To monitor a patient for the possibility of reactive bronchospasm during aerosol drug therapy,
what should you do?
1. Measure pre- and post-peak 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.

Each actuation of a typical metered dose inhaler delivers approximately what output volume?
a. 10 to 30 mcl
b. 30 to 100 mcl
c. 10 to 30 ml
d. 30 to 100 ml

When using a metered dose inhaler without a holding chamber or a spacer, the patient should
be instructed to fire the device at what point?
a. Immediately before beginning a slow inspiration
b. Immediately after beginning a slow exhalation
c. Immediately after beginning a slow inspiration

Which of the following devices would you select to deliver an aerosolized bronchodilator to a
young child?
a. Metered dose inhaler (MDI) and spacer
b. MDI, holding chamber, and mask
c. MDI and holding chamber
d. Dry powder inhaler

Which of the following small-volume jet nebulizer design features affect its performance?
1. Position
2. Residual volume
3. Baffles
4. Reservoirs

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?
a. Discontinue the heated water aerosol treatments.
b. Switch to a higher-density aerosol (e.g., ultrasonic).
c. Add coughing and postural drainage to the therapy.
d. Consider prior treatment with a bronchodilator.

Most of the spray generated by the majority of metered dose inhalers consists of which of the
following?
a. Active drug
b. Propellant

Before inspiration and actuation of a metered dose inhaler, the patient should exhale to which
of the following?
a. Total lung capacity
b. Residual volume
c. Functional residual capacity
d. Expiratory reserve volume

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

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 considered a drug aerosol delivery system?
1. Dry powder inhalers (DPIs)
2. Small-volume jet nebulizers
3. Metered dose inhalers (MDIs)
4. Spinning disk nebulizers

Approximately what range of drug dosages can be provided with each firing of a metered dose
inhaler?
a. 5 to 50 mg
b. 50 to 100 mg
c. 5 to 50 mcg
d. 50 mcg to 5 mg

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.

Proper use of a dry powder inhaler (DPI) requires that the patient be able to do which of the
following?
a. Generate inspiratory flows of 60 L/min or higher.
b. Exhale forcibly through the device before drug delivery.
c. Inhale slowly (<0.5 L/sec) and perform a breath-hold.
d. Coordinate firing of the DPI with inspiration.

Which of the following drug formulation characteristics affect the performance of
small-volume jet nebulizers?
1. Homogeneity
2. Surface tension
3. Viscosity
4. Potency

What is the preferred method for delivering bronchodilators to spontaneously breathing and
intubated, ventilated patients?
a. Dry powder inhaler
b. Small-volume jet nebulizer
c. Metered dose inhaler
d. Hand-bulb atomizer

A typical metered dose inhaler produces which of the following particle distributions?
a. 2 to 6-m mean mass aerodynamic diameter (MMAD)
b. 1- to 3-m MMAD
c. 6- to 9-m MMAD
d. Less than 1-m MMAD

Which of the following are beneficial effects of using a holding chamber with a metered dose
inhaler (MDI)?
1. Reduction in oropharyngeal aerosol deposition
2. Decrease in need for hand-breath coordination
3. Elimination of medication waste
a. 1 and 2 only
b. 1 and 3 only
c. 2 and 3 only
d. 1, 2, and 3

Which of the following devices depends on the patient’s inspiratory effort to dispense the
dose?
a. Small-volume jet nebulizers
b. Metered dose inhaler
c. Dry powder inhaler
d. Soft mist inhaler

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)

Immediately after firing, the aerosol particles produced by most metered dose inhalers are
approximately how large?
a. 1 m
b. 5 m
c. 20 m
d. 35 m

When fired inside the mouth, what percentage of the drug dose delivered by a simple metered
dose inhaler (MDI) deposits in the oropharynx?
a. Approximately 20%
b. Approximately 40%
c. Approximately 60%
d. Approximately 80%

The key difference between a metered dose inhaler (MDI) holding chamber and a spacer is
that the holding chamber incorporates which of the following?

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

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