Cardiopulmonary NPTE questions

Which term is used to describe the outer layer of the cardiac tissue which protects the surface of the heart against trauma or infection?

a. endocardium

b. epicardium

c. myocardium

d. pericardium

B

A therapist discusses the important of cholesterol level as a risk factor for coronary artery disease. Which total blood cholesterol level would place the patient at the greatest risk?

a. 110 mg/dL

b. 140 mg/dL

c. 190 mg/dL

d. 230 mg/dL

d

Which heart sound occurs when the mitral and tricuspid valves close at the onset of systole?

a. S1

b. S2

c. S3

d. S4

a

Which of the following measures would be utilized to determine cardiac output?

a. end systolic volume and heart rate reserve

b. stroke volume and heart rate

c. venous return and heart rate

d. ejection fraction and heart rate reserve

b

A therapist begins an exercise session with a patient diagnosed with left sided heart failure. Which of the following findings would most likely occur with the initiation of the exercise session?

a. hyperoxemia

b. dyspnea

c. bradycardia

d. pitting edema

b

A patient in a cardiac rehabilitation program is clinically stable, independent with self-monitoring techniques, and no longer requires electrocardiograph monitoring. This description is most consistent with a patient entering:

a. phase I

b. phase II

c. phase III

d. phase IV

c

The most appropriate location to palpate the posterior tibial artery is on the:

a. anterior aspect of the medial malleolus

b. posterior aspect of the medial malleolus

c. anterior aspect of the lateral malleolus

d. posterior aspect of the lateral malleolus

b

A therapist reviews a laboratory report for a patient receiving oral anticoagulant therapy. Which test would be most important to determine the effectiveness of the therapy?

a. hematocrit

b. hemoglobin

c. platelet count

d. prothrombin time

d

What value is most representative of the pH of arterial blood?

a. 7.2

b. 7.3

c. 7.4

d. 7.5

c

Which of the following values would be considered a normal platelet count?

a. 100,000 /mm3

b. 250,000 /mm3

c. 500,000 /mm3

d. 700,000 /mm3

b

Which component of the cardiac cycle would be the most useful in identifying the presence of myocardial ischemia?

a. P wave

b. QRS complex

c. ST segment

d. T wave

c

Which of the following conditions would maintain a normal heart rate of 60-100 beats per minute?

a. atrial fibrillation

b. premature atrial contractions

c. supraventricular tachycardia

d. ventricular tachycardia

B

A therapist attempts to locate the ulnar artery at the wrist. Which two tendons should the therapist utilize to locate the ulnar artery?

a. extensor digitorum and extensor carpi ulnaris

b. extensor digiti minimi and extensor carpi ulnaris

c. flexor carpi radialis and flexor carpi ulnaris

d. flexor digitorum superficialis and flexor carpi ulnaris

D

A therapist notes that the pulse of a patient with premature ventricular contractions skips every other beat. This finding is best termed?

a. couplet

b. bigeminy

c. trigemini

d. quadrigeminy

B

Which of the following would be a common laboratory finding for a patient receiving chemotherapy?

a. high hematocrit

b. low white blood cell count

c. high platelet count

d. low prothrombin time

B

Which Korotkoff's sound is most closely associated with diastolic pressure?

a. phase II

b. phase III

c. phase IV

d. phase V

C

A therapist attempts to quantify the resting pulse rate of a patient with an irregular heart rhythm using an upper extremity pulse site. Which variable would be the most critical to control in order to obtain a valid measurement?

a. location of the pulse site

b. patient position

c. duration of the pulse assessment

d. position of the extremity

C

A therapist assesses the blood pressure of a patient that repeatedly reports feeling dizzy when changing positions. Which blood pressure measurement would be most likely to produce this type of clinical finding?

a. 114 mm Hg systolic and 71 mm Hg diastolic

b. 110 mm Hg systolic and 81 mm Hg diastolic

c. 104 mm Hg systolic and 78 mm Hg diastolic

d. 96 mm Hg systolic and 73 mm Hg diastolic

D

Which structure serves as the primary pacemaker of the heart?

a. atrioventricular node

b. bundle of His

c. Purkinje fibers

d. sinoatrial node

D

A therapist reviews the medical record to determine a patient's ankle-brachial index. Which lower extremity locations would be utilized to obtain this measure?

a. femoral artery

b. popliteal artery

c. lateral plantar artery

d. dorsalis pedis artery

D

Which heart sound occurs when the aortic and pulmonic valves close at the onset of diastole?

a. S1

b. S2

c. S3

d. S4

B

A therapist assesses a patient's pulse by palpating along the medial aspect of the arm midway between the shoulder and elbow. This location would be used to assess the:

a. carotid artery

b. brachial artery

c. radial artery

d. ulnar artery

B

Which measurement method describes the technique used to determine the ankle-brachial index?

a. divide the obtained upper extremity systolic pressure by the obtained lower extremity systolic pressure

b. divide the obtained lower extremity systolic pressure by the obtained upper extremity systolic pressure

c. divide the obtained upper extremity diastolic pressure by the obtained lower extremity diastolic pressure

d. divide the obtained lower extremity diastolic pressure by the obtained upper extremity diastolic pressure

B

A therapist determines the target heart rate of a 45-year-old patient using the age-adjusted target heart rate formula. Which of the following heart rates would fall within the patient's normal training range?

a. 104 beats per minute

b. 145 beats per minute

c. 160 beats per minute

d. 183 beats per minute

B

Which activity would be most consistent with a metabolic equivalent level of 5 METs?

a. dressing

b. walking at 4 miles per hour

c. toileting

d. showering

B

A therapist assesses the oxygen saturation rate of a patient using supplemental oxygen. What is the minimum level of oxygen saturation the patient should maintain?

a. 80%

b. 85%

c. 90%

d. 95%

C

A therapist educates a patient on modifiable and non-modifiable risk factors for cardiac pathology. Which factor would be considered modifiable?

a. age

b. sex

c. physical inactivity

d. family history

C

Which variable would have the greatest impact on the measurement of hematocrit?

a. hydration

b. nutrition

c. weight

d. age

A

Which pharmacological agent would increase the incidence of first-degree atrioventricular heart block?

a. anticoagulant agents

b. digitalis

c. diuretics

d. mucolytic agents

B

Which of the following medical conditions would result in a patient not being a candidate for cardiac rehabilitation?

a. myocardial infarction

b. coronary artery bypass surgery

c. peripheral vascular disease

d. thrombophlebitis

D

Which of the following would be considered a contraindication to cardiac rehabilitation?

a. resting systolic pressure of 185 mm Hg

b. resting diastolic pressure of 115 mm Hg

c. resting ST segment displacement of 1 mm

d. stable angina

B

A therapist attempts to assess the dorsalis pedis pulse. The most appropriate location to palpate is:

a. on the volar surface of the foot between the first and second metatarsals

b. on the dorsal surface of the foot between the first and second metatarsals

c. on the volar surface of the foot between the second and third metatarsals

d. on the dorsal surface of the foot between the second and third metatarsals

B

Which component of the cardiac cycle is most representative of ventricular depolarization?

a. P wave

b. QRS complex

c. ST segment

d. T wave

B

Which value would be most representative of an adult's normal resting cardiac output?

a. 5 liters per minute

b. 10 liters per minute

c. 15 liters per minute

d. 25 liters per minute

A

A note in the patient's medical record indicates that a patient should avoid any position that requires his head to be down. Which position would be the most problematic for the patient?

a. Trendelenburg position

b. reverse Trendelenburg position

c. Fowler's position

d. semi-Fowler's position

A

Which value would be considered the greatest risk factor associated with coronary artery disease?

a. 20 mg/dL high-density lipoproteins

b. 90 mg/dL low-density lipoproteins

c. 84 mm Hg diastolic blood pressure

d. 125 mm Hg systolic blood pressure

A

Which class of pharmacological agents would most likely be used to treat an acute angina attack?

a. calcium channel blockers

b. nitrates

c. diuretics

d. beta blockers

B

Which heart valve prevents blood from returning to the right ventricle?

a. aortic

b. mitral

c. pulmonic

d. tricuspid

C

Which of the following blood pressure measurements would be most representative of hypertension?

a. 138 mm Hg systolic and 88 mm Hg diastolic

b. 134 mm Hg systolic and 92 mm Hg diastolic

c. 128 mm Hg systolic and 83 mm Hg diastolic

d. 137 mm Hg systolic and 86 mm Hg diastolic

B

Which class of pharmacological agents decreases plasma volume by increasing the excretion of sodium and urine?

a. calcium channel blockers

b. nitrates

c. diuretics

d. beta blockers

C

Which structure consists of a double-walled connective tissue sac that surrounds the heart and protects it from trauma and infection?

a. endocardium

b. epicardium

c. myocardium

d. pericardium

D

A therapist notes that a patient's medication makes it extremely difficult for them to reach their target heart range during exercise. Which class of pharmacological agents would be most likely to produce the described effect?

a. bronchodilators

b. diuretics

c. beta blockers

d. glucocorticoids

C

Which period of the cardiac cycle includes the emptying of blood from the atria to the ventricles?

a. atrial systole

b. atrial diastole

c. ventricular systole

d. ventricular diastole

A

Which clinical condition is characterized by a heart rate between 160 and 250 beats per minute?

a. complete heart block

b. supraventricular tachycardia

c. premature atrial contractions

d. premature ventricular contractions

B

Which component of the cardiac cycle represents atrial depolarization?

a. P wave

b. QRS complex

c. ST segment

d. T wave

A

A note in the patient's medical record indicates the presence of anemia. Which laboratory test finding would be most consistent with the described state?

a. decreased hematocrit

b. increased hemoglobin

c. increased platelet count

d. decreased prothrombin time

A

Results of recent laboratory testing indicate that a patient may be at risk for easily bruising and bleeding. This finding is most consistent with a/an:

a. increased hematocrit

b. decreased hemoglobin

c. decreased platelet count

d. increased white blood cell count

C

A therapist plans to assess a patient's pulse for 15 seconds to determine their resting heart rate. Which variable would provide the best rationale for increasing the duration of the pulse assessment?

a. change in rhythm

b. strength of the pulse

c. location of the pulse

d. position of the patient

A

Which position would be the most appropriate for a patient experiencing orthostatic hypotension?

a. Trendelenburg position

b. reverse Trendelenburg position

c. Fowler's position

d. semi-Fowler's position

A

Which class of pharmacological agents places a patient at increased risk of bleeding?

a. antiarrhythmic agents

b. angiotensin-converting enzyme inhibiting agents

c. anticoagulant agents

d. alpha adrenergic antagonist agents

C

A therapist reviews the results of an arterial blood gas analysis performed on a male patient. Which value would be most representative of a normal hematocrit?

a. 16 mL/dL

b. 24 mL/dL

c. 38 mL/dL

d. 46 mL/dL

D

Which artery serves as the primary artery that carries blood from the right ventricle to the lungs?

a. aorta

b. circumflex

c. pulmonary

d. right coronary

C

Which heart valve prevents the systemic blood from returning to the left ventricle?

a. aortic

b. mitral

c. pulmonic

d. tricuspid

A

Which etiology would most likely be associated with right-sided heart failure?

a. hypertension

b. coronary artery disease

c. aortic valve disease

d. pulmonic valve disease

D

A therapist uses the borders of the femoral triangle to identify the femoral artery. Which structure DOES NOT serve as a border for the femoral triangle?

a. sartorius

b. adductor longus

c. gracilis

d. inguinal ligament

C

Which of the following would not be considered a lower extremity pulse site?

a. popliteal

b. temporal

c. dorsal pedal

d. posterior tibial

B

Which phase of cardiac rehabilitation typically concludes with a low-level exercise test?

a. phase I

b. phase II

c. phase III

d. phase IV

A

Which finding would necessitate the termination of low-level exercise for a patient participating in a cardiac rehabilitation program?

a. a decrease in systolic blood pressure of 15 mm Hg

b. an increase in diastolic blood pressure of 5 mm Hg

c. heart rate of 108 beats per minute during exercise

d. mild lower extremity claudication

A

Which Korotkoff's sound is associated with a patient's systolic blood pressure?

a. phase I

b. phase II

c. phase III

d. phase IV

A

Which period of the cardiac cycle is characterized by ventricular relaxation and filling?

a. atrial systole

b. atrial diastole

c. ventricular systole

d. ventricular diastole

D

Which clinical condition would be considered a potential clinical emergency?

a. premature atrial contractions

b. atrial fibrillation

c. ventricular fibrillation

d. supraventricular tachycardia

C

Which value would represent the age-adjusted maximum heart rate for a 56-year-old male?

a. 174

b. 169

c. 164

d. 156

C

An individual with a high caffeine intake may have increased susceptibility to:

a. ventricular tachycardia

b. premature ventricular contractions

c. atrial fibrillation

d. supraventricular tachycardia

B

Which pharmacological agent decreases the heart's oxygen demand by minimizing the effect of epinephrine?

a. beta blockers

b. diuretics

c. angiotensin-converting enzyme inhibitors

d. nitrates

A

Which heart structure receives arterial blood from the pulmonary veins?

a. left atrium

b. right atrium

c. left ventricle

d. right ventricle

A

Which structure would be the least appropriate to utilize when palpating an artery as part of a pulse assessment?

a. index finger

b. middle finger

c. ring finger

d. thumb

D

A therapist discusses a general cardiovascular training program with a patient scheduled to be discharged from physical therapy. What percentage of the age-adjusted maximum heart rate would be considered within a normal training range?

a. 45%

b. 55%

c. 75%

d. 95%

C

A therapist treats a patient taking an anticoagulant medication. When treating the patient the therapist should be aware that the patient is at an increased risk of:

a. pulmonary edema

b. arrhythmias

c. orthostatic hypotension

d. bleeding

D

Which value is most representative of the partial pressure of oxygen in arterial blood?

a. 40 mm Hg

b. 55 mm Hg

c. 70 mm Hg

d. 85 mm Hg

D

Which heart structure is responsible for pumping blood into the aorta and the systemic circulation?

a. left ventricle

b. right ventricle

c. left atria

d. right atria

A

Which area of the body is not supplied with blood from the ascending aorta?

a. head

b. neck

c. arms

d. visceral tissues

D

Which cardiac medication acts to decrease cardiac contractility and increase vasodilation resulting in a reduction of the heart's oxygen demand?

a. antiarrhythmics

b. calcium channel blockers

c. angiotensin-converting enzyme inhibitors

d. antithrombotics

B

White blood cell count is not used in the assessement of:

a. bone marrow integrity

b. degree of immunosuppression

c. extrinsic coagulations factors

d. infection

C

Which diagnosis is characterized by pressure in the substernal area without radiating pain?

a. emphysema

b. myocardial infarction

c. restrictive lung disease

d. congestive heart failure

B

What cardiac measure would most closely approximate the volume associated with a patient's venous return?

a. ejection fraction

b. blood volume

c. cardiac output

d. stroke volume

C

What artery can be palpated deep within the posterior aspect of the knee?

a. posterior tibial artery

b. popliteal artery

c. dorsalis pedis artery

d. fibular artery

B

Laboratory testing reveals that a patient has an extremely high platelet count. The primary risk for the patient is:

a. thrombosis

b. bleeding

c. anemia

d. immunosuppression

A

A physical therapist observes an electrocardiogram of a patient on beta-blockers. Which of the following electrocardiogram changes could be facilitated by beta blockers?

a. sinus bradycardia

b. sinus tachycardia

c. premature ventricular contractions

d. ST segment sagging

A

A physical therapist monitors a patient's vital signs while completing 20 minutes of jogging at 5 mph on a treadmill. As the session approaches its conclusion, the therapist incorporates a cool down period. The anticipated response during the post-exercise period is:

a. a progressive increase in systolic blood pressure

b. a progressive decrease in systolic blood pressure

c. a progressive increase in diastolic blood pressure

d. a progressive increase in rate pressure product

B

3. A physical therapist determines that a 67-year-old female is at an increased fall risk after being prescribed a new medication that tends to promote postural hypotension. The mediation MOST consistent with the described scenario is:

a. ACE inhibitor

b. antiepileptic agents

c. anticoagulant agents

d. antispasticity agents

A

4. A patient treated in an acute care hospital one day ago is not able to attend a scheduled physical therapy session due to suspected critical limb ischemia. Which symptom is MOST commonly associated with this condition?

a. severe pain in the legs and feet at rest

b. increased temperature in the lower leg and foot

c. bounding lower extremity peripheral pulses

d. flaking skin on the legs with brownish discoloration

A

5. A physical therapist attempts to calculate the target heart rate range for a 40-year-old female with no significant past medical history. The patient's resting heart rate is recorded as 60 beats per minute and the maximal heart rate is 180 beats per minute. Using the heart rate reserve method (Karvonen formula) and a range of 60%-80% intensity, the patient's target heart rate range should be recorded as:

a. 96-120 bpm

b. 132-156 bpm

c. 144-174 bpm

d. 164-185 bpm

B

6. A patient exercising in the physical therapy gym informs the physical therapist that he is experiencing chest pain. After resting for 20 minutes the patient's condition is unchanged, however, he insists it is something he can work through. The MOST appropriate therapist action is:

a. allow the patient to resume exercise and continue to monitor the patient's condition

b. reduce the intensity of the exercise and continue to monitor the patient's condition

c. discontinue the treatment session and encourage the patient to make an appointment with his physician

d. discontinue the treatment session and call an ambulance

D

7. A patient with a lengthy medical history of cardiac pathology is referred to a phase II cardiac rehabilitation program. During the first session the physical therapist prepares to measure the patient's blood pressure by inflating the cuff 20 mm Hg above the patient's estimated systolic value. Which of the following values describes the MOST appropriate rate to release the pressure when obtaining the blood pressure measurement?

a. 2-3 mm Hg per second

b. 3-5 mm Hg per second

c. 5-7 mm Hg per second

d. 8-10 mm Hg per second

A

8. 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 175 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. 135 beats per minute

c. 169 beats per minute

d. 195 beats per minute

B

9. A physical therapist employed in an acute care hospital reviews the medical record of a patient diagnosed with congestive heart failure. The therapist would like to implement a formal exercise program, but is concerned about the patient's exercise tolerance. Which condition is MOST responsible for the patient's limited exercise tolerance?

a. diminished lung volume

b. arterial oxygen desaturation

c. insufficient stroke volume during ventricular systole

d. excessive rise in blood pressure

C

10. A physical therapist monitors the blood pressure response to exercise of a 52-year-old male on a stationary bicycle. The therapist notes a relatively linear increase in systolic blood pressure with increasing exercise intensity. The change in the patient's systolic blood pressure with exercise is BEST explained by:

a. increased cardiac output

b. decreased peripheral resistance

c. increased oxygen saturation

d. decreased myocardial oxygen consumption

A

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

C

12. A physical therapist reviews the medical record of a 52-year-old male status post myocardial infarction. The patient is currently in the coronary care unit and is scheduled to begin cardiac rehabilitation tomorrow. 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

B

13. A physical therapist reads in the medical chart that a patient is taking digitalis. The patient is MOST likely taking this medication to treat:

a. angina

b. atrial fibrillation

c. hypertension

d. thrombus formation

B

14. A physical therapist reviews the medical record of a patient 24 hours status post total hip arthroplasty. A recent entry in the medical record indicates that the patient was placed on anticoagulant medication. Which of the following laboratory values would be MOST affected based on the patient's current medication?

a. hematocrit

b. hemoglobin

c. prothrombin time

d. white blood cell count

C

15. 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

A

16. A physical therapist attempts to auscultate over the aortic valve. Which of the following areas is the MOST appropriate to isolate the desired valve?

a. second left intercostal space at the left sternal border

b. second right intercostal space at the right sternal border

c. fourth left intercostal space along the lower left sternal border

d. fifth left intercostal space at the midclavicular line

B

17. A patient with known cardiac disease experiences angina while exercising on a recumbent bicycle. The patient self-administers a nitroglycerin tablet to control the angina. Nitroglycerin helps control this symptom by:

a. decreasing heart rate

b. inhibiting vasospasm of the coronary arteries

c. dilating peripheral arteries and veins

d. decreasing platelet aggregation

C

18. A physical therapist employed in an acute care hospital conducts an initial interview with a patient referred to physical therapy. During the interview, the therapist asks the patient if he feels dependent on coffee, tea or soft drinks. Which clinical scenario would MOST appropriately warrant this type of question?

a. a 27-year-old female status post arthroscopic medial meniscectomy

b. a 42-year-old male with premature ventricular contractions

c. a 37-year-old female with restrictive pulmonary disease

d. a 57-year-old male with respiratory alkalosis

B

19. A physical therapist monitors the blood pressure of a 28-year-old male during increasing levels of physical exertion. Assuming a normal physiologic response, which of the following BEST describes the patient's blood pressure response to dynamic exercise?

a. systolic pressure decreases, diastolic pressure increases

b. systolic pressure remains the same, diastolic pressure increases

c. systolic pressure and diastolic pressure remain the same

d. systolic pressure increases, diastolic pressure remains the same

D

20. A physical therapist attempts to monitor exercise intensity during an exercise session with a patient after cardiac transplantation. The MOST appropriate method is:

a. metabolic equivalents

b. perceived exertion scale

c. pulmonary function tests

d. target heart rate range

B

21. Echocardiographic testing revealed a significant decrease in a patient's anticipated cardiac output. Which variable would MOST likely contribute to this finding?

a. increase in heart rate

b. increase in preload

c. increase in afterload

d. increase in stroke volume

C

22. A physical therapist attempts to identify a patient's risk factors for coronary artery disease as part of a health screening. The patient's heart rate is recorded as 78 beats per minute and blood pressure as 110/70 mm Hg. A recent laboratory report indicates a total cholesterol level of 170 mg/dL with high-density lipoproteins reported as 20 mg/dL and low-density lipoproteins as 100 mg/dL. Which of the following values would be considered atypical?

a. heart rate

b. blood pressure

c. high-density lipoproteins (HDL)

d. low-density lipoproteins (LDL)

C

23. A patient rehabilitating from congestive heart failure is examined in physical therapy. During the examination the patient begins to complain of pain. The MOST immediate physical therapist action is to:

a. notify the nursing staff to administer pain medication

b. contact the referring physician

c. discontinue the treatment session

d. ask the patient to describe the location and severity of the pain

D