Which of the following best defines an aerosol?
suspension of liquid or solid particles in a gas
With which of the following devices are therapeutic aerosols generated?
atomizers
nebulizers
The mass of aerosol particles produced by a nebulizer in a given unit time best describes which quality of the aerosol?
output
Which of the following describes the mass of drug leaving the mouthpiece of a nebulizer as aerosol?
emitted dose
Which of the following is a common method to measure aerosol particle size?
cascade impaction
What measure is used to describe the variability of particle diameters in an aerosol?
GSD
Most nebulizers used in respiratory care produce which type of aerosol suspension?
heterodisperse
What is the retention of aerosol particles resulting from contact with the respiratory tract mucosa called?
deposition
Which of the following factors affect pulmonary deposition of an aerosol?
size of the particles
shape and motion of the particles
physical characteristics of the airways
Which of the following will increase aerosol deposition by inertial impaction?
high-velocity gas flow
Where do most aerosol particles in the 5- to 10-�m range deposit?
upper airways
What is the primary mechanism for central airway deposition of particles in the 1- to 5-�m range?
sedimentation
Where do most aerosol particles in the 1- to 5-�m range deposit?
central airways
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?
5 to 50 �m
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?
2 to 5 �m
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?
less than 1 �m
What is the process by which aerosol suspension changes over time?
aging
Which of the following is false about changes in aerosol suspensions over time?
The rate of particle growth is directly proportional to particle size.
As hygroscopic aerosol particles enter the respiratory tract, what do they tend to do?
increase in size because of the absorption of molecular water
What is the primary hazard of aerosol drug therapy?
untoward drug reactions
To minimize the risk of infection associated with aerosol drug therapy, what should you do?
Sterilize nebulizers between patients.
Frequently replace in-use units.
Rinse nebulizers with sterile water.
All of the following drugs or drug categories have been associated with increased airway resistance and bronchospasm during aerosol administration except:
albuterol
To monitor a patient for the possibility of reactive bronchospasm during aerosol drug therapy, what should you do?
Measure pre- and post-peak flow and/or percentage forced expiratory volume in 1 second (%FEV1).
Auscultate for adventitious breath sounds.
Carefully observe the patient's response.
Communicate with the patient during therapy.
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
Add coughing and postural drainage to the therapy.
Drug aerosol delivery systems include all of the following except:
spinning disk nebulizers
What is the preferred method for delivering bronchodilators to spontaneously breathing and intubated, ventilated patients?
metered-dose inhaler
Immediately after firing, the aerosol particles produced by most metered-dose inhalers are about how large?
35 �m
Each firing of a typical metered-dose inhaler delivers about what output volume?
30 to 100 �l
Most of the spray generated by the majority of metered-dose inhalers consists of which of the following?
propellant
About what range of drug dosages can be provided with each firing of a metered-dose inhaler?
50 �g to 5 mg
Which of the following particle distributions is produced by a typical metered-dose inhaler?
2 to 6-�m mean mass aerodynamic diameter (MMAD)
When fired inside the mouth, what percentage of the drug dose delivered by a simple metered-dose inhaler (MDI) deposits in the oropharynx?
about 80%
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?
immediately after beginning a slow inspiration
Before inspiration and actuation of a metered-dose inhaler, the patient should exhale to which of the following?
functional residual capacity
To ensure delivery of the proper drug dosage with a metered-dose inhaler, which of the following must be done before its use?
The canister should be warmed to hand or body temperature.
The canister should be vigorously shaken.
Which of the following groups of patients are most likely to have difficulty using a simple metered-dose inhaler for aerosol drug therapy?
patients in acute distress
infants and young children
elderly persons
Which of the following agents has been associated with increased intraocular pressure?
anticholinergics
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?
Use a spacer or holding chamber.
Rinse the mouth after each treatment.
What is a potential limitation of flow-triggered metered-dose inhaler devices?
high flows necessary for actuation
For which of the following patients would you recommend against using a flow-triggered metered-dose inhaler (MDI) as the sole bronchodilator delivery system?
patient likely to develop acute severe bronchospasm
Which of the following are beneficial effects of using a holding chamber with a metered-dose inhaler (MDI)?
reduction in oropharyngeal aerosol deposition
decrease in need for hand-breath coordination
The key difference between a metered-dose inhaler (MDI) holding chamber and a spacer is that the holding chamber incorporates which of the following?
one-way inspiratory valve
After actuating a metered-dose inhaler with a holding chamber, what should the patient be instructed to do?
Continue to breathe through the device for three breaths
Which of the following devices would you select to deliver an aerosolized bronchodilator to a young child?
MDI, holding chamber, and mask
Advantages of the dry power inhaler (DPI) drug delivery systems include all of the following except:
unaffected by humidity
Proper use of a dry power inhaler (DPI) requires that the patient be able to do which of the following?
generate inspiratory flows of 60 L/min or higher
Which of the following devices depends on the patient's inspiratory effort to dispense the dose?
dry power inhaler
Which of the following would be correct instructions for a patient being taught proper use of a dry power inhaler?
Exhale slowly to FRC.
Repeat until dose is used up.
For which of the following patient groups is use of a dry power inhaler (DPI) for bronchodilator administration NOT recommended?
infants and children younger than 5 years
patients with an acute bronchospastic episode
Exhalation into which device can result in loss of drug delivery?
dry power inhaler
Which of the following small-volume jet nebulizer design features affect its performance?
position
residual volume
baffles
reservoirs
All of the following source gas characteristics affect the performance of small-volume jet nebulizers except:
viscosity
All of the following drug formulation characteristics affect the performance of small-volume jet nebulizers except:
potency
What is the average amount of dead volume in a small-volume jet nebulizer after the device runs dry?
0.5 to 2.2 ml
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 outp
Reposition the patient so that the SVN is more upright.
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?
increase
What happens as the pressure or flow delivered through a small-volume jet nebulizer gets higher?
Treatment time becomes shorter.
Particle size becomes smaller.
Aerosol output becomes greater.
Which of the following is the effect of aerosol particles entrained into a warm and fully saturated gas stream?
increase in size
Which of the following is false about the optimal technique for using a small-volume jet nebulizer (SVN) for aerosol drug delivery?
Deep breathing or breath-holding improves SVN deposition.
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?
patient preference and comfort
Normally, when using a 50-psi flowmeter to drive a small-volume jet nebulizer, to what should you set the flow?
6 to 10 L/min
To decrease the VDS of a small-volume jet nebulizer during drug administration, what should you do?
continue treatment until nebulizer begins to sputter
To minimize a patient's infection risk between drug treatments with a small-volume jet nebulizer (SVN), what would you do?
Rinse the SVN with sterile water; air dry.
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
Consider continuous nebulization of the drug.
What is the major problem with using large-volume nebulizers for continuous aerosol drug therapy?
drug reconcentration and toxicity
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?
small-particle aerosol generator (SPAG)
The small-particle aerosol generator (SPAG) produces a small monodisperse aerosol through which of the following?
particle evaporation in a glass drying chamber
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 both at 8L/min
What serious problems associated with the delivery of ribavirin (Virazole) using the small-particle aerosol generator (SPAG)?
caregiver exposure to the drug aerosol
drug precipitation in ventilator circuits
This problem of ribavirin (Virazole) aerosol precipitation causing malfunction of ventilator circuits can be overcome by which of the following?
Placing a one-way valve between the small-particle aerosol generator (SPAG) and the circuit
Which of the following are true about a solution that is being aerosolized by an ultrasonic nebulizer?
The temperature of the solution increases.
The solute concentration increases.
Which of the following make small-volume ultrasonic drug delivery systems different from their large-volume counterparts?
They do not use a couplant compartment.
Drugs are placed directly on the transducer.
Battery power is available on some units.
Patient flow, not a blower, carries the aerosol.
Advantages of small-volume ultrasonic nebulizers for drug delivery include all of the following except:
decreased cost
What is the average mean mass aerodynamic diameter (MMAD) generated by the vibrating mesh nebulizers?
2 to 3 �m
In selecting the appropriate aerosol drug delivery device for a given patient, what must you consider?
available drug formulation(s)
desired site of deposition
patient's characteristics
patient's preference
For maintenance administration of bronchodilators to an adult patient with adequate inspiratory flow, which of the following aerosol drug delivery devices would you recommend?
dry powder inhaler
pMDI and holding chamber
Which of the following aerosol drug delivery devices would you recommend against using with a toddler or small child?
metered-dose inhaler (MDI)
small-volume jet nebulizer
On the average, what percentage of an aerosol drug delivery device's output actually deposits in the lungs?
10%
Factors associated with reduced pulmonary deposition of aerosolized drugs include all of the following except:
mouth breathing
Possible complications associated with the selection of an aerosol drug delivery device include all of the following except:
overhydration or fluid imbalances
A semiconscious patient with inadequate spontaneous ventilation requires aerosol drug administration. Which of the following approaches would you recommend?
SVN with delivery by intermittent positive-pressure breathing
To assess the effectiveness of a particular aerosol delivery device selection, what would you evaluate?
patient's technique in using the device
patient's response to and compliance with procedure
objective measures of improvement (e.g., peak flow)
Which of the following would you recommend as initial therapy for a patient admitted to the emergency department with acute airway obstruction (wheezing, cough, dyspnea, peak expiratory flow rate [PEFR] less than 60% predicted)?
Assess dose-response of metered-dose inhaler (MDI) albuterol (up to 12 puffs).
Provide up to three small-volume jet nebulizer (SVN) treatments with albuterol every 20 minutes.
Indications for assessment of patient's response to bronchodilator therapy include all of the following except to:
quantify the degree of bronchial hyperresponsiveness
Appropriate documentation when conducting point-of-care assessment of a patient's response to bronchodilator therapy includes all of the following except:
blood levels of the bronchodilator agent
Which of the following is false about the use of the peak expiratory flow rate (PEFR) in assessing a patient's response to bronchodilator therapy?
PEFR is the standard for determining bronchodilator response.
In addition to bedside pulmonary function test measures, what other components of patient assessment are useful in evaluating bronchodilator therapy?
patient interview and observation
measurement of vital signs
chest auscultation
arterial blood gas analysis and oximetry
Which of the following best describes a proper a dose-response assessment of a metered-dose inhaler (MDI) bronchodilator?
Give 4 puffs spaced 1 to 2 minutes apart; repeat up to 12 puffs with continued improvement. The best dose provides maximum subjective relief and the highest peak expiratory flow rate (PEFR) without side effects.
In a dose-response assessment of a patient's response to a metered-dose inhaler bronchodilator, when would you stop increasing the dose?
when the peak expiratory flow rate improves <10% to 15%
when tachycardia occurs
when tremors are evident
An asthmatic patient in severe distress with wheezing and dyspnea is admitted to the emergency department and started on albuterol via small-volume jet nebulizer. Which of the following approaches would you recommend to assess this therapy for this patien
Perform arterial blood gas analysis.
Continuously monitor the SpO2.
Assess breath sounds and vital signs before and after each treatment.
Measure peak expiratory flow rate or forced expiratory volume in 1 second before and after
An asthmatic patient in severe distress with wheezing and dyspnea is admitted to the emergency department. After a conducting a full assessment and obtaining a pretreatment baseline, you start the patient on albuterol with a small-volume jet nebulizer. Yo
The patient's symptoms are relieved, or the peak expiratory flow rate (PEFR)/forced expiratory volume in 1 second (FEVl) exceeds 70% of "personal best.
After initially conducting a pre- and post-bronchodilator assessment on a stable asthmatic patient admitted to the hospital, how often would you recommend reassessment of peak expiratory flow rate/forced expiratory volume in 1 second?
twice daily
What schedule of peak expiratory flow rate assessment would you recommend for a home care asthmatic patient?
3 to 4 times daily (on rising, noon, 4 to 7 PM, bedtime)
For a hospitalized patient who will require ongoing maintenance bronchodilator therapy after discharge, what should your end goal be?
effective self-administration of the drug
Which of the following factors is most crucial in developing an effective program of aerosol drug self-administration in an adult patient requiring maintenance bronchodilator therapy?
good patient education
Which of the following patient skills are necessary to ensure effectiveness of drug administration via the aerosol route?
ability to keep track of dosing requirements
understanding of the methods and goals of therapy
ability to recognize undesirable side effects
What is the best way to confirm that an asthmatic outpatient can properly self-manage a newly prescribed aerosol drug therapy?
Have the patient provide a repeat or return demonstration
After administering 12 puffs of metered-dose inhaler (MDI) albuterol to an acutely ill asthmatic patient in the emergency department, assessment indicates no significant improvement in symptoms. Which of the following would you now recommend?
Use continuous bronchodilator therapy.
What is the recommended dosage for continuous bronchodilator therapy (CBT)?
15.0 mg/hr
A physician orders continuous bronchodilator therapy with 1:200 albuterol for an asthmatic patient at the dosage of 20 mg/hr. How much 1:200 albuterol will be needed for the first hour of treatment?
4 ml
Indications of an adverse drug response during continuous bronchodilator therapy include all of the following except:
decreased consciousness
To provide an extra margin of safety during continuous bronchodilator therapy (CBT), which of the following would you recommend be monitored?
serum potassium levels
electrocardiogram
All of the following device-related factors have a major effect on pressurized metered-dose inhaler (MDI) delivery of aerosolized drugs during mechanical ventilation except:
MDI propellant formula
All of the following circuit-related factors have a major effect on metered-dose inhaler delivery of aerosolized drugs during mechanical ventilation except:
temperature
presence of positive end-expiratory pressure
On the average, what is the range of the actual pulmonary deposition of small-volume jet nebulizer aerosolized drugs in intubated patients receiving mechanical ventilation?
1.5% to 3.0%
Which of the following would you recommend to optimize drug delivery with a small-volume jet nebulizer (SVN) to an intubated, mechanically ventilated patient?
Increase dose to compensate for decreased delivery.
Place SVN in the inspiratory line 18 inches from the patient "wye."
Disconnect or bypass heated humidifier system.
Adjust ventilator volume or pressure limit for added flow.
A patient on mechanical ventilation was given 4 puffs of albuterol 5 minutes ago through a metered-dose inhaler (MDI) and holding chamber placed 18 inches from the circuit's airway connector. The patient continues to exhibit clinical signs of increased ai
Repeat administration until the desired response is achieved.
When using a chamber-style adapter with a metered-dose inhaler (MDI) to deliver a bronchodilator to a patient receiving mechanical ventilation, with what would you coordinate MDI firing?
beginning of inspiration
What is the most reliable indicator of a change in airway resistance due to bronchodilator administration during mechanical ventilation?
difference between peak airway and plateau pressures
Which of the following drugs present the greatest exposure risks for health care workers?
pentamidine (Pentam 300)
ribavirin (Virazole)
Side effects of environmental exposure to ribavirin or pentamidine aerosols include all of the following except:
tachyphylaxis
Which of the following methods can be used to minimize the harmful effects of environmental exposure to ribavirin or pentamidine aerosols?
Use an isolation booth or tent with HEPA filtered exhaust.
Have health care personnel wear a HEPA filtered mask.
Use a negative pressure room with adequate air exchange.