PFT Final Exam Study Guide With Complete Solutions 2024, Exams of Nursing

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PFT Final Exam Study Guide With Complete Solutions 2024 List obstructive and restrictive pulmonary disorders - correct answers Obstructive: CF, bronchitis, asthma, bronchieactasis, emphysema, vocal cord dysfunction, tumors, obstructive sleep apnea Restrictive: ILDs, kyphoscoliosis, obesity, pleurisy, pleural effusions, pneumothorax Identify the disease processes with air trapping - correct answers COPD (emphysema, bronchieactisis), asthma, CF Identify the disease processes with diffusion defects - correct answers Pulmonary Fibrosis, emphysema Relate pulmonary history to indications for performing PFTs - correct answers History of cough, shortness of breath, wheezing, obesity, pulmonary disease, smoking Describe and list preliminary patient testing requirements - correct answers Hold bronchodilators 6 hours pre PFT, hold smoking for 24 hours before PFT, don't eat 6 hours before PFT Explain why various preliminary requirements are necessary - correct answers To get the best and most accurate results for the PFT, and so the patient doesn't throw up during the test Relate the proper testing sequence, protocols, and patient instructing techniques - correct answers Protocols: Tests have to be performed in a certain order, can't do a N2 washout right before a DLCO Instruction: tests are effort dependent, instruction and coaching is vital, proper feedback to patient is important, some patients can't do it (document this) Calculate percent of predicted and discuss the basis of predicted values - correct answers (Measured value / predicted normal) x 100 = % predicted Determine whether spirometry is acceptable and reproducible - correct answers VC acceptability: volumes should be 150 ml of each other, VC should be within 200 ml of FVC value FVC acceptability: two largest FVC values within 150 ml, two largest FEV1 values within 150ml, report the highest FEV1, even if from separate maneuvers Be able to identify normal and abnormal values of the DLCO and what disease processes may influence these values - correct answers The DLCO represents the amount of CO that travels across the AC membrane. Normal = around 25 CO/min/mmHg A decreased DLCO is often a restrictive disease like pulmonary fibrosis and pulmonary edema. Emphysema is the only obstructive disorder with reduced DLCO. Be able to describe testing methods to measure static lung volumes including gas dilution methods and body plethysmography - correct answers Nitrogen washout: N2 concentration in your lungs is about 75-85% and if you breathe in 100% O2 you will wash out all of the nitrogen in your lungs. Helium dilution: A known volume of helium is added to room air in a spirometer. The patient breathes through the system until the helium concentration falls to a steady level. Body Box: patient pants against a closed shutter in a closed body box. Change in mouth pressure and body box are measured, volume is estimated by measuring changes in the pressure of the body box. The breathing pattern results in loops and the computer then measures their slopes to calculate the VTG (thoracic gas volume). Be able to distinguish between the measurement of lung volumes using open-circuit and closed-circuit methods - correct answers A closed circuit method would require CO2 scrubber, but an open circuit method would not require this since the patient will not be rebreathing their own air. Be able to explain two advantages of measuring lung volumes using the body plethysmograph - correct answers Thoracic gas volume is not affected by the distribution of ventilation. Multiple measurements can be made quickly and averaged. It provides a more accurate estimate of lung volumes in patients who have airway obstruction. Raw and SGaw can be measured in the same testing session. Be able to calculate residual volume and total lung capacity from FRC and the subdivisions of VC - correct answers VC + RV = TLC ERV + RV = FRC IRV + Vt + ERV = VC Be able to identify restriction from measured lung volumes - correct answers FRC, TLC, and RV are decreased in a restriction. Measure and assess tidal volume and minute ventilation - correct answers Vt = the amount of gas inspired or expired during each respiratory cycle. -average: 400-700 mL -Reduced in severe restrictive processes Ve = The volume of gas expired per minute -Vt x RR = Ve -Normal is 5 to 10 L/min -VD + VA Identify at least 2 causes of decreased minute ventilation - correct answers Hypocapnia, metabolic alkalosis, respiratory center depression, neuromuscular disorders Calculate the VD/VT ratio - correct answers {(PaCO2 - PECO2) / PaCO2} x Vt List at least 2 causes of increased VD/VT ratio - correct answers A large VE could be a large increase in in VD. Pulmonary hypertension can cause a decrease in deadspace. Field walk tests: ISWT- incremental shuttle: speed increased until the patient stops or 20 minutes has passed. ESWT- endurance shuttle: ISWT done first to determine max speed, pt. walks a predetermined percentage of this speed for as long as possible, time and distance are recorded. 6 MWT- 6 minute walk test, self paced test, distance is the goal. Work: kpm= work of moving a 1 kg of pass a vertical distance of 1 meter against the force of gravity. Energy= VO2, metabolic equivalents or METs; 1 Met = 3.5 mL O2/min/kg Be able to interpret a basic CET - correct answers What is monitored? HR & rhythm, BP, CO2, SpO2, spirometry Max HR: 220-age, 85% of max HR = max effort Max ventilation: 35 x FEV1, MVV = maximal voluntary ventilation in L/min Ventilatory limited = exceeds a 10-15 L/min different in minute volume and max ventilation, Mve max is more than 70% of MVV Cardiac limited = HR increases past max, changes in EKG, CO goes down, SV goes down, BP goes down or extremely high (past 250 SBP), oxygen pulse does not increase to expected levels Be able to describe two methods of performing bronchial challenge tests - correct answers Methacholine challenge: causes smooth muscle contraction, can also be used with manitol (causes reaction in the histamine cycle), manitol test is positive with a 15% change in FEV1. 5-breath dosimeter: patient inhales slowly and deeply with a breath hold for 5 breaths, perform an FVC maneuver to obtain the FEV1 at 30 seconds and 90 seconds after breath 5, the cycle of administering the drug followed by testing continues until you have a 20% drop in FEV1. 2-minute tidal breathing: uses an SVN for particle size to reach the medium and small airways, patient uses a normal breathing pattern for 2 minutes, and then spirometry is repeated at 30 and 90 seconds at the ned of the test. Exhaled nitric oxide: asses airway inflammation, FENO reported in parts per billion; the patient exhales to RV, inspires to TLC, patient exhales slowly and evenly: more than 35 ppb (25 in children) in adults indicates eosinophilic inflammation of the airways Forced oscillation technique: measures respiratory impedance, apply oscillating gas to the respiratory system and measures the pressures generated, impedance is the force needed to overcome resistance and compliance Be able to list two indications for preoperative pulmonary function tests - correct answers Smoking history, symptoms of pulmonary disease, abnormal physical examination findings, abnormal chest x-ray, obesity, advanced age, current or recent respiratory infections, debilitated or malnourished Select test protocols for ABG sample collection, ABG analysis, and hemoximetry - correct answers ABG analysis: evaluate how well a patient oxygenates evaluate how well a patient oxygenates and ventilates from a gas exchange and ventilates from a gas exchange perspective Describe the different tests steps to completing the different field walking tests - correct answers ISWT: incremental shuttle: speed increased until the patient stops or 20 minutes has passed. ESWT: endurance shuttle: ISWT done first to determine max speed, pt. walks a predetermined percentage of this speed for as long as possible, time and distance are recorded. Be able to define FOT - correct answers Forced oscillation technique Recommend treatment based on FENO outcomes - correct answers More than 35 ppb in adults and more than 25 ppb in children is indicative of eosinophilic inflammation of the airways. This would need asthma treatments and allergy treatments. Could also need a biologic. -Problems with water seal are usually caused by leaks in the bell or in the breathing circuit. -Bell misposition- inadequate water in the device (evaporates) -Difficult to transport (weights) -Maintenance includes draining water routinely, checking for cracks or leaks, chemical absorbers need to be checked. Be able to list two principles used by flow-sensing spirometers to measure volume - correct answers Pilot tube flow sensor: The pressure of gas flowing against a small tube is related to the gas's density and velocity. Flow can be measured by placing a series of small tubes in a flow sensor and connecting them to a sensitive pressure transducer. Heated-wire flow sensors: Gas flow past the wire causes a temperature decrease so that more current must be supplied to maintain a preset temperature. The current needed to maintain the temperature is proportional to flow. Be able to select a directional breathing valve for a specific testing situation - correct answers DLCO = demand valve, gas sampling valve N2 washout = free breathing valve, demand valve He dilution = free breathing valve Be able to state how different types of gas analyzers are used in the pulmonary function laboratory. - correct answers Oxygen Polarographic electrodes A platinum cathode is used without a membrane Zirconium fuel cells When zirconium coated in platinum is heated to 700 to 800 degrees C acts as an electrode Infrared absorption (CO2 and CO) analyzers Based on absorption of infrared radiation Can measure small changes Emissions spectroscopy analyzers Giesler tube ionizer (N2 analyzer) Requires a vacuum pump A patient performs three FVC maneuvers using an analog spirometer. The technologist reports that all maneuvers had a back-extrapolated volume of less than 5% and 150 mL. The maneuvers met all other criteria for acceptability and repeatability. The technologist should: - correct answers a. Repeat all maneuvers b. Correct the FEV1 and all other flows by the amount of the back-extrapolated volume c. Perform at least one more maneuver d. Report the average of the three FVC values How long should the pulmonary function technologist wait after giving inhaled β-agonist before conducting post- bronchodilator testing? - correct answers a. 5 minutes b. 15 minutes c. 30 minutes d. 45 minutes A decrease in lung compliance is consistent with all of the following EXCEPT: - correct answers a. Fibrosis b. Pulmonary edema c. Pulmonary emboli d. Emphysema Which of the following assessments can be made when the FEF50% is decreased and the FIF50% is normal? - correct answers a. Variable extrathoracic obstruction is present b. Variable intrathoracic obstruction is present c. Fixed airway obstruction d. No obstruction, this is normal III.. Congestive heart failure IV. Anemia - correct answers a. I and II only b. III and IV only c. I, II, and III d. II, III, and IV In an emphysema patient the DLCO will be decreased due to all of the following, EXCEPT: - correct answers a. Decreased surface area b. Increased surface area c. Reduction in pulmonary capillary bed d. V/Q abnormalities All of the following factors will account for a decreased DLCO in the absence of pulmonary disease, EXCEPT: - correct answers a. Decreased hemoglobin b. Measurements made at sea level c. Increased carboxyhemoglobin d. Decreased capillary blood volume Why is carbon monoxide used to measure the diffusion capacity? - correct answers a. Physiologically normal b. Less expensive c. Compatible with helium d. Combines faster with Hb Why would the corrected DLCO be higher than the measured DLCO? - correct answers a. A high PaCO2 b. Correction for a low Hb c. A low COHB d. A low PaO2 A patient performs the 7 minute N2 washout procedure; after 5 minutes the % N2 displayed on the graph of the washout ids 0.5%. This is consistent with: - correct answers a. Moderate obstructive disease b. Mild restrictive disease c. Normal distribution d. Early small airway disease 1. The following volumes are reported for a patient. Which of the following capacities is erroneous? i. TLC 5.4 L RV 1.0 L ii. IRV 2.6 L VC 4.2 L iii. ERV 1.0 L VT 0.6 L iv. FRC 2.0 L IC 3.2 L - correct answers a. TLC b. VC c. FRC d. IC Which of the following methods would provide the most accurate determination of the volume of gas in the lungs at end-tidal expiration for a patient who has severe emphysema? - correct answers a. body-box b. helium dilution c. nitrogen washout d. single breath nitrogen elimination All of the following are techniques for determining FRC except: - correct answers a. Single-breath nitrogen washout b. Open-circuit multiple-breath nitrogen washout c. Closed-circuit multiple-breath helium dilution d. Body plethysmography The calculation of FRC with the body plethysmograph is based on: - correct answers a. Charles' law b. Poiseuille's law c. Boyle's law d. Dalton's law A patient with an FEV1 of 1.24 L and an FVC of 3.10 L performs the FRC test. The He concentration between 6 I. patietne's weight II. speed of walking surface III. slope of walking surface IV. belt length - correct answers a. I and II b. II and IV c. III and IV d. I, II, and III Which of the following would be a normal blood pressure response to exercise? - correct answers a. systolic increases little; diastolic increases 80 to 150 mm Hg above resting levels. b. diastolic increases little; systolic increases 80 to 150 mmHg above resting levels. c. systolic and diastolic both increase 80 to 150 mm Hg above resting levels d. systolic and diastolic both remain the same at resting levels with exercise. All of the following are indications for terminating an exercise stress test, EXCEPT: - correct answers a. a systolic blood pressure greater than 175 mm Hg b. diaphoresis and pallor c. nausea and vomiting d. a diastolic blood pressure greater then 130 mm Hg Mr. Smith is a 56 y/o male who complains of SOB on exertion. Please calculate his maximum heart rate and his target heart rate for an CET test. - correct answers Max: 164 bpm Target HR: 139 bpm (164 x 0.85) What is the normal breathing reserve? - correct answers 20-40% After inhalation of methacholine, a patient has spirometry and specific conductance measured. Which of the following changes are consistent with a positive methacholine challenge test? - correct answers a. FEV1 decreased 10%, sGaw increased 10% b. FEV1 decreased 15%, sGaw increased 35% c. FEV1 decreased 25%, sGaw decreased 50% d. FEV1 increased 5%, sGaw decreased 25% A patient's FEV1 is 3.10 liters before an exercise-induced asthma screening and 2.32 liters f minutes after the exercise period ends. The percent fall in FEV1 is: - correct answers a. 134% b. 75% c. 34% d. 25% Is the change in FEV1 results above a significant change? - correct answers a. Yes b. No Which of the following is measured when a bronchial provocation test is performed? - correct answers a. PD20 b. P100 c. RER d. Gaw A patient has the following results from a methacholine challenge test: Dose FEV1 Baseline 4.25 Diluent 3.80 Diluent 3.70 0.31 mg/ml 3.40 0.62 mg/ml 2.73 The percent change from diluent to 0.62 mg/ml is: - correct answers a. 26 b. 28 c. 32