CRE Technology & Digital Tools 3 — Questions and Answers
Question 1: A patient's digital pulmonary rehabilitation platform shows declining step counts and session completion rates over two weeks. The educator's BEST response is to:
- Automatically discharge the patient due to non-adherence
- Schedule a motivational check-in to identify barriers and adjust the program (Correct answer)
- Increase exercise intensity targets to improve engagement
- Report the data to the insurance company for claim review
Correct answer: Schedule a motivational check-in to identify barriers and adjust the program
Declining engagement metrics signal barriers that require a supportive check-in to identify and address root causes before adjusting the program.
Question 2: Which capnography waveform pattern is characteristic of bronchospasm or COPD exacerbation?
- A rectangular waveform with a sharp vertical upstroke and flat plateau
- A 'shark fin' waveform with a sloped, gradual rise to peak ETCO2 (Correct answer)
- A flat waveform with ETCO2 near zero
- A waveform with a notch on the expiratory plateau
Correct answer: A 'shark fin' waveform with a sloped, gradual rise to peak ETCO2
The 'shark fin' (sloped expiratory upstroke) pattern reflects uneven CO2 emptying due to airway obstruction in bronchospasm or COPD.
Question 3: A remote patient monitoring program transmits nightly pulse oximetry data. Which value should trigger an automated alert to the care team per standard protocols?
- SpO2 consistently 97-99%
- SpO2 below 88% for more than 5 minutes (Correct answer)
- SpO2 fluctuating between 92% and 95% during sleep
- SpO2 of 95% with no change in trend
Correct answer: SpO2 below 88% for more than 5 minutes
SpO2 sustained below 88% is the standard threshold for clinically significant nocturnal hypoxemia requiring evaluation.
Question 4: When conducting a virtual inhaler technique assessment via video, the educator notes they cannot verify the patient's inspiratory flow rate. The BEST solution is:
- Assume the technique is correct based on visual observation alone
- Mail an In-Check DIAL or similar training device so flow can be quantified at the next visit (Correct answer)
- Discontinue telehealth visits for inhaler education
- Ask the patient to self-report whether breathing felt adequate
Correct answer: Mail an In-Check DIAL or similar training device so flow can be quantified at the next visit
Mailing a low-tech inspiratory flow training device enables objective flow assessment at a subsequent in-person or virtual session.
Question 5: A respiratory educator reviews oscillometry (impulse oscillometry, IOS) results. Elevated R5-R20 difference primarily indicates:
- Restrictive lung disease with reduced total lung capacity
- Peripheral (small) airway resistance disproportionate to central airway resistance (Correct answer)
- Diffusion impairment of carbon monoxide
- Upper airway obstruction during inspiration
Correct answer: Peripheral (small) airway resistance disproportionate to central airway resistance
R5 measures total (central + peripheral) resistance while R20 reflects mainly central airways; an elevated R5-R20 difference indicates peripheral airway disease.
Question 6: A digital asthma action plan app allows patients to log symptoms and PEF daily. Which feature is MOST critical for safety?
- Social sharing of daily symptom scores
- Automated color-zone thresholds that prompt the patient to contact their provider or call 911 (Correct answer)
- Gamification points for consecutive logging days
- Integration with the patient's fitness tracker calorie data
Correct answer: Automated color-zone thresholds that prompt the patient to contact their provider or call 911
Automated action-zone thresholds that escalate to provider contact or emergency services are the safety-critical feature in digital asthma action plans.
Question 7: Which interoperability standard enables EHR systems from different vendors to exchange respiratory function test results?
- PDF/A archiving format
- HL7 FHIR (Fast Healthcare Interoperability Resources) (Correct answer)
- DICOM imaging protocol exclusively
- CSV file export via secure email
Correct answer: HL7 FHIR (Fast Healthcare Interoperability Resources)
HL7 FHIR provides a standardized API framework that enables different EHR systems to exchange structured clinical data, including pulmonary function results.
CRE Technology & Digital Tools 3
A patient's digital pulmonary rehabilitation platform shows declining step counts and session completion rates over two weeks.
The educator's BEST response is to: