Deck 50: Cardiopulmonary Rehabilitation

Question 1

A patient is being considered for participation in a pulmonary rehabilitation program. Which of the following test regimens would you recommend in order to ascertain the patient's cardiopulmonary status?
I)cardiopulmonary exercise evaluation
II)pulmonary function testing
III)cardiac catheterization

A)II and III
B)I and II
C)I, II, and III
D)I and III

Answer 1

B

Question 2

Common goals shared by most pulmonary rehabilitation programs include which of the following?
I)improvement in physical activity levels
II)control of respiratory infections
III)reduction in medical costs and hospitalizations
IV)family education, counseling, and support

A)I, II, and III
B)II and IV
C)I, II, III, and IV
D)III and IV

Answer 2

C

Question 3

Which of the following occur when the ventilatory threshold is exceeded during exercise?
I .Metabolism becomes anaerobic.
II.Energy production increases.
III.Fatigue increases.

A)I and II
B)II and III
C)I and III
D)I, II, and III

Answer 3

I and III

Question 4

To physically recondition a patient and increase exercise tolerance, which of the following must be accomplished?
I .The body's overall O₂ utilization must be improved.
II.The patient's essential muscle groups must be strengthened.
III.The cardiovascular response to exercise must be enhanced.

A)II and III
B)I and II
C)I, II, and III
D)I and III

Question 5

What is the first step in evaluating patients for participation in a pulmonary rehabilitation program?

A)complete blood gas analysis
B)complete patient history
C)cardiopulmonary stress test
D)pulmonary function testing

Question 6

Attrition in pulmonary rehabilitation programs is most associated with which of the following?

A)success of the physical reconditioning component
B)degree to which patients' psychosocial needs are met
C)scope and depth of the group educational activities
D)availability of adequate and reliable exercise equipment

Question 7

What is the term used to describe the restoration of individuals to the fullest possible medical, mental, emotional, social, and vocational potential?

A)disease prevention
B)rehabilitation
C)intensive care
D)home care

Question 8

A cardiopulmonary exercise evaluation is conducted on a patient before participation in pulmonary rehabilitation for what purposes?
I)to quantify the patient's baseline exercise capacity
II)to develop an exercise prescription (including target heart rate)III.to determine how much desaturation occurs with exercise

A)II and III
B)I, II, and III
C)I and II
D)I and III

Question 9

During exercise, the point at which increased levels of lactic acid production result in an increased VCO₂ and V_E is referred to as what?

A)respiratory quotient (RQ)
B)ventilatory threshold
C)crossover point
D)exercise limit

Question 10

Which of the following would you not expect to observe after a chronic obstructive pulmonary disease (COPD) patient completes a sound pulmonary rehabilitation program?

A)reduced pulse rate during exercise
B)decreased breathing rates during exercise
C)reduction in CO₂ production during exercise
D)permanent increase in forced expiratory volume in 1 second (FEV₁) and forced expiratory flow (FEF_25%-75%)
E)lower minute volumes during exercise

Question 11

Knowledge from the clinical sciences is used in pulmonary rehabilitation programming for mainly what purpose?
I)quantify the extent of physiological impairment
II)establish ways to improve the quality of life
III)set expectations for reasonable outcomes

A)I and II
B)II and III
C)I and III
D)I, II, and III

Question 12

Specific patient objectives for a pulmonary rehabilitation program could include all of the following except:

A)proper use of medications, O₂, and breathing equipment
B)reconditioning of both skeletal and respiratory muscles
C)adherence to proper hygiene and good nutrition
D)improvement in the results of pulmonary function tests

Question 13

The principal objectives of pulmonary rehabilitation include which of the following?
I)control and alleviate the symptoms
II)restore functional capabilities as much as possible
III)improve quality of life

A)I and II
B)II and III
C)I and III
D)I, II, and III

Question 14

Patients with chronic cardiopulmonary disorders all share an inability to do what?

A)understand the disease process
B)regain functional use of atrophied muscles
C)improve tolerance for physical activity
D)cope effectively with their disease process

Question 15

What are the overall goals of rehabilitation?
I)reverse the course or progression of the disease process
II)minimize the disability's impact on the individual or family
III)maximize the functional ability of the individual

A)I and II
B)II and III
C)I and III
D)I, II, and III

Question 16

Which of the following is NOT a reasonable expectation for a pulmonary rehabilitation program?

A)reduction in hospitalizations
B)improvement in ambulation
C)reversal of the disease process
D)control of respiratory infections

Question 17

Which of the following elements should be considered in most pulmonary rehabilitation programs?
I)individual needs
II)patient's education
III)patient's personality
IV)patient's aptitudes

A)I, II, and III
B)II and IV
C)I, II, III, and IV
D)III and IV

Question 18

Knowledge from the social sciences is used in pulmonary rehabilitation programming for mainly what purpose?
I)determine the impact of the disability on the patient or family
II)quantify the extent of physiological impairment due to disease
III)establish ways to improve the 'patient's quality of life

A)I and II
B)II and III
C)I and III
D)I, II, and III

Question 19

A patient is being considered for participation in a pulmonary rehabilitation program. Which of the following pulmonary function tests would you recommend be performed as a component of the preliminary evaluation?
I)lung volumes, including functional residual capacity (FRC)II.diffusing capacity (DLCO)III.pre- and post-bronchodilator flows
IV)lung and thoracic compliance

A)II and IV
B)I, II, and III
C)I, II, III, and IV
D)I, II, and IV

Question 20

In which of the following ways does the body respond to increased levels of physical activity?
I)decreased cardiac output
II)increased minute ventilation
III)neuroendocrine stimulation

A)III
B)I and II
C)I and III
D)II and III
E)I, II, and III

Question 21

Which of the following patients are good candidates for pulmonary rehabilitation?
I)those with malignant neoplasms involving the lungs
II)those with severe arthritis or neuromuscular abnormalities
III)those with exercise limitations due to severe dyspnea
IV)those with moderate to severe obstructive lung disease

A)I, II, and III
B)II and IV
C)III and IV
D)II, III, and IV

Question 22

A patient in your pulmonary rehabilitation program has an orthopedic disability that precludes her from walking or using a stationary bicycle. Which of the following activities would you recommend to help recondition the lower extremities?

A)use of a rowing machine
B)calisthenic exercises
C)aquatic exercises
D)use of a treadmill

Question 23

While you are assisting in a treadmill cardiopulmonary stress test procedure, the patient complains to you of severe shortness of breath and some chest pain. Which of the following actions would you recommend at this time?

A)Increase the O₂ flow rate.
B)Decrease the treadmill speed.
C)Decrease the treadmill incline.
D)Terminate the procedure at once.

Question 24

Under which of the following conditions would you recommend ending a cardiopulmonary exercise evaluation?
I)electrocardiogram indicating supraventricular tachycardia
II)10% fall from baseline oxyhemoglobin (HbO₂) saturation
III)fall in systolic blood pressure of more than 20 mm Hg
IV)request from the patient to terminate the test

A)II, III, and IV
B)I, II, and III
C)I, II, III, and IV
D)I, II, and IV

Question 25

Absolute contraindications for conducting a cardiopulmonary exercise evaluation include all of the following except:

A)diastolic blood pressure greater than 110 mm Hg
B)serious cardiac arrhythmias
C)unstable angina
D)recent myocardial infarction

Question 26

Which of the following measures during cardiopulmonary exercise evaluation are most useful in differentiating between exercise intolerance of cardiac versus ventilatory origin?
I.maximum heart rate
II. $\dot { V }$ O_2max
III.PaCO₂
IV.PaO₂

A)II and IV
B)I, II, and III
C)III and IV
D)II, III, and IV

Question 27

What are some relative contraindications for cardiopulmonary exercise testing?
I)severe pulmonary hypertension or cor pulmonale
II)known electrolyte disturbances (e.g., hypokalemia)III.SaO₂ or SpO₂ less than 85% breathing room air
IV)untreated or unstable asthma

A)II and IV
B)I, II, and III
C)I, II, III, and IV
D)I, II, and IV

Question 28

The O_2max at termination of exercise (as a percentage of the predicted) for five patients appears below. Which of these patients is the best candidate for pulmonary rehabilitation?

Question 29

Below what level of the predicted FEV₁/FVC are patients with irreversible airway obstruction considered good candidates for pulmonary rehabilitation?

A)75%
B)80%
C)60%
D)70%

Question 30

To increase the likelihood that positive patient results are lasting, what must pulmonary rehabilitation programs provide?

A)vocational and social counseling
B)staff training in rehabilitation methods
C)financial support for rehospitalization
D)periodic follow-up and reinforcement

Question 31

Which of the following patients with irreversible airway obstruction are the best candidates for pulmonary rehabilitation? $$\begin{array} { | l | l | l | l | } \hline & \text { Patient } & \text { FEV } _ { 1 } & \text { FEV } / \text { FVC } \\\hline \text { I. } & \text { A } & 3.2 \mathrm {~L} & 65 \% \\\hline \text { II. } & \text { B } & 1.6 \mathrm {~L} & 67 \% \\\hline \text { III. } & \text { C } & 2.3 \mathrm {~L} & 53 \% \\\hline \text { IV. } & \text { D } & 3.1 \mathrm {~L} & 72 \% \\\hline\end{array}$$

A)II and IV
B)I, II, and III
C)II and III
D)I, II, III, and IV

Question 32

In preparing an outpatient for a cardiopulmonary stress test to be conducted the next day, which of the following instructions would you provide?
I .The patient should fast for at least 8 hours before testing.
II.The patient should wear loose-fitting clothing and sneakers.
III.The patient should stop all medications at once.
IV.The patient should review the drugs with the physician.

A)I, II, and III
B)II and IV
C)I, II, III, and IV
D)I, II, and IV

Question 33

Which of the following patients are NOT good candidates for pulmonary rehabilitation?
I)unstable cardiovascular patients who require monitoring
II)patients with exercise limitations due to severe dyspnea
III)patients with malignant neoplasms involving the lungs

A)I and II
B)II and III
C)I and III
D)I, II, and III

Question 34

The physical reconditioning component of a pulmonary rehabilitation program usually includes which of the following?
I)aerobic exercises for the extremities
II)timed walking exercise
III)ventilatory muscle training

A)I, II, and III
B)II and III
C)I and III
D)III

Question 35

All of the following should be monitored during a cardiopulmonary exercise evaluation except:

A)respiratory rate
B)HbO₂ saturation
C)ECG and blood pressure
D)FEV₁ and FVC

Question 36

Which of the following pulmonary function tests are most useful in determining whether a patient with restrictive lung disease should be considered for pulmonary rehabilitation?
I)DLCO
II)total lung capacity (TLC)III.FEV₁/FVC

A)I and II
B)II and III
C)I and III
D)I, II, and III

Question 37

Which of the following patients would benefit least from pulmonary rehabilitation?

A)patient with chronic bronchitis
B)patient with pulmonary emphysema
C)patient with pulmonary fibrosis
D)patient with malignant lung cancer

Question 38

Which of the following exercises are useful for reconditioning the lower extremities of patients undergoing pulmonary rehabilitation?
I)walking on a flat surface for a specified period of time
II)walking on a treadmill for a specified distance or time
III)pedaling a stationary bicycle for a specified distance

A)II and III
B)I and II
C)I, II, and III
D)I and III

Question 39

For which of the following patients would you recommend an open-ended format for a pulmonary rehabilitation program?
I)those with scheduling difficulties
II)those who require individual attention
III)those who are self-directed

A)II and III
B)I and II
C)I, II, and III
D)I and III

Question 40

To maximize patient safety during cardiopulmonary stress testing, which of the following precautions would you recommend?
I)immediate availability of a crash cart
II)staff training in emergency life support
III)presence of a physician throughout testing
IV)patient physical exam or ECG before testing

A)I, II, and III
B)I, II, III, and IV
C)I and III
D)III and IV

Question 41

Appropriate topical areas to be covered in a rehabilitation education session on nutrition include which of the following?
I)elements of a good diet
II)proper eating habits
III)foods to avoid
IV)daily menu planning

A)I, II, and III
B)II and IV
C)I, II, III, and IV
D)III and IV

Question 42

By following the reimbursement guidelines for a comprehensive outpatient rehabilitative facility (CORF), Medicare will reimburse up to what percentage of the allowable charge for a rehabilitation program?

A)60%
B)80%
C)20%
D)40%

Question 43

A small pulmonary rehabilitation program class size has which of the following beneficial effects?
I.It facilitates group interaction.
II.It allows for more individualized attention.
III.It helps to sustain participant motivation.
IV.It reduces the likelihood of attrition.

A)II and IV
B)I, II, and III
C)III and IV
D)I, II, III, and IV

Question 44

A small-group discussion format for pulmonary rehabilitation educational sessions is recommended in order to foster which of the following?
I)group interaction
II)peer support
III)group identity

A)I and II
B)II and III
C)I and III
D)I, II, and III

Question 45

To deal with incidents of hypoxemia, dyspnea, or airway hyperreactivity during physical reconditioning activities, which of the following should be available in the rehabilitation area?
I)intubation tray
II)bronchodilator agents
III)emergency oxygen

A)I and II
B)II and III
C)I and III
D)I, II, and III

Question 46

Minimum equipment requirements for the physical reconditioning component of a pulmonary rehabilitation program include which of the following?
I)inspiratory resistive breathing devices
II)rowing machines or upper extremity ergometers
III)pulse oximeters (for pulse rate/SaO₂)IV.stationary bicycles

A)I, II, and III
B)II and IV
C)I, II, III, and IV
D)III and IV

Question 47

Which of the following health professionals would be best for conducting a pulmonary rehabilitation session on methods of relaxation and stress management?

A)clinical psychologist
B)physical therapist
C)respiratory therapist
D)pulmonary physician

Question 48

Which of the following topics should be covered in a rehabilitation education session on respiratory home care?
I)self-administration of therapy
II)care of home equipment (e.g., cleaning)III.safe use of home care equipment

A)I and II
B)II and III
C)I and III
D)I, II, and III

Question 49

Which of the following is NOT a factor affecting the cost of a pulmonary rehabilitation program?

A)space and utility expenses
B)equipment and supplies
C)patient health insurance
D)program promotion costs

Question 50

Which of the following health professionals would be best for conducting a pulmonary rehabilitation session on recreation and vocational counseling?

A)physical therapist
B)respiratory therapist
C)clinical psychologist
D)occupational therapist

Question 51

What is the ideal class size for pulmonary rehabilitation programs?

A)5 to 15
B)10 to 20
C)20 to 30
D)3 to 10

Question 52

Which of the following are legitimate ways to obtain reimbursement from third-party payers for pulmonary rehabilitation programs?
I)charge sessions as physical therapy exercises for COPD patients
II)charge sessions as office visits with therapeutic exercises
III)charge sessions as physician office visits-intermediate

A)II and III
B)I and II
C)I, II, and III
D)I and III

Question 53

Which of the following educational topics covered in a typical pulmonary rehabilitation program are most suitable for presentation by a respiratory care practitioner?
I)methods of relaxation and stress management
II)recreation and vocational counseling
III)diaphragmatic and pursed-lip breathing techniques
IV)respiratory structure, function, and disease

A)II and IV
B)I, II, and III
C)III and IV
D)I, II, III, and IV

Question 54

Reconditioning the inspiratory muscles of patients undergoing pulmonary rehabilitation is accomplished through which of the following methods?

A)walking aerobically for a specified time
B)using a rowing machine for a specified time
C)pedaling a stationary bicycle for a specified distance
D)performing inspiratory resistive breathing exercises

Question 55

What government programs can serve as a source for reimbursement for pulmonary rehabilitation?
I)prospective payment system (PPS)II.comprehensive outpatient rehabilitative facility (CORF)III.Veterans Administration benefits
IV)Civilian Health and Medical Programs of the Uniformed Services (CHAMPUS)

A)I, II, and III
B)II and IV
C)I, II, III, and IV
D)II, III and IV

Question 56

Which of the following is/are true about the flow-resistor breathing exerciser?
I.Exhaled gas flows unimpeded out a one-way valve.
II.Resistance is created by a variable-size orifice.
III.Imposed load varies with the rate of flow.

A)II and III
B)I, II, and III
C)I and II
D)II

Question 57

Which of the following exercises are useful for reconditioning the upper extremities of patients undergoing pulmonary rehabilitation?
I)using a rowing machine
II)using an arm ergometer
III)pedaling a stationary bicycle
IV)using free hand weights

A)I, II, III, and IV
B)I and III
C)I, II, and IV
D)II and IV

Question 58

For which of the following procedures pulmonary rehabilitation has become recognized as a prerequisite?

A)thoracotomy
B)lung volume reduction surgery
C)lung transplantation
D)heart transplantation

Question 59

During inspiratory resistive exercises, the desired load should be about what percentage of the maximum inspiratory pressure?

A)15%
B)25%
C)30%
D)20%

Question 60

Which of the following outcome measures is considered a major predictor for improvement in a COPD patient's health-related quality of life?

A)frequent attendance in a maintenance program
B)repeated admission to a rehabilitation program
C)frequent medical evaluations
D)antibiotic therapy

Question 61

Which of the following are differences between cardiac and pulmonary rehabilitation?
I.Cardiac patients are typically younger.
II.Most cardiac patients are not able to walk for 1 hour.
III.Reimbursement is easier to obtain with cardiac rehabilitation.
IV.Breathing exercises are not essential to cardiac patients.

A)I and II
B)II and III
C)I, III, and IV
D)I, II, and III

Question 62

What is the level of involvement of the respiratory therapist in cardiac rehabilitation?

A)same as in the pulmonary rehabilitation
B)greater than in pulmonary rehabilitation
C)significantly less than in pulmonary rehabilitation
D)respiratory therapist does not participate in cardiac rehabilitation

Question 63

Which of the following clinicians are commonly involved in the cardiac rehabilitation programs?
I)nurse specialist
II)cardiologist
III)dietitian

A)I and II
B)II and III
C)I and III
D)I, II, and III

Question 64

Where are most cardiac rehabilitation programs conducted?

A)private practice offices
B)clinics
C)hospital facilities
D)homes

Question 65

Common cardiovascular hazards of physical reconditioning for patients with chronic lung disease include which of the following?
I)cardiac arrhythmias
II)systemic hypotension
III)muscle contractures

A)I and II
B)II and III
C)I and III
D)I, II, and III