Deck 11: Aerosols and Administration of Medication

Question 1

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

Answer 1

D
Compared with adults,infants and children have smaller airway diameters,higher and irregular breathing rates,engage in nose breathing (which filters out large particles),and often have difficulty with mouthpiece administration.Cooperation and ability to perform aerosol inhalation techniques effectively vary with the child's age and developmental ability.

Question 2

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

Answer 2

B
Pneumatic nebulizers use the Bernoulli principle to drive a high-pressure gas through a restricted orifice and draw the medication and diluents into the gas stream through a capillary tube immersed in the solution.Shearing the fluid stream in the jet forms the aerosol stream that impacts against a baffle,removing larger particles that may return to the reservoir.

Question 3

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)66%
D)100%

Answer 3

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 4

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 a 6 inches of tubing on the expiratory side of the nebulizer
D)Using breath-enhanced nebulizers

Question 5

The respiratory therapist is administering a 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 excessive crying.What should the RT consider doing to improve aerosol lung deposition?

A)Comfortably 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 mouthpiece.
D)Ask the mother of the child to hold the mask and continue "blow-by" therapy.

Question 6

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 7

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/min
D)An 11-year-old diagnosed with stable asthma

Question 8

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 9

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 10

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 yeast infections

Question 11

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 12

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 13

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

Question 14

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

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

Question 15

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 16

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 17

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 18

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 treatment time shortens.
C)The particle size remains stable.
D)The nebulizer will nebulize the full dose more slowly.

Question 19

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

A)Between the "y" adapter and the endotracheal tube
B)30 cm from the ETT in the inspiratory limb
C)30 cm from the heated humidifier
D)In the expiratory limb

Question 20

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 21

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

Question 22

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)II,III,and IV only