NPTE-PT Cardiovascular and Pulmonary PT 3 — Questions and Answers
Question 1: 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 2: 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 3: 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 4: 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 5: 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 6: 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 7: 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.
NPTE-PT Cardiovascular and Pulmonary PT 3
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?