PREMID

Question 1

The most important function of the lungs is _____.

Answer 1

gas ex- change

Question 2

1. The diaphragm and thoracic muscles must be capable of expanding the thorax and lungs to produce a subatmo- spheric pressure.
2. The airways must be unobstructed to allow gas to flow into the lungs and reach the alveoli.
3. O2 and CO2 must be able to diffuse through the alveolar- capillary membrane.
4. The cardiovascular system must circulate blood through the lungs and ventilated alveoli.

Answer 2

ability of the lungs to perform gas exchange

Question 3

_______ can provide valuable information
about these important individual processes that support gas exchange.

Answer 3

Pulmonary function tests

Question 4

Various _______ are available to aid in the diagnosis and assessment of pulmonary diseases, to determine the need for therapy, and to evaluate the effectiveness of respira- tory care.

Answer 4

measurements

Question 5

For ________ , knowledge of these tests and the ability to interpret the measurements are essential for assessing patients objectively and for planning and imple- menting effective patient care.

Answer 5

respiratory therapists (RTs)

Question 6

A complete evaluation of the respiratory system includes a ____

Answer 6

patient history, physical examination, radiographic imaging, arterial blood gas analysis, and tests of pulmonary function.

Question 7

Although diagnostic ______ is performed in a laboratory setting and usually only on patients in a stable condition, RTs also perform many of these tests at the bedside on patients who are acutely ill or being evaluated for surgical readiness.

Answer 7

pulmonary function testing

Question 8

There are three categories of pulmonary function tests, measuring ________123

Answer 8

(1) dynamic flow rates of gases through the airways,
(2) lung volumes and capacities, and
(3) the ability of the lungs to diffuse gases.

Question 9

A combination of these measurements provides a quantitative picture of ______

Answer 9

lung function.

Question 10

Although ______ do not diagnose specific pulmonary diseases, these tests identify the presence and type of pulmonary impairments and the degree of pulmonary disease present.

Answer 10

pulmonary function tests

Question 11

Some basic tests of pul- monary function are often performed at the _____ to provide immediate information about the need for _______ and its effectiveness.

Answer 11

bedside / respiratory therapy

Question 12

Generally, the primary purposes of pulmonary function testing are to identify ____ and _____

Answer 12

pulmonary impairment and quantify the severity of pulmonary impairment if present.

Question 13

_____ has diagnostic and therapeutic roles and helps clinicians answer some general questions about patients with lung disease

Answer 13

Pulmonary function testing

Question 14

• Is lung disease present?
• What type of lung impairment is present?
• What is the degree of lung impairment?
• Is more than one type of lung impairment present?
• Can multiple lung diseases be separated?

Answer 14

DIAGNOSTIC

Question 15

• Is therapy indicated?
• What treatments are most effective?
• To what degree is the disease reversible?
• Can treatments be evaluated?
• Is rehabilitation feasible?

Answer 15

THERAPEUTIC

Question 16

The indications for pulmonary function testing are as follows

Answer 16

• To identify and quantify changes in pulmonary function.
• To evaluate need and quantify therapeutic effectiveness.
• To perform epidemiologic surveillance for pulmonary disease.
• To assess patients for risk for postoperative pulmonary compli- cations.
• To determine pulmonary disability.

Question 17

The most common purposes of pulmonary function testing are to detect the presence or absence of pulmonary disease, to classify the type of disease as either obstructive, restrictive, or both (mixed), and to quantify the severity of pulmonary impairment as mild, moderate, severe, or very severe. Over time, pulmonary function tests help quantify the progres- sion or the reversibility of the disease.

Answer 17

To identify and quantify changes in pulmonary function.

Question 18

Pulmonary function tests may aid clinicians in selecting or modifying a specific therapeutic regimen or technique (e.g., bronchodilator medication, airway clearance therapy, reha- bilitation exercise protocol). Clinicians and researchers use pulmonary function tests to measure changes in lung func- tion objectively before and after treatment.

Answer 18

To evaluate need and quantify therapeutic effectiveness.

Question 19

Screening programs may detect pulmonary abnormalities caused by disease or environmental factors in general popu- lations, in people in occupational settings, in smokers, or in other high-risk groups. In addition, researchers have deter- mined what normal pulmonary function is by measuring the pulmonary function of healthy people.

Answer 19

To perform epidemiologic surveillance for pulmonary disease.

Question 20

Preoperative testing can identify patients who may have an increased risk for pulmonary complications after surgery. Sometimes the risk for complications can be reduced by preoperative respiratory care, or in some cases, the risk may be significant enough to rule out surgery.

Answer 20

To assess patients for risk for postoperative pulmonary compli- cations.

Question 21

Pulmonary function tests can also determine the degree of disability caused by lung diseases, such as occupational asthma or coal workers’ pneu- moconiosis. Some federal entitlement programs and insur- ance policies rely on pulmonary function tests to confirm claims for financial compensation.

Answer 21

To determine pulmonary disability.

Question 22

There are also contraindications to pulmonary function testing. Patients with acute, _________ should not be tested.

Answer 22

unstable cardiopulmonary problems, such as hemoptysis, pneumothorax, myocardial infarction, pulmonary embolism, and patients with acute chest or abdominal pain

Question 23

Patients who have ___ and who have ____ should not be tested because there is a risk of aspiration.

Answer 23

nausea / recently vomited

Question 24

Testing for patients who have had recent ______ should be delayed because changes in ocular pressure may be harmful to the eye.

Answer 24

cataract removal surgery

Question 25

Pulmonary function testing requires patient ____ and ____

Answer 25

effort and cooperation.

Question 26

Patients with ___ or ____ may not achieve optimal or repeatable results.

Answer 26

dementia or confusion

Question 27

_____ should not be performed if valid and reliable results cannot be predicted.

Answer 27

Pulmonary function testing

Question 28

In patients who are acutely ill or who have recently smoked a ciga- rette, the test validity of measuring the ______ may be hindered.

Answer 28

forced vital capacity (FVC)

Question 29

Pulmonary function testing provides the basis for classifying pulmonary diseases into two major categories, ____ and ______

Answer 29

obstructive pulmonary disease and restrictive pulmonary disease.

Question 30

These two types of lung diseases sometimes occur together as a mixed impairment.

Answer 30

obstructive pul- monary disease and restrictive pulmonary disease.

Question 31

The primary problem in ______ is an increased airway resistance (Raw).

Answer 31

obstructive pulmonary disease

Question 32

____ is the difference in pressure between the ends of the airways divided by the flow rate of gas moving through the airway

Answer 32

Raw

Question 33

There is an inverse relationship between Raw and _____

Answer 33

flow rate V.

Question 34

If the pressure difference is constant, a reduced flow rate indicates an _____.

Answer 34

increase in Raw

Question 35

the ____ of the airways normally lessens slightly during expiration,

Answer 35

radius

Question 36

_____ are usually measured during expiration.

Answer 36

flow rates

Question 37

According to ______ , Raw is inversely related to the radius (r) of the airways

Answer 37

Poiseuille’s law

Question 38

The most important point of this formula is that a small decrease in airway radius (or diameter) leads to exponential increase in the _____

Answer 38

airway resistance

Question 39

_____ can be reduced by excessive contraction of the bronchial and bronchiolar muscles (bronchospasm), excessive secretions in the airways, swelling of the airway mucosa, airway tumors, collapse of the bronchioles, and other causes.

Answer 39

Airway radius

Question 40

By measuring ______ pulmonary function tests measure Raw, estimate the size of the airways, and indicate the presence of obstructive disease.

Answer 40

flow rates

Question 41

The primary problem in _______ is reduced lung compliance, thoracic compliance, or both.

Answer 41

restrictive lung disease

Question 42

______ is the volume of gas inspired per the amount of inspiratory effort;

Answer 42

Compliance

Question 43

____ is measured as the amount of pressure created in the lung or in the pleural space when the inspiratory muscles contract.

Answer 43

effort

Question 44

_______is calculated according to the following formula: C = ∆V / ∆P

Answer 44

Compliance

Question 45

Anatomy affected Obstructive Disease / Restrictive Disease

Answer 45

Obstructive Disease - Airways Restrictive Disease -Lung parenchyma, thoracic pump

Question 46

Breathing phase difficulty Obstructive Disease / Restrictive Disease

Answer 46

Obstructive Disease - Expiration Restrictive Disease - Inspiration

Question 47

Pathophysiology Obstructive Disease Restrictive Disease

Answer 47

Obstructive Disease -Increased airway resistance Restrictive Disease -Decreased lung or thoracic compliance

Question 48

Useful measurements Obstructive Disease Restrictive Disease

Answer 48

Obstructive Disease - Flow rates Restrictive Disease - Volumes or capacities

Question 49

If the pressure difference is constant, a reduced inspi- ratory volume indicates a reduction in ______.

Answer 49

compliance

Question 50

________ is usually the result of alveolar inflammation (pneumonia), swelling (pulmonary edema), or scarring (pulmonary fibrosis);

Answer 50

Reduced lung compliance

Question 51

a _____ may be the result of thoracic wall abnormalities, such as kyphoscoliosis, or exogenous pressure exerted on the thoracic cavity, such as asci- tes or pregnancy.

Answer 51

reduced thoracic compliance

Question 52

____ diseases also can result in reduced lung volumes and restrictive-type pulmonary impairments, mainly by affecting the function of the inspiratory muscles.

Answer 52

Neuromuscular

Question 53

lung compliance and thoracic compliance may be normal, but the patient is unable to generate enough ______ pressure to take a _____

Answer 53

sub-atmospheric / full, deep breath.

Question 54

Some _____ and some ______ also may affect the ability of the lung to diffuse gases.

Answer 54

obstructive diseases and restrictive diseases

Question 55

In some dis- eases, there is damage to the alveolar-capillary membrane, or less alveolar surface area is accessible for diffusion. Measuring the _______ can identify the destruction of alveolar tissue or the loss of functioning alveolar surface area.

Answer 55

diffusing capacity of the lung for carbon monoxide (DLCO)

Question 56

For each measurement of pulmonary function, there is a predicted ____ and _____

Answer 56

value and upper and lower limit of normal

Question 57

It is expected that most healthy individuals would fall between the values of ___ and ___

Answer 57

LLN and ULN

Question 58

The percent predicted value can be used to quantify ____

Answer 58

severity of impairment.

Question 59

______ is generally regarded as a very low- risk procedure. However, there is potential to transmit infective microorganisms to ____ and _____

Answer 59

Pulmonary function testing / patients and technologists

Question 60

Transmission can occur by ______

Answer 60

direct or indirect contact.

Question 61

Standard precautions should be applied because of the potential exposure to ______ which can harbor potentially hazardous microorganisms.

Answer 61

saliva, mucus, or blood,

Question 62

Patients with ____ or ______ pose the greatest potential hazard, and patients with ______ are at the greatest risk.

Answer 62

oral lesions or active respiratory infections / compromised immune systems

Question 63

Practitioners should wear ____ when handling potentially contaminated mouthpieces, valves, tubing, and equipment surfaces.

Answer 63

gloves

Question 64

When performing procedures on patients with potentially infectious airborne diseases, practitioners should wear a ____ or _____ , especially if the testing induces coughing.

Answer 64

personal respirator or a close-fitting surgical mask

Question 65

Practitioners should always ______ between testing patients and after contact with testing equipment.

Answer 65

wash their hands

Question 66

it is ____ to clean the interior surfaces of the testing instruments routinely between patients, the mouthpiece, nose clips, tubing, and any parts of the instrument that come into direct contact with a patient should be ______ between patients.

Answer 66

unnecessary / disposed, sterilized, or disinfected

Question 67

Any equipment surface showing visible condensation from exhaled air should be _____ before reuse.

Answer 67

discarded, disinfected, or sterilized

Question 68

When testing instruments are disassembled for cleaning and disinfecting, ______ should be considered and _____ may be necessary before testing resumes.

Answer 68

manufacturer recommendations / recalibration

Question 69

The routine use of ______, in-line barrier filters is controversial.

Answer 69

low-resistance

Question 70

____ may be appropriate when internal surfaces of manifolds and valves proximal to mouthpieces are inaccessible or difficult to disassemble for cleaning and disinfecting.

Answer 70

Filters

Question 71

____ provide visible evidence to reassure patients that their protection has been considered.

Answer 71

Filters

Question 72

_______ requires measurement of gas volume or flow, and various instruments and measurement principles are used to make these measurements.

Answer 72

Pulmonary function testing

Question 73

There are two general types of measuring instruments: _____

Answer 73

instruments that measure gas volume and instruments that measure gas flow.

Question 74

instruments that measure gas volume and instruments that measure gas flow. Both types of instruments simultaneously measure ____ , and both compute various ___ and ___ used in pulmonary function testing.

Answer 74

time / volumes and flow rates

Question 75

The term _____ is sometimes used as a generic term for all volume-measuring and flow-measuring devices.

Answer 75

spirometer

Question 76

Volume-measuring devices are specifically called______ and include water-sealed, bellows, and dry rolling seal types. These devices expand as they collect gas volumes.

Answer 76

spirometers

Question 77

The magnitude of the expansion is the ____ measured,

Answer 77

volume

Question 78

the speed of expansion represents the _____

Answer 78

flow rate

Question 79

Flow-measuring devices are commonly called _____ , although some practitioners reserve this term for only the device originally designed by Fleisch. These devices measure flow using a variety of unique principles.

Answer 79

pneumotachometers

Question 80

The Fleisch-type ______ measures the change in pressure as gas flows through it.

Answer 80

pneumotachometer

Question 81

Known as _____ , another type of flow-measuring device measures the tempera- ture change created by gas flowing through it.

Answer 81

thermistors or mass flowmeters

Question 82

There are also ____, which use rotation of a fan or blades similar to a windmill.

Answer 82

tubinometers

Question 83

The _____ of an instrument refers to the range or limits of how much it can measure.

Answer 83

capacity

Question 84

____refers to the accuracy of the instru- ment over its entire range of measurement, or its capacity.

Answer 84

Linearity

Question 85

For tests of pulmonary function, these general principles should be considered:

Answer 85

test sensitivity and specificity, validity, and reliability.

Question 86

_______ address the test’s ability to detect disease, or absence of it, respectively.

Answer 86

Sensitivity and specificity

Question 87

_____ of the test relates to its meaningfulness or the ability to measure what it is intended to measure.

Answer 87

Validity

Question 88

____ of the test is its consistency.

Answer 88

Reliability

Question 89

Never report test results that are ______

Answer 89

invalid or unreliable.

Question 90

______ —the measurement of air entering and leaving the lungs—includes measurement of several values of forced airflow and volume during inspiration and expiration.

Answer 90

Spirometry

Question 91

the purpose of _____ is to assess the ability of the lungs to move large volumes of air quickly through the airways to identify airway obstruction.

Answer 91

spirometry

Question 92

To a lesser extent, _____ can also identify and quantify a restrictive pattern of pulmonary disease.

Answer 92

spirometry

Question 93

_____ is an effort-dependent test that requires careful patient instruction, understanding, coordination, and cooperation.

Answer 93

Spirometry