Kacmarek: Egan's Fundamentals of Respiratory Care, 10th

Edition Chapter 19: Pulmonary Function Testing

Test Bank

MULTIPLE CHOICE

1. 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 determining pulmonary disability
5. modify the therapeutic approach to patient care
a. 1, 3, and 4
b. 2, 4, and 5
c. 1, 2, 3, 4, and 5
d. 2, 4, and 5

2. What do relative contraindications for lung volume determinations include?

1. recent cataract removal surgery
2. unstable cardiovascular status
3. untreated pneumothorax
4. hemoptysis of unknown origin
a. 1, 2, and 3
b. 2 and 4
c. 1, 3, and 4
d. 1, 2, 3, and 4

3. 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

4. Which of the following is typically elevated in restrictive lung disease?

a. lung compliance
b. lung volumes
c. pressure needed to expand the lung
d. airway’s resistance

5. 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
b. 1 and 2
c. 2 and 3
d. 1, 2, and 3

6. All of the following pulmonary function devices directly collect and measure gas volumes
except:
a. water-sealed spirometer
b. dry rolling-seal spirometer
c. bellows spirometer
d. pneumotachometer

7. To what does the range or limit of a device’s measuring ability refer?

a. capacity
b. accuracy
c. error
d. precision
8. How closely a device measures a certain reference value refers to what quality?

a. capacity
b. accuracy
c. linearity
d. precision
9. 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

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%

11. 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
12. 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
13. 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

14. 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

15. How often should a spirometer in continual use undergo volumetric calibration?
a. every 4 hours
b. every shift
c. at least daily
d. weekly

16. Tests of pulmonary mechanics include all of the following except:

a. maximum voluntary ventilation (MVV)
b. functional residual capacity
c. forced expiratory flows (FEFs)
d. forced expiratory volumes (FEVs)

17. Which of the following adverse reactions is NOT seen with pulmonary function testing?
a. syncope
b. cough
c. hemoptysis
d. chest pain

18. 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

19. 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.

20. 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

21. What is the minimum objective standard for the volume exhaled during the final 1 second of
an acceptable forced vital capacity effort?
a. 0.10 L
b. 0.05 L
c. 0.025 L
d. 0.001 L
22. Which of the following statements is NOT true 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.

23. 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

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
25. What is the predicted normal FEV 1 for the average 20-year-old man?
a. 3.3 L
b. 4.0 L
c. 4.7 L
d. 5.2 L

26. What is the minimum percent of the forced vital capacity that healthy people can exhale in the
first 1 second?
a. 50%
b. 60%
c. 70%
d. 80%

27. 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%
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

29. 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

30. When evaluating a forced vital capacity maneuver post bronchodilator 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%

31. 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 hour 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.

32. 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
b. 1, 2, 3, and 4
c. 1 and 3
d. 1 and 4
33. 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)

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
35. 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

36. 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

37. How can you ensure reliability when measuring the expiratory reserve volume (ERV)?
a. Have the patient perform the maneuver twice, ensure consistency, 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, then take the
mean value.
d. Have the patient perform the maneuver until he or she becomes fatigued, and then
take the last value.

38. What is the most common lung volume measured during spirometry?
a. tidal volume
b. vital capacity
c. total lung capacity
d. expiratory reserve volume

39. 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
b. 1, 2, and 3
c. 1, 2, 3, and 4
d. 1, 3, and 4

40. 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
41. During a helium dilution test for functional residual capacity, you notice that it takes 19
minutes 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.

42. 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
43. 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)

44. 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

45. 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.

46. Which of the following are true statements related to 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 for.
a. 1
b. 2 and 3
c. 2, 3, and 4
d. 4
47. 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

48. 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
49. 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

50. What is the normal average inspiratory capacity (IC)?

a. 1200 ml
b. 2400 ml
c. 3600 ml
d. 4800 ml

51. Which of the following statements is TRUE about inspiratory capacity (IC)?
1. It is reduced in restrictive lung diseases.
2. It may be reduced in obstructive lung diseases.
3. It may help determine the type of lung expansion therapy to apply.
a. 1 only
b. 2 only
c. 3 only
d. 1, 2, and 3

52. 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

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

a. Males and females have the same predicted values when corrected for height.
b. Males and 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.
54. What is the normal predicted total lung capacity (TLC) for adults?
a. about 6 L
b. about 7 L
c. about 8 L
d. about 9 L

55. What percent of the total lung capacity (TLC) does the residual volume (RV) normally
represent?
a. 10%
b. 20%
c. 30%
d. 40%

56. What causes the residual volume (RV) and functional residual capacity (FRC) to increase?
a. atelectasis
b. chronic obstructive lung disease
c. pneumonia
d. pneumothorax

57. 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

58. What is the gas normally used to measure the diffusing capacity of the lung?
a. O2
b. CO
c. CO2
d. He

59. 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
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

60. 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 seconds.
3. Corrections for hemoglobin (Hb) and COHb should be included.
4. The maneuvers should be reproducible to within 10%.
a. 1, 2, and 3
b. 2 and 4
 c. 1, 3, and 4
d. 1, 2, 3, and 4

61. 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
62. The DLCO would be decreased in all of the following except:
a. pulmonary emphysema
b. secondary polycythemia
c. severe anemia
d. pulmonary fibrosis

63. 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

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

TLC 4.93 5.27 94% FVC 3.67 3.86 95%

FRC 2.41 2.43 99% %FEV1 84% 78%

RV 1.29 1.35 96% FEF200– 5.66 5.74 99%

1200

VC 3.64 3.86 94% FEF25%– 3.53 3.49 101%

75%

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.
65. 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?

ACTUAL PRED % ACTUAL PRED %

PRED PRED

TLC 4.34 7.73 56% FVC 2.86 4.74 60%

FRC 1.73 4.36 40% %FEV1 96% 83%

RV 1.45 2.63 55% FEF200-1200 6.89 6.71 103%

VC 2.89 4.74 61% FEF25%- 2.78 2.88 96%

75%

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.

66. 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?
ACTUAL PRED % ACTUAL PRED %
PRED PRED

TLC 4.75 4.90 97% FVC 2.96 3.63 82%

FRC 2.31 2.21 105% %FEV1 82% 78%

RV 1.28 1.20 106% FEF200-1200 4.33 5.45 79%

VC 3.48 3.63 96% FEF25%- 1.95 3.37 58%

75%

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.
67. 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
b. 2 and 3
c. 1, 3, and 4
d. 1, 2, and 3

68. All of the following statements for quality assurance for measuring diffusing capacity are
correct, except:
a. Measuring the diffusing capacity of a well-known subject will provide a quality
control standard.
b. Measuring the diffusing capacity of the 5.0 L syringe will provide a quality control
standard.
c. Accuracy and linearity of the gas analyzer.
d. Accuracy and precision of the volume or flow measuring device.

69. 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 seconds.
3. The performance of the technologist.
4. Test results when measuring a standard.
a. 2, 3, and 4
b. 2 and 3
c. 1, 3, and 4
d. 1, 2, and 3

70. 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.
71. Which of the following precautions must be considered when performing pulmonary function
procedures on patients with potentially infectious airborne disease?
1. Practitioners should always wear gloves.
2. Practitioner should wear a personal respirator or a close-fitting surgical mask. 3.
Practitioners should always 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. 1,
2, 3, and 4
b. 2 and 3
c. 1, 3, and 4
d. 1, 2, and 3