CH 55 test

59. 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

ANS: A One of the major predictors for improvement in a COPD patient's health-related quality-of-life is frequent attendance in a maintenance program.

32. The O2max 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? a. 65% b. 80% c. 90% d. 95%

ANS: A Patients in whom there is a respiratory limitation to exercise resulting in termination at a level less than 75% of the predicted maximum oxygen consumption (O2max).

46. 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

ANS: A Table 55-4 provides an example of topics covered during a 12-week rehabilitation program.

12. 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

ANS: B Studies show that the relative success of reconditioning plays less of a role in determining whether patients complete a program than does meeting their psychosocial support needs.

2. 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. Homecare

ANS: B The Council on Rehabilitation defines rehabilitation as "the restoration of the individual to the fullest medical, mental, emotional, social, and vocational potential of which he or she is capable."

24. Which of the following should be monitored during a cardiopulmonary exercise evaluation? 1. Respiratory rate 2. HbO2 saturation 3. ECG and blood pressure 4. FEV1 and FVC a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only

ANS: B The actual exercise evaluation procedure involves serial or continuous measurements of several physiologic parameters during various graded levels of exercise on either an ergometer or a treadmill.

20. A cardiopulmonary exercise evaluation is conducted on a patient before participation in pulmonary rehabilitation for what purposes? 1. To quantify the patient's baseline exercise capacity 2. To develop an exercise prescription (including target heart rate) 3. To determine how much desaturation occurs with exercise a. 2 and 3 only b. 1, 2, and 3 c. 1 and 2 only d. 1 and 3 only

ANS: B The cardiopulmonary exercise evaluation serves two key purposes in pulmonary rehabilitation. First, it quantifies the patient's initial exercise capacity. This provides the basis for the exercise prescription (including setting a target heart rate) and also yields the baseline data for assessing a patient's progress over time. In addition, the evaluation helps to determine the degree of hypoxemia or desaturation that can occur with exercise.

3. What are the overall goals of rehabilitation? 1. To reverse the course or progression of the disease process 2. To minimize the disability's impact on the individual or family 3. To maximize the functional ability of the individual a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3

ANS: B The overall goal is to maximize the functional ability and to minimize the impact the disability has on the individual, the family, and the community.

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? 1. Lung volumes, including functional residual capacity (FRC) 2. Diffusing capacity (DLCO) 3. Pre- and post-bronchodilator flows 4. Lung and thoracic compliance a. 2 and 4 only b. 1, 2, and 3 only c. 1, 2, 3, and 4 d. 1, 2, and 4 only

ANS: B The pulmonary function testing can include assessment of pulmonary ventilation, lung volume determinations, diffusing capacity (DLCO), and pre-bronchodilator and post-bronchodilator spirometry.

18. 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? 1. Cardiopulmonary exercise evaluation 2. Pulmonary function testing 3. Cardiac catheterization a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only

ANS: B To determine the patient's cardiopulmonary status and exercise capacity, both pulmonary function testing and a cardiopulmonary exercise evaluation may be performed.

8. Knowledge from the social sciences is used in pulmonary rehabilitation programming for mainly what purpose? 1. To determine the impact of the disability on the patient or family 2. To quantify the extent of physiological impairment due to disease 3. To establish ways to improve the patient's quality-of-life a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3

ANS: C Application of the social sciences is helpful in determining the psychological, social, and vocational impact of the disability on the patient and family and in establishing ways to improve the patient's quality-of-life.

41. Which of the following exercises are useful for reconditioning the upper extremities of patients undergoing pulmonary rehabilitation? 1. Using a rowing machine 2. Using an arm ergometer 3. Pedaling a stationary bicycle 4. Using free hand weights a. 1, 2, 3, and 4 b. 1 and 3 only c. 1, 2, and 4 only d. 2 and 4 only

ANS: C Arm ergometers or rowing machines are available for this purpose; however, simple calisthenics using either a broomstick or free weights (by prescription and with training) are a satisfactory alternative.

49. Appropriate topical areas to be covered in a rehabilitation education session on nutrition include which of the following? 1. Elements of a good diet 2. Proper eating habits 3. Foods to avoid 4. Daily menu planning a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only

ANS: C Dietary guidelines focus on weight management and good nutrition as they relate to cardiopulmonary health. Emphasis should be on the importance of a sound high-protein, low-carbohydrate diet. The facilitator also should cover proper eating habits, methods of gaining and losing weight, foods to avoid, ways to increase appetite, and daily menu planning. This session will stimulate patients to eat better.

63. Which of the following are differences between cardiac and pulmonary rehabilitation? 1. Cardiac patients are typically younger. 2. Most cardiac patients are not able to walk for 1 hr. 3. Reimbursement is easier to obtain with cardiac rehabilitation. 4. Breathing exercises are not essential to cardiac patients. a. 1 and 2 only b. 2 and 3 only c. 1, 3, and 4 only d. 1, 2, and 3 only

ANS: C Differences include disease focus, patient age (most cardiac patients will range from their late 30s on up to their 60s and 70s, while pulmonary patients, for the most part, will be 50 years or older), and exercises used within the program. Many cardiac patients will walk for up to 1 hr, while this may be virtually impossible for most respiratory patients. On the other hand, breathing exercises to improve ventilation are essential to the respiratory patient but are not that important to patients with cardiovascular diseases. Reimbursement variables between the two types of programs also exist, with cardiac rehabilitation being more recognized by insurance payers.

7. In which of the following ways does the body respond to increased levels of physical activity? 1. Decreased cardiac output 2. Increased minute ventilation 3. Neuroendocrine stimulation a. 3 only b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 3

ANS: C Figure 55-1 shows how the body responds to exercise.

53. Minimum equipment requirements for the physical reconditioning component of a pulmonary rehabilitation program include which of the following? 1. Inspiratory resistive breathing devices 2. Rowing machines or upper extremity ergometers 3. Pulse oximeters (for pulse rate/SaO2) 4. Stationary bicycles a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only

ANS: C For physical reconditioning, stationary bicycles, treadmills, rowing machines, upper extremity ergometers, weights, pulse oximeters, and inspiratory resistance breathing devices represent the minimum equipment requirements.

44. 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%

ANS: C If the patient's inspiratory pressure is less than 30% of the measured PImax, the next smaller orifice is selected, with this procedure repeated until the 30% effort is consistently achieved.

31. Which of the following patients are good candidates for pulmonary rehabilitation? 1. Those with malignant neoplasms involving the lungs 2. Those with severe arthritis or neuromuscular abnormalities 3. Those with exercise limitations due to severe dyspnea 4. Those with moderate to severe obstructive lung disease a. 1, 2, and 3 only b. 2 and 4 only c. 3 and 4 only d. 2, 3, and 4 only

ANS: C Indications for pulmonary rehabilitation are listed in Box 55-4.

6. Knowledge from the clinical sciences is used in pulmonary rehabilitation programming for mainly what purpose? 1. To quantify the extent of physiological impairment 2. To establish ways to improve the quality-of-life 3. To set expectations for reasonable outcomes a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3

ANS: C Knowledge from the clinical sciences can help quantify the degree of physiologic impairment and establish outcome expectations for reconditioning.

14. Common goals shared by most pulmonary rehabilitation programs include which of the following? 1. Improvement in physical activity levels 2. Control of respiratory infections 3. Reduction in medical costs and hospitalizations 4. Family education, counseling, and support a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only

ANS: C Pulmonary rehabilitation programs vary in their design and implementation but generally share common goals. Examples of these common goals appear in Box 55-1.

11. To physically recondition a patient and increase exercise tolerance, which of the following must be accomplished? 1. The body's overall O2 utilization must be improved. 2. The patient's essential muscle groups must be strengthened. 3. The cardiovascular response to exercise must be enhanced. a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only

ANS: C Reconditioning involves strengthening essential muscle groups, improving overall oxygen utilization, and enhancing the body's cardiovascular response to physical activity.

25. What are some relative contraindications for cardiopulmonary exercise testing? 1. Severe pulmonary hypertension or cor pulmonale 2. Known electrolyte disturbances (e.g., hypokalemia) 3. SaO2 or SpO2 less than 85% breathing room air 4. Untreated or unstable asthma a. 2 and 4 only b. 1, 2, and 3 only c. 1, 2, 3, and 4 d. 1, 2, and 4 only

ANS: C Relative contraindications to exercise testing include (1) patients who cannot or will not perform the test, (2) severe pulmonary hypertension/cor pulmonale, (3) known electrolyte disturbances (hypokalemia, hypomagnesemia), (4) resting diastolic blood pressure greater than 110 mm Hg or resting systolic blood pressure greater than 200 mm Hg, (5) neuromuscular, musculoskeletal, or rheumatoid disorders exacerbated by exercise, (6) uncontrolled metabolic disease (e.g., diabetes), (7) SaO2 or SpO2 less than 85% with the subject breathing room air, (8) untreated or unstable asthma, or (9) angina with exercise.

64. 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

ANS: C Respiratory involvement in cardiac rehabilitation is significantly less.

13. Which of the following elements should be considered in most pulmonary rehabilitation programs? 1. Individual needs 2. Patient's education 3. Patient's personality 4. Patient's aptitudes a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 3 and 4 only

ANS: C Such a program should be based on the individual needs and expectations of each patient. Not only each patient's physical ability must be considered, but also his or her education, past experience, aptitude, and personality must be considered as well.

26. Which of the following measures during cardiopulmonary exercise evaluation are most useful in differentiating between exercise intolerance of cardiac versus ventilatory origin? 1. Maximum heart rate 2. O2max 3. PaCO2 4. PaO2 a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only

ANS: C Table 55-1 summarizes these key similarities and differences.

1. 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.

ANS: D Although differences in diagnoses can have an impact on treatment outcomes and survival, patients with chronic pulmonary disorders have much in common. All have difficulty coping with the physiologic limitations of their diseases.

57. Which of the following are legitimate ways to obtain reimbursement from third-party payers for pulmonary rehabilitation programs? 1. Charge sessions as physical therapy exercises for COPD patients 2. Charge sessions as office visits with therapeutic exercises 3. Charge sessions as physician office visits—intermediate a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only

ANS: D Box 55-6 provides a listing of all possible sources of reimbursement.

58. What government programs can serve as a source for reimbursement for pulmonary rehabilitation? 1. Prospective payment system (PPS) 2. Comprehensive outpatient rehabilitative facility (CORF) 3. Veterans Administration benefits 4. Civilian Health and Medical Programs of the Uniformed Services (CHAMPUS) a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 2, 3, and 4 only

ANS: D Box 55-6 provides a listing of all possible sources of reimbursement.

52. A small pulmonary rehabilitation program class size has which of the following beneficial effects? 1. It facilitates group interaction. 2. It allows for more individualized attention. 3. It helps to sustain participant motivation. 4. It reduces the likelihood of attrition. a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4

ANS: D Keeping the class size manageable facilitates vital group interaction processes and allows for more individualized attention. These factors help to sustain motivation, thereby reducing the likelihood of participant attrition.

5. 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 sec (FEV1) and forced expiratory flow (FEF25% to 75%)

ANS: D Pulmonary rehabilitation does not reverse or stop the disease progression, but it can improve a patient's overall quality-of-life.

15. Which of the following are reasonable expectations for a pulmonary rehabilitation program? 1. Reduction in hospitalizations 2. Improvement in ambulation 3. Reversal of the disease process 4. Control of respiratory infections a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, and 4 only

ANS: D Pulmonary rehabilitation programs vary in their design and implementation but generally share common goals. Examples of these common goals appear in Box 55-1.

55. Which of the following are factors affecting the cost of a pulmonary rehabilitation program? 1. Space and utility expenses 2. Equipment and supplies 3. Patient health insurance 4. Program promotion costs a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, and 4 only

ANS: D Several factors must be considered when projecting program costs (Box 55-5).

45. Which of the following educational topics covered in a typical pulmonary rehabilitation program are most suitable for presentation by a respiratory care practitioner? 1. Methods of relaxation and stress management 2. Recreation and vocational counseling 3. Diaphragmatic and pursed-lip breathing techniques 4. Respiratory structure, function, and disease a. 2 and 4 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4

ANS: D Table 55-4 provides an example of topics covered during a 12-week rehabilitation program.

47. 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

ANS: D Table 55-4 provides an example of topics covered during a 12-week rehabilitation program.

48. Which of the following topics should be covered in a rehabilitation education session on respiratory homecare? 1. Self-administration of therapy 2. Care of home equipment (e.g., cleaning) 3. Safe use of home care equipment a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3

ANS: D Table 55-4 provides an example of topics covered during a 12-week rehabilitation program.

4. The principal objectives of pulmonary rehabilitation include which of the following? 1. To control and alleviate the symptoms 2. To restore functional capabilities as much as possible 3. To improve quality-of-life a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3

ANS: D The general goals of pulmonary rehabilitation are to control and alleviate the symptoms, restore functional capabilities as much as possible, and improve the quality-of-life.

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

ANS: D The ideal class size should range from 3 to 10 participants.

50. A small-group discussion format for pulmonary rehabilitation educational sessions is recommended in order to foster which of the following? 1. Group interaction 2. Peer support 3. Group identity a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3

ANS: D To foster group identity, interaction, and support, small-group discussions are encouraged.

21. Absolute contraindications for conducting a cardiopulmonary exercise evaluation include which of the following? 1. Diastolic blood pressure greater than 110 mm Hg 2. Serious cardiac arrhythmias 3. Unstable angina 4. Recent myocardial infarction a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only

ANS: D To guide practitioners in implementing exercise evaluation, the AARC has published Clinical Practice Guidelines: Exercise Testing for Evaluation of Hypoxemia and/or Desaturation and Pulmonary Rehabilitation.

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.

ANS: D To guide practitioners in implementing exercise evaluation, the AARC has published Clinical Practice Guidelines: Exercise Testing for Evaluation of Hypoxemia and/or Desaturation and Pulmonary Rehabilitation.

42. 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

ANS: D Ventilatory muscle training is based on the concept of progressive resistance.

28. In preparing an outpatient for a cardiopulmonary stress test to be conducted the next day, which of the following instructions would you provide? 1. The patient should fast for at least 8 hr before testing. 2. The patient should wear loose-fitting clothing and sneakers. 3. The patient should stop all medications at once. 4. The patient should review the drugs with the physician. a. 1, 2, and 3 only b. 2 and 4 only c. 1, 2, 3, and 4 d. 1, 2, and 4 only

ANS: D With regard to test preparation, patients should fast 8 hr before the procedure. If the purpose of the test is to formulate an exercise prescription, the patient can take his or her regular medications. The patient should wear comfortable, loose-fitting clothing and footwear with adequate traction for treadmill or ergometer activity. The mouthpiece or face mask used during the test should be sized properly and fit comfortably with no leaks.

65. Which of the following clinicians are commonly involved in the cardiac rehabilitation programs? 1. Nurse specialist 2. Cardiologist 3. Dietitian a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3

ANS: A Most often, the cardiologist and cardiac nurse specialist are involved with program facilitation and administration.

35. 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? 1. DLCO 2. Total lung capacity (TLC) 3. FEV1/FVC a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3

ANS: A DLCO and TLC are the most useful pulmonary function tests to evaluate the need of pulmonary rehabilitation of patients with restrictive lung disease. Patients in whom there is a significant restrictive lung disease with a TLC of less than 80% of predicted and single-breath carbon monoxide-diffusing capacity (DLCO) of less than 80% of predicted.

29. Which of the following patients are good candidates for pulmonary rehabilitation? 1. Unstable cardiovascular patients who require monitoring 2. Patients with exercise limitations due to severe dyspnea 3. Patients with malignant neoplasms involving the lungs a. 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3

ANS: A Indications for pulmonary rehabilitation are listed in Box 55-4.

22. Under which of the following conditions would you recommend ending a cardiopulmonary exercise evaluation? 1. Electrocardiogram indicating sinus tachycardia 2. 10% fall from baseline oxyhemoglobin (HbO2) saturation 3. Fall in systolic blood pressure of more than 20 mm Hg 4. Request from the patient to terminate the test a. 2, 3, and 4 only b. 1, 2, and 3 only c. 1, 2, 3, and 4 d. 1, 2, and 4 only

ANS: A To guide practitioners in implementing exercise evaluation, the AARC has published Clinical Practice Guidelines: Exercise Testing for Evaluation of Hypoxemia and/or Desaturation and Pulmonary Rehabilitation.

38. The physical reconditioning component of a pulmonary rehabilitation program usually includes which of the following? 1. Aerobic exercises for the extremities 2. Timed walking exercise 3. Ventilatory muscle training a. 1, 2, and 3 b. 2 and 3 only c. 1 and 3 only d. 3 only

ANS: A Typically, the exercise prescription includes the following four related components: (1) lower extremity (leg) aerobic exercises, (2) timed walking (6- or 12-min walk), (3) upper extremity (arm) aerobic exercises, and (4) ventilatory muscle training.

9. During exercise, the point at which increased levels of lactic acid production result in an increased VCO2 and VE is referred to as what? a. Respiratory quotient (RQ) b. Ventilatory threshold c. Crossover point d. Exercise limit

ANS: B As excess lactic acid is buffered, CO2 levels rise and the stimulus to breathe increases. The result is an abrupt upswing in both CO2 and VE (referred to as the ventilatory threshold, or VT).

56. 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%

ANS: B By following recognized guidelines, Medicare will be able to establish an allowable charge for the program and reimburse 80% of this rate after the patient meets the annual prescribed deductible.

16. Specific patient objectives for a pulmonary rehabilitation program could include which of the following? 1. Proper use of medications, O2, and breathing equipment 2. Reconditioning of both skeletal and respiratory muscles 3. Adherence to proper hygiene and good nutrition 4. Improvement in the results of pulmonary function tests a. 1 and 3 only b. 1, 2, and 3 only c. 3 and 4 only d. 2, 3, and 4 only

ANS: B Depending on the specific needs of the participants, program objectives can include the following: development of diaphragmatic breathing skills; development of stress management and relaxation techniques; involvement in a daily physical exercise regimen to condition both skeletal and respiratory-related muscles; adherence to proper hygiene, diet, and nutrition; smoking cessation (if applicable); proper use of medications, oxygen, and breathing equipment (if applicable); application of airway clearance techniques (when indicated); focus on group support; and provisions for individual and family counseling.

54. 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? 1. Intubation tray 2. Bronchodilator agents 3. Emergency oxygen a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3

ANS: B Emergency oxygen and bronchodilator medications should also be maintained in the rehabilitation area.

17. 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

ANS: B Patient evaluation begins with a complete patient history: medical, psychological, vocational, and social.

61. Common cardiovascular hazards of physical reconditioning for patients with chronic lung disease include which of the following? 1. Cardiac arrhythmias 2. Systemic hypotension 3. Muscle contractures a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3

ANS: B Potential hazards include the following: (1) cardiovascular abnormalities, such as cardiac arrhythmias (can be reduced with supplemental oxygen during exercise) and systemic hypotension and hypertension tension; (2) blood gas abnormalities (arterial desaturation, hypercapnia, and acidosis); and (3) muscular abnormalities (functional or structural injuries, diaphragmatic fatigue and failure, and exercise-induced muscle contracture).

60. 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

ANS: B Pulmonary rehabilitation has become recognized as a prerequisite for certain emphysema patients who are able to undergo lung volume reduction surgery.

27. To maximize patient safety during cardiopulmonary stress testing, which of the following precautions would you recommend? 1. Immediate availability of a crash cart 2. Staff training in emergency life support 3. Presence of a physician throughout testing 4. Patient physical exam or ECG before testing a. 1, 2, and 3 only b. 1, 2, 3, and 4 c. 1 and 3 only d. 3 and 4 only

ANS: B To minimize patient risk during exercise evaluation, certain safety measures are implemented. First, the patient should undergo a physical examination just before the test, including a resting ECG. Second, a qualified physician should be present throughout the entire test. Third, emergency resuscitation equipment (cardiac crash cart with monitor, defibrillator, oxygen, cardiac drugs, suction, and airway equipment) must be readily available. Fourth, staff conducting and assisting with the procedure should be certified in basic and advanced life support techniques. Finally, the test should be terminated promptly whenever indicated.

39. Which of the following exercises are useful for reconditioning the lower extremities of patients undergoing pulmonary rehabilitation? 1. Walking on a flat surface for a specified period of time 2. Walking on a treadmill for a specified distance or time 3. Pedaling a stationary bicycle for a specified distance a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only

ANS: C Lower extremity exercises may include either walking or bicycling. Patients can walk on a stationary treadmill (with set goals for distance or time and grade) or on a flat, smooth surface. Patients can bicycle on an exercise cycle. With the treadmill or stationary bicycle, patients are required to cover a certain distance or duration every day that they are in the program.

10. Which of the following occur when the ventilatory threshold is exceeded during exercise? 1. Metabolism becomes anaerobic. 2. Energy production increases. 3. Fatigue increases. a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3

ANS: C Metabolism becomes anaerobic, the efficiency of energy production decreases, lactic acid accumulates, and fatigue sets in.

62. Where are most cardiac rehabilitation programs conducted? a. Private practice offices b. Clinics c. Hospital facilities d. Homes

ANS: C Most cardiac rehabilitation programs are conducted within a hospital facility, and these programs are generally divided into monitored and maintenance segments, with home options available. Exercise prescriptions are individualized for participating patients in an effort to maximize outcomes and reduce the likelihood of adverse effects.

33. 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%

ANS: C Patients in whom there is significant irreversible airway obstruction with a forced expiratory volume in 1 sec (FEV1) of less than 2 L or an FEV1% (FEV1/FVC) of less than 60%.

34. Which of the following patients with irreversible airway obstruction are the best candidates for pulmonary rehabilitation? Patient FEV1 FEV1/FVC 1. A 3.2 L 65% 2. B 1.6 L 67% 3. C 2.3 L 53% 4. D 3.1 L 72% a. 2 and 4 only b. 1, 2, and 3 only c. 2 and 3 only d. 1, 2, 3, and 4

ANS: C Patients in whom there is significant irreversible airway obstruction with an FEV1 of less than 2 L or an FEV1% (FEV1/FVC) of less than 60%.

40. 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

ANS: C Patients with significant orthopedic disabilities can participate in aerobic aquatic exercises.

36. For which of the following patients would you recommend an open-ended format for a pulmonary rehabilitation program? 1. Those with scheduling difficulties 2. Those who require individual attention 3. Those who are self-directed a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only

ANS: C This format is good for self-directed patients, or those with scheduling difficulties. It also may be the best format for patients requiring individual attention.

43. Which of the following is/are true about the flow-resistor breathing exerciser? 1. Exhaled gas flows unimpeded out a one-way valve. 2. Resistance is created by a variable-size orifice. 3. Imposed load varies with the rate of flow. a. 2 and 3 only b. 1, 2, and 3 c. 1 and 2 only d. 2 only

ANS: C Varying the size of this orifice varies the inspiratory load, as do changes in the patient's inspiratory flow. During expiration, gas flows unimpeded out the one-way exhalation valve. Other types of devices are also available. One model replaces the variable size orifice with an adjustable spring-loaded valve. This ensures a relatively constant load regardless of how fast or slowly the patient breathes.

37. 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 re-hospitalization d. Periodic follow-up and reinforcement

ANS: D Follow-up or reinforcement could be open-ended (available during regular rehabilitation sessions and offering open attendance) or could be scheduled weekly, monthly, bimonthly, or quarterly. The important thing is to have some type of follow-up available.

30. 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

ANS: D Indications for pulmonary rehabilitation are listed in Box 55-4.