Deck 20: Pulmonary Function Testing

Question 1

How often should a spirometer in continual use undergo volumetric calibration?

A) Every 4 hr
B) Every shift
C) At least daily
D) Weekly

Answer 1

C
Explanation: For quality control, the standards include verifying volume accuracy with a 3.0-L calibration syringe at least daily.

Question 2

What do we measure to determine the precision of an instrument?

A) Mean measured reference value
B) Difference between the mean measured and actual reference value
C) Range of the mean measured reference value
D) Standard deviation (SD) of the mean measured reference value

Answer 2

D
Explanation: A small SD indicates low variability and high precision.

Question 3

What would you use to determine the accuracy of a water-sealed spirometer in measuring lung volumes?

A) Calibrated high-flow flowmeter
B) Computer-generated flow patterns
C) Calibrated 3-L syringe
D) Standard subject with known volumes

Answer 3

C
Explanation: For volume measurements, standard reference values are provided by a graduated 3.0-L calibration syringe.

Question 4

Which of the following measure is typically increased in patients with restrictive lung disease?

A) Lung compliance
B) Lung volumes
C) Pressure needed to expand the lung
D) Airway resistance

Question 5

What is the most common measurement of pulmonary mechanics during pulmonary function testing?

A) Tidal volume
B) Forced vital capacity
C) Residual volume
D) Inspiratory reserve volume

Question 6

Which of the following are indications for assessing pulmonary function?
1) Screen for pulmonary disease.
2) Evaluate patients for surgical risk.
3) Assess the progression of disease.
4) Assist in diagnosing cardiac disability.

A)1, 2, and 3 only
B)2 and 4 only
C)1 and 3 only
D)2, 3, and 4 only

Question 7

Which of the following pulmonary function devices directly collect and measure gas volumes?
1) Water-sealed spirometer
2) Dry rolling-seal spirometer
3) Bellows spirometer
4) Pneumotachometer

A)3 and 4 only
B)1 and 2 only
C)1, 2, and 3 only
D)2, 3, and 4 only

Question 8

To ensure validity of the forced vital capacity (FVC) measurement, how many attempts should the patient perform?

A) Just one good one
B) Two that are nearly the same
C) Three that are acceptable
D) At least four

Question 9

Tests of pulmonary mechanics include:
1) maximum voluntary ventilation.
2) functional residual capacity.
3) forced expiratory flows.
4) forced expiratory volumes.

A)3 and 4 only
B)1 and 2 only
C)1, 2, and 3 only
D)1, 3, and 4 only

Question 10

While checking the accuracy of a portable spirometer for volumetric measures with a calibrated super syringe, you obtain a mean measured value of 2.7 L. What is the percent error of this instrument?
a.
1%
b.
10%
c.
30%
d.
90%

Question 11

Which of the following statements is false regarding measurement of the patient's forced vital capacity (FVC)?

A) The patient can be sitting or standing.
B) Nose clips are not required.
C) It is an effort-dependent test.
D) Accurate results can be obtained without patient cooperation.

Question 12

What is the American Thoracic Society standard for accuracy when measuring flows during pulmonary function testing?

A) 90% accuracy or within 0.30 L/sec, whichever is greater
B) 95% accuracy or within 0.20 L/sec, whichever is greater
C) 97% accuracy or within 0.10 L/sec, whichever is greater
D) 99% accuracy or within 0.05 L/sec, whichever is greater

Question 13

You perform a series of pulmonary function tests on a patient with a potentially infectious disease carried via the airborne route. Which of the following infection-control procedures should you implement?
1) Wear a respirator or close-fitting surgical mask.
2) Dispose of, sterilize, or disinfect the tubing circuit after testing.
3) Clean the interior surface of the spirometer before the next test.

A)1 only
B)1 and 2 only
C)2 and 3 only
D)1, 2, and 3

Question 14

What is the American Thoracic Society standard for volumetric accuracy of spirometers?

A) ±1% error, or within 10 ml of the reference value
B) ±3% error, or within 50 ml of the reference value
C) ±5% error, or within 100 ml of the reference value
D) ±10% error, or within 500 ml of the reference value

Question 15

What do relative contraindications for lung volume determinations include?
1) Recent cataract removal surgery
2) Unstable cardiovascular status
3) Treated pneumothorax
4) Hemoptysis of unknown origin

A)1, 2, and 3 only
B)2 and 4 only
C)3 and 4 only
D)1, 2, and 4 only

Question 16

Which of the following adverse reactions is not typically seen with pulmonary function testing?

A) Syncope
B) Cough
C) Hemoptysis
D) Chest pain

Question 17

How closely a device measures a certain reference value refers to what quality?

A) Capacity
B) Accuracy
C) Linearity
D) Precision

Question 18

What is the primary problem in obstructive lung disease?

A) Increased airway resistance
B) Low lung volumes
C) Increased pulmonary capillary pressure
D) Reduced lung diffusion

Question 19

To what does the range or limit of a device's measuring ability refer?

A) Capacity
B) Accuracy
C) Error
D) Precision

Question 20

What is the ability of a measuring device to consistently provide the same measure of the same quantity?

A) Capacity
B) Accuracy
C) Linearity
D) Precision

Question 21

Which of the following techniques are used to measure residual volume?
1) Helium dilution
2) Body plethysmography
3) Nitrogen washout
4) Flow-volume loops

A)2 and 4 only
B)1, 2, and 3 only
C)1, 2, 3, and 4
D)1, 3, and 4 only

Question 22

In both the helium dilution test and nitrogen washout functional residual capacity (FRC) determinations, at what point should the patient normally be connected to the system to begin the test?

A) Resting expiration
B) Full forced inspiration
C) Resting inspiration
D) Full forced expiration

Question 23

What shape of the flow-volume loop is typical for the patient with a fixed upper airway obstruction?

A) Circular
B) Box
C) Elliptical
D) Ramp

Question 24

What is the predicted normal forced vital capacity (FVC) for the average 20-year-old man?

A) 4.5 L
B) 5.6 L
C) 6.2 L
D) 7.0 L

Question 25

Which of the following volumes or capacities cannot be measured by simple spirometry?
1) Functional residual capacity (FRC)
2) Expiratory reserve volume (ERV)
3) Residual volume (RV)
4) Inspiratory reserve volume (IRV)

A)1, 3, and 4 only
B)1, 2, 3, and 4
C)1 and 3 only
D)1 and 4 only

Question 26

After a resting expiration, air still remains in the lungs. What is this volume called?

A) Functional residual capacity (FRC)
B) Vital capacity (VC)
C) Residual volume (RV)
D) Expiratory reserve volume (ERV)

Question 27

Which of the following statements is false about the FEV₁ measurement?

A) It is a volume measurement.
B) The recorded FEV₁ must come from the same forced vital capacity (FVC) effort.
C) It is often compared to the size of the FVC.
D) It is a popular test.

Question 28

What is the predicted normal for the peak expiratory flow (PEF) in the average man?

A) 5.5 L/sec
B) 6.5 L/sec
C) 8.0 L/sec
D) 9.5 L/sec

Question 29

What pulmonary function test presents the highest risk for fainting?

A) Slow vital capacity
B) Tidal volume per minute
C) Maximum voluntary ventilation
D) Total lung capacity

Question 30

You are examining the expiratory flow tracing during the patient's forced vital capacity (FVC) maneuver. At what point during the exhalation can you generally begin to see flow from the bronchioles?

A) Beyond 30%
B) Beyond 50%
C) Beyond 70%
D) Beyond 90%

Question 31

What is the most common lung volume measured during spirometry?

A) Tidal volume
B) Vital capacity
C) Total lung capacity
D) Expiratory reserve volume

Question 32

Which of the following is a true statement?

A) VC = FRC + V_T
B) VC = IRV + V_T + ERV
C) VC = V_T + IRV + RV
D) FRC = V_T + ERV

Question 33

You have just given your patient a 0.03 mg/ml dose of methacholine to assess for asthma. The subsequent forced vital capacity (FVC) shows no change. What should you do next?

A) Report to the physician that the patient does not have asthma.
B) Wait 1 hr and repeat the test at the same dose.
C) Have the patient return tomorrow to repeat the test.
D) Double the dose and repeat the FVC maneuver.

Question 34

Which of the following is equal to total lung capacity (TLC)?

A) V_T + ERV + IRV + RV
B) IC + V_T + ERV
C) VC + ERV
D) FRC + IRV

Question 35

Normal healthy people can exhale what percentage of the forced vital capacity in 1 sec?

A) 50%
B) 60%
C) 70%
D) 80%

Question 36

When evaluating a forced vital capacity maneuver postbronchodilator use to determine the reversibility of any airway obstruction, what percent increase in FEV₁ is needed to be able to say the treatment was effective?

A) 5%
B) 10%
C) 15%
D) 20%

Question 37

A patient has an expired minute ventilation of 14.2 L and a ventilatory rate of 25/min. What is the average V_T?

A) 568 ml
B) 635 ml
C) 725 ml
D) 410 ml

Question 38

How can you ensure reliability when measuring the expiratory reserve volume (ERV)?

A) Have the patient perform the maneuver twice, ensure consistency, and then take the best value.
B) Have the patient perform the maneuver three times, and then take the last value.
C) Have the patient perform the maneuver twice, ensure consistency, and then take the mean value.
D) Have the patient perform the maneuver until he or she becomes fatigued, and then take the last value.

Question 39

What is the predicted normal FEV₁ for the average 20-year-old man?

A) 3.3 L
B) 4.0 L
C) 4.7 L
D) 5.2 L

Question 40

What is the minimum objective standard for the volume exhaled during the final 1 sec of an acceptable forced vital capacity effort?

A) 0.10 L
B) 0.05 L
C) 0.025 L
D) 0.001 L

Question 41

Which gas normally used to measure the diffusing capacity of the lung?

A) O₂
B) CO
C) CO₂
D) He

Question 42

What is the normal predicted total lung capacity (TLC) for adults?

A) Approximately 6 L
B) Approximately 7 L
C) Approximately 8 L
D) Approximately 9 L

Question 43

Which of the following are true statements regarding the volume of tissue nitrogen excreted during the N₂ washout test for measuring functional residual capacity (FRC)?
1) It is not a factor.
2) It varies with the length of the test.
3) It varies with the weight of the patient.
4) It cannot be correct.

A)1 only
B)2 and 3 only
C)2, 3, and 4 only
D)4 only

Question 44

In which of the following conditions is total lung capacity (TLC) always reduced?

A) Restrictive lung disease
B) Obstructive lung disease
C) Combined restrictive and obstructive disease
D) Acute airways obstruction

Question 45

During a helium dilution test for functional residual capacity, you notice that it takes 19 min for equilibration between the gas concentrations in the spirometer and the patient's lungs. Based on this information, what can you conclude?

A) The patient has restrictive lung disease.
B) The spirometer is leaking helium.
C) The patient has obstructive lung disease.
D) Insufficient oxygen was added to the system.

Question 46

When used to determine functional residual capacity, the body plethysmograph operates on which of the following physical principles?

A) Dalton's law
B) Charles' law
C) Boyle's law
D) Gay-Lussac's law

Question 47

Which of the following are necessary to ensure a valid single-breath diffusing capacity of the lungs (DLCO) test result?
1) Two or more acceptable tests should be averaged.
2) Breath-hold time should be between 3 and 5 sec.
3) Corrections for hemoglobin (Hb) and COHb should be included.
4) The maneuvers should be reproducible to within 10%.

A)1, 2, and 3 only
B)2 and 4 only
C)1, 3, and 4 only
D)1, 2, 3, and 4

Question 48

Under which of the following conditions would you postpone a diffusing capacity test?
1) Just before the test, the patient smoked two cigarettes.
2) Just before the test, the patient had an episode of severe coughing.
3) Just before the test, the patient had a long wait at a busy bus stop.

A)1 only
B)1 and 3 only
C)2 and 3 only
D)1, 2, and 3

Question 49

A patient has a vital capacity of 4200 ml, a functional residual capacity (FRC) of 3300 ml, and an expiratory reserve volume (ERV) of 1500 ml. What is the residual volume (RV)?

A) 5700 ml
B) 2700 ml
C) 1800 ml
D) 7500 ml

Question 50

What is the normal predicted vital capacity (VC) measurement in the adult patient?

A) 3600 ml
B) 4800 ml
C) 5400 ml
D) 6000 ml

Question 51

How reliable is the tidal volume measurement in predicting the type of lung disease present?

A) Very reliable
B) Somewhat reliable
C) Not reliable
D) Reliable but only in certain age groups

Question 52

What causes the residual volume (RV) and functional residual capacity (FRC) to increase?

A) Atelectasis
B) Chronic obstructive lung disease
C) Pneumonia
D) Pneumothorax

Question 53

What is a normal single-breath diffusing capacity for carbon monoxide for a young, healthy man of average size?

A) 10 ml/min/mm Hg
B) 20 ml/min/mm Hg
C) 30 ml/min/mm Hg
D) 40 ml/min/mm Hg

Question 54

What percent of the total lung capacity (TLC) does the residual volume (RV) normally represent?

A) 10%
B) 20%
C) 30%
D) 40%

Question 55

To what should all spirometric values obtained under ambient conditions be converted?

A) Ambient temperature and pressure, saturated (ATPS)
B) Standard temperature and pressure, dry (STPD)
C) Body temperature, ambient pressure, saturated (BTPS)
D) Ambient temperature and pressure, dry (ATPD)

Question 56

During a helium (He) dilution functional residual capacity (FRC) measurement, the technologist first bleeds in 500 ml of He (He Vol) and obtains an initial reading of 4.0% (FiHe). After equilibration, the second He reading is 3.2% (FfHe). What is the patient's FRC?

A) 4450 ml
B) 3125 ml
C) 2680 ml
D) 3670 ml

Question 57

Toward the end of a nitrogen washout test for functional residual capacity, the expired concentration of N₂ begins rising. What does this probably indicate?

A) The patient is trying too hard.
B) There is a leak in the system.
C) The test is nearing completion.
D) N₂ is being trapped in the lungs.

Question 58

Which of the following statements is true when comparing the pulmonary function test results of men versus women?

A) Females have larger predicted volumes when corrected for height.
B) Females have the same predicted values when corrected for weight.
C) Males and females have the same predicted values when corrected for age.
D) Males have larger predicted volumes when corrected for height.

Question 59

What is the predicted normal tidal volume in the adult patient?

A) 300 to 450 ml
B) 400 to 500 ml
C) 500 to 700 ml
D) 450 to 750 ml

Question 60

Comprehensive quality assurance of pulmonary function testing consists of which of the following:
1) The accuracy and precision of the measured instrument.
2) Patient must be able to do a breath-hold between 3 and 5 sec.
3) The performance of the technologist.
4) Test results when measuring a standard.

A)2, 3, and 4 only
B)2 and 3 only
C)1, 3, and 4 only
D)1, 2, and 3 only

Question 61

What conclusions can you draw from the following data, obtained on a 67-year-old, 76-kg man admitted for pulmonary complications arising from silicosis?

A) Results indicate generalized airway obstruction.
B) Results indicate normal pulmonary function.
C) Results indicate a combined disease process.
D) Results indicate a restrictive lung disorder.

Question 62

Which of the following is necessary to assure comprehensive quality for helium dilution and nitrogen washout testing?
1) The accuracy and precision of the volume or flow-measuring device must be assured.
2) The accuracy and linearity of the gas analyzer must be verified.
3) Leak test must be acceptable while monitoring change in volume and gas concentrations over at least a minute.
4) Corrections for hemoglobin (Hb) and COHb must be included.

A)2, 3, and 4 only
B)2 and 3 only
C)1, 3, and 4 only
D)1, 2, and 3 only

Question 63

Which of the following precautions must be considered when performing pulmonary function procedures on patients with potentially infectious airborne disease?
1) Practitioners should wear sterile gloves.
2) Practitioner should wear a personal respirator or a close-fitting surgical mask.
3) Practitioners should wash their hands between testing patients and after contact with testing equipment.
4) The mouthpiece, nose clips, tubing, and any parts of the instrument that come into direct contact with a patient should be disposed, sterilized, or disinfected between patients.

A)2, 3, and 4 only
B)2 and 3 only
C)1, 3, and 4 only
D)1, 2, and 3 only

Question 64

Airway resistance (R_aw) is usually defined as:

A) the pressure difference between the ends of the airway divided by the flow rate of gas moving through the airway.
B) the sum of the pressures between the ends of the airway divided by the flow rate of gas moving through the airway.
C) the pressure difference between the ends of the airway multiplied by the flow rate of gas moving through the airway.
D) the sum of the pressures between the ends of the airway multiplied by the flow rate of gas moving through the airway.

Question 65

What conclusions can you draw from the following data, obtained from a 41-year-old man who admits to "occasional smoking" but otherwise reveals no past history of pulmonary problems?

A) Results indicate small airway obstruction.
B) Results indicate generalized airway obstruction.
C) Results indicate a restrictive lung disorder.
D) Results indicate a combined disease process.

Question 66

What conclusions can you draw from the following data, obtained on a 32-year-old 53-kg woman admitted for elective surgery?

A) Results indicate a mild restrictive lung disorder.
B) Results indicate normal pulmonary function.
C) Results indicate a combined disease process.
D) Results indicate generalized airway obstruction.

Question 67

In which of the following conditions will you see an increase in the DLCO?

A) Pulmonary emphysema
B) Secondary polycythemia
C) Severe anemia
D) Pulmonary fibrosis

Question 68

A patient has a decreased DLCO but a normal DLCO/V_A ratio. The patient most likely has:

A) emphysema.
B) pulmonary fibrosis.
C) a small lung (low total lung capacity).
D) secondary polycythemia.