Cardiopulmonary 3 2010

1. A physical therapist administers a submaximal exercise test to a patient in a cardiac

rehabilitation program. The protocol requires the patient to ride a cycle ergometer for a
predetermined amount of time using progressive work loads. In order to predict the
patient’s maximum oxygen uptake, it is necessary to determine the relationship between:

a) Heart rate and perceived exertion.

b) Heart rate and oxygen uptake
c) Perceived exertion and blood pressure.
d) Blood pressure and oxygen up take.

Rationale: The purpose of sub maximal exercise testing is to determine the

relationship between heart rate and oxygen uptake in order to predict maximum
oxygen uptake. In order to do this it is necessary to determine the relationship
between heart rate and oxygen uptake at two or more different submaximal.

2. Which side effect of Digoxin warrants medical attention?

a) memory loss
b) bradycardia
c) confusion
d) weakness and palpitations

Rationale: Patients with heart disease are comfortable at rest. However, ordinary
physical activity causes fatigue, palpitation, dyspnea, or anginal pain. Digitalis
(Digoxin) is frequently used to treat congestive heart failure (it slows heart rate and
increases force of myocardial contraction). Adverse side effects of digitalis can
include muscle weakness and supraventricular or ventricular arrhythmias including
ventricular fibrillation without premonitory signs.

3. After pneumonectomy, which changes will not occur?

a) tracheal deviation
b) decreased breath sounds
c) decreased residual volume
d) increased tidal volume

Rationale: Deviated trachea towards the side of the pneumonectomy, decreased

breath sounds on the side of the pneumonectomy and decreased residual volume
will be expected. Tidal volume would not change. Pulmo: Evaluation

4. 4 weeks post myocardial infarction, when are resistive exercise appropriate?

a) Resistive Exercises are not appropriate at this time

b) if they can tolerate 5 METS as long as there are no anginal symptoms
c) Resistive exercises can be performed without restriction
d) if they can tolerate 10 METS as long as there are no anginal symptoms
 Rationale: Patients should demonstrate an exercise capacity greater than 5 METs
without anginal symptoms or ST segment depression. Cardiac: Evaluation

5. All of these are signs and symptoms of respiratory alkalosis except:

a) disorientation
b) tingling or numbness of the extremities
c) dizziness or lightheadedness
d) hyperreflexia

Rationale: A patient with respiratory acidosis may present with many symptoms of
increased carbon dioxide levels in the arterial blood. Significant acidosis may lead to
disorientation, stupor, or coma. The other choices are signs and symptoms of
respiratory alkalosis or a decrease of carbon dioxide in the arterial blood.

6. You are treating an elderly patient with a cardiac history. He presents with initial
symptoms of mental confusion, shortness of breath and generalized weakness. What do
you suspect?

a) pneumonia
b) transient ischemic attack
c) COPD
d) myocardial infarction

Rationale: An elderly patient with a cardiac history may present with initial
symptoms of mental confusion, the result of oxygen deprivation to the brain. The
SOB and generalized weakness may also be due to generalized circulatory
insufficiencies coexisting with the developing myocardial infarction. Cardiac

7. The combined signs and symptoms of absent breath sounds, sudden onset of chest
pain and shortness of breath may indicate:

a) bronchitis
b) pneumothorax
c) cystic fibrosis
d) pneumonia

Rationale: The combined signs and symptoms of absent breath sounds, sudden
onset of chest pain and shortness of breath indicate a pneumothorax. This is an
emergency situation. Pulmo: Eval

8. Your patient's ECG shows ST segment depression is present during comfortable,

stable rest. He has history of a myocardial infarction. You should inform the physician to
rule out:

a) nothing is wrong with this patient

b) ventricular tachycardia
c) cardiac arrest
d) silent ischemia
 Rationale: If ST segment depression is present during comfortable, stable rest in a
patient with a history of a myocardial infarction, it likely represents the presence of a
nontransmural myocardial infarction and is the patient's baseline ECG. However, this
should be confirmed to rule out silent ischemia. Cardiac: Exam

9. A patient with a C5 spinal cord injury will not have the abdominal musculature
necessary to return the diaphragm to a high domed position during exhalation. Which
position will best help the patient?

a) prone
b) supine
c) sitting
d) sidelying

Rationale: A patient with a C5 spinal cord injury will not have the abdominal
musculature necessary to return the diaphragm to a high domed position during
exhalation. Inspiration will be affected by the change in the diaphragm's resting
position. In supine, gravity will take the place of abdominals, holding the abdominal
contents under the diaphragm, improving the zone of apposition, the height of the
diaphragm dome and therefore, the ability to ventilate. The other positions listed
negate the positive effects of gravity on the abdomen. Pulmo: Intervention

10. A patient in the intensive care unit rehabilitating from a serious infection is connected
to a series of lines and tubes. Which lower extremity intravenous site would be most
appropriate to administer an intravenous line ?

a) Antecubital vein
b) Basilic vein
c) Cephalic vein
d) Saphenous vein

Rationale: The saphenous vein is a superficial vein that extends from the foot to the
saphenous opening; The antecubital , basilic vein are located in the upper
extremities.

11. A physical therapist examines a patient diagnosed with left-sided heart failure. Which
finding is NOT typically associated with this condition?

a) pulmonary edema
b) persistent cough
c) dependent edema
d) muscular weakness

Rationale: Dependent edema is a characteristic of right-sided heart failure along

with liver enlargement, weight gain, and cyanosis. Left-sided heart failure can occur
as a result of hypertension, coronary artery disease, infective endocarditis, and
various connective tissue disorders.
12. This is used to improve ventilation to hypoventilated lung segments, alter regional
distribution of gas, maintain or restore functional regional capacity, maintain or improve
mobility of chest wall and prevent pulmonary compromise.

a) Segmental Breathing
b) Sustained Maximal Inspiration
c) Active Cycle Breathing
d) Diaphragmatic breathing

Rationale: Answer: 1. Segmental Breathing Reason Segmental Breathing is used to

improve ventilation to hypoventilated lung segments, alter regional distribution of
gas, maintain or restore functional regional capacity, maintain or improve mobility of
chest wall and prevent pulmonary compromise.

13. The recommended time duration for endotracheal suctioning is:

a) 5 seconds
b) 10 seconds
c) 20 seconds
d) 30 seconds

Rationale: The recommended time duration for endotracheal suctioning is 10 to 15

seconds. Any longer time risks serious hypoxemia, any shorter and the risk is
ineffective secretion removal. Pulmo : Intervention

14. Your patient reports a dull ache, tightness, or pain in the calf. What should you
suspect?

a) deep venous thrombosis

b) arterial insufficiency
c) venous insufficiency
d) muscle strain

Rationale: Venous ulcers are often painless, or present with minimal pain when
compared to arterial ulcers which are painful (claudication and rest pain). Chronic
venous insufficiency is also characterized by thickening, coarsening, and brownish
pigmentation of the skin around the ankles. The skin is usually thin, shiny, and
cyanotic. DVT may be asymptomatic initially. When symptoms occur, patients
typically report a dull ache, tightness, or pain in the calf. Vascular: Diff Diag

15. A physical therapist monitors the blood pressure of a 28 - year- old male during
increasing levels of physical exertion. Assuming a normal physiologic response to
exercise, what effect would this have ?

a) Systolic pressure decreases, diastolic pressure increases.

b) Systolic pressure remains the same.
c) Systolic pressure and diastolic pressure remain the same.
d) Systolic pressure increases, diastolic pressure remains the same.

Rationale: Systolic pressure gradually increases as exercise intensity increases,

however, diastolic pressure remains relatively stable.
16. Patients with congestive heart failure tend to have excessive fluid retention in the
pulmonary and systemic circulation. As a result, a diet high in what is prescribed?

a) fiber
b) sodium
c) calcium
d) potassium

Rationale: Patients with congestive heart failure tend to have excessive fluid
retention in the pulmonary and systemic circulation. As a result, a diet high in
potassium is prescribed, while items high in sodium are restricted. Cardiac:
Intervention

17. Which technique that can allow patients to complete functional activities without
shortness of breath or dyspnea?

a) Activity pacing
b) Pursed lip breathing
c) Meditation
d) Yoga

Rationale: Pacing is a technique that can allow patients to complete functional

activities without shortness of breath or dyspnea. Pulmo: Intervention

18. A physical therapist reviews the medical record of a 60-year-old male status post
myocardial infarction. Which potential complication of a myocardial infarction is the
patient MOST susceptible to?

a) heart failure
b) arrhythmias
c) thrombus formation
d) heart structural damage

Rationale: Arrhythmias occur in approximately 90% of individuals following

myocardial infarction. Each of the listed options are possible complications following
myocardial infarction, however, they are not as prevalent as arrhythmias.

19. This is an obstructive pulmonary disease, often a sequela of premature infants with
respiratory distress syndrome.

a) Bronchopulmonary Dysplasia
b) Asthma
c) Bronchiectasis
d) SARS

Rationale: Answer: 1. Bronchopulmonary Dysplasia Reason Bronchopulmonary

Dysplasia: an obstructive pulmonary diseas, often a sequela of premature infants
with respiratory distress syndrome; results from high pressures of mechanical
ventilation, high fractions of inspired oxygen and/or infection. The lungs show areas
of pulmonary immaturity and dysfunction due to hyperinflation.
20. A physical therapist attempts to obtain information on a patient's endurance level by
administering a low-level exercise test on a treadmill. Which of the following
measurement methods would provide the therapist with an objective measurement of
endurance?

a) facial color
b) facial expression
c) rating on a perceived exertion scale
d) respiration rate

Rationale: Respiratory rate is an objective measure that is used to assess

endurance. Respiratory rate typically increases as a patient becomes fatigued.

21. A physical therapist identifies a number of substances that influence circulation.

Which of the following substances is stimulated by decreased arterial pressure and acts
as a vasoconstrictor?

a) angiotensin
b) histamine
c) epinephrine
d) norepinephrine

Rationale: Angiotensin is a polypeptide in the blood that causes vasoconstriction,

increased blood pressure, and the release of aldosterone from the adrenal cortex.
Release of angiotensin is stimulated by decreased arterial pressure.

22. A physician orders the nursing staff to administer digitalis to a patient diagnosed with
congestive heart failure. The physician's PRIMARY goal using this medication is to:

a) increase cardiac pumping ability

b) increase cellular metabolism
c) regulate fluid and electrolyte levels
d) regulate glucose metabolism

Rationale: Digitalis is utilized in the treatment of congestive heart failure. Digitalis

works directly on electrolytes to improve the force and contractility of the heart.

23. A physical therapist reviews the results of pulmonary function testing on a 44-year-
old female diagnosed with emphysema. Assuming the patient's testing was classified as
unremarkable, which of the following lung volumes would MOST likely approximate 10%
of the patient's total lung capacity?

a) tidal volume
b) inspiratory reserve volume
c) residual volume
d) functional residual capacity

Rationale: Tidal volume is defined as the amount of air inspired and expired per
breath and is approximately 450-600 mL in an adult. This value represents
approximately 10% of the total lung capacity.
24. A physical therapist monitors a patient's respiration rate during exercise. Which of
the following would be considered a normal response?

a) the respiration rate declines during exercise as the intensity of exercise increases
b) the respiration rate does not increase during exercise
c) the rhythm of the respiration pattern becomes irregular during exercise
d) the respiration rate decreases as the intensity of the exercise plateaus

Rationale: As the intensity of exercise plateaus, a patient will accommodate to the

level of exercise and their respiration rate will tend to decrease.

25. This is used with patients who are unable to cough on command, such as infants,
patients following brain injury or stroke.

a) Cough
b) Endotracheal suctioning
c) Assisted cough
d) Tracheal stimulation

Rationale: Answer: 4. Tracheal stimulation Reason Tracheal stimulation is used with

patients who are unable to cough on command, such as infants, patients following
brain injury or stroke.

26. A physical therapist reviews the results of a pulmonary function test. Assuming
normal values, which of the following measurements would you expect to be the
GREATEST?

a) vital capacity
b) tidal volume
c) residual volume
d) inspiratory reserve volume

Rationale: Vital capacity is defined as the amount of air that can be exhaled
following a maximal inspiratory effort. Vital capacity varies directly with height and
indirectly with age.

27. The physical therapist prepares an educational program for an individual with chronic
venous insufficiency. Which of the following would not be appropriate to include in the
patient education program?

a) Wear shoes that accommodate to size and shape of your feet

b) Observe you skin daily for breakdown.
c) Wear your compression stockings only at night.
d) Keep your feet elevated as much as possible through out the day.
 Rationale: Patients with chronic venous insufficiency must wear compression
stockings during periods of activity, such as ambulation, in order to promote
return to the heart and avoid venous stasis.

28. A physical therapist designs a training program for a patient without cardiovascular
pathology. The therapist calculates the patient's age-predicted maximal heart rate as
180 beats per minute. Which of the following would be an acceptable target heart rate
for the patient during cardiovascular exercise?

a) 93 beats per minute

b) 122 beats per minute
c) 169 beats per minute
d) 195 beats per minute

Rationale: The American College of Sports Medicine recommends prescribing the

intensity of exercise as 60 to 90% of maximum heart rate or 50-85% of VO2 max

29. A physical therapist instructs the patient to expire maximally after taking a maximal
inspiration. The therapist can use these instructions to measure:

a) Expiratory reserve volume

b) Inspiratory reserve volume
c) Total lung capacity
d) Vital capacity

Rationale: Vital capacity equals the sum of inspiratory reserve volume, tidal volume,
and expiratory reserve volume.

30. A physical therapist positions a patient in sitting prior to administering bronchial

drainage. Which lung segment would require the patient to be in this position.

a) Anterior basal segments of the lower lobes

b) Posterior apical segments of the upper lobes
c) Posterior segments of the lower lobes
d) Right middle lobe.

Rationale: Postural drainage to the posterior apical segments of the upper lobes is
performed with the patient sitting , leaning over a pillow at a 30 degree angle.

31. A physical therapist performs palpation with a patient positioned in standing as part
of a respiratory assessment. Which structure would be Most appropriate to assess with
the therapist positioned behind the patient?

a) Mediastinum
b) Upper lobes
c) Right middle lobe
d) Lower lobes

Rationale: The lower lobes should be examined with the patient’s back towards the
physical therapist. The therapist positions their hands around the anterior axillary fold
 and draws the skin medially until the thumbs meet. The patient should be instructed
to inspire once. The hand movement during inspiration is examined and recorded.

32. What is the potential space between the two pleura that maintains the approximation
of the ribcage and lungs?

a) Upper airways
b) Intrapleural space
c) Visceral Pleura
d) Parietal Pleura

Rationale: Answer: 2. Intrapleural space Reason Intrapleural space is the potential

space between the two pleura that maintains the approximation of the ribcage and
lungs, allowing forces to be transmitted from one structure to another.

33. This is part of the heart chamber that receives blood from the RA and pumps blood
via the pulmonary artery to the lungs for oxygenation.

a) Left Atrium
b) Right Ventricle
c) Right Atrium
d) Left Ventricle

Rationale: Answer: 2. Right Ventricle Reason HEART CHAMBERS 1. Right Atrium

(RA)- part of the heart chamber that receives blood from systemic circulation, from
the superior and inferior vena cavae. 2. Right Ventricle (RV)- receives blood from the
RA and pumps blood via the pulmonary artery to the lungs for oxygenation; low
pressure pulmonary pump. 3. Left Atrium (LA)- receives oxygenated blood from the
lungs and the four pulmonary veins. 4. Left Ventricle (LV)- receives blood from the
LA and pumps blood via the aorta throughout the entire systemic circulation; the high
pressure systemic pump. The walls of the LV are thicker and stronger than the RV
and forms most of the left side and apex of the heart.

34. A physical therapist listens to the lung sounds of a 56-year-old male with chronic
bronchitis. While performing auscultation the therapist identifies distinct lung sounds with
a high constant pitch during exhalation. This type of sound is MOST consistent with:

a) crackles
b) rales
c) rhonchi
d) wheezes

Rationale: During expiration wheezes are often indicative of narrowed airways or an

airway obstruction. This condition is most commonly associated with asthma or
bronchitis.
35. The physical therapist claps between the clavicle and nipple bilaterally on a patient.
The patient is in supine with a pillow under the knees. The This technique is utilized for
postural drainage of the:

a) anterior segments of the upper lobes

b) anterior basal segments of the lower lobes
c) superior segments of the lower lobes
d) posterior basal segments of the lower lobes

Rationale: The supplied description is the classic position for the anterior segments
of the upper lobes.

36. A patient with cardiopulmonary pathology is referred to physical therapy. The

physical therapist documents the following clinical signs: pallor, cyanosis, and cool skin.
These clinical signs are MOST consistent with:

a) cor pulmonale
b) anemia
c) atelectasis
d) diaphoresis

Rationale: Anemia refers to a reduction in the number of circulating red blood cells.
Symptoms may include pallor, cyanosis, cool skin, vertigo, weakness, headache,
and general malaise.

37. A physical therapist examines the breath sounds of a 62-year-old male diagnosed
with lung problems. The therapist identifies rales during both inspiration and expiration.
This finding is MOST representative of:

a) pleural effusion
b) pulmonary fibrosis
c) impaired secretion clearance
d) localized stenosis

Rationale: Low-pitched, non-rhythmical sounds occurring throughout the ventilatory

cycle often are indicative of fluid in the large airways due to impaired secretion
clearance.

38. A physical therapist elects to utilize the Six-Minute Walk Test as a means of
quantifying endurance for a patient rehabilitating from a lengthy illness. Which variable
would be the MOST appropriate to measure when determining the patient's endurance
level with this objective test?

a) perceived exertion
b) heart rate response
c) elapsed time
d) distance walked
 Rationale: The Six-Minute Walk Test provides an indirect measure of cardiovascular
endurance by examining the distance a patient can walk in six minutes. Patients are
instructed to walk as far and as fast as possible in six minutes.

39. The medical record of your patient indicates that he is currently taking digitalis. What
effect would you expect digitalis to have on the patient's ECG?

a) lengthened ventricular activation time

b) increased refractory period of AV node
c) lengthened QT interval
d) elevated ST segment

Rationale: Digitalis is used to alleviate symptoms of congestive heart failure. The

drug increases the force of myocardial contraction and increases the refractory
period of the AV node. The refractory period is the time the AV node is incapable of
responding to an action potential. By slowing down the rate of ventricular contraction,
digitalis allows for increased filling time and improved cardiac output.

40. This is part of the heart chamber that receives blood from systemic circulation, from
the superior and inferior vena cavae.

a) Left Atrium
b) Right Ventricle
c) Right Atrium
d) Left Ventricle

Rationale: Answer: 3. Right Atrium Reason HEART CHAMBERS 1. Right Atrium

(RA)- part of the heart chamber that receives blood from systemic circulation, from
the superior and inferior vena cavae. 2. Right Ventricle (RV)- receives blood from the
RA and pumps blood via the pulmonary artery to the lungs for oxygenation; low
pressure pulmonary pump. 3. Left Atrium (LA)- receives oxygenated blood from the
lungs and the four pulmonary veins. 4. Left Ventricle (LV)- receives blood from the
LA and pumps blood via the aorta throughout the entire systemic circulation; the high
pressure systemic pump. The walls of the LV are thicker and stronger than the RV
and forms most of the left side and apex of the heart.

41. A physical therapist observes a patient's breathing as part of a respiratory

assessment. Which muscle of respiration is MOST active during forced expiration?

a) diaphragm
b) external intercostals
c) internal intercostals
d) upper trapezius

Rationale: The internal intercostals act to depress the ribs during forceful expiration.
42. A physical therapist observes an electrocardiogram of a patient on beta-blockers.
Which of the following ECG changes could be facilitated by beta-blockers?

a) bradycardia
b) tachycardia
c) increased AV conduction time
d) ST segment sagging

Rationale: Beta-blockers decrease heart rate and the force associated with
myocardial contraction. On an electrocardiogram beta-blockers may cause sinus
bradycardia.

43. These are valves which prevent backflow of blood from aorta and pulmonary arteries
into the ventricles during diastole.

a) Heart Tissue
b) Heart Chambers
c) Semilunar Valves
d) Atrioventricular valves

Rationale: Answer: 3. Semilunar Valves Reason Valves: provide one-way flow of the
blood. a. Atrioventricular valves: prevent backflow of blood into atria during
ventricular systole; anchored by chordae tendineae to papillary muscles; valves
close when ventricular walls contract. b. Semilunar Valves: prevent backflow of blood
from aorta and pulmonary arteries into the ventricles during diastole.

44. Your patient has difficulty clearing out secretions through coughing alone. Which
other technique would you implement to help him clear the more peripheral secretions?

a) Cough
b) Endotracheal suctioning
c) Active Cycle Breathing
d) Tracheal stimulation

Rationale: Answer: 3. Active Cycle Breathing Reason Active Cycle Breathing is an

independent program used to assist in the removal of the more peripheral secretions
that coughing alone may not clear.

45. This is an independent program using an external device that vibrates the airways on
exhalation to improve airway clearance.

a) Autogenic Drainage
b) The Flutter device
c) Active Cycle Breathing
d) Tracheal stimulation

Rationale: Answer: 2. The Flutter device Reason The Flutter device is an

independent program using an external device that vibrates the airways on
exhalation to improve airway clearance.
46. This is a genetically inherited disease characterized by thickening of secretions of all
exocrine glands, leading to obstruction.

a) Cystic Fibrosis
b) Asthma
c) Bronchiectasis
d) SARS

Rationale: Answer: 1. Cystic Fibrosis Reason Cystic Fibrosis: genetically inherited

disease characterized by thickening of secretions of all exocrine glands, leading to
obstruction. CF may present as an obstructive, restrictive or mixed disease.

47. Which of the following should NOT be done when controlling external bleeding?

a) Wear gloves
b) Apply gauze pads using firm pressure
c) Elevate the bleeding part if possible
d) Perform CPR

Rationale: Answer: 4. Perform CPR Reason In controlling external bleeding, the

following should be performed: a. Wear gloves b. Apply gauze pads using firm
pressure c. Elevate the bleeding part if possible d. Apply a pressure bandage e. If
necessary, apply pressure with the heel of your hand over pressure points. f. Monitor
A,B,Cs and opverall status of the patient.

48. You are in a restaurant, when suddenly you overheard that someone is choking. You
arrive at the scene and note that the patient is unconscious. What should NOT be done
when the patient is unconscious?

a) Check airway
b) Use Heimlich maneuver
c) Give two breaths
d) Perform CPR

Rationale: Answer: 2. Use Heimlich maneuver Reason Procedure for obstructed

airway a. If victim is conscious and standing, use Heimlich maneuver. Make a fist
with one hand, place thumb side of fist with one handp, place thumb side of fist on
victim’s abdomen, below breast bone and above navel. Grasp around victim with
other hand and provide quick upward thrusts into the victim’s abdomen. Repeat until
object is expelled. b. If victim is unconscious, check airway, give two breaths and
perform CPR.

49. You are treating a 50 year old patient with a total knee replacement. She suddenly
complains of chest pain and shortness of breath. She is at risk for:

a) Pleural Effusion
b) Myocardial Infarction
c) Pulmonary embolism
d) Pneumonia
 Rationale: Pulmonary embolism is a condition that occurs when one or more
arteries in your lungs become blocked. In most cases, pulmonary embolism is
caused by blood clots that travel to your lungs from another part of your body —
most commonly, your legs. Pulmonary embolism can occur in otherwise healthy
people. Signs and symptoms can vary from person to person, but commonly include
sudden and unexplained shortness of breath, chest pain and a cough that may bring
up blood-tinged sputum. Ref: Mayo Clinic,
http://www.mayoclinic.com/health/pulmonary-embolism/DS00429

50. You are treating a patient with no active abdominal muscle strength. He is also not
able to follow directions. You want to clear his lungs from secretions. Which technique
would you choose?

a) Cough
b) Endotracheal suctioning
c) Assisted cough
d) Tracheal stimulation

Rationale: Answer: 2. Endotracheal suctioning Reason Endotracheal suctioning is

used only when the above airway clearance techniques fail to adequately remove
secretions.