CP

Question 1

The resting heart rate of a 32-year-old runner is measured at 46 bpm. Which of the following explanations for this heart rate is MOST likely?

1. The individual has a hypotensive disorder.
2. The rate is secondary to an increased stroke volume.
3. The individual has an atrioventricular block.
4. Endurance training has stimulated the sympathetic nervous system.

Answer 1

2. Cardiac output is the product of stroke volume multiplied by heart rate. A training effect is an increase in stroke volume. There is a resultant decrease in heart rate to maintain the same cardiac output at rest. (pp. 144-146)

Question 2

A patient admitted to the hospital with a diagnosis of exacerbation of heart failure is preparing for discharge to home. Which of the following clinical characteristics would be MOST important to monitor as part of the home program?

1. Blood pressure and fatigue level
2. Heart rate and cough productivity
3. Presence of cyanosis and diaphoresis
4. Presence of shortness of breath and dependent edema

Answer 2

4. Shortness of breath and dependent edema are symptoms of heart failure exacerbation.

Question 3

A patient who has chronic obstructive pulmonary disease becomes short of breath when walking 5 feet (1.5 m) with a rolling walker. Which of the following techniques would be MOST appropriate in order to increase the distance the patient is able to walk without becoming short of breath?

1. Incentive spirometry
2. Pacing
3. Diaphragmatic breathing
4. Segmental breathing

Answer 3

2. Using pacing, the patient would learn to work within his or her exercise tolerance. This may mean walking slower or walking with breaks and would allow greater total walking distance without shortness of breath. (O’Sullivan, p. 513)

Question 4

A patient’s electrocardiogram shows a junctional rhythm. The patient’s heart rate is 60 bpm and regular. Which of the following waves will MOST likely be absent from the rhythm strip?

1. P
2. R
3. S
4. T

Answer 4

1. Junctional rhythm originates from the atrioventricular junction instead of the sinoatrial node, which normally causes the P wave. Therefore, the P wave will be missing. R, S, T waves come from the ventricles after stimulation from the atrioventricular junction and will be unaffected.

Question 5

Which of the following laboratory values should a physical therapist monitor when treating a patient who is taking warfarin (Coumadin)?

1. Hemoglobin
2. Red blood cell count
3. International normalized ratio
4. Erythrocyte sedimentation rate

Answer 5

3. Warfarin (Coumadin) is an anticoagulant. The physical therapist must be aware when a patient is taking an anticoagulant so that treatment can be modified if there is an increased risk of hemorrhage. The international normalized ratio (INR) was developed to provide results that would not vary between laboratories. Therapeutic anticoagulation requires an INR of 2 to 3. As the INR increases above these values, the risk of bleeding during activity is increased. (pp. 1712-1713)

Question 6

Patients with advanced emphysema experience difficulty in breathing during exercise because of:

1. hypocapnia.
2. atrophy of secondary breathing muscles.
3. alveolar dilation.
4. damage to the phrenic nerve.

Answer 6

3. Emphysema is characterized by abnormal and permanent enlargement of the air spaces distal to the terminal nonrespiratory bronchioles accompanied by destructive changes of the alveolar walls (p. 86).

Question 7

A therapist is treating a patient who recently had a myocardial infarction. At the beginning of treatment, blood pressure was 120/80 mm Hg and heart rate was 90 beats/min. Midway through treatment, blood pressure was 130/84 mm Hg and heart rate was 105 beats/min. The BEST action for the therapist to take is to:

1. continue with treatment.
2. increase the intensity of treatment.
3. stop the treatment, and notify the physician.
4. decrease the intensity of the next treatment.

Answer 7

1. Systolic blood pressure is expected to rise in direct proportion to the level of exertion performed. A hypertensive response to low-level exercise (over 160/90 mm Hg) in the patient who is at least 3 days post myocardial infarction may be indicative of cardiac ischemia. Heart rate should increase between 12-24 bpm above the resting heart rate. The patient is showing a normal response to exercise and should continue with treatment.

Question 8

When compared to maximal oxygen uptake values obtained in a lower extremity exercise test, values obtained in an upper extremity exercise test are typically:

1. 30% to 40% lower.
2. the same.
3. 10% to 20% higher.
4. 30% to 40% higher.

Answer 8

1. Arm exercise typically results in 30% to 40% lower maximal oxygen uptake than leg exercise.

Question 9

A physical therapist is conducting a graded exercise stress test of an apparently healthy adult using a treadmill. The test should be discontinued if which of the following events occurs?

1. Heart rate continues to increase throughout the test.
2. Borg rating of perceived exertion is reported as 13/20.
3. Diastolic blood pressure reaches 120 mm Hg.
4. Significant redness of the skin and perspiration are observed.

Answer 9

3. A diastolic blood pressure of 120 mm Hg is an indicator for ending the test. A diastolic blood pressure greater than 115 mm Hg is too high to continue testing. (ASCM, p. 84)

Question 10

A patient in an intensive care unit is intubated and is being treated with a mechanical ventilator. The patient would be UNABLE to participate in which of the following interventions?

1. Pursed-lip breathing training
2. Diaphragmatic breathing training
3. Deep breathing exercises
4. Lateral costal expansion exercises

Answer 10

1. Pursed-lip breathing is not possible when the patient is intubated.

Question 11

A patient has an irregular heartbeat of greater than 100 bpm. Which of the following methods is MOST accurate for measuring the patient’s heart rate?

1. Auscultate the apical heart rate for at least 60 seconds.
2. Take the radial pulse for 15 seconds and multiply by 4.
3. Measure the carotid pulse for 30 seconds and multiply by 2.
4. Take the radial pulse for 30 seconds and multiply by 2.

Answer 11

1. With an irregular heart rate greater than 100 bpm, auscultation is the most accurate method of measuring the heart rate.

Question 12

A patient who has pleural effusion is performing segmental breathing exercises. Where should manual counterpressure be applied to encourage expansion of the posterior basal segments of the patient’s lower lobes?

1. Lower lateral costal area
2. Posterior lower ribs
3. Anterior midchest
4. Anterior lower ribs

Answer 12

2. Segmental breathing combines breathing control with manual cues to specific areas of the chest wall. Proper hand placement to encourage posterior basal expansion is over the posterior aspect of the lower ribs.

Question 13

A patient’s electrocardiogram report describes the presence of significant Q waves. This finding is suggestive of which of the following conditions?

1. Premature atrial complex
2. Myocardial infarction
3. Supraventricular tachycardia
4. Atrial fibrillation

Answer 13

2. A prominent, pathological Q wave is indicative of a transmural myocardial infarction (p. 170).

Question 14

A 65-year-old patient arrives for outpatient physical therapy. The patient reports swimming earlier that morning. Since then the patient has felt pain down both arms, has had shortness of breath, and has continued to perspire. What should a physical therapist do NEXT?

1. Refer the patient to a physician for magnetic resonance imaging of the cervical spine.
2. Contact emergency medical services.
3. Evaluate the cervical spine and provide stretches to decrease bilateral arm pain.
4. Treat the patient and recommend that the patient follow up with a physician within 1 week.

Answer 14

2. The patient shows signs of having had a myocardial infarction. A myocardial infarction is more apt to occur in the morning, during exertion, and when one is working with the arms overhead (e.g., swimming). The patient demonstrates all of these warning signs, and emergency medical services should be contacted immediately.

Question 15

A physical therapist is providing supervised exercise to a patient who has been restricted to extended bed rest. After 2 weeks of intervention, which of the following measures would BEST reflect cardiopulmonary system improvement?

1. Delayed cardiovascular response upon rising from supine position
2. Decreased heart rate response to exercise
3. Decreased respiratory rate in response to exercise
4. Increased cardiovascular peripheral resistance

Answer 15

2. Exercise will increase the patient’s stroke volume secondary to increased myocardial contractility. The increased stroke volume will result in a reduced heart rate response with exercise. The intensity of the exercises is directly correlated to the heart rate response. (Kisner, p. 252)

Question 16

A patient with chronic obstructive pulmonary disease would MOST likely have a DECREASED value in which of the following pulmonary function tests?

1. Residual volume
2. Total lung capacity
3. Vital capacity
4. Functional residual capacity

Answer 16

3. Chronic obstructive pulmonary disease is a combination of airway narrowing, parenchymal destruction, and pulmonary vascular thickening. Vital capacity is an indicator of the amount of air that is expelled after the patient takes a maximal inspiration and follows that with a maximal expiration (Goodman, p. 1723). Chronic obstructive pulmonary disease causes a decrease in vital capacity (O’Sullivan, pp. 486-490).

Question 17

When taking a patient’s pulse, which of the following numerical pulse amplitude classifications represents a normal finding?

1. 1+
2. 2+
3. 3+
4. 4+

Answer 17

2. 2+ is considered normal under resting conditions.

Question 18

Glossopharyngeal breathing is an appropriate technique to teach a patient who has:

1. a high cervical spinal cord injury.
2. emphysema.
3. cystic fibrosis.
4. asthma.

Answer 18

1. Glossopharyngeal breathing is a means of increasing pulmonary function, especially tidal volume and vital capacity, when there is severe weakness of the muscles of inspiration (Frownfelter, p. 372), as found in a patient with a higher cervical spinal cord injury.

Question 19

A patient has right lower lobe atelectasis following abdominal surgery. Upon auscultation, a physical therapist notes no adventitious breath sounds. Which of the following is MOST appropriate for this patient?

1. Percussion and vibration in left Trendelenburg position
2. Vigorous percussion and vibration with nebulizer
3. Spirometry with segmental breathing exercises
4. Practice of incisional splinting for coughing techniques

Answer 19

3. Adventitious breath sounds are abnormal sounds such as crackles, wheezes, and stridor. Atelectasis is a collapse of lung tissue. Spirometry and segmental breathing exercises are appropriate interventions for atelectasis without the presence of adventitious breath sounds (pp. 363-364, 496).

Question 20

A healthy, older, sedentary individual has normal vital signs at rest. During maximal aerobic exercise, which of the following values should demonstrate MINIMAL change?

1. Stroke volume
2. Diastolic blood pressure
3. Venous oxygen content
4. Systolic blood pressure

Answer 20

2. During endurance exercise systolic blood pressure increases, but diastolic blood pressure should not change significantly. Change in blood pressure response to exercise is not the primary difference in an elderly person’s cardiovascular system. (p. 189)

Question 21

A physical therapist places a patient in a seated position with the patient’s back leaning against a pillow at a 45° to 60° angle. This position BEST facilitates postural drainage of which of the following parts of the lungs?

1. Bilateral apical
2. Right anterior
3. Left lingula
4. Bilateral posterior

Answer 21

1. Postural drainage of the apical segments of the upper lobes occurs when the patient leans back on a pillow at a 30° angle (O’Sullivan, p. 516; Frownfelter, p. 314).

Question 22

During a bedside evaluation, a patient shows a sudden increase in the rate and depth of respirations, followed by a gradual decrease in respirations and periods of apnea. Which of the following respiratory patterns is the patient exhibiting?

1. Hyperventilation
2. Paradoxical breathing
3. Tachypnea
4. Cheyne-Stokes

Answer 22

4. Cheyne-Stokes respiration is breathing that waxes and wanes cyclically so that periods of deep breathing alternate with periods of apnea (no breathing) (pp. 98, 550, 517).

Question 23

The BEST exercise level for an aerobic program for weight loss is:

1. less than or equal to 60% of maximum heart rate for 45 to 60 minutes, 5 to 7 days/week.
2. 80% to 90% of maximum heart rate for 45 to 60 minutes, 3 days/week.
3. less than or equal to 60% of maximum heart rate for 15 to 20 minutes, 3 days/week.
4. 80% to 90% of maximum heart rate for 15 to 20 minutes, 5 to 7 days/week.

Answer 23

1. Initial exercise training for obese individuals should be moderate (40% to 60% of maximum heart rate) and eventually progress to higher intensities (50% to 75%). Frequency should be 5-7 days/week; duration should be 45-60 minutes/session.

Question 24

A patient is taking anticoagulants. Which of the following side effects should the therapist be concerned about during the patient’s exercise?

1. Ecchymosis
2. Deep vein thrombosis
3. Dehydration
4. Hypotension

Answer 24

1. Anticoagulants prevent clots. A potential side effect is ecchymosis due to the increased risk of bleeding.

Question 25

Which of the following findings are associated with the LOWEST risk for a subsequent cardiac event?

1. Left ventricular ejection fraction of 55% and functional capacity of 3 metabolic equivalents (METs)
2. Occasional premature ventricular contractions and functional capacity of 6 metabolic equivalents (METs)
3. Exercise-induced ST segment depression of less than 2 mm and sustained supraventricular tachycardia
4. Exercise-induced ST segment depression of greater than 2 mm and left ventricular ejection fraction of 45%

Answer 25

2. It is common to have a few premature ventricular contractions in a normal heart (O’Sullivan, p. 547). A patient is at low risk for increased morbidity and mortality if functional capacity is greater than or equal to 6 metabolic equivalents 3 or more weeks after a clinical event (O’Sullivan, p. 560).

Question 26

A patient who had a myocardial infarction 5 days ago is referred for a low-level treadmill test. The patient reports having had several episodes of mild angina at rest, after meals, and during the night since being hospitalized. Which of the following actions is MOST appropriate for the physical therapist?

1. Proceed with the usual low-level protocol, because mild angina is common this soon after a myocardial infarction.
2. Defer testing the patient, because the symptoms suggest unstable angina after a myocardial infarction.
3. Perform the test at a lower-than-usual workload, because the symptoms suggest unstable angina after a myocardial infarction.
4. Defer testing the patient, because 5 days after a myocardial infarction is too soon to begin physical exertion.

Answer 26

2. Unstable angina warrants immediate medical attention (O’Sullivan, p. 534).