Chapter 6 Mucokinetics and Surfactants

Which would not occur after inserting an endotracheal tube: a. Accumulation of mucus in the lungs b. Improved ciliary action c. Infection d. Impaired ciliary action

B. improved ciliary action

0.9% saline is a hypotonic solution. T or F

False - 0.45%

5% saline is an isotonic solution. T or F

False - 0.9%

The airway is made up of five layers. T or F

False - 3 layers : muscoa , submucosa, adventitia

The volume or thickness of mucus is generally decreased with asthma. T or F

False - Mucus increased with asthma

Mucomyst® has no adverse reactions associated with it. T or F

False - acetylcysteine now

Bronchial smooth muscle is located in the mucosa. T or F

False - bronchial SM located in submucosa

Guaifenesin will make you not cough. T or F

False - cough suppressant

Mucomyst® is not a mucolytic. T or F

False - now called acetylcysteine

Goblet cells and bronchial glands produce 100,000 ml of mucus a day. T or F

False - produces 100 ml

Distilled water has bacteriostatic properties. T or F

False - sterile and pure, no additives

Acetylcysteine will alter the consistency of the gel layer. T or F

True

Albuterol will improve ciliary activity. T or F

True

Among the purposes for mucus is to lubricate the airway. T or F

True

Cilia are found in the sol layer. T or F

True

Dextromethorphan is a cough suppressant. T or F

True

Dornase alfa is given to Cystic Fibrosis patients. T or F

True

Mucosol® smells like rotten eggs. T or F

True

Sterile water has bacteriostatic properties. T or F

True

Storage of surfactant occurs in lamellar bodies. T or F

True

Surface tension is decreased by surfactant. T or F

True

The administration of hypertonic saline can be done for sputum induction. T or F

True

The mucosal blanket consists of the gel and sol layers. T or F

True

The volume or thickness of mucus is increased with cystic fibrosis. T or F

True

Type II pneumocytes produce surfactant. T or F

True

Water, saline, or expectorants increase the depth of the sol layer. T or F

True

Of the following, which is an isotonic solution? a. 0.90% b. 5% c. 10% d. 0.45%

a. 0.9%

Which of the following describes synthetic surfactants? I.Exogenous II.Containing proteins SP-B and SP-C III.Free of infection and foreign proteins a. I & III b. I, II, & III c. I & II d. II & III

a. 1 and 3

What is the recommended dose for Survanta? a. 4 ml/kg b. 8 ml/kg c. 12 ml/kg d. 16 ml/kg

a. 4ml/kg

Of the following solutions, which would you most likely choose to facilitate sputum induction? a. 5% saline b. 0.5% saline c. 0.45% saline d. 0.9% saline

a. 5% saline

How much Infasurf® should be given if the patient weighs 2 kg? a. 6 ml b. 5 ml c. 10 ml d. 8 ml

a. 6ml 2kg * 3 ml/kg = 6ml

Pulmonary surfactant is stored in the ______ after production. a. Lamellar bodies b. Mitochondria c. Bronchial glands d. Sebaceous glands

a. Lamellar bodies

Guaifenesin is considered to be which of the following? a. Expectorant b. Surface- active agent c. Antitussive d. Mucolytic

a. expectorant

Sputum induction is best achieved with which of the following solutions? a. Hypertonic saline b. Hypotonic saline c. Sterile water d. Normal saline

a. hypertonic solution

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. Hypotonic saline b. Sterile water c. Tap water d. Hypertonic saline

a. hypotonic saline

Which of the following is not a means of secretion management? a. Increasing the number of bronchial glands b. Improving ciliary action c. Increasing the depth of the sol layer d. Altering the consistency of the gel layer

a. increasing the number of bronchial glands

In which layer of the airway are cilia found? a. Mucosa b. Submucosa c. Adventitia d. Endothelium

a. muscosa

The mucociliary system performs all of the following except: a. Removal of inhaled debris from alveoli through ciliary action b. Prevention of excessive loss of heat and moisture c. Warming and humidifying inspired gas d. Antimicrobial properties to prevent infection

a. remove inhaled debris from alveoli through ciliary action

The most cost-effective and readily available means of maintaining mucokinetics is: a. Water b. Sodium bicarbonate c. Mucomyst® d. Normal saline

a. water

Which of the following statements is true concerning the difference between sterile water and distilled water? I. Sterile water contains additives with bacteriostatic properties. II. Sterile water is an isotonic solution. III. Distilled water is an isotonic solution. IV. Distilled water is considered to be both sterile and pure. a. II & III b. I & IV c. I only d. I & II

b. 1 and 4

Pulmozyme® is used for which of the following conditions? a. Heart failure b. Cystic fibrosis c. COPD d. Asthma

b. CF

All except which of the following are used to administer surfactant? a. Double-lumen endotracheal tube b. MDI spacer c. Side-port d. Catheter

b. MDI spacer

Infants should not be delivered supplemental oxygen via which of the following? a. Large-volume nebulizer b. Ultrasonic nebulizer c. Small-volume nebulizer d. Simple humidifier

b. US nebulizer

Of the following, which can cause impaired ciliary activity? I.Dehydration II.Thick mucus III.High concentrations of FiO2 IV.Endotracheal tubes a. I, II, & III b. I, II, III, & IV c. I & II d. I, II, & IV

b. all of the above

Which of the following is a potential adverse reaction associated with the administration of Mucomyst®? I. Bronchospasm II. Rhinorrhea III. Bronchorrhea IV. Stomatitis a. I, II, & III b. I, II, III, & IV c. I & IV d. I & IV

b. all of the above

Mucolytics are an important agent to administer for the overall health of the mucociliary system for which of the following reasons? a. Stimulate coughing b. Alter the viscosity of secretions c. Promote bronchial smooth muscle relaxation d. Prevent atelectasis

b. alter the viscosity of secretions

Which of the following is dextromethorphan considered to be? a. Mucolytic b. Antitussive c. Surfactant d. Expectorant

b. antitussive

Repeated, prolonged exposure to irritants causes all of the following changes to occur in the airways except: a. Increased number of bronchial glands b. Decreased mucous production c. Increased size of bronchial glands d. Decreased ciliary action

b. decreased mucous production

The gel layer is affected most by the administration of which of the following? a. Water or saline solution and expectorants b. Mucolytics c. Sympathomimetic bronchodilators and corticosteroids d. Anticholinergic medications

b. mucolytics

A patient has ingested an entire bottle of acetaminophen which of the following would you recommend? a. Salmeterol b. n-acetylcysteine c. Dornase alfa d. Pulmozyme®

b. n-acetylcysteine

Mucus does not normally do which of the following in the healthy lung? a. Prevent water movement across epithelia b. Obstruct the airway c. Lubricate the airway d. Prevent infection

b. obstruct the airway

What makes it more difficult for a neonate to breathe spontaneously if born before 34 weeks' gestation? a. Perinatal asphyxia b. Immature type II pneumocytes c. Damaged type I pneumocytes d. Aspiration

b. type 2 pneumocytes

Surfactant replacement therapy requires which of following guidelines for proper administration? I.Placement of an endotracheal tube into the infant's airway II.Suctioning the infant prior to surfactant administration III.Having the infant remain in the supine position during instillation a. I & III b. I, II, & III c. I & II d. II & III

c. 1 and 2

Which of the following are considered to be an antitussive? I. Codeine II. Dextromethorphan III. Guaifenesin IV. Potassium iodide a. I & IV b. II & III c. I & II d. III & IV

c. 1 and 2

Which of the following are responsible for the primary mucus production within the lungs? I.Goblet cells II.Bronchial glands III.Type I pneumocytes IV.Type II pneumocytes a. I only b. II, III, & IV c. I & II d. II & IV

c. 1 and 2

Surface tension is best explained by which of the following laws? a. Henry's b. Dalton's c. LaPlace's d. Poiseuille's

c. LaPlace

Pulmozyme® should only be administered with which of the following nebulizers? a. HOPE® b. AeroEclipse® c. Marquest Acorn II® d. Aeroneb®

c. Marquest Acorn 2

Which of the following is not a way in which expectorants are thought to work? a. Being absorbed into respiratory glands, causing direct stimulation to increase mucous production b. Increasing the amount of fluid in the respiratory tract c. Breaking disulfide bonds in the mucus d. Increasing vagal-gastric reflex

c. breaking disulfide bonds in the mucus

The volume or thickness of mucus can be increased with which of the following? a. Dehydration b. Infection c. Chronic bronchitis d. Endotracheal tubes

c. chronic bronchitis

Which of the following is a reason to give an antitussive medication? a. Fulminant pulmonary edema b. Bronchospasm accompanied by frequent cough c. Dry, hacking, nonproductive cough d. Accumulation of the thick secretions leading to shortness of breath

c. dry, hacking, nonproductive cough

Which of the following mostly impairs ciliary activity? a. Pneumonia b. Cystic fibrosis c. Endotracheal tubes d. Asthma

c. endotracheal tubes

Which of the following is not a means of delivering particles of water to the lungs? a. Direct instillation b. Ultrasonic nebulizers c. Humidifiers d. Large-volume nebulizers

c. humidifiers

For which of the following reasons would one expect to see a transient decrease in the patient's oxygenation after the administration of surfactant? a. Pre-hyperoxygenation b. Vagal stimulation c. Initial diffusion barrier d. Bradycardia

c. initial diffusion barrier

What is the true statement in regard to sterile water? a. It is sterile and pure with no additives. b. It is not commonly used as a diluent for aerosolized medications. c. It is free of microorganisms and may contain additives to make it bacteriostatic. d. It is free of bacteriostatic properties.

c. it is free of microorganisms and may contain additives to make it bacteriostatic

Which of the following best describes the effect of having water available during mucous production? a. Depletes the gel layer b. Depletes the sol layer c. Maintains the viscoelasticity of the mucous d. Antitussive properties

c. maintains the viscoelasticity of the mucous

Which of the following is NOT an advantage to the administration of rescue surfactant replacement therapy? a. Treatment is only provided if it is truly needed b. More time is allowed for ETT placement c. Potential for progressed lung injury d. Reduction of surface tension

c. potential for progressed lung injury

Which surfactant is synthetically manufactured? a. Infasurf® b. Curosurf® c. Surfaxin d. Survanta®

c. surfaxin

Ciliary activity is improved by which of the following? a. Water or saline solution and expectorants b. Mucolytics c. Sympathomimetic bronchodilators and corticosteroids d. Anticholinergic medications

c. sympathomimetic bronchodilators and corticoseroids

The sol layer can be increased with the administration of which of the following? a. Sympathomimetic bronchodilators and corticosteroids b. Anticholinergic medications c. Water or saline solution and expectorants d. Mucolytics

c. water or saline solution and expectorants

Which of the following patients would benefit the most from aerosolized hypertonic saline? a. Those with asthma. b. Those with heart failure. c. Those with cystic fibrosis. d. Those with COPD.

c.. those in CF

The goblet cells and bronchial glands produce about how much mucus per day? a. 10 ml b. 20 ml c. 50 ml d. 100 ml

d. 100ml

When giving surfactant, in how many aliquots is the dose administered? a. 2 b. 3 c. 1 d. 4

d. 4

The most mucus is produced in the airway by which of the following? a. Goblet cells b. Clara cells c. Serous cells d. Bronchial glands

d. Bronchial glands

Which medication is recommended to be given with the PARI Neb? a. Mucomyst® b. Acetylcysteine c. Albuterol d. Dornase Alfa

d. Dornase Alfa

Which of the following are not considered an appropriate treatment plan for someone who has thick, retained secretions who is currently receiving oxygen therapy? a. Intermittent treatments with Mucomyst® and short-acting bronchodilator b. Deep breathing, assisted coughing, and suctioning c. Bland aerosol with sterile water via a LVN d. Administration of an antitussive, such as dextromethorphan

d. administration of an antitussive, such as dextromethorphan

Which of the following explains why a patient may be hyperoxemic and hypocapnic following surfactant administration? a. Increase in ventilating pressure b. Increase in respiratory rate c. Increase in heart rate d. Increase in VT due to improved CL

d. increase Vt due to improved CL

You receive a call from the attending physician of a 68-year-old patient with chronic bronchitis. The physician reports that the patient has very thick secretions that she is unable to remove from her airway. He asks for your recommendations. The drug most indicated for this patient is: a. Sodium bicarbonate b. Survanta® c. Dornase alfa d. n-acetylcysteine

d. n-acetylcysteine

Which of the following contributes to mucous clearance from the airways by altering the water content of the mucus? a. Mucomyst® b. Infasurf® c. Dornase alfa d. Normal saline

d. normal saline

Which of the following pneumocytes produce surfactant? a. Type III b. Type IV c. Type I d. Type II

d. type 2

Surfactant is produced by which of the following? a. Clara cells b. Alveolar ducts c. Type I pneumocytes d. Type II pneumocytes

d. type 2 pneumocytes