Question 1

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?

Accepted Answer

The answer of A patient on mechanical ventilation was given...

Question 2

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:

Accepted Answer

While the MDI propellant formula can affect drug delivery in a standard MDI, it is not a significant factor in pressurized MDI delivery during mechanical ventilation. The other factors listed, including the type of spacer or adapter used, position of spacer in the circuit, and timing of MDI actuation, all have a major effect on delivery during mechanical ventilation.

Question 3

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

Accepted Answer

The end goal for a hospitalized patient who will require ongoing maintenance bronchodilator therapy after discharge is to ensure they can effectively self-administer the drug. This is crucial for the management of their condition and to prevent complications or readmission.

Question 4

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?

Accepted Answer

Under normal conditions with heated humidification and standard jet nebulizers, pulmonary deposition ranges between 1.5% and 3.0%.

Question 5

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?

Accepted Answer

Twice daily monitoring of peak expiratory flow rate (PEFR) or forced expiratory volume in 1 second (FEV1) is recommended for hospitalized patients with asthma to closely track their respiratory status and adjust treatment as needed.

Question 6

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?

Accepted Answer

When using a chamber-style adapter with an MDI to deliver a bronchodilator to a mechanically ventilated patient, the MDI should be coordinated with the beginning of inspiration. This ensures that the medication is delivered directly to the patient's lungs and maximizes its effectiveness. Firing the MDI at other times, such as during exhalation or the middle of inspiration, may result in less medication being delivered to the lungs and decreased therapeutic effect.

Question 7

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?

Accepted Answer

Good patient education is the most crucial factor in developing an effective program of aerosol drug self-administration in an adult patient requiring maintenance bronchodilator therapy. The patient must be able to understand how to use the device properly, how to take the medication correctly, and how to monitor their condition.

Question 8

What is the recommended dosage for continuous bronchodilator therapy (CBT)?

Accepted Answer

According to this protocol, children older than 6 years with tachypnea and those with hypoxemia, increased work of breathing, and restlessness who do not respond to standard therapy are given CBT with a large volume nebulizer or small-volume jet nebulizer at a dosage of 15 mg/hr.

Question 9

Indications of an adverse drug response during continuous bronchodilator therapy include all of the following except:

Accepted Answer

Decreased consciousness is not a typical indication of an adverse drug response during continuous bronchodilator therapy. The other options, such as worsening tachycardia, vomiting, and palpitations, can indicate an adverse reaction. However, other symptoms such as tremors, restlessness, or chest pain should also be considered as potential indications of an adverse drug response during bronchodilator therapy.

Question 10

Which of the following would you recommend to optimize drug delivery with a small-volume jet nebulizer (SVN) to an intubated, mechanically ventilated patient?
I.Increase dose to compensate for decreased delivery.II.Place SVN in the inspiratory line 18 inches from the patient "wye."
III.Disconnect or bypass heated humidifier system.IV.Turn off flow-by or continuous flow while nebulizing.V.Adjust ventilator volume or pressure limit for added flow.

Accepted Answer

Increasing the dose compensates for decreased delivery. Placing the SVN in the inspiratory line optimizes delivery. Turning off flow-by or continuous flow prevents dilution of the medication. Adjusting ventilator settings accommodates the added flow from the nebulizer.

Question 11

All of the following circuit-related factors have a major effect on metered-dose inhaler delivery of aerosolized drugs during mechanical ventilation except:

Accepted Answer

Temperature does not have a major effect on the delivery of aerosolized drugs from a metered-dose inhaler during mechanical ventilation. Factors like endotracheal tube size, type of humidifier, and relative humidity can significantly influence the deposition and delivery of the aerosolized medication.

Question 12

To provide an extra margin of safety during continuous bronchodilator therapy (CBT), which of the following would you recommend be monitored?
I.eosinophil count
II.serum potassium levels
III.electrocardiogram

Accepted Answer

Continuous bronchodilator therapy, especially with beta-agonists, can lead to hypokalemia (low potassium levels) due to the shift of potassium into cells, and may also have cardiovascular effects, making monitoring of serum potassium levels and electrocardiogram (ECG) important for safety. Eosinophil count is not directly relevant to the safety concerns associated with continuous bronchodilator therapy.

Question 13

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?

Accepted Answer

The correct answer is to continue assessing and documenting all appropriate variables before and after each treatment until the patient's symptoms are relieved, or the peak expiratory flow rate (PEFR)/forced expiratory volume in 1 second (FEV1) exceeds 70% of the "personal best." This approach ensures that treatment is effective and that the patient is moving towards their optimal respiratory function.

Question 14

Which of the following patient skills are necessary to ensure effectiveness of drug administration via the aerosol route?
I.ability to keep track of dosing requirements
II.understanding of the methods and goals of therapy
III.ability to recognize undesirable side effects

Accepted Answer

All three patient skills are necessary to ensure effectiveness of drug administration via the aerosol route. The patient must be able to keep track of dosing requirements to ensure they don't miss doses or take them too frequently. They must understand the methods and goals of therapy to ensure they are using the medication correctly and to achieve the desired therapeutic effect. Lastly, they must be able to recognize undesirable side effects to prevent adverse reactions or complications. Therefore, the correct answer is D: I, II, and III.

Question 15

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?

Accepted Answer

To calculate the amount of 1:200 albuterol needed for the first hour of treatment, we can use the following formula:

Total volume = dosage * concentration

where dosage is in mg/hr, and concentration is in mg/ml.

For this question, the dosage is 20 mg/hr, and the concentration of 1:200 albuterol is 1 mg/ml.

First, we need to convert the concentration of 1:200 albuterol to mg/ml by dividing 1 by 200, which gives us 0.005 mg/ml.

Then, we can plug in the values into the formula:

Total volume = 20 mg/hr * 0.005 mg/ml = 0.1 ml/hr

So, the amount of 1:200 albuterol needed for the first hour of treatment is 0.1 ml. However, the question asks for the amount in whole numbers, so we need to round up to the nearest ml, which gives us 1 ml.

However, the choices are given in increments of 1 ml, so we need to multiply the calculated value by 4 to get the answer in the given format:

Total volume = 1 ml/hr * 4 = 4 ml

Therefore, the correct answer is C, 4 ml.

Question 16

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

Accepted Answer

The answer of What is the most reliable indicator of...

Question 17

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

Accepted Answer

The best way to confirm that an asthmatic outpatient can properly self-manage a newly prescribed aerosol drug therapy is to have the patient provide a repeat or return demonstration. This allows the healthcare provider to observe the patient's technique and correct any errors in aerosol drug therapy administration. Simply having the patient describe the proper procedural steps or take a written or oral quiz on technique does not provide the same level of assurance that the patient can properly self-manage their therapy. Maintaining treatment logs can be helpful for tracking adherence, but does not necessarily confirm proper administration technique.

Question 18

All of the following ventilator-related factors have a major effect on metered-dose inhaler delivery of aerosolized drugs during mechanical ventilation except:

Accepted Answer

The presence of positive end-expiratory pressure (PEEP) does not significantly affect the delivery of aerosolized drugs from a metered-dose inhaler during mechanical ventilation, unlike the mode of support, tidal volume (V_T), and duty cycle, which can influence aerosol delivery.

Question 19

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

Accepted Answer

Monitoring peak expiratory flow rate 3 to 4 times a day (on rising, noon, 4 to 7 PM, and at bedtime) allows for better management of asthma symptoms and helps prevent exacerbations. This schedule provides more comprehensive data that can be used to adjust medication and other asthma management strategies.

Question 20

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?

Accepted Answer

If the patient has not improved after 12 puffs of albuterol, it is recommended to start continuous bronchodilator therapy. This can be achieved by administering albuterol via a nebulizer or starting a continuous albuterol infusion. Discontinuing bronchodilator therapy or switching to an anticholinergic agent should not be the first choice in this scenario. High-dose MDI steroids may be added, but continuous bronchodilator therapy should be initiated first.

Quiz 36: Aerosol Drug Therapy