Essentials of Cardiopulmonary Physical Therapy 3rd Edition by Hillegass – Test Bank  

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INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS

 

Essentials of Cardiopulmonary Physical Therapy 3rd Edition by Hillegass – Test Bank

 

Sample  Questions

 

Hillegass: Essentials of Cardiopulmonary Physical Therapy, 3rd Edition

 

Chapter 2: Physiology of the Cardiovascular and Pulmonary Systems

 

Test Bank

 

MULTIPLE CHOICE

 

  1. The primary function of the pulmonary system is which of the following?
A. Regulating acid-base balance and maintaining normal blood pH
B. Filter and metabolize toxic substances
C. Achieving temperature homeostasis through evaporative heat loss
D. Exchange oxygen and carbon dioxide between environment, blood, and tissue

 

 

ANS:   D

According to the author, the most important function of the pulmonary system is to exchange oxygen and carbon dioxide between the environment, blood, and tissue.

 

PTS:    1

 

  1. The total volume of air that is inhaled or exhaled in 1 minute is termed:
A. Tidal volume
B. Minute ventilation
C. Inspiratory reserve volume
D. Inspiratory capacity

 

 

ANS:   B

The minute ventilation represents the total volume of air that is inhaled or exhaled in 1 minute.

 

PTS:    1

 

  1. The maximum amount of air that can be inhaled after a normal tidal exhalation is termed:
A. Inspiratory reserve volume
B. Expiratory reserve volume
C. Inspiratory capacity
D. Vital capacity

 

 

ANS:   C

The inspiratory capacity (IC) is the sum of the tidal and inspiratory reserve volumes; it is the maximum amount of air that can be inhaled after a normal tidal exhalation.

 

PTS:    1

 

  1. Which of the following brain areas provides control for automatic breathing?
A. Medulla oblongata
B. Pons
C. Frontal lobe of the cerebrum
D. Hypothalamus

 

 

ANS:   A

The medulla oblongata contains inspiratory neurons that produce inspiration and expiratory neurons that are triggered with force expiration. These neurons control automatic breathing.

 

PTS:    1

 

  1. Which of the following statements BEST explains why increasing administered oxygen should be done cautiously in a patient with severe chronic obstructive pulmonary disease (COPD)?
A. The body may rely on hypoxic drive to breathe (oxygen receptors) and increasing administered oxygen leads to hyperoxemia suppressing the hypoxic drive.
B. The body needs additional time to allow the peripheral chemoreceptors to cause an increase of ventilatory rate to improve oxygenation.
C. The body is relying on carbon dioxide to regulate the respiratory cycle, and increasing administered oxygen leads to inhibition of the carbon dioxide receptors.
D. Increasing administered oxygen to the body oversaturates the system leading to toxicity

 

 

ANS:   A

A patient with severe COPD who develops high CO2 blood levels subsequently leads to the body relying more on oxygen receptors instead of carbon dioxide receptors. This is termed hypoxic drive to breathe. If administered oxygen is too high and causes hyperoxemia (increased oxygen in the blood) the oxygen receptors may be suppressed, which reduces the drive to breathe.

 

PTS:    1

 

  1. Which of the following lung tissue receptors are located along the smooth muscles lining the airways are sensitive to increasing size and volume within the lung, termed the Hering-Breuer reflex?
A. Irritant receptors
B. Stretch receptors
C. Chemoreceptors
D. Juxtapulmonary receptors

 

 

ANS:   B

Stretch receptors are located along smooth muscles lining the airways and are sensitive to increasing size and volume within the lung. The Hering-Breuer reflex is active with large increases in the tidal volume, especially seen during exercise, and protects the lung from excessive inflation.

 

PTS:    1

 

 

  1. Which of the following lung receptors are stimulated in a patient with left-sided congestive heart failure who develops pulmonary edema causing the patient to breathe in a SHALLOW, tachypneic pattern.
A. Irritant receptors
B. Stretch receptors
C. Chemoreceptors
D. Juxtapulmonary receptors

 

 

ANS:   D

The juxtapulmonary receptors (J receptor) are located near the pulmonary capillaries and are sensitive to increased pulmonary capillary pressures. On stimulation, these receptors initiate a rapid, shallow breathing pattern. In a patient with congestive heart failure, pulmonary edema would stimulate the interstitial J receptors.

 

PTS:    1

 

  1. Which of the following events occur as a result of the diaphragm and external intercostals contracting to facilitate inspiration?
A. An increase in the volume of the thoracic cavity and lung reducing the intrapulmonary pressure
B. An increase in the pressure within the lung occurs due to Boyle’s law
C. A decrease in the volume of the thoracic cavity and lung increasing the intrapulmonary pressure
D. A change in the thoracic cavity and lung volume leads to an intrapulmonary pressure that exceeds the atmospheric pressure

 

 

ANS:   A

When the diaphragm and external intercostals contract to facilitate inspiration it causes an increase in the volume of the thoracic cavity and lung, which reduces the intrapulmonary pressure. The intrapulmonary pressure is decreased below the atmospheric levels facilitating the flow of air into the lungs to normalize pressure differences.

 

PTS:    1

 

  1. Which of the following BEST describes the intrapleural pressure compared to the intrapulmonary pressure?
A. Intrapleural pressure is less than intrapulmonary pressure
B. Intrapleural pressure is the same as intrapulmonary pressure
C. Intrapleural pressure is greater than intrapulmonary pressure
D. Intrapleural pressure is not related to the intrapulmonary pressure

 

 

ANS:   A

The intrapleural pressure is normally lower than the intrapulmonary pressure developed during both inspiration and expiration. This difference in pressures helps to maintain the lung near the chest wall.

 

PTS:    1

 

  1. Compliance is BEST explained by which of the following statements.
A. The tendency of a structure to return to its initial size after being distended
B. The pressure that acts to collapse the alveolus and increase the pressure of air within the structure
C. The tendency of a force that exists to collapse or recoil the structure while inflated
D. The pressure that allows changes in lung volume to parallel changes in thoracic excursion during breathing

 

 

ANS:   C

Compliance of lung tissue is likened to a balloon during inspiration, where there exists a tendency to collapse or recoil while inflated. A = elasticity; B = surface tension; D = transmural pressure.

 

PTS:    1

 

  1. Which of the following statements is MOST correct about surfactant?
A. Diminishes the overall surface tension of the alveoli to keep air in smaller alveoli
B. Pulmonary surfactant is composed of a single class of molecules
C. Compression of the surfactant molecules decreases their density
D. Surfactant develops early in fetal life

 

 

ANS:   A

Surfactant is a surface-active agent that is needed to decrease the overall surface tension of alveoli in order to lower wall tension in proportion to the radius of the alveolus. Pressure within the alveolus is directly proportional to the surface tension and inversely proportional to the radius of the alveolus. The availability of surfactant assists in keeping air in alveoli of varying sizes.

 

PTS:    1

 

  1. Which of the following factors act to decrease airway resistance?
A. The presence of mucus and edema
B. Smaller airway diameter
C. Parasympathetic nervous system
D. Sympathetic nervous system

 

 

ANS:   D

Sympathetic nervous system influence decreases airway resistance, which would be congruent with the need to improve airflow in order to keep up with the body’s demand for oxygen during exercise. Poiseuille’s law states that the flow through a vessel or airway is directly proportional to the pressure difference and radius and inversely proportional to the length of the airway and viscosity of the gas. Small changes in radius account for large changes in airflow.

 

PTS:    1

 

 

  1. Which of the following physical properties of lungs facilitates passive expiration?
A. Compliance
B. Elasticity
C. Surface tension
D. Resistance to airflow

 

 

ANS:   B

Elasticity refers to the tendency of a structure to return to its initial size after being distended. This elastic recoil of the lung allows passive expiration to occur.

 

PTS:    1

 

  1. To facilitate the diffusion of oxygen from alveoli to pulmonary capillary which of the following must occur?
A. The alveolar walls become thicker
B. Concentration of oxygen is high in the pulmonary artery
C. Concentration of oxygen is high in the alveoli
D. Partial pressure of oxygen must equal 20.93%

 

 

ANS:   C

For gas exchange to occur, a pressure gradient must be created across the alveolar capillary interface. This gradient will enable gases to diffuse from an area of high concentration to areas of low concentration across the semipermeable respiratory membrane.

 

PTS:    1

 

  1. Which of the following improve gas exchange in the base of the lungs?
A. Gas ventilation is greater than blood perfusion
B. Patient is positioned in prone
C. Patient is positioned in upright sitting
D. Blood perfusion amount is greater than gas ventilation

 

 

ANS:   C

A change in the position of the patient changes areas of ventilation and perfusion. Generally, greater ventilation and perfusion occur in gravity-dependent areas, thereby allowing better respiration to occur in the dependent lung. The upright sitting position would facilitate better ventilation/perfusion matching in the base of the lungs due to gravity dependency.

 

PTS:    1

 

  1. Which of the following forms of hemoglobin molecules refers to the binding of heme to carbon monoxide instead of oxygen?
A. Oxyhemoglobin
B. Deoxyhemoglobin
C. Methemoglobin
D. Carboxyhemoglobin

 

 

ANS:   D

Carboxyhemoglobin is another form of hemoglobin that involves the binding of heme to carbon monoxide instead of oxygen. The bond with carbon monoxide is 210 times stronger than oxygen, and therefore displaces oxygen and inhibits its binding capacity.

 

PTS:    1

 

  1. In the systemic arteries, at a partial pressure of 100 mm Hg, the percent of hemoglobin should be:
A. 85%
B. 97%
C. 74%
D. 21%

 

 

ANS:   B

In the systemic arteries, at a partial pressure of 100 mm Hg, the percent of hemoglobin is 97% indicating that 97% of hemoglobin molecules in blood are bound to oxygen. The remaining 35 reflects deoxyhemoglobin, methemoglobin, and carboxyhemoglobin concentrations.

 

PTS:    1

 

  1. Which of the following is the BEST way to measure oxyhemoglobin saturation?
A. Pulse oximeter
B. Hemoglobin blood test
C. Arterial blood gas
D. Pulmonary function test

 

 

ANS:   C

The gold standard or best test for measuring oxyhemoglobin saturation is through an analysis of arterial blood gases. Pulse oximeter can also be utilized to obtain this number, but is less accurate due to it being an estimation and not a direct measure.

 

PTS:    1

 

  1. Which of the following changes in the system would cause a shift in the oxyhemoglobin dissociation curve to the left?
A. An increase in the pH
B. A decrease in the pH
C. Increase in tissue temperature
D. Prolonged hypoxemia

 

 

ANS:   A

An increase in pH or alkalemia would shift the curve to the left. Answer choices B, C, and D all shift the curve to the right.

 

PTS:    1

 

  1. Which of the following factors will potentially diminish cardiac output?
A. Medications that have a positive ionotropic effect
B. Beta-blocker effect on beta-receptors
C. Release of epinephrine and norepinephrine
D. An increase in blood volume

 

 

ANS:   B

Beta-blocker medications blunt heart rate response during exercise by making the beta-receptors on the myocardial wall unresponsive to sympathetic stimulation and appropriately increase heart rate. A lack of heart rate response would potentially diminish cardiac output.

 

PTS:    1

 

  1. In patients with congestive heart failure, which of the following positions should be avoided to minimize the preload on a failing heart?
A. Sitting up in a bedside chair
B. Standing at a support surface
C. Semireclined on an exercise mat
D. Supine with lower extremities elevated

 

 

ANS:   D

In patients with congestive heart failure, the Frank-Starling mechanism does not apply. An increase in preload puts additional stress on the failing heart. These patients will not tolerate supine (flat) or supine with legs elevated due to the effects of gravity and a resultant increase of blood volume return to the heart.

 

PTS:    1

 

  1. The positive ionotropic effect on myocardial contractility produced by the release of norepinephrine from sympathetic nerve endings is an example of:
A. Intrinsic control factor
B. Extrinsic control factor
C. Frank-Starling mechanism
D. Parasympathetic stimulus

 

 

ANS:   B

The extrinsic control of contractility depends on the activity of the sympathoadrenal system. Epinephrine from the adrenal medulla and norepinephrine from the sympathetic nerve endings produce a positive ionotropic effect, or increase myocardial contractility by promoting an influx of calcium available to the sarcomeres of the myocardial cells.

 

PTS:    1

 

  1. Afterload is BEST defined by which of the following statements?
A. A reflection of the pressure against which the heart has to contract
B. The amount of load (stretch) on the myocardial wall prior to contraction
C. The maximum amount of blood that can be filled in the ventricles
D. The pressure within the arterial system during the diastolic phase of the cardiac cycle

 

 

ANS:   A

The afterload is a reflection of the pressure against which the heart has to contract to pump blood into the aorta. The pressure within the arterial system during the diastolic phase of the cardiac cycle is a function of total peripheral resistance.

 

PTS:    1

 

  1. The BEST indicator of cardiac function is:
A. Stroke volume
B. End diastolic volume
C. Ejection fraction
D. End systolic volume

 

 

ANS:   C

The ejection fraction represents a ratio or percentage of the volume of blood ejected out of the ventricles relative to the volume of blood received by the ventricles before contraction and is the best indicator of cardiac function.

 

PTS:    1

 

  1. In a patient with systolic heart failure, the compromised ejection fraction is commonly reflected as:
A. 70%
B. 60%
C. 50%
D. 35%

 

 

ANS:   D

In patients with systolic heart failure, the ejection fraction is compromised as evidenced by a ratio less than 40%. For every 100 ml of blood brought into the ventricles, less than 40 ml of blood is ejected per contraction due to a failing heart.

 

PTS:    1

 

  1. Peripheral muscle contraction and deep diaphragmatic inspiratory maneuvers directly enhance which of the following influences on cardiac function?
A. Venous return
B. Myocardial contractility
C. Afterload
D. End systolic volume

 

 

ANS:   A

Venous return represents the return of blood to the right side of the heart via the veins. Factors that directly influence venous return include the pressure gradient in the venous system, peripheral muscle activity, deep diaphragmatic inspiratory maneuvers, and sympathetic nerve fiber stimulation on smooth muscle cell contraction in veins.

 

PTS:    1

 

  1. Myocardial tissue require constant aerobic metabolism both at rest and during heavy exercise. Which of the following attributes of myocardial tissue BEST facilitates the supply of oxygen during systole (myocardium contraction)?
A. High capillary density
B. Myoglobin
C. Coronary perfusion
D. Hemoglobin

 

 

ANS:   B

The myocardium contains large amounts of myoglobin. These structures have the ability to store oxygen during diastole and release the stored oxygen during systole to myocardial cells. Systole involves myocardial contraction, which squeezes coronary arteries reducing the perfusion of blood. Capillary density is helpful, but its influence does not change as related to diastole and systole phases.

 

PTS:    1

 

  1. The rate pressure product is a clinically useful tool to estimate the myocardial oxygen demand and is calculated using which of the following variables?
A. Respiratory rate × systolic blood pressure
B. Respiratory rate × diastolic blood pressure
C. Heart rate × systolic blood pressure
D. Heart rate × diastolic blood pressure

 

 

ANS:   C

The rate pressure product is a clinically useful tool to estimate the myocardial oxygen demand and is calculated by using heart rate × systolic blood pressure. During exercise, alterations in autonomic nervous system stimulation also influence coronary blood flow by directly affecting heart rate and force of contraction––the two primary determinants of the myocardium’s metabolic rate.

 

PTS:    1

 

  1. Which of the following age-related cardiovascular physiological changes MOST likely leads to increased ventricular wall thickness?
A. Increased body weight
B. Decreased maximal heart rate
C. Reduced arteriovenous oxygen uptake
D. Increased collagen presence

 

 

ANS:   D

With increasing age, left ventricular wall thickness increases due to increased collagen and the enhanced size of myocardial cells. Increased body weight, decreased maximal heart rate, and reduced arteriovenous oxygen uptake contribute to a decline in maximal oxygen uptake.

 

PTS:    1

 

  1. Which of the following age-related cardiovascular physiological changes is considered a peripheral factor?
A. Compromised arteriovenous oxygen uptake
B. Reduced stroke volume
C. Decreased maximal heart rate
D. Low stroke volume values

 

 

ANS:   A

Arteriovenous oxygen uptake is considered a peripheral factor (not specific to heart) whereas reduced stroke volume, decreased maximal heart rate, and low stroke volume values all reflect specific heart (central) factors.

 

PTS:    1

Hillegass: Essentials of Cardiopulmonary Physical Therapy, 3rd Edition

 

Chapter 4: Cardiac Muscle Dysfunction and Failure

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Which of the following pathological conditions may lead to congestive heart failure (CHF)?
A. Hypertension
B. Renal insufficiency
C. Pulmonary embolism
D. All of the above

 

 

ANS:   D

Table 4-b highlights 11 specific pathological processes/causes for congestive heart failure. Hypertension, renal insufficiency, and pulmonary embolism are all considered causes of CHF.

 

PTS:    1

 

  1. Increased arterial pressure that leads to left ventricular hypertrophy potentially causing CHF after a period of time describes which of the following?
A. Pulmonary embolism
B. Systemic hypertension
C. Pulmonary hypertension
D. Cardiomyopathy

 

 

ANS:   B

Hypertension is increased arterial pressure that leads to left ventricular hypertrophy (increased myocardial cell mass) and increased energy expenditure.

 

PTS:    1

 

  1. Which of the following statements describes the reason energy expenditure is increased in persons with systemic hypertension?
A. Myocardial contractile fibers become overstretched
B. Increase in afterload
C. Increase in myocardial cell mass
D. Mismatch of cell mass to vasculature

 

 

ANS:   C

Two problems with left ventricular hypertrophy that occur are increased afterload and increased energy expenditure (metabolic cost) required for myocardial contraction because of increased myocardial cell mass.

 

PTS:    1

 

  1. Which of the following pathological conditions will result in scar formation with associated decreased contractility and reduced relaxation in the myocardial tissue?
A. Atrial fibrillation
B. Cardiomyopathy
C. Coronary bypass pump syndrome
D. Myocardial infarction

 

 

ANS:   D

Actual injury to myocardial tissue from an infarction may result in scar formation and decreased contractility as well as reduced relaxation.

 

PTS:    1

 

  1. Which of the following categories of cardiomyopathy is characterized by marked endocardial scarring of the ventricles with resulting impaired diastolic filling?
A. Dilated cardiomyopathy
B. Hypertrophic cardiomyopathy
C. Restrictive cardiomyopathy
D. Idiopathic cardiomyopathy

 

 

ANS:   C

Restrictive cardiomyopathy is identified by marked endocardial scarring of the ventricles with resulting impaired diastolic filling.

 

PTS:    1

 

  1. Which of the following categories of cardiomyopathy is characterized by rapid ventricular emptying and high ejection fraction?
A. Dilated cardiomyopathy
B. Hypertrophic cardiomyopathy
C. Restrictive cardiomyopathy
D. Idiopathic cardiomyopathy

 

 

ANS:   B

The characteristic findings of hypertrophic cardiomyopathy are rapid ventricular emptying and high ejection fraction, which are opposite of those found in dilated cardiomyopathy.

 

PTS:    1

 

  1. Dilated cardiomyopathy is caused by which of the following factors?
A. Long-term alcohol abuse
B. Malalignment of myocardial fibers
C. Myocardial fibrosis
D. Abnormal sympathetic stimulation

 

 

ANS:   A

Causes of dilated cardiomyopathy include long-term alcohol abuse, systemic hypertension, a variety of infections, cigarette smoking, pregnancy, and carnitien deficiency.

 

PTS:    1

 

  1. Mitral valve insufficiency frequently dilates which of the following heart chambers?
A. Left ventricle
B. Right ventricle
C. Left atrium
D. Right atrium

 

 

ANS:   C

Mitral insufficiency frequently dilates the left atrium, whereas tricuspid insufficiency dilates the right atrium.

 

PTS:    1

 

  1. Which of the following physiological changes would be considered true effects of aging as opposed to pathological processes?
A. Decreased distensibility of arteries
B. Development of coronary disease
C. Exposure to toxins such as cigarette smoking
D. Malnutrition

 

 

ANS:   A

True effects of aging include increased systolic arterial pressure due to decreased distensibility of arteries and decreased aortic distensibility.

 

PTS:    1

 

  1. Pulmonary hypertension is defined by mean pulmonary arterial pressure (mPAP) and is considered abnormal in individuals with primary pulmonary hypertension recorded as:
A. >20 mm Hg
B. >25 mm Hg
C. >40 mm Hg
D. >45 mm Hg

 

 

ANS:   B

mPAP is considered abnormal in individuals with primary hypertension if >25 mm Hg, and abnormal in individuals with COPD if >20 mm Hg.

 

PTS:    1

 

  1. Which of the following causes is MOST related to right heart failure?
A. Pulmonary embolus
B. Myocardial infarction
C. Hypertension
D. Aortic valve dysfunction

 

 

ANS:   A

Right-sided CHF may occur because of eventual left-sided CHF or because of right ventricle failure (e.g., secondary to pulmonary hypertension, pulmonary embolus, right ventricular infarction).

 

PTS:    1

 

  1. Which of the following statements BEST describes the term diastolic heart failure?
A. Impaired contraction that produces an inefficient expulsion of blood
B. Loss of contracting myocardium as a result of anterior myocardial infarction
C. Inability of the ventricles to accept the blood ejected from the atria
D. Change in filling due to replacement of infracted area with distensible fibrous tissue

 

 

ANS:   C

The inability of the ventricles to accept the blood ejected from the atria during rest or diastole, such as due to the replacement of an infracted area with nondistensible fibrous scar tissue (which does not readily or adequately accept the blood ejected into the left ventricle from the left atria producing diastolic failure).

 

PTS:    1

 

  1. According to the Frank-Starling mechanism, an insignificant ventricular end-diastolic volume will result in which of the following changes in heart function?
A. Increase in stretch of the myocardium
B. Decrease in ventricular mechanical performance
C. No change in filling pressure
D. Increase in stroke volume producing elevated blood pressure

 

 

ANS:   B

The Frank-Starling mechanism explains the relationship between ventricular filling pressure (or end-diastolic volume) and ventricular mechanical activity. An optimal filling pressure (or ventricular end-diastolic volume) exists and if exceeded or insignificant will decrease ventricular mechanical performance. Stroke volume is the result of an optimal degree of myocardial stretch as well as that of myocardial contractility.

 

PTS:    1

 

  1. The resistance stroke volume encounters after it is ejected from the left ventricle is BEST defined as which of the following?
A. Preload
B. Ventricular end-diastolic volume
C. Pulmonary artery pressure
D. Afterload

 

 

ANS:   D

Afterload is defined as the resistance encountered by stroke volume after it is ejected from the left ventricle and is essentially peripheral vascular resistance.

 

PTS:    1

 

  1. Pulmonary capillary wedge pressure commonly monitored in patients in coronary care units closely approximates which of the following pressures?
A. Left ventricular filling pressure
B. Pulmonary artery pressure
C. Left atrial filling pressure
D. Right ventricular filling pressure

 

 

ANS:   A

Left ventricular filling pressure can be closely estimated using the pulmonary capillary wedge pressure, which is frequently monitored in patients being treated in coronary care or intensive care units.

 

PTS:    1

 

  1. Natriuretic peptides are released by cardiac muscle in response to increased stretch due to high filling or atrial pressures or cardiac dilation to produce which of the following affects?
A. Stimulation of rennin and aldosterone
B. Arterio- and venoconstriction
C. Reduced blood volume through natriuresis
D. Stimulation of vascular smooth muscle

 

 

ANS:   C

Both ANP and BNP (natriuretic peptides) released by cardiac muscle act to reduce the adverse stimulus of stretch as a result of high filling and atrial pressures or cardiac dilation. The effects include arterio- and venodilation, reduction in blood volume through natriuresis, and suppression of secretions of renin and aldosterone.

 

PTS:    1

 

  1. An accumulation of fluid in the lungs along with hypoxemia and tachypnea BEST describes which of the following pulmonary edema stages?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4

 

 

ANS:   B

Stage 2 consists of an accumulation of fluid in the lungs, hypoxemia, and tachypnea. Stage 1 is difficult to detect. Stage 3 involves alveolar flooding/pulmonary edema, auscultation of crackles, and absence of air movement in the lungs. Stage 4 does not exist.

 

PTS:    1

 

  1. Which of the following is the BEST indirect method for a physical therapist to measure an increase in pulmonary capillary wedge pressure?
A. Pulse oximetry
B. Arterial blood gases
C. Auscultation
D. Pitting edema scale

 

 

ANS:   A

A PT should monitor oximetry because an increase in pulmonary capillary wedge pressure produces an increase in hypoxemia. The PT cannot collect ABGs; auscultation and pitting edema are unrelated to hypoxemia.

 

PTS:    1

 

  1. In normal cardiac neurohumoral function, beta2-adrenergic receptors facilitate which of the following physiological changes?
A. Increases heart rate and myocardial force of contraction
B. Promotes vasodilation of capillary beds
C. Activates the inhibitory G protein and inhibits adenylate cyclase
D. Transmit stimulatory (Gs) or inhibitory (G1) signals to the catalytic unit

 

 

ANS:   B

The beta2-adrenergic receptor has a greater affinity for epinephrine and promotes vasodilation of capillary beds and muscle relaxation in bronchial tracts. Beta1-adrenergic receptor stimulation increases HR and myocardial force of contraction.

 

PTS:    1

 

  1. Which of the following pathophysiological changes potentially noted in patients with CHF results in the heart becoming insensitive to beta-adrenergic stimulation?
A. Excessive sympathetic nervous system stimulation
B. Decreased concentrations of norepinephrine
C. Decrease in beta1-adrenergic receptor density
D. Deactivation of adenylate cyclase

 

 

ANS:   C

The insensitivity to beta-adrenergic stimulation is the result of a decrease in beta1-adrenergic receptor density and is very important because the heart normally contains a ratio of 3.3 to 1.0 beta1– to beta2-adrenergic receptors. In CHF the ratio drops to 1.5 to 1.0 producing a 62% decrease in beta1-adrenergic receptors.

 

PTS:    1

 

  1. Liver dysfunction associated with congestive heart failure can be identified using which of the following laboratory values?
A. Elevated blood urea nitrogen
B. Abnormal AST
C. Elevated creatinine levels
D. Low hemoglobin and hematocrit

 

 

ANS:   B

Laboratory values indicating liver involvement as a result of congestive heart failure include abnormal AST, bilirubin, and LDH5.

 

PTS:    1

 

  1. The reduction of glucose metabolism in a patient with congestive heart failure is MOST likely due to impairment related to which of the following organs?
A. Skeletal muscle
B. Kidney
C. Liver
D. Pancreas

 

 

ANS:   D

Severe CMD (or CHF) can potentially reduce blood flow to the pancreas as a consequence of splanchnic visceral vasoconstriction, which accompanies severe left ventricular failure. The reduction in blood flow impairs insulin secretion and glucose tolerance.

 

PTS:    1

 

  1. Patients with anemia who have less reserve before their oxygen stores desaturate are indicative of what type of shift in the oxyhemoglobin curve?
A. Left
B. Right
C. More steep
D. More shallow

 

 

ANS:   B

Anemia shifts the curve to the right, representing a lower concentration of arterial oxygen, which moves the critical point of O2 saturation to 70 mm Hg vs. 60 mm Hg. These patients have less reserve before their oxygen stores desaturate.

 

PTS:    1

 

  1. Paroxysmal nocturnal dyspnea (PND) is defined as which of the following statements?
A. Breathlessness or air hunger
B. Sudden shortness of breath in sitting
C. Sudden shortness of breath in supine
D. Dyspnea due to fluid in the lower portions of the lungs

 

 

ANS:   C

PND is sudden, unexplained episodes of shortness of breath that occur as patients with CHF assume a more supine position to sleep.

 

PTS:    1

 

  1. A breathing pattern characterized by waxing and waning depths of respiration with recurring periods of apnea is termed which of the following?
A. Paroxysmal nocturnal dyspnea
B. Tachypnea
C. Cheyne-Stokes respiration
D. Orthopnea

 

 

ANS:   C

Frequently associated with CHF is a breathing pattern characterized by waxing and waning depths of respiration with recurring periods of apnea.

 

PTS:    1

 

  1. A noncompliant left ventricle that occurs as blood passively fills a poorly relaxing ventricle during early diastole and is considered the hallmark of congestive heart failure describes which of the following heart sounds?
A. S1
B. S2
C. S3
D. S4

 

 

ANS:   C

S3 is heard during early diastole (after S2) and indicates a noncompliant left ventricle that occurs as blood passively fills a poorly relaxing left ventricle that appears to make contact with the chest wall. The presence of S3 is considered a hallmark of CHF.

 

PTS:    1

 

  1. A patient with cardiac disease resulting in marked limitation of physical activity, who is comfortable at rest, but reports fatigue, palpitation, dyspnea, or angina pain during less than ordinary activity, is considered to be in which of the following New York Heart Association functional classifications?
A. Class I
B. Class II
C. Class III
D. Class IV

 

 

ANS:   C

Class III is defined as patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or angina pain. Class II is slight limitation, Class I has no limitations, and Class IV results in an inability to carry on any physical activity.

 

PTS:    1

 

  1. Which of the following distances walked by a patient with congestive heart failure during a 6-minute walk test assists with determination of short- and long-term survival?
A. 300 meters
B. 350 meters
C. 400 meters
D. 450 meters

 

 

ANS:   A

The 6-minute walk test can assist with the evaluation of cardiopulmonary response and exercise tolerance of a person with CHF and a distance of 300 m walked appears to be important in determining short- and long-term survival.

 

PTS:    1

 

  1. Which of the following medications prescribed for heart failure is noted to provide a positive inotropic effect evidenced by an increased left ventricular ejection fraction?
A. Diuretics
B. Digoxin
C. Nitroglycerin
D. Torpral

 

 

ANS:   B

Digoxin is noted to provide a positive inotropic (increased force of contraction) effect evidenced by an increased left ventricular ejection fraction. Diuretics reduce fluid overload, nitroglycerin is a vasodilator, and torpral is a beta-blocker.

 

PTS:    1

 

  1. The intraaortic balloon pump (IABP) improves oxygen delivery to the myocardium by which of the following mechanisms?
A. Increases intraaortic pressure forcing blood into a retrograde direction
B. Creates a diastolic attenuation
C. Deflation of balloon decreases left ventricular afterload
D. Creates a decrease in diastolic pressure

 

 

ANS:   A

The IABP has an inflated balloon in the thoracic aorta at the beginning of ventricular diastole. This inflation creates an increase in intraaortic pressure as well as diastolic pressure in general and forces the blood in the aortic arch to flow in a retrograde direction into the coronary arteries. This mechanism of action is referred to as diastolic augmentation and profoundly improves oxygen delivery to the myocardium.

 

PTS:    1

 

  1. A patient with congestive heart failure is being seen by a physical therapist for exercise progression. The patient is currently taking beta-blocker medication. Which of the following methods to monitor exercise intensity is MOST appropriate for this patient?
A. Heart rate response
B. Patient observation
C. Rating of perceived exertion
D. Blood pressure response

 

 

ANS:   C

More patients with CHF and CMD are being prescribed beta-blockers, which often cause little or no change in resting and exercise heart rates. The Borg rating scale is a good clinical tool for monitoring intensity and assisting the clinician with the appropriate time to progress the exercise.

 

PTS:    1

 

  1. Which of the following factors significantly predict survival in persons with congestive heart failure?
A. Diminished left ventricular ejection fraction
B. New York Heart Failure Class II functional status
C. Episodes of hypotension
D. Exercise tachycardia

 

 

ANS:   A

Significant factors included decreasing LVEF, worsening NYHA functional status (not one particular class), degree of hyponatremia, decreasing peak exercise oxygen uptake, decreasing hematocrit, widened QRS on 12-lead ECG, chronic hypotension (not just one episode), resting tachycardia (not exercise tachycardia), renal insufficiency, intolerance to conventional therapy, and refractory volume overload.

 

PTS:    1

 

  1. A patient with NYHA Class II congestive heart failure is currently receiving physical therapy. Instruction about energy conservation will be included in the patient education session. Which of the following recommendations would be appropriate for this patient?
A. Stop and rest when you get tired
B. Complete several tedious tasks at one time
C. Alternate easy tasks with difficult tasks, plan for rest
D. Keep the living environment set-up the same

 

 

ANS:   C

Table 4-R provides a number of recommendations for energy conservation. Of the answers choices, (C) is correct as it recommends alternating easy tasks with difficult tasks to help a patient maintain an overall low intensity with rest incorporated. Answer (A) is incorrect; it should be stop to rest before you get tired; answer (B) is incorrect; you should spread out tedious tasks; answer (D) is incorrect; you should make changes in the environment to make activities easier such as keeping items within easy reach.

 

PTS:    1

 

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