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?

Accepted Answer

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?

Accepted Answer

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?

Accepted Answer

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?

Accepted Answer

In response to higher temperatures and dilation of peripheral vasculature,the heart rate increases to maintain adequate cardiac output.

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?

Accepted Answer

Specificity of training is related to the specific exercise needs of the patient's regular daily needs and interests.

Question 6

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

Accepted Answer

Behavioral outcomes include diet,weight management,exercise,smoking cessation,stress reduction,recognition of signs/symptoms,and medical management.

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?

Accepted Answer

Patients with limited exercise tolerance may not be able to tolerate even 10 minutes of exercise,so they should be exercised to their tolerance and then insert a rest.Interval training is the best method of improving exercise tolerance;frequent bouts of exercise are important,but not increases in intensity.

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?

Accepted Answer

At 2 weeks into the cardiac rehabilitation,increasing the duration should be the first priority for a patient who is walking 20 minutes.Duration should be increased until the patient can exercise for at least 30 minutes,then intensity can be increased.A patient with a CABG should wait for 8 weeks with 3 weeks of continuous participation before resistive training is started.

Question 9

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

Accepted Answer

The following criteria are used to exclude patients from participation in the activity program:(1)severe pump failure (shortness of breath,peripheral edema,diaphoresis or CXR,and falling blood pressure with activity),(2)recurrent malignant arrhythmias,and (3)angina at rest,second or third degree heart block,persistent hypotension,rapid atrial rhythm,and unstable angina pectoris.

Question 10

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

Accepted Answer

Overall,the goals of inpatient cardiac rehabilitation are to assess for safety to perform activities in the home or the alternative care site after discharge from the hospital,and to increase patient knowledge of the disease and the management of the disease.In addition,the team members must function cohesively in preparing the patient for discharge.

Question 11

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

Accepted Answer

It is the combination of all factors (hemodynamic,symptoms,and ECG findings)that must be considered in determining specific intensity parameters.

Question 12

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

Accepted Answer

Caution should be taken with patients who have COPD and who are taking beta-blocking medications,specifically nonselective beta-blockers.These medications block sympathetic stimulation to the beta₁ receptors in the heart as well as the beta₂ receptors found in the smooth muscles of the bronchi.The result of blocked beta₂ receptors can be bronchoconstriction resulting in an increase in dyspnea.

Question 13

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

Accepted Answer

Key points for discharge include (1)the anticipated goals and desired outcomes have been achieved,(2)patient declines to continue intervention,(3)patient is unable to continue to progress toward goals because of medical or psychosocial complications,and (4)failure to make reasonable progress toward goals due to nonadherence to home program,failure to attend scheduled appointments,or lack of willingness or ability to participate in the program.

Question 14

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

Accepted Answer

Cardiovascular risk factors that are considered modifiable include hypertension,smoking,hypercholesterolemia,physical inactivity,stress,weight,and diabetes.Non modifiable risk factors include family history,age,gender,and menopausal phase.

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?

Accepted Answer

Use of upper extremity support with exercise,such as holding the bars of treadmills,stationary bikes,and rolling walkers,may assist the patient in stabilizing accessory muscles of improved ventilation.

Question 16

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

Accepted Answer

Cold temperatures cause an increase in peripheral resistance at rest and with exercise.This peripheral vasoconstriction can subsequently cause an increase in arterial blood pressure and possibly create a situation for earlier ischemic changes with increased myocardial oxygen demands.

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?

Accepted Answer

Too abrupt an end or a cessation of exercise can reduce the return of blood to the myocardium,creating irritation and increased arrhythmia.

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?

Accepted Answer

To decrease the risk of coronary artery disease and its progression,it is necessary to increase levels of HDL and decrease levels of LDL cholesterol,total cholesterol,and triglycerides.

Question 19

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

Accepted Answer

Clinical domain is measured by the following outcome categories:physical,weight,blood pressure,lipids,functional capacity,blood nicotine levels,oxygenation,symptom management,psychosocial,return to vocational/leisure,psychological status,medical utilizations,hospitalizations,medications,and physician/ER visits.

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?

Accepted Answer

CHF was recently included in Medicare coverage in the NCD for cardiac rehabilitation,but these individuals who have CHF cannot attend Cardiac Rehab if they were hospitalized in the past 6 weeks.These individuals are excellent candidates for outpatient rehabilitation in a physical therapy setting for those 6 weeks.

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