question

A physician orders a 70% He/30% O2 mixture to be delivered to a patient having an acute asthmatic attack. Which of the following systems would be most appropriate to deliver this mixture?

answer

tight-fitting nonrebreathing mask with competent valving

question

A doctor prescribes heliox therapy for a patient admitted to the Emergency Department with an acute exacerbation of asthma. A full cylinder of 70% helium and 30% O2 is at the bedside with a standard nasal cannula attached. You should

answer

obtain a nonrebreathing mask and administer the therapy

question

A physician wants to administer a steroid via small volume nebulizer to a 3 year old child as prophylaxis for asthma. Which of the following agents would you recommend?

answer

budesonide (Pulmicort Respules)

question

You just completed an albuterol (Proventil) aerosol treatment on an elderly patient. Which of the following is an objective response to the therapy?

answer

tachycardia

question

Which of the following describes the ventilatory pattern that is best suited for maximum aerosol deposition in the small airways?

answer

slow inhalation, pause, slow exhalation

question

You are monitoring a patient receiving volume controlled SIMV and note an increased peak pressure and bilateral wheezes. Which of the following would be appropriate?

answer

administer prescribed bronchodilators

question

A COPD patient receiving albuterol via SVN three times daily for bronchospasm repeatedly complains of palpitations with therapy, and you confirm tachycardia during and after treatment. Which of the following strategies could help decrease this side effect?

answer

decreasing the dose of albuterol

question

Which of the following patient instructions for using a dry powder inhaler (DPI) is correct?

answer

seal lips tightly around mouthpiece

question

A 23 year-old patient is admitted to the Emergency Department with status asthmaticus. Which of the following drugs would you recommend for administration via nebulization?

answer

albuterol

question

When hypertonic saline solution (3-7%) is administered by aerosol, it is being used as a:

answer

mucokinetic

question

A doctor orders 10 mg of 0.5% albuterol (Proventil) in 50 mL normal saline via continuous nebulization for a patient with asthma. How many mL of albuterol would you place in the nebulizer?

answer

10/5 = 2 mL

question

Prior to beginning bronchodilator therapy, you note that the patient has a heart rate of 150/min. The most appropriate action is to:

answer

notify the charge nurse and inform the physician

question

After withdrawal from inhaled nitric oxide (NO) therapy, an infant suddenly becomes hemodynamically unstable. You should:

answer

return the infant to the prior NO dosage

question

Which one of the following would be an acceptable quality assurance (QA) criterion for assessing the appropriateness of care for patients receiving aerosolized bronchodilator therapy?

answer

reversible airway obstruction confirmed before treatment

question

Bronchodilation is most commonly achieved via the use of which of the following drug categories?

answer

adrenergic agents

question

You initiate aerosol drug therapy with albuterol (Proventil) on a patient just admitted to the medical unit with a diagnosis of asthma. Which of the following would you assess before, during and/or after treatment?

answer

Heart rate Breath sounds Peak flow or FEV1 Sideeffects

question

Which one of the following would be an acceptable quality assurance (QA) criterion for assessing the appropriateness of care for patients receiving aerosolized bronchodilator therapy?

answer

observed signs of bronchospasm not associated with CHF

question

A patient who is receiving an aerosol treatment with acetylcysteine (Mucomyst) and hypertonic saline via a SVN suddenly becomes dyspneic. The most likely cause of this problem is:

answer

bronchospasm

question

Your patient is receiving aerosolized bronchodilators to treat her asthma. What is the best way to determine whether this treatment is achieving the desired goal?

answer

measure the patient's FEV1% before-and-after treatment

question

After completing an aerosol drug treatment, which of the following is the most appropriate chart notation for you to make?

answer

Aerosol therapy given with 0.5 mL albuterol and 3 mL normal saline; pulse stable at 72/min during therapy; B.P. stable at 120/80; respiratory rate 10/min; therapy well tolerated; chest clear on auscultation

question

Adverse reactions associated with the administration of aerosolized beclomethasone dipropionate (Vanceril) therapy include which of the following?

answer

upper airway fungal infections

question

When administering aerosolized pentamidine (NebuPent) to an HIV-infected patient with a history of Pneumocystis jiroveci pneumonia, you should be on guard for which of the following adverse reactions?

answer

bronchospasm

question

A physician orders 20% acetylcysteine (Mucomyst) 4 mL QID via SVN for a COPD patient with an abnormally large volume of viscid secretions. Based on your preliminary bedside assessment you determine that the patient has an inadequate cough. Which of the following would you recommend?

answer

oro-/nasotracheal suctioning after treatment

question

Soon after a severe asthmatic patient is started on 80/20 Heliox therapy via nonrebreathing mask, his SpO2 drops from 94% to 88%. Which of the following actions should be considered at this time?

answer

switching to 70/30 Heliox

question

An adult patient is prescribed steroid administration via an MDI formulation. To help minimize pharyngeal deposition of the drug, which of the following would you recommend?

answer

have the patient use a holding chamber with the MDI

question

You note on the setup bag of a patient receiving aerosol therapy via small volume nebulizer (SVN) that the unit was last changed 48 hours ago. You should:

answer

discard the setup and replace it with a new one

question

Your supervisor gives you a multi-dose vial of an expensive medication for aerosol administration to patients on your shift. You note that the expiration date on the label was two days ago. The supervisor says that since the med is kept refrigerated, it is OK to use for another week or so. You should:

answer

discard the medication and obtain a new unexpired vial

question

Small volume nebulizer therapy is indicated primarily to

answer

deliver medication to the airways

question

The recommended adult dosage when delivering albuterol (Proventil) by small volume nebulizer (SVN) is:

answer

0.5 ml of 1:200 aqueous solution in diluent

question

Which of the following drug categories would you select if the goal of therapy was to achieve bronchodilation with minimal cardiac side effects?

answer

beta-2 adrenergic

question

A patient is prescribed Triamcinolone acetonide (Azmacort) via MDI 2 puffs TID. To decrease the likelihood of oral candidiasis, you would recommend that the patient:

answer

rinse her mouth and gargle with water after inhalation

question

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

answer

small particle aerosol generator

question

A physician has ordered albuterol (Proventil) and deoxyribonuclease (DNase) by aerosol for a cystic fibrosis patient who also receives postural drainage TID. You should administer these therapies in which of the following sequences?

answer

albuterol (Proventil), deoxyribonuclease (DNase), postural drainage

question

After an aerosol treatment with acetylcysteine (Mucomyst), a patient with retained secretions develops wheezing. You should recommend

answer

mixing the Mucomyst with a bronchodilator

question

To obtain maximum benefit from a medication delivered via metered dose inhaler (MDI), a patient should be in which of the following positions?

answer

sitting upright

question

A physician orders 2.5 mL (1.0 mg/mL) dornase alpha (Pulmozyme) via aerosol once per day for a 12 year old cystic fibrosis patient with purulent secretions. Which of the following methods would you use to deliver this drug?

answer

breath-actuated drug nebulizer with mouthpiece

question

A patient complains that after his last SVN bronchodilator treatment he experienced nervousness and increased anxiety. Your best response would be which of the following?

answer

Relax and try to breathe slowly and I will be here with you so that nothing goes wrong."

question

A doctor orders a metered dose inhaler (MDI) bronchodilator for a patient receiving mechanical ventilation via a dual-limb breathing circuit. To maximize aerosol deposition, you would:

answer

place the MDI plus a spacer in-line on the inspiratory side of the circuit

question

A patient with asthma is given an adrenergic bronchodilator agent to combat acute airway obstruction. Instead of demonstrating improvement in airflow, the patient's symptoms worsen (e.g., increased wheezing, etc.). A possible explanation for this observation is:

answer

a paradoxical response to the agent

question

A doctor orders aerosol drug therapy via small volume nebulizer for a patient receiving mechanical ventilation via a dual-limb breathing circuit. To prevent drug residue from affecting ventilator performance you must make sure that:

answer

both inspiratory and expiratory HEPA filters are in place

question

When administering aerosolized albuterol (Proventil) you should be on guard for which of the following adverse effects?

answer

tachycardia

question

Which of the following aerosol delivery devices cannot be used to administer medication during mechanical ventilation?

answer

dry powder inhaler

question

The most important property of helium with respect to its use in helium-oxygen therapy is its:

answer

density

question

A patient complains to you that he is not getting any benefit from using his dry powder inhaler (DPI). You inspect the device and note a substantial amount of caked powder residue in its outlet. Which of the following would you recommend to the patient?

answer

clean the outlet with a dry cloth and stored it capped in a dry place

question

A physician has ordered pentamidine isethionate by aerosol for an AIDS patient with Pneumocystis carinii (jiroveci) pneumonia. Pneumocystis tends to localize in the alveolar region of the lungs. Which of the following nebulizers would you select to deliver this drug agent (MMD = mass median diameter of aerosol)?

answer

nebulizer B - MMAD of 3-4 µm

question

Your patient is receiving aerosolized bronchodilators to treat her asthma. What is the best way to determine whether the medication is having a positive effect?

answer

Measure the patient's FEV1% before-and-after treatment

question

A postoperative patient develops bilateral wheezing. Which of the following is the most appropriate therapy for this condition?

answer

bronchodilator

question

A cooperative patient receiving aerosol therapy with 0.9% NaCl is unable to produce an acceptable volume of sputum for laboratory studies. The most appropriate action would be to

answer

change to hypertonic saline

question

Which of the following will tend to impair peripheral deposition of an inhaled aerosol in the lungs?

answer

nose breathing

question

You are called to the ED to provide a bronchodilator treatment for a patient having a severe asthma attack. When quickly confirming the written order you find it contains some prohibited notations and thus could be read as either '.5 U albuterol by SVN' or 5 c.c albuterol by SVN" The prescribing physician is busy overseeing a code. You should:

answer

administer the treatment using the standard dosage (0.5 mL) and clarify the order as soon as possible thereafter

question

During an aerosol drug treatment, you instruct a patient to hold her breath at the end of inspiration. You should explain that this will enhance:

answer

medication delivery

question

An asthmatic patient started on a 70% He/30% O2 mixture via a pneumatically powered volume ventilator through a cuffed ET tube exhibits worsening hypercapnia despite higher than normal volume settings. Which of the following actions should you consider?

answer

use density conversion factors to adjust the volume/flow settings

question

Which of the following measurements done before and after treatment would best determine the effectiveness of an aerosolized albuterol (Proventil) administered to an asthmatic patient?

answer

forced expiratory volume (FEV)

question

Which of the following would be the most important data utilized to assess a patient's ability to perform metered dose inhaler (MDI) aerosol therapy?

answer

capacity to follow instructions

question

You are working with a confused elderly patient who has atelectasis and is ordered to receive an aerosolized bronchodilator for bronchospasm. Which of the following delivery methods would you choose?

answer

use a small volume nebulizer + CPAP

question

When administering aerosolized pentamidine (NebuPent) to an HIV-infected patient with a history of Pneumocystis jiroveci pneumonia, you should be on guard for which of the following adverse reactions?

answer

cough

question

The administration of what drug is most appropriate to thin secretions and help in the removal of a mucous plug?

answer

acetylcysteine

question

A first-year resident orders a stat salmeterol (Serevent Diskus) treatment for an asthma patient who was admitted in acute distress to the Emergency Department. Which of the following actions would be appropriate?

answer

recommend albuterol (Proventil) instead of salmeterol

question

A physician orders an expensive pulmonary vasodilator that is prepared as a premixed solution for aerosol administration to an outpatient. She want to assure precise dosing and minimal wastage. Which of the following devices would be suitable for this task?

answer

valved or breath-actuated nebulizer

question

Which of the following is associated with the administration of aerosolized epinephrine?

answer

. tachycardia

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