Exercise Testing - (Module) Flashcards
Indications for exercise testing include all of the following EXCEPT
A. determine ventilatory limitations to work.
B. determine maximum workloads for exercise.
C. chief complaint of dyspnea on exertion.
D. evaluate response to bronchodilators.
D. evaluate response to bronchodilators
*page E-5
There are 5 listed indications:
MOST IMPORTANT INDICATION:
chief complaint of dyspnea on exertion.
Other Indications:
determine ventilatory limitations to work
determine cardiac limitations to work
determine maximum workloads for developing an exercise plan or adjusting daily activities
for disability purposes
While reviewing the medical record of a 55-year-old patient referred for exercise testing, the pulmonary function technologist notes that the patient has a history of unstable angina, congestive heart failure, and severe aortic stenosis. The technologist should
A. start the test according to protocol.
B. contact the referring physician.
C. administer sublingual nitroglycerin prior to the test.
D. perform a 12-lead electrocardiogram.
B. contact the referring physician
Remember, don’t test a significantly compromised patient!
- audio lecture 00:02:00 in exercise testing
- page E-5
unstable angina, congestive heart failure, and severe aortic stenosis are all contraindications to exercise testing
When a treadmill is used for exercise testing, the workload can be varied by adjusting the
1. resistance. 2. speed. 3. grade.
A. 2 only
B. 1 only
C. 2 and 3 only
D. 1, 2, and 3
C. 2 and 3 only
*page E-7
You can adjust speed and grade (incline) to vary workload on a treadmill.
You cannot adjust resistance on a treadmill.
What is the maximum heart rate for a 60-year-old patient?
A. 160/min
B. 170/min
C. 180/min
D. 190/min
A 160/min
*page E-10
Maximum heart rate = 220 - age
This patient is 60
220 - 60 = 160
Note: stress testing will usually take a patient to 50%-75% of their maximum heart rate
Prior to exercise testing utilizing a treadmill, the pulmonary function technologist verifies the slope of the treadmill. Placing a 40-inch ruler on the treadmill belt, the technologist notes that the upper end of the ruler is 2 inches higher than the lower end. If the treadmill is calibrated correctly, the slope displayed on the control panel should read
A.5%.
B.10%.
C.15%.
D.20%.
A. 5%
The slope is 5% because 2 inches of 40 total inches is 5%.
If the higher end of the ruler was 4 inches higher than the low end, the slope would be 10%, because 4 inches of 40 total inches is 10%.
When a patient reaches their anaerobic threshold during exercise,
A.lactic acid production decreases.
B.pH increases.
C.heart rate remains stable.
D.ventilatory equivalent for oxygen remains stable.
C. heart rate remains stable
*page E-9
Lactic acid production will increase
pH decreases (more acidotic)
Ventilatory equivalent for oxygen (Ve/VO2) will increase. Ve will go up but oxygen consumption will not. This is what triggers anaerobic metabolism. This is why CO2 production will eventually become 1:1 with oxygen consumption (which is once instance in which you’d stop the test for the patient)
All of the choices were the opposite of the truth except C. heart rate will remain stable
When the Bruce Protocol is implemented for stress testing, the pulmonary function technologist increases the patient’s workload every
A. 2 minutes.
B. 3 minutes.
C. 4 minutes.
D. 5 minutes.
B. 3 minutes
*page E-12
The Bruce Protocol is the most popular protocol in stress testing. Workload is increased every 3 minutes.
The following ECG tracing was obtained prior to exercise testing of a 50-year-old woman:
See saved image “Exercise Testing - Question 8”
The pulmonary function technologist should report this as
A. normal sinus rhythm.
B. sinus bradycardia.
C. sinus arrhythmia.
D. sinus tachycardia.
B. sinus bradycardia
*page E-15
is there a p wave? yes
is it positive? yes
is it regular? yes
how fast? > 5 big boxes (indicates bradycardia)
A normal heart rate will have R waves between 3-5 large boxes
Note: you treat bradycardia with O2 and atropine.
Which of the following are considered normal responses to stress testing?
- Heart rate increases
- Tidal volume decreases
- Deadspace increases
- Oxygen consumption increases
A. 2 and 3 only
B. 1 and 2 only
C. 1 and 4 only
D. 2, 3, and 4 only
C. 1 and 4 only
*page E-20, read this section.
Deadspace will decrease with stress testing. (important)
Tidal volume will increase
Several notes…
PVC’s are common, but stop the test if there are more than 2 seen on your rhythm strip on the exam, or if there are more than 10 in a minute.
Systolic BP can double, but diastolic BP should not increase into the 100’s.
Pulmonary artery pressure should stay the same.
Prior to exercise testing, spirometry reveals an FEV1 of 4 L in a 58-year-old patient. This patient’s maximum voluntary ventilation should be estimated as
A. 40 L/min.
B. 80 L/min.
C. 140 L/min.
D. 190 L/min.
C. 140 L/min
Remember, MVV can be calculate by multiplying FEV1 by 35.
The following data is recorded for a 44-year-old woman referred for exercise testing:
Height 163 cm (5’4”)
Weight 54 kg (120 lb)
Respiratory Frequency 20/min
Tidal Volume 0.3 L
ABG on Room Air: pH 7.38, PaCO2 43 torr, PaO2 90 torr, HCO3- 24 mEq/L, SaO2 (calc) 99%
What should the pulmonary function technologist report as this patient’s V̇E Alveolar?
A. 2,400 mL
B. 3,600 mL
C. 4,800 mL
D. 6,000 mL
B. 3600 ml
Listen to the audio. To calculate alveolar ventilation, you need to know deadspace, and remove deadspace from Ve.
Calculate Ve. In this case RR of 20 x Vt of 300. That’s 6000 ml.
Calculate deadspace. In this case her weight is 120 lbs. Deadspace is typically 1 ml per pound. That’s 120 ml per breath. RR of 20 x 120 is 2400.
6000 - 2400 = 3600.
The following data is obtained from a 33-year-old patient:
CVP 4 mm Hg PAP 24/8 mm Hg PCWP 8 mm Hg QT 4.5 L/min Blood Pressure 130/100 mm Hg
What is this patient’s mean systemic arterial pressure?
A. 110 mm Hg
B. 115 mm Hg
C. 120 mm Hg
D. 125 mm Hg
A. 110 mm Hg
To find mean arterial pressure (MAP)
(Diastolic x 2) + Systolic
__________________
3
(100 x 2) + 130 = 330
330 / 3 = 110
While drawing blood from a pulmonary artery catheter, the pulmonary function technologist observes bright red blood in the sample syringe. The technologist should
A. flush the catheter with sterile saline.
B. add sodium heparin to the sample.
C. place the sample on ice and send to the laboratory.
D. deflate the balloon and obtain another sample.
D. deflate the balloon and obtain another sample
*page E-31
Bright red blood is the clue. If you withdraw blood from a PA catheter with the balloon up, you are creating suction pulling oxygenated blood backwards through the capillaries and into the catheter.
The balloon should be down so you can pull blood directly from the pulmonary artery, before it has been oxygenated in the capillaries.
While evaluating hemodynamic data for a 61 year-old man with a pulmonary artery catheter in place, the pulmonary function technologist notes that the patient’s cardiac index has been steadily decreasing over the last two hours. The technologist should conclude that
A. body surface area is decreasing.
B. stroke volume is increasing.
C. cardiac output is decreasing.
D. pulmonary artery pressure is increasing.
C. cardiac output is decreasing
*page E-32
Remember from the audio lecture (approximately 01:38:00) that cardiac output and cardiac index are essentially the same, but CI accounts for body surface area.
CI is usually about half of Qt.
If cardiac index is decreasing, cardiac output is decreasing.
While performing a Six-Minute Walking Test for a 70-year-old man with COPD, the pulmonary function technologist records the following data while the patient breathes oxygen by nasal cannula at 2 L/min:
Elapsed Time Heart Rate SpO2 Borg Scale Baseline 80 /min 93% 2 1 minute 88 /min 91% 2 2 minutes 90 /min 91% 3 3 minutes 95 /min 89% 3 4 minutes 95 /min 89% 3
The technologist should
A. terminate the test.
B. continue for two more minutes.
C. increase the oxygen flow to 4 L/min.
D. instruct the patient to walk slower.
B. continue for two more minutes
*page E-38
The test should only stop early if there is significant chest pain (angina), mental confusion, or SpO2 <85%.
Remember the regular Borg scale goes up to 20. A score of 2-3 is very low.
