Question 1

The use of a drug in an age group for which there is a lack of FDA-approved dosing information is termed&#10;A)against the law.&#10;B)off-label.&#10;C)unapproved.&#10;D)orphan drug.

Accepted Answer

The termed off-label is used to refer to drugs lacking U.S.Food and Drug Administration (FDA)-approved dosing information for a specific age group or condition.Off-label prescribing is a commonly used and accepted medical practice.Although these drugs do have FDA approval,it is for a different use than the one prescribed.

Question 2

A respiratory therapist is administering a nebulizer treatment to an intubated pediatric patient and notices an increase in the patient's airway pressure.What could be the cause?&#10;A)The nebulizer&#10;B)The medication is working&#10;C)PEEP has decreased&#10;D)Decrease in volume delivered by the ventilator

Accepted Answer

Aerosol delivery appears less efficient in pediatric intubated patients than in spontaneously breathing patients.It is important to consider changes associated with the use of jet nebulizers in-line on pediatric and particularly neonatal ventilated patients because unexpected changes in both volume and pressure may have deleterious effects.An externally powered nebulizer increases volume and pressure during volume-targeted ventilation and creates a bias flow in the ventilator circuit that may interfere with patient-triggered modes of ventilation,may result in increased airway pressure and unexpected positive end-expiratory pressure (PEEP),and may result in variable fractional inspired oxygen (FIO₂)levels.Constant flow during expiration seriously limits the inspired concentration of the inspired aerosol.Other nebulizer designs,such as vibrating mesh/membrane systems,do not require a gas source to operate and do not affect airway pressures during operation as usually seen with externally gas powered nebulizers.

Question 3

You enter the room of a 15-month-old patient with respiratory syncytial virus (RSV)infection to deliver racemic epinephrine via small volume nebulizer (SVN).His mother asks you if it is okay for her to give her child the breathing treatment.Because your hospital policy allows this,you agree.During the treatment you notice that the patient's mother is holding the aerosol mask about 4 cm off of his face.You tell her

A)"Good idea … he seems much calmer this way."
B)"Maybe we should try blow-by instead."
C)"I'll be back later … it's my lunchtime."
D)"We need to hold the mask as close to his face as we possibly can to make sure he gets his medicine."

"We need to hold the mask as close to his face as we possibly can to make sure he gets his medicine."

Accepted Answer

Changes in respiratory patterns during nebulization have been shown to have an adverse impact on the delivery of aerosolized medication.Often the mask is simply held near the face,a technique known as "blow-by." It has been shown that a 1-cm to 2-cm gap between the mask and the face reduces the inhaled drug mass as a percentage of the nominal dose in a pediatric lung model of spontaneous breathing as much as 50%.

Question 4

Which of the following does affect aerosol drug delivery in infants and children?
1)Airway diameter
2)Gender
3)Tidal volume and flow rate
4)Respiratory rate

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

Accepted Answer

Functional and structural features of the infant lung that may affect aerosol delivery and deposition include tracheal diameter,tracheal length,tidal volume,respiratory rate,minute ventilation,dead space,and inspiratory flow rate.

Question 5

What is the average minute ventilation for a neonate?&#10;A)200-300 mL/kg/min&#10;B)2 L/min&#10;C)4 L/min&#10;D)6 L/min

Accepted Answer

Comparison of neonatal and adult respiratory parameters.
 11ea589b_08a3_d08b_91e5_1f9dc7318a26_TB3777_00

Question 6

A dry powder inhaler (DPI)is not recommended for children younger than age&#10;A)5 years&#10;B)7 years&#10;C)8 years&#10;D)12 years

Accepted Answer

An evidence-based review by the American College of Chest Physicians determined that for most patients with asthma,small volume nebulizers (SVNs),DPIs,and metered dose inhalers (MDIs)are equally effective in delivering short-acting F1F1F1S1F1F1F10 agonists.However,children younger than 5 years of age cannot effectively use,unassisted,a DPI or an MDI.

Question 7

A patient is considered a neonate if he or she is&#10;A)less than 37 weeks of gestational age.&#10;B)in the first month of postnatal life.&#10;C)12 to 18 years.&#10;D)1 to 12 months.&#10;E) 1 to 12 years.

Accepted Answer

Premature neonate,less than 37 weeks of gestational age;neonate,1st month of postnatal life;infant,1 to 12 months;child,1 to 12 years;adolescent,12 to 18 years;adult,older than 18 years

Question 8

An infant is given albuterol via a small volume nebulizer (SVN);what will happen to the L/T ratio of the infant compared with an adult?&#10;A)It will be much higher&#10;B)It will be the same&#10;C)It will be lower&#10;D)It will be slightly higher

Accepted Answer

As suggested by in vitro studies,the increasing upper airway geometry in adults may explain the higher amount of aerosol deposition reaching the lower airway compared with neonatal and pediatric patients.The clinician should always keep in mind the impact of higher upper airway aerosol deposition in infants who are obligate nasal breathers and children wearing facemasks.A smaller fraction of the nominal dose of an aerosol reaches the lower airways with a child-size oropharynx compared with an adult-size oropharynx.The smaller diameter of neonatal and pediatric lower airways,added to the effects of bronchoconstriction,inflammation,secretions,and the possible presence of an endotracheal tube,dramatically decreases aerosolized drug deposition in the lungs.Because the amount of drug deposited in the infant lung would be less,the L/T ratio would decline,provided that the same total dose was being used in both the adult and the infant.

Question 9

Generally,neonatal and pediatric drug dosing with inhaled aerosols is based on&#10;A)body size.&#10;B)a target effect strategy.&#10;C)when side effects occur.&#10;D)achievement of a certain blood level.

Accepted Answer

Generally,drug dosing with inhaled aerosols for neonatal and pediatric patients is not based on body size and blood level but rather on a target effect strategy with avoidance of toxicity.

Question 10

A patient is considered a premature neonate if he or she is&#10;A)less than 37 weeks of gestational age.&#10;B)in the first month of postnatal life.&#10;C)12 to 18 years.&#10;D)1 to 12 months.&#10;E) 1 to 12 years.

Accepted Answer

Premature neonate,less than 37 weeks of gestational age;neonate,1st month of postnatal life;infant,1 to 12 months;child,1 to 12 years;adolescent,12 to 18 years;adult,older than 18 years

Question 11

A patient is considered an infant if he or she is&#10;A)less than 37 weeks of gestational age.&#10;B)in the first month of postnatal life.&#10;C)12 to 18 years.&#10;D)1 to 12 months.&#10;E) 1 to 12 years.

Accepted Answer

The answer of A patient is considered an infant if...

Question 12

Which of the following affect penetration and deposition of an aerosol in neonatal and pediatric patients?
1)Inertial impaction
2)Particle size
3)Velocity
4)Sedimentation

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

Accepted Answer

The answer of Which of the following affect penetration and...

Question 13

A patient is considered an adolescent if he or she is&#10;A)less than 37 weeks of gestational age.&#10;B)in the first month of postnatal life.&#10;C)12 to 18 years.&#10;D)1 to 12 months.&#10;E) 1 to 12 years.

Accepted Answer

The answer of A patient is considered an adolescent if...

Question 14

A patient is considered a child if he or she is&#10;A)less than 37 weeks of gestational age.&#10;B)in the first month of postnatal life.&#10;C)12 to 18 years.&#10;D)1 to 12 months.&#10;E) 1 to 12 years.

Accepted Answer

The answer of A patient is considered a child if...

Deck 17: Neonatal and Pediatric Aerosolized Drug Therapy