Which of the following is true about the use of ribavirin? 1. It is used as an antiviral agent against respiratory syncytial virus. 2. It is delivered via a Respirgard unit. 3. Adverse effects include skin rash, conjunctivitis, and eyelid erythema. 4. It can occlude endotracheal tube and ventilator exhalation valves.

Which of the following methods limits the systemic distribution of an inhaled aerosolized drug?

Which of the following inhaled corticosteroids is a prodrug?

Which of the following would you recommend to optimize drug delivery with a small-volume jet nebulizer (SVN) to an intubated, mechanically ventilated patient? 1. Increase dose to compensate for decreased delivery. 2. Adjust ventilator volume or pressure limit for added flow. 3. Disconnect or bypass heated humidifier system. 4. Turn off flow-by or continuous-flow while nebulizing.

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.

Which of the following nebulizers is used to nebulize iloprost?

For maintenance administration of bronchodilators to an adult patient with adequate inspiratory flow, which of the following aerosol drug delivery devices would you recommend? 1. Pressurized metered dose inhaler (pMDI) 2. Small-volume jet nebulizer 3. Dry powder inhaler 4. pMDI and holding chamber

Which phase describes the mechanism of drug action by which a drug causes its effects within the body through drug-receptor interactions?

Which of the following is true about the use of tobramycin? 1. It is primarily used by patients with cystic fibrosis. 2. It is intended to manage chronic infections with Pseudomonas aeruginosa. 3. It prevents deterioration of lung function due to recurrent infections. 4. It has very good lung bioavailability. 5. It is associated with a high rate of bacterial resistance.

Adrenergic bronchodilators improve flow rates for which of the following diseases? 1. Asthma 2. Acute bronchitis 3. Chronic bronchitis 4. Pulmonary fibrosis

Which of the following are side effects of dornase alfa administration? 1. Allergic reactions due to antibody production in the patient against dornase alfa 2. Chest pain 3. Rash 4. Laryngitis

Which of the following is the generic name for Arcapta Neohaler?

What amount of ipratropium bromide (Atrovent) is delivered by metered dose inhaler?

A semiconscious patient with inadequate spontaneous ventilation requires aerosol drug administration. Which of the following approaches would you recommend?

After initially conducting a pre- and postbronchodilator 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?

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

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 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?

Which of the following best defines an aerosol?

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

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?

Proper use of a soft mist inhaler requires that the patient be able to do which of the following?

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

Which phase describes the time course and disposition of a drug in the body based on its absorption, distribution, metabolism, and elimination?

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

Which of the following factors is most crucial in developing an effective program of aerosol drug self-administration in an adult patient requiring maintenance of bronchodilator therapy?

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

On the average, what percentage of an aerosol drug delivery device’s output actually deposits in the lungs?

To provide an extra margin of safety during continuous bronchodilator therapy (CBT), which of the following would you recommend be monitored? 1. Eosinophil count 2. Serum potassium levels 3. Electrocardiogram

Which of the following comprises the largest single group of drugs among aerosolized agents used for inhalation?

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

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

What is the brand name of the (R)-isomer of formoterol?

What is the dosage for salmeterol MDI?

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

When administering aerosolized pentamidine, what should the respiratory care practitioner do? 1. Use a nebulizer that produces particles in the 1- to 2-μm mean mass aerodynamic diameter (MMAD) range. 2. Use a nebulizer system with one-way valves and scavenging expiratory filters. 3. Provide isolation and an environmental containment system. 4. Screen patients for human immunodeficiency virus (HIV).

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?

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

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

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

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

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

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

What is the average duration of action of the short-acting noncatecholamine agents?

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

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

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?

In addition to nitric oxide, which of the following inhalational agents have been approved by the U.S. Food and Drug Administration for the treatment of pulmonary hypertension? 1. Treprostenil 2. Epoprostenol 3. Iloprost 4. Alprostadil

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

Which of the following is NOT considered part of the assessment of severity of symptoms recommended by the NAEPP and GOLD guidelines to modify level or dosage of corticosteroids?

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?

When assessing a patient’s response to bronchodilator therapy, you notice a decrease in wheezing accompanied by an overall decrease in the intensity of breath sounds. Which of the following is most likely?

What is the mechanism behind nitric oxide (INOmax)?

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

Which of the following are advantages for the treatment of the respiratory tract with inhaled aerosols? 1. Doses are usually smaller. 2. Onset of drug action is rapid. 3. Delivered dose is consistent with each administration. 4. Systemic side effects are often fewer and less severe.

Which of the following is an indication for use of an adrenergic bronchodilator?

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

What is the recommended dosage for continuous bronchodilator therapy (CBT)?

What is the dosage for ipratropium bromide (Atrovent)?

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)

Which one or more of the following devices are used in combination with metered dose inhaler (MDI) therapy to reduce the need for hand-breathing coordination and oropharyngeal impaction of aerosolized drugs? 1. Reservoir devices 2. One-way spacers 3. Valved holding chambers 4. Drying chambers

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.

What is the best way to confirm that an asthmatic outpatient can properly self-manage a newly prescribed aerosol drug therapy?

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

Side effects associated with parenteral administration of aminoglycosides include which of the following? 1. Ototoxicity 2. Voice alteration 3. Nephrotoxicity 4. Deafness

Which of the following circuit-related factors have a major effect on metered dose inhaler delivery of aerosolized drugs during mechanical ventilation? 1. Endotracheal tube size 2. Type of humidifier 3. Relative humidity 4. Temperature

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

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

Indications of an adverse drug response during continuous bronchodilator therapy include which of the following? 1. Decreased consciousness 2. Worsening tachycardia 3. Vomiting 4. Palpitations

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

Short-acting adrenergic bronchodilators are considered what type of agent according to the National Asthma Education and Prevention Program?

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?

What schedule of peak expiratory flow rate assessment would you recommend for a home care asthmatic patient?

When assessing a patient’s response to bronchodilator therapy, you notice a decrease in wheezing accompanied by an overall increase in the intensity of breath sounds. Which of the following is most likely?

What is the duration of action for ipratropium bromide?

Which of the following terms is used to describe a drug that stimulates a receptor responding to norepinephrine?

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.

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

For a hospitalized patient who will require ongoing maintenance bronchodilator therapy after discharge, what should your end goal be?

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

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. You should continue assessing and documenting all appropriate variables before and after each treatment until what point?

What is the name of the enzyme responsible for the short duration of action of catecholamine bronchodilators?

Which of the following are medications contain fluticasone furoate? 1. Arnuity Ellipta 2. Breo Ellipta 3. Combivent Respimat 4. Advair Diskus

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?

What are some common side effects seen with ipratropium bromide (Atrovent)?

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

In selecting the appropriate aerosol drug delivery device for a given patient, what must you consider? 1. Available drug formulation(s) 2. Desired site of deposition 3. Patient’s characteristics 4. Patient’s preference

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.

What is the most reliable indicator of a change in airway resistance due to bronchodilator administration during mechanical ventilation?

Acetylcysteine (Mucomyst) is indicated in which of the following diseases? 1. Acute tracheobronchitis 2. Bronchiectasis 3. Chronic obstructive pulmonary disease (COPD) 4. Asthma

Which of the following is the usual neurotransmitter in the sympathetic system?

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.

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

Which of the following should be assessed during the administration of mucolytic agents? 1. Breathing pattern and rate 2. Monitoring peak flow changes 3. Patient’s reaction to treatment 4. Monitoring for presence of hydrogen sulfide (a rotten egg odor), which means that the acetylcysteine (Mucomyst) is no longer active

Foradil is a brand name for which of the following beta-adrenergic bronchodilators?

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 45-year-old man has a history of heart failure and is diagnosed with pulmonary arterial hypertension. Initially, he is prescribed treprostinil (Tyvaso) 3 breathes (18 mcg) per treatment session via the Tyvaso Inhalation System. Upon first administration, the patient feels nauseated, throat irritation, muscle pain, and experiences flushing. What is the best next course of action?

Zileuton belongs to which of the following categories?

Which of the following aerosol drug delivery devices would you recommend against using with a toddler or small child? 1. Metered dose inhaler (MDI) 2. Small-volume jet nebulizer 3. Dry powder inhaler 4. MDI, holding chamber, and mask

In a dose-response assessment of a patient’s response to a metered dose inhaler bronchodilator, when would you stop increasing the dose? 1. When the peak expiratory flow rate improves 2. When tachycardia occurs 3. When tremors are evident 4. When 6 to 8 puffs are delivered