Question 1

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?

Accepted Answer

PEFR is not considered the standard for determining bronchodilator response. Instead, the change in forced expiratory volume in 1 second (FEV1) or forced vital capacity (FVC) is commonly used to assess response to bronchodilator therapy.

Question 2

A semiconscious patient with inadequate spontaneous ventilation requires aerosol drug administration. Which of the following approaches would you recommend?

Accepted Answer

Intermittent positive-pressure breathing (IPPB) can assist in delivering aerosolized medication to patients with inadequate spontaneous ventilation by providing positive pressure to help with inhalation.

Question 3

Appropriate documentation when conducting point-of-care assessment of a patient's response to bronchodilator therapy includes all of the following except:

Accepted Answer

Blood levels of the bronchodilator agent are not routinely tested or documented during point-of-care assessment of a patient's response to bronchodilator therapy. The other options listed (medication type, dose, and time received; vital signs, breath sounds, and pulmonary function test measures; patient's progress and ability to self-assess symptoms) are all appropriate documentation for this type of assessment.

Question 4

To assess the effectiveness of a particular aerosol delivery device selection, what would you evaluate?
I.patient's technique in using the device
II.patient's response to and compliance with procedure
III.objective measures of improvement (e.g., peak flow)

Accepted Answer

To fully assess the effectiveness of a particular aerosol delivery device selection, all three factors should be evaluated. The patient's technique in using the device, their response to and compliance with the procedure, and objective measures of improvement (e.g. peak flow) are all important components in determining the success of the treatment. Therefore, the best choice is D, which includes all three factors.

Question 5

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

MDIs and dry powder inhalers require good coordination and inspiratory flow rates, which may be difficult for toddlers or small children to achieve.

Question 6

Indications for assessment of patient's response to bronchodilator therapy include all of the following except to:

Accepted Answer

Assessing the patient's response to bronchodilator therapy is not done to quantify the degree of bronchial hyperresponsiveness. Rather, it is done to confirm whether the therapy works as intended, individualize the dose, frequency, or type of medication, and help follow the patient's status during long-term therapy.

Question 7

A patient admitted to the emergency department has acute, severe bronchospasm and will likely need high or multiple doses of bronchodilator. Which of the following aerosol drug delivery devices would you recommend in this situation?
I.large-volume continuous nebulizer
II.small-volume jet nebulizer (SVN)III.dry powder inhaler
IV.pressurized metered-dose inhaler and holding chamber

Accepted Answer

In acute, severe bronchospasm, a large-volume continuous nebulizer or a small-volume jet nebulizer (SVN) is recommended because they can deliver a continuous or high dose of medication directly to the lungs, which is necessary for rapid relief in emergency situations. Dry powder inhalers and pressurized metered-dose inhalers require a level of inhalation technique that might be difficult for a patient in severe distress to achieve.

Question 8

Possible complications associated with the selection of an aerosol drug delivery device include all of the following except:

Accepted Answer

Overhydration or fluid imbalances are not usually associated with the selection of an aerosol drug delivery device. Complications with selection are more related to drug delivery and technique, drug-specific adverse effects, and exposure risks.

Question 9

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?
I.	Perform arterial blood gas analysis.
II.	Continuously monitor the SpO2.
III.	Assess breath sounds and vital signs before and after each treatment.
IV.	Measure peak expiratory flow rate or forced expiratory volume in 1 second before and after each treatment.

Accepted Answer

All the approaches listed are valid methods to assess the effectiveness of albuterol therapy in an asthmatic patient in severe distress. Arterial blood gas analysis can provide information on the patient's oxygenation and carbon dioxide levels, continuous SpO2 monitoring offers real-time data on oxygen saturation, assessing breath sounds and vital signs before and after each treatment can help determine the clinical response to the therapy, and measuring peak expiratory flow rate or forced expiratory volume in 1 second before and after each treatment can quantitatively assess the improvement in airway obstruction.

Question 10

In a dose-response assessment of a patient's response to a metered-dose inhaler bronchodilator, when would you stop increasing the dose?
I.when the peak expiratory flow rate improves <10% to 15%
II.when tachycardia occurs
III.when tremors are evident
IV.when 6 to 8 puffs are delivered

Accepted Answer

The dose of a bronchodilator should be stopped from increasing when the peak expiratory flow rate improves by less than 10% to 15%, indicating optimal bronchodilation has been achieved, or when side effects such as tachycardia or tremors occur, as these are signs of overdosage or excessive response to the medication. The specific number of puffs (6 to 8) is not a universal criterion for stopping dose escalation.

Question 11

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

Accepted Answer

Option B provides a reasonable dose-response assessment of a metered-dose inhaler bronchodilator by giving an initial 4 puffs, waiting for 1-2 minutes, and repeating up to 12 puffs with continued improvement. The best dose is the one that produces maximum subjective relief and the highest peak expiratory flow rate without side effects. Option A recommends giving up to 16 puffs, which is a higher dose than necessary, and repeating them every minute, which is not practical. Option C recommends giving 12 puffs every minute until maximum relief of symptoms is achieved, which may also result in a higher dose than necessary. Option D recommends giving only 2 puffs initially, which may not provide adequate relief of symptoms, and repeating them up to 6 puffs, which is likely to result in a suboptimal dose.

Question 12

For maintenance administration of bronchodilators to an adult patient with adequate inspiratory flow, which of the following aerosol drug delivery devices would you recommend?
I.pressurized metered-dose inhaler (pMDI)II.small-volume jet nebulizer
III.dry powder inhaler
IV.pMDI and holding chamber

Accepted Answer

Dry powder inhalers and pressurized metered-dose inhalers with a holding chamber can be recommended for maintenance administration of bronchodilators to an adult patient with adequate inspiratory flow. Small-volume jet nebulizers are typically reserved for patients who cannot adequately use the other devices or for acute exacerbations.

Question 13

In selecting the appropriate aerosol drug delivery device for a given patient, what must you consider?
I.available drug formulation(s)II.desired site of deposition
III.patient's characteristics
IV.patient's preference

Accepted Answer

The answer of In selecting the appropriate aerosol drug delivery...

Question 14

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

Accepted Answer

The average mean mass aerodynamic diameter (MMAD) generated by the vibrating mesh nebulizers is 2 to 3 μm.

Question 15

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)?
I.	Assess dose-response of metered-dose inhaler (MDI) albuterol (up to 12 puffs).
II.	Provide up to three small-volume jet nebulizer (SVN) treatments with albuterol every 20 minutes.
III.	Immediately begin continuous albuterol therapy at 15 mg/hr.

Accepted Answer

For acute airway obstruction, initial therapy often involves rapid-acting bronchodilators like albuterol. Both metered-dose inhalers (MDIs) with a spacer and small-volume jet nebulizer (SVN) treatments are effective for delivering albuterol in acute settings. Continuous albuterol therapy at 15 mg/hr is typically reserved for more severe cases and not usually the first step.

Question 16

In addition to bedside pulmonary function test measures, what other components of patient assessment are useful in evaluating bronchodilator therapy?
I.patient interview and observation
II.measurement of vital signs
III.chest auscultation
IV.arterial blood gas analysis and oximetry

Accepted Answer

All listed components are useful in evaluating bronchodilator therapy. Patient interview and observation can provide subjective data on symptom improvement. Measurement of vital signs, chest auscultation, and arterial blood gas analysis and oximetry offer objective data on the physiological effects of the therapy.

Question 17

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?

Accepted Answer

A decrease in wheezing with a decrease in breath sound intensity may indicate increasing airway obstruction, as the air movement is reduced, leading to less audible wheezing and breath sounds.

Question 18

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

Accepted Answer

Mouth breathing actually facilitates the pulmonary deposition of aerosolized drugs by allowing the medication to be directly inhaled into the lungs, bypassing the nasal passages where some of the medication might otherwise be filtered out or deposited.

Question 19

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

The decrease in wheezing and increase in the intensity of breath sounds after bronchodilator therapy indicate that the airways are becoming less obstructed, allowing more air to flow through, which is consistent with decreasing airway obstruction.

Question 20

On the average, what percentage of an aerosol drug delivery device's output actually deposits in the lungs?

Accepted Answer

On average, 10% to 20% of an aerosol drug delivery device's output actually deposits in the lungs, with the rest being lost due to factors like evaporation, exhalation, or deposition in the oropharynx.

Quiz 36: Aerosol Drug Therapy

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 semiconscious patient with inadequate spontaneous ventilation requires aerosol drug administration. Which of the following approaches would you recommend?

Appropriate documentation when conducting point-of-care assessment of a patient's response to bronchodilator therapy includes all of the following except:

To assess the effectiveness of a particular aerosol delivery device selection, what would you evaluate? I.patient's technique in using the device II.patient's response to and compliance with procedure III.objective measures of improvement (e.g., peak flow)

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

Indications for assessment of patient's response to bronchodilator therapy include all of the following except to:

Possible complications associated with the selection of an aerosol drug delivery device include all of the following except:

In a dose-response assessment of a patient's response to a metered-dose inhaler bronchodilator, when would you stop increasing the dose? I.when the peak expiratory flow rate improves <10% to 15% II.when tachycardia occurs III.when tremors are evident IV.when 6 to 8 puffs are delivered

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

For maintenance administration of bronchodilators to an adult patient with adequate inspiratory flow, which of the following aerosol drug delivery devices would you recommend? I.pressurized metered-dose inhaler (pMDI) II.small-volume jet nebulizer III.dry powder inhaler IV.pMDI and holding chamber

In selecting the appropriate aerosol drug delivery device for a given patient, what must you consider? I.available drug formulation(s) II.desired site of deposition III.patient's characteristics IV.patient's preference

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

In addition to bedside pulmonary function test measures, what other components of patient assessment are useful in evaluating bronchodilator therapy? I.patient interview and observation II.measurement of vital signs III.chest auscultation IV.arterial blood gas analysis and oximetry

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?

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

On the average, what percentage of an aerosol drug delivery device's output actually deposits in the lungs?