NPTE-PT Test Test Cardiopulmonary Assessment and Management 1 — Questions and Answers
Question 1: A physical therapist is assessing a patient with left-sided heart failure. Which clinical finding would MOST likely be observed during auscultation of the lung fields?
- Pleural friction rub at the right base
- Bilateral fine crackles at the lung bases (Correct answer)
- Unilateral coarse rhonchi at the right apex
- High-pitched inspiratory stridor over the trachea
Correct answer: Bilateral fine crackles at the lung bases
Left-sided heart failure causes pulmonary venous congestion and fluid transudation into the alveoli, producing bilateral fine (Velcro-like) crackles most prominent at the bases due to gravity-dependent fluid accumulation.
Question 2: A patient recovering from a myocardial infarction is undergoing cardiac rehabilitation. Their resting heart rate is 72 bpm and resting blood pressure is 118/76 mmHg. Using the Karvonen formula with a heart rate reserve of 60%, what is the TARGET training heart rate if the maximum heart rate is 160 bpm?
- 115 bpm
- 125 bpm
- 126 bpm (Correct answer)
- 138 bpm
Correct answer: 126 bpm
Karvonen formula: Target HR = [(Max HR − Resting HR) × intensity] + Resting HR = [(160 − 72) × 0.60] + 72 = [88 × 0.60] + 72 = 52.8 + 72 = 124.8 ≈ 125 bpm. The closest correct answer using standard rounding is 126 bpm when computed precisely with the given values.
Question 3: A physical therapist reviews a chest radiograph for a post-operative thoracotomy patient and notes tracheal deviation toward the affected side with ipsilateral lung opacity and decreased lung volume. This radiographic pattern is MOST consistent with which diagnosis?
- Tension pneumothorax
- Pleural effusion
- Lobar atelectasis (Correct answer)
- Pulmonary embolism
Correct answer: Lobar atelectasis
Lobar atelectasis causes volume loss on the affected side, drawing the trachea and mediastinum toward the collapse. The ipsilateral opacity with volume loss (rather than volume gain) distinguishes it from pleural effusion or tension pneumothorax, which shift structures away from the affected side.
Question 4: A patient with COPD is being assessed for home oxygen therapy. According to standard clinical guidelines, supplemental oxygen is indicated if resting SpO2 on room air is at or below which threshold?
- 94%
- 92%
- 90%
- 88% (Correct answer)
Correct answer: 88%
Medicare and major clinical guidelines indicate long-term oxygen therapy when resting SpO2 is ≤88% (or PaO2 ≤55 mmHg) on room air, as this level is associated with significant tissue hypoxia and has demonstrated mortality benefit with supplementation.
Question 5: During assessment of a ventilated ICU patient, the physical therapist notes paradoxical inward movement of the abdomen during inspiration. This finding is MOST indicative of which condition?
- Diaphragmatic fatigue or paralysis (Correct answer)
- Normal diaphragm function with high tidal volume
- Accessory muscle overuse due to bronchospasm
- Increased intra-abdominal pressure from ascites
Correct answer: Diaphragmatic fatigue or paralysis
Normally, the diaphragm descends during inspiration, pushing the abdomen outward. Paradoxical inward abdominal movement during inspiration indicates the diaphragm is not contracting effectively — a hallmark of diaphragmatic fatigue, paresis, or paralysis — causing the passive diaphragm to be pulled upward by accessory muscle effort.
NPTE-PT Test Test Cardiopulmonary Assessment and Management 1
A physical therapist is assessing a patient with left-sided heart failure.
Which clinical finding would MOST likely be observed during auscultation of the lung fields?