Pulmonary NPTE prep quiz
A 72 year-old patient is walking on a treadmill in the PT department while his vital signs are being monitored. It is noted that his SaO2 drops from 97% to 95%. In this case, it would be BEST to: A. Not use supplemental O2 B. Place 2 liters of O2 by nasal cannula on the patient for the remainder of the exercise session C. Place a 40% O2 face mask on the patient for the remainder of the exercise session D. Place a 100% O2 face mask on the patient for the remainder of the exercise session
Answer Key:A Feedback:A 70 year-old male would likely have a resting Ox saturation of 95% from the changes associated with aging alone. There is no need to supplement with O2 in this case. The guideline for supplemental O2 is an SaO2
Which of the following findings is NOT typically present with cystic fibrosis? A. Excessive weight gain due to decreased ability to exercise B. Frequent respiratory infections caused by Staph and Pseudomonads C. Increased pancreatic secretions which cause gastrointestinal obstruction D. Increased pulmonary secretions which cause airway obstruction
Answer Key:A Feedback:A characteristic of CF is the inability to gain weight despite adequate caloric intake. Despite a decreased exercise tolerance, excessive weight gain is rarely a finidng in a patient with CF
A patient is being seen for shortness of breath. Notable on physical examination is a deviated trachea to the left. Which of the following processes would account for such a finding? A. right hemothorax. B. left pneumothorax. C. left pleural effusion. D. right lung collapse.
Answer Key:A Feedback:A left pneumothorax and a left pleural effusion take up space in the left thorax. The air (pneumothorax) or the sterile fluid (effusion) in the pleural space would push contents of the left hemithorax, including the trachea, to the right. A lung collapse, or a volume loss phenomenon, on the right side would pull the trachea over towards the right. A right hemothorax (blood in the pleural space) takes up space in the right hemithorax, shifting the trachea to the left.
A physical therapist uses a spirometer to administer a pulmonary function test to a patient with suspected pulmonary dysfunction. Which of the following measurements would the therapist be able to obtain directly without utilizing the results of other pulmonary function tests? A. expiratory reserve volume B. inspiratory reserve volume C. minute volume D. residual volume
Answer Key:A Feedback:Expiratory reserve volume is defined as the maximal amount of air that cam be expired after a normal exhalation. As a result, the measure can be obtained with relative ease using a spirometer.
Your patient has a very large right-sided bacterial pneumonia. Her oxygen level is dangerously low. The body position that would MOST LIKELY improve her PaO2 is: A. Left sidelying with the head of the bed in the flat position B. Prone-lying with the head of the bed in the Trendelenberg position C. Right sidelying with the head of the bed in the flat position D. Supine-lying with the head of the bed in the Trendeleberg position
Answer Key:A Feedback:In order to match perfusion and ventilation, you need to place the unaffected side in a gravity dependent position, or that of left sidelying. While prone and supine with the head of the bed in the flat position might be helpful, these positions would not be as likely to show as much improvement as left sidelying. Given that the answer adds the use of Trendelenberg these are now poor answers to the question.
A patient had been on oxygen, but it was discontinued by physician order yesterday. During PT, the patient becomes short of breath and requests supplemental oxygen. The patient's SaO2 is measured at 90%. The choice that is NOT appropriate is: A. Administer supplemental O2 B. Allow the patient to rest C. Continue to monitor the SaO2 D. Encourage an efficient breathing pattern
Answer Key:A Feedback:Oxygen should only be used with a MD order. Since the patient's SaO2 is above 88%, there is no clear indication for its use. Allowing the patient to recover from exercise through rest and breathing exercises, the patients O2 level should return to baseline. the O2 levels and patient symptoms should be noted in the medical record.
A patient with chronic obstructive pulmonary disesase receives two liters per minute of supplemental oxygen using a nasal cannula. The most relevant indicator for the use of supplemental oxygen for the patient would be: A. arterial saturation = 85% B. partial pressure of arterial oxygen = 70 mm Hg C. partial pressure of carbon dioxide = 40 mm Hg D. pH = 7.40
Answer Key:A Feedback:Supplemental oxygen is often warranted when the partial pressure of arterial oxygen is less than 60mm Hg or when arterial saturation is below 90%. A partial pressure of arterial oxygen of 70 mm Hg corresponds to arterial saturation of 92-93%. Normal pH is 7.35-7.45.
A therapist monitors a client's respiration rate during exercise. Which of the following would be considered a normal response? A. Respiration rate declines during exercise before the intensity of exercise declines B. Respiration rate decreases as the intensity of the exercise plateaus C. Respiration rate does not increase during exercise D. The rhythm of the respiration pattern becomes irregular during exercise
Answer Key:B Feedback:Respiratory rate will increase as intensity increases and decrease once a sustained plateau or decrease in exercise intensity occurs.
A patient with COPD reports to his fourth outpatient pulmonary rehabilitation session complaining of nausea, gastric upset and feeling jittery. The patient reports no change in pulmonary symptoms. The PT records the following set of vital signs: temperature: 98.6 degrees F, HR 110 beats/min and irregular, BP 150/86, respiratory rate 20. Breath sounds show no change from baseline. The therapist checks the medical record and finds that the patient has no history of gastric disease. he is presently taking theophylline, ventolin, and azmacort. The PT should: A. Call the patient's MD due to signs of theophylline toxicity B. Have the patient call the physician when he returns home due to signs of increased pulmonary dysfunction C. Have the patient use his ventolin to inprove respiratory status D. Send the patient home and reschedule for another day
Answer Key:A Feedback:The combination of symptoms of irregular heart rate, feeling jittery, and gastric upset is consistent with this problem. Theophylline toxicity can cause arrythmias and seizures, the patient's MD should be notified by the PT rather than wait for the patient to return home to call. It is also likely that a blood test will be needed to check the theophylline toxicity level.
You are treating a post surgical patient, three times a day, with a regimen of postural drainage. You could reduce the frequency of treatment if the: A. Amount of productive secretions decreases B. Consistency of the sputum changes C. Patient becomes febrile D. Patient experiences decreased postoperative pain
Answer Key:A Feedback:The purpose of postural drainage is to help remove secretions. If the amount diminishes this might be an indicator that the treatment has been successful and that the frequency can be reduced. The other choices of fever, sputum consistency an dpain do not provide a rationale to decrease treatment frequency
A patient with a long history of systemic steroid use for asthma control has a contraindication for percussion if there is evidence of: A. decreased bone density. B. intercostals muscle wasting. C. BP>140/90 D. barrel chest.
Answer Key:A Feedback:While many of the choices are sequelae to long term systemic steroid use, the only one that is a contraindication to percussion would be decreased bone density, as a rib fracture might be a possible result. An increased blood pressure, probably higher than that reported in the scenario, might be a contraindication to postural drainage. It is not a contraindication to percussion. Barrel chest is seen in patients with emphysema, not asthma.
Which of the following is NOT typical of early stage cystic fibrosis? A. excessive appetite and weight gain B. increased pulmonary secretions with airway obstruction. C. frequent recurrent respiratory infections. D. salty skin and sweat.
Answer Key:A Feedback:fibrosis is an inherited disorder affecting the exocrine glands of the hepatic, digestive, respiratory systems. The patient with CF is prone to chronic bacterial airway infections and progressive loss of pulmonary function from progressive obstructive lung disease. Early clinical manifestations include an inability to gain weight despite excessive appetite and adequate caloric intake. Excessive weight gain is rarely a finding in a patient with CF. All other choices are typically present along with persistent coughing, wheezing, and reduced exercise tolerance.
physical therapist from a home care agency examines a 50-year-old patient diagnosed with chronic bronchitis. The patient is overweight and presents with cyanosis at the fingertips and shallow breathing. The most immediate goal would be to: A. implement a low level exercise program B. implement breathing exercises and postural drainage techniques C. prescribe a wheelchair for mobility D. complete a manual muscle test of the upper and lower extremities
Answer Key:B Feedback:Chronic bronchitis is an obstructive disease characterized by increased mucus secretions of the tracheobronchial tree. Postural drainage techniques and breathing exercises can serve to clear secretions and improve ventilation.
A computer programmer, with no significant past medical history, presents to the emergency room with complaints of fever, shaking chills and a worsening productive cough. He has chest pains over the posterior base of his left thorax which is made worse on inspiration. Which of the following is NOT an appropriate finding for this patient? A. crackles over the posterior aspect of his left thorax. B. slowed respiratory rate C. asymmetrical breathing D. limited chest expansion
Answer Key:B Feedback:Crackles are a typical finding with infiltrate. Since the patient is having pain, thoracic expansion would likely be limited and assymetrical. With a lower than normal tidal volume, a respiratory rate would have to be elevated, not slowed, to maintain an adequate minute ventilation (resp rate times tidal volume= minute ventilation).
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 that the patient's total lung capacity is significantly increased when compared to established norms. Which medical condition would most likely produce this type of result? A. chronic bronchitis B. emphysema C. spinal cord injury D. pulmonary fibrosis
Answer Key:B Feedback:Emphysema is a chronic obstructive pulmonary disease characterized by an increase in the size of air spaces distal to the terminal bronchiole accompanied by destructive changes in their 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.
A 14 year-old boy with advanced Duchenne muscular dystrophy is administered a pulmonary function test. The value that is UNLIKELY to show any deviation from normal is: A. FEV 1 B. Functional residual capacity C. Total lung capacity D. Vital capacity
Answer Key:B Feedback: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 MD 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 volume will not change.
A patient has developed congestive heart failure after experiencing a first myocardial infarction. The pulmonary signs and symptoms the therapist expect to find include: A. inspiratory wheezing and shortness of breath B. crackles and cough C. cough productive of thick yellow secretions. D. crackles and clubbing of the digits.
Answer Key:B Feedback:Patients who present with myocardial infarction and CHF have changes to their pulmonary exam, the most common being crackles and dry cough. Inspiratory wheezing occurs whith extreme airway narrowing, which is not a hallmarck of CHF. The cough associated with CHF is most likely nonproductive. Clubbinc of the digits is a sign of chronic hypoxia. In this case scenario, this patient presents with his first myocardial infarction. It is not possible for any chronic changes to have taken place at this point.
A chronic smoker developed carcinoma of the lung. Following a right pneumonectomy, post-operative physical therapy intervention should include: A. percussion in all postural drainage positions. B. sustained maximal inspiration training with an incentive spirometer. C. shaking in all postural drainage positions. D. breathing exercises to both sides of the thorax to maintain adequate aeration.
Answer Key:B Feedback:Sustained inspiration is an appropriate part of a plan of care. Percussion and shaking are indicated but not to both sides, since phymonectomy removes the entire lung. Chest tubes are not a contraindication to the use of these techniques. There is no point in teaching breathing exercises to the right thorax as there is no lung underneath.
A patient is taking a drug from the sympathomimetic group, Albuterol. Which is NOT an expected effect of this drug? A. Bronchodilation B. Exercise induced bronchospasm C. Hypertension D. Tachycardia
Answer Key:B Feedback:Sympathomimetics are a class of drugs that mimic the effects of stimulation of body organs and structures by the sympathetic nervous system. Albuterol is an antiasthmatic medication used to promote bronchodilation. It's primary effects are on the Beta2 receptors in the bronchiole smooth muscle. It may also have an effect on Beta1 receptors, producing cardiovascular adverse reactions (hypertension and tachycardia). One of the indications for its use is exercise-induced bronchospasms
A 56-year-old female diagnosed with emphysema is referred to physical therapy. As part of the examination the physical therapist assesses tactile fremitus by asking the patient to repeat the term "ninety-nine" several times in succession. The most appropriate method when assessing tactile fermiuts is: A. examine voice sounds through auscultation B. examine vibration using the ulnar border of the hand C. examine chest excursion with a tape measure D. examine the intensity and clarity of spoken words using a recording device
Answer Key:B Feedback:Tactile fremitus is often examined by using a hand or portion of a hand to assess the vibration associated with spoken words. The examination technique can be used to provide information on the density of the lungs and thoracic cavity.
A patient with COPD is sitting in a bedside chair. The apices of the lungs in this position compared to other areas of the lungs in this position would demonstrate: A. Increased perfusion B. Increased volume of air at resting end expiratory pressure (REEP) C. The highest changes in ventilation during the respiratory cycle D. The lowest oxygenation and highest CO2 in blood exiting this zone
Answer Key:B Feedback:The gravity independent area of the lung in the upright sitting position refers to the apices of the lungs which house the most air at REEP. That area has the least perfusion because of the effects of gravity on blood flow. The apices also hav ethe smallest change in ventilation during the respiratory cycle because they are the most full at rest. Finally, this area of the lungs has the highest oxygenation and the lowest carbon dioxide content due to the small volume of blood that needs to be diffused.
The therapist is reading a recent report of arterial blood gas analysis with the following values: Fraction of inspired oxygen (FiO2) = 0.21; PaO2= 53mmHg; PaCO2= 30 mm Hg; pH= 7.48; Bicarbonate ion= 24 mEq/l. This would indicate that the patient is in: A. metabolic alkalosis. B. respiratory alkalosis. C. respiratory acidosis. D. metabolic acidosis.
Answer Key:B Feedback:This arterial blood gas shows an increased pH which is an alkalosis. It is caused by the low carbon dioxide level, therefore, it is a respiratory alkalosis. There is no compensation, since the bicarbonate ion is at the baseline level of 24 mEq/dl.
A patient using an incentive spirometer complains of feeling lightheaded. Your instructions to the patient should be to: A. Lie down while using the spirometer B. Take a deeper breath on the following attempt C. Take a rest period and only use the device 10 times/hour D. Try to use the spirometer more frequently to get used to it
Answer Key:C Feedback:A patient feels lightheaded, it may be that they are blowing off too much CO2 by hyperventilating. The device should always be used in the upright position to allow for the greatest amount of expansion and higher values
A physical therapist reviews the results of a pulmonary function test for a patient with chronic obstructive pulmonary disease. Which of the following results is typical with chronic obstructive pulmonary disease? A. decreased functional residual capacity B. increased vital capacity C. increased residual volume D. increased forced expiratory volume in one second
Answer Key:C Feedback:Chronic obstructive pulmonary disease is characterized by a progressive reductive in expiratory flow rates. Hyperinflation of the lungs results in an increase in residual volume.
A physical therapist treats a patient with emphysema. As part of the treatment session the therapist teaches the patient to perform diaphragmatic breathing exercises. The primary goal of diaphragmatic breathing is to: A. decrease tidal ventilation B. increase respiration rate C. decrease accessory muscle use D. decrease oxygenation
Answer Key:C Feedback:Diaphragmatic breathing is often used as a method to increase activity of the diaphragm during inspiration, while diminishing the reliance on accessory muscles.
A patient has developed congestive heart failure after experiencing his first myocardial infarction. The pulmonary signs and symptoms you expect to find include: A. Cough productive of thick yellow secretions B. Crackles and clubbing of the digits C. Crackles and cough D. Inspiratory wheezing and shortness of breath
Answer Key:C Feedback:Patients who present with a MI and CHF have changes to their pulmonary exam, the most common being crackles and a dry cough. Inspiratory wheezing occurs with extreme airway narrowing, which is not a hallmark of CHF. The cough associated with CHF is most likely nonproductive. Clubbing of the digits is a sign of chronic hypoxia. In this case scenario, this patient presents with his first MI. It is not possible for any chronic changes to have taken place at this point.
Standard postural drainage positions for specific lung segments utilize a variety of client positions, including sitting, sidelying, supine, and prone. Postural drainage of the ___________ typically is administered with the client in sitting? A. Anterior basal segments of the lower lobes B. Posterior basal segments of the lower lobes C. Posterior segments of the upper lobes D. Right middle lobe
Answer Key:C Feedback:Postural drainage to the posterior segments of the upper lobes is performed with the person sitting leaning over a pillow at a 30 degree angle.
A therapist reviews a client's blood gas analysis. The PT identifies that the PaCo2 is elevated and the pH is below the normal level. These findings are most representative of ______________? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Resiraory alkalosis
Answer Key:C Feedback:Respiratory acidosis is caused by retention of carbon dioxide due to pulmonary insufficiency. signs and symptoms include dizziness, tingling, and syncope
A patient with COPD reports to his fourth outpatient rehabilitation session complaining of nausea, gastric upset and feeling jittery. The patient reports no change in the pulmonary symptoms. The physical therapist records the following set of vital signs: temperature= 98.6 degrees Fahrenheit; HR = 110 bpm; and irregular blood pressure 150/86, respiratory rate of 20 bpm. Breath sounds show no change from baseline. The therapist checks the medical record and finds that the patient has no history of gastric disease. He is presently taking theophylline, Ventolin, and Amcort. The physical therapist should: A. send the patient home and have him notify the physician of his current symptoms. B. have the patient increase his use of Ventolin to improve respiratory status. C. call the patient's physician and report the signs of theophylline toxicity. D. have the patient stop his use of Amcort until he can schedule an appointment with his physician.
Answer Key:C Feedback:Theophylline is a bronchodilator used to reverse airway obstruction. The combination of symptoms of irregular heart rate, feeling jittery, and gastric upset is consistent with theophylline toxicity. As theophylline toxicity can cause arrhthmias and seizures, the patient's physician should be notified by the physical therapist rather than waiting for the patient to return home to call the physician. It is also likely that a blood test will be needed to check the theophylline toxicity level and this could be done at the facility. Ventolin (Albubterol) is a bronchodilator used In the treatment of asthma or COPD. Amcort (Triamcinolone) is an anti-inflammatory agent used to manage bronchial asthmal.
A patient with a long history of systemic steroid use for asthma control has a contraindication for percussion if there is evidence of: A. Ankle edema from fluid retention B. BP>140/90 C. Decreased bone density D. Muscle wasting
Answer Key:C Feedback:While all of the answers are sequelae to long term systemic steroid use, the only one that is a contraindication to percussion would be decreased bone density, as a rib fx might be more possible. An increased blood pressure, probably higher than what reported in the scenario, might be a contraindication to postural drainage. It is not a contraindication to percussion.
A patient with recent history of rib fractures suddenly becomes short of breath during secretion removal techniques. The patient looks panicked and complains of sharp pain in the left chest. A quick screen shows a deviated trachea to the right among other signs and symptoms. The MOST LIKELY explanation for the above is: A. angina B. pulmonary emboli C. pneumothorax D. mucous plugging of an airway
Answer Key:C Feedback:While all of the pathologies listed would cause panic on the part of the patient, mucous plugging of an airway would not cause pain. The deviation of the trachea would not result from angina or pulmonary emboli, but would happen with a pneumothorax and lung tissue collapse (which would occur with mucous plugging). The deviation of the trachea toward the right, with the chest pain on the left, is a match of symptoms for the occurrence of a pneumothorax on the left. The history of a rib fracture makes pneumothorax more likely.
A patient with a recent history of rib fractures suddenly becomes short of breath during secretion removal techniques. The patient looks panicked and complains of sharp pain in the left chest. A quick screen shows a deviated trachea to the right among other signs and symptoms. The MOST LIKELY explanation for the above is: A. Angina B. Mucous plugging of an airway C. Pneumothorax D. Pulmonary emboli
Answer Key:C Feedback:While all the pathological listed would cause panic on the part of the patient, mucous plugging of an airway would not cause pain. The deviation of the trachea would not result from angina or pulmonary emboli, but would happen with a pneumothorax an dlung tissue collapse (which could result from mucous plugging). The deviation of the trachea toward the right, with the chest pain on the left, is a match of symptoms for the occurrence of a pneumothorax on the left. The history of rib fracture makes this more likely.
A PT instructs a client in breathing exercises to improve ventilation and oxygenation. The therapist's treatment objective emphasizes the expansion of a selected area of the chest wall during inspiration. The MOST appropriate breathing exercise to achieve the desired outcome is ______________? A. Abdominal breathing B. Deep breathing C. Diaphragmatic breathing D. Segmental breathing
Answer Key:D
A chronic smoker developed carcinoma of the lung. Following a right pneumonectomy, post-operative PT care should include:Sustained maximal inspiration is an appropriate part of a plan of care. Percussion and shaking are indicated, but not to both sides, since pneumonectomy removes the entire lung. Chest tubes are not a contraindication to the use of therapeutic techniques. There is no point in teaching breathing exercises to the right thorax as there is no lung underneath. A. Breathing exercises to both sides of the thorax to maintain adequate aeration B. Percussion in all postural drainage positions C. Shaking in all postural drainage positions D. Sustained maximal inspiration training with an incentive spirometer
Answer Key:D
The optimal position for ventilation of a patient with a C5 complete spinal cord injury is: A. Semi Fowler's position B. Sidelying, head of bed flat C. Sidelying, head of bed elevated 45 degrees D. Supine, head of bed flat
Answer Key:D Feedback:A patient with a C5 spinal cord injury will not have the abdominal musculature necessary to return the diaphragm to a high domed position during exhalation. Inspiration will be affected by the change in the diaphragm's resting position. In supine, gravity will take the place of abdominals, holding the abdominal contents under the diaphragm, improving the zone of opposition, the height of the diaphragm dome and therefore, the ability to ventilate. The other positions listed negate the positive effects of gravity on the abdomen.
A physical therapist assesses a patient's voice sounds as part of a respiratory examination. Which condition is typically associated with increased voice sound. A. pneumothorax B. atelectasis C. pleural effusion D. consolidation
Answer Key:D Feedback:A whisper sound will not typically be audible through a stethoscope with normal air-filled lung tissue, but may be distinctly audible with consolidation.
A physical therapist provides preoperative training for a patient scheduled for thoracic surgery. Which activity would be the most appropriate to prevent a deep vein thrombosis post surgery? A. deep breathing B. increntive spirometry C. coughing D. ankle pumps
Answer Key:D Feedback:Bedrest is the primary cause of acute postoperative thrombosis in the lower extremities. Ankle pumps can be an effective active exercise to facilitate venous return, and decrease the risk of deep vein thrombosis.
A 45 year-old computer programmer, with no significant past medical history, presents to the emergency room with complaints of fever, shaking chills and a worsening productive cough. He has chest pains over the posterior base of his left thorax which is made worse on inspiration. Which of the following is NOT an appropriate physical finding for this patient? A. Asymmetrical breathing B. Crackles over the posterior aspect of his left thorax C. Limited chest excursion D. Slowed respiratory rate
Answer Key:D Feedback:Crackles are a typical finding with an infiltrate. Since the patient is having pain, thoracic expansion would likely be limited and asymmetrical. With a lower than normal tidal volume, a RR would have to be elevated, not slowed, to maintain an adequate minute ventilation (RR X tidal volume= minute ventilation).
Secretion removal techniques are often a necessary component of a pulmonary rehabilitation program. Which pulmonary disease is usually associated with a change in the composition of secretions? A. asthma B. bronchiectasis C. chronic bronchitis D. cystic fibrosis
Answer Key:D Feedback:Cystic fibrosis is an inherited disease affecting the exocrine glands. The disease is characterized by hypertrophy of goblet cells resulting in excessive airway secretions.
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 accessory muscle use and emphasize diaphragmatic breathing
Answer Key:D Feedback: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 patient's breathing pattern.
A patient has a very large right-sided bacterial pneumonia. Oxygen level is dangerously low. The body position that would MOST LIKELY improve the patient's PaO2 is: A. right sidelying with the head of the bed in the flat position. B. prone-lying with the head of the bed in the Trendelenburg position. C. supine-lying with the head of the bed in the Trendelenburg position. D. left sidelying with the head of the bed in the flat position.
Answer Key:D Feedback:In order to match perfusion and ventilation, the therapist needs to place the unaffected side in a gravity dependent position, or that of left sidelying. While prone and supine with the head of the bed in the flat position might be helpful, these positions would not be as likely to show as much improvement as left sidelying. The use of the Trendelenburg position (head lower than legs) is inappropriate.
A physical therapist designs an exercise program for a patient rehabilitating from cardiac surgery. During the treatment session the therapist monitors the patient's oxygen saturation rate. Which of the following would be most representative of a normal oxygen saturation rate? A. 82% B. 87% C. 92% D. 97%
Answer Key:D Feedback:Oxygen saturation rate refers to the percentage of oxygen bound to hemoglobin in the blood. Normal oxygen saturation rates range from 95-98%.
A physical therapist develops a treatment program for a patient diagnosed with cystic fibrosis. Which of the following treatment activities would be the most essential to improve ventilation? A. gait training B. family education C. home adaptations D. postural drainage
Answer Key:D Feedback:Postural drainage should be the highest priority in the care of a patient with cystic fibrosis. Postural drainage enhances gas exchange by removing mucus from the lungs and limits the incidence of infection.
An INAPPROPRIATE home physical therapy intervention for a young child with cystic fibrosis is: A. secretion removal techniques by the parents to all lobes once or twice a day. B. functional activities to increase endurance 3-5 times per week. C. using a capella device in postural drainage positions once or twice a day D. autogenic drainage for secretion removal once or twice a day
Answer Key:D Feedback:Proper at home interventions include: secretion removal techniques including a capella device or manual techniques performed by an adult, and exercise are appropriate interventions in this case. Autogenic drainage can be helpful in clearing secretions but is not appropriate for a young child as it relies on independent ability to monitor secretion build up in the airways and to make appropriate choices for clearance.
A physical therapist reviews the results of a patient's arterial blood gases. The report indicates the following: PaO2 = 45mm Hg, PaCO2 = 55 mm Hg, HCO3 = 24 mEq/L, pH = 7.20. These values are most indicative of: A. respiratory alkalosis B. metabolic acidosis C. metabolic alkalosis D. respiratory acidosis
Answer Key:D Feedback:Respiratory acidosis is characterized by decreased pH, increased PaCO2, and HCO3 that is within normal limits.
A patient with bacterial pneumonia has crackles and wheezes at her left lateral basal segment and decreased breath sounds throughout. She is on 4L of O2 by nasal cannula which brings her SaO2 to 90%. Respiratory rate is 28. The intervention that would be INAPPROPRIATE to use in this case is: A. Breathing exercises encouraging expansion of the left lateral basilar thorax B. Percussion to the appropriate area of the left lateral basilar thorax C. Shaking over the appropriate area of the left lateral basilar thorax D. Standard postural drainage for the lateral basal segment, left lower lobe
Answer Key:D Feedback:The appropriate postural drainage for the lateral basilar segment of the left lower lobe is in sidelying position with the head of bed tipped in full Trendelenberg. With a respiratory rate of 28 at rest and borderline SaO2 values on 4L O2, modification of the position is in order.
A patient with bacterial pneumonia has crackles and wheezes at the left lateral basal segment and decreased breath sounds throughout. The patient is on 4 liters of oxygen by nasal canula which brings the SaO2 to 90%. Respiratory rate is 28. The intervention that would be INAPPROPRIATE to use in this case is: A. percussion to the appropriate area on the left lateral basilar thorax. B. shaking over the appropriate area on the left lateral basilar thorax. C. breathing exercises encouraging expansion of the left lateral basilar thorax. D. standard postural drainage for the lateral basal segment, left lower lobe.
Answer Key:D Feedback:The appropriate postural drainage for the lateral basilar segment of the left lower lobe is in sidelying position with the head of the bed tipped in full Trendelenburg. With a respiratory rate of 28 at rest and borderline SaO2 values on 4 liters of O2, modification of the position is in order. Use of the standard position is very risky in this case.
Clinical findings in a patient with severe emphysema would NOT include: A. Clubbing B. Cor Pulmonale C. Cyanosis D. Decreased A-P to lateral chest ratio
Answer Key:D Feedback:The barreled chest commonly seen in emphysema is measured as an increased A-P to lateral ratio. Cor pulmonale is hypertrophy or failure of the right ventricle and results from disorders of the lungs, pulmonary vessels, or chest wall. Clubbing (bulbous, shiny fingertips and toes) and cyanosis (bluish and grayish skin) are both present with chronic lung disease.
A client is positioned on a treatment table in prone with two pillows under her hips. This position most likely would be used to perform postural drainage techniques to the___________________? A. Anterior basal segment of the lower lobes B. Lateral basal segment of the lower lobes C. Right middle lobe D. Superior segment of the lower lobes
Answer Key:D Feedback:The optimal position for the superior segments of the lower lobes is described as having the client in the above position. The therapist claps over the middle back at the tip of the scapula on either side of the spine.
A physical therapist positions a patient in prone with two pillows under the hips in preparation for bronchial drainage. If the therapist's goal is to perform bronchial drainage to the superior segments of the lower lobes, which area should the therapist's force be directed? A. between the clavicle and nipple on each side B. over the area between the clavicle and top of the scapula on each side C. over the lower ribs on each side D. over the middle of the back at the tip of the scapula on each side
Answer Key:D Feedback:The supplied description accurately describes the position and techniques associated with bronchial drainage to the superior segments of the lower lobes.
You are reading a recent report of arterial blood gas analysis with the following values: PaO2: 53mmHg PaCO2: 30mmHg pH: 7.48 Bicarbonate ion: 24mEq/l This would indicate that your patient is in: A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
Answer Key:D Feedback:This arterial blood gas shows an increased pH which is an alkalosis. it is caused by the low carbon dioxide level; therefore, it is a respiratory alkalosis. There is no compensation, since the bicarbonate ion is at the baseline level of 24 mEq/l
While on a home visit, a 9 month-old infant becomes unresponsive. You tell the mother to call for emergency medical services. Your IMMEDIATE next step is: A. Begin with chest compressions and alternate with rescue breaths at a ration of 1:7 B. Check for a pulse, if no pulse begin chest compressions at a rate of 80 compressions per minute C. Check for pulse, if no pulse begin chest compressions at a rate of 100 compressions per minute D. Tilt the infants head back and give 2 full breaths, covering both the mouth and nose with yours
Answer Key:D Feedback:Tilt the head back, cover mouth and nose and give two slow breaths. Then, check pulse. If there is no pulse, begin with chest compressions depressing 1/2 to 1 inch using 2 fingers at a rate of 100 compressions/minute.
A physical therapist employed in a nursing home routinely treats patients in excess of 70 years of age. Which of the following physical changes is not associated with aging? A. increased residual volume B. decreased vital capacity C. decreased cardiac output D. decreased total lung capacity
Answer Key:D Feedback:Total lung capacity equals the sum of residual volume and vital capacity. Total lung capacity does not change significantly as a result of aging. Although residual volume increases with age, the nest result on total lung capacity is negligible.
A physical therapist instructs a patient to expire maximally after taking a maximal inspiration. The therapist can use these instructions to measure the patient's: A. expiratory reserve volume B. inspiratory reserve C. total lung capacity D. vital capacity
Answer Key:D Feedback:Vital capacity equals the sum of inspiratory reserve volume, tidal volume, and expiratory reserve volume.
A therapist reviews the results of a pulmonary function test. Assuming normal values, which of the following measurements would you expect to be the greatest? A. Inspiratory reserve volume B. Residual volume C. Tidal volume D. Vital capacity
Answer Key:D Feedback:Vital capacity is defined as the amount of air that can be exhaled following maximal inspiratory effort. Vital capacity varies directly with height and indirectly with age.v
