PME Cardiopulmo Flashcards
A patient has an episode of syncope. The therapist attempts to rule out orthostatic hypotension as the cause of the fainting. What is the BEST test protocol to use?
A. Palpate the carotid arteries and take resting HR and BP in the supine position.
B. Take resting HR and BP in supine, then in sitting, then in standing after 1 minute.
C. Take resting HR and BP in supine after 5 minutes, then in semi-Fowler position.
D. Take resting HR and BP in sitting and after 3 and 5 minutes of cycle ergometry exercise.
Which is typical early clinical manifestation of cystic fibrosis (CF)?
A. Increase in secretions of the endocrine system.
B. Frequent recurrent urinary tract infections.
C. Excessive appetite and weight loss.
D. Increased FEV1 (forced expiratory volume in 1 sec) during pulmonary function testing
A patient is admitted to a coronary care unit with a mild myocardial infarction (MI). after 2 days, the patient is referred to therapy for inpatient cardiac rehabilitation. During an initial exercise session on the unit, the patient reports chest pain, appears anxious and wants to go back to bed to rest. What is the therapist’s BEST initial course of action?
A. Assist the patient back to bed and contact the charge nurse on the floor.
B. Sit the patient and monitor vital signs carefully during the rest period.
C. Assign the PTA to assist the patient back to bed and monitor vital signs carefully
D. Terminate the exercise and contact the attending physician immediately
A patient recovering from surgery for triple coronary artery bypass grafts is scheduled to begin a phase III cardiac rehabilitation program. During the resistance training portion of the circuit training program, the therapist instructs the patient to avoid the Valsalva maneuver. What are the expected adverse effects of the Valsalva maneuver?
A. Slowing of pulse and increased venous pressure are possible.
B. The decreased return of blood to the heart can lead to pitting edema.
C. Heart rate (HR) and blood pressure are likely to be elevated.
D. A cholinergic or vagal response can occur.
A patient experiences color changes in the skin during position changes of the foot. During elevation, pallor develops. When the limb is then positioned in the seated hanging position, hyperemia develops. What do these changes indicate?
A. Lymphedema
B. Arterial insufficiency
C. Deep vein thrombophlebitis
D. Chronic venous insufficiency
A 72-year-old patient is walking on a treadmill while vital signs and pulse oximetry are being monitored. It is noted that the patient’s arterial oxygen saturation (SpO2) drops from 95% to 92%. What is the therapist’s BEST response to this change?
A. Place a 40% O2face mask on the patient for the remainder of the exercise session.
B. Not use supplemental O2
C. Place 2 L of O2 by nasal cannula on the patient for the remainder of the exercise session
D. Place a 100% O2 face mask on the patient for the remainder of the exercise session.
The PT is supervising a phase II cardiac rehabilitation class of 10 patients. One of the patients, who is being monitored with radiotelemetry, is having difficulty. Which change would be a criterion for terminating this exercise session?
A. An increase in systolic BP to 150 and diastolic BP to 90
B. 1-mm ST segment depression, upsloping.
C. A second-degree atrioventricular (AV) heart block
D. An increase in HR 20 beats/minute above resting
A patient presents with severe claudication that is evident when walking distances greater than 200 feet. The patient also exhibits muscle fatigue and cramping of both calf muscles. Upon examination, the PT finds the skin is pale and shiny with some trophic nail changes. What is the BEST choice for this patient’s initial exercise program?
A. Avoid any exercise stress until the patient has been on calcium channel blockers for at least 2 weeks.
B. Begin with an interval walking program, exercising just to the point of pain.
C. Utilize non-weight-bearing exercises such as cycle ergometry.
D. Utilize a walking program of moderate intensity, instructing the patient that some pain is expected and to be tolerated.
A patient who is participating in a cardiac
rehabilitation program suddenly collapses and falls to the floor. The therapist checks for a response and
finds the patient unresponsive. After activating the emergency response system (phone 911), what is the
BEST action for the therapist to take?
A. Use the automated external defibrillator (AED) to shock the patient after 3 minutes of cardiopulmonary resuscitation (CPR)
B. Begin CPR and attach and use the AED as soon as possible
C. Give 100 chest compressions per minute.
D. Give two rescue breaths followed by 15 chest compressions, repeating the cycle for at least 2 minutes.
A patient with a significant history of coronary artery disease is currently taking atropine. Based on knowledge of this medication, what are the expected effects?
A. Increased HR and contractility at rest.
B. Increased myocardial ischemia.
C. Palpitations at rest and with exercise.
D. Orthostatic hypotension.
An elderly patient has been hospitalized and on complete bed rest for 10 days. The referral requests mobilization out of bed and ambulation. The patient complains of aching in the right calf. The therapist’s examination reveals calf tenderness with slight swelling and warmth. What is the BEST course of
action for the therapist?
A. Begin with ankle pump exercises in bed and then ambulate.
B. Postpone ambulation and report the findings immediately.
C. Ambulate the patient with support stockings on.
D. Use only AROM exercises with the patient sitting at the edge of the bed.
A patient with a recent history of rib fractures suddenly becomes short of breath during a bout of coughing. The patient looks panicked and complains
of sharp pain in the left chest. A quick screen shows a deviated trachea to the right, among other signs and symptoms. What is the MOST likely diagnosis based
on these symptoms?
A. Pulmonary emboli
B. Pneumothorax
C. Angina
D. Mucous plugging of an airway
An apparently healthy individual has several risk factors for coronary artery disease. The client is interested in improving overall fitness and cardiac
health. After a graded exercise test, which was asymptomatic, the client is referred for an exercise class. Which is the BEST measure of exercise intensity in a newly tested and exercising individual?
A. Heart rate (HR)
B. Rating of perceived exertion (RPE)
C. MET level
D. Respiratory rate
A young patient presents with primary lymphedema of the right lower extremity. What is the BEST choice for initial exercise?
A. Treadmill walking
B. Treadmill jogging
C. Exercising on a stair climbing machine
D. Step aerobics
A patient has a 10-year history of peripheral vascular disease (PVD) affecting the right lower extremity.
During auscultation of the popliteal artery, what would the therapist expect to find?
A. A positive Homan’s sign
B. Intense pain and cramping
C. A bruit
D. 4+ pulses
A patient presents with tachypnea, cor pulmonale, hypoxemia, rales on inspiration, and decreased diffusing capacity. What is the probable cause?
A. Restrictive lung dysfunction
B. Chronic obstructive pulmonary disease
C. Neither of the above
D. A and B
A 63-year-old man was diagnosed with sciatica. The MRI report is negative for lumbar disc involvement. During the evaluation the therapist cannot reproduce the symptoms of radiculopathy with any test. Lower
extremity strength is equal bilaterally and is not weak in any particular pattern. The patient informs the therapist that the pain is bilateral, located in the gastrocnemius area, and increases with prolonged ambulation. The pain stops soon after resting in a seated position. What is the most likely source of this
patient’s pain?
A. Impingement of the L5 dorsal root
B. Multiple sclerosis
C. Compartment syndrome
D. Intermittent claudication
Which of the following are tests for peripheral arterial involvement in a patient with complaints of calf musculature pain?
A. Percussion test
B. Claudication time
C. Homan’s sign
D. None of the above
A therapist is treating a patient with cystic fibrosis who has just walked 75 feet before experiencing significant breathing difficulties. In an effort to assist the patient in regaining her normal breathing rate, the therapist gives a set of instructions. Which of the following set of instructions is appropriate?
A. “Take a slow deep breath through pursed lips and exhale slowly through your nose only”
B. “Take small breaths through your nose only and exhale quickly through pursed lips”
C. “Breath in through your nose and exhale slowly through pursed lips”
D. “Breath in through pursed lips and breath out slowly through pursed lips”
A therapist is treating a patient who is participating in cardiac rehabilitation. Because the patient complains of chest pain, the therapist attempts to assess heart sounds with a stethoscope. Which of the following is true about the second sound during auscultation of the heart?
A. The closure of the aortic and pulmonic valves
B. The closure of the mitral and tricuspid valves
C. The beginning of ventricular systole
D. B and C
A 53-year-old man with chronic obstructive pulmonary disease reports to an outpatient cardiopulmonary rehabilitation facility. Pulmonary testing reveals that forced expiratory volume in 1 second (FEV1) and vital capacity (VC) are within 60% of predicted values.
What is the appropriate exercise prescription?
A. Exercise at 75-80% of the target heart rate 3 times/week.
B. Begin exercise with level of 1.5 METs and increase slowly 3 times/week
C. Exercise at 75-80% of the target heart rate 7 times/week
D. Begin exercise with levels of 1.5 METs and increase slowly 7 times/week.
The use of compression stockings on the feet and ankles is contraindicated in which patient population?
A. Chronic venous disease
B. Chronic arterial disease
C. Recent total knee replacement
D. Burn patients
A therapist is evaluating a wound in a patient with the following signs: painless ulceration of medial malleolus with edema. The patient has what type of
ulcer?
A. Decubitus ulcer
B. Trophic ulcer
C. Venous insufficiency ulcer
D. Arterial insufficiency ulcer
A therapist is asked to evaluate a patient in the intensive care unit. The patient is comatose but breathing independently. During the assessment of range of motion in the right upper extremity the
therapist notices that the patient is breathing unusually. The involves deep gasping with no period of dyspnea. The therapist should notify the appropriate personnel that the patient is exhibiting
which of the following patterns?
A. Biot’s
B. Cheyne-Stokes
C. Kussmaul’s
D. Paroxysmal nocturnal dyspnea
At a team meeting, the respiratory therapist informs the rest of the team that the patient, just admitted to
the subacute floor, experienced breathing difficulty in the acute care department. The respiratory therapist describes the breathing problem as a pause before exhaling after a full inspiration. Which of the following is the therapist describing?
A. Apnea
B. Orthopnea
C. Eupnea
D. Apneusis
A 50-year-old man has a persistent cough, purulent sputum, abnormal dilation of bronchi, more frequent
involvement of the left lower lobe than the right, hemoptysis, and reduced forced vital capacity. What is the most likely pulmonary dysfunction?
A. Chronic bronchitis
B. Emphysema
C. Asthma
D. Bronchiectasis
A patient presents to a clinic with decreased tidal volume (TV). What is the most likely cause of this change in normal pulmonary function?
A. Chronic pulmonary disease
B. Restrictive lung dysfunction
C. Both of the above
D. None of the above
A 3-month-old infant has a heart condition known as tetralogy of Fallot. This condition presents with which
of the following signs?
A. Atrial septal defect, pulmonary valve stenosis, aorta abnormally located to the right, and right ventricular hypertrophy.
B. Atrial septal defect, pulmonary valve stenosis, aorta abnormally located to the left, and right ventricular hypertrophy
C. Ventricular septal defect, pulmonary valve stenosis, aorta abnormally located to the right, and left ventricular hypertrophy
D. Ventricular septal defect, pulmonary valve stenosis, aorta abnormally located to the right, and right ventricular hypertrophy.
Which of the following is not a realist goal of a phase II cardiac rehabilitation program?
A. to increase exercise capacity and endurance
B. to teach the patient self monitoring
techniques
C. to assess cardiovascular responses to work
D. all of the above are realistic goals
A therapist studies a normal resting
electrocardiogram for one cardiac cycle. What wave or change in shape of the electrocardiogram results from atrial depolarization?
A. P wave
B. QRS complex
C. ST segment
D. T wave
The therapist’s primary emphasis when treating a child with ______ is aggressive bronchial drainage, chest vibration and percussion?
A. cystic fibrosis
B. chronic asthma
C. respiratory muscle weakness
D. pneumothorax
Which illness is characterized by bronchial hyperirritability that is triggered by a number of stimuli, resulting in narrowing of the air passages?
A. asthma
B. pneumonia
C. bronchitis
D. pleurisy
Therapeutic objectives of diaphragmatic breathing include all of the following EXCEPT
A. alleviate dyspnea
B. increase respiratory rate
C. increase tidal volume
D. reduce the incidence of postoperative
pulmonary complication
Pulse pressure is the difference between:
A. CO and SV
B. SBP and TPR
C. EDV and ESV
D. SBP and DBP
A patient develops a pulmonary embolism postoperatively. The patient is hemodynamically stable and began anticoagulant therapy yesterday. All
of the following would be appropriate treatment techniques, EXCEPT:
A. deep and segmental breathing
B. extended expiration
C. postural drainage
D. percussion and vibration
Which treatment would be indicated for a patient diagnosed with chronic obstructive pulmonary disease?
A. bronchodilators
B. smoking cessation
C. oxygen therapy to prevent cor pulmonale
D. all of these
A therapist positions a patient in the Trendelenburg position in preparation for postural drainage. Which of the following is not a relative precaution for the use of the Trendelenburg position?
A. nausea
B. obesity
C. pulmonary edema
D. secretion retention
Secretion removal techniques are often a necessary component of a pulmonary rehabilitation program. Secretion retention can occur for a multitude of
reasons, however, it is usually associated with a pulmonary disease. Which pulmonary disease is usually associated with a change in the composition of the secretions?
A. asthma
B. bronchiectasis
C. chronic bronchitis
D. cystic fibrosis
Certain types of drugs such as nitroglycerin can be metabolized and destroyed by the liver. What route of
administration would best allow nitroglycerin to reach the systemic circulation?
A. oral
B. rectal
C. nasal
D. sublingual
A therapist evaluates the breathing pattern of a patient with chronic obstructive pulmonary disease. The therapist identifies cycles of increased rate and depth or respiration with apneic pauses between cycles. This type of breathing pattern is best described as
A. Biot’s
B. Cheyne-Stokes
C. eupnea
D. Kussmaul’s
