Exercise Testing - Test Your Knowledge (Workbook)

Question 1

The amount of work being performed by the patient per minute during an exercise test is measured in

A. METs
B. watts
C. kilocalories
D. volts

Answer 1

B. watts

*page E-9

“amount of work per minute is normally measured in watts”

Question 2

A 55 year old male is scheduled for a steady state stress test. What is the estimated maximum heart rate for this man?

A. 120
B. 145
C. 165
D. 190

Answer 2

C. 165

Maximum heart rate is 220 - age.

Question 3

While conducting a multi-stage exercise stress test the patient’s heart rate does not increase and the test is stopped after 3 minutes because of marked dyspnea and fatigue. This response would be associated with all of the following conditions EXCEPT

A. ventilatory limit to exercise
B. pulmonary disability
C. chronic lung disease
D. coronary artery disease

Answer 3

D. coronary artery disease

*page E-35

Note: remember, on questions with an “EXCEPT”, if you have to guess, pick the answer that is most unlike the others

“ventilatory” limit to exercise
“pulmonary” disability
chronic “lung” disease

are all similar

coronary artery disease is the most dissimilar choice

Question 4

While performing a steady state exercise test the VO2 rate slows while the VCO2 continues to rise. This would indicate that the patient has

A. mild cardiac failure
B. increased deadspace
C. reached his anaerobic threshold
D. decreasing RQ

Answer 4

C. reached his anaerobic threshold

*page E-9

In the question, VO2 (oxygen consumption) slows while VCO2 rises. This is the the point in which anaerobic metabolism starts. The body can no longer supply enough oxygen to meet demand, but is still increasing in CO2 production due to workload.

Question 5

Stress testing with exhaled gas analysis can measure all of the following EXCEPT

A. RER
B. Vd/Vt
C. VO2
D. Ve.

Answer 5

B. Vd/Vt

*page E-11

Stress testing with exhaled gas analysis is “steady-state” testing.

It cannot measure deadspace to tidal volume ration (Vd/Vt)

Note: remember, RER is “respiratory exchange ratio”. *page E-23. It is a ratio of CO2 produced to O2 consumed

RER =

VCO2
_____
VO2

Looks similar to the respiratory quotient at rest (0.8) and gets closer to 1 when workload increases.

Question 6

Which of the following ECG changes would indicate the presence of myocardial ischemia during a stress test?

A. increased P-R interval
B. T wave depression
C. large Q waves
D. wide QRS complex

Answer 6

B. T wave depression

*page E-19

recall the definitions:
ischemia - reduced blood flow to tissue
injury - acute damage to tissue (often from ischemia)
infarction - necrosis or death of tissue (end result of ischemia and injury)

Ischemia is indicated by depressed or inverted T waves
Injury is indicated by elevated S-T segment
Infarction is indicated by “significant Q waves”

Question 7

While performing a treadmill test on a patient the technologist should instruct the patient to do all of the following EXCEPT

A. take long strides
B. lean forward against the hand rails
C. try not to talk too much
D. do not hold on tight to the edge of the rail

Answer 7

B. lean forward against the hand rails

*page E-7

treadmill instructions:
take long strides
do not lean on or hold tightly to the edge of the handrails
do not talk during the test

handrails should only be used for balance.

Question 8

During an incremental exercise test the patient reaches their anaerobic threshold. All of the following will increase EXCEPT

A. blood pH
B. VCO2
C. Ve
D. VO2

Answer 8

A. blood pH

*page E-20

All of the values listed will increase
VCO2 (CO2 production)
Ve (minute ventilation)
VO2 (O2 consumption)

blood pH may increase initially due to hyperventilation, but will fall when anaerobic threshold is reached.

Question 9

The following data is collected while a 55 year old man peforms a stress test:

Time 4 minutes
Work 50 watts
HR  98
RER  0.87
BP  178/95
Ve  42 L/min

The ECG monitor shows frequent PVC with S-T changes and the stress test is stopped.
which of the following is the most likely explanation for this?

A. normal response to heavy exercise
B. gas exchanges limit to exercise
C. ventilatory limit to exercise
D. cardiac limit to exercise

Answer 9

D. cardiac limit to exercise

*page E-20

ANY S-T SEGMENT CHANGE IS BAD. STOP THE TEST.

frequent PVC’s should also be a concern. 10 or more a minute may indicate ischemia. Stop the test if more than 10 a minute occur, or more than 1 per rhythm strip.

Question 10

The technologist performs an exercise stress test on a 30 year old patient. The technologist has increased the workload from 20 watts to 30 watts and then 40 watts resulting in steady increases in the patient’s minute volume and pulse. His PaCO2 and PaO2 remained constant as well as his RER. The patient tells the technologist that he wants to stop the test. The technologist should report that the test was ended because the patient

A. was malingering
B. had reached his anaerobic threshold
C. was unable to tolerate the increased workload
D. was hyperventilating

Answer 10

A. was malingering

“malingering” means to feign illness in order to escape duty or work.

< 50 watts is considered a low level of work. There is nothing unusual stated about the patient’s values or performance during the test, yet he wants to stop.

This indicates poor effort, and the patient is malingering.

Question 11

How would the technologist determine if a patient is achieving his maximum cardiac work?

A. heart rate of 210
B. Ve = 170 L/min
C. RER = 0.86
D. oxygen uptake was failing to rise with increasing workloads

Answer 11

D. oxygen uptake was failing to rise with increasing workloads

• page E-9
• by definition, this would indicate that the has reached his O2 max.

If you understand the process, this would also indicate that the patient is at or near his anaerobic threshold and his RER is going to move closer to 1. Both situations would indicate it is time to stop the test.

Question 12

In a steady state exercise test, the patient has reached his anaerobic threshold when the

A. measured heart rate is 80% of maximum heart rate
B. minute ventilation is double the resting minute ventilation
C. pH is acidotic and the PaCO2 is below 35 torr
D. pH is acidotic and the PaCO2 is above 45 torr

Answer 12

C. pH is acidotic and the PaCo2 is below 35 torr

*no supporting information found in the study guide or audio.

Disregard this question other than for memory recall.

Question 13

During an exercise evaluation, a patient develops premature ventricular contractions at a frequency of 12 per minute and significant S-T segment depression. Which of the following contitions would be most likely to cause these changes?

A. ischemic heart disease
B. deconditioning
C. acute hypertension
D. this ia a normal finding during exercise

Answer 13

A. ischemic heart disease

*page E-20

more than 10 PVC’s per minute is associated with cardiac ischemia.

*page E-19

Note: T wave depression indicates ischemia

remember to stop the test if any S-T changes are noted.

Question 14

A patient’s SVR (systemic vascular resistance) value has been steadily increasing over the last several hours. The most likely explanation for the change in this value is

A. hypoxemia
B. vasoconstricting agents
C. COPD
D. diuretic therapy

Answer 14

B. vasoconstricting agents

*page E-34

“SVR is increased with systemic hypertension and/or vasoconstriction (especially from alpha type drugs)

Note: normal SVR is 1600 dynes

Question 15

A normal Ve/VCO2 is

A. 30 L/L CO2
B. 40 L/L CO2
C. 50 L/L CO2
D. 60 L/L CO2

Answer 15

A. 30 L/L CO2

*page E-25

Normal Ve/VCO2 “Ventilatory Equivalent for CO2” is 25-35

Associate this with normal “Ventilatory Equivalent for O2” which is a little lower at 20-30.

Question 16

A patient’s expected maximum minute ventilation during exercise can be estimated by

A. Vt x 100
B. MVV x 2
C. FEV1 x 35
D. FVC x 5

Answer 16

C. FEV1 x 35

*page E-21

maximum minute ventilation is synonymous with maximum voluntary ventilation “MVV”

MVV = FEV1 x 35

Question 17

Which of the following is a contraindication for exercise stress testing?

A. age over 60 years
B. smoking history of more than 40 pack/years
C. obesity
D. PaO2 < 40 torr on room air

Answer 17

D. PaO2 of < 40 on room air

*page E-5

“PaO2 < 45 torr on room air” is a contraindication

Other noteworthy contraindications
PaCO2 > 70
FEV1 < 30% of predicted
MI
Unstable angina
2nd or 3rd degree heart block
CHF
Severe aortic stenosis
etc...

Question 18

Which of the following will vary the workload during an incremental stress test using a treadmill?

1. resistance adjustment
2. incline angle
3. belt speed
4. percent grade

A. 1 only
B. 2 and 3
C. 1, 2, and 3 only
D. 2, 3, and 4 only

Answer 18

D. 2, 3, and 4 only

*page E-7 and E-8

“vary workload by adjusting the speed and grade of the treadmill.”

“workloads are varied by: increasing the percent of the grade (amount of incline)”

percent grade and incline mean the same thing.

Question 19

The expired volume during a six minute incremental stress test is 300 liters. What should the technologist report ast the VE if the testing temperature is 22C and the conversion factor is 1.091?

A. 45 L/min
B. 50 L/min
C. 55 L/min
D. 60 L/min

Answer 19

C. 55 L/min

If you want to do the math, you multiply your measured result by the conversion factor.

300 L in 6 minutes is 50 L/min (your Ve)

Ve x conversion factor = result

50 x 1.091 = 54.55

Or you just remember that your measured value always has to be adjusted for BTPS so you pick the next highest answer. Your Ve was 50, next answer up is 55.

Question 20

During a six-minute walking test, the patient complains of angina and the pulse oximeter displays a SpO2 of 75%. The technologist should have the patient

A. continue the test
B. terminate the test
C. walk at a slower pace
D. use oxygen at 2 L/min

Answer 20

B. terminate the test

*page E-25

You should terminate an exercise test if SpO2 falls to 85% or less.

Other specific reasons to terminate a test are found on page E-35.