Exam 1 Review Questions Flashcards
Which of the following is a contraindication for Phase I Cardiac Rehabilitation?
- A. Resting systolic blood pressure of 140 mmHg
- B. Active pericarditis or myocarditis
- C. History of stable angina
- D. Completed PCI with no complications
B. Active pericarditis or myocarditis
What is the primary goal of Phase I Cardiac Rehabilitation?
- A. Maximize aerobic capacity
- B. Prevent complications and ensure safe discharge
- C. Begin strength training
- D. Teach advanced exercise techniques
B. Prevent complications and ensure safe discharge
A patient post-MI with a resting heart rate of 70 bpm should not exceed what heart rate during inpatient therapy in the absence of a stress test?
- A. 90 bpm
- B. 110 bpm
- C. 100 bpm
- D. 120 bpm
A. 90 bpm (Post-MI: Resting HR + 20 bpm limit)
Which of the following symptoms would warrant immediate discontinuation of exercise during cardiac rehabilitation?
- A. A drop in systolic blood pressure of 8 mmHg
- B. Heart rate increases within target range
- C. Angina and marked dyspnea
- D. Mild fatigue
C. Angina and marked dyspnea
What is the expected timeline for achieving sternal stability following CABG surgery?
- A. 2-4 weeks
- B. 4-6 weeks
- C. 6-10 weeks
- D. 10-12 weeks
C. 6-10 weeks
True or False
Patients in cardiac rehab Phase I should engage in activities that increase their heart rate by no more than 40 bpm above resting values.
False (Post-op limit is 30 bpm, post-MI is 20 bpm above resting HR).
True or False
Active exercise is contraindicated in patients with resting ST segment elevation greater than 2 mm.
True
True or False
Education about cardiovascular risk factors and self-monitoring is a key component of all phases of cardiac rehabilitation.
True
Scenario: You are seeing a patient with a recent anterior MI in the acute care setting. During therapy, their vitals are as follows: HR 95 bpm, BP 140/88 mmHg, SpO2 96%, and they report mild dizziness.
Question: What is your next step?
- A. Stop treatment and monitor for worsening symptoms.
- B. Adjust activity to reduce intensity.
- C. Continue treatment and monitor vitals closely.
- D. Call for emergency assistance immediately.
A. Stop treatment and monitor for worsening symptoms.
Which of the following patients would be contraindicated for participating in Phase I Cardiac Rehabilitation?
- A. A patient with controlled atrial fibrillation and resting HR of 78 bpm.
- B. A patient with stable angina but no chest pain in the last 24 hours.
- C. A patient with an acute systemic illness and a fever of 101°F.
- D. A patient who has undergone a PCI procedure and is hemodynamically stable.
Correct Answer: C. A patient with an acute systemic illness and a fever of 101°F.
Rationale:
- C: Acute systemic illness or fever is a contraindication for cardiac rehab because it indicates the body is in a stressed state, which increases the risk of complications.
- A: Controlled atrial fibrillation is not a contraindication as long as the patient is hemodynamically stable.
- B: Stable angina without recent chest pain is a common condition in cardiac rehab patients.
- D: PCI patients, once stable, are cleared to begin low-level activity.
Scenario: You are treating a 65-year-old patient post-MI in Phase I Cardiac Rehab. During ambulation, their vitals are as follows: HR 92 bpm (resting HR: 74 bpm), BP 120/80 mmHg, SpO2 96%, and they report no symptoms.
What is your next step?
- A. Continue the activity and monitor closely for any changes.
- B. Stop the activity due to the HR increase.
- C. Increase the intensity to test their cardiovascular limits.
- D. Stop the activity and consult the physician immediately.
Correct Answer: A. Continue the activity and monitor closely for any changes.
Rationale:
- A: The HR increase (18 bpm) is within the acceptable limit (20 bpm above resting for post-MI patients). The vitals are stable, and the patient is asymptomatic.
- B: There is no indication to stop the activity since HR is within the safe range.
- C: Increasing intensity in this phase is contraindicated; the goal is safe, gradual progression.
- D: There is no clinical need to stop and consult a physician as the vitals and symptoms are normal.
During Phase I Cardiac Rehabilitation, which of the following abnormal responses to activity requires immediate cessation of exercise?
- A. Increase in systolic blood pressure by 25 mmHg.
- B. Heart rate increase of 22 bpm above resting in a post-op patient.
- C. Patient reports angina with an intensity of 3/10.
- D. Mild dizziness that resolves within a few seconds.
Correct Answer: C. Patient reports angina with an intensity of 3/10.
Rationale:
- C: Angina, regardless of intensity, is a critical symptom that requires immediate cessation of exercise to prevent further ischemic damage.
- A: A 25 mmHg increase in SBP is not abnormal unless it exceeds 210 mmHg.
- B: An HR increase of 22 bpm in a post-op patient is acceptable as the limit is 30 bpm above resting.
- D: Mild dizziness that resolves quickly is not a reason to stop activity but should be monitored.
Scenario: A 70-year-old patient post-CABG is participating in their first inpatient rehab session. During a 2-minute walk, they report mild sternal discomfort but deny chest pain or dyspnea. Vitals are HR: 88 bpm, BP: 128/82 mmHg, SpO2: 97%.
What is your next step?
- A. Stop activity and report sternal discomfort to the physician.
- B. Continue activity but instruct the patient to monitor their discomfort closely.
- C. Discontinue activity and reassess their sternal precautions.
- D. Increase the intensity to test tolerance to discomfort.
Correct Answer: B. Continue activity but instruct the patient to monitor their discomfort closely.
Rationale:
- B: Mild sternal discomfort is common post-CABG, especially early in rehab. The patient’s vitals are stable, and no other concerning symptoms are present.
- A: Reporting to the physician is unnecessary unless the discomfort worsens or interferes with mobility.
- C: There is no need to stop entirely, as the discomfort is not severe.
- D: Increasing intensity is contraindicated due to the discomfort and early phase of rehab.
A patient in Phase I Cardiac Rehab demonstrates the following during seated exercises: HR 110 bpm, BP 150/88 mmHg, SpO2 95%, and they report dizziness.
What should you do?
- A. Stop the activity and monitor symptoms while resting.
- B. Continue the activity and recheck vitals in 5 minutes.
- C. Adjust the intensity and encourage hydration.
- D. Call for emergency medical assistance immediately.
Correct Answer: A. Stop the activity and monitor symptoms while resting.
Rationale:
- A: Dizziness is a sign of activity intolerance and should prompt immediate cessation to prevent worsening symptoms or adverse events.
- B: Continuing activity despite dizziness could worsen the patient’s condition.
- C: Adjusting intensity does not address the underlying issue and may delay proper response.
- D: Emergency assistance is not needed unless dizziness persists or vitals deteriorate significantly.
Which of the following symptoms during activity requires immediate cessation of exercise in a Phase I cardiac rehab patient?
- A. Heart rate increase of 15 bpm above resting in a post-MI patient.
- B. Diastolic blood pressure of 85 mmHg during activity.
- C. Angina rated 2/10 and dizziness.
- D. Systolic blood pressure increase of 30 mmHg during activity.
Correct Answer: C. Angina rated 2/10 and dizziness.
- C: Angina, regardless of intensity, and dizziness are signs of exercise intolerance that require stopping exercise immediately.
- A: A 15 bpm HR increase is within acceptable limits for post-MI patients.
- B: A DBP of 85 mmHg is within the normal range during activity.
- D: A 30 mmHg SBP increase is not concerning unless it exceeds 210 mmHg.
Scenario: You are treating a patient post-CABG on Day 2 in an ICU setting. During seated exercises, their vitals are: HR 90 bpm, BP 145/85 mmHg, SpO2 94%. The patient reports mild sternal discomfort and denies dyspnea. What is your next step?
- A. Discontinue exercise and consult the physician.
- B. Continue the session but monitor closely for worsening symptoms.
- C. Stop the session and educate the patient on sternal precautions.
- D. Increase intensity to improve exercise tolerance.
Correct Answer: B. Continue the session but monitor closely for worsening symptoms.
- B: Mild sternal discomfort is common post-CABG, and the vitals are stable. Close monitoring is sufficient.
- A: Discontinuation is not necessary unless symptoms worsen or become severe.
- C: Stopping is unnecessary unless there is significant discomfort or a violation of sternal precautions.
- D: Increasing intensity is contraindicated in the early post-operative phase.
A patient in the ICU with a pulmonary artery catheter reports dizziness during activity. Their MAP is 55 mmHg. What is your next step?
- A. Continue exercise but reduce intensity.
- B. Stop exercise and monitor vitals while resting.
- C. Increase intensity to improve MAP.
- D. Adjust the catheter and continue activity.
Correct Answer: B. Stop exercise and monitor vitals while resting.
- B: A MAP < 60 mmHg indicates inadequate tissue perfusion and requires cessation of exercise.
- A: Continuing exercise would worsen the situation.
- C: Increasing intensity is inappropriate in the presence of hemodynamic instability.
- D: Adjusting the catheter is not within the PT scope of practice.
Scenario: A 58-year-old patient with an LVAD begins a low-intensity walking program. Their MAP via Doppler is 65 mmHg, and their RPE is 14. What is your best action?
- A. Stop the session and notify the physician.
- B. Adjust the exercise to lower intensity and continue.
- C. Continue the session at the current intensity.
- D. Increase intensity to target MAP 70 mmHg.
Correct Answer: B. Adjust the exercise to lower intensity and continue.
- B: The MAP is below the recommended range (70–90 mmHg), and the RPE is slightly high. Reducing intensity is appropriate.
- A: Notification is not necessary unless the patient remains symptomatic or MAP fails to improve.
- C: Continuing without adjustment risks worsening hemodynamic status.
- D: Increasing intensity is contraindicated due to the low MAP.