| Question | Answer |
| Which of the following describes the mass of drug leaving the mouthpiece of a nebulizer as aerosol? | B. Emitted Dose |
| To monitor a pt for possibility of reactive bronchospasm during aerosol drug therapy what should u do? | D. I,II,III,IV-Measure pre & post peak flow and/or %forced expiratory volume in 1 second, Auscultatefor adventitious breath sounds, Observe pt's response & Communicate with pt during therapy |
| Before inspiration and actuation of a MDI, the pt should exhale to which of the following? | C. Functional residual capacity |
| What devices generate therapeutic aerosols? | A. I & II- Atomizers & Nebulizers |
| Which of the following best defines an aerosol? | D. Suspension of liquid or solid particles in a gas |
| Proper use of a dry powder inhaler(DPI) requires that the pt be able to do what? | A. Generate inspiratory flows of 60 l/min or higher |
| When fired inside the mouth what % of the drug dose delivered by a simple MDI deposits in the oropahrynx? | D. About 80% |
| What will increase aerosol deopisiton by inertial impaction? | A. II & III-Variable or irregular passages & turbulent gas flow |
| What is a potential limitation of flow triggered MDI devices? | C. High flows necessary for actuation |
| What is teh proper dose response assessment of an MDI bronchodilator? | B. Give 4 puffs 1-2 minutes apart; repeat up to 12 puffs w/continued improvement. Best dose provides max subjective relief and highest PEFR w/o side effects. |
| Most of the spray generated by the majority of MDI's consist of what? | B. Propellant |
| The key difference b/w and MDI holding chamber and a spacer is that the holding chamber incorporates what? | B. One way inspiratory valve |
| What serious problems are associated with the delivery of Virazole using the SPAG? | B. I&III-Caregiver exposure to drug aerosol, drug precipitation in ventilator circuits |
| Asthma pt in severe resp distress presents to ER and is started on albuterol by SVN. Approaches recommended to assess therapy to pt.? | D. I,II,III,IV-Perform ABG analysis, Monitor SpO2, Asses breath sound & vitals before & after each tx., Measure PEFR or forced expiratory volume(FEV1) in 1 second before & after tx. |
| The mass of aerosol particles produced by a nebulizer in a given unit time best describes which quality of the aerosol? | C. Output |
| Indications of an adverse drug response during continuous bronchodilator therapy include all except: | A. decreased consciousness |
| SVN ouput drops after lowering pt's bed while giving a treatment but there is 3ml of solution still left in reservoir. Correct Problem? | C. Reposition pt so that the SVN is more upright. |
| Virazole aerosol precipitation causing malfunction of vent circuits can be overcome by what? | A. I&II-Placing a one way valve b/w SPAG and circuit, Placing HEPA filter proximal to exhgalation valve |
| Advantages of SVUN (Small volume ultrasonic Nebs) for drug delivery include all of the following except: | D. Decreased Cost |
| what is the retention of aerosol particles resulting from contact with respiratory tradct mucosa called? | D. Deposition |
| Which of the following is a common method to measure aerosol particle size? | C. Cascade Impaction |
| What aerosol drug delivery system would you recommend against using with a toddler or small child? | A. I&II- MDI & SVN |
| To ensure delivery of proper drug dosage with an MDI, which of the following must be done first? | C. II&III- Canister should be warmed to hand or body temp, & canister should be vigorously shaken. |
| What device depends the pt's inspiratory effort to dispense the dose? | C. Dry Powder Inhaler(DPI) |
| What device would you select to deliver an aerolized bronchodilatoir to a young child? | B. MDI, holding chamber, and mask |
| Where do most aerol particles in the 1-5 um range deposit? | C. Central airways |
| Which of the following aerosols would have the highest rate of deposition by diffusion? | MMAD of 0.1 um |
| When using a SPAG to administer Virazole to an infant which air flow settings would you use? | A. NEB-8L/min Drying Chamber-8L/min |
| Exhalation into what device can result in loss of drug delivery? | C. Dry powder inhaler |
| What measure is used to identify the particle diameter, which corresponds to the most typical settling behavior of an aerosol? | C. mean mass aerodynamic diameter(MMAD) |
| Where do most aerosol particles that are less than 3 um deposit? | A. Alveoli |
| Ina dose response seessment of pt's response to MDI bronchodilator, you would stop increasing the dose when? | A. I,II,&III-When PEFR improves <10%to15%, When tachycardia occurs, when tremors are evident |
| On average, what % of an aerosol drug delivery device's output actually deposits in the lungs? | B. 10%-20% |
| What would you recommend as initial therapy for pt admitted to ER w/ acute airway obstruction? | A. I&II- Asess dose response of MDI albuterol (up to 12 puffs), & Provide up to 3 SVN tx's w/albuterol q 20 minutes. |
| For maintenance administration of bronchodilators to adult pt w/adequate inspiratory flow, which aersol devices would u recommend? | D. III&IV- DPI, pMDI and holding chamber |
| What happens as the pressure for flow delivered thru a SVN gets higher? | D. I,II,III-Tx time becomes shorter, Patricle size becomes smaller, Aerosol output becomes greater. |
| To minimize risk of infection associated with aerosol drug therapy, whjat should you do? | D. I, II, III-Sterilize nebs b/w pts, Frequently replace in use units, rinse nebs with sterile water |
| Physician ordes continuous bronchodilator therapy with 1:200 albuterol for asthma pt at dosage of 20mg/hr. How much 1:200 albuterol will be needed for 1st hr of tx? | C. 4 ml |
| Immediately aftert firing, the aerosol produced by most MDI's are about how large? | D. 35 um |
| Normally, when using a 50-psi flowmeter to drive a SVN, you set the flow at what? | C. 6-8 L/min |
| For which pts would you recommend against using a flow triggered MDI as the sole bronchodilator delivery system? | A. Pt likely to develop acute severe bronchospasm |
| Best way to confirm that an asthmatic OP can prpoerly self manage a newly prescribed aerosol drug therapy? | B. Have pt provide a repeat or return demo. |
| When assessing a pt's response to bronchodilator therapy u notice a decrease in wheezing accompanied by an overall decrease in breath sounds. Whats most likely? | A. Increasing airway obstruction |
| When assessing a pt's response to bronchodilator therapy u notice a decrease in wheezing accompanied by an overall increase in breath sounds. Whats most likely? | C. Decrease in airway obstruction |
| For what pt groups is the DPI for bronchodilator administration NOT recommended? | A. I&II- Infants and children under 5, pt's with an acute bronchospastic episode |
| What is teh process by which aerosol suspension changes over time? | C. Aging |
| Appropriate documentation when conducting point of care assessment of a pt's response to bronchodilator therapy includes all except: | D. blood levels of the bronchodilator agent |
| What term describes the primary mechanism for deposition of small particles? | C. Brownian diffusion |
| What is false about the use of PEFR in assessing pts response to bronchodilator therapy? | B. PEFR is the standard for determining bronchodilator response |
| To minimize a pt's infection risk b/w drug tx's with a SVN what would you do? | A. Rinse the SVN with sterile water; air dry |
| After heated water aerosol tx thru jet nebs you notice a dramatic increase in the magnitude of coarse crackles heard on auscultation. Recommendations? | C. Add coughing and postural drainage to the therapy |
| Possible complications associated w. the selection of an aerosol drug delivery device include all except: | B. Overhydration or fluid imbalances |
| What is the preferred method for delivering bronchodilators to spntaneously breathing and intubated, ventialted pts? | C. MDI(Metered Dose Inhaler) |
| What is the primary mechanism for deposition of large, high mass particles(greater than 5 um) inthe respiratory tract? | A. Inertial Impaction |
| What is the primary hazard of aerosol drug therapy? | A. untoward drug reactions |
| What factor is most crucial in developing an effective program of aerosol drug self administration in an adult pt requiring maintenance bronchodilator therapy? | D. good patient education |
| What groups of pts are most likely to have difficulty using a simple MDI inhaler for aerosol drug therapy? | D. I,II,III- Pts in acute distress, infants & young children, elderly persons |
| Where do most aerosol particles in the 5-10 um range deposit? | D. Upper airways |
| When using a chamber style adapter with an MDI to deliver a bronchodilator to a pt receiving mech ventilation, with what would you coordinate MDI firing? | A. beginning of inspiration |
| Physician has ordered an anitviral agent ribavirin(Virazole) to be administered by aerosol to an infant with bronchiolitis. Use which device? | B. SPAG-Small particle aerosol generator |
| An asthmatic in severe ditress is admitted to ER. After full asessment and obatining a pre-tx baseline, you start pt on albuterol with a SVN. When should you stop documentation & tx? | A. The pt's symptoms are relieved pr PEFR/FEV1 in 1 second exceeds 70% of personal best. |
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