NPTE-PT Cardiopulmonary Assessment and Management — Questions and Answers

Question 1: A patient with COPD has a PaCO2 of 55 mmHg and pH of 7.32. Which acid-base disturbance does this represent?

Respiratory alkalosis
Metabolic acidosis
Respiratory acidosis (Correct answer)
Metabolic alkalosis

Correct answer: Respiratory acidosis

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

Question 2: During auscultation, a physical therapist hears a high-pitched, continuous musical sound during expiration. This is best described as:

Crackles
Wheezing (Correct answer)
Rhonchi
Stridor

Correct answer: Wheezing

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

Question 3: 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:

Continue ambulation and recheck in 5 minutes
Stop activity, apply supplemental oxygen, and notify nursing (Correct answer)
Increase ambulation pace to improve cardiac output
Document and proceed with the session

Correct 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.

Question 4: Which breathing pattern is characterized by alternating periods of hyperpnea and apnea, often seen in patients with heart failure or neurological damage?

Kussmaul breathing
Biot's breathing
Cheyne-Stokes respiration (Correct answer)
Apneustic breathing

Correct 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.

Question 5: A physical therapist is treating a patient with left-sided heart failure. Which pulmonary finding is MOST expected on auscultation?

Expiratory wheezes bilaterally
Bilateral basilar crackles (Correct answer)
Absent breath sounds at the apex
Pleural friction rub

Correct answer: Bilateral basilar crackles

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

Question 6: When performing airway clearance with postural drainage, which position is used to drain the right middle lobe?

Prone with pillow under abdomen
Left side-lying with bed tilted head-down (Correct answer)
Right side-lying with bed flat
Supine with bed tilted head-down

Correct 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.

Question 7: 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:

Ventricular tachycardia
Atrial flutter
Atrial fibrillation (Correct answer)
Junctional tachycardia

Correct answer: Atrial fibrillation

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

Question 8: Which parameter BEST reflects a patient's ventilatory reserve during a cardiopulmonary exercise test?

Maximum heart rate achieved
Breathing reserve (MVV minus peak VE) (Correct answer)
Oxygen pulse at peak exercise
Anaerobic threshold

Correct 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.

Question 9: A 6-Minute Walk Test is performed on a patient with pulmonary fibrosis. The MOST important physiologic variable to monitor during this test is:

Blood pressure
Rate of perceived exertion only
Oxygen saturation via pulse oximetry (Correct answer)
Respiratory rate

Correct 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.

Question 10: The Borg RPE scale is used during cardiopulmonary rehabilitation. A patient reports an RPE of 13. This corresponds to which perceived exertion level?

Light
Somewhat hard (Correct answer)
Hard
Very hard

Correct 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.

Question 11: A patient with a recent MI is in Phase I cardiac rehabilitation. Which activity is MOST appropriate during this phase?

Treadmill walking at 3.5 METs
Low-intensity ADLs and bedside range of motion (Correct answer)
Stationary cycling at 70% of max heart rate
Stair climbing with moderate resistance

Correct 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.

Question 12: 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:

Pneumothorax
Pleural effusion
Lobar pneumonia (Correct answer)
Pulmonary embolism

Correct 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.

Question 13: 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:

Left-sided pneumonia
Right-sided pleural effusion
Left-sided tension pneumothorax (Correct answer)
Pulmonary embolism

Correct 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.

Question 14: Which diaphragmatic breathing technique MOST effectively reduces accessory muscle use in a patient with COPD?

Pursed-lip breathing combined with diaphragmatic breathing (Correct answer)
Glossopharyngeal breathing
Incentive spirometry
Controlled coughing technique

Correct 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.

Question 15: 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:

Increased lung compliance
Circuit leak or airway disconnect (Correct answer)
Decreased respiratory rate
Auto-PEEP

Correct 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.

Question 16: The ankle-brachial index (ABI) is 0.55 in a patient referred for cardiac rehabilitation. The therapist should:

Proceed with full aerobic exercise program
Avoid all lower extremity exercise
Modify exercise intensity and monitor for claudication symptoms (Correct answer)
Refer directly to vascular surgery before any exercise

Correct 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.

Question 17: Which of the following is the CORRECT normal range for arterial oxygen partial pressure (PaO2) in a healthy adult breathing room air?

60–70 mmHg
75–100 mmHg (Correct answer)
45–55 mmHg
100–120 mmHg

Correct answer: 75–100 mmHg

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

Question 18: 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:

Hypoventilation
Ventilation-perfusion mismatch (Correct answer)
Diffusion impairment
Right-to-left shunt

Correct 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.

Question 19: A physical therapist is performing manual chest physiotherapy on a patient with cystic fibrosis. The MOST important contraindication to percussion and vibration is:

Bronchiectasis
Recent rib fracture or osteoporosis (Correct answer)
Productive cough with thick sputum
Barrel chest deformity

Correct 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.

Question 20: 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:

Reduce exercise intensity by 10%
Stop exercise immediately and notify the physician (Correct answer)
Continue and recheck after 2 minutes
Administer sublingual nitroglycerin

Correct 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.

Question 21: In a patient with right-sided heart failure, which of the following peripheral signs would the therapist MOST likely observe?

Pulmonary crackles and orthopnea
Jugular venous distension and peripheral edema (Correct answer)
Frothy pink sputum and paroxysmal nocturnal dyspnea
Cyanosis of the lips and reduced SpO2

Correct answer: Jugular venous distension and peripheral edema

Right-sided heart failure causes backpressure in the systemic venous circulation, leading to jugular venous distension, hepatomegaly, and dependent peripheral edema.

NPTE-PT Cardiopulmonary Assessment and Management

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

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