Pharmacology. / Practice. / TMC. / Questions. / (Kettering. / -. / NBRC. / -
. / Lindsey. / jones)
1../1.
When./instructing./a./patient./on./the./administration./of./umeclidinium/vilanterol./(An
oro./Ellipta),./which./of./the./following./is./most./important./to./emphasize?
a. Gargle. / immediately. / after. / use.
b. Inhale./slowly./with./a./breath./hold.
c. Breathe./in./fast./and./deep.
d. Shake./medication./vigorously./before./use.:./Ïanswer:./c
ÏExplanation:./This./is./a./dry./powder./inhaler./(DPI),./which./requires./a./fast./and./deep./inhalation./to./disperse./the./medication./pr
operly../Gargling./is./necessary./with./steroid-containing./inhalers,./not./Anoro../It./should./not./be./shaken.
2../2.
A./patient./with./a./history./of./hypertension./was./awakened./by./cough./and./short-
ness./of./breath../He./has./fine./inspiratory./crackles./bilaterally.
a. prednisone
b. albuterol
c. furosemide. / (Lasix)
d. guaifenesin./(Mucinex):./Ïanswer:./c
ÏExplanation:./Fine./crackles./and./shortness./of./breath./are./signs./of./pulmonary./edema../Furosemide./(Lasix)./is./a./diureti
c./used./to./remove./fluid../Albuterol./is./for./bronchospasm,./not./fluid./overload.
3../3.
A./35-year-
old./patient./with./asthma./is./being./evaluated./1./week./after./discharge./for./an./acut
e./exacerbation../The./patient's./home./regimen./is./albuterol./MDI./2./puffs./q.i.d../Th
e./patient./continues./to./have./wheezing./throughout./the./day../A./respiratory. / ther
apist. / should. / recommend. / changing. / to
a. levalbuterol. / (Xopenex).
b. umeclidinium/vilanterol. / (Anoro. / Ellipta).
c. fluticasone/salmeterol. / (Advair. / Diskus).
d. azithromycin./ (Zithromax).:./Ïanswer:./c
, Pharmacology. / Practice. / TMC. / Questions. / (Kettering. / -. / NBRC. / -
. / Lindsey. / jones)
ÏExplanation:./Persistent./wheezing./indicates./the./need./for./long-
term./control../Advair./contains./a./corticosteroid./and./LABA,./suitable./for./maintenance./therapy../Albuterol./is./a./rescue./med./
and./insuflcient./alone.
4../4.
A./respiratory./therapist./is./reviewing./the./plan./of./care./for./a./patient./diagnosed./wit
h./cystic./fibrosis../The./patient./uses./an./albuterol./HFA./as./needed,./inhales./nebuli
zed./7%./NaCl./2./times./daily,./and./uses./an./HFCWO./vest./3./times./daily../The./patient./
was./hospitalized./3./times./in./the./past./year./due./to./pneumonia../Which./of./the./follo
wing./should./the./therapist./recommend./be./added./to./the./care./plan./for. / the./patie
nt?
a. postural./drainage./with./percussion
b. n-acetylcysteine
c. PEP./therapy
d. dornase./alfa./(Pulmozyme):./Ïanswer:./d
ÏExplanation:./Dornase./alfa./is./a./mucolytic./enzyme./specific./for./CF./patients./that./helps./break./down./thick./DNA-
laden./mucus. / and./reduces./exacerbations.
5../5.
When. / administering. / dornase. / alfa. / (Pulmozyme). / with. / a. / hand-
held. / nebulizer,. / a./respiratory./therapist./notes./a./patient./is./developing./marked./con
gestion./with./copious./sputum./production../The./therapist's./most./appropriate./acti
on./is./to./pause./the./treatment./and
a. dilute./dornase./alfa./(Pulmozyme)./with./saline.
b. allow./the./patient./to./clear./secretions../c../increase./the./dornase./alfa./(Pul-
mozyme)./dose.
d../contact./the./physician.:./Ïanswer:./b
ÏExplanation:./Dornase./alfa./can./mobilize./thick./secretions../Letting./the./patient./clear./the./mucus./ensures./better./ventilati
on. / and./comfort../No./dose./change./or./dilution./is./indicated./here.
6../6.
A./25-year-old,./female./patient./in./an./ICU./has./been./receiving./mechanical./venti-
, Pharmacology. / Practice. / TMC. / Questions. / (Kettering. / -. / NBRC. / -
. / Lindsey. / jones)
lation./for./the./past./4./days../She./has./severe./anxiety./issues./regarding./ventilatory./
support../She./panics./each./time./an./SBT./is./initiated./despite./a./respiratory./thera-
pist./providing./reassurance./and./coaching../The./patient./requires./maximal./doses./
of./anxiolytics./and./VC,./A/C./ventilation./is./reinitiated../Which./of./the./following./sho
uld./the./therapist./recommend?
a. Increase./PS,./and./perform./a./percutaneous./tracheostomy.
b. Maintain. / current. / settings,. / and. / transfer. / the. / patient. / to. / long-term. / acute. / care.
c. Discontinue./SBTs,./and./administer./an./IV./infusion./of./midazolam./HCl./(Versed).
d. Administer./dexmedetomidine./(Precedex)./and./repeat./an./SBT.:./Ïanswer:./d
ÏExplanation:./Precedex./is./useful./for./anxious./patients./during./weaning./as./it./provides./sedation./with./minimal./respiratory./
depression../Midazolam./can./suppress./respiration,./which./is./risky./during./weaning./trials.
7../7.
A./19-year-
old./female./with./a./history./of./moderate,./persistent./allergic./asthma./is./adherent./t
o./a./home./regimen./of./budesonide/formoterol ./(Symbicort)./and./albuterol. / prn.. /
She. / presents. / to. / an. / outpatient. / clinic. / with. / increases. / in. / frequency./and./severity
./of./asthma ./symptoms./over./the./last./several./months../She./reports./daily./asthma./
symptoms./with./nighttime./awakenings./3./times./in./the./last./week../Her./daily./activi
ties./are./limited./by./her./symptoms,./even./though./she./uses./an./albuterol. / inhaler. / s
everal. / times. / per. / day.. / According. / to. / NAEPP,. / which. / of. / the./following./should./b
e./added./to./her./regimen./NEXT?
a. a. / leukotriene. / modifier
b. short-acting. / anticholinergic
c. an./antibiotic
d. systemic./corticosteroid:./Ïanswer:./a
ÏExplanation:./A./leukotriene./modifier./(like./montelukast)./can./help./control./persistent./asthma./by./reducing./airway./inflam
mation./and./allergic./response../Antibiotics./are./not./warranted./unless./infection./is./confirmed.
8../8.
Which. / of. / the. / following. / drugs. / is. / most. / appropriate. / to. / paralyze. / a. / sedated
, Pharmacology. / Practice. / TMC. / Questions. / (Kettering. / -. / NBRC. / -
. / Lindsey. / jones)
30-year-old./patient./in./status./asthmaticus./who./is./receiving./continuous./me-
chanical./ventilation?
a. cisatracurium. / (Nimbex)
b. morphine
c. midazolam. / HCl. / (Versed)
d. succinylcholine./chloride./(Anectine):./Ïanswer:./a
ÏExplanation:. / Cisatracurium. / is. / a. / non-depolarizing. / neuromuscular. / blocker. / used. / for. / long-
term./paralysis./in./ventilated./patients../Succinylcholine./is./for./short-
term./use./only../Morphine./and./Versed./are./seda-tives/analgesics.
9../9.
A./patient./with./recently./diagnosed./cystic./fibrosis./is./admitted./due./to./an./exacer-
bation../A./respiratory./therapist./reviews./the./home./care./plan:
• albuterol./q.i.d.
• HFCWO./t.i.d.
• dornase./alfa./(Pulmozyme)./b.i.d.
A./sputum./culture./was./positive./for./mucoid./pseudomonas../Which./of./the./follow-
ing./inhaled./medications./should./the./therapist./recommend?
a. hypertonic. / saline
b. tobramycin. / (TOBI)
c. budesonide. / (Pulmicort)
d. n-acetylcysteine:. / Ïanswer:./b
ÏExplanation:./Tobramycin./is./an./inhaled./antibiotic./ettective./against./Pseudomonas,./commonly./used./in./CF./patients../Hype
rtonic./saline./and./NAC./help./with./mucus,./but./not./bacterial./control.
10../10.
A./patient./with./a./pulmonary./artery./catheter./in./place./has./the./following./hemo-
dynamic. / values. / before. / and. / after. / infusion. / of. / 500. / mL. / IV. / normal. / saline:. / Bef
ore:
•
BP:./100/70./mmHg
. / Lindsey. / jones)
1../1.
When./instructing./a./patient./on./the./administration./of./umeclidinium/vilanterol./(An
oro./Ellipta),./which./of./the./following./is./most./important./to./emphasize?
a. Gargle. / immediately. / after. / use.
b. Inhale./slowly./with./a./breath./hold.
c. Breathe./in./fast./and./deep.
d. Shake./medication./vigorously./before./use.:./Ïanswer:./c
ÏExplanation:./This./is./a./dry./powder./inhaler./(DPI),./which./requires./a./fast./and./deep./inhalation./to./disperse./the./medication./pr
operly../Gargling./is./necessary./with./steroid-containing./inhalers,./not./Anoro../It./should./not./be./shaken.
2../2.
A./patient./with./a./history./of./hypertension./was./awakened./by./cough./and./short-
ness./of./breath../He./has./fine./inspiratory./crackles./bilaterally.
a. prednisone
b. albuterol
c. furosemide. / (Lasix)
d. guaifenesin./(Mucinex):./Ïanswer:./c
ÏExplanation:./Fine./crackles./and./shortness./of./breath./are./signs./of./pulmonary./edema../Furosemide./(Lasix)./is./a./diureti
c./used./to./remove./fluid../Albuterol./is./for./bronchospasm,./not./fluid./overload.
3../3.
A./35-year-
old./patient./with./asthma./is./being./evaluated./1./week./after./discharge./for./an./acut
e./exacerbation../The./patient's./home./regimen./is./albuterol./MDI./2./puffs./q.i.d../Th
e./patient./continues./to./have./wheezing./throughout./the./day../A./respiratory. / ther
apist. / should. / recommend. / changing. / to
a. levalbuterol. / (Xopenex).
b. umeclidinium/vilanterol. / (Anoro. / Ellipta).
c. fluticasone/salmeterol. / (Advair. / Diskus).
d. azithromycin./ (Zithromax).:./Ïanswer:./c
, Pharmacology. / Practice. / TMC. / Questions. / (Kettering. / -. / NBRC. / -
. / Lindsey. / jones)
ÏExplanation:./Persistent./wheezing./indicates./the./need./for./long-
term./control../Advair./contains./a./corticosteroid./and./LABA,./suitable./for./maintenance./therapy../Albuterol./is./a./rescue./med./
and./insuflcient./alone.
4../4.
A./respiratory./therapist./is./reviewing./the./plan./of./care./for./a./patient./diagnosed./wit
h./cystic./fibrosis../The./patient./uses./an./albuterol./HFA./as./needed,./inhales./nebuli
zed./7%./NaCl./2./times./daily,./and./uses./an./HFCWO./vest./3./times./daily../The./patient./
was./hospitalized./3./times./in./the./past./year./due./to./pneumonia../Which./of./the./follo
wing./should./the./therapist./recommend./be./added./to./the./care./plan./for. / the./patie
nt?
a. postural./drainage./with./percussion
b. n-acetylcysteine
c. PEP./therapy
d. dornase./alfa./(Pulmozyme):./Ïanswer:./d
ÏExplanation:./Dornase./alfa./is./a./mucolytic./enzyme./specific./for./CF./patients./that./helps./break./down./thick./DNA-
laden./mucus. / and./reduces./exacerbations.
5../5.
When. / administering. / dornase. / alfa. / (Pulmozyme). / with. / a. / hand-
held. / nebulizer,. / a./respiratory./therapist./notes./a./patient./is./developing./marked./con
gestion./with./copious./sputum./production../The./therapist's./most./appropriate./acti
on./is./to./pause./the./treatment./and
a. dilute./dornase./alfa./(Pulmozyme)./with./saline.
b. allow./the./patient./to./clear./secretions../c../increase./the./dornase./alfa./(Pul-
mozyme)./dose.
d../contact./the./physician.:./Ïanswer:./b
ÏExplanation:./Dornase./alfa./can./mobilize./thick./secretions../Letting./the./patient./clear./the./mucus./ensures./better./ventilati
on. / and./comfort../No./dose./change./or./dilution./is./indicated./here.
6../6.
A./25-year-old,./female./patient./in./an./ICU./has./been./receiving./mechanical./venti-
, Pharmacology. / Practice. / TMC. / Questions. / (Kettering. / -. / NBRC. / -
. / Lindsey. / jones)
lation./for./the./past./4./days../She./has./severe./anxiety./issues./regarding./ventilatory./
support../She./panics./each./time./an./SBT./is./initiated./despite./a./respiratory./thera-
pist./providing./reassurance./and./coaching../The./patient./requires./maximal./doses./
of./anxiolytics./and./VC,./A/C./ventilation./is./reinitiated../Which./of./the./following./sho
uld./the./therapist./recommend?
a. Increase./PS,./and./perform./a./percutaneous./tracheostomy.
b. Maintain. / current. / settings,. / and. / transfer. / the. / patient. / to. / long-term. / acute. / care.
c. Discontinue./SBTs,./and./administer./an./IV./infusion./of./midazolam./HCl./(Versed).
d. Administer./dexmedetomidine./(Precedex)./and./repeat./an./SBT.:./Ïanswer:./d
ÏExplanation:./Precedex./is./useful./for./anxious./patients./during./weaning./as./it./provides./sedation./with./minimal./respiratory./
depression../Midazolam./can./suppress./respiration,./which./is./risky./during./weaning./trials.
7../7.
A./19-year-
old./female./with./a./history./of./moderate,./persistent./allergic./asthma./is./adherent./t
o./a./home./regimen./of./budesonide/formoterol ./(Symbicort)./and./albuterol. / prn.. /
She. / presents. / to. / an. / outpatient. / clinic. / with. / increases. / in. / frequency./and./severity
./of./asthma ./symptoms./over./the./last./several./months../She./reports./daily./asthma./
symptoms./with./nighttime./awakenings./3./times./in./the./last./week../Her./daily./activi
ties./are./limited./by./her./symptoms,./even./though./she./uses./an./albuterol. / inhaler. / s
everal. / times. / per. / day.. / According. / to. / NAEPP,. / which. / of. / the./following./should./b
e./added./to./her./regimen./NEXT?
a. a. / leukotriene. / modifier
b. short-acting. / anticholinergic
c. an./antibiotic
d. systemic./corticosteroid:./Ïanswer:./a
ÏExplanation:./A./leukotriene./modifier./(like./montelukast)./can./help./control./persistent./asthma./by./reducing./airway./inflam
mation./and./allergic./response../Antibiotics./are./not./warranted./unless./infection./is./confirmed.
8../8.
Which. / of. / the. / following. / drugs. / is. / most. / appropriate. / to. / paralyze. / a. / sedated
, Pharmacology. / Practice. / TMC. / Questions. / (Kettering. / -. / NBRC. / -
. / Lindsey. / jones)
30-year-old./patient./in./status./asthmaticus./who./is./receiving./continuous./me-
chanical./ventilation?
a. cisatracurium. / (Nimbex)
b. morphine
c. midazolam. / HCl. / (Versed)
d. succinylcholine./chloride./(Anectine):./Ïanswer:./a
ÏExplanation:. / Cisatracurium. / is. / a. / non-depolarizing. / neuromuscular. / blocker. / used. / for. / long-
term./paralysis./in./ventilated./patients../Succinylcholine./is./for./short-
term./use./only../Morphine./and./Versed./are./seda-tives/analgesics.
9../9.
A./patient./with./recently./diagnosed./cystic./fibrosis./is./admitted./due./to./an./exacer-
bation../A./respiratory./therapist./reviews./the./home./care./plan:
• albuterol./q.i.d.
• HFCWO./t.i.d.
• dornase./alfa./(Pulmozyme)./b.i.d.
A./sputum./culture./was./positive./for./mucoid./pseudomonas../Which./of./the./follow-
ing./inhaled./medications./should./the./therapist./recommend?
a. hypertonic. / saline
b. tobramycin. / (TOBI)
c. budesonide. / (Pulmicort)
d. n-acetylcysteine:. / Ïanswer:./b
ÏExplanation:./Tobramycin./is./an./inhaled./antibiotic./ettective./against./Pseudomonas,./commonly./used./in./CF./patients../Hype
rtonic./saline./and./NAC./help./with./mucus,./but./not./bacterial./control.
10../10.
A./patient./with./a./pulmonary./artery./catheter./in./place./has./the./following./hemo-
dynamic. / values. / before. / and. / after. / infusion. / of. / 500. / mL. / IV. / normal. / saline:. / Bef
ore:
•
BP:./100/70./mmHg
