Deck 6: Mucokinetics and Surfactants

Question 1

Patients that would benefit most from aerosolized hypertonic saline solution are those with which of the following?

A)Cystic fibrosis
B)COPD
C)Asthma
D)Heart failure

Answer 1

Cystic fibrosis

Question 2

Synthetic surfactants can be described as which of the following? I.Exogenous
II)Containing proteins SP-B and SP-C
III)Free of infection and foreign proteins

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

Answer 2

I and III

Question 3

Methods for delivering liquid particles of water to the lung include all the following except:

A)Humidifiers.
B)Large-volume nebulizers.
C)Direct instillation.
D)Ultrasonic nebulizers.

Answer 3

Humidifiers.

Question 4

The alveolar structures responsible for the manufacture of surfactant are:

A)Type I pneumocytes.
B)Type II pneumocytes.
C)Clara cells.
D)Alveolar ducts.

Question 5

Which of the following contributes to mucous clearance from the airways by altering its water content?

A)Dornase alfa
B)Normal saline
C)Mucomyst
D)Infasurf

Question 6

Of the following,which is responsible for producing most of the mucus found in the airways?

A)Serous cells
B)Bronchial glands
C)Goblet cells
D)Clara cells

Question 7

The role of the mucociliary system includes all of the following except:

A)Warming and humidifying inspired gas.
B)Antimicrobial properties to prevent infection.
C)Removal of inhaled debris from alveoli through ciliary action.
D)Prevention of excessive loss of heat and moisture.

Question 8

Lack of surfactant in premature infants less than 34 weeks' gestation is a result of:

A)Damaged type I pneumocytes.
B)Aspiration.
C)Perinatal asphyxia.
D)Immature type II pneumocytes.

Question 9

You receive a call from the attending physician of a 68-year-old patient with chronic bronchitis.He reports that the patient has very thick secretions that she is unable to remove from her airway and asks for your recommendations.The drug most indicated for this patient is:

A)Dornase alfa.
B)N-acetylcysteine.
C)Sodium bicarbonate.
D)Survanta.

Question 10

Repeated,prolonged exposure to irritants causes all of the following changes to occur in the airways except:

A)Increased size of bronchial glands.
B)Decreased ciliary action.
C)Increased number of bronchial glands.
D)Decreased mucous production.

Question 11

Bypassing the upper airway by placing an endotracheal tube into the lungs can lead to which of the following?

A)Infection
B)Impaired ciliary action
C)Accumulation of mucus in the lungs
D)All of the above

Question 12

Antitussives are indicated for which of the following conditions?

A)Dry,hacking,nonproductive cough
B)Accumulation of thick secretions leading to shortness of breath
C)Fulminant pulmonary edema
D)Bronchospasm accompanied by frequent cough

Question 13

The most cost-effective and readily available means of maintaining mucokinetics is with which of the following agents?

A)Mucomyst
B)Normal saline
C)Water
D)Sodium bicarbonate

Question 14

Pulmozyme would be the treatment of choice for which of the following conditions?

A)COPD
B)Asthma
C)Heart failure
D)Cystic fibrosis

Question 15

A treatment regime for a patient with thick,retained secretions who is currently receiving oxygen should include all the following except:

A)Bland aerosol with sterile water via a large-volume nebulizer.
B)Administration of an antitussive such as dextromethorphan.
C)Intermittent treatments with Mucomyst and a short-acting bronchodilator.
D)Deep breathing,assisted coughing,and suctioning.

Question 16

Expectorants are thought to work by all except which of the following actions?

A)Breaking disulfide bonds in the mucus
B)Increasing vagal-gastric reflex stimulation
C)Being absorbed into respiratory glands,causing direct stimulation to increase mucous production
D)Increasing the amount of fluid in the respiratory tract

Question 17

A patient with hyperreactive airways is to receive a bland aerosol treatment with an ultrasonic nebulizer.Which of the following solutions would you select to cause the least irritation?

A)Tap water
B)Hypertonic saline
C)Hypotonic saline
D)Sterile water

Question 18

Of the following devices used for delivery of water to the lungs,which would not be suitable when treating infants?

A)Small-volume nebulizers
B)Simple humidifiers
C)Large-volume nebulizers
D)Ultrasonic nebulizers

Question 19

You are called to the emergency room to administer a bland aerosol treatment to a patient for sputum induction.Which of the following agents would you select for its effect in producing irritation and cough?

A)Sterile water.
B)Normal saline.
C)Hypertonic saline.
D)Hypotonic saline.

Question 20

The pharmacologic approach to secretion management includes all the following except:

A)Increasing the depth of the sol layer.
B)Altering the consistency of the gel layer.
C)Increasing the number of bronchial glands.
D)Improving ciliary action.

Question 21

______ 10.Pulmozyme aids in secretion removal by disrupting the disulfide bonds in mucus.
FILL-IN-THE-BLANK
Write the word or phrase that best completes each statement.

Question 22

______ 3.Expectorants work by increasing the amount of fluid in the respiratory tract and by increasing vagal-gastric reflex stimulation.

Question 23

______ 1.The role of goblet cells and clara cells is to produce about 100 ml of mucus each day.

Question 24

______ 8.Solutions that are used for inhalation must be sterile and distilled.

Question 25

Surfactant replacement therapy requires which of following guidelines for proper administration? I.Place an endotracheal tube into the infant's airway.
II)Suction the infant prior to surfactant administration.
III)Have infant remain in the supine position during instillation.

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

Question 26

The ability of mucus to change from thick to thin and back is referred to as having ________________ properties.

Question 27

You are called to the labor and delivery department to aid in the care of a 28 weeks' gestation infant.Soon after the baby is delivered,the decision is made to begin surfactant replacement therapy.The physician orders Infasurf for the 2,000-gm infant.What dosage would you prepare?

A)10 ml
B)8 ml
C)6 ml
D)5 ml

Question 28

______ 6.Mucolytics achieve their effect in mucus control by changing the molecular structure of the mucous gel.

Question 29

Hazards that can occur with surfactant replacement therapy after administration include hyperoxemia and decreased PaCO₂.These changes can be explained as occurring because of:

A)Increases in heart rate
B)Increases in tidal volumes due to improvement in lung compliance
C)Increases in ventilating pressures
D)Increases in respiratory rates

Question 30

The most frequently used solution for a diluent with aerosolized medications is ________________.

Question 31

______ 7.The use of bland aerosols aids in mucous clearance by restoring the gel layer.

Question 32

______ 9.The use of hypertonic saline solutions for sputum induction is likely to cause bronchospasm.

Question 33

______ 2.Mucomyst can cause bronchospasm in patients with hyperactive airway disease and should therefore be given in combination with a short-acting bronchodilator.

Question 34

________________ aerosols dilute mucus by altering its water content.

Question 35

______ 4.Surfactant is required to increase the surface tension in the alveoli and make inflation easier with less pressure.

Question 36

Pulmozyme should be administered using which of the following nebulizers?

A)Marquest Acorn II
B)Aeroneb
C)HOPE nebulizer
D)AeroEclipse TRUE/FALSE
Write 'T' if the statement is true and 'F' if the statement is false.

Question 37

Which of the following surfactants is synthetically manufactured?

A)Exosurf
B)Survanta
C)Infasurf
D)Curosurf

Question 38

______ 5.After surfactant is administered to a newborn,the baby should be monitored for changes in oxygenation and changes in ventilating pressures.

Question 39

When a patient has a dry,nonproductive cough,a ________________ saline solution can be administered to stimulate a cough and produce more mucus.

Question 40

A device that is used to minimize the drying effects of oxygen is a ________________.

Question 41

Mucomyst can be given by ________________ or by ________________ to the tracheobronchial tree.

Question 42

________________ is indicated for maintenance therapy in the management of pulmonary secretions in cystic fibrosis.

Question 43

What is the difference between the modes of action for Mucomyst and Pulmozyme in the treatment of thick,viscous secretions?

Question 44

The only synthetically produced surfactant that is current available on the market is ________________.

Question 45

Surfactant that is naturally produced in lung tissue is called ________________ surfactant.

Question 46

Compare and contrast the two types of exogenous surfactants that are currently available.

Question 47

Treatment of acetaminophen overdose includes oral or intravenous administration of ________________.

Question 48

Discuss the benefit and risk of direct instillation of normal saline into the respiratory tract.

Question 49

Explain the two types of therapeutic approaches to surfactant administration for a premature infant with respiratory distress.

Question 50

A commonly used expectorant that is available in OTC cough and cold medications is ________________.

Question 51

Mucous production will increase when the respiratory tract is irritated and during ________________ stimulation.

Question 52

A device that is designed to produce aerosol droplets for delivery to the airways is a ________________.

Question 53

Identify the methods available for delivering bland aerosol to the lungs and explain how they differ.

Question 54

The saline solution that is considered to be an expectorant is ________________.

Question 55

When administering breathing treatments to patients who are on sodium-restricted diets,the diluent of choice is ________________.