1. A physician orders an 70% He/30% O2 mixture to be delivered to a patient having an acute asthmatic attack. Assuming use of a 70% He/30% O2 bulk cylinder, which of the following systems would be most appropriate to deliver this mixture?
A. nebulizer set at 100% oxygen + aerosol mask
B. tight-fitting nonrebreathing mask at 10 L/min
C. simple oxygen mask at 10 L/min oxygen
D. nasal cannula at 10 L/min
2. When administering aerosolized albuterol (Proventil) you should be on guard for which of the following adverse effects?
3. 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?
4. 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:
A. wait until the physician is done with the code so you can clarify the improper notation and the correct order
B. administer the treatment using the standard dosage (0.5 mL) and clarify the order as soon as possible thereafter
C. cross out the prohibited notations, provide the correct abbreviations and initial and date the changes
D. have the nurse review the order and correct the improper notation
5. 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?
D. magnesium sulfate
A. 2 ppm
B. 20 ppm
C. 200 ppm
7. 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?
A. vibrating mesh nebulizer
B. dry powder inhaler (DPI)
C. small volume jet nebulizer
D. small particle aerosol generator
8. 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?
A. order a stat chest X-ray
B. suction the patient
C. administer prescribed bronchodilators
D. check the cuff inflation pressure
9. Which of the following is the preferred delivery method for cromolyn sodium to young children?
A. MDI with mask
B. small volume nebulizer
C. MDI with holding chamber
D. dry powder inhaler
10. Which of the following patient instructions for using a dry powder inhaler (DPI) is correct?
A. hold the device vertically after loading
B. inhale rapidly for 1-2 seconds
C. blow slowly into the device
D. breathe normally in/out of the device
11. 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:
A. tachyphylaxis or tolerance to the agent
B. alterations in the V/Q ratio (a beta-2 effect)
C. the additive effect of other drug agents
D. a paradoxical response to the agent
12. A patient during CPR cannot have an intravenous line started. The physician wants to administer Naloxone because the patient is suffering from a morphine overdose. What is an alternative route of administration?
A. nasogastric (NG) tube
B. feeding tube
C. sublingual tab
D. endotracheal tube
13. The recommended adult dosage when delivering albuterol (Proventil) by small volume nebulizer (SVN) is:
A. 0.3 ml of 1:20 aqueous solution in diluent
B. 0.3 ml of 1:200 aqueous solution in diluent
C. 0.5 ml of 1:200 aqueous solution in diluent
D. 1.0 ml of 1:200 aqueous solution in diluent
14. 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:
A. administer the therapy with the cannula as ordered
B. administer the therapy and then draw an ABG
C. obtain a nonrebreathing mask and administer the therapy
D. obtain a venturi mask and administer the therapy
15. 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?
A. “Suggest to your physician that your medication
B. “Increase your rate and depth of breathing to remove the excess CO2 from the aerosol mask.”
C. “Relax and try to breathe slowly and I will be here with you so that nothing goes wrong.”
D. “There is no need to worry because all patients become nervous and anxious while taking this kind of treatment.”
16. 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
A. administer the aerosol continuously
B. change to hypertonic saline
C. initiate chest physiotherapy
D. perform nasotracheal suctioning
17. Which of the following breathing patterns would optimize pulmonary aerosol deposition of a drug administered by MDI?
A. Pattern A
B. Pattern B
C. Pattern C
D. Pattern D
18. After withdrawal from inhaled nitric oxide (NO) therapy, an infant suddenly becomes hemodynamically unstable. You should:
A. return the infant to the prior NO dosage
B. recommend administration of vasodilators
C. decrease the FIO2 to the lowest level tolerable
D. initiate rapid chest compressions
19. 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?
A. measure the patient’s MIP before-and-after treatment
B. measure the patient’s inspiratory capacity before-and-after treatment
C. measure the patient’s FEV1% before-and-after treatment
D. calculate the patient’s alveolar minute volume
20. You are instructing an 8-year-old boy with asthma on the use of an albuterol MDI. What can be done to increase the deposition of the bronchodilator?
A. add a spacer or holding chamber to the MDI
B. have the child inhale the as quickly as possible
C. switch from an MDI to a small volume nebulizer
D. remove the mouthpiece from the MDI
21. 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:
A. be prescribed an appropriate antibiotic
B. decrease the frequency of inhalations to BID
C. rinse her mouth and gargle with water after inhalation
D. receive concurrent bronchodilator therapy
22. 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:
A. both inspiratory and expiratory HEPA filters are in place
B. a HEPA filter is in place on the inspiratory limb of the circuit
C. a heat and moisture exchanger is in place at the patient connector
D. a HEPA filter is in place on the expiratory limb of the circuit
23. 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?
D. postponing therapy until the patient can cough effectively
24. To help prevent infection after an aerosol drug treatment provided via small volume nebulizer (SVN) you would:
A. shake out any residual solution then bag the SVN
B. rinse the SVN with tap water then dry and bag it
C. run the SVN at high flows until completely dry
D. rinse the SVN with sterile water then dry and bag it
25. When administering aerosolized albuterol (Proventil) you should be on guard for which of the following adverse effects?
26. When acetylcysteine (Mucomyst) is appropriately ordered for a patient in the ICU, it can be helpful in treating which of the following conditions?
A. mucous plugs
C. pulmonary hypertension
D. pleural effusion
27. Which of the following represents the primary indication for and approved use of inhaled nitric oxide?
A. hypoxemia associated with obstructive sleep apnea
B. hypoxemia in neonates with persistent pulmonary hypertension
C. ventilatory failure in premature neonates
D. hypoxemia associated with hyaline membrane disease
28. A postoperative patient develops bilateral wheezing. Which of the following is the most appropriate therapy for this condition?
A. incentive spirometry
B. mucolytic agent
C. chest physiotherapy
29. Which of the following drug would you recommend for a patient with acute bronchospasm?
A. racemic epinephrine
B. acetylcysteine (Mucomyst)
C. albuterol (Proventil)
D. cromolyn sodium (
30. Which of the following are possible side effects associated with the administration of beta-adrenergic bronchodilators?
A. Yes Yes No
B. Yes No Yes
C. No Yes Yes
D. Yes Yes Yes