Deck 11: Aerosols and Administration of Inhaled Medications

Question 1

A conventional jet nebulizer with a dead volume of 1 mL is filled with a 3-mL solution of albuterol. What percent of the medication is available for nebulization?

A) 33%
B) 50%
C) 75%
D) 100%

Answer 1

C
With a residual volume of 1 mL, a fill of 2 mL would leave only 50% of the nebulizer charge available for nebulization, whereas a fill of 4 mL would make 3 mL, or 75%, of the medication available for nebulization.

Question 2

Which of the following considerations is most important when using a large-volume nebulizer to provide oxygen and humidification to an infant in an incubator?

A) Meeting the inspiratory flow demands of the infant
B) Supplying the infant with adequate humidification
C) Delivering sufficient oxygen to meet the infant's needs
D) Preventing a high noise level from developing

Answer 2

D
Caution should be exercised when using LVNs with incubators or hoods because of the noise produced. The American Academy of Pediatrics recommends a sound level less than 58 dB to avoid hearing loss in patients in incubators and hoods. Many LVNs are designed to deliver controlled concentrations of oxygen and use a Venturi system to entrain air into the stream of gas administered to the patient. Standard entrainment nebulizers may deliver a fractional concentration of delivered oxygen approaching 1.00 but cannot provide a fractional concentration of inspired oxygen (FiO₂) greater than 0.40. High-flow nebulizers are designed to deliver high-flow rates of oxygen, bringing the FiO₂ up to 0.60 to 0.80. Closed dilution and gas injection nebulizers provide high-flow access to the nebulizer from two gas sources, allowing gas to mix without compromising FiO₂.

Question 3

Where in the ventilator circuit should a pMDI be placed to improve efficiency of aerosol delivery?

A) Near the ventilator before the humidifier than in the inspiratory limb near the Y
B) The inspiratory limb near the Y
C) 30 cm from the heated humidifier
D) In the expiratory limb

Answer 3

B
When operated in the inspiratory limb near the Y, the pMDI, USN, and VMN delivered 16% to 17% of the dose distal to the ETT, whereas the jet nebulizer delivered 3.5% in a heated, humidified circuit. Moving the aerosol generator back toward the ventilator increased the jet nebulizer to 6%, but reduced efficiency of the other generators. In a similar experiment with 2 and 5 LPM of bias flow, both VMN and jet nebulizer were more efficient placed near the ventilator before the humidifier than in the inspiratory limb near the Y.

Question 4

For which of the following types of patients would using a dry powder inhaler (DPI) for medication delivery likely be contraindicated?

A) A 4-year-old child
B) A patient with COPD
C) A teenager able to generate an inspiratory flow of 40 L/minute
D) An 11-year-old diagnosed with stable asthma

Question 5

When a conventional jet nebulizer is operated at a flow of 10 L/min versus 5 L/min, what should the respiratory therapist expect?

A) The particle size gets larger.
B) The particle size gets smaller.
C) The particle size remains stable.
D) The nebulizer will nebulize the full dose more slowly.

Question 6

The respiratory therapist is administering a standard nebulizer with a mask to a 2-year-old child. The mask is being held away from the child's face ("blow-by") due to crying. What should the RT consider doing to improve aerosol lung deposition?

A) Hold the mask close to the face to minimize the leak.
B) Change the aerosol to a pMDI.
C) Change the aerosol mask to a breath-enhanced nebulizer.
D) Ask the mother of the child to hold the mask and continue "blow-by" therapy.

Question 7

Pneumatic nebulizers operate according to which of the following physical tenets?

A) Venturi principle
B) Bernoulli principle
C) Law of continuity
D) Law of conservation of energy

Question 8

Which of the following functions are served by spacer and holding chambers in conjunction with pMDIs?
I) Reduction in oropharyngeal deposition of drug
II) Elimination of the "cold Freon effect"
III) Improvement in lower respiratory tract deposition
IV) Decrease in treatment time without sacrificing efficacy

A) I and III only
B) II and IV only
C) I, II, and III only
D) I, III, and IV only

Question 9

The respiratory therapist verifies an order to administer albuterol 1.25 mg to a 2-kg infant. Why does this dose have the same safety and efficacy profile as a 2.5-mg dose in the adult?

A) The deposition efficiency in the infant results in a similar lung dose per kg of the adult patient.
B) The liver of the infant metabolizes 95% of the drug. Therefore, the lung deposition is similar to that of the adult.
C) Albuterol targets only a minimal number of beta-2 receptors in the infant's airways.
D) The infant gets a higher lung dose, but it does not produce side effects.

Question 10

The physician in the emergency department is attending to a 12-year-old child who has an exacerbation of asthma. The physician asks the therapist to recommend a medication that has a synergistic effect with beta-2 agonists during asthma exacerbations. Which of the following medications should the therapist recommend?

A) Montelukast
B) Ipratropium bromide
C) Fluticasone
D) Triamcinolone

Question 11

Which of the following suggestions will have the most significant impact on the inhaled dose of medications with nebulizers?

A) Increasing the flow rate powering the nebulizer
B) Terminating the treatment prior to "sputter"
C) Adding 6 inches of tubing on the expiratory side of the nebulizer
D) Using breath-enhanced nebulizers

Question 12

An 18-month-old patient brought to the emergency department is exhibiting signs and symptoms consistent with an acute asthma episode and is administered a beta-2 agonist to which the patient does not respond favorably. Which of the following conditions could be responsible for this patient's problem?

A) Aspiration of a foreign object
B) Croup
C) Bronchiolitis
D) Pneumonia

Question 13

In order to guarantee the same performance of the nebulizer after repeated use, what should be suggested to the user?

A) Rinse with vinegar and air dry.
B) Rinse with sterile water and dry with a clean paper towel.
C) Rinse with a mixture of vinegar and sterile water and air dry.
D) Rinse with sterile water and air dry.

Question 14

Why are pass-over humidifiers preferred over pneumatic nebulizer humidifiers?

A) Pass-over humidifiers produce smaller particles and have a greater output.
B) The fraction of inspired oxygen (FiO₂) used with pass-over humidifiers is easier to control.
C) Pass-over humidifiers transmit fewer pathogens than pneumatic nebulizers.
D) Pass-over humidifiers have a smaller residual volume than pneumatic nebulizers.

Question 15

Which of the following nebulizers should be suggested to improve lung dose in patients undergoing invasive mechanical ventilation?

A) Jet nebulizer
B) Ultrasonic nebulizer
C) Breath-actuated nebulizer
D) Vibrating mesh nebulizer

Question 16

Why should pMDIs containing steroids in particular be used with a valved holding chamber?

A) To provide better lung deposition
B) To increase the dose of the medication
C) To enable the patient to take a deeper breath
D) To reduce the risk of oral thrush

Question 17

By what percentage can breath holding increase particle deposition in the lungs?

A) 5%
B) 10%
C) 15%
D) 20%

Question 18

An aerosol treatment is being administered via a jet nebulizer. After 8 minutes the nebulizer starts "sputtering." What should the therapist do at this point?

A) Tap the nebulizer cup until no more mist is produced.
B) Terminate the treatment at this time.
C) Allow the nebulizer to continue the treatment for 2 more minutes.
D) Add more diluent to the nebulizer cup.

Question 19

How can a patient avoid the problem of terminating inhalation when a plume from a pressurized metered-dose inhaler (pMDI) impacts the oropharynx?

A) Hold the pMDI closer the mouth.
B) Use a valved holding chamber.
C) Depress the nozzle only half the full distance.
D) Instruct the patient to inspire a short, rapid breath.

Question 20

When administering aerosol therapy to a pediatric patient, which of the following conditions can affect aerosol deposition?
I) Airway diameter
II) Respiratory rate
III) Body weight
IV) Nasal breathing

A) I and II only
B) II, III, and IV only
C) III and IV only
D) I, II, and IV only

Question 21

The therapist receives an order to administer a bronchodilator in-line to an infant receiving mechanical ventilation. The order also indicates that the nebulizer must not significantly increase the patient's delivered tidal volume. Which of the following aerosol delivery devices should the therapist select?
I) Vibrating mesh nebulizer
II) pMDI
III) Jet nebulizer
IV) Ultrasonic nebulizer

A) II and III only
B) I, II, and IV only
C) I, III, and IV only
D) III and IV only

Question 22

Which of the following tracheostomy sizes would produce the lowest amount of aerosol deposition in a spontaneously breathing pediatric patient?

A) 3.5 mm ID
B) 4.5 mm ID
C) 5.5 mm ID
D) All have similar deposition

Question 23

Which of the following methods is acceptable for delivering a drug via a pMDI to an intubated neonate receiving mechanical ventilation?

A) In-line with the ventilator
B) Through a resuscitation bag
C) Through a T-piece
D) In-line with a spacer