NPTE-PT Cardiovascular and Pulmonary PT — Questions and Answers

Question 1: A patient with COPD demonstrates pursed-lip breathing during exertion. What is the PRIMARY physiological benefit of this technique?

Increases respiratory rate to improve ventilation
Creates back-pressure to prevent early airway collapse (Correct answer)
Strengthens the diaphragm by increasing resistance
Reduces functional residual capacity

Correct answer: Creates back-pressure to prevent early airway collapse

Pursed-lip breathing creates positive back-pressure during exhalation, preventing dynamic airway collapse and promoting more complete emptying of air trapping.

Question 2: Which ECG finding is MOST consistent with left ventricular hypertrophy?

Tall R waves in V1-V2 with deep S waves in V5-V6
Deep Q waves in leads II, III, and aVF
Tall R waves in V5-V6 with deep S waves in V1-V2 (Correct answer)
Peaked P waves greater than 2.5 mm in lead II

Correct answer: Tall R waves in V5-V6 with deep S waves in V1-V2

Left ventricular hypertrophy produces tall R waves in lateral leads (V5-V6) and deep S waves in right precordial leads (V1-V2) due to the enlarged left ventricular mass.

Question 3: A PT is treating a post-MI patient who suddenly develops a respiratory rate of 32 breaths/min, crackles bilaterally, and frothy pink sputum. Which condition does this BEST represent?

Pulmonary embolism
Pneumothorax
Acute pulmonary edema (Correct answer)
Lobar pneumonia

Correct answer: Acute pulmonary edema

Frothy pink sputum, bilateral crackles, and tachypnea following MI indicate acute pulmonary edema due to left heart failure and fluid extravasation into alveoli.

Question 4: During a 6-minute walk test, a patient's SpO2 drops from 96% to 87%. What is the MOST appropriate PT action?

Continue the test while monitoring closely
Stop the test and position the patient in Trendelenburg
Stop the test and administer supplemental oxygen if available (Correct answer)
Encourage the patient to slow their walking pace and continue

Correct answer: Stop the test and administer supplemental oxygen if available

A drop in SpO2 below 88% is a standard criterion to stop the 6MWT and apply supplemental oxygen per established safety guidelines.

Question 5: Which breathing exercise is MOST appropriate for a patient with a flail chest to improve ventilatory mechanics?

Incentive spirometry
Pursed-lip breathing
Glossopharyngeal breathing
Diaphragmatic breathing with manual stabilization (Correct answer)

Correct answer: Diaphragmatic breathing with manual stabilization

Manual stabilization of the paradoxical segment during diaphragmatic breathing reduces the inefficiency caused by the floating chest wall segment in flail chest.

Question 6: A patient status post-coronary artery bypass graft (CABG) has sternal precautions. Which activity is CONTRAINDICATED in early rehabilitation?

Ankle pumps in supine
Bilateral shoulder flexion to 90 degrees
Pushing up from a chair using both arms simultaneously (Correct answer)
Diaphragmatic breathing exercises

Correct answer: Pushing up from a chair using both arms simultaneously

Pushing up with both arms simultaneously creates bilateral sternal stress and risks sternal dehiscence, which is contraindicated with sternal precautions after CABG.

Question 7: Which pulmonary function test pattern is characteristic of restrictive lung disease?

Decreased FVC with normal or increased FEV1/FVC ratio (Correct answer)
Decreased FEV1 with decreased FEV1/FVC ratio
Normal FVC with decreased FEV1
Increased TLC with decreased FVC

Correct answer: Decreased FVC with normal or increased FEV1/FVC ratio

Restrictive disease reduces lung volumes including FVC, but since both FEV1 and FVC are proportionally reduced, the FEV1/FVC ratio remains normal or elevated.

Question 8: A physical therapist auscultates a patient's chest and hears a high-pitched, musical wheeze during expiration. Which condition is this finding MOST consistent with?

Pneumonia with consolidation
Pleural effusion
Asthma or bronchospasm (Correct answer)
Pulmonary fibrosis

Correct answer: Asthma or bronchospasm

High-pitched expiratory wheezing (sibilant rhonchi) results from narrowed lower airways during expiration, which is characteristic of bronchospasm in conditions like asthma.

Question 9: At what heart rate threshold should a PT terminate exercise in a patient on a beta-blocker, given the Karvonen formula cannot be used reliably?

110 bpm
130 bpm
Rate of perceived exertion of 13-15 on the Borg scale (Correct answer)
220 minus age

Correct answer: Rate of perceived exertion of 13-15 on the Borg scale

Beta-blockers blunt the heart rate response, making HR-based targets unreliable; RPE (Borg scale 13-15) is the preferred exercise intensity guide in these patients.

Question 10: Which chest drainage position is MOST appropriate for draining the right middle lobe in postural drainage?

Prone with the right side elevated 20 degrees
Supine with foot of bed elevated 18 inches
Left side-lying with foot of bed flat
Left side-lying with the head of bed down 15 degrees (Correct answer)

Correct answer: Left side-lying with the head of bed down 15 degrees

The right middle lobe drains optimally in the left side-lying position with slight head-down tilt (Trendelenburg), directing secretions toward the right mainstem bronchus.

Question 11: A patient with heart failure has a New York Heart Association (NYHA) Class III classification. What does this indicate about their functional capacity?

No symptoms; ordinary activity is well tolerated
Symptoms with less-than-ordinary activity; comfortable only at rest
Symptoms with ordinary activity; marked limitation (Correct answer)
Symptoms at rest; unable to carry on any activity without discomfort

Correct answer: Symptoms with ordinary activity; marked limitation

NYHA Class III denotes marked limitation of physical activity, with symptoms occurring during ordinary activity such as walking short distances, though comfortable at rest.

Question 12: A patient presents with tracheal deviation toward the right, absent breath sounds on the right, and hemodynamic instability. Which emergency condition is MOST likely?

Right-sided pleural effusion
Right-sided atelectasis
Tension pneumothorax on the left side (Correct answer)
Right-sided pneumothorax

Correct answer: Tension pneumothorax on the left side

Tension pneumothorax on the left shifts the trachea and mediastinum away from the affected side (toward the right) and is a life-threatening emergency requiring immediate intervention.

Question 13: Which outcome measure is MOST appropriate to assess functional exercise capacity in a patient with chronic heart failure?

Spirometry with FVC measurement
6-Minute Walk Test (6MWT) (Correct answer)
Maximum Voluntary Ventilation (MVV)
Peak expiratory flow rate

Correct answer: 6-Minute Walk Test (6MWT)

The 6MWT is a validated, submaximal functional exercise test that correlates with peak VO2 and clinical outcomes in heart failure populations.

Question 14: Which of the following is an absolute contraindication to initiating cardiopulmonary physical therapy?

Resting heart rate of 95 bpm
Blood pressure of 145/90 mmHg
Resting SpO2 of 91% on room air
Unstable angina with recent pain at rest (Correct answer)

Correct answer: Unstable angina with recent pain at rest

Unstable angina with rest pain indicates critical myocardial ischemia and is an absolute contraindication to exercise or physical therapy until medically stabilized.

Question 15: A patient with chronic bronchitis has copious, thick secretions. Which airway clearance technique uses high-frequency chest wall oscillation to mobilize secretions?

Active cycle of breathing technique (ACBT)
The Vest airway clearance system (Correct answer)
Autogenic drainage
Positive expiratory pressure (PEP) therapy

Correct answer: The Vest airway clearance system

The Vest (high-frequency chest wall oscillation device) uses an inflatable vest to deliver rapid chest wall compressions that loosen and mobilize secretions toward central airways.

Question 16: During cardiac rehabilitation, a patient's blood pressure drops 20 mmHg systolic during low-intensity exercise. What is the MOST appropriate response?

Continue exercise and monitor blood pressure every 2 minutes
Increase exercise intensity to improve cardiac output
Stop exercise immediately and assess the patient (Correct answer)
Administer nitroglycerin and continue light activity

Correct answer: Stop exercise immediately and assess the patient

A systolic BP drop of ≥10 mmHg during exercise (especially with symptoms) is an indication to stop exercise immediately and evaluate for hemodynamic compromise.

Question 17: Which of the following is the CORRECT interpretation of a PaO2 of 55 mmHg and PaCO2 of 55 mmHg on arterial blood gas?

Hypoxemia with respiratory alkalosis
Hypoxemia with hypercapnic respiratory failure (Correct answer)
Normal ventilation with mild hypoxemia
Metabolic acidosis with compensatory hyperventilation

Correct answer: Hypoxemia with hypercapnic respiratory failure

PaO2 of 55 mmHg indicates hypoxemia and PaCO2 of 55 mmHg indicates CO2 retention (hypercapnia), together consistent with type II (hypercapnic/ventilatory) respiratory failure.

Question 18: A physical therapist notes that a patient's peripheral edema worsens in the afternoon and improves after overnight rest. This pattern is MOST consistent with which condition?

Lymphedema
Chronic venous insufficiency (Correct answer)
Deep vein thrombosis
Pulmonary hypertension

Correct answer: Chronic venous insufficiency

Gravity-dependent edema that worsens with prolonged standing and resolves with elevation overnight is the classic presentation of chronic venous insufficiency.

Question 19: Which heart sound is associated with a stiff, noncompliant left ventricle and is heard early in diastole?

S1
S2
S3 gallop
S4 gallop (Correct answer)

Correct answer: S4 gallop

S4 is a late diastolic sound produced when atrial contraction forces blood into a stiff, noncompliant ventricle; it is associated with hypertensive heart disease and hypertrophy.

Question 20: A patient with cystic fibrosis performs the active cycle of breathing technique (ACBT). What is the CORRECT order of components?

Forced expiration technique → breathing control → thoracic expansion exercises
Breathing control → thoracic expansion exercises → forced expiration technique (Correct answer)
Thoracic expansion exercises → forced expiration technique → breathing control
Forced expiration technique → thoracic expansion exercises → breathing control

Correct answer: Breathing control → thoracic expansion exercises → forced expiration technique

ACBT follows the sequence: breathing control (relaxed tidal breathing) → thoracic expansion exercises (deep breaths) → forced expiration technique (huffing), repeated cyclically.

Question 21: Which medication classification is MOST likely to cause a dry, nonproductive cough as a side effect relevant to cardiopulmonary PT monitoring?

Beta-1 selective blockers
Calcium channel blockers
ACE inhibitors (Correct answer)
Loop diuretics

Correct answer: ACE inhibitors

ACE inhibitors block bradykinin breakdown, allowing it to accumulate in the airways and stimulate cough receptors, causing a persistent dry cough in 10-15% of patients.

NPTE-PT Cardiovascular and Pulmonary PT

A patient with COPD demonstrates pursed-lip breathing during exertion.
What is the PRIMARY physiological benefit of this technique?

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