Deck 18: Interventions and Prevention Measures for Individuals With Cardiovascular Disease, or Risk of Disease

Question 1

Which of the following factors should the physical therapist consider when prescribing frequency and duration of exercise for a patient in cardiac rehabilitation?

A)How long the patient has been disabled with the condition
B)How much has the patient's activity been reduced by the acute event
C)The patient's premorbid activity level and capability
D)All of the above should be considered for the individualized program

Answer 1

D
Exercise duration should be individualized and based on several factors:(1)length of disability,(2)reduced activity as a result of the acute event,and (3)premorbid activity level and neuromuscular capability.

Question 2

Which of the following methods for determining intensity would be BEST for a patient who is currently prescribed a beta-blocker?

A)Karoven method for predicted heart rate range
B)Ventilatory threshold
C)Rating of perceived exertion
D)Electrocardiogram

Answer 2

C
Patients on beta-blockers and those with pacemakers need alternative methods for determining intensity of exercise other than heart rate due to the blunting effect of the medications.Establishing a training heart rate by rating of perceived exertion is recommended along with the use of signs and symptoms.

Question 3

Which of the following components of a cardiac rehabilitation program provide the BEST benefit for return to activities of daily living and vocational activities?

A)Aerobic training at moderate intensity
B)Resistive training at low intensity with high frequency
C)Flexibility exercise
D)Circuit training

Answer 3

B
Resistive exercises improve muscle strength and endurance and may improve exercise tolerance as well.Muscle strengthening and endurance may be important for the return to activities of daily living and leisure and vocational activities in many patients.

Question 4

Which of the following environmental factors results in vasodilation creating an increase in heart rate to maintain adequate cardiac output?

A)Altitude
B)Cold temperature
C)Heat
D)Humidity

Question 5

Developing an exercise program that addresses the specific needs of the patient's daily life and interests is BEST described by which of the following parameters of exercise?

A)Mode
B)Intensity
C)Specificity
D)Duration

Question 6

Measuring a patient's ability to recognize signs and symptoms is considered an outcome targeting which of the following domains?

A)Clinical
B)Health
C)Behavioral
D)Service

Question 7

Which of the following aerobic exercise prescriptions would be BEST for a cardiac patient who is unable to tolerate more than 10 minutes of continuous aerobic exercise at one time?

A)Walk for 10 minutes at 40% to 50% of maximal heart rate;increase duration each week.
B)Walk for 5 minutes at 50% to 85% of maximal heart rate;increase duration each week.
C)Walk for bouts of tolerated exercise (10 minutes)at 50% to 85% of maximal heart rate followed by a rest of 5 to 10 minutes;repeat;increase the number of bouts as tolerated.
D)Walk for bouts of exercise at 50% to 85% of maximal heart rate followed by a rest of 5 to 10 minutes;repeat and increase intensity as tolerated.

Question 8

Which of the following progressions in exercise parameters would be MOST appropriate for a patient 2 weeks postoperative a coronary artery bypass graft who is currently walking on a treadmill for 20 minutes at 50% of maximal heart rate?

A)Increase the intensity of exercise to 60% of maximal heart rate.
B)Increase the duration of exercise with the goal being at least 30 minutes.
C)Add resistive training exercise at 40% of one repetition maximum.
D)Add low-intensity upper extremity exercise during treadmill walking.

Question 9

Which of the following indicators would subsequently lead to withholding a program in the acute phase of cardiac rehabilitation?

A)Resting tachycardia (100 bpm)
B)Large infarction clinically,stable after 2 to 3 days
C)Angina at rest
D)Blood pressure failing to rise with self-care activities

Question 10

Overall,the goals of an inpatient cardiac rehabilitation program for a patient post-myocardial infarction include which of the following?

A)Assess patient safety during performance of activities anticipated in the home setting.
B)Increase patient knowledge of the disease and management of the disease.
C)Deliver optimal discharge instructions specific to a patient as a member of a cohesive team.
D)All of the above.

Question 11

Which of the following factors should be considered when determining specific intensity parameters of an acute phase cardiac rehabilitation program?

A)ECG findings only
B)Heart rate
C)Physician's preference
D)Combination of ECG,hemodynamics,and symptoms

Question 12

Use of nonselective beta-blockers may be MOST detrimental to which of the following special patient populations during physical activity?

A)Patients with peripheral arterial disease
B)Patients with chronic obstructive pulmonary disease (COPD)
C)Patients with diabetes mellitus
D)Patients with renal disease

Question 13

In which of the following situations is it appropriate for a patient to be discharged from a cardiac rehabilitation program?

A)Anticipated goals and desired outcomes have been achieved.
B)Patient declines to continue intervention.
C)Patient is failing to attend scheduled appointments and not making progress.
D)All of the above meet the criteria for discharge.

Question 14

Which of the following factors would be considered a modifiable risk factor to target in a primary prevention program for cardiovascular disease?

A)Male gender
B)Family history of coronary artery disease
C)Age
D)Elevated cholesterol level

Question 15

A patient with chronic obstructive pulmonary disease may be encouraged to perform which of the following activities to improve use of accessory muscles for breathing and subsequently reduce dyspnea?

A)Perform pursed lip-breathing.
B)Use upper extremity support with exercise.
C)Titrate supplemental oxygen.
D)Slow pace or intensity.

Question 16

Which of the following environmental factors tends to increase peripheral resistance at rest and with exercise?

A)Altitude
B)Cold temperature
C)Heat
D)Humidity

Question 17

Which of the following reasons provides the BEST rationale for never abruptly ending an exercise session at training intensity without a cool-down phase?

A)May result in reduced blood flow return to the myocardium leading to irritation.
B)May result in a higher risk of falling.
C)May result in muscular soreness in the lower extremities.
D)May result in high blood pressure for an extended period after exercise.

Question 18

From a diet and nutritional viewpoint,which of the following changes in cholesterol levels will MOST likely result in a decreased risk of coronary artery disease and progression?

A)Decrease levels of HDL,LDL,total cholesterol,and triglycerides
B)Increase levels of HDL and decrease levels of LDL,total cholesterol,and triglycerides
C)Decrease levels of LDL and total cholesterol
D)None of the above

Question 19

Which of the following outcomes categories would be considered a measure of the clinical domain?

A)Functional capacity
B)Smoking cessation
C)Quality of life
D)Patient satisfaction

Question 20

Which of the following specific diagnoses was recently included in the CMS National Coverage Determination (NCD)for cardiac rehabilitation and requires patient to not have been hospitalized in the past 6 weeks?

A)Myocardial infarction within the last 12 months
B)Coronary artery bypass surgery
C)Congestive heart failure (CHF)
D)Heart valve repair or replacement surgery

Question 21

Which of the following programs potentially has the MOST impact on physical work capacity of a patient with coronary artery disease?

A)Home-based cardiac rehabilitation
B)No program;patient follows hospital discharge instructions
C)Supervised Phase II cardiac rehabilitation program
D)Traditional outpatient physical therapy clinic

Question 22

A cardiac rehabilitation program focuses on exercise tolerance testing and developing an appropriate exercise program for the patient that is supervised.

Question 23

Patients with low functional capacity are generally not good candidates for cardiac rehabilitation due to failure to make reasonable progress.

Question 24

Which of the following symptoms of coronary artery disease is more common in women than men?

A)Angina
B)Chest pressure
C)Abdominal pain
D)Radiating pain in left arm

Question 25

For which of the following cardiovascular conditions are patients NOT considered to be good candidates for rehabilitation?

A)Myocardial infarction
B)Heart transplant
C)Uncontrolled hypertension
D)Coronary artery bypass graft surgery

Question 26

Coronary patients who are able to tolerate only 20 minutes of exercise (shorter duration)will need to increase their workout frequency to two times per day (higher frequency).

Question 27

Which of the following are considered precautions with regard to safety in the cardiac rehabilitation?

A)Avoid exercise within 1 to 2 hours after meals.
B)Avoid isometric exercise and breath holding during exercise.
C)Add warm-up and extended cool-down periods.
D)All of the above should be precautions.

Question 28

If a patient with type II diabetes presents with a blood glucose of 80 mg/dL prior to an exercise session in the physical therapy clinic,what is the suggested next step for this patient?

A)If the patient feels well,is adequately hydrated,then she or he can perform with low-intensity exercise.
B)The patient should be given a 10- to 15-g carbohydrate snack and exercise should be postponed until hypoglycemia is resolved.
C)Exercise is contraindicated and the patient should ingest a snack.
D)The patient can begin to exercise,but blood glucose should be monitored every 15 minutes.

Question 29

Which of the following intervention would MOST likely be considered a primary prevention of cardiovascular disease?

A)Education of the patient and family in the recognition and treatment of cardiovascular disease
B)Dealing with psychological factors
C)Dietary counseling for those with diabetes,weight management problems,and elevated cholesterol
D)Structured,progressive physical activity

Question 30

Which of the following is considered a sign of an abnormal response to exercise?

A)Undue dyspnea
B)Pallor
C)Excessive fatigue
D)Severe leg claudication