NPTE-PT Cardiopulmonary Assessment and Management 4 — Questions and Answers
Question 1: 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 2: 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 3: 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 4: 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 5: 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 6: 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 7: 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 4
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: