In a dose-response assessment of a patient's response to a metered dose inhaler bronchodilator, when would you stop increasing the dose?
1. When the peak expiratory flow rate improves less than 10 to 15
2. When tachycardia occurs
3. When tremors are evident
4. When 6 to 8 puffs are delivered
a. 1, 2, and 3 only
b. 1, 3, and 4 only
c. 2, 3, and 4 only
d. 1, 2, 3, and 4
Q. 2 Which of the following best describes a proper a dose-response assessment of a metered dose inhaler (MDI) bronchodilator?
a. Give 4 puffs one after the other, wait 1 min, repeat up to 16 puffs. The best dose is the highest dose given without side ef-fects.
b. Give 4 puffs spaced 1 to 2 min apart; re-peat up to 12 puffs with continued im-provement. The best dose provides maxi-mum subjective relief and the highest peak expiratory flow rate (PEFR) without side effects.
c. Give 12 puffs 1 min apart; repeat every 20 min until maximum relief of symptoms is achieved without side effects.
d. Give 2 puffs 1 to 2 min apart; repeat up to 6 puffs with continued improvement. The best dose provides maximum subjective relief and the highest PEFR without side effects.
Q. 3 When assessing a patient's response to bronchodilator therapy, you notice a decrease in wheezing accompanied by an overall decrease in the intensity of breath sounds. Which of the following is most likely?
a. Increasing airway obstruction
b. Improving ventilation/perfusion ratio (V/Q)
c. Decreasing airway obstruction
d. Deteriorating oxygenation
Q. 4 In addition to bedside pulmonary function test measures, what other components of patient as-sessment are useful in evaluating bronchodilator therapy?
1. Patient interview and observation
2. Measurement of vital signs
3. Chest auscultation
4. Arterial blood gas analysis and oximetry
a. 1, 3, and 4 only
b. 2 and 3 only
c. 2, 3, and 4 only
d. 1, 2, 3, and 4
Q. 5 When assessing a patient's response to bronchodilator therapy, you notice a decrease in wheezing accompanied by an overall increase in the intensity of breath sounds. Which of the following is most likely?
a. Increasing airway obstruction
b. Improving
c. Decreasing airway obstruction
d. Deteriorating oxygenation
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