Cardiopulmonary Assessment and Management Flashcards

A patient with COPD has a PaCO2 of 55 mmHg and pH of 7.32. Which acid-base disturbance does this represent?

Answer: Respiratory acidosis

Elevated PaCO2 (>45 mmHg) combined with decreased pH (<7.35) indicates respiratory acidosis.

During auscultation, a physical therapist hears a high-pitched, continuous musical sound during expiration. This is best described as:

Answer: Wheezing

Wheezing is a high-pitched, continuous, musical sound caused by narrowed airways, most commonly heard during expiration.

A patient post-CABG is on day 2. The therapist notices the patient's SpO2 drops from 95% to 88% during ambulation. The MOST appropriate action is:

Answer: Stop activity, apply supplemental oxygen, and notify nursing

An SpO2 drop below 90% during activity is a contraindication to continuing exercise and requires immediate supplemental oxygen and medical notification.

Which breathing pattern is characterized by alternating periods of hyperpnea and apnea, often seen in patients with heart failure or neurological damage?

Answer: Cheyne-Stokes respiration

Cheyne-Stokes respiration features a cyclic pattern of gradual increase and decrease in tidal volume followed by apnea, associated with heart failure or brain injury.

A physical therapist is treating a patient with left-sided heart failure. Which pulmonary finding is MOST expected on auscultation?

Answer: Bilateral basilar crackles

Left-sided heart failure causes pulmonary edema, leading to bilateral basilar crackles from fluid accumulation in the lung bases.

When performing airway clearance with postural drainage, which position is used to drain the right middle lobe?

Answer: Left side-lying with bed tilted head-down

The right middle lobe is drained with the patient in left side-lying position with a slight head-down tilt to use gravity effectively.

A patient's ECG shows a heart rate of 150 bpm with narrow QRS complexes and no identifiable P waves. This rhythm is MOST consistent with:

Answer: Atrial fibrillation

Atrial fibrillation presents with an irregularly irregular rhythm, absent P waves, and narrow QRS complexes at an elevated ventricular rate.

Which parameter BEST reflects a patient's ventilatory reserve during a cardiopulmonary exercise test?

Answer: Breathing reserve (MVV minus peak VE)

Breathing reserve (MVV − peak VE) indicates how close a patient is to their maximum ventilatory capacity, reflecting ventilatory limitation.

A 6-Minute Walk Test is performed on a patient with pulmonary fibrosis. The MOST important physiologic variable to monitor during this test is:

Answer: Oxygen saturation via pulse oximetry

Patients with pulmonary fibrosis are prone to severe exercise-induced desaturation, making continuous SpO2 monitoring essential during the 6MWT.

The Borg RPE scale is used during cardiopulmonary rehabilitation. A patient reports an RPE of 13. This corresponds to which perceived exertion level?

Answer: Somewhat hard

On the original Borg 6–20 scale, a rating of 13 corresponds to 'somewhat hard,' which is a moderate intensity typically targeted in cardiac rehab.

A patient with a recent MI is in Phase I cardiac rehabilitation. Which activity is MOST appropriate during this phase?

Answer: Low-intensity ADLs and bedside range of motion

Phase I (inpatient) cardiac rehab focuses on low-intensity activities (1–2 METs) such as ADLs and gentle range of motion to prevent deconditioning without stressing the heart.

A therapist reviews a chest X-ray and notes opacification of the right lower lobe with an air bronchogram. This radiographic finding is MOST consistent with:

Answer: Lobar pneumonia

Air bronchograms within an area of opacification indicate air-filled bronchi surrounded by consolidated (fluid-filled) lung tissue, characteristic of lobar pneumonia.

During a physical therapy session, a patient suddenly develops tracheal deviation toward the right side, absent breath sounds on the left, and hypotension. The therapist should suspect:

Answer: Left-sided tension pneumothorax

Tension pneumothorax causes tracheal deviation away from the affected side due to mediastinal shift, along with absent breath sounds and hemodynamic compromise.

Which diaphragmatic breathing technique MOST effectively reduces accessory muscle use in a patient with COPD?

Answer: Pursed-lip breathing combined with diaphragmatic breathing

Pursed-lip breathing slows expiration and maintains positive airway pressure to prevent dynamic airway collapse, and when combined with diaphragmatic breathing reduces accessory muscle recruitment.

A patient receiving mechanical ventilation has a tidal volume of 800 mL set on the ventilator but only 550 mL is delivered to the patient. The MOST likely cause is:

Answer: Circuit leak or airway disconnect

A significant discrepancy between set and delivered tidal volume in a ventilated patient most commonly results from a circuit leak or partial airway disconnection.

The ankle-brachial index (ABI) is 0.55 in a patient referred for cardiac rehabilitation. The therapist should:

Answer: Modify exercise intensity and monitor for claudication symptoms

An ABI of 0.55 indicates moderate peripheral arterial disease; exercise is beneficial but must be adjusted in intensity with close monitoring for intermittent claudication.

Which of the following is the CORRECT normal range for arterial oxygen partial pressure (PaO2) in a healthy adult breathing room air?

Answer: 75–100 mmHg

Normal PaO2 on room air ranges from 75–100 mmHg; values below 60 mmHg indicate hypoxemia requiring supplemental oxygen.

A patient with a pulmonary embolism has a PaO2 of 58 mmHg and PaCO2 of 30 mmHg. The primary mechanism of hypoxemia in this case is:

Answer: Ventilation-perfusion mismatch

Pulmonary embolism creates dead space (ventilated but unperfused alveoli), causing a V/Q mismatch that leads to hypoxemia despite a low PaCO2 from compensatory hyperventilation.

A physical therapist is performing manual chest physiotherapy on a patient with cystic fibrosis. The MOST important contraindication to percussion and vibration is:

Answer: Recent rib fracture or osteoporosis

Recent rib fractures or severe osteoporosis are absolute contraindications to percussion and vibration because of the risk of further fracture or injury.

During cardiac monitoring, a therapist notices ST-segment elevation of 3 mm in leads II, III, and aVF during exercise. The BEST immediate action is:

Answer: Stop exercise immediately and notify the physician

ST-segment elevation during exercise indicates myocardial ischemia or acute MI and is an absolute indication to stop exercise testing or rehabilitation immediately.