Deck 39: Aerosol Drug Therapy

Question 1

Where do most aerosol particles that are less than 3 µm deposit?

A) Alveoli
B) Bronchioles
C) Central airways
D) Upper airways

Answer 1

A

Question 2

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

A) Scan
B) Gravimetric
C) Cascade impaction
D) Penetration studies

Answer 2

C
Explanation: The two most common laboratory methods used to measure aerosol particle size are cascade impaction and laser diffraction.

Question 3

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

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

Answer 3

D
Explanation: The GSD describes the variability of particle sizes in an aerosol distribution set at 1 standard deviation (SD) above or below the median (15.8% and 84.13%).

Question 4

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

A) Hygroscopic condensation
B) Gravity sedimentation
C) Brownian diffusion
D) Inertial impaction

Question 5

What is the primary mechanism for deposition of large, high-mass particles (>5 µm) in the respiratory tract?

A) Inertial impaction
B) Sedimentation
C) Diffusion
D) Brownian motion

Question 6

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 7

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

A) MMAD of 0.1 µm
B) MMAD of 3.0 µm
C) MMAD of 10.0 µm
D) MMAD of 50.0 µm

Question 8

Which of the following factors affect pulmonary deposition of an aerosol?
1) Size of the particles
2) Shape and motion of the particles
3) Physical characteristics of the airways
4) Class of medication being delivered

A)1 and 4 only
B)1 and 3 only
C)2, 3, and 4 only
D)1, 2, and 3 only

Question 9

Which of the following will increase aerosol deposition by inertial impaction?
1) High-velocity gas flow
2) Variable or irregular passages
3) Turbulent gas flow
4) Particles of high mass

A)2 and 3 only
B)2, 3, and 4 only
C)1, 3, and 4 only
D)1, 2, 3, and 4

Question 10

Where do most aerosol particles in the 5- to 10-µm range deposit?

A) Alveoli
B) Bronchioles
C) Central airways
D) Upper airways

Question 11

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 12

Where do most aerosol particles in the 1- to 5-µm range deposit?

A) Alveoli
B) Bronchioles
C) Central airways
D) Upper airways

Question 13

What is the primary fate of inhaled aerosol particles that are between 1 and 0.5 µm?

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

Question 14

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 15

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 16

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

A) High inspiratory flow
B) Short inspiratory time
C) 10-sec breath-hold
D) Short expiratory time

Question 17

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 18

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

A) Monodisperse
B) Microaerosol
C) Heterodisperse
D) Macroaerosol

Question 19

What is the primary mechanism for central airway deposition of particles in the 1- to 5-µm range?

A) Impaction
B) Sedimentation
C) Diffusion
D) Brownian motion

Question 20

With which of the following devices are therapeutic aerosols generated?
1) Atomizers
2) Nebulizers
3) Humidifiers
4) Soft mist inhalers

A)1, 2, and 4 only
B)1 and 4 only
C)2 and 3 only
D)1, 2, 3, and 4

Question 21

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 22

What is the primary hazard of aerosol drug therapy?

A) Adverse drug reactions
B) Pulmonary infection
C) Airway reactivity
D) Drug reconcentration

Question 23

Approximately 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 mcg
D) 50 mcg to 5 mg

Question 24

Which of the following is not considered a drug aerosol delivery system?

A) Dry powder inhalers (DPIs)
B) Small-volume jet nebulizers
C) Metered dose inhalers (MDIs)
D) Spinning disk nebulizers

Question 25

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

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

Question 26

Which of the following drugs or drug categories have been associated with increased airway resistance and bronchospasm during aerosol administration?
1) Steroids
2) Albuterol
3) Acetylcysteine
4) Antibiotics

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 3, and 4 only

Question 27

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

A) Evaporation
B) Deposition
C) Aging
D) Sublimation

Question 28

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

A) 1 µm
B) 5 µm
C) 20 µm
D) 35 µm

Question 29

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

A)1 and 2 only
B)1 and 3 only
C)2 and 3 only
D)1, 2, and 3

Question 30

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 31

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

A)1 and 3 only
B)1, 3, and 4 only
C)2, 3, and 4 only
D)1, 2, 3, and 4

Question 32

Each actuation of a typical metered dose inhaler delivers approximately what output volume?

A) 10 to 30 mcl
B) 30 to 100 mcl
C) 10 to 30 ml
D) 30 to 100 ml

Question 33

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 34

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 35

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 36

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 µm
B) 2 to 5 µm
C) 1 to 3 µm
D) Less than 1 µm

Question 37

A typical metered dose inhaler produces which of the following particle distributions?

A) 2 to 6-µm mean mass aerodynamic diameter (MMAD)
B) 1- to 3-µm MMAD
C) 6- to 9-µm MMAD
D) Less than 1-µm MMAD

Question 38

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 µm
B) 2 to 5 µm
C) 1 to 3 µm
D) Less than 1 µm

Question 39

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 µm
B) 2 to 5 µm
C) 1 to 3 µm
D) Less than 1 µm

Question 40

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 41

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

A) Anticholinergics
B) Epinephrine
C) Beta-2 agonists
D) Antibiotics

Question 42

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 43

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

A) Small-volume jet nebulizers
B) Metered dose inhaler
C) Dry powder inhaler
D) Ultrasonic nebulizer

Question 44

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 45

Proper use of a dry powder 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 (<0.5 L/sec) and perform a breath-hold.
D) Coordinate firing of the DPI with inspiration.

Question 46

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 powder inhaler

Question 47

Which of the following groups of patients are most likely to have difficulty using a simple metered dose inhaler for aerosol drug therapy?
1) Patients in acute distress
2) Infants and young children
3) Elderly persons

A)1 and 2 only
B)1 and 3 only
C)2 and 3 only
D)1, 2, and 3

Question 48

Which of the following small-volume jet nebulizer design features affect its performance?
1) Position
2) Residual volume
3) Baffles
4) Reservoirs

A)1, 2, and 3 only
B)2 and 4 only
C)3 and 4 only
D)1, 2, 3, and 4

Question 49

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 50

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 51

Which of the following are beneficial effects of using a holding chamber with a metered dose inhaler (MDI)?
1) Reduction in oropharyngeal aerosol deposition
2) Decrease in need for hand-breath coordination
3) Elimination of medication waste

A)1 and 2 only
B)1 and 3 only
C)2 and 3 only
D)1, 2, and 3

Question 52

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 sec.
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 53

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 powder inhaler
D) Soft mist inhaler

Question 54

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

A)1 and 2 only
B)1 and 3 only
C)2 and 3 only
D)1, 2, and 3

Question 55

Advantages of the dry powder inhaler (DPI) drug delivery systems include which of the following?
1) Low relative cost
2) No propellants required
3) No hand-breath coordination necessary
4) Unaffected by humidity

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 56

Which of the following drug formulation characteristics affect the performance of small-volume jet nebulizers?
1) Homogeneity
2) Surface tension
3) Viscosity
4) Potency

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 57

Which of the following source gas characteristics affect the performance of small-volume jet nebulizers?
1) Humidity
2) Flow
3) Pressure
4) Viscosity

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 58

For which of the following patient groups is use of a dry powder inhaler (DPI) for bronchodilator administration recommended?
1) Infants and children younger than 5 years
2) Patients with an acute bronchospastic episode
3) Patients requiring maintenance therapy

A)1 and 2 only
B)3 only
C)2 and 3 only
D)1, 2, and 3

Question 59

Which of the following would be correct instructions for a patient being taught proper use of a dry powder inhaler?
1) Place mouthpiece 4 cm from mouth
2) Exhale slowly to FRC
3) Inhale slowly (<30 L/min)
4) Repeat until dose is used up

A)2 and 4 only
B)3 and 4 only
C)1, 2, and 3 only
D)1, 2, 3, and 4

Question 60

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 does?
1) Cut in half the number of puffs or treatments.
2) Use a spacer or holding chamber.
3) Rinse the mouth after each treatment.

A)1 and 2 only
B)1 and 3 only
C)2 and 3 only
D)1, 2, and 3

Question 61

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 62

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 63

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 64

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 65

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 10 L/min
D) 8 to 10 L/min

Question 66

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 67

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 68

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 69

Side effects of environmental exposure to ribavirin or pentamidine aerosols include which of the following?
1) Bronchospasm
2) Skin rashes
3) Conjunctivitis
4) Tachyphylaxis

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 2, 3, and 4

Question 70

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 71

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

A)2 and 4 only
B)3 and 4 only
C)1, 2, and 3 only
D)1, 2, 3, and 4

Question 72

Which of the following are true about a solution that is being aerosolized by an ultrasonic nebulizer?
1) The solute concentration decreases.
2) The temperature of the solution increases.
3) The solute concentration increases.
4) The temperature of the solution decreases.

A)1 and 2 only
B)2 and 3 only
C)2 and 4 only
D)3 and 4 only

Question 73

Which of the following methods can be used to minimize the harmful effects of environmental exposure to ribavirin or pentamidine aerosols?
1) Use an isolation booth or tent with HEPA filtered exhaust.
2) Have health care personnel wear a HEPA filtered mask.
3) Use a negative pressure room with adequate air exchange.

A)1 and 2 only
B)1 and 3 only
C)2 and 3 only
D)1, 2, and 3

Question 74

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 75

Advantages of small-volume ultrasonic nebulizers for drug delivery include which of the following?
1) Greater respirable drug mass
2) Less dead space and waste
3) Increased mobility
4) Decreased cost

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 76

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

A)1 and 2 only
B)1 and 3 only
C)2 and 3 only
D)1, 2, and 3

Question 77

To decrease the dead space volume 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 78

Which of the following drugs present the greatest exposure risks for health care workers?
1) Albuterol (Proventil)
2) Pentamidine (NebuPent)
3) Ribavirin (Virazole)
4) Acetylcysteine (Mucomyst)

A)1 and 4 only
B)2 and 3 only
C)1, 2, and 3 only
D)2, 3, and 4 only

Question 79

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 2.2 ml
C) 2.0 to 4.0 ml
D) Less than 0.1 ml

Question 80

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 min. 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 min.
C) Consider continuous nebulization of the drug.
D) Add more diluent to the SVN to extend treatment time.