問題一覧
1
Which of the following phases constitute the course of drug action from dose to effect?
1. Drug administration
2. Pharmacognosy
3. Pharmacokinetic
4. Pharmacodynamic
1, 3, and 4 only
2
Which of the following devices are most commonly used to deliver aerosols by the inhalation route?
1. Small particle aerosol generator
2. Metered dose inhaler
3. Small volume nebulizer
4. Soft-mist inhaler
2, 3, and 4 only
3
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
1, 2, and 3 only
4
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.
1, 2, and 4 only
5
Which phase describes the time course and disposition of a drug in the body based on its absorption, distribution, metabolism, and elimination?
Pharmacokinetic
6
Which of the following methods limits the systemic distribution of an inhaled aerosolized drug?
Use of a fully ionized drug
7
Which of the following anticholinergics is poorly ionized?
Atropine
8
Which of the following lung availability/total systemic availability (L/T) ratios is consistent with an efficient aerosol delivery?
0.6
9
Which phase describes the mechanism of drug action by which a drug causes its effects within the body through drug-receptor interactions?
Pharmacodynamic
10
Pharmacologic control of the airway is mediated by receptors found on which of the following structures?
1. Smooth muscle
2. Secretory cells
3. Blood vessels
4. Alveolar epithelium
1, 2, and 3 only
11
Which of the following is the usual neurotransmitter in the sympathetic system?
Norepinephrine
12
Which of the following terms is used to describe a drug that stimulates a receptor responding to norepinephrine?
Adrenergic
13
When stimulated, which of the following receptors causes bronchoconstriction?
M3
14
Which of the following comprises the largest single group of drugs among aerosolized agents used for inhalation?
Adrenergic bronchodilators
15
Proventil and Ventolin are brand names for which of the following beta-adrenergic bronchodilators?
Albuterol
16
Foradil is a brand name for which of the following beta-adrenergic bronchodilators?
Formoterol
17
A metered dose inhaler of salmeterol delivers which of the following?
25 mcg/puff
18
What is the dosage for salmeterol MDI?
2 puffs every 12 hr
19
Which of the following is an indication for use of an adrenergic bronchodilator?
Treatment of reversible airflow obstruction
20
Adrenergic bronchodilators improve flow rates for which of the following diseases?
1. Asthma
2. Acute bronchitis
3. Chronic bronchitis
4. Pulmonary fibrosis
1, 2, and 3 only
21
Short-acting adrenergic bronchodilators are considered what type of agent according to the National Asthma Education and Prevention Program?
Rescue
22
What is the name of the enzyme responsible for the short duration of action of catecholamine bronchodilators?
Catechol O-methyltransferase (COMT)
23
Which of the following short-acting catecholamines is used for their strong alpha-1-vasoconstricting effects to reduce swelling in the nose and larynx and to control bleeding during bronchoscopic biopsy?
Racemic epinephrine
24
What is the average duration of action of the short-acting noncatecholamine agents?
4 to 6 hr
25
Which of the following are LABA bronchodilators?
1. Indacaterol
2. Olodaterol
3.. Albuterol
4. Salmeterol
1, 2, and 4 only
26
Which of the following is the generic name for Arcapta Neohaler?
Indacaterol
27
What is the brand name of the (R)-isomer of formoterol?
Brovana
28
Which of the following are side effects of beta-2-selective bronchodilators?
1. Bradycardia
2. Tremor
3. Insomnia
4. Headache
2, 3, and 4 only
29
What are some potential adverse effects with use of adrenergic bronchodilators?
1. Hypokalemia
2. Dizziness
3. Worsening ventilation/perfusion ratio (V/Q)
4. Bradycardia
1, 2, and 3 only
30
Which of the following are indications for the use of acetylcysteine (Mucomyst)?
1. Treatment of acetaminophen overdose
2. Treatment of excessive, viscous mucus secretions
3. Treatment of aspirin overdose
4. Treatment of purulent mucus secretions by breaking up DNA
1 and 2 only
31
What amount of ipratropium bromide (Atrovent) is delivered by metered dose inhaler?
17 mcg/puff
32
What is the dosage for ipratropium bromide (Atrovent)?
2 puffs four times daily
33
What is the duration of action for ipratropium bromide?
4 to 6 hr
34
What is the duration of action for the formulation of ipratropium bromide plus albuterol sulfate (DuoNeb)?
4 to 6 hr
35
Which of the following nebulizers is used to nebulize iloprost?
I-neb
36
What are some common side effects seen with ipratropium bromide (Atrovent)?
Cough and dry mouth
37
Ipratropium bromide should be used with precaution in which of the following diseases/conditions?
1. Prostatic hypertrophy
2. Urinary retention
3. Kidney stones
4. Glaucoma
1, 2, and 4 only
38
Which of the following are mucoactive agents currently approved for inhalation in the United States?
1. Tryptase alfa
2. Dornase alfa
3. Hyperosmolar saline
4. Mucomyst
2, 3, and 4 only
39
Acetylcysteine (Mucomyst) is indicated in which of the following diseases?
1. Acute tracheobronchitis
2. Bronchiectasis
3. Chronic obstructive pulmonary disease (COPD)
4. Asthma
1, 2, and 3 only
40
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?
Reduce dose to 1 to 2 breaths per session and then gradually increase to 3.
41
Which of the following explains how acetylcysteine (Mucomyst) lowers the viscosity of mucus?
Substituting its sulfhydryl group for disulfide bonds and breaking a portion of the bond forming the gel structure
42
Which of the following prophylactic therapies is recommended to reduce the irritant effect of acetylcysteine?
Administration of adrenergic bronchodilator
43
When administering acetylcysteine (Mucomyst), the respiratory therapist should be particularly focused on which of the following potential adverse effects?
1. Incompatibility with certain antibiotics when administered together
2. Blurred vision
3. Bronchospasm
4. Airway obstruction due to rapid liquefaction of mucus
1, 3, and 4 only
44
Which of the following is a contraindication for the use of nitric oxide?
Right-to-left shunt dependence
45
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
2, 3, and 4 only
46
Bland aerosols are best classified as:
expectorants
47
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
1, 2, and 3 only
48
Which of the following FEV1 values indicates severe compromise of expiratory airflow that may contraindicate the use of mucoactive therapy?
Less than 25%
49
The National Asthma Education and Prevention Program guidelines advocate the use of oral corticosteroids for which of the following?
Maintenance of mild to moderate persistent asthma
50
Which of the following is not an available formulation strength for fluticasone propionate (Flovent) by metered dose inhaler?
250 mcg/puff
51
Which of the following are true regarding glucocorticoids?
1. They work through activation of intracellular receptors.
2. Relief is immediate.
3. Daily compliance is essential to controlling inflammation in asthma.
4. They work in a similar fashion to adrenergic bronchodilators.
1 and 3 only
52
Aerosolized delivery of corticosteroids usually does not manifest in adrenal suppression compared to systemic use as long as the daily dose in adults is kept below what level?
800 mcg
53
Which of the following inhaled corticosteroids is a prodrug?
Ciclesonide
54
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?
Use of anticholinergics
55
Which of the following are considered nonsteroidal antiasthma drugs?
1. Cromolyn-like agents
2. Leukotriene modifiers
3. Anti-IgE agents
4. Anti-IgA agents
1, 2, and 3 only
56
How does cromolyn sodium work?
Inhibits degranulation of mast cells.
57
Which of the following are medications contain fluticasone furoate?
1. Arnuity Ellipta
2. Breo Ellipta
3. Combivent Respimat
4. Advair Diskus
1 and 2 only
58
Zileuton belongs to which of the following categories?
Leukotriene modifiers
59
Which of the following are considered an aerosolized antiinfective agent?
1. Pentamidine
2. Ribavirin
3. Tobramycin
4. Amikacin
1, 2, and 3 only
60
Pentamidine is indicated for the treatment of which of the following diseases?
Pneumocystis jiroveci
61
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).
1, 2, and 3 only
62
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.
1, 3, and 4 only
63
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.
1, 2, 3, and 5 only
64
Side effects associated with parenteral administration of aminoglycosides include which of the following?
1. Ototoxicity
2. Voice alteration
3. Nephrotoxicity
4. Deafness
1, 3, and 4 only
65
Inhaled zanamivir is indicated for which of the following treatment of uncomplicated respiratory illness?
Influenza
66
What is the mechanism behind nitric oxide (INOmax)?
It relaxes vascular smooth muscle by binding to the heme group of cystolic guanylate, activating guanylate cyclase, increasing cyclic GMP.
67
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
1 and 3 only
68
Which of the following best defines an aerosol?
Suspension of liquid or solid particles in a gas
69
With which of the following devices are therapeutic aerosols generated?
1. Atomizers
2. Nebulizers
3. Humidifiers
4. Soft mist inhalers
1, 2, and 4 only
70
The mass of aerosol particles produced by a nebulizer in a given unit time best describes which quality of the aerosol?
Output
71
Which of the following describes the mass of drug leaving the mouthpiece of a nebulizer as aerosol?
Emitted dose
72
Which of the following is a common method to measure aerosol particle size?
Cascade impaction
73
What measure is used to identify the particle diameter, which corresponds to the most typical settling behavior of an aerosol?
Mean mass aerodynamic diameter (MMAD)
74
What measure is used to describe the variability of particle diameters in an aerosol?
GSD
75
Most nebulizers used in respiratory care produce which type of aerosol suspension?
Heterodisperse
76
What is the retention of aerosol particles resulting from contact with the respiratory tract mucosa called?
Deposition
77
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
1, 2, and 3 only
78
What is the primary mechanism for deposition of large, high-mass particles (>5 μm) in the respiratory tract?
Inertial impaction
79
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
2 and 3 only
80
Where do most aerosol particles in the 5- to 10-μm range deposit?
Upper airways
81
What is the primary mechanism for central airway deposition of particles in the 1- to 5-μm range?
Sedimentation
82
Where do most aerosol particles in the 1- to 5-μm range deposit?
Central airways
83
Which of the following techniques will increase aerosol deposition by sedimentation in the lungs?
10-sec breath-hold
84
Which term describes the primary mechanism for deposition of small particles?
Brownian diffusion
85
What is the primary fate of inhaled aerosol particles that are between 1 and 0.5 μm?
Most are cleared during exhalation.
86
Which of the following aerosols would have the highest rate of deposition by diffusion?
MMAD of 0.1 μm
87
Where do most aerosol particles that are less than 3 μm deposit?
Alveoli
88
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 μm
89
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 μm
90
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 μm
91
What is the process by which aerosol suspension changes over time?
Aging
92
Which of the following is false about changes in aerosol suspensions over time?
The rate of particle growth is directly proportional to particle size.
93
As hygroscopic aerosol particles enter the respiratory tract, what do they tend to do?
Increase in size because of the absorption of molecular water.
94
What is the primary hazard of aerosol drug therapy?
Adverse drug reactions
95
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.
1, 2, and 3
96
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
1, 3, and 4 only
97
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.
1, 2, 3, and 4
98
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?
Add coughing and postural drainage to the therapy.
99
Which of the following is not considered a drug aerosol delivery system?
Spinning disk nebulizers
100
What is the preferred method for delivering bronchodilators to spontaneously breathing and intubated, ventilated patients?
Metered dose inhaler
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47問 • 2年前問題一覧
1
Which of the following phases constitute the course of drug action from dose to effect?
1. Drug administration
2. Pharmacognosy
3. Pharmacokinetic
4. Pharmacodynamic
1, 3, and 4 only
2
Which of the following devices are most commonly used to deliver aerosols by the inhalation route?
1. Small particle aerosol generator
2. Metered dose inhaler
3. Small volume nebulizer
4. Soft-mist inhaler
2, 3, and 4 only
3
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
1, 2, and 3 only
4
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.
1, 2, and 4 only
5
Which phase describes the time course and disposition of a drug in the body based on its absorption, distribution, metabolism, and elimination?
Pharmacokinetic
6
Which of the following methods limits the systemic distribution of an inhaled aerosolized drug?
Use of a fully ionized drug
7
Which of the following anticholinergics is poorly ionized?
Atropine
8
Which of the following lung availability/total systemic availability (L/T) ratios is consistent with an efficient aerosol delivery?
0.6
9
Which phase describes the mechanism of drug action by which a drug causes its effects within the body through drug-receptor interactions?
Pharmacodynamic
10
Pharmacologic control of the airway is mediated by receptors found on which of the following structures?
1. Smooth muscle
2. Secretory cells
3. Blood vessels
4. Alveolar epithelium
1, 2, and 3 only
11
Which of the following is the usual neurotransmitter in the sympathetic system?
Norepinephrine
12
Which of the following terms is used to describe a drug that stimulates a receptor responding to norepinephrine?
Adrenergic
13
When stimulated, which of the following receptors causes bronchoconstriction?
M3
14
Which of the following comprises the largest single group of drugs among aerosolized agents used for inhalation?
Adrenergic bronchodilators
15
Proventil and Ventolin are brand names for which of the following beta-adrenergic bronchodilators?
Albuterol
16
Foradil is a brand name for which of the following beta-adrenergic bronchodilators?
Formoterol
17
A metered dose inhaler of salmeterol delivers which of the following?
25 mcg/puff
18
What is the dosage for salmeterol MDI?
2 puffs every 12 hr
19
Which of the following is an indication for use of an adrenergic bronchodilator?
Treatment of reversible airflow obstruction
20
Adrenergic bronchodilators improve flow rates for which of the following diseases?
1. Asthma
2. Acute bronchitis
3. Chronic bronchitis
4. Pulmonary fibrosis
1, 2, and 3 only
21
Short-acting adrenergic bronchodilators are considered what type of agent according to the National Asthma Education and Prevention Program?
Rescue
22
What is the name of the enzyme responsible for the short duration of action of catecholamine bronchodilators?
Catechol O-methyltransferase (COMT)
23
Which of the following short-acting catecholamines is used for their strong alpha-1-vasoconstricting effects to reduce swelling in the nose and larynx and to control bleeding during bronchoscopic biopsy?
Racemic epinephrine
24
What is the average duration of action of the short-acting noncatecholamine agents?
4 to 6 hr
25
Which of the following are LABA bronchodilators?
1. Indacaterol
2. Olodaterol
3.. Albuterol
4. Salmeterol
1, 2, and 4 only
26
Which of the following is the generic name for Arcapta Neohaler?
Indacaterol
27
What is the brand name of the (R)-isomer of formoterol?
Brovana
28
Which of the following are side effects of beta-2-selective bronchodilators?
1. Bradycardia
2. Tremor
3. Insomnia
4. Headache
2, 3, and 4 only
29
What are some potential adverse effects with use of adrenergic bronchodilators?
1. Hypokalemia
2. Dizziness
3. Worsening ventilation/perfusion ratio (V/Q)
4. Bradycardia
1, 2, and 3 only
30
Which of the following are indications for the use of acetylcysteine (Mucomyst)?
1. Treatment of acetaminophen overdose
2. Treatment of excessive, viscous mucus secretions
3. Treatment of aspirin overdose
4. Treatment of purulent mucus secretions by breaking up DNA
1 and 2 only
31
What amount of ipratropium bromide (Atrovent) is delivered by metered dose inhaler?
17 mcg/puff
32
What is the dosage for ipratropium bromide (Atrovent)?
2 puffs four times daily
33
What is the duration of action for ipratropium bromide?
4 to 6 hr
34
What is the duration of action for the formulation of ipratropium bromide plus albuterol sulfate (DuoNeb)?
4 to 6 hr
35
Which of the following nebulizers is used to nebulize iloprost?
I-neb
36
What are some common side effects seen with ipratropium bromide (Atrovent)?
Cough and dry mouth
37
Ipratropium bromide should be used with precaution in which of the following diseases/conditions?
1. Prostatic hypertrophy
2. Urinary retention
3. Kidney stones
4. Glaucoma
1, 2, and 4 only
38
Which of the following are mucoactive agents currently approved for inhalation in the United States?
1. Tryptase alfa
2. Dornase alfa
3. Hyperosmolar saline
4. Mucomyst
2, 3, and 4 only
39
Acetylcysteine (Mucomyst) is indicated in which of the following diseases?
1. Acute tracheobronchitis
2. Bronchiectasis
3. Chronic obstructive pulmonary disease (COPD)
4. Asthma
1, 2, and 3 only
40
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?
Reduce dose to 1 to 2 breaths per session and then gradually increase to 3.
41
Which of the following explains how acetylcysteine (Mucomyst) lowers the viscosity of mucus?
Substituting its sulfhydryl group for disulfide bonds and breaking a portion of the bond forming the gel structure
42
Which of the following prophylactic therapies is recommended to reduce the irritant effect of acetylcysteine?
Administration of adrenergic bronchodilator
43
When administering acetylcysteine (Mucomyst), the respiratory therapist should be particularly focused on which of the following potential adverse effects?
1. Incompatibility with certain antibiotics when administered together
2. Blurred vision
3. Bronchospasm
4. Airway obstruction due to rapid liquefaction of mucus
1, 3, and 4 only
44
Which of the following is a contraindication for the use of nitric oxide?
Right-to-left shunt dependence
45
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
2, 3, and 4 only
46
Bland aerosols are best classified as:
expectorants
47
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
1, 2, and 3 only
48
Which of the following FEV1 values indicates severe compromise of expiratory airflow that may contraindicate the use of mucoactive therapy?
Less than 25%
49
The National Asthma Education and Prevention Program guidelines advocate the use of oral corticosteroids for which of the following?
Maintenance of mild to moderate persistent asthma
50
Which of the following is not an available formulation strength for fluticasone propionate (Flovent) by metered dose inhaler?
250 mcg/puff
51
Which of the following are true regarding glucocorticoids?
1. They work through activation of intracellular receptors.
2. Relief is immediate.
3. Daily compliance is essential to controlling inflammation in asthma.
4. They work in a similar fashion to adrenergic bronchodilators.
1 and 3 only
52
Aerosolized delivery of corticosteroids usually does not manifest in adrenal suppression compared to systemic use as long as the daily dose in adults is kept below what level?
800 mcg
53
Which of the following inhaled corticosteroids is a prodrug?
Ciclesonide
54
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?
Use of anticholinergics
55
Which of the following are considered nonsteroidal antiasthma drugs?
1. Cromolyn-like agents
2. Leukotriene modifiers
3. Anti-IgE agents
4. Anti-IgA agents
1, 2, and 3 only
56
How does cromolyn sodium work?
Inhibits degranulation of mast cells.
57
Which of the following are medications contain fluticasone furoate?
1. Arnuity Ellipta
2. Breo Ellipta
3. Combivent Respimat
4. Advair Diskus
1 and 2 only
58
Zileuton belongs to which of the following categories?
Leukotriene modifiers
59
Which of the following are considered an aerosolized antiinfective agent?
1. Pentamidine
2. Ribavirin
3. Tobramycin
4. Amikacin
1, 2, and 3 only
60
Pentamidine is indicated for the treatment of which of the following diseases?
Pneumocystis jiroveci
61
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).
1, 2, and 3 only
62
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.
1, 3, and 4 only
63
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.
1, 2, 3, and 5 only
64
Side effects associated with parenteral administration of aminoglycosides include which of the following?
1. Ototoxicity
2. Voice alteration
3. Nephrotoxicity
4. Deafness
1, 3, and 4 only
65
Inhaled zanamivir is indicated for which of the following treatment of uncomplicated respiratory illness?
Influenza
66
What is the mechanism behind nitric oxide (INOmax)?
It relaxes vascular smooth muscle by binding to the heme group of cystolic guanylate, activating guanylate cyclase, increasing cyclic GMP.
67
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
1 and 3 only
68
Which of the following best defines an aerosol?
Suspension of liquid or solid particles in a gas
69
With which of the following devices are therapeutic aerosols generated?
1. Atomizers
2. Nebulizers
3. Humidifiers
4. Soft mist inhalers
1, 2, and 4 only
70
The mass of aerosol particles produced by a nebulizer in a given unit time best describes which quality of the aerosol?
Output
71
Which of the following describes the mass of drug leaving the mouthpiece of a nebulizer as aerosol?
Emitted dose
72
Which of the following is a common method to measure aerosol particle size?
Cascade impaction
73
What measure is used to identify the particle diameter, which corresponds to the most typical settling behavior of an aerosol?
Mean mass aerodynamic diameter (MMAD)
74
What measure is used to describe the variability of particle diameters in an aerosol?
GSD
75
Most nebulizers used in respiratory care produce which type of aerosol suspension?
Heterodisperse
76
What is the retention of aerosol particles resulting from contact with the respiratory tract mucosa called?
Deposition
77
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
1, 2, and 3 only
78
What is the primary mechanism for deposition of large, high-mass particles (>5 μm) in the respiratory tract?
Inertial impaction
79
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
2 and 3 only
80
Where do most aerosol particles in the 5- to 10-μm range deposit?
Upper airways
81
What is the primary mechanism for central airway deposition of particles in the 1- to 5-μm range?
Sedimentation
82
Where do most aerosol particles in the 1- to 5-μm range deposit?
Central airways
83
Which of the following techniques will increase aerosol deposition by sedimentation in the lungs?
10-sec breath-hold
84
Which term describes the primary mechanism for deposition of small particles?
Brownian diffusion
85
What is the primary fate of inhaled aerosol particles that are between 1 and 0.5 μm?
Most are cleared during exhalation.
86
Which of the following aerosols would have the highest rate of deposition by diffusion?
MMAD of 0.1 μm
87
Where do most aerosol particles that are less than 3 μm deposit?
Alveoli
88
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 μm
89
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 μm
90
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 μm
91
What is the process by which aerosol suspension changes over time?
Aging
92
Which of the following is false about changes in aerosol suspensions over time?
The rate of particle growth is directly proportional to particle size.
93
As hygroscopic aerosol particles enter the respiratory tract, what do they tend to do?
Increase in size because of the absorption of molecular water.
94
What is the primary hazard of aerosol drug therapy?
Adverse drug reactions
95
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.
1, 2, and 3
96
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
1, 3, and 4 only
97
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.
1, 2, 3, and 4
98
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?
Add coughing and postural drainage to the therapy.
99
Which of the following is not considered a drug aerosol delivery system?
Spinning disk nebulizers
100
What is the preferred method for delivering bronchodilators to spontaneously breathing and intubated, ventilated patients?
Metered dose inhaler