Test bank for respiratory care anatomy and physiology 3nd edition by will beachey

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Chapter 5: Pulmonary Function Measurements
Test Bank
MULTIPLE CHOICE
1. 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

2. 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

3. 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

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4. 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

5. 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

6. 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

7. 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

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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

8. 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

9. 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.

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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

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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.

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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%.

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DIF: Recall

REF: 102

21. How long does it take a normal individual to exhale 100% of the FVC?
a. 2 to 4 seconds
b. 4 to 6 seconds
c. 1 to 2 seconds
d. 6 to 8 seconds
ANS: B

Normal people can exhale 100% of the FVC in 4 to 6 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 1 second (FEV1), 94% in 2
seconds (FEV2), and 97% in 3 seconds (FEV3).
DIF: Recall

REF: 103

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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 7 years ago and who

smokes two packs of cigarettes a day is brought to the emergency department. She complains
of having the flu 2 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 do these pulmonary function results suggest?
a. Obstructive
b. Restrictive
c. Mixed
d. Neuromuscular disease

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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 4 to 5 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 4 to 5 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


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 2 mm?
a. 10%
b. 20%
c. 30%
d. 40%
ANS: B

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Small airways less than 2 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

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