchodilator therapy with 1:200 albuterol for an asthmatic patient at the dosage of 20 mg/hr. How much 1:200 albuterol will be needed for the first hour of treatment?

    A.4 ml
    B.2 ml
    C.3 ml
    D.5 ml
    A.4 ml
    (this multiple choice question has been scrambled)
  110. Indications of an adverse drug response during continuous bronchodilator therapy include all of the following except:

    A.decreased consciousness
    B.vomiting
    C.palpitations
    D.worsening tachycardia
    A.decreased consciousness
    (this multiple choice question has been scrambled)
  111. To provide an extra margin of safety during continuous bronchodilator therapy (CBT), which of the following would you recommend be monitored?

    1.eosinophil count
    2.serum potassium levels 3.electrocardiogram
    A.2 and 3
    B.1 and 2
    C.1 and 3
    D.1, 2, and 3
    A.2 and 3
    (this multiple choice question has been scrambled)
  112. 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:

    A.timing of MDI actuation
    B.MDI propellant formula
    C.position of spacer in circuit
    D.type of spacer or adapter used
    B.MDI propellant formula
    (this multiple choice question has been scrambled)
  113. All of the following circuit-related factors have a major effect on metered-dose inhaler delivery of aerosolized drugs during mechanical ventilation except:

    A.type of humidifier
    B.endotracheal tube size
    C.temperature
    D.relative humidity
    C.temperature
    (this multiple choice question has been scrambled)
  114. All of the following ventilator-related factors have a major effect on metered-dose inhaler delivery of aerosolized drugs during mechanical ventilation except:

    A.VT
    B.duty cycle
    C.presence of positive end-expiratory pressure
    D.mode of support
    C.presence of positive end-expiratory pressure
    (this multiple choice question has been scrambled)
  115. 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.6.5% to 9.0%
    B.1.5% to 3.0%
    C.9.5% to 15.0%
    D.3.5% to 6.0%
    B.1.5% to 3.0%
    (this multiple choice question has been scrambled)
  116. 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.Place SVN in the inspiratory line 18 inches from the patient “wye.”
    3.Disconnect or bypass heated humidifier system.
    4.Turn off flow-by or continuous flow while nebulizing.
    5.Adjust ventilator volume or pressure limit for added flow
    A.1, 2, 3, 4, and 5
    B.1, 2, 3, and 5
    C.2, 3, and 4
    D.1, 2, and 3
    B.1, 2, 3, and 5
    (this multiple choice question has been scrambled)
  117. A patient on mechanical ventilation was given 4 puffs of albuterol 5 minutes ago through a metered-dose inhaler (MDI) and holding chamber placed 18 inches 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. Which of the following would you recommend at this time?

    A.Remove the circuit-holding chamber and repeat MDI actuation.
    B.Move the MDI closer to the patient’s airway and repeat use.
    C.Repeat administration until the desired response is achieved.
    D.Discontinue the albuterol and switch to a systemic bronchodilator.
    C.Repeat administration until the desired response is achieved.
    (this multiple choice question has been scrambled)
  118. 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.middle of inspiration
    B.beginning of inspiration
    C.end of inspiration
    D.beginning of exhalation
    B.beginning of inspiration
    (this multiple choice question has been scrambled)
  119. What is the most reliable indicator of a change in airway resistance due to bronchodilator administration during mechanical ventilation?

    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
    B.difference between peak airway and plateau pressures
    (this multiple choice question has been scrambled)
  120. Which of the following drugs present the greatest exposure risks for health care workers?

    1.albuterol (Proventil)
    2.pentamidine (Pentam 300)
    3.ribavirin (Virazole)
    4.acetylcysteine (Mucomyst)
    A.2 and 3
    B.1 and 4
    C.2, 3, and 4
    D.1, 2, and 3
    A.2 and 3
    (this multiple choice question has been scrambled)
  121. Side effects of environmental exposure to ribavirin or pentamidine aerosols include all of the following except:

    A.bronchospasm
    B.skin rashes
    C.tachyphylaxis
    D.conjunctivitis
    C.tachyphylaxis
    (this multiple choice question has been scrambled)
  122. Which of the following methods 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.
    A.1, 2, and 3
    B.1 and 2
    C.2 and 3
    D.1 and 3
    A.1, 2, and 3
    (this multiple choice question has been scrambled)

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Author:
idk
ID:
328157
Filename:
Ch36
Updated:
2017-02-05 17:32:30
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