This is full Test Bank for Respiratory Care Anatomy and Physiology 3nd Edition by Will Beachey CLICK HERE Chapter 5: Pulmonary Function Measurements Test Bank MULTIPLE CHOICE Which of the following characteristics influence pulmonary function? I Age II Gender III Height IV Diet a I, III b II, III, IV c I, II, III d II, IV ANS: C Physical characteristics that influence pulmonary function the most are age, gender, height, ethnic origin, and body size or surface area DIF: Recall REF: 96 Lung function is considered normal when values are within what range of predicted? a 80% to 120% b 100% to 120% c 60% to 80% d 80% to 90% ANS: A Function is generally classified as normal if values are within 20% of the predicted values (i.e., 80% to 120% of the predicted values) DIF: Recall REF: 96 Which of the following values cannot be directly measured? a RV b VC c IC d VT ANS: A Because residual volume (RV) cannot be exhaled, it cannot be measured via direct spirometry Therefore, no capacity containing RV can be directly measured DIF: Recall REF: 96 full file at http://testbankcorner.eu Which of the following methods allow indirect measurement of RV and capacities containing it? I Helium dilution II End-tidal CO2 III Nitrogen washout IV Body plethysmography a I, III, IV b III, IV c I, II, III, IV d II, IV ANS: A RV and capacities containing it are measured indirectly via one of the following methods: helium dilution, nitrogen washout, or body plethysmography DIF: Recall REF: 96 Which of the following methods allows measurement of gas in the lung of a patient with obstructed airways? I Helium dilution II End-tidal CO2 III Nitrogen washout IV Body plethysmography a I, III b IV c III d I, IV ANS: B Neither the helium dilution nor the nitrogen washout techniques measure gas trapped behind occluded airways DIF: Recall REF: 98 Which of the following methods to measure gas in the lungs is based on Boyle’s law? a Helium dilution b End-tidal CO2 c Nitrogen washout d Body plethysmography ANS: D The plethysmographic method is based on Boyle’s law DIF: Recall REF: 98 Which of the following are features of plethysmography? I It is quite rapid II Successive FRC measurements can be made III It measures ventilated air space IV It measures nonventilated air space a I, II, III full file at http://testbankcorner.eu b I, II, III, IV c II, III d I, IV ANS: B The plethysmographic method is quite rapid; successive functional residual capacity (FRC) measurements can be made as the patient pants against the occluded mouthpiece This technique measures the ventilated and nonventilated air spaces DIF: Recall REF: 99 An abnormally increased FRC is typically associated with which of the following conditions? a Hyperinflation b Increased elastic recoil c Increased compliance d Pulmonary fibrosis ANS: A An abnormally increased FRC represents hyperinflation, which may be caused by a loss of elastic recoil or partial airway obstruction DIF: Recall REF: 99 Which of the following explains the lack of response to bronchodilators by some patients with severe emphysema? a Airway obstruction is caused by severe bronchospasm b Airway obstruction is caused by passive airway compression and collapse during expiration c Airway obstruction is associated with air trapping d Airway obstruction with hyperinflation is not sensitive to bronchodilators ANS: B Partial airway obstruction caused by bronchospasm is generally reversed by bronchodilator drugs; thus the associated increase in FRC is reversible Increased FRC caused by a permanent loss of elastic recoil is not reversible In severe emphysema, this loss of lung elasticity is associated with passive airway compression and collapse during expiration, causing air trapping Bronchodilator drugs are not useful in these circumstances DIF: Application REF: 99 10 A pulmonary function study is performed on a 68-year-old man suspected of having emphysema The physician requests that the study be performed to measure FRC Upon completion of both the helium dilution and body plethysmography it is found that the FRC obtained via body plethysmography is higher than that obtained via helium dilution What is the probable explanation for the difference in obtained FRC values? a Body plethysmography overestimates FRC b Helium dilution measures only the true FRC c Body plethysmography measures only gas that is in communication with unobstructed airways while helium dilution measures all gas in the chest d Body plethysmography measures all gas in the chest while helium dilution measures only gas that is in communication with unobstructed airways full file at http://testbankcorner.eu ANS: D The helium dilution test can measure only gas that is in communication with unobstructed airways Body plethysmography measures all gas in the chest, including gas trapped behind obstructed airways Thus, if body plethysmography yields higher FRC values than helium dilution measurements, air trapping must be present This is consistent with diseases such as emphysema, in which a loss of elastic lung recoil results in a loss of tethering forces that hold airways open during forceful exhalations As a result, small noncartilaginous airways collapse prematurely, trapping air In this patient, test results are consistent with the presence of emphysema DIF: Application REF: 100 11 Which of the following conditions is associated with increased FRC and RV? a Obstructive b Restrictive c Mixed d Idiopathic ANS: A Diseases increasing FRC and RV are generally classified as obstructive DIF: Recall REF: 100 12 Which of the following conditions are associated with restrictive pulmonary disease? I Fibrotic lung disease II ARDS III Skeletal deformities IV Asthma a I, II, III b II, III c I, II, III, IV d II, III, IV ANS: A Fibrotic lung diseases increase lung elastic recoil, shrinking all volumes and capacities Increased alveolar-capillary membrane permeability, characteristic of acute respiratory distress syndrome (ARDS), disrupts surfactant synthesis and increases alveolar surface tension This decreases FRC and RV by causing widespread alveolar collapse Extrapulmonary restriction of lung expansion by skeletal deformities also reduces all lung volumes and capacities Regardless of the mechanisms involved, reduced FRC and high lung recoil increase the work of breathing Diseases decreasing FRC and RV are generally classified as restrictive DIF: Recall REF: 100 13 Which of the following is the major feature of pulmonary obstructive disease? a Increased RV b Reduced maximum expiratory flow rate c Decreased VC d Increased TLC full file at http://testbankcorner.eu ANS: B The major feature of obstructive disease is a reduced maximum expiratory flow rate DIF: Recall REF: 101 14 Which of the following mechanisms primarily explains the increased WOB in obstructive diseases? a Loss of elastance b Increased airway resistance c Loss of compliance d Increased airflow ANS: B Obstructive diseases increase the work of breathing primarily by increasing airway resistance DIF: Recall REF: 101 15 Which of the following is the major feature of pulmonary restrictive disease? a Increased RV b Reduced maximum expiratory flow rate c Decreased lung volumes and capacities d Increased TLC ANS: C The major feature of restrictive disease is a reduction of lung volumes and capacities DIF: Recall REF: 101 16 Which of the following mechanisms primarily explains the increased WOB in restrictive diseases? a Loss of elastance b Increased airway resistance c Loss of compliance d Increased airflow ANS: C Restrictive diseases generally increase the WOB by decreasing lung compliance, making expansion difficult DIF: Recall REF: 101 17 Which of the following conditions is classified as a restrictive pulmonary disease with normal compliance? a ARDS b Pulmonary fibrosis c Neuromuscular disease d Pneumonia ANS: C Neuromuscular diseases are unique in that they are classified as restrictive, although lung and thoracic compliance may be normal However, they present a restrictive pulmonary function pattern because muscle weakness limits inspiratory and expiratory volumes full file at http://testbankcorner.eu DIF: Recall REF: 101 18 What is the normal RV/TLC value in healthy adults up to age 49? a 5% to 10% b 10% to 15% c 20% to 25% d 30% to 35% ANS: C The normal RV/TLC ratio is 20% to 25% in healthy adults up to age 49 In people older than 50 years of age, the RV/TLC ratio may range as high as 35%, reflecting normal loss of elastic recoil with aging DIF: Recall REF: 101 19 The ability to generate high flow rates depends on which of the following factors? I Muscle strength II Airway patency III Neurological function IV Diaphragmatic function a I, II, III b II, III, IV c I, II, III, IV d II, III, IV ANS: A The ability to generate high flow rates depends on muscular strength, airway patency, and neurological function DIF: Recall REF: 102 20 Which of the following concepts apply to FVC? I It is the most frequently performed pulmonary function test II It provides much information about large and small airway function III It is an effort-dependent test IV A test is assumed valid if the person can repeat three FVC maneuvers with a variation no greater than 10% a III, IV b I, II, III c I, II, IV d I, II, III, IV ANS: B The forced vital capacity (FVC) measurement requires the person to exhale the vital capacity (VC) as forcefully and rapidly as possible The FVC is the most frequently performed pulmonary function test because it provides much information about large and small airway function It is an effort-dependent test, requiring thorough patient instruction, understanding, and maximal effort A test is assumed valid if the person can repeat three FVC maneuvers with a variation no greater than 5% full file at http://testbankcorner.eu DIF: Recall REF: 102 21 How long does it take a normal individual to exhale 100% of the FVC? a to seconds b to seconds c to seconds d to seconds ANS: B Normal people can exhale 100% of the FVC in to seconds People who have severe airway obstruction may require more than 10 seconds DIF: Recall REF: 102 22 Which of the following conditions define an obstructive impairment? a A low FEV1 and a low FEV1/FVC ratio b A high FEV1 and a low FEV1/FVC ratio c A low FEV1 and a high FEV1/FVC ratio d A normal FEV1 and a low FEV1/FVC ratio ANS: A A low 1-second forced expiratory volume (FEV1) and a low FEV1/FVC ratio define an obstructive impairment DIF: Recall REF: 103 23 Which of the following conditions define a restrictive impairment? a A low FEV1 and a low FEV1/FVC ratio b A high FEV1 and a low FEV1/FVC ratio c A low FEV1 and a normal FEV1/FVC ratio d A normal FEV1 and a low FEV1/FVC ratio ANS: C Restrictive impairments also have a low FEV1 but a normal or even high FEV1/FVC ratio DIF: Recall REF: 103 24 What is the normal amount of FVC expired during FEV1 in a healthy adult? a 67% b 83% c 94% d 97% ANS: B The FEV1 is an index of severity in chronic obstructive pulmonary disease (COPD) The ability to work and the likelihood of dying from respiratory disease are statistically correlated with the FEV1 Normal healthy adults exhale approximately 83% of the FVC in second (FEV1), 94% in seconds (FEV2), and 97% in seconds (FEV3) DIF: Recall REF: 103 full file at http://testbankcorner.eu 25 Which of the following values indicates significant airway obstruction? a FEV1/FVC < 85% b FEV1/FVC < 80% c FEV1/FVC < 75% d FEV1/FVC < 65% ANS: D Age causes the FEV1/FVC ratio to decrease because of reduced elastic recoil An FEV1/FVC ratio lower than 70% indicates that significant airway obstruction is present DIF: Recall REF: 103 26 Which of the following are characteristics of PEF? I It reflects large airway function II PEF in normal adults may exceed 10 L/sec III It is an effort-dependent test IV PEF is useful in assessing gross changes in airway function and evaluating the response to bronchodilator drugs a III, IV b I, II, III c I, II, IV d I, II, III, IV ANS: D The peak expiratory flow (PEF) reflects initial expiratory flow coming from the large airways at the beginning of the FVC Thus, PEF reflects large airway function It is an effort-dependent test: the greater the effort, the higher the test value PEF in normal adults may exceed 10 L/sec Reproducibility of the PEF is a good indication of maximal patient effort The PEF is useful in assessing gross changes in airway function and evaluating the response to bronchodilator drugs This test is very useful in managing asthma in outpatient and home settings DIF: Recall REF: 103 27 A 52-year-old woman who was diagnosed with pulmonary emphysema years ago and who smokes two packs of cigarettes a day is brought to the emergency department She complains of having the flu weeks earlier and that her breathing has become more difficult since then Her pulmonary function test reveals the following results: Predicted Actual Percent of Predicted FVC 4.67 L 4.00 L 86% FEV1 3.52 L 1.23 L 35% FEV1/FVC More than 75% 31% — (A value equal to or greater than 80% of the predicted value is considered normal.) What condition these pulmonary function results suggest? a Obstructive b Restrictive c Mixed d Neuromuscular disease full file at http://testbankcorner.eu ANS: A Diagnoses of obstructive and restrictive patterns are traditionally based on three main variables: FVC, FEV1, and FEV1/FVC This woman’s test shows that the FVC is normal (above 80% of predicted), but the FEV1 and FEV1/FVC are decreased The normal FVC rules out restrictive disease These findings are consistent with an obstructive impairment because they point to expiratory airflow limitation A normal person is expected to exhale about 80% of the FVC in the first second This woman’s reduced flows are probably caused by loss of elastic support in the airways, producing premature bronchiolar collapse during forced expiration As the obstructive disease becomes more severe, the FVC also may decrease because air trapping limits her ability to exhale as much air as a normal person DIF: Application REF: 104 28 Which of the following statements are true of the FEF25-75%? I It is more sensitive to flow coming from medium to small airways II Normal FEF25-75% for a healthy young adult is approximately to L/sec III It does not have more variance than other measures of flow IV Because the FEF25-75% is so variable, its validity is questionable a III, IV b I, II, III c I, II, IV d I, II, III, IV ANS: C The average forced expiratory flow rate over the middle 50% of the FVC (FEF25-75%) is more sensitive to flow coming from medium to small airways The primary resistance to expiratory flow during the middle half of the FVC comes from rapid narrowing of small airways as the lung deflates Normal FEF25-75% for a healthy young adult is approximately to L/sec Unfortunately, this test has more variance than other measures of flow, even in normal people An FEF25-75% equal to 65% of the predicted value may still be within statistically normal limits Because the FEF25-75% is so variable, its validity is questionable; the FEV1 is more useful and reliable in assessing the response to bronchodilators DIF: Recall REF: 103-104 29 The maximum voluntary ventilation reflects the overall integrated function of which of the following parameters? I Ventilatory apparatus II Muscle strength III Endurance IV Airway diameter, lung compliance, and neural control mechanisms a III, IV b I, II, III c I, II, IV d I, II, III, IV ANS: D full file at http://testbankcorner.eu The maximum voluntary ventilation (MVV) reflects the overall integrated function of the ventilatory apparatus, including muscle strength, endurance, airway diameter, lung compliance, and neural control mechanisms As such, MVV is a nonspecific test MVV varies considerably in healthy people, as much as 30% from the mean Therefore, only large reductions in MVV are significant DIF: Recall REF: 106 30 The MMV is relatively unaffected by which of the following respiratory conditions? a Obstructive b Restrictive c Mixed d Idiopathic ANS: B The MVV is relatively unaffected by purely restrictive disease Faster breathing rates compensate for smaller tidal volumes, producing near normal MVV values DIF: Recall REF: 106 31 According to the GOLD guidelines, a patient with COPD is classified as stage III (severe) in the presence of which of the following spirometric values? a FEV1 30% to 50% and FEV1/FVC < 70% b FEV1 < 50% and FEV1/FVC < 70% c FEV1 50% to 80% and FEV1/FVC < 70% d FEV1 < 80% and FEV1/FVC < 60% ANS: A GOLD Classification of COPD by Severity Stage Characteristics I: Mild COPD FEV1/FVC less than 70% FEV1 80% or more of predicted II: Moderate COPD FEV1/FVC less than 70% FEV1 50% or more but less than 80% of predicted III: Severe COPD FEV1/FVC less than 70% FEV1 less than 50% but greater than 30% of predicted IV Very severe COPD FEV1/FVC less than 70% FEV1 less than 30% of predicted; life threatening exacerbations; severe DIF: Recall REF: 107 32 Which percentage of the total airway resistance depends on small airways less than mm? a 10% b 20% c 30% d 40% ANS: B full file at http://testbankcorner.eu Small airways less than mm in diameter account for less than 20% of total airway resistance This means a significant amount of small airway obstruction may remain undetected by conventional spirometry DIF: Recall REF: 107 33 Which of the following tests is considered the most sensitive for early detection of abnormal small airways resistance? a FEF25-75% b Frequency dependence of compliance c Closing volume d Low-density gas spirometry ANS: B Frequency dependence of compliance is an extremely sensitive test for early detection of abnormal small airways resistance and is the standard against which other tests are compared DIF: Recall REF: 107 34 Which of the following tests is considered more sensitive for detection of small airway obstruction than FEF25-75% or FEV1? a PEF b The volume of isoflow (VisoV.) c FEV1/FVC d Dynamic compliance ANS: B The VisoV· test is more sensitive to small airway obstruction than the FEF25-75% or FEV1 DIF: Recall REF: 109 full file at http://testbankcorner.eu ... function test because it provides much information about large and small airway function It is an effort-dependent test, requiring thorough patient instruction, understanding, and maximal effort A test. .. extremely sensitive test for early detection of abnormal small airways resistance and is the standard against which other tests are compared DIF: Recall REF: 107 34 Which of the following tests is considered... an effort-dependent test: the greater the effort, the higher the test value PEF in normal adults may exceed 10 L/sec Reproducibility of the PEF is a good indication of maximal patient effort