Kacmarek: Egan's Fundamentals of Respiratory Care, 10th Edition

Chapter 11: Gas Exchange and Transport

Test Bank

MULTIPLE CHOICE

1. On what does the movement of gases between the lungs and the body tissues mainly depend?
a. active transport
b. gaseous diffusion
c. membrane dialysis
d. membrane transport

ANS: B
Gas movement between the lungs and tissues occurs by simple diffusion.

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2. The lowest PO2 would normally be found in what location?

a. arterial blood
b. atmospheric air
c. cells
d. venous blood

ANS: C
The intracellular PO2 (approximately 5 mm Hg) provides the final gradient for oxygen
diffusion into the cell.

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3. The highest PCO2 levels are found in what location?

a. arterial blood
b. atmospheric air
c. cells
d. venous blood

ANS: C
The partial pressure of carbon dioxide (PCO2) is highest in the cells (approximately 60 mm
Hg).

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4. Which of the following are true regarding the PACO2?

1. directly proportional to whole-body carbon dioxide production
2. inversely proportional to alveolar ventilation ( A)

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 Test bank 11-2

3. normally maintained at about 35 to 45 mm Hg

a. 2 and 3
b. 1, 2, and 3
c. 1 and 2
d. 1 and 3

ANS: B
PACO2 varies directly with the body’s production of carbon dioxide (CO2) and inversely with
alveolar ventilation ( A). Under normal conditions it is maintained at about 35 to 45 mm Hg.

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5. What is the approximate normal level of carbon dioxide production (CO2) for an adult?
a. 200 ml/min
b. 250 ml/min
c. 4200 ml/min
d. 6000 ml/min

ANS: A
In a healthy individual the normal CO2 of is about 200 ml/min.

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6. Under what conditions will the alveolar PACO2 rise above normal?
a. if both metabolic rate and ventilation increase (e.g., through exercise)
b. if carbon dioxide production decreases relative to A
c. if A decreases relative to carbon dioxide production
d. when the patient is febrile

ANS: C
The PACO2 will increase above this level if carbon dioxide production increases while
alveolar ventilation remains constant or when alveolar ventilation decreases while CO2
remains constant.

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7. A 70-kg male patient has a CO2 of 200 ml/min and a A of 9 L/min. From this information,
what can you infer?
a. The patient’s carbon dioxide production is abnormally low.
b. The patient’s A is abnormally low.
c. The patient will have a lower than normal PACO2.
d. The patient will have a higher than normal PACO2.

ANS: C
When the CO2 is normal while the A is elevated, the PACO2 must be lower then normal.
Likewise, the PACO2 will fall if carbon dioxide production decreases or alveolar ventilation
increases.

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8. What is the primary determinant of the PAO2?

a. body’s CO2
b. metabolic rate of the body tissues
c. PaO2
d. PO2 in the inspired gas

ANS: D
Many factors determine the alveolar partial pressure of oxygen (PAO2). Most important is the
inspired partial pressure of oxygen, or PIO2.

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9. The PAO2 depends on which of the following factors?

1. ambient (atmospheric) pressure
2. fractional concentration of inspired oxygen
3. level of A
4. types of fuels burned (fat, protein, carbohydrate)
a. 1, 2, and 3
b. 1 and 2
c. 3 only
d. 1, 2, 3, and 4

ANS: D
PAO2 = FIO2 × (PB – 47) – PACO2 ÷ 0.8
where FIO2 is fraction of inspired oxygen, PB is barometric pressure, 47 is water vapor
tension (in mm Hg) at 37° C, PACO2 is alveolar PCO2, and 0.8 is normal respiratory exchange
ratio (R). As the A is the primary determinant of PACO2 any changes in A will affect the
PAO2. Likewise the fuel source will determine the RQ which is normally 0.8.

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10. Calculate the approximate PAO2 given the following conditions (assume R = 0.8): FIO2 = .40,
PB = 770 mm Hg, PACO2 = 31 mm Hg
a. 100 mm Hg
b. 135 mm Hg
c. 250 mm Hg
d. 723 mm Hg

ANS: C
PAO2 = FIO2 × (PB – 47) – PACO2 ÷ 0.8
where FIO2 is fraction of inspired oxygen, PB is barometric pressure, 47 is water vapor
tension (in mm Hg) at 37° C, PACO2 is alveolar PCO2, and 0.8 is normal respiratory exchange
ratio (R).
PAO2 = 0.4(770 – 47) – (31/0.8)

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 Test bank 11-4

PAO2 = 250.45 mm Hg

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11. A normal person breathing 100% oxygen at sea level would have PAO2 of about what level?
a. 149 mm Hg
b. 670 mm Hg
c. 713 mm Hg
d. 760 mm Hg

ANS: B
If the FIO2 is 1.0, the PB is 760 mm Hg, and the PACO2 is 40 mm Hg, the alveolar partial
pressure of oxygen can be estimated as follows:
PAO2 = 1 × (760 mm Hg – 47 ) – (40 mm Hg ÷ 0.8) = 663 mm Hg

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12. Which of the following best represents the partial pressures of all gases in the normally
ventilated and perfused alveolus when breathing room air at sea level?
a. PO2 = 40 mm Hg; PCO2 = 100 mm Hg; PN2 = 573 mm Hg; PH2O = 47 mm Hg
b. PO2 = 100 mm Hg; PCO2 = 40 mm Hg; PN2 = 573 mm Hg; PH2O = 47 mm Hg
c. PO2 = 100 mm Hg; PCO2 = 40 mm Hg; PN2 = 713 mm Hg; PH2O = 47 mm Hg
d. PO2 = 149 mm Hg; PCO2 = 40 mm Hg; PN2 = 573 mm Hg; PH2O = 47 mm Hg

ANS: B
Nitrogen is inert and plays no role in gas exchange. However, nitrogen does occupy space and
exert pressure. According to Dalton’s law, the partial pressure of alveolar nitrogen must equal
the pressure it would exert if it alone were present. Thus, to compute the partial pressure of
alveolar nitrogen, subtract the pressures exerted by all the other alveolar gases, as follows:
PAN2 = PB – (PAO2 + PACO2 + PH2O)
PAN2 = 760 mm Hg – (100 mm Hg + 40 mm Hg + 47 mm Hg)
PAN2 = 760 mm Hg – 187 mm Hg
PAN2 = 573 mm Hg

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13. In a person breathing room air (and with all else being normal), if the alveolar PCO2 rises
from 40 to 70 mm Hg, what would you expect?
a. PAO2 to fall by about 30 mm Hg
b. PAO2 to fall by about 40 mm Hg
c. PAO2 to rise by about 30 mm Hg
d. PAO2 to rise by about 40 mm Hg

ANS: A
Based on the alveolar air equation, if the FIO2 remains constant, then the PAO2 must vary
inversely with the PACO2.

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14. Assuming a constant FIO2 and carbon dioxide production, which of the following statements
are correct?
a. An increased PACO2 will result in and increased PAO2.
b. Increased FIO2 blows off carbon dioxide.
c. Increases in A decrease the PACO2 and increase the PAO2.
d. The PAO2 varies proportionally with the PACO2.

ANS: C
With a constant carbon dioxide production, a decrease in A simultaneously raises the PACO2
and lowers the PAO2.

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15. What is the highest PAO2 one could expect to observe in an individual breathing room air at
sea level?
a. 90 to 100 mm Hg
b. 110 to 120 mm Hg
c. 640 to 670 mm Hg
d. 710 to 760 mm Hg

ANS: B
Neural control mechanisms and the increased of work breathing prevent decreases in PACO2
much below 15 to 20 mm Hg. Thus, whenever a patient is breathing room air at sea level, the
respiratory therapist should not expect to see a PaO2 any higher than 120 mm Hg during
hyperventilation.

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16. Which of the following conditions must exist for gas to move between the alveolus and
pulmonary capillary?
a. adequate alveolar ventilation (VA)
b. difference in partial pressures (pressure gradient)
c. normal central nervous system (CNS) control mechanism
d. sufficient amount of blood hemoglobin (Hb)

ANS: B
Diffusion is the process whereby gas molecules move from an area of high partial pressure to
an area of low partial pressure.

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17. Which of the following “layers” must be traversed by gases moving across the alveolar-
capillary membrane?
1. alveolar epithelial membrane
2. capillary endothelial membrane

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3. interstitial space
4. transbronchial radial tethering mechanisms
a. 1, 2, and 3
b. 1, 2, and 4
c. 2 and 3
d. 1, 2, 3, and 4

ANS: A
For carbon dioxide or oxygen to move between the alveoli and the pulmonary capillary blood,
the following three barriers must be penetrated: (1) alveolar epithelium, (2) interstitial space,
and (3) capillary endothelium.

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18. When is the rate of gaseous diffusion across a biological membrane decreased?
a. The diffusion distance is small.
b. The gas diffusion constant increases.
c. The partial pressure gradient is low.
d. The surface area is large.

ANS: C
Given that the area of and distance across the alveolar-capillary membrane are relatively
constant in healthy people, diffusion in the normal lung mainly depends on gas pressure
gradients.

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19. Which of the following values corresponds most closely to the normal PO2 and PCO2 in the
mixed venous blood returning to the lungs from the right side of the heart?
a. PO2 = 40 mm Hg; PCO2 = 46 mm Hg
b. PO2 = 40 mm Hg; PCO2 = 100 mm Hg
c. PO2 = 100 mm Hg; PCO2 = 40 mm Hg
d. PO2 = 100 mm Hg; PCO2 = 46 mm Hg

ANS: A
Venous blood returning to the lungs has a lower PO2 (40 mm Hg) than alveolar gas. Thus the
pressure gradient for oxygen diffusion into the blood is approximately 60 mm Hg (100 mm
Hg – 40 mm Hg). Therefore, as blood flows past the alveolus, it takes up oxygen, leaving the
capillary with a PO2 close to 100 mm Hg. Because venous blood has a higher PCO2 than
alveolar gas (46 mm Hg versus 40 mm Hg), the pressure gradient for carbon dioxide causes
diffusion of carbon dioxide in the opposite direction, from the blood into the alveolus.

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20. Which of the following gases would diffuse fastest across the alveolar-capillary membrane?
a. air
b. carbon dioxide

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c. oxygen
d. nitrogen

ANS: B
Carbon dioxide diffuses approximately 20 times faster across the alveolar-capillary membrane
than does oxygen, because of its much higher solubility in plasma.

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21. Carbon dioxide diffuses across the alveolar-capillary membrane about how many times faster
than oxygen?
a. 10
b. 20
c. 30
d. 40

ANS: B
Carbon dioxide diffuses approximately 20 times faster across the alveolar-capillary membrane
than does oxygen, because of its much higher solubility in plasma.

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22. The time available for diffusion in the lung is mainly a function of which of the following?
a. functional residual capacity (FRC)
b. inspired oxygen concentration
c. level of VA
d. rate of pulmonary blood flow

ANS: D
The diffusion time in the lung depends on the rate of pulmonary blood flow.

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23. What is the minimum amount of time that blood must take for pulmonary capillary transit for
equilibration of oxygen to occur across the alveolar-capillary membrane?
a. 0.15 second
b. 0.25 second
c. 0.35 second
d. 0.45 second

ANS: B
If blood flow increases, such as during heavy exercise, capillary transit time can decrease to as
low as 0.25 seconds. Even this short time frame is adequate to ensure that equilibration takes
place, as long as no other factors impair diffusion. However, in the presence of a diffusion
limitation, rapid blood flow through the pulmonary circulation can result in inadequate
oxygenation.

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DIF: Recall REF: p. 252 OBJ: 1

24. What is the primary factor that maintains the pressure gradient that drives oxygen from the
capillaries into the interstitial spaces and into the cells?
a. Bohr effect on the RBC
b. cellular consumption of oxygen
c. Haldane effect on the RBC
d. increased carbon dioxide in blood decreasing Hb affinity for oxygen

ANS: B
As cellular metabolism depletes its oxygen, the intracellular PO2 drops below that of the blood
entering the tissue capillary. This provides the diffusion gradient by which oxygen diffuses
from the tissue capillary blood (PO2 = 100 mm Hg) to the cells (PO2 less than 40 mm Hg).

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25. In order to assess the events occurring at the tissue level, especially tissue oxygenation, what
parameter would you sample and measure?
a. coronary sinus blood
b. left-sided heart blood
c. systemic arterial blood
d. systemic mixed venous blood

ANS: D
To assess tissue gas exchange, the respiratory therapist must consider mixed venous blood
parameters. The use of mixed venous blood to assess tissue oxygenation also is discussed in
Chapter 43.

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26. What is the normal range of PAO2 – PaO2 for healthy young adults breathing room air?
a. 5 to 10 mm Hg
b. 10 to 20 mm Hg
c. 20 to 30 mm Hg
d. 50 to 60 mm Hg

ANS: A
Rather than equaling the alveolar PO2, the PaO2 of healthy individuals breathing air at sea
level is always approximately 5 to 10 mm Hg less than the calculated PAO2.

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27. Breathing room air, a normal PAO2  PaO2 of 5 to 10 mm Hg exists due to which of the
following?
1. anatomical shunts in the pulmonary and cardiac circulations
2. normal limitations to oxygen diffusion in the lung
3. regional differences in pulmonary ventilation and blood flow

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 Test bank 11-9

a. 1 and 3
b. 2 and 4
c. 1, 2, and 3
d. 1 and 2

ANS: A
Two factors account for the normal PAO2  PaO2: (1) right-to-left shunts in the pulmonary
and cardiac circulation and (2) regional differences in pulmonary ventilation and blood flow.

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28. Which of the following would you expect to occur if ventilation to an area of the lung
remained constant but perfusion to this same area decreased?
1. The PACO2 should fall.
2. The PAO2 should fall.
3. The / ratio should rise.
a. 3 only
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3

ANS: C
A decrease in pulmonary capillary blood flow will cause a fall in alveolar PCO2 and a rise in
alveolar PO2) assuming minute ventilation remains the same. The will result in an area of high
/ .

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29. Which of the following would you expect to occur if perfusion to an area of the lung remained
constant, but VA to this same area decreased?
a. The PACO2 should fall.
b. The HCO3 will fall.
c. The PAO2 should fall.
d. The ventilation/perfusion ratio ( / ) should rise.

ANS: C
A low / indicates that ventilation is less than normal, perfusion is greater than normal, or
both. In areas with a low / , the alveolar PO2 is lower and the PCO2 is higher than normal.

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30. An area of the lung has no blood flow but is normally ventilated. Which of the following
statements are true about this area?
1. The alveolar gas is like air (PO2 = 150; PCO2 = 0).
2. The area represents alveolar dead space.
3. The / is elevated.

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 Test bank 11-10

a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

ANS: D
At the extreme right of the graph, perfusion is 0 ( / = 0). Areas with ventilation but no
blood flow represent alveolar dead space, as defined in Chapter 10. The makeup of gases in
these areas is similar to that of inspired air (PO2 = 150 mm Hg; PCO2 = 0 mm Hg).

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31. An area of the lung has no ventilation but is normally perfused by the pulmonary circulation.
Which of the following statements are correct?
1. Blood exiting the pulmonary capillary will have a PO2 = 40 and a PCO2 = 46.
2. The area represents an alveolar shunt.
3. The / is 0.
a. 2 and 3
b. 1 and 3
c. 2 only
d. 1, 2, and 3

ANS: D
With no ventilation to remove carbon dioxide and restore fresh oxygen, the makeup of gases
in these areas is like that of mixed venous blood (P O2 = 40 mm Hg; P CO2 = 46 mm Hg).
The / is zero. Venous blood entering areas with / ratios of 0 cannot pick up oxygen or
unload carbon dioxide and leave the lungs unchanged. For such areas to be distinguished from
true anatomical shunts, exchange units with / values of 0 are called alveolar shunts.
Although small anatomical shunts are normal, alveolar shunts are not.

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32. Regarding pulmonary blood flow in the upright lung, which of the following statements is
true?
a. The apexes receive about 20 times more blood flow than the bases.
b. The bases receive about 20 times more blood flow than the apexes.
c. The greatest blood flow is found at the apexes of the lungs.
d. The pulmonary circulation is a high-pressure system.

ANS: B
Farther down the lung, perfusion increases linearly in proportion to the hydrostatic pressure so
the lung bases receive nearly 20 times as much blood flow as do the apexes.

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33. During normal inspiration, which of the following occurs?

a. Alveoli at the apexes expand less than those at the bases.

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 Test bank 11-11

b. Alveoli at the apexes expand more than those at the bases.

c. Alveoli at the bases and apexes expand almost equally.
d. Alveoli at the bases expand less than those at the apexes.

ANS: A
Like perfusion, ventilation also is increased in the lung bases, with approximately four times
as much ventilation going to the bases than to the apexes of the upright lung.

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34. What occurs in the bases of the upright lung?

a. The PAO2 is higher than normal.
b. The respiratory exchange ratio is elevated.
c. There is significant dead space under normal conditions.
d. The / is lower than the average.

ANS: D
At the bottom of the lung, blood flow is greater than ventilation, resulting in a low /
(approximately 0.66), low PO2 (89 mm Hg), and slightly higher PCO2 (42 mm Hg).

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35. Even in healthy young subjects, regional differences in pulmonary ventilation and blood flow
result in the PaO2 being lower than the PAO2. Why is this so?
a. Most blood flows through the apexes of the lung.
b. Most blood flows through areas with high / .
c. Most blood flows through the bases of the lung.
d. Most ventilation goes to the apexes of the lung.

ANS: C
As shown in Table 11-1, because of gravity most blood flows to the lung bases, where the PO2
is lower and the PCO2 is higher than normal. After leaving the lung, this relatively large
volume of blood combines with the smaller volume coming from the middle and apical
regions. The result is a mixture of blood with less oxygen and more carbon dioxide than
would come from an ideal gas exchange unit.

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36. How is the vast majority of oxygen carried in the blood?

a. as bicarbonate ion (HCO3)
b. as carbamino compounds
c. chemically combined with Hb
d. in physical solution

ANS: C
The majority of oxygen is carried in a reversible chemical combination with hemoglobin
inside the RBC.

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DIF: Recall REF: p. 255 OBJ: 6

37. As the amount of oxygen that dissolves in the plasma increases, what is it directly
proportional to?
a. its partial pressure
b. its solubility coefficient
c. minute ventilation
d. temperature

ANS: A
The relationship between partial pressure and dissolved oxygen is direct and linear. By
applying Henry’s law, the amount of dissolved oxygen in the blood (at 37° C) can be
computed with the following simple formula:
Dissolved oxygen (ml/dl) = PO2 × 0.003.

DIF: Application REF: p. 255 OBJ: 6

38. At body temperature, how much oxygen will physically dissolve in plasma at a PO2 of 40 mm
Hg?
a. 0.12 ml/dl
b. 0.20 ml/dl
c. 0.30 ml/dl
d. 1.34 g/dl

ANS: A
By applying Henry’s law, the amount of dissolved oxygen in the blood (at 37° C) can be
computed with the following simple formula:
Dissolved oxygen (ml/dk) = PO2 × 0.003

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39. Under normal physiologic circumstances, how many milliliters of oxygen are capable of
combining with 1 g of Hb?
a. 0.003 ml
b. 0.450 ml
c. 0.820 ml
d. 1.340 ml

ANS: D
In whole blood, each gram of hemoglobin can carry approximately 1.34 ml of oxygen.

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40. If the total hemoglobin content (Hb + HbO2) of a sample of blood is 20 g/dl and the
oxyhemoglobin (HbO2) content is 15 g/dl, what is the HbO2 saturation?
a. 17%

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 Test bank 11-13

b. 50%
c. 75%
d. 83%

ANS: C
If there were a total of 20 g/dl Hb in the blood, of which 15 g was HbO2, the SaO2 would be
calculated as follows:
SaO2 (%) = [15 ÷ 20] × 100 = 75%

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41. At a PaO2 of 65 mm Hg, what is the approximate saturation of Hb with oxygen?

a. 73%
b. 80%
c. 90%
d. 97%

ANS: C
If some abnormality reduced the PaO2 to 65 mm Hg, the SaO2 would still be approximately
90%.

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42. Why is it necessary to keep the patient’s PaO2 greater than 60 mm Hg?
a. A level of 60 mm Hg marks the beginning of the steep part of O2Hb dissociation
curve.
b. Below the 60 mm Hg level, tissue hypoxia is ensured.
c. Oxygen deprivation will cause severe cerebral vasoconstriction below 60 mm Hg.
d. The PaCO2 will start to rise precipitously if the PaO2 falls further.

ANS: A
With a PO2 lower than 60 mm Hg, the curve steepens dramatically. Here, in the normal
operating range of the tissues, even a small drop in PO2 causes a large drop in SaO2,
indicating a lessening affinity for oxygen. This normal decrease in the affinity of hemoglobin
for oxygen helps release large amounts of oxygen to the tissue, where the PO2 is low. This
also explains why it is necessary to keep the PaO2 higher than 60 mm Hg in clinical practice.

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43. Given the following blood parameters, compute the total oxygen content (dissolved + HbO2)
of the blood in ml/dl: Hb = 18; PO2 = 40 mm Hg; SO2 = 73%.
a. 16.5 ml/dl
b. 17.7 ml/dl
c. 18.6 ml/dl
d. 19.5 ml/dl

ANS: B

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 Test bank 11-14

Known values are (1) PO2, (2) total hemoglobin content (g/dl), and (3) hemoglobin saturation.
Given these values, the following equation can be applied:
CaO2 = (0.003 × PO2) + (Hbtot × 1.34 × SO2)

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44. Given the following blood parameters, compute the total oxygen content (dissolved + HbO2)
of the blood in ml/dl: Hb = 16; PO2 = 625 Hg; SO2 = 100%.
a. 17.8 ml/dl
b. 19.4 ml/dl
c. 21.4 ml/dl
d. 23.3 ml/dl

ANS: D
The respiratory therapist obtains a sample of arterial blood from a patient breathing 100%
oxygen. The PO2 is 625 mm Hg, Hb is 16 g/dl, and the oxygen saturation is 100%. To
compute the total oxygen content, the respiratory therapist should apply the aforementioned
equation as follows:
CaO2 = (0.003 × PaO2) + (Hbtot × 1.34 × SaO2)
CaO2 = (0.003 ml × 625 mm Hg) + (16 g/dl × 1.34 × 1.0)
CaO2 = (1.875 ml) + (21.44 g/dl)
CaO2 = 23.3 ml/dl

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45. What is the approximate normal CaO2  C O2 in a healthy adult at rest?

a. 5 ml/dl
b. 15 ml/dl
c. 20 ml/dl
d. 250 ml/dl

ANS: A
As indicated in Table 11-2, the difference between the normal arterial and venous oxygen
contents is approximately 5 ml/dl.

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46. A patient has a whole-body oxygen consumption of 320 ml/min and a measured CaO2  C O2
of 8 ml/dl. What is the cardiac output?
a. 3.2 L/min
b. 4.0 L/min
c. 5.0 L/min
d. 7.0 L/min

ANS: B
Fick equation:
t = O2 C(a  v)O2  10

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 Test bank 11-15

In this equation, t is cardiac output (L/min), O2 is the whole-body oxygen consumption

(ml/min), and C(a – )O2 is the arteriovenous oxygen contents difference (ml/dl). The factor of
10 converts ml/dl to ml/L. Given a normal O2 of 250 ml/min and a normal C(a – )O2 of 5
ml/dl, a normal cardiac output is calculated as follows:
t = 200 ml/min  5 ml/dl  10
t = 250 ml/min  5 ml/L
t = 5.0 L/min

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47. According to the Fick principle, if oxygen consumption remains constant, an increase in
cardiac output will manifest itself as which of the following?
a. decrease in the CaO2  C O2
b. increase in the CaO2
c. increase in the CaO2  C O2
d. decrease in the C O2

ANS: A
If the cardiac output rises and oxygen consumption remains constant, the C(a – )O2 will fall
proportionately.

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48. According to the Bohr effect, when the pH drops (blood becomes more acidic), what
happens?
1. The affinity of Hb for oxygen decreases.
2. The Hb saturation for a given PO2 falls.
3. The Hb saturation for a given PO2 rises.
a. 1 and 2
b. 2 only
c. 2 and 3
d. 1, 2, and 3

ANS: A
The impact of changes in blood pH on hemoglobin affinity for oxygen is called the Bohr
effect. As shown in Figure 11-10, the Bohr effect alters the position of the HbO2 dissociation
curve. A low pH (acidity) shifts the curve to the right, decreasing Hb affinity for oxygen and
thus oxygen saturation.

DIF: Application REF: p. 258-259 OBJ: 10

49. Compared to normal levels, a shift in the HbO2 curve to the right has which of the following
effects?
1. The affinity of Hb for oxygen decreases.
2. The Hb saturation for a given PO2 falls.
3. The Hb saturation for a given PO2 rises.
a. 1 only

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 Test bank 11-16

b. 1 and 2
c. 2 and 3
d. 1, 2, and 3

ANS: B
As blood pH drops and the curve shifts to the right, the Hb saturation for a given PO2 falls
(decreased Hb affinity for oxygen.

DIF: Application REF: p. 259 OBJ: 10

50. What role does the Bohr effect play in oxygen transport?
a. describes the affect of varying enzyme levels on Hb and oxygen affinity
b. diminishes tissue oxygenation due to electrolyte imbalances
c. enhances oxygen delivery to tissues and oxygen pickup at lungs
d. explains the affect that oxygen levels have on carbon dioxide transport

ANS: C
The Bohr effect enhances oxygen loading in the lungs and oxygen unloading in the tissues.

DIF: Application REF: p. 259 OBJ: 10

51. What happens when the temperature of the blood rises?

1. The Hb saturation for a given PO2 falls.
2. The HbO2 curve shifts to the right.
3. The affinity of Hb for oxygen increases.
a. 1 and 2
b. 1 and 3
c. 2 only
d. 1, 2, and 3

ANS: A
Conversely, as body temperature rises, the curve shifts to the right, and the affinity of Hb for
oxygen decreases.

DIF: Application REF: p. 260 OBJ: 10

52. What is the affect of an elevated intracellular 2,3-DPG concentration?

a. decreases the availability of oxygen to the tissues
b. increases the affinity of Hb for oxygen
c. increases the availability of oxygen to the tissues
d. shifts the HbO2 dissociation curve to the left

ANS: C
Increased 2,3-DPG concentrations shift the HbO2 curve to the right, promoting oxygen
unloading.

DIF: Application REF: p. 260 OBJ: 10

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 Test bank 11-17

53. In which of the following conditions will erythrocyte concentration of 2,3-DPG be decreased?
a. anemia
b. banked blood
c. high pH
d. hypoxemia

ANS: B
Erythrocyte concentrations of 2,3-DPG in banked blood decrease over time. After a week of
storage, the 2,3-DPG level may be less than one third of the normal value.

DIF: Recall REF: p. 260 OBJ: 10

54. The oxidation of the Hb molecule’s iron ions to the ferric state (Fe3+) results in which of the
following?
1. form of anemia called sickle cell anemia
2. formation of methemoglobin (metHb)
3. inability of metHb to bind with oxygen
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

ANS: C
metHb is an abnormal form of the molecule in which the heme-complex normal ferrous iron
ion (Fe2+) loses an electron and is oxidized to its ferric state (Fe3+). In the ferric state, the iron
ion cannot combine with oxygen.

DIF: Recall REF: p. 261 OBJ: 10

55. The affinity of Hb for carbon monoxide (CO) is approximately how many times greater than
its affinity for oxygen?
a. 10 to 50 times greater
b. 50 to 90 times greater
c. 100 to 190 times greater
d. 200 or greater

ANS: D
Carboxyhemoglobin (HbCO) is the chemical combination of hemoglobin with CO.
Hemoglobin’s affinity for CO is more than 200 times greater than it is for oxygen.

DIF: Application REF: p. 261 OBJ: 10

56. Which of the following does NOT increase the affinity of Hb for oxygen?
a. decreased 2,3-DPG
b. decreased PCO2
c. increased pH

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 Test bank 11-18

d. increased temperature

ANS: D
An increased pH results in a right shift in the oxygen-hemoglobin dissociation curve resulting
in a decreased affinity.

DIF: Application REF: p. 261 OBJ: 10

57. Which of the following are true regarding fetal hemoglobin (HbF)?
a. It has a reduced level of 2,3-DPG.
b. It is replaced in the first month of life.
c. It delivers more oxygen to tissues at low PaO2 than normal Hb.
d. It has a higher P50 than normal Hb.

ANS: C
HbF has a greater affinity for oxygen than does normal adult Hb, as manifested by a leftward
shift of the HbO2 curve. Given the low PO2 values available to the fetus in utero, this leftward
shift aids oxygen loading at the placenta. Because of the relatively low pH of the fetal
environment, oxygen unloading at the cellular level is not greatly affected.

DIF: Application REF: p. 262 OBJ: 10

58. A patient has a P50 value of 29 mm Hg. What does this indicate?
a. decreased affinity of Hb for oxygen
b. higher than normal Hb saturation for a given PO2
c. increased affinity of Hb for oxygen
d. normal position in the HbO2

ANS: A
Conditions that cause a decrease in Hb affinity for oxygen (a shift of the HbO2 curve to the
right) increase the P50 to higher than normal. A normal P50 is 26 mm Hg.

DIF: Application REF: p. 262 OBJ: 10

59. In which of the following forms is carbon dioxide transported by the blood?
1. chemically combined with proteins
2. ionized as bicarbonate (HCO3-)
3. simple physical solution
a. 2 only
b. 3 only
c. 2 and 3
d. 1, 2, and 3

ANS: D
Approximately 45 to 55 ml/dl of carbon dioxide is normally carried in the blood in the
following three forms: (1) dissolved in physical solution, (2) chemically combined with
protein, and (3) ionized as bicarbonate.

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 Test bank 11-19

DIF: Application REF: p. 263 OBJ: 8

60. Which of the following applies to the following reaction:

Prot-NH2 + CO2 Prot-NHCOO + H+?
a. About 20% of the total blood carbon dioxide is carried in this form.
b. It is second in importance to only the bicarbonate buffer system.
c. It represents the formation of blood carbamino compounds.
d. The resulting H+ ions are buffered by reduced HCO3.

ANS: C
A small amount of the carbon dioxide leaving the tissues combines with plasma proteins to
form these carbamino compounds.

DIF: Analysis REF: p. 263 OBJ: 8

61. The largest percentage of carbon dioxide transported in the blood occurs as which of the
following?
a. carbamino-Hb
b. carbonic acid (H2CO3)
c. HCO3
d. physically dissolved carbon dioxide

ANS: C
Approximately 80% of the blood carbon dioxide is transported as bicarbonate.

DIF: Recall REF: p. 263 OBJ: 8

62. Why is the presence of carbonic anhydrase in RBCs so crucial for carbon dioxide transport?
a. forms H2CO3 which is the major buffer for carbon dioxide
b. drives the hydrolysis reaction that forms HCO3-
c. forms H2CO3, which is the way the majority of carbon dioxide is transported
d. without its formation, carbon dioxide could not be excreted at the lungs

ANS: B
Hydrolysis of carbon dioxide initially forms carbonic acid, which quickly ionizes into
hydrogen and bicarbonate ions:
CO2 + H2O H2CO3 HCO3– + H+
However, the rate of this plasma hydrolysis reaction is extremely slow, producing minimal
amounts of H+ and HCO3–. This reaction is greatly enhanced by an enzyme catalyst called
carbonic anhydrase.

DIF: Application REF: p. 263 OBJ: 8

63. When a Hb molecule accumulates excessive amounts of HCO3-, it is expelled from the cell in
exchange for Cl-. What is this called?
a. Bohr effect

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 Test bank 11-20

b. Haldane effect
c. Hamburger phenomenon
d. hydrolysis phenomenon

ANS: C
As the hydrolysis of carbon dioxide continues, HCO3– ions begin to accumulate in the
erythrocyte. To maintain a concentration equilibrium across the cell membrane, some of these
anions diffuse outward into the plasma. Because the erythrocyte is not freely permeable by
cations, electrolytic equilibrium must be maintained by way of an inward migration of anions.
This is achieved by the shifting of chloride ions (Cl–) from the plasma into the erythrocyte, a
process called the chloride shift, or the Hamburger phenomenon.

DIF: Recall REF: p. 264 OBJ: 8

64. When Hb saturation with oxygen is high, less carbon dioxide is carried in the blood. What is
this relationship called?
a. Bohr effect
b. chloride shift
c. dissociation constant
d. Haldane effect

ANS: D
Figure 11-14 shows that oxyhemoglobin saturation also affects the position of the carbon
dioxide dissociation curve. The influence of oxyhemoglobin saturation on carbon dioxide
dissociation is called the Haldane effect.

DIF: Application REF: p. 264 OBJ: 9

65. The conversion of HbO2 to deoxygenated Hb does which of the following?

1. decreases blood carbon dioxide content
2. enhances carbon dioxide loading on Hb
3. helps buffer H+ ions
a. 2 and 3
b. 1 and 2
c. 3 only
d. 1, 2, and 3

ANS: A
Figure 11-14 shows that oxyhemoglobin saturation also affects the position of the CO2
dissociation curve. The influence of oxyhemoglobin saturation on CO2 dissociation is called
the Haldane effect. As previously explained, this phenomenon is a result of changes in the
affinity of hemoglobin for CO2, which occur as a result of its buffering of H+ ions.

DIF: Analysis REF: p. 264 OBJ: 9

66. Which of the following statements is true regarding the Haldane effect?
a. At high SaO2 levels, carbon dioxide more readily forms carbamino compounds.

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 Test bank 11-21

b. At high SaO2 levels, the capacity of blood to hold carbon dioxide decreases.
c. At high SaO2 levels, the capacity of blood to hold carbon dioxide increases.
d. At low SaO2 levels, the capacity of blood to hold carbon dioxide decreases.

ANS: B
At point “a,” the high SaO2 decreases the blood’s capacity to hold carbon dioxide, thus
helping unload this gas at the lungs.

DIF: Application REF: p. 264 OBJ: 9

67. Which of the following equations best describes oxygen delivery to the tissues?
a. arterial oxygen content ÷ cardiac output
b. arterial oxygen content  cardiac output
c. cardiac output + arterial oxygen content
d. cardiac output  vascular resistance

ANS: B
Oxygen delivery ( O2) to the tissues is a function of arterial oxygen content (CaO2) times
cardiac output ( t):
O2 = CaO2  t

DIF: Analysis REF: p. 265 OBJ: 10

68. In the presence of an acutely reduced arterial oxygen content (hypoxemia), normal oxygen
delivery to the tissues can be maintained by which of the following?
a. hyperventilation (increased VA)
b. increased RBC production
c. increasing the cardiac output
d. peripheral vasoconstriction

ANS: C
Oxygen delivery ( O2) to the tissues is a function of arterial oxygen content (CaO2) times
cardiac output ( t):
O2 = CaO2  t
If arterial oxygen content falls an increased cardiac output will compensate.

DIF: Analysis REF: p. 265 OBJ: 10

69. Hypoxia is best defined as a condition in which what occurs?

a. Blood Hb levels are less than normal (15 g/dl).
b. The arterial PCO2 is greater than normal (45 mm Hg).
c. The arterial PO2 is greater than normal (100 mm Hg).
d. Tissue oxygen delivery is inadequate to meet cellular needs.

ANS: D
When oxygen delivery falls short of cellular needs, hypoxia occurs.

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 Test bank 11-22

DIF: Application REF: p. 265 OBJ: 10

70. Which of the following are potential causes of hypoxia?

1. decrease in arterial PO2
2. decrease in available Hb
3. decrease in cardiac output
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

ANS: D
Hypoxia occurs if (1) the arterial blood oxygen content is decreased (hypoxemia),or (2)
cardiac output, or perfusion is decreased (shock or ischemia).

DIF: Application REF: p. 265 OBJ: 10

71. An abnormal metabolic state in which the tissues are unable to utilize the oxygen made
available to them best describes which of the following?
a. diffusion hypoxia
b. dysoxia
c. hemic hypoxia
d. physiologic shunt

ANS: B
Abnormal cellular function prevents proper uptake of oxygen is called dysoxia.

DIF: Application REF: p. 269 OBJ: 10

72. A patient breathing room air at sea level has the following arterial blood gases: PaO2 = 62 mm
Hg; PCO2 = 75 mm Hg. When the FIO2 is raised to 0.28, the PaO2 rises to 95 mm Hg. What is
the most likely cause of the hypoxemia?
a. hypoventilation
b. impaired diffusion
c. right-to-left shunt
d. / imbalance

ANS: A
In the case of simple hypoventilation, a rise in the alveolar PCO2 is always accompanied by a
proportionate fall in alveolar PO2. The P(A – a)O2 is normal in such cases. The hypoxemia
will respond readily to oxygen therapy.

DIF: Application REF: p. 266 OBJ: 10

73. What is the most common cause of hypoxemia in patients with lung disease?
a. diffusion defect
b. hypoventilation

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 Test bank 11-23

c. right-to-left shunt
d. / mismatch

ANS: D
Ventilation-perfusion ( / ) imbalances are the most common cause of hypoxemia in patients
with lung disease.

DIF: Application REF: p. 266 OBJ: 9

74. A patient breathing 40% oxygen at sea level has a PaO2 of 50 mm Hg, a PCO2 of 30 mm Hg
and a PAO2  PaO2 of 250 mm Hg. When the FIO2 is raised to 0.7, the PaO2 rises to only 58
mm Hg. Hypoxemia is primarily due to which of the following?
a. hypoventilation
b. impaired diffusion
c. right-to-left shunt
d. / imbalance

ANS: C
A / of 0 represents a special type of imbalance. When the / is 0, there is blood flow but
no ventilation. The result is equivalent to a right-to-left anatomical shunt, shown at the bottom
of Figure 11-15. Venous blood bypasses ventilated alveoli and mixes with freshly oxygenated
arterial blood, resulting in what is called a venous admixture. Right-to-left physiologic
shunting results in a more severe form of hypoxemia than does a simple / .

DIF: Analysis REF: p. 266 OBJ: 9

75. The expected PaO2 for an 80-year-old man who is otherwise in good health and breathing
room air is about what level?
a. 50 mm Hg
b. 75 mm Hg
c. 80 mm Hg
d. 90 mm Hg

ANS: B
One may estimate the expected PaO2 in older adults by using the following formula:
Expected PaO2 = 100.1 – (0.323  age in years)

DIF: Analysis REF: p. 266 OBJ: 9

76. A patient with a normal PaO2 and cardiac output is exhibiting signs and symptoms of tissue
hypoxia. What is the most likely cause?
a. hemoglobin deficiency
b. low ambient PO2
c. right-to-left shunt
d. hypoventilation

ANS: A

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 Test bank 11-24

If the blood hemoglobin is low—even when the PaO2 is normal—hypoxia can occur because
of low oxygen content in the arterial blood.

DIF: Analysis REF: p. 268 OBJ: 9

77. What is the most important component in the oxygen transport system?
a. dissolved oxygen in ml/dl
b. HCO3
c. Hb
d. PaO2

ANS: C
Progressive falls in blood hemoglobin content cause large drops in arterial oxygen content
(CaO2). In fact, a 33% decrease in hemoglobin content (from 15 to 10 g/dl) reduces the CaO2
as much as would a drop in PaO2 from 100 to 40 mm Hg.

DIF: Analysis REF: p. 255 OBJ: 9

78. When oxygen uptake by the tissues is abnormally low, as occurs in certain forms of dysoxia,
what would you expect to find?
a. decreased CaO2
b. decreased CvO2
c. decreased PaO2
d. increased CvO2

ANS: D
Dysoxia is a form of hypoxia in which the cellular uptake of oxygen is abnormally decreased.
The best example of dysoxia is cyanide poisoning. Cyanide disrupts the intracellular
cytochrome oxidase system, thereby preventing cellular use of oxygen.

DIF: Analysis REF: p. 269 OBJ: 9

79. Which of the following would you expect to find with “oxygen debt”?
1. accentuated in diseases such as sepsis
2. oxygen demand exceeds oxygen delivery
3. oxygen excess usage results in debt
a. 1, 2, and 3
b. 1 and 2
c. 2 only
d. 2 and 3

ANS: B

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 Test bank 11-25

Decreases in oxygen delivery result in an oxygen “debt,” when oxygen demand exceeds
oxygen delivery. Under conditions of oxygen debt, oxygen consumption becomes dependent
on oxygen delivery (sloped line on Figure 11-19). This in turn leads to lactic acid
accumulation and metabolic acidosis. In pathologic conditions such as septic shock and adult
respiratory distress syndrome (dotted line on Figure 11-19), this critical point may occur at
levels of oxygen delivery considered normal.

DIF: Application REF: p. 270 OBJ: 10

80. Under which of the following conditions may carbon dioxide removal be impaired?
1. when a / imbalance exists
2. when the dead space ventilation/min is increased
3. when the minute ventilation is inadequate
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

ANS: D
Anything that decreases alveolar ventilation can impair carbon dioxide removal. A decrease in
alveolar ventilation occurs when (1) the minute ventilation is inadequate, (2) the dead space
ventilation per minute is increased, or (3) a / imbalance exists.

DIF: Application REF: p. 270 OBJ: 11

81. Carbon dioxide is most commonly elevated due to significant pulmonary disease that results
in small tidal volumes.
a. False
b. True

ANS: B
Clinically, inadequate minute ventilation usually is caused by decreased tidal volumes. This
occurs in restrictive conditions, such as atelectasis, neuromuscular disorders, or impeded
thoracic expansion (e.g., kyphoscoliosis).

DIF: Application REF: p. 270 OBJ: 11

82. What can you assume about a patient who has a / imbalance and exhibits hypercapnia
(PCO2 greater than 45 mm Hg)?
a. The central nervous system is not responding to the increased PCO2.
b. The patient cannot sustain the high E to overcome the high VD.
c. The patient is compensating for an acute metabolic alkalosis.
d. The patient is compensating for a chronic metabolic acidosis.

ANS: B

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 Test bank 11-26

An increase in dead space ventilation is caused by either (1) rapid, shallow breathing (an
increase in anatomical dead space per minute) or (2) increased physiologic dead space ( / =
0). In either case, the proportion of wasted ventilation increases. Without compensation, this
lowers alveolar ventilation per minute and impairs carbon dioxide removal.

DIF: Application REF: p. 271 OBJ: 11

83. What does / mismatch have the biggest impact on?

a. carbon dioxide elimination
b. dissolved HCO3
c. Oxygenation
d. pH

ANS: C
/ imbalances have a greater effect on oxygenation than on carbon dioxide removal.

DIF: Application REF: p. 271 OBJ: 11

84. If blood from an area of the lung with a high / is mixed with blood perfusing an area with a
low / , what will be the result?
a. CaO2 higher than the average of the two
b. CaO2 lower than the average of the two
c. PaO2 equal to the average of the two
d. PaO2 lower than the average of the two

ANS: D
The final oxygen content, also arrived at by averaging the high and low / points, is shown
as point X on the oxygen curve (Figure 11-20). Whereas the averaged value for carbon
dioxide was normal, the PaO2 resulting from averaging the oxygen content of the high and
low / units is well below normal (point “a” on the oxygen curve of Figure 11-20).

DIF: Application REF: p. 271 OBJ: 10

85. Which of the following statements is NOT true about the effect of / imbalances on oxygen and
carbon dioxide exchange?
a. Blood leaving high / units has a high PO2 and a low PCO2.
b. Blood leaving low / units has a low PO2 and a high PCO2.
c. High / units can compensate for high PCO2 levels from low / units.
d. High / units can compensate for low PO2 levels from low / units.

ANS: D
However, the shape of the dissociation curves dictates that a high / unit can reverse the
high PCO2 but not the low PO2.

DIF: Analysis REF: p. 271 OBJ: 11

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 Test bank 11-27

86. Under which of the following conditions can the alveolar partial pressure of carbon dioxide
(PACO2) be increased?
1. when the body increases its production of CO2 ( VCO2)
2. when the dead space ventilation/min. is increased ( VD)
3. when the minute ventilation is inadequate ( VE)
4. when the alveolar ventilation is decreased ( VA)
a. 1 and 2
b. 1 and 3
c. 1, 2 and 3
d. 1, 2, 3, and 4

ANS: D
The alveolar partial pressure of carbon dioxide, or PACO2, varies directly with the body`s
production of carbon dioxide (VCO2) and inversely with alveolar ventilation (VA). A decrease
in alveolar ventilation occurs when the minute ventilation is inadequate, the dead space
ventilation per minute is increased, or a / imbalance exists.

DIF: Analysis REF: p. 249-250 OBJ: 2

87. When using therapeutic agents that can cause methhemoglobinemia methHb, which of the
following are important to prevent adverse effects?
a. checking the frequency of ventilation
b. frequent monitoring for methHb to weigh the risk against the benefit
c. occasional monitoring for sickle cell anemia
d. frequent monitoring for abnormal body temperature (high or low)

ANS: B
Methemoglobin (metHb) is an abnormal form of the molecule, in which the heme-complex
normal ferrous iron ion (Fe ) loses an electron and is oxidized to its ferric state (Fe ).
In the ferric state, the iron ion cannot combine with oxygen. The result is a special form of
anemia called methemoglobinemia. As with HbCO, clinical abnormalities come from the
associated increased affinity for oxygen and loss of oxygen-binding capacity. The most
common cause of methemoglobinemia is the therapeutic use of oxidant medications such as
nitric oxide, nitroglycerin, and lidocaine. When using these therapeutic agents, frequent
monitoring for metHg is important to weigh the risk against the benefit.

DIF: Application REF: p. 261 OBJ: 7

88. The two major causes of dead space ventilation are:

1. a decreased tidal volume
2. dysoxia
3. impaired CO2 removal
4. increased physiologic dead space
a. 1 and 2 only
b. 1 and 3 only
c. 1 and 4 only
d. 1, 2, 3 only

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 Test bank 11-28

ANS: C
An increase in dead space ventilation, or VD/VT, is caused by either (1) a decreased tidal
volume as with rapid, shallow breathing (an increase in anatomic dead space per minute) or
(2) increased physiologic dead space as in pulmonary embolus.(V./Q. = 0). In either case, the
proportion of wasted ventilation increases.

DIF: Application REF: p. 268 OBJ: 10

89. Disorders that can lead to alveolar dead space include:

1. pulmonary emboli
2. partial obstruction of the pulmonary vasculature
3. destroyed pulmonary vasculature
4. reduced cardiac output
a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 4 only
d. 1, 2, 3, and 4

ANS: D
Alveolar dead space is that ventilation that enters into alveoli that are without any perfusion or
without adequate perfusion. Disorders that can lead to alveolar dead space include pulmonary
emboli, partial obstruction of the pulmonary vasculature, destroyed pulmonary vasculature (as
can occur in COPD) and with reduced cardiac output.

DIF: Application REF: p. 265 OBJ: 10

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