NPTE-PT Cardiovascular and Pulmonary PT 4 — Questions and Answers
Question 1: 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 2: 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 3: 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 4: 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 5: 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 6: 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 7: 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 4
A patient with chronic bronchitis has copious, thick secretions.
Which airway clearance technique uses high-frequency chest wall oscillation to mobilize secretions?