Question 1

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 2

Proper use of a soft mist inhaler requires that the patient be able to do which of the following?

Accepted Answer

To operate the device, patients twist the body of the device to load an internal spring, place the mouthpiece of the Respimat between the lips, and press a button to release the drug through a uniblock to create the aerosol, which is released over 1.1 to 1.4 sec, depending on the formulation configuration. The Respimat requires hand-breath coordination on the part of the patient, as does a pMDI, but because of the longer aerosolization time, it seems more likely that the patient will get a greater percent of emitted dose despite coordination issues.

Question 3

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

Improvement is indicated when wheezing decreases and the overall intensity of breath sounds increases.

Question 4

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

Continuing assessment and documentation 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" is a standard approach in managing acute asthma exacerbations. This threshold indicates significant improvement in airway obstruction and is a practical target for adjusting treatment.

Question 5

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

In terms of breath sounds, a decrease in wheezing accompanied by an overall decrease in the intensity of breath sounds indicates worsening airway obstruction or patient fatigue.

Question 6

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

Accepted Answer

For patients who need ongoing maintenance therapy after the acute phase of illness, the goal should be effective self-administration of the drug.

Question 7

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
3) Chest auscultation
4) 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 can show physiological responses to therapy. Chest auscultation can reveal changes in airway sounds, indicating improvement or worsening. Arterial blood gas analysis and oximetry provide objective measures of gas exchange and oxygenation, which are directly affected by bronchodilator therapy.

Question 8

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

Accepted Answer

The exit velocity of the aerosol is low, less than 4 m/sec, and the particle size can range between 2 and 3 µm MMAD, varying with the exit diameter of the apertures

Question 9

After initially conducting a pre- and postbronchodilator 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 asthmatic patients to closely track their respiratory status and adjust treatment as needed.

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?
1) When the peak expiratory flow rate improves less than 10% to 15%
2) When tachycardia occurs
3) When tremors are evident
4) When 6 to 8 puffs are delivered

Accepted Answer

According to the question, we are assessing the patient's response to a metered dose inhaler bronchodilator. The question asks when to stop increasing the dose. Options 2 and 3 both indicate adverse effects of the medication, which would require cessation or reduction of the dose. Therefore, options 2 and 3 are correct. Option 4 is not a valid reason for stopping the dose, as the number of puffs delivered does not indicate the patient's response to the medication. Option 1 is incorrect as it only indicates a partial improvement in the patient's condition. Therefore, the correct answer is A.

Question 11

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

Accepted Answer

A simple albuterol dose-response titration involves giving an initial 4 puffs (90 mcg/puff) at 1-min intervals through a pressurized MDI with a holding chamber. If after 5 min, airway obstruction is not relieved, the respiratory therapist gives 1 puff/min until symptoms are relieved, heart rate increases to more than 20 beats/min, tremors increase, or 12 puffs are delivered. The best dose is that which provides maximum relief of symptoms and the highest PEFR without side effects.

Question 12

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

Accepted Answer

The answer of Which of the following aerosol drug delivery...

Question 13

Factors associated with reduced pulmonary deposition of aerosolized drugs include which of the following?
1) Mechanical ventilation
2) Artificial airways
3) Poor patient technique
4) Mouth breathing

Accepted Answer

Mechanical ventilation and artificial airways can alter the flow of inhaled air and reduce the deposition of aerosolized drugs in the lungs. Poor patient technique, such as improper inhalation, can also lead to reduced deposition. Mouth breathing can also cause a higher proportion of the drug to be deposited in the oropharynx rather than the lungs. Therefore, factors 1, 2, and 3 can all contribute to reduced pulmonary deposition.

Question 14

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

Accepted Answer

Checking the peak expiratory flow rate 3 to 4 times daily (on rising, noon, 4 to 7 PM, bedtime) provides a better overview of the patient's asthma control throughout the day. This allows for earlier detection and management of potential exacerbations.

Question 15

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 characteristics
4) Patient's preference

Accepted Answer

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

Question 16

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] <60% predicted)?
1) Assess dose-response of metered dose inhaler (MDI) albuterol (up to 12 puffs).
2) Provide up to three small-volume jet nebulizer (SVN) treatments with albuterol every 20 min.
3) Immediately begin continuous albuterol therapy at 15 mg/hr.

Accepted Answer

Options 1 and 2 are appropriate initial therapies for acute airway obstruction. Metered dose inhalers (MDIs) with a spacer or nebulized treatments are both effective for delivering fast-acting bronchodilators like albuterol. Option 3, continuous albuterol therapy, is typically reserved for more severe cases and not usually the first step.

Question 17

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

Accepted Answer

Dry powder inhalers (3) are suitable for patients with adequate inspiratory flow as they require a strong and fast inhalation. A pMDI with a holding chamber (4) improves medication delivery and is effective for maintenance therapy.

Question 18

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 sec 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. Arterial blood gas analysis can help determine the severity of the asthma attack and the effectiveness of treatment. Continuous monitoring of oxygen saturation (SpO2) provides real-time information on the patient's oxygenation status. Assessing breath sounds and vital signs before and after each treatment can help determine the clinical response to the therapy. Measuring peak expiratory flow rate or forced expiratory volume in 1 second before and after treatment can provide objective data on the improvement in airway obstruction.

Question 19

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)

Accepted Answer

To assess the effectiveness of an aerosol delivery device, it's important to evaluate the patient's technique in using the device, their response to and compliance with the procedure, and objective measures of improvement such as peak flow. This comprehensive approach ensures that the device is being used correctly and is effectively improving the patient's condition.

Question 20

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

Accepted Answer

Depending on device and patient, as little as 10% or less of drug emitted from an aerosol device may be deposited in the lungs

Quiz 39: Aerosol Drug Therapy

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

Proper use of a soft mist inhaler requires that the patient be able to do which of the following?

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?

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?

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

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 3) Chest auscultation 4) Arterial blood gas analysis and oximetry

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

After initially conducting a pre- and postbronchodilator 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?

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 less than 10% to 15% 2) When tachycardia occurs 3) When tremors are evident 4) 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?

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

Factors associated with reduced pulmonary deposition of aerosolized drugs include which of the following? 1) Mechanical ventilation 2) Artificial airways 3) Poor patient technique 4) Mouth breathing

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

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 characteristics 4) Patient's preference

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

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)

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