Cardiac, Vascular and Pulmonary Systems 2010

Minimum Passing Grade: 75%

Time Allowed for Exam: 1 hrs 0 mins

1. A patient rehabilitating from congestive cardiac failure is examined in physical therapy. During
the examination the patient begins to complain of pain. The most immediate physical therapist
action is to:

a) Notify the nursing staff to administer pain medication

b) Contact the referring physician
c) Discontinue the treatment session
d) Ask the patient to describe the location and severity of the pain.

Rationale: In order to adequately address the patient's subjective report of pain, it is

essential to gather additional information.

2. A patient rehabilitating from a CVA, is referred to physical therapy. The medical record
indicates that the CVA primarily, involved the right hemisphere of the brain. Which of the
following objective findings would be least likely when examining the patient?

a) Diminished motor control of the left side of the body

b) impaired awareness of the left side of the body
c) impaired spatial ability
d) diminished awareness of disability

Rationale: A patient rehabilitating from a CVA , with right hemisphere involvement and
resultant left hemiplegia would most likely exhibit impaired awareness of the left side of the
body. Other characteristics of this patient may include poor attention span, left hemianopsia,
and impulsive behavior.

3. A patient with right hemiplegia is observed during gait training . The patient performs side
stepping towards the hemiplegic side. The physical therapist may expect the patient to
compensate for weakened abductors by:

a) Hip hiking of the unaffected side

b) lateral trunk flexion towards the affected side
c) lateral trunk flexion towards the unaffected side
d) Hip extension of the affected side

Rationale: A patient with right hemiplegia, can compensate for weak hip abductors while
side stepping towards the right by leaning towards the left. This action unweighs the right
lower extremity and utilizes momentum along with the abductor muscles to perform
sidestepping.

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4. A patient undergoing a pulmonary rehabilitation program is positioned in supine with a pillow
under the knees. The physical therapist cups between the clavicle and nipple bilaterally. This
technique is utilized for postural drainage of the :

a) Anterior segments of the upper lobes

b) Anterior basal segments of the lower lobes
c) Superior segments of the lower lobes
d) Posterior basal segments of the lower lobes

Rationale: Anterior segments of the upper lobes will be drained. This is a classic position
for this treatment.

5. A physician indicates that a patient rehabilitating from a CVA has significant perceptual
deficits. Which anatomical region would most likely be affected by the stroke?

a) primary motor cortex

b) sensory cortex
c) Basal ganglia
d) cerebellum.

Rationale: A lesion affecting the sensory cortex often results in numerous impairments
including loss of sensation, perception, proprioception, and diminished motor control.

6. A physical therapist prepares to administer Berg Balance scale to a patient rehabilitating from
a CVA. Which of the following tools is considered necessary when administering this outcome
measure?

a) Reflex hammer
b) Goniometer
c) Stop watch
d) stethoscpe

Rationale: The Berg Balance scale is used for assessing a patients risk of falling, the Berg
consists of fourteen tasks of everyday life that are scored according to a 0- 4 scale. A
maximum total score possible is 56, with a score of less than 45 indicating that the patient is
at risk from multiple falls. Necessary equipment to administer the Berg includes a stop watch
, two chairs, a ruler and a step stool. Observation and scoring should take approximately 15-
20 minutes.

7. A physical therapist examines the electrocardiogram of a patient during exercise. What

changes in the ECG would be indicated of myocardial ischemia?

a) P wave changes
b) PR interval changes
c) QRS changes
d) ST segment changes

Rationale: ST segment depression greater than 1mm is an indication of ischemia and is

often used to confirm a diagnosis of coronary artery disease.

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8. A physical therapist treats a patient diagnosed with chronic atherosclerotic vascular disease,
the patient exhibits cool skin, decreased sensitivity to temperature changes and intermittent
claudication with activity. The most appropriate ambulation parameters to increase ambulation
distance are :

a) short duration, frequent intervals

b) short duration, infrequent intervals
c) long duration, frequent intervals
d) long duration, infrequent intervals

Rationale: Intermittent claudication occurs as a result of insufficient blood supply and

ischemia. The condition occurs with activity and subsides on periods of rest. As a result, it
can serve to limit the duration of exercise activities. Symptoms most commonly include pain
and cramping distal to the occluded vessel.

9. The therapist wants to auscultate over the aortic valve. Which of the following areas is most
appropriate to isolate the desired valve?

a) Second left intercostals space at the left sternal border

b) Second right intercostals space at the right sternal border
c) Forth left intercostals space along the lower left sternal border
d) fifth left intercostals space at the midclavicular line

Rationale: The aortic valve is located at the junction of the left ventricle and the ascending
aorta. The aortic valve prevents regurgitation at the entrance of the aorta to the heart.

10. A physical therapist treats a patient status post right cerebrovascular accident with left
hemiplegia. A note left by the primary therapist indicates that the patient exhibits pusher"
syndrome when examining the patient's sitting posture ? Which of the following findings would
be most likely?

a) Increase lean to the left with increase weight bearing on the left buttock
b) increase lean to the right with increase weight bearing on the right buttock
c) increase forward lean with increase weight nearing on the right buttock
d) increase forward lean with increase weight bearing on the left buttock

Rationale: Pusher syndrome is characterized by a significant lateral deviation towards the

hemiplegia side in all positions. A patient with left hemiplegia would exhibit a lateral lean to
the left in sitting with increased weight bearing on the left buttock. Pusher syndrome is most
common in patients with right cerebrovascular accidents and left hemiplegia.

11. Concurrent validity is exhibited if the blood pressure reading by an aneroid

sphygmomanometer is equal to the blood pressure reading of:

a) An electrocardiogram
b) A pressure transducer inserted into the artery
c) A physician using a mercury sphygmomanometer
d) A pulse oximeter

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 Rationale: Concurrent validity is demonstrated when the measurement to be validated
(blood pressure sphygmomanometer ) and the criterion measurement (gold standard) are
measured at relatively the same time. This form of validity is useful when a new or unproven
test or measure is being proposed.

12. A patient eight weeks status post myocardial infarction is involved in a phase two cardiac
rehabilitation program at a local hospital. What signifies the completion of a phase two
program?

a) Echocardiogram
b) Invitation to a high level aerobic exercise program
c) low level treadmill test
d) Maximal treadmill test

Rationale: A phase two cardiac rehabilitation program begins with the completion of a low
level treadmill test and ends with a maximal treadmill test.

13. A physical therapist attempts to calculate the target heart rate range for a 32 year old female
with no significant past medical history. The patient’s resting heart rate is recorded as 60 beats
per minute and the maximal heart rate is 180 beats per minute. Using the heart rate reserve
method ( Karvonen formula ) the patient’s target heart rate range should be recorded as:

a) 96-120 beats per minute

b) 132- 162 beats per minute
c) 144-174 beats per minute
d) 164-185 beats per minute

Rationale: The American college of sports medicine recommends prescribing the intensity
of exercise as 60 to 90 % of maximum heart rate or 50- 85% of vO2 max or heart rate
reserve. The heart rate reserve method (karvonen formula ) is determined as follows: target
heart rate range= (Hr max- HR rest ) *0.60 and 0.85}+ HR rest. For this patient, the heart
rate would be 132-162 beats per minute.

14. A 47 year old patient with a diagnosis of CVA with left hemiplegia is referred for orthotic
examination. Manual muscle testing reveals hip flexion 3+/5, hip extension3/5, knee flexion
3+/5, knee extension 3+/5, ankle dorsiflexion 2/5 ankle inversion and eversion 1/5. Sensation is
intact and no abnormal tone is noted. The most appropriate orthosis for this patient is a:

a) Knee-ankle foot orthosis with a locked knee

b) Plastic articulating ankle-foot orthosis
c) Metal upright ankle- foot orthosis
d) Prefabricated posterior leaf orthosis

Rationale: Intact sensation along with the absence of tone allows for a plastic orthosis with
an articulating ankle joint. This type of orthosis promotes a more normal gait pattern.
Despite significant strength deficits in the ankle an articulating ankle-foot orthosis would still
restrict motion into plantarflexion while allowing movement into dorsiflexion.

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15. A physical therapist identifies a number of substances that influence circulation. Which of
the following substances is stimulated by decreased arterial pressure and acts as a
vasoconstrictor ?

a) Angiotensin
b) Histamine
c) Epinephrine
d) Nora epinephrine

Rationale: Angiotensin is a polypeptide in the blood that causes vasoconstriction, increased

blood pressure, and the release of aldosterone from the adrenal cortex. Release of
angiotensin is stimulated by decreased arterial pressure.

16. A physical therapist records the vital signs of individuals at a health and wellness fair
designed to promote physical therapy week. Which age group should the therapist expect to
have the highest resting pulse rate?

a) Infants
b) Children
c) Teenagers
d) Adults

Rationale: Infants have resting pulses rates that can approach 130 beats per minute.

17. A patient is having her medical chart reviewed by the physical therapist who notes that the
patient has a history of recurrent dysrhythmias. The therapist is concerned about the patient's
past medical history and would like to monitor the patient during selected formal exercise
activities. Which of the following monitoring devices would be the most beneficial?

a) Pulmonary artery catheter

b) Electrocardiogram
c) Intracranial pressure monitor
d) Pulse oximeter

Rationale: An electrocardiogram is a common monitoring device for patients with know n or

suspected cardiac abnormalities. The electrocardiogram measures the electrical activity of
the heart as well as the heart rate, blood pressure, and respiration rate.

18. A 72 year old female six weeks post CVA is scheduled for discharge from an acute
rehabilitation hospital in one week. At the present time, the patient is unable to ambulate and
requires maximal assistance to complete most transfers. Prior to her CVA, the patient lived
alone in an apartment on the first floor. The most appropriate discharge plan would be:

a) Home with support servces

b) Home with home health aide during the day
c) Home with physical therapy three times per week
d) A nursing facility

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 Rationale: The patient’s dependence with ambulation and transfers eliminates home care
as a viable option at this time. The patient would be more suited for a nursing facility.

19. A patient referred to physical therapy is having a manual vibration as a means of airway
clearance. The patient is diagnosed with chronic obstructive pulmonary disease. When
performing vibration the most appropriate form of manual contact over the affected lung is:

a) Contact with a cupped hand

b) Contact with the entire palmar surface of the hand
c) Contact with the ulnar border of the hand
d) Contact with the distal phalanx of the middle finger

Rationale: The palmar aspect of the therapist’s hands should be in full contact over the
affected lung segment. The therapist may elect to partially or fully overlap the hands during
manual vibration.

20. A patient with a lengthy medical history of cardiac pathology is referred to a phase 2 cardiac
rehabilitation program. During the first session, the physical therapist prepares to measure the
patient’s blood pressure by inflating the cuff 20mm hg above the estimated systolic value. Which
of the following values describes the most appropriate rate to release the pressure when
obtaining the blood pressure measurement ?

a) 2.3mmHg per second

b) 3.5mmHg persecond
c) 5.7mmHg per second
d) 8.10mmHg per second

Rationale: A patient with a lengthy medical history of cardiac pathology is referred to a

phase 2 cardiac rehabilitation program. During the first session, the physical therapist
prepares to measure the patient’s blood pressure by inflating the cuff 20mmHg above the
estimated systolic value. The most appropriate rate to release the pressure when obtaining
the blood pressure measurement is 2.3 mmHg per second.

21. A patient in phase 1 cardiac rehabilitation program is referred to physical therapy. The
patient is status post myocardial infarction and has progressed without difficulty. Which of the
following vital sign recordings would exceed the typical limits of a phase 1 program?
a) Heart rate elevated 18 beats per minute above resting level
b) respiration rate of 25 breaths per minute
c) Systolic blood pressure decreases by 20mmHg from resting level
d) Diastolic blood pressure less than 100 mmHg

Rationale: A decrease in the systolic pressure of greater than or equal to 15 mmHg

exceeds the typical limits associated with a phase 1 cardiac rehabilitation program. Since
the patient’s systolic blood pressure decreased by 20 mmHg, this would be the correct
response.

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22. Your patient’s heart rate is recorded as 78 beats per minute and blood pressure as 130/ 85
mmHg. A recent laboratory report indicates a total cholesterol level of 170 mg /dl with high -
density lipoproteins reported as 20 mg /dl and low density lipoproteins as 110 md /dl. Which of
the patient's values would be considered atypical ?

a) Heart rate
b) Blood pressure
c) High density lipoproteins
d) Low density proteins

Rationale: In the average man, HDL cholesterol levels range from 40 to 50 mg/dL. In the
average woman, they range from 50 to 60 mg/dL. An HDL cholesterol of 60 mg/dL or higher
gives some protection against heart disease.

23. You are trying to determine a patient’s heart rate by counting the number of QRS complexes
in a six second electrocardiogram strip. Assuming the therapist identifies eight QRS complexes
in the strip, the patient’s heart rate should be recorded as :

a) 40 bpm
b) 60 bpm
c) 80 bpm
d) 100 bpm

Rationale: The QRS complex reflects the electrical activity of the ventricles during the
cardiac cycle. If the physical therapist identifies eight QRS complexes in a six second
interval, the therapist should multiply the number by ten to determine the patient’s heart rate.

24. During a treatment session, the therapist monitors the patients oxygen saturation rate.
Which of the following would be the most representative of a normal oxygen saturation rate?

a) 82%
b) 87%
c) 92%
d) 97%

Rationale: Oxygen saturation rate refers to the percentage of oxygen bound to hemoglobin
in the blood. Normal oxygen saturation rates range from 95% -98%.

25. A physical therapist reviews the medical record of a patient 24 hours status post total hip
replacement. A recent entry in the medical record indicates that the patient was placed on an
anti-coagulant medication. Which of the following laboratory values would be most affected
based on the patient’s current medication?

a) Hematocrit
b) Hemoglobin
c) Prothrombin time
d) White blood cell count

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 Rationale: Anti-coagulant drugs are often prescribed post-operatively for patient’s at risk of
acquiring deep venous thrombosis. Prothrombin time is often used as a screening
procedure to examine extrinsic coagulation factors and to determine the effectiveness of
oral anticoagulant therapy.

26. A physical therapist treats a patient who is on a waiting list for a heart transplant. The patient
has a lengthy history of cardiac pathology and recently received a right ventricular assistive
device due to persistent ventricular failure. Which two structures would house the tubes for this
device?

a) Left atrium and aorta

b) Left atrium and pulmonary artery
c) Right atrium and aorta
d) Right atrium and pulmonary aorta

Rationale: A right ventricle assistive device is designed to pump a percentage of the

plutonic blood flow around the right ventricle in order to decrease the work load on the
myocardium. The right atrium would house one tube because it functions as a primer for the
right ventricle and the other tube would be located in the pulmonary artery since its function
is to deliver blood from the right ventricle to the lungs.

27. A physician orders the nursing staff to administer digitalis to a patient diagnosed with
congestive heart failure. The physician's primary goal in using this medication is to:

a) increase cardiac pumping ability

b) increase cellular metabolism
c) regulate fluid and electrolyte levels
d) regulate glucose metabolism

Rationale: Digitalis is used in the treatment of congestive heart failure. Digitalis works
directly on electrolytes to improve the force and contractility of the heart.

28. A physical therapist identifies a bluish discoloration of the skin and the nail beds of a 55 year
old male referred to physical therapy for pulmonary rehabilitation. What does this objective
finding indicate?

a) Hyperoxemia
b) Hyperoxia
c) Hypokalemia
d) Emphysema

Rationale: Hypoxemia refers to a deficiency of oxygen in arterial blood.

29. A physical therapist employed in a large medical center reviews the chart of a 63 year old
male referred to physical therapy for pulmonary rehabilitation. The chart indicates that the
patient has smoked 1-2 packs of cigarettes a day since the age of 25. The admitting physician
documented that the patient’s thorax was enlarged with flaring of the costal margins and
widening of the costochondral angle. Which pulmonary disease does the chart most accurately
describe ?

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 a) Asthma
b) Bronchiestasis
c) Chronic bronchitis
d) Emphysema

Rationale: Emphysema is a obstructive pulmonary disease characterized by overinflation

and destructive changes in the alveolar walls. Although closely related to other obstructive
pulmonary diseases, the presence of a barrel chest is most characteristic of emphysema.

30. A physical therapist reviews the results of a pulmonary function test on a 44 year old female
diagnosed with emphysema. Assuming that patient’s testing was classified as unremarkable,
which of the following lung volumes would MOST likely approximate 10% of the patient’s total
lung capacity ?

a) Tidal volume
b) Inspiratory reserve volume
c) Residual volume
d) Functional residual capacity

Rationale: Tidal volume is defined as the amount of air inspired and expired per breath and
is approximately 450-600 ml in an adult. This value represents approximately 10% of the
total lung capacity.

31. A physical therapist employed in an acute care hospital reviews the results of recent
laboratory test for one of his patients. A note in the medical record indicates that the patient was
dehydrated at the time the blood sample was taken. Which finding would be MOST likely based
on the patient’s hydration status?

a) Increased coagulation time

b) Decreased hematocrit level
c) Increased blood urea nitrogen level
d) decreased hemaglobin level

Rationale: Urea is the metabolic by product of the breakdown of amino acids used for
energy production. The level of urea in the blood provides a gross estimate of kidney
function. An increased blood urea nitrogen level can be indicative of dehydration, pre renal
failure or renal failure. Normal blood urea nitrogen levels for adults are 10-20 mg /dl.

32. A patient with cardiopulmonary pathology is referred to physical therapy. The physical
therapist documents the following clinical signs, pallor, cyanosis, and cool skin. These clinical
signs are most consistent with :

a) Cor pulmonale
b) Anemia
c) Atelectasis
d) Diaphoresis

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 Rationale: Anemia refers to the reduction in the number of circulating red blood cells.
Symptoms may include pallor, cyanosis, cool skin, vertigo, weakness, headache, and
general malaise.

33. A physician orders an electrocardiogram for a patient diagnosed with congestive heart
failure. The medical record indicates the patient is currently taking digitalis. What effect would
you expect digitalis to have on the patients ECG?

a) Lengthened ventricular activation time

b) Increased refractory period of AV node
c) Lengthen QT interval
d) Elevated ST segment

Rationale: Digitalis is used to elevate the symptoms of congestive heart failure. The drug
increases the force of myocardial contraction and increases the refractory period of the av
node. The refractory period is the time the AV node is incapable of responding to an action
potential. By slowing down the rate of ventricular contraction, digitalis allows for increased
filling time and improved cardiac output.

34. A physical therapist works with a patient status post stroke on a mat program. The therapist
assists the patient in lateral weight shifting activities while positioned in prone on elbows. Which
therapeutic exercise technique is the therapist using?

a) alternating isometrics
b) Approximation
c) Rhythmic initiation
d) Timing for emphasis

Rationale: Approximation is a therapeutic exercise technique designed to facilitate

contraction and stability through joint compression.

35. A physical therapist observes an electrocardiogram of a patient on beta blockers. The

patient has a history of hypertension. Which of the following ECG changes could be facilitated
by beta blockers?

a) Bradycardia
b) Tachycardia
c) Increased AV induction time
d) ST segment depression

Rationale: Beat blockers decrease heart rate and force. On an electrocardiogram, beta
blockers may cause sinus bradycardia.

36. A physical therapist observes a patient's breathing as part of a respiratory assessment.

Which muscle of the respiration is most active during forced expiration?

a) Diaphragm
b) External intercostals

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 c) internal intercostals
d) Upper trapezius

Rationale: The internal intercostals act to depress the ribs during forced expiration.

37. A physical therapist recommends a wheelchair for a patient rehabilitating from CVA with the
goal of independent mobility. The left upper and lower extremities are flaccid and present with
edema. There is normal strength on the right, however, the patient is hypotonic. The patient is
cognitively intact. The most appropriate wheelchair for the patient is:

a) Solid seat , solid back, elevating leg rests and anti tippers
b) sling seat sling back, arm board and elevating leg rest
c) Lightweight, solid seat solid back , arm board and elevating leg rest
d) lightweight, solid seat, solid back, arm board, standard foot rest

Rationale: Independent propulsion is facilitated by the use of a light weight wheelchair,

while a solid seating system assists with posture and transfer activities. An arm board,
allows the flaccid upper extremities to be supported and elevating leg rests assist to
decrease dependent edema.

38. A physical therapist reviews the results of a pulmonary function test for a 58 year old male
patient recently admitted to the hospital. The therapist notes the patient’s total lung capacity is
significantly increased when compared to established norms. Which medical condition does this
patient have?

a) Bronchitis
b) Emphysema
c) Spinal cord injury
d) Pulmonary fibrosis

Rationale: Emphysema is a chronic obstructive pulmonary disease characterized by an

increase in the size of air spaces distal to the terminal bronchiole accompanied by the
destructive changes in the walls. As a result, the lungs become hyperinflated and the chest
wall becomes fixed in a hyperinflated position. Total lung capacity and dead space in the
lungs significantly increase.

39. A female patient status post CVA with global asphasia is being discharged from a
rehabilitation hospital. What would be the Most appropriate form of education to facilitate a safe
discharge?

a) Perform hands on training sessions with the patient and family members
b) Videotape the patient performing transfers and ADLS
c) Provide written instructions on all ADLS and functional tasks
d) Meet the family members to discuss the patients present status and abilities

Rationale: Hands on training sessions, provide unique opportunities for the therapist to
assess the competence of the family members in a structured environment.

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40. A patient with muscular dystrophy is administered with a pulmonary function test. The value
that will not show any deviation is:

a) functional residual capacity

b) vital capacity
c) FEV
d) total lung capacity

Rationale: Muscular dystrophy will alter the respiratory muscles ability to pull in air and blow
out air; therefore, vital capacity, total lung capacity, and forced expiratory volume in one
second will be decreased. Since muscular dystrophy does not change the lung parenchyma,
REEP will occur at the same point of equilibrium between lung recoil and thoracic outward
pull. Therefore, functional residual capacity will not change.

41. The physical therapist reviews the patient's blood gas analysis. The therapist identifies that
the paCO2 is elevated and the ph is below normal level. These findings are most representative
of :

a) Respiratory acidosis
b) respiratory alkalosis
c) metabolic acidosis
d) metabolic alkalosis

Rationale: Respiratory acidosis is caused by retention of carbon dioxide due to pulmonary

inefficiency. Signs and symptoms include dizziness, tingling, and syncope.

42. A physical therapist examines the heart sounds of a 48 year old female status post coronary
artery bypass graft. When auscultating, the therapist identifies the heart sound associated with
closing of the mitral tricuspid valves. This heart sound best describes what level :

a) S1
b) S2
c) S3
d) S4

Rationale: S1: The "lub" in "lub-dub". The sound is from the closing of the bicuspid and
tricuspid valves, which live between the atria and ventricles. They close because the
ventricles are contracting. You also hear the pulmonic and aortic valves opening at the
same time as the blood is forced from the ventricles into the arteries. S2: The "dub" in "lub-
dub". The sound is from the closing of the pulmonic and aortic valves as the pressure from
the arteries becomes greater than the pressure in the ventricles - this is the end of systole.
You can also hear the bicuspid and tricuspid valves opening. An S3 sound comes right after
the S2 - it sounds like a split S2, but the size of the split never changes with breathing. It's
fairly normal in children and athletes. In other people, it can indicate a non-specific
impairment of ventricular function - listen with the bell to determine which ventricle is making
the sound (left side at the apex, right side at the xiphoid process). An S4 sound comes right
before the S1 - sounds like a "split S1." It is the sound of the ventricle filling during diastole.
It becomes more pronounced when the ventricular wall gets more rigid (as in hypertrophy)
such as with ischemia, aortic or pulmonic stenosis.

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43. During a balance assessment of patient with hemiplegia, it is noted that in sitting the patient
requires minimal assistance to maintain the position, and cannot accept any additional
challenge. The physical therapist would appropriately document the patient sitting position as:

a) Normal
b) Good
c) Fair
d) Poor

Rationale: Inability to sit unsupported without assistance is indicative of poor sitting

balance.

44. A female 65 years-old was admitted with the following symptoms- fatigue, intolerant of cold
and pale skin. Her diagnosis was iron deficiency anemia. What can cause this?

a) Inadequate absorption of iron

b) Inability to produce intrinsic factor, which is needed for absorption of B12
c) excessive loss of blood through bleeding from large wounds, stomach ulcers, or heavy
menstruation
d) abnormal red blood cells, enzymes , toxins or antibodies from incompatible transfused
blood

Rationale: The most prevalent kind of anemia is caused by inadequate absorption of iron,
excessive loss of iron, increased iron requirement or insufficient intake of iron.

45. A patient diagnosed with emphysema is referred to physical therapy. Physical examination
reveals increased accessory muscle use during normal breathing and a forward head posture.
The primary goal for the patient is:

a) Eliminate accessory muscle activity and decrease respiratory rate with pursed lip
breathing
b) Optimize accessory muscle strength to promote alveolar ventilation
c) Utilize the accessory muscles to balance the activity of the upper and lower chest
d) Diminish the accessory muscle use and emphasize diaphragmatic breathing

Rationale: Emphysema is a disease of the alveoli with associated irreversible lung damage.
Breathing exercises directed at increasing the activity of the diaphragm and decreasing the
activity of the accessory muscles may influence the efficiency of the of the patient’s
breathing pattern

46. A physical therapist positions a patient for bronchial drainage to the anterior segments of the
upper lobes. The Most appropriate patient position is:

a) Supine with a pillow under the knees

b) Supine with head of the bed elevated 16 inches
c) Supine with the foot of the bed elevated 16 inches
d) Prone with the head of the bed elevated 12 inches

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 Rationale: To perform bronchial drainage to the anterior segments of the upper lobes the
physical therapist should clap between the clavicle and the nipple on each side with patient
positioned in supine.

47. A physical therapist attempts to obtain information on a patient's endurance level by

administering a low level exercise test on a treadmill. Which of the following measurements
methods would provide the therapist with an objective measurement of endurance ?

a) Facial color
b) Facial expression
c) Rating on perceived exertion scale
d) Respiration rate

Rationale: Respiratory rate is an objective measure that is used top assess endurance .
Respiratory rate typically increases as the patient becomes fatigued.

48. A physical therapist examines a patient status, post stroke with a flaccid left side. In order to
facilitate muscular activity, the treatment plan should include :

a) weight bearing, tapping , elevation

b) Vibration, tapping, prolonged stretch
c) Weight bearing, tapping, approximation
d) Approximation, elevation, prolonged stretch

Rationale: normalization of tone is a priority in stroke rehabilitation. Facilitation techniques

are utilized when hypotonic exits. Facilitation techniques include vibration , weight bearing,
approximation, tapping, and quick stretch.

49. A physical therapist discusses the importance of proper diet with a patient diagnosed with
congestive heart failure. Which of the following substances would most likely be restricted in the
patient’s diet ?

a) Cholesterol
b) Potassium
c) Sodium
d) Triglycerides

Rationale: Patient’s with congestive heart failure tend to have excessive fluid retention in
the pulmonary and systemic circulation. As a result, a diet in potassium is prescribed, while
items high in sodium are restricted.

50. A male patient is being treated with breathing conservation techniques. Which of the
following techniques would be most effective when assisting a patient to complete a selected
activity without dyspnea?

a) Diaphragmatic breathing
b) Pacing
c) Pursed lip breathing
d) Ventilatory muscle training

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 Rationale: Pacing is a technique that can allow a patient to complete functional activities
without shortness of breath or dyspnea.

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