3D- Administer Medications and Specialty Gases

TMC: 4 questions

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

administer the aerosol continuously

change to hypertonic saline

initiate chest physiotherapy

perform nasotracheal suctioning

change to hypertonic saline

Hypertonic saline solution can help draw fluid out of the airway mucosa. For this reason, the aerosolization of hypertonic saline solution can help mobilize secretions and can be effective with sputum induction.

A 70-year-old male presents in the emergency department with shortness of breath and a non-productive cough. Auscultation of the chest reveals bilateral expiratory wheezes. Which of the following intervention would be most helpful to the patient?

comolyn sodium (Intal)

dexamethasone (Decadron)

osmitrol (Mannitol)

ipratropium bromide (Atrovent)

ipratropium bromide (Atrovent)

Bilateral expiratory wheezing, or bronchial wheezing of any type, is best remedied by the administration of bronchodilator medication. Of the options listed, only ipratropium bromide, or Atrovent, is considered to be a bronchodilator. This type of bronchodilator, together with such drugs as albuterol, is considered to be a rescue medication. Cromolyn sodium is considered a long-term solution to prevent the release of histamine which will help prevent bronchoconstriction. The other drugs listed are not noted for achieving short-term bronchodilation.

A patient with asthma has arrived in the Emergency Department with bilateral wheezing. Which of the following would best treat this problem?

28% O2 by air-entrainment mask

Aerosolized albuterol (Proventil HFA)

Aerosolized ipratropium bromide (Atrovent HFA)

Aerosolized warm normal saline solution

Aerosolized albuterol (Proventil HFA)

A patient in the emergency department (ED) with asthma has been on a continuous Albuterol treatment for one hour at 10mg/hr. Aeration has improved slightly upon auscultation. Peak flow is currently less than 50% of normal baseline. The respiratory therapist is asked to recommend additional bronchodilator therapy to be combined with Albuterol. Which of the following should the therapist recommend?

Flovent MDI 2 Puffs

Serevent MDI 2 Puffs

Atrovent MDI 2 Puffs

Pributerol MDI 2 Puffs

Atrovent MDI 2 Puffs

Atrovent is an appropriate choice because it is a back-door bronchodilator and can safely be combined with albuterol. Serevent and Pributerol are not appropriate because they are also front-door bronchodilators and should not be combined with albuterol. Flovent is a maintenance drug that is not helpful in this acute situation.

A patient with left-sided heart failure has decreased pulmonary venous drainage pressure. The patient would benefit from which of the following medications?

Spiriva

Pavulon

Anectine

Digitalis

Digitalis (digoxin)

This question is about understanding the classification of medications. The patient has left-sided heart failure and therefore needs to have a medication that increases the contraction of the left heart. The only medication offered that will accomplish this is digitalis. Be sure to study the other medications to know how they are used.

Pulmozyme is best used for

COPD patients with airway inflammation

tuberculosis patients with blood-tinged secretions

cystic fibrosis patients with a FVC of at least 40% predicted

asthma patients refractory to sympathomimetic bronchodilators

cystic fibrosis patients with a FVC of at least 40% predicted

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

diluting the Mucomyst with distilled water

switching to dornase alpha (Pulmozyme)

mixing the Mucomyst with a bronchodilator

discontinuing administration of the drug

mixing the Mucomyst with a bronchodilator

The correct pediatric dosage for Xopenex is

0.31 mg TID for children between age 6 and 11 year

0.31 mg TID for children under age six

1.25 mg TID for all ages

0.63 mg Q3 hours for children between age 6 and 11 years

0.31 mg TID for children between age 6 and 11 year

Xopenex should not be given prior to age 6. 0.31 mg is the appropriate dosage for a patient between age 6 and 11 years. Q3 hours is too frequent for this medication. TID is the appropriate starting frequency for Xopenex

A patient has received three aerosolized bronchodilator treatments over the past 2 hours with no relief noted. Which of the following may benefit the patient?

administer Atropine sulfate (SCH 1000)

administer cromolyn sodium (Intal)

administer Atrovent (Ipratropium bromide) with Albuterol

administer continuous Albuterol at 1 mg/hr

administer Atrovent (Ipratropium bromide) with Albuterol

A patient who continues to wheeze after a few bronchodilator treatments is in need of further bronchodilator medication. Of the options offered, Atrovent with albuterol is the best option. Continuous bronchodilator therapy would be appropriate but the dose offered is subtherapeutic. For a pediatric patient at least 7 mg per hour is appropriate and 10 mg per hour is required for an adult.

A 20-year-old male is going to be orally intubated in the emergency room in response to drug overdose and ventilator failure. Which of the following medications is most appropriate to facilitate oral intubation?

Pavulon

Vecuronium Bromide

Anectine (succinylcholine chloride)

Curare (d-turbo curare)

Anectine (succinylcholine chloride)

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

tachycardia

upper airway fungal infections

adrenal suppression

osteoporosis

upper airway fungal infections

Adrenal suppression and osteoporosis are adverse reactions to SYSTEMIC steroid administration. Tachycardia is not likely with steroids. However, patients who fail to rinse their mouth out after the administration of an aerosolized steroid such as beclomethasone are at risk for developing an oral Candida albicans (thrush) fungal infection.

During an aerosol treatment with albuterol (Proventil), an adult patient complains of dizziness and lightheadedness. The patient's pulse increases from 70 to 85/min during the treatment. Which of the following notes should be recorded in the patient's chart?

patient instructed to relax and breathe more slowly during therapy

treatment given as ordered and tolerated well by patient

treatment was terminated due to increase in heart rate

tachycardia during Rx; drug dosage should be decreased

patient instructed to relax and breathe more slowly during therapy

The normal pulse rate for an adult is 60 to 100/min. Beta-adrenergic bronchodilators such as albuterol can increase a patient's heart rate (beta-1 receptor stimulation). In this instance, the patient's heart rate remained within a safe range and the lightheadedness and dizziness was likely the result of mild hyperventilation which can be addressed by instructing the patient to relax and breathe more slowly during therapy.

Which of the following nonsteroidal anti-inflammatory drugs is administered by the inhalation route?

zileuton (Zyflo)

montelukast (Singulair)

zafirlukast (Accolate)

cromolyn sodium (Intal)

cromolyn sodium (Intal)

Of the drugs listed, only cromolyn sodium (Intal) is available for administration via the inhalation route. Montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo) are leukotriene modifiers available only for oral administrations via tablets or oral granules.

A patient with status asthmaticus has received multiple bronchodilator treatments. Peak expiratory flow has not improved and wheezing persists. The physician is concern about the patient's ability to endure this level of breathing labor. Which of the following may the therapist suggest to decrease the work of breathing related to airway resistance?

Nitrous oxide therapy

Helium/oxygen therapy

CPAP

Hyperbaric therapy

Helium/oxygen therapy

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?

bradycardia

bronchospasm

fever

hemoptysis

bronchospasm

Common side effects of aerosolized pentamidine include: bronchospasm, wheezing, cough and bad taste. Cough and bronchospasm/wheezing can be prevented or minimized by administration of an inhaled bronchodilator prior to pentamidine treatment. Fever may well accompany an active Pnemocystis infection but is not a common side effect of pentamidine.

A respiratory therapist is performing a routine check on a patient with a molecular sieve device (oxygen concentrator). The therapist should check which of the following?

1. concentrator filters

2. concentrator flow rates with a calibration device

3. integrity of the electrical cord

4. length of the oxygen tubing going to the patient

1 and 2 only

1, 2, and 3 only

1, 2, 3, and 4

2 and 3 only

1, 2, and 3 only

Only a qualified professional respiratory therapist should perform routine checks on an oxygen concentrator. Some of these assessments may include checking the filters (which may also be done by the patient), assuring accurate flow rates with a calibration device, and checking the integrity of the electrical cord. Determining the length of the oxygen tubing is not part of the routine check of the concentrator.

A respiratory therapist is called to the nursery to assess a 36-week gestational age neonate delivered five hours prior. Supraclavicular retractions are present. Respiratory rate is 70/min with nasal flaring and grunting. Radiological examination has a honeycomb pattern in the chest. The respiratory therapist should

place the patient on a 40% oxygen hood

place the patient on a nasal cannula at 2 L/min

intubate and mechanically ventilate

intubate and deliver surfactant

intubate and deliver surfactant

Radiological descriptions such as "honeycomb" or "ground glass" patterns suggest RDS. These signs along with the respiratory distress of a premature neonate strongly suggest the need for surfactant therapy, which must be delivered through an endotracheal tube. Intubation is necessary for delivering surfactant.

Which of the following can safely be combined with inhaled albuterol?

Phosphodiesterase inhibitor

Xopenx

Ipratropium Bromide

Pirbuterol

Ipratropium Bromide

Xopenex should not be combined with albuterol because both are front-door bronchodilators. It is not appropriate to combine multiple front-door bronchodilators.

A patient is on 70%/30% heliox therapy by nonrebreathing mask. If flowing through an oxygen flow meter, what is the actual flow of the mixture if the flow meter indicates 10 L/min?

5 L/min

16 L/min

8 L/min

18 L/min

16 L/min

When helium-oxygen mixtures are run through flow meters that are intended for oxygen only, the indicated flow on the flow meter is inaccurate. This is because the helium-oxygen mixture is less viscous and does not push the indicator ball up as much as does oxygen. In this case, a correction factor must be used depending upon the mixture percentage. For an 80/20% mixture a correction factor of 1.8 must be used. A 70/30% mixture has a correction factor of 1.6 and a 60/40% mixture has a correction factor of 1.4. In this problem the 70/30% mixture factor of 1.6 must be multiplied by the indicated flow on the oxygen flow meter to calculate actual total gas flow. When we do this we get a total gas flow of 16 L/min.

What is the typical frequency for Flovent MDI?

Q6 hours

PRN

BID

TID

BID

Flovent (fluticasone) is a corticosteroid used generally to prevent and relieve inflammation of airway walls. Inflammation is one of the components of asthma so corticosteroids are key in treatment. The frequency is twice per day or b.i.d.