Deck 36: Aerosol Drug Therapy

Question 1

Most nebulizers used in respiratory care produce which type of aerosol suspension?

A)monodisperse
B)microaerosol
C)heterodisperse
D)macroaerosol

Answer 1

C

Question 2

With which of the following devices are therapeutic aerosols generated?
I)atomizers
II)nebulizers
III)humidifiers

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

Answer 2

A

Question 3

Which of the following factors affect pulmonary deposition of an aerosol?
I)size of the particles
II)shape and motion of the particles
III)physical characteristics of the airways

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

Answer 3

D

Question 4

What is the retention of aerosol particles resulting from contact with the respiratory tract mucosa called?

A)stability
B)density
C)penetration
D)deposition

Question 5

Which of the following will increase aerosol deposition by inertial impaction?
I)high-velocity gas flow
II)variable or irregular passages
III)turbulent gas flow
IV)particles of high mass

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

Question 6

Where do most aerosol particles that are less than 3 $\mu$ m deposit?

A)alveoli
B)bronchioles
C)central airways
D)upper airways

Question 7

Where do most aerosol particles in the 5- to 10- $\mu$ m range deposit?

A)alveoli
B)bronchioles
C)central airways
D)upper airways

Question 8

What is the primary mechanism for central airway deposition of particles in the 1- to 5- $\mu$ m range?

A)impaction
B)sedimentation
C)diffusion
D)Brownian motion

Question 9

What term describes the primary mechanism for deposition of small particles?

A)hygroscopic condensation
B)gravity sedimentation
C)Brownian diffusion
D)inertial impaction

Question 10

Where do most aerosol particles in the 1- to 5- $\mu$ m range deposit?

A)alveoli
B)bronchioles
C)central airways
D)upper airways

Question 11

Which of the following best defines an aerosol?

A)suspension of liquid droplets in a gas
B)suspension of particulate matter in a gas
C)molecular water dispersed throughout a carrier gas
D)suspension of liquid or solid particles in a gas

Question 12

What is the primary fate of inhaled aerosol particles that are between 1 and 0.5 $\mu$ m?

A)Most are cleared during exhalation.
B)Most deposit in the central airways.
C)Most deposit in the upper airway.
D)Most deposit in the alveoli.

Question 13

Which of the following describes the mass of drug leaving the mouthpiece of a nebulizer as aerosol?

A)single dose
B)emitted dose
C)multiple dose
D)output dose

Question 14

What measure is used to identify the particle diameter, which corresponds to the most typical settling behavior of an aerosol?

A)mean mass velocity coefficient (MMVC)
B)logarithmic standard diameter (LSD)
C)mean mass aerodynamic diameter (MMAD)
D)geometric standard deviation (GSD)

Question 15

The mass of aerosol particles produced by a nebulizer in a given unit time best describes which quality of the aerosol?

A)stability
B)density
C)output
D)deposition

Question 16

Which of the following aerosols would have the highest rate of deposition by diffusion?

A)MMAD of 0.1 $\mu$ m
B)MMAD of 3.0 $\mu$ m
C)MMAD of 10.0 $\mu$ m
D)MMAD of 50.0 $\mu$ m

Question 17

Which of the following techniques will increase aerosol deposition by sedimentation in the lungs?

A)high inspiratory flow
B)short inspiratory time
C)10-second breath-hold
D)short expiratory time

Question 18

Which of the following is a common method to measure aerosol particle size?

A)scan
B)gravimetric
C)cascade impaction
D)penetration studies

Question 19

What measure is used to describe the variability of particle diameters in an aerosol?

A)MMVC
B)LSD
C)MMAD
D)GSD

Question 20

What is the primary mechanism for deposition of large, high-mass particles (greater than 5 $\mu$ m) in the respiratory tract?

A)inertial impaction
B)sedimentation
C)diffusion
D)Brownian motion

Question 21

Immediately after firing, the aerosol particles produced by most metered-dose inhalers are about how large?

A)1 $\mu$ m
B)5 $\mu$ m
C)20 $\mu$ m
D)35 $\mu$ m

Question 22

To monitor a patient for the possibility of reactive bronchospasm during aerosol drug therapy, what should you do?
I. Measure pre- and post-peak flow and/or percentage forced expiratory volume in 1 second (%FEV1).
II. Auscultate for adventitious breath sounds.
III. Carefully observe the patient’s response.
IV. Communicate with the patient during therapy.

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

Question 23

When using a metered-dose inhaler without a holding chamber or a spacer, the patient should be instructed to fire the device at what point?

A)immediately before beginning a slow inspiration
B)immediately after beginning a slow exhalation
C)immediately after beginning a slow inspiration
D)immediately before beginning a slow exhalation

Question 24

Each firing of a typical metered-dose inhaler delivers about what output volume?

A)10 to 30 $\mu$ l
B)30 to 100 $\mu$ l
C)10 to 30 ml
D)30 to 100 ml

Question 25

To minimize the risk of infection associated with aerosol drug therapy, what should you do?
iI. Sterilize nebulizers between patients.
II. Frequently replace in-use units.
III. Rinse nebulizers with sterile water.

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

Question 26

Most of the spray generated by the majority of metered-dose inhalers consists of which of the following?

A)active drug
B)propellant
C)surfactant agents
D)water solution

Question 27

As hygroscopic aerosol particles enter the respiratory tract, what do they tend to do?

A)decrease in size because of the absorption of molecular water
B)increase in size because of the absorption of molecular water
C)increase in size because of the evaporation of molecular water
D)decrease in size because of the evaporation of molecular water

Question 28

A physician wants to deliver a therapeutic aerosol to the lung parenchyma (alveolar region). To help ensure maximum deposition in this area, you would select an aerosol generator with an MMAD in what range?

A)5 to 20 $\mu$ m
B)2 to 5 $\mu$ m
C)1 to 3 $\mu$ m
D)less than 1 $\mu$ m

Question 29

What is the preferred method for delivering bronchodilators to spontaneously breathing and intubated, ventilated patients?

A)dry powder inhaler
B)small-volume jet nebulizer
C)metered-dose inhaler
D)hand-bulb atomizer

Question 30

Which of the following particle distributions is produced by a typical metered-dose inhaler?

A)3- to 6- $\mu$ m mean mass aerodynamic diameter (MMAD)
B)1- to 3- $\mu$ m MMAD
C)6- to 9- $\mu$ m MMAD
D)less than 1- $\mu$ m MMAD

Question 31

All of the following drugs or drug categories have been associated with increased airway resistance and bronchospasm during aerosol administration except:

A)steroids
B)albuterol
C)acetylcysteine
D)antibiotics

Question 32

Which of the following is false about changes in aerosol suspensions over time?

A)Liquid aerosol particles can shrink (evaporation) or grow (water absorption).
B)The rate of particle growth is directly proportional to particle size.
C)Small water-based particles tend to shrink when exposed to dry gas.
D)Aerosols of water-soluble salts tend to grow in a humidified environment.

Question 33

What is the process by which aerosol suspension changes over time?

A)evaporation
B)deposition
C)aging
D)sublimation

Question 34

A physician wants to deliver a therapeutic aerosol to the upper airway (nose, larynx, trachea). To help ensure maximum deposition in this area, you would select an aerosol generator with an MMAD in what range?

A)5 to 50 $\mu$ m
B)2 to 5 $\mu$ m
C)1 to 3 $\mu$ m
D)less than 1 $\mu$ m

Question 35

About what range of drug dosages can be provided with each firing of a metered-dose inhaler?

A)5 to 50 mg
B)50 to 100 mg
C)5 to 50 $\mu$ g
D)50 $\mu$ g to 5 mg

Question 36

Drug aerosol delivery systems include all of the following except:

A)dry powder inhalers (DPIs)
B)small-volume jet nebulizers
C)metered-dose inhalers (MDIs)
D)spinning disk nebulizers

Question 37

A patient with chronic bronchitis is receiving heated water aerosol treatments through a jet nebulizer four times daily to aid in mobilizing retained secretions. After each treatment, you note a dramatic increase in the magnitude of coarse crackles heard on auscultation. Which of the following recommendations would you make to the physician?

A)Discontinue the heated water aerosol treatments.
B)Switch to a higher-density aerosol (e.g., ultrasonic).
C)Add coughing and postural drainage to the therapy.
D)Consider prior treatment with a bronchodilator.

Question 38

When fired inside the mouth, what percentage of the drug dose delivered by a simple metered-dose inhaler (MDI) deposits in the oropharynx?

A)about 20%
B)about 40%
C)about 60%
D)about 80%

Question 39

A physician wants to deliver a therapeutic aerosol to the central and lower airways. To help ensure maximum deposition in this area, you would select an aerosol generator with an MMAD in what range?

A)5 to 20 $\mu$ m
B)2 to 5 $\mu$ m
C)1 to 3 $\mu$ m
D)less than 1 $\mu$ m

Question 40

What is the primary hazard of aerosol drug therapy?

A)untoward drug reactions
B)pulmonary infection
C)airway reactivity
D)drug reconcentration

Question 41

For which of the following patients would you recommend against using a flow-triggered metered-dose inhaler (MDI) as the sole bronchodilator delivery system?

A)patient likely to develop acute severe bronchospasm
B)stable elderly patient on maintenance bronchodilator therapy
C)teenage asthmatic who refuses to use a holding chamber
D)patient who cannot coordinate MDI firing with inhalation

Question 42

Which of the following small-volume jet nebulizer design features affect its performance?
I)position
II)residual volume
III)baffles
IV)reservoirs

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

Question 43

After actuating a metered-dose inhaler with a holding chamber, what should the patient be instructed to do?

A)Take a large breath and hold it for at least 5 seconds.
B)Continue to breathe through the device for three breaths.
C)Immediately exhale as fast and as much as possible.
D)Take one quick breath and remove the holding chamber.

Question 44

Advantages of the dry power inhaler (DPI) drug delivery systems include all of the following except:

A)low relative cost
B)no propellants required
C)no hand-breath coordination necessary
D)unaffected by humidity

Question 45

Which of the following groups of patients are most likely to have difficulty using a simple metered-dose inhaler for aerosol drug therapy?
I)patients in acute distress
II)infants and young children
III)elderly persons

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

Question 46

To decrease the likelihood of an opportunistic yeast or fungal infection associated with metered-dose inhaler (MDI) steroids, what would you recommend that a patient do?
I. Cut in half the number of puffs or treatments.
II. Use a spacer or holding chamber.
III. Rinse the mouth after each treatment.

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

Question 47

Proper use of a dry power inhaler (DPI) requires that the patient be able to do which of the following?

A)generate inspiratory flows of 60 L/min or higher
B)exhale forcibly through the device before drug delivery
C)inhale slowly (less than 0.5 L/sec) and perform a breath-hold
D)coordinate firing of the DPI with inspiration

Question 48

Before inspiration and actuation of a metered-dose inhaler, the patient should exhale to which of the following?

A)total lung capacity
B)residual volume
C)functional residual capacity
D)expiratory reserve volume

Question 49

What is a potential limitation of flow-triggered metered-dose inhaler devices?

A)increased pharyngeal impaction
B)less effective lung deposition
C)high flows necessary for actuation
D)requires accessory equipment

Question 50

Which of the following devices depends on the patient's inspiratory effort to dispense the dose?

A)small-volume jet nebulizers
B)metered-dose inhaler
C)dry power inhaler
D)ultrasonic nebulizer

Question 51

Which of the following would be correct instructions for a patient being taught proper use of a dry power inhaler?
I. Place mouthpiece 4 cm from mouth.
II. Exhale slowly to FRC.
III. Inhale slowly (less than 30 L/min).
IV. Repeat until dose is used up.

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

Question 52

Which of the following are beneficial effects of using a holding chamber with a metered-dose inhaler (MDI)?
I)reduction in oropharyngeal aerosol deposition
II)decrease in need for hand-breath coordination
III)elimination of medication waste

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

Question 53

All of the following source gas characteristics affect the performance of small-volume jet nebulizers except:

A)humidity
B)flow
C)pressure
D)viscosity

Question 54

Exhalation into which device can result in loss of drug delivery?

A)small-volume jet nebulizers
B)metered-dose inhaler
C)dry power inhaler
D)ultrasonic nebulizer

Question 55

Which of the following devices would you select to deliver an aerosolized bronchodilator to a young child?

A)metered-dose inhaler (MDI) and spacer
B)MDI, holding chamber, and mask
C)MDI and holding chamber
D)dry power inhaler

Question 56

For which of the following patient groups is use of a dry power inhaler (DPI) for bronchodilator administration NOT recommended?
I)infants and children younger than 5 years
II)patients with an acute bronchospastic episode
III)patients requiring maintenance therapy

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

Question 57

The key difference between a metered-dose inhaler (MDI) holding chamber and a spacer is that the holding chamber incorporates which of the following?

A)larger enclosed space
B)one-way inspiratory valve
C)heated chamber
D)series of baffles

Question 58

Which of the following agents has been associated with increased intraocular pressure?

A)anticholinergics
B)epinephrine
C) $\beta$ ₂-agonists
D)antibiotics

Question 59

All of the following drug formulation characteristics affect the performance of small-volume jet nebulizers except:

A)homogeneity
B)surface tension
C)viscosity
D)potency

Question 60

To ensure delivery of the proper drug dosage with a metered-dose inhaler, which of the following must be done before its use?
I. The canister valve stem should be cleaned with a pin.
II. The canister should be warmed to hand or body temperature.
III. The canister should be vigorously shaken.

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

Question 61

What is the average amount of dead volume in a small-volume jet nebulizer after the device runs dry?

A)0.1 ml
B)0.5 to 3.0 ml
C)2.0 to 4.0 ml
D)less than 0.1 ml

Question 62

Which of the following is false about the optimal technique for using a small-volume jet nebulizer (SVN) for aerosol drug delivery?

A)SVNs are less technique and device dependent.
B)Slow inspiration improves SVN aerosol deposition.
C)Deep breathing or breath-holding improves SVN deposition.
D)Use of a mouthpiece or mask provides similar results.

Question 63

A physician has ordered the antiviral agent ribavirin (Virazole) to be administered by aerosol to an infant with bronchiolitis. Which of the following devices would you recommend in this situation?

A)hydrodynamic (Babbington) nebulizer
B)small-particle aerosol generator (SPAG)
C)ultrasonic (piezoelectric) nebulizer
D)large-volume heated jet nebulizer

Question 64

A patient with an acute exacerbation of asthma is not responding to the standard dose and frequency of an aerosolized bronchodilator and is now receiving small-volume jet nebulizer (SVN) therapy every 30 minutes. Which of the following would you recommend to the patient's physician at this time?

A)Discontinue the aerosolized bronchodilator.
B)Increase the frequency of SVN therapy to every 10 minutes.
C)Consider continuous nebulization of the drug.
D)Add more diluent to the SVN to extend treatment time.

Question 65

You increase the fill volume from 2 to 4 ml in a small-volume jet nebulizer being used to administer a bronchodilator agent with an aerosol. What effect will this have on the amount of drug delivered?

A)no effect
B)increase
C)decrease
D)more waste

Question 66

When using a small-particle aerosol generator (SPAG) to administer ribavirin (Virazole) to an infant, which pair of flow settings is correct? Nebulizer
Drying Chamber

A) $8 \mathrm {~L} / \mathrm { min } \quad8 \mathrm {~L} / \mathrm { min }$
B) $5 \mathrm {~L} / \mathrm { min }\quad 5 \mathrm {~L} / \mathrm { min }$
C) $8 \mathrm {~L} / \mathrm { min } \quad4 \mathrm {~L} / \mathrm { min }$
D) $4 \mathrm {~L} / \mathrm { min }\quad 8 \mathrm {~L} / \mathrm { min }$

Question 67

In mouth-breathing adult patients, which of the following factors is crucial in determining whether to use a mask or mouthpiece for aerosol drug delivery with a small-volume jet nebulizer?

A)clinician experience
B)drug concentration
C)patient preference and comfort
D)brand of small-volume jet nebulizer

Question 68

To minimize a patient's infection risk between drug treatments with a small-volume jet nebulizer (SVN), what would you do?

A)Rinse the SVN with sterile water; air dry.
B)Carefully repackage the SVN in its wet state.
C)Rinse the SVN with tap water; run until dry.
D)Throw out the SVN after every treatment.

Question 69

Normally, when using a 50-psi flowmeter to drive a small-volume jet nebulizer, to what should you set the flow?

A)2 to 4 L/min
B)4 to 6 L/min
C)6 to 8 L/min
D)8 to 10 L/min

Question 70

What serious problems associated with the delivery of ribavirin (Virazole) using the small-particle aerosol generator (SPAG)?
I)caregiver exposure to the drug aerosol
II)drug reconcentration in the drying chamber
III)drug precipitation in ventilator circuits

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

Question 71

During aerosol drug delivery using a small-volume jet nebulizer (SVN) set at 8 L/min input flow, a patient asks that the head of the bed be lowered to a semi-Fowler's position. Immediately after doing so, you observe a significant drop in SVN aerosol output, despite there being at least 3 ml of solution left in the reservoir. What would you do to correct this problem?

A)Add 1 to 2 ml more diluent to the nebulizer reservoir.
B)Increase the nebulizer input flow to 10 to 12 L/min.
C)Reposition the patient so that the SVN is more upright.
D)Decrease the nebulizer input flow to 3 to 4 L/min.

Question 72

Advantages of small-volume ultrasonic nebulizers for drug delivery include all of the following except:

A)greater respirable drug mass
B)less dead space and waste
C)increased mobility
D)decreased cost

Question 73

Which of the following make small-volume ultrasonic drug delivery systems different from their large-volume counterparts?
I. They do not use a couplant compartment.
II. Drugs are placed directly on the transducer.
III. Battery power is available on some units.
IV. Patient flow, not a blower, carries the aerosol.

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

Question 74

Which of the following is the effect of aerosol particles entrained into a warm and fully saturated gas stream?

A)no effect
B)increase in size
C)decrease in size
D)increase in number

Question 75

This problem of ribavirin (Virazole) aerosol precipitation causing malfunction of ventilator circuits can be overcome by which of the following?
I)Placing a one-way valve between the small-particle aerosol generator (SPAG) and the circuit
II)Placing a HEPA filter proximal to the exhalation valve
III)Decreasing the SPAG's total flow to below 10 L/min

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

Question 76

What is the major problem with using large-volume nebulizers for continuous aerosol drug therapy?

A)decreased pulmonary deposition
B)drug reconcentration and toxicity
C)frequent interruption of therapy
D)greater waste of drug

Question 77

The small-particle aerosol generator (SPAG) produces a small monodisperse aerosol through which of the following?

A)aerosol impaction by sequential baffling
B)particle evaporation in a glass drying chamber
C)use of an inert liquefied gas propellant
D)aerosol generation using vibrational energy

Question 78

Which of the following are true about a solution that is being aerosolized by an ultrasonic nebulizer?
I. The solute concentration decreases.
II. The temperature of the solution increases.
III. The solute concentration increases.
IV. The temperature of the solution decreases.

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

Question 79

To decrease the VDS of a small-volume jet nebulizer during drug administration, what should you do?

A)Decrease the nebulizer flow.
B)Turn the nebulizer upside-down.
C)continue treatment until nebulizer begins to sputter
D)Increase the nebulizer flow.

Question 80

What happens as the pressure or flow delivered through a small-volume jet nebulizer gets higher?
I. Treatment time becomes shorter.
II. Particle size becomes smaller.
III. Aerosol output becomes greater.

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