Chapter 6
MULTIPLE CHOICE
Choose the one alternative that best completes the statement or answers the question.
1. The most cost-effective and readily available means of maintaining mucokinetics is with which of the following agents?
a. Mucomyst
b. Normal saline
c. Water
d. Sodium bicarbonate
2. Bypassing the upper airway by placing an endotracheal tube into the lungs can lead to which of the following?
a. Infection
b. Impaired ciliary action
c. Accumulation of mucus in the lungs
d. All of the above
3. Of the following, which is responsible for producing most of the mucus found in the airways?
a. Serous cells
b. Bronchial glands
c. Goblet cells
d. Clara cells
4. Repeated, prolonged exposure to irritants causes all of the following changes to occur in the airways except:
a. Increased size of bronchial glands.
b. Decreased ciliary action.
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c. Increased number of bronchial glands.
d. Decreased mucous production.
5. Methods for delivering liquid particles of water to the lung include all the following except:
a. Humidifiers.
b. Large-volume nebulizers.
c. Direct instillation.
d. Ultrasonic nebulizers.
6. You are called to the emergency room to administer a bland aerosol treatment to a patient for sputum induction. Which of the following agents would you select for its effect in producing irritation and cough?
a. Sterile water.
b. Normal saline.
c. Hypertonic saline.
d. Hypotonic saline.
7. The pharmacologic approach to secretion management includes all the following except:
a. Increasing the depth of the sol layer.
b. Altering the consistency of the gel layer.
c. Increasing the number of bronchial glands.
d. Improving ciliary action.
8. A treatment regime for a patient with thick, retained secretions who is currently receiving oxygen should include all the following except:
a. Bland aerosol with sterile water via a large-volume nebulizer.
b. Administration of an antitussive such as dextromethorphan.
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c. Intermittent treatments with Mucomyst and a short-acting bronchodilator.
d. Deep breathing, assisted coughing, and suctioning.
9. You receive a call from the attending physician of a 68-year-old patient with chronic bronchitis. He reports that the patient has very thick secretions that she is unable to remove from her airway and asks for your recommendations. The drug most indicated for this patient is:
a. Dornase alfa.
b. N-acetylcysteine.
c. Sodium bicarbonate.
d. Survanta.
10. A patient with hyperreactive airways is to receive a bland aerosol treatment with an ultrasonic nebulizer. Which of the following solutions would you select to cause the least irritation?
a. Tap water
b. Hypertonic saline
c. Hypotonic saline
d. Sterile water
11. Which of the following contributes to mucous clearance from the airways by altering its water content?
a. Dornase alfa
b. Normal saline
c. Mucomyst
d. Infasurf
12. Patients that would benefit most from aerosolized hypertonic saline solution are those with which of the following?
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a. Cystic fibrosis
b. COPD
c. Asthma
d. Heart failure
13. Antitussives are indicated for which of the following conditions?
a. Dry, hacking, nonproductive cough
b. Accumulation of thick secretions leading to shortness of breath
c. Fulminant pulmonary edema
d. Bronchospasm accompanied by frequent cough
14. Expectorants are thought to work by all except which of the following actions?
a. Breaking disulfide bonds in the mucus
b. Increasing vagal-gastric reflex stimulation
c. Being absorbed into respiratory glands, causing direct stimulation to increase mucous production
d. Increasing the amount of fluid in the respiratory tract
15. Pulmozyme would be the treatment of choice for which of the following conditions?
a. COPD
b. Asthma
c. Heart failure
d. Cystic fibrosis
16. Of the following devices used for delivery of water to the lungs, which would not be suitable when treating infants?
a. Small-volume nebulizers
b. Simple humidifiers
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c. Large-volume nebulizers
d. Ultrasonic nebulizers
17. The role of the mucociliary system includes all of the following except:
a. Warming and humidifying inspired gas.
b. Antimicrobial properties to prevent infection.
c. Removal of inhaled debris from alveoli through ciliary action.
d. Prevention of excessive loss of heat and moisture.
18. The alveolar structures responsible for the manufacture of surfactant are:
a. Type I pneumocytes.
b. Type II pneumocytes.
c. Clara cells.
d. Alveolar ducts.
19. Lack of surfactant in premature infants less than 34 weeks’ gestation is a result of:
a. Damaged type I pneumocytes.
b. Aspiration.
c. Perinatal asphyxia.
d. Immature type II pneumocytes.
20. Synthetic surfactants can be described as which of the following?
I. Exogenous
II. Containing proteins SP-B and SP-C
III. Free of infection and foreign proteins
a. I and II
b. II and III
c. I and III
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d. I, II, and III
21. Which of the following surfactants is synthetically manufactured?
a. Exosurf
b. Survanta
c. Infasurf
d. Curosurf
22. Surfactant replacement therapy requires which of following guidelines for proper administration?
I. Place an endotracheal tube into the infant’s airway.
II. Suction the infant prior to surfactant administration.
III. Have infant remain in the supine position during instillation.
a. I and II
b. II and III
c. I and III
d. I, II, and III
23. You are called to the labor and delivery department to aid in the care of a 28 weeks’ gestation infant. Soon after the baby is delivered, the decision is made to begin surfactant replacement therapy. The physician orders Infasurf for the 2,000-gm infant. What dosage would you prepare?
a. 10 ml
b. 8 ml
c. 6 ml
d. 5 ml
24. Hazards that can occur with surfactant replacement therapy after administration include hyperoxemia and decreased PaCO2. These changes can be explained as occurring because of:
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a. Increases in heart rate
b. Increases in tidal volumes due to improvement in lung compliance
c. Increases in ventilating pressures
d. Increases in respiratory rates
25. Pulmozyme should be administered using which of the following nebulizers?
a. Marquest Acorn II
b. Aeroneb
c. HOPE nebulizer
d. AeroEclipse
TRUE/FALSE
Write ‘T’ if the statement is true and ‘F’ if the statement is false.
______ 1. The role of goblet cells and clara cells is to produce about 100 ml of mucus each day.
______ 2. Mucomyst can cause bronchospasm in patients with hyperactive airway disease and should therefore be given in combination with a short-acting bronchodilator.
______ 3. Expectorants work by increasing the amount of fluid in the respiratory tract and by increasing vagal-gastric reflex stimulation.
______ 4. Surfactant is required to increase the surface tension in the alveoli and make inflation easier with less pressure.
______ 5. After surfactant is administered to a newborn, the baby should be monitored for changes in oxygenation and changes in ventilating pressures.
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______ 6. Mucolytics achieve their effect in mucus control by changing the molecular structure of the mucous gel.
______ 7. The use of bland aerosols aids in mucous clearance by restoring the gel layer.
______ 8. Solutions that are used for inhalation must be sterile and distilled.
______ 9. The use of hypertonic saline solutions for sputum induction is likely to cause bronchospasm.
______ 10. Pulmozyme aids in secretion removal by disrupting the disulfide bonds in mucus.
FILL-IN-THE-BLANK
Write the word or phrase that best completes each statement.
1. When a patient has a dry, nonproductive cough, a ________________ saline solution can be administered to stimulate a cough and produce more mucus.
2. The most frequently used solution for a diluent with aerosolized medications is ________________.
3. ________________ aerosols dilute mucus by altering its water content.
4. The ability of mucus to change from thick to thin and back is referred to as having ________________ properties.
5. A device that is used to minimize the drying effects of oxygen is a ________________.
6. A device that is designed to produce aerosol droplets for delivery to the airways is a ________________.
7. Mucomyst can be given by ________________ or by ________________ to the tracheobronchial tree.
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8. ________________ is indicated for maintenance therapy in the management of pulmonary secretions in cystic fibrosis.
9. When administering breathing treatments to patients who are on sodium-restricted diets, the diluent of choice is ________________.
10. The saline solution that is considered to be an expectorant is ________________.
11. A commonly used expectorant that is available in OTC cough and cold medications is ________________.
12. Mucous production will increase when the respiratory tract is irritated and during ________________ stimulation.
13. Surfactant that is naturally produced in lung tissue is called ________________ surfactant.
14. The only synthetically produced surfactant that is current available on the market is ________________.
15. Treatment of acetaminophen overdose includes oral or intravenous administration of ________________.
SHORT ANSWER
Answer the following questions or statements.
1. Identify the methods available for delivering bland aerosol to the lungs and explain how they differ.
2. Discuss the benefit and risk of direct instillation of normal saline into the respiratory tract.
3. What is the difference between the modes of action for Mucomyst and Pulmozyme in the treatment of thick, viscous secretions?
4. Compare and contrast the two types of exogenous surfactants that are currently available.
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5. Explain the two types of therapeutic approaches to surfactant administration for a premature infant with respiratory distress.
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Chapter 7
MULTIPLE CHOICE
Choose the one alternative that best completes the statement or answers the question.
1. Immunoglobulins are produced by which of the following?
a. Antigens
b. B lymphocytes
c. Antibodies
d. T lymphocytes
2. All of the following function as a natural defense to inhaled foreign material except:
a. Lymphocytes.
b. Antigens.
c. Macrophages.
d. Antibodies.
3. The immunoglobulin that is responsible for allergic rhinitis and allergic asthma is:
a. IgG.
b. IgM.
c. IgE.
d. IgA.
4. After an antigen-antibody reaction occurs, all of the following events contribute to the early phase inflammatory response except:
a. Mast cell membrane rupturing.
b. Release of chemical mediators to the site.
c. Arachidonic acid metabolism.
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d. Antibodies attacking antigens.
5. Which of the following would indicate that an asthma attack is allergy related?
a. The presence of eosinophils
b. Mast cell degranulation
c. An early phase response
d. A late-phase response
6. The type of asthma that responds to immunotherapy or allergy shots is:
a. Anaphylactic.
b. Intrinsic.
c. Nonatopic.
d. Extrinsic.
7. Leukotriene release can be explained by which of the following?
a. The release occurs during the early phase inflammatory response.
b. The lipoxygenase pathways release leukotriene, adding to the late-phase inflammatory response.
c. Arachidonic acid metabolism produces leukotriene through cyclooxygenase pathways.
d. Leukotrienes and prostaglandins are released through cyclooxygenase pathways.
8. The difference between mineralocorticoids and glucocorticoids is that:
a. Mineralocorticoids minimize salt-retention activity.
b. Glucocorticoids increase sodium and water reabsorption.
c. Mineralocorticoids affect carbohydrate, protein, and fat metabolism.
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d. Mineralocorticoids are useful for their anti-inflammatory activity.
9. If exogenous corticosteroid drugs are used, all except which of the following can occur?
a. Adrenal gland atrophy
b. Dependence on pharmacologic corticosteroids
c. HPA suppression
d. Hypothalamic stimulation, causing CRF to be released
10. Tapered doses of exogenous pharmacologic corticosteroid drugs are used to do which of the following?
a. Reduce the release of glucose
b. Allow time for the body to regain internal regulation of endogenous corticosteroids
c. Reduce stimulation of the hypothalamus
d. Increase adrenal suppression
11. All of the following are effects associated with the administration of glucocorticoids except:
a. Depletion of bone calcium.
b. Impairment of immunologic response.
c. A decrease in blood pressure.
d. An increase in blood glucose levels.
12. The most common side effect of inhaled steroids is:
a. Hypocalcemia.
b. Candidiasis.
c. Hypertension.
d. Hypoglycemia.
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13. Which of the following adverse reactions are associated with the use of inhaled corticosteroids?
I. Voice changes
II. Oropharyngeal fungal infection
III. Hoarseness
IV. Suppression of HPA
a. I and III
b. II and III
c. I, II, and III
d. I, II, III, and IV
14. Which of the following anti-inflammatory agents are available in MDI form?
I. Hydrocortisone
II. Flunisolide
III. Triamcinolone
IV. Solu-Medrol
a. I and II
b. II, III, and IV
c. II and III
d. I, II, and IV
15. Patients receiving inhaled corticosteroids should be instructed to do which of the following to reduce common side effects?
a. Take supplemental calcium to reduce the risk of osteoporosis.
b. Reduce the amount of sugar intake to reduce the risk of hyperglycemia.
c. Take prophylactic antibiotics to treat immunosuppression.
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d. Rinse the mouth with water or mouthwash after using the inhaled steroid.
16. The Advair Diskus combines which of the following medications?
I. Solu-Medrol
II. Serevent
III. Flovent
IV. Flonase
a. I and III
b. II and III
c. I and IV
d. II and IV
17. The mechanism of action of cromolyn sodium is the:
a. Inhibition of calcium influx into the mast cell, which prevents the release of chemical mediators
b. Inhibition of arachidonic acid metabolism
c. Suppression of HPA
d. Stimulation of lipoxygenase pathways
18. Which of the following drugs are advantageous in treating late-phase inflammatory asthma?
I. Tilade
II. Accolate
III. Albuterol
IV. Flovent
a. I and II
b. I, II, and III
c. I, III, and IV
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d. I, II, and IV
19. Which of the following is given as an oral medication?
a. Singulair
b. Azmacort
c. Flovent
d. Serevent
20. Cromolyn is supplied for intranasal use under the trade name:
a. Nasalide.
b. Rhinocort.
c. Nasalcrom.
d. Nasonex.
21. The antihistamine effect of Allegra is accomplished by which of the following mechanisms?
a. Blocking the action of histamine at histamine 1 receptors
b. Stabilizing the mast cell membrane and preventing release of histamine c. Inhibiting the effect of histamine by blocking lipoxygenase pathways
d. Inhibiting cytokine release from nasal epithelial cells
22. During an asthmatic attack, the production of fatty acid arachidonic acid results in all of the following except:
a. Mast cell membrane destruction.
b. Leukotriene release.
c. A cascade of chemical mediators.
d. Prostaglandin release.
23. You are asked to recommend treatment for a 16 year old who is seen in a hospital clinic for seasonal allergies and rhinitis. She explains to you that she
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suffers from scratchy throat, runny nose, cough, and sneezing but denies SOB and wheezing. What combination of drugs would best treat her allergy symptoms?
I. Advair Diskus
II. Flonase
III. Allegra
a. I and II
b. I and III
c. II and III
d. I, II, and III
24. Prophylactic antiasthmatic agents are known as:
a. Corticosteroids
b. Prostaglandins
c. Mast cell stabilizers
d. Leukotriene modifiers
25. Drugs that are time dependent and should not be used for acute reversal of bronchospasm include which of the following:
I. Nedocromil
II. Montelukast
III. Fluticasone
a. I and II
b. I and III
c. II and III
d. I, II, and III
TRUE/FALSE
Write ‘T’ if the statement is true and ‘F’ if the statement is false.
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______ 1. Inflammation that occurs in the airways is usually in response to the release of IgG.
______ 2. Allergic asthma is also referred to as “extrinsic asthma.”
______ 3. Over time, daily use of inhaled corticosteroids reverses airway remodeling.
______ 4. Patients on long-term systemic steroid use may develop Cushing’s syndrome and osteoporosis.
______ 5. Cromolyn sodium can be used to relieve acute bronchospasm.
______ 6. The late-phase response in the inflammatory process is not responsive to bronchodilator therapy.
______ 7. All prostaglandins produce bronchial smooth muscle relaxation.
______ 8. Leukotriene modifiers can be used as an alternative to low-dose inhaled steroids for long-term control of asthma.
______ 9. Intranasal mast cell stabilizers and intranasal corticosteroids are used to treat allergic rhinitis.
______ 10. Mast cells containing histamine are located in nasal passages but are not found in the airways.
FILL-IN-THE-BLANK
Write the word or phrase that best completes each statement.
1. Asthma that results from infection, cold air, exercise, or stress is referred to as ________________.
2. Airway inflammation occurs in response to stimulus that causes the release of ________________.
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3. Antigens attach themselves to ________________ causing them to become sensitized.
4. The most commonly produced immune system antibody is the ________________.
5. The immune response is not involved in ________________ asthma.
6. The lipoxygenase pathway causes the release of ________________, which contributes to the late-phase response in asthma.
7. The cyclooxygenase pathway causes the release of ________________, which contributes to the late-phase response in asthma.
8. Inhaled corticosteroids are used primarily for their ________________ response in allergic asthma.
9. Agents that prevent mast cell degranulation are referred to as ________________ and are useful in both nonallergic and allergic asthma.
10. Intranasal corticosteroids can take ________________ weeks to become beneficial in decreasing nasal congestion.
11. Corticosteroids block or diminish late-phase asthma responses by blocking the ________________ cascade.
12. Histamine smooth muscle contraction is controlled by ________________ receptors.
13. _______________ receptors mediate the actions of histamine on gastric secretions.
14. Nasal decongestants are ________________ drugs and cause vasoconstriction that reduces blood flow and swelling of the nasal passages.
15. The breakdown of the phospholipid membrane during an inflammatory response produces ________________ acid.
SHORT ANSWER
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Answer the following questions or statements.
1. Explain what occurs in the late-phase response of the inflammatory process.
2. What is the difference between a B lymphocyte and a T lymphocyte in an antigen response?
3. What is meant by immunotherapy?
4. Explain the mechanism of prostaglandin inhibitors in airway function.
5. Discuss the difference between topical nasal decongestants and intranasal mast cell stabilizers.
