Deck 12: Quality Systems in the Pulmonary Function Laboratory

Question 1

A helium analyzer is checked using a 3-L syringe;300 ml of He is added to 2.70 L of air in the syringe.If the dead space of the syringe and tubing is 100 ml,what is the expected concentration of He in the syringe?

A) 11.1%
B) 0.2%
C) 9.7%
D) 8.8%

Answer 1

C

Question 2

An automated blood gas analyzer displays acceptable calibrations with no electrode drift noted.Multiple-level QC shows values for PCO₂ and PO₂ that are within 2 SD of the mean,but all pH values are more than 3 SD above the mean.Which of the following is most likely the cause?

A) Buffers are contaminated.
B) Calibration gas is contaminated.
C) Analyzer temperature is not 37° C.
D) Gas-liquid correction factor is set too low.

Answer 2

A

Question 3

A 3-L syringe is used to calibrate a flow-sensing spirometer;the spirometer reads a volume of 3.04 L.The software correction factor for this system would be which of the following?

A) 0.95
B) 0.99
C) 1.01
D) 1.04

Answer 3

B

Question 4

A biologic control subject has an established FVC of 5.00 L with an SD of 0.20 L.After spirometer maintenance,the following values are obtained from the biologic control: On the basis of these findings,the pulmonary function technologist should conclude what?

A) Spirometer performance is within acceptable statistical limits.
B) Spirometer performance is questionable.
C) The control subject's efforts were greater than normal.
D) The control subject's efforts were not temperature-corrected to BTPS.

Question 5

Multiple injections from a 3-L syringe into a flow-based spirometer produce an average reading of 2.92 L.This value indicates:

A) The spirometer has a leak.
B) The spirometer meets ATS accuracy requirements.
C) Excessive flows were used for calibration.
D) The spirometer should not be used for pediatric patients.

Question 6

Tonometry of whole blood may be used to provide QC for which of the following?

A) PO₂ and PCO₂ electrodes
B) PCO₂ and pH electrodes
C) PO₂ electrode only
D) pH electrode only

Question 7

Quality control of an automated DLCO system is performed using a 3-L syringe.The syringe is filled to 1.5 L with room air and is then connected to the system.A simulated DLCOsb maneuver is performed with 1.5 L of test gas drawn into the syringe.Acceptable performance of the gas analyzers should produce a DLCO of approximately:

A) 0 ml CO/min/mm Hg
B) 25 ml CO/min/mm Hg
C) 50 ml CO/min/mm Hg
D) 100 ml CO/min/mm Hg

Question 8

A spirometer recorder used for plotting flow-volume curves has a volume (x axis)sensitivity of 25 mm/L.The flow axis (y axis)sensitivity should be:

A) 12.5 mm/L/sec
B) 25.0 mm/L/sec
C) 50.0 mm/L/sec
D) 50.0 mm/L

Question 9

According to ATS recommendations,the acceptable "back pressure" (flow resistance)from a spirometer is less than _____ cm H₂O at _____ L/sec.

A) 3.0;7
B) 3.0;14
C) 1.5;7
D) 1.5;14

Question 10

According to ATS recommendations,the range and accuracy for a diagnostic spirometer should be which of the following?

A) 0 to 14 L with less than 1.5 cm H₂O/L/sec resistance
B) 0.5 to 8 L ± 3% of reading or ± 0.05 L,whichever is greater
C) 0.5 to 6 L ± 5% of reading or ± 0.1 L,whichever is greater
D) 0.1 to 5 L ± 3% of reading or ± 0.05 L,whichever is greater

Question 11

A CO₂ analyzer is calibrated using a 5% CO₂ mixture with a water vapor absorber in the sample line.If the barometric pressure is 747 mm Hg and the analyzer is set up to read partial pressure,the analyzer should be adjusted to read which of the following?

A) 40 mm Hg
B) 37 mm Hg
C) 35 mm Hg
D) 31 mm Hg

Question 12

Quality control run on a PO₂ electrode shows the following results when plotted on a QC chart: Which of the following best describes the result of run 7?

A) Out-of-control situation
B) Shift
C) Trend
D) Random error

Question 13

A 50-ml sine-wave pump is used to calibrate a 450-L plethysmograph.While the pump is running,the computer display shows a deflection of 25 cm.What is the box calibration factor for this system?

A) 0.5 L/cm
B) 1.25 L/cm
C) 2 ml/cm
D) 0.5 ml/cm

Question 14

Quality control of a body plethysmograph is performed using an isothermal lung analog and a biologic control subject with the following results: On the basis of these findings,the pulmonary function technologist should conclude what?

A) There is a leak in the door seal.
B) Box pressure calibration was performed incorrectly.
C) Mouth pressure calibration was performed incorrectly.
D) The box is functioning within acceptable limits.

Question 15

A patient who is short of breath performs eight FVC maneuvers,and these results from the three best efforts are recorded: Which of the following is appropriate to report in the technologist's comments?

A) "Spirometry meets all ATS criteria."
B) "FVC is not repeatable."
C) "FEV₁ is not repeatable."
D) "FEF_50% shows poor patient effort."

Question 16

A CO₂ analyzer is calibrated using a 5% CO₂ mixture with the sampling pump set at 500 ml/min;a water vapor absorber is then added to the sample line.Which of the following should be done before using this system?

A) Increase the sampling pump flow to at least 750 ml/min.
B) Decrease the sampling pump flow to less than 50 ml/min.
C) Recalibrate the analyzer.
D) Calculate the "corrected" CO₂ reading.

Question 17

A 3-L syringe is used to calibrate a computerized spirometer;at ATPS the spirometer reads a volume of 2.94 L.The software correction factor for this system is:

A) 1.02
B) 1.00
C) 0.98
D) 0.95

Question 18

The pulmonary function technologist should observe which of the following precautions in drawing an arterial blood sample?

A) Determine whether gloves are needed by checking the patient's history.
B) Carefully resheath used needles using the original protective covering.
C) Dispose of used needles in puncture-resistant containers marked "biohazard."
D) Use protective barriers if there is danger of blood splashing.

Question 19

An automated blood gas analyzer performs two-point calibrations that match expected values.Subsequent quality control runs show unacceptable values for PO₂ and PCO₂,but pH is acceptable.Which of the following is the most likely problem?

A) Contaminated buffers
B) Contaminated calibration gas
C) Analyzer temperature not at 37° C
D) Computer error

Question 20

Multiple injections by a 3-L syringe into a bellows-type spirometer produce the following results: Which of the following best describes these results?

A) The spirometer shows excessive drift.
B) The volume is being inappropriately corrected to BTPS.
C) The spirometer bellows are sticking.
D) Spirometer performance is acceptable.

Question 21

Which of the following control materials would be best suited for quality control of a PO₂ electrode used to measure O₂ tensions less than 50 mm Hg?

A) Fluorocarbon-based control
B) Aqueous-based control
C) Tonometered buffer
D) Tonometered whole blood

Question 22

A pulmonary function technologist uses a 3-L syringe and a tank of 10% He to prepare serial dilutions of gas to verify the linearity of a helium analyzer used for closed-circuit measurements of FRC.The following data are recorded: On the basis of these results,the technologist should conclude that:

A) The He analyzer is performing acceptably.
B) The He analyzer is nonlinear.
C) The syringe had a significant leak.
D) The He tank was mislabeled.

Question 23

According to ATS-ERS recommendations (2005),a computer display of flow-volume curves should have a scale factor of:

A) 5 mm/L on the volume axis
B) 5 mm/L/sec on the flow axis
C) 20 mm/sec on the time axis
D) A 1:1 aspect ratio with expiratory flow plotted downward

Question 24

A patient performs spirometry,and the following results are obtained: The pulmonary function technologist should conclude which of the following?

A) Only the FVC is repeatable.
B) Only the FEV₁ is repeatable.
C) Both the FVC and FEV₁ are repeatable.
D) The FEV₁/FVC is 52%.

Question 25

A 3-L syringe is used to calibrate a spirometer;injection of the complete volume produces an output of 3.04 L.The correction factor for this system would be:

A) 0.967
B) 0.987
C) 1.013
D) 1.100

Question 26

A subject performs spirometry,and these results are recorded from three acceptable trials: The flow-volume curve from which trial should be reported?

A) Trial 1
B) Trial 2
C) Trial 3
D) Either Trial 1 or Trial 3

Question 27

The greatest risk of cross-contamination in the pulmonary function laboratory is associated with:

A) Failure to use bacteria filters for spirometry
B) Inadequate disinfection of reusable nebulizers
C) Moisture inside dry rolling-seal spirometers
D) Pulse oximetry finger sensors

Question 28

A biologic control subject performs DLCO measurements on 20 consecutive days,and the following statistics are calculated: The coefficient of variation for the DLCO in this subject:

A) Is approximately 4.5%
B) Cannot be calculated until 30 measurements have been made
C) Suggests that the patient may have asthma
D) Indicates that the DLCO system displays excessive variability

Question 29

Quality control runs on a PCO₂ electrode have produced a mean of 40 mm Hg ± 2 mm Hg (1 SD).What are the chances of obtaining a value of 45 mm Hg on a control run if the electrode is functioning properly?

A) 95%
B) 50%
C) 5%
D) Less than 1%

Question 30

Quality control is performed on a cartridge-based blood gas analyzer,and the following control chart is recorded for the pH: What action should the pulmonary function technologist take,based on these results?

A) Begin analyzing blood gases because the instrument is in control.
B) Run one additional Level 2 control to determine instrument status.
C) Take the instrument out of service because it is out of control.
D) Re-membrane the pH electrode and rerun Level 2.

Question 31

According to the current ATS-ERS guidelines,spirometers should be able to measure volumes of at least:

A) 7 L
B) 8 L
C) 12 L
D) 14 L

Question 32

A 3-L syringe is used to check the calibration of a portable spirometer,and the following results are obtained: Which of the following best describes these findings?

A) The spirometer temperature is less than 24 $\degree$ C.
B) The BTPS correction factor is being applied.
C) The syringe has a small but significant leak.
D) The spirometer is functioning acceptably.

Question 33

Spirometers used to measure FEV₁ should be able to measure flows in the range of 0 to 14 L/sec (ATS-ERS,2005).The maximal resistance allowable at all flows is:

A) Less than 6 cmH₂O/L/sec
B) Less than 1.5 cmH₂O/L/sec
C) Determined by the type of filter used
D) One half of the flow rate in L/sec

Question 34

A patient whose FVC is 4 L performs two DLCOsb maneuvers with the following results: The pulmonary function technologist should:

A) Reject Trial 1 because of the V_I.
B) Reject Trial 2 because of the breath-hold time.
C) Report the DLCOsb as 22.0 ml CO/min/mm Hg.
D) Report the DLCOsb as 21.2 ml CO/min/mm Hg.

Question 35

A pulmonary function technologist uses an isothermal lung analog to check the accuracy of a constant volume plethysmograph.The lung analog has a volume of 4.00 L.Simulating the V_TG maneuver produces the following volumes: On the basis of these findings,the technologist should:

A) Check the door seal for leaks or cracks.
B) Recalibrate the box pressure transducer.
C) Zero the mouth pressure transducer and repeat the measurement.
D) Begin patient testing with the body box.

Question 36

According to 2005 ATS-ERS recommendations,calibration syringes should be accurate to within (±):

A) 3.5%
B) 0.5%
C) 20 ml
D) 30 ml

Question 37

A DLCO simulator using two precision gases is set up to check the accuracy of an automated single-breath diffusion testing system.The following results are obtained using a 4-L inspired volume: Both of the DLCO values are less than the expected values from the simulator.Which of the following best describes these findings?

A) The IVC measurement is erroneous.
B) The gas analyzer measured CO incorrectly.
C) The gas analyzer measured the trace gas incorrectly.
D) BTPS correction was inadvertently left on during the simulation.

Question 38

The calibration gas for a blood gas analyzer contains 20.1% O₂ and 4.99% CO₂.If the barometric pressure is 744 mm Hg,what is the partial pressure of gas used to calibrate the PCO₂ electrode?

A) 149.5 mm Hg
B) 140.0 mm Hg
C) 37.1 mm Hg
D) 34.8 mm Hg

Question 39

The acceptable range for accuracy of a spirometer checked with a 3-L syringe is:

A) 0.00 to 14.00 L
B) 0.00 to 8.00 L
C) 2.910 to 3.090 L
D) 2.895 to 3.105 L

Question 40

A patient whose VC is 3.5 L performs two DLCOsb maneuvers with the following results: The pulmonary function technologist should do which of the following?

A) Perform at least one additional maneuver.
B) Report the average of Trials 1 and 2.
C) Report the DLCOsb as 20.3 ml CO/min/mm Hg.
D) Report the DLCOsb as 19.0 ml CO/min/mm Hg.

Question 41

A portable office spirometer is being checked with a 3-L syringe as a simulated patient.The spirometer uses disposable flow sensors that are calibrated during manufacture.These results are recorded: On the basis of these findings,the pulmonary function technologist should:

A) Replace the device's temperature sensor.
B) Stop using the spirometer for patient testing until it can be repaired.
C) Have the calibration syringe checked for volume accuracy.
D) Continue using the spirometer for patient testing.

Question 42

What would be your next action after reviewing the data from the following level 1 PaO₂ QC Levy-Jennings plot?

A) Begin analyzing blood gases because the instrument is in-control.
B) Run one additional Level 1 control to determine instrument status.
C) Take the instrument out of service because it is out-of-control.
D) Run the next control level to determine instrument status.

Question 43

All of the following statements are important ATS instrument specifications except:

A) Back pressure and resistance must be less than 1.5 cm H₂O/L/sec up to an air flow of 14 L/sec.
B) Spirometer must be capable of measuring volumes of at least 8 L (BTPS)with flows between zero and 14 L/sec.
C) The paper must move at a chart speed of at least 32 mm/sec.
D) Spirometer must be capable of measuring expired volumes for at least 15 seconds.

Question 44

According to ATS-ERS recommendations,what three flow rates are required to calibrate a flow sensor?

A) 0.5 L/sec,4.0 L/sec,6.0 L/sec
B) 1.5 L/sec,3.0 L/sec,6.0 L/sec
C) 0.5 L/sec,3.0 L/sec,12.0 L/sec
D) 1.0 L/sec,4.0 L/sec,12.0 L/sec

Question 45

When developing a quality manual,which of the following questions is addressed with a process?

A) How do we do this at organization XYZ?
B) How do we perform spirometry?
C) How are reliable lung volumes obtained?
D) How do we obtain an arterial specimen?

Question 46

While performing a calibration check of a spirometer using a 3.00-L syringe,2.84 L is measured.What should you do next?

A) Proceed with testing subjects.
B) Add 0.16 L to all subject measurements.
C) Check for leaks and recheck calibration.
D) Turn on the BTPS correction and recheck calibration.

Question 47

A pulmonary laboratory has purchased a new plethysmograph.During the installation process,the technologist verifies the data integrity.Which QSE is the technologist following?

A) Equipment
B) Process management
C) Information management
D) Purchasing and inventory control

Question 48

If a volume-measuring spirometer meets the ATS-ERS standards for measuring FVC and is verified using a calibration syringe,how much measurement error is allowed?

A) 0%
B) 3.5%
C) 5.3%
D) 10%

Question 49

A pulmonary function technologist injects 3-L volumes from a calibration syringe into a spirometer that uses a turbine device to sense flow.The following results are observed: The pulmonary function technologist should:

A) Turn off BTPS correction and repeat the trial.
B) Turn on BTPS correction and repeat the maneuvers.
C) Have the syringe recalibrated.
D) Have the spirometer serviced.

Question 50

The technologist is following a procedure for measuring the correct height of a patient.This step is from which portion of the path of workflow?

A) Pre-test process
B) Test performance
C) Post-testing
D) Clinical evaluation

Question 51

The BTPS correction adjusts the measured result obtained in the spirometer to the:

A) Ambient temperature for the surrounding air
B) Volume that was originally in the lungs
C) Barometric pressure at the altitude where the testing is conducted
D) Relative humidity in the testing room

Question 52

What should the technologist do in response to the following Levy-Jennings plot of a PO₂ electrode?

A) Rerun the control.
B) Take the analyzer out of service.
C) Run another PaO₂ control level.
D) Continue to test patient samples and call technical support.

Question 53

According to the ATS-ERS recommendations,when using a 3.00-L syringe to check spirometer calibration,which of the following represents an acceptable difference between the expected and actual result?

A) 100 ml
B) 110 ml
C) 120 ml
D) 130 ml