NPTE-PT Cardiopulmonary Assessment and Management 5 — Questions and Answers
Question 1: A patient reports dyspnea at rest, orthopnea requiring 3 pillows to sleep, and has a chest X-ray showing an enlarged cardiac silhouette. These findings are MOST consistent with:
- Acute asthma exacerbation
- Congestive heart failure (Correct answer)
- Spontaneous pneumothorax
- Pulmonary fibrosis
Correct answer: Congestive heart failure
Dyspnea at rest, orthopnea, and an enlarged cardiac silhouette on chest X-ray are classic hallmarks of congestive heart failure.
Question 2: Which metric is used to calculate a patient's target heart rate using the Karvonen (heart rate reserve) method?
- (Max HR − Resting HR) × intensity% + Resting HR (Correct answer)
- (220 − age) × intensity%
- Max HR × intensity%
- (Max HR + Resting HR) / 2 × intensity%
Correct answer: (Max HR − Resting HR) × intensity% + Resting HR
The Karvonen formula uses heart rate reserve (max HR − resting HR) multiplied by the desired intensity percentage, then adds resting HR to give target HR.
Question 3: A patient has a forced expiratory volume in 1 second (FEV1) of 60% predicted and an FEV1/FVC ratio of 0.65. These findings indicate:
- Restrictive lung disease
- Normal pulmonary function
- Obstructive lung disease (Correct answer)
- Mixed obstructive-restrictive disease
Correct answer: Obstructive lung disease
A reduced FEV1/FVC ratio below 0.70 with a reduced FEV1% predicted is diagnostic of obstructive lung disease such as asthma or COPD.
Question 4: When using the Active Cycle of Breathing Technique (ACBT) for airway clearance, the CORRECT sequence of components is:
- Forced expiratory technique → breathing control → thoracic expansion exercises
- Breathing control → thoracic expansion exercises → forced expiratory technique (Correct answer)
- Thoracic expansion exercises → forced expiratory technique → breathing control
- Forced expiratory technique → thoracic expansion exercises → breathing control
Correct answer: Breathing control → thoracic expansion exercises → forced expiratory technique
ACBT follows the sequence: breathing control (diaphragmatic relaxation) → thoracic expansion exercises (deep breathing) → forced expiratory technique (huffing), repeated cyclically.
Question 5: A patient with a spinal cord injury at C5 undergoes pulmonary function testing. The MOST expected finding is:
- Reduced FVC with preserved FEV1/FVC ratio (restrictive pattern) (Correct answer)
- Reduced FEV1/FVC ratio with preserved FVC (obstructive pattern)
- Normal pulmonary function
- Isolated reduction in diffusing capacity (DLCO)
Correct answer: Reduced FVC with preserved FEV1/FVC ratio (restrictive pattern)
C5 SCI impairs intercostal and abdominal muscle function while partially preserving diaphragm function, resulting in reduced lung volumes and a restrictive pulmonary pattern.
Question 6: During ambulation with a post-surgical patient, the therapist notes a heart rate increase from 72 bpm at rest to 130 bpm with mild activity. The MOST appropriate interpretation is:
- Chronotropic incompetence requiring immediate cessation
- An abnormal response indicating cardiac pathology
- A normal physiological response to exercise in a deconditioned patient (Correct answer)
- Supraventricular tachycardia requiring ECG confirmation
Correct answer: A normal physiological response to exercise in a deconditioned patient
A heart rate of 130 bpm during mild activity in a deconditioned post-surgical patient is within an expected physiological range and does not alone indicate pathology.
Question 7: A patient with emphysema demonstrates a barrel chest. Which underlying pathophysiological mechanism BEST explains this finding?
- Fibrosis causing lung retraction and chest wall inward pull
- Air trapping due to loss of elastic recoil causing hyperinflation (Correct answer)
- Increased respiratory muscle tone causing rib cage expansion
- Chronic pleural effusion pushing the chest wall outward
Correct answer: Air trapping due to loss of elastic recoil causing hyperinflation
Emphysema destroys alveolar walls and reduces elastic recoil, causing air trapping and chronic lung hyperinflation that remodels the chest into a barrel shape.
NPTE-PT Cardiopulmonary Assessment and Management 5
A patient reports dyspnea at rest, orthopnea requiring 3 pillows to sleep, and has a chest X-ray showing an enlarged cardiac silhouette.
These findings are MOST consistent with: