NPTE-PT Cardiovascular and Pulmonary PT 2 — 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.
NPTE-PT Cardiovascular and Pulmonary PT 2
A patient with COPD demonstrates pursed-lip breathing during exertion.
What is the PRIMARY physiological benefit of this technique?