Deck 19: Pulmonary Rehabilitation

Question 1

Which of the following criteria would be considered an indication for supplemental oxygen in a patient with right-sided heart failure?

A)Arterial partial pressure of ≤ 55 mm Hg or oxygen saturation ≤ 88%
B)Arterial partial pressure of ≤ 59 mm Hg or oxygen saturation ≤ 89%
C)Arterial partial pressure of ≤ 50 mm Hg or oxygen saturation ≤ 85%
D)Arterial partial pressure of 40 ≤ mm Hg or oxygen saturation ≤ 83%

Answer 1

B
The indications for supplemental oxygen use are (1)arterial partial pressure of oxygen ≤ 55 mm Hg or SpO₂ ≤ 88% and (2)arterial partial pressure of oxygen ≤ 59 mm Hg or SpO₂ ≤ 89% if evidence of cor pulmonale,right heart failure,or erythrocytosis is present.

Question 2

Which of the following educational components provided in a pulmonary rehabilitation program aims to address self-management skills?

A)Anatomy and pathophysiology of chronic respiratory diseases
B)Use and misuse of oxygen
C)Be able to recognize an early acute exacerbation of the disease
D)Practical solutions to incorporate activity into daily lives

Answer 2

C
Self-management for patients with chronic respiratory disease includes being able to recognize an early acute exacerbation of disease,when/how to initiate or increase specific therapy such as antibiotics,steroids,and bronchodilators,and when to contact health care providers.Self-management education involves the transfer of knowledge and skill in performing self-care techniques.

Question 3

Which of the following outcomes is MOST associated with improvement in clinical symptoms?

A)Timed activities of daily living tests
B)Questionnaire to measure impact of dyspnea
C)Evaluation of a patient diary
D)Evaluation of a behavioral survey

Answer 3

B
Outcome measures associated with improvement in clinical symptoms include (1)use of Borg or visual analog scale to measure dyspnea or fatigue,(2)dyspnea questionnaire to measure impact of dyspnea on ADL,(3)the distress of dyspnea,(4)the influence of dyspnea on the quality of life,and (5)evaluation of fatigue.

Question 4

Which of the following outcomes is MOST associated with improvement in exercise capacity?

A)Timed distance walk tests
B)Use of a visual analog scale to measure dyspnea
C)Measurement of carbon monoxide levels
D)The evaluation of fatigue

Question 5

Which of the following changes in a conditioning program would be considered a method of progressing functional training with a pulmonary patient?

A)Keeping the repetitions the same and lower the weight
B)Encouraging the patient to work at a higher level within a given time
C)Encouraging longer rest periods between bouts of exercise
D)Encouraging the use of an assistive device when ambulating

Question 6

A pulmonary patient who is unable to tolerate an extended session of moderate- to high-intensity aerobic endurance training is able to MOST likely improve exercise endurance using which of the following alternative methods of training?

A)Interval training,alternating periods of high and low intensity (or rest)
B)Lower intensity training (<40% of maximal work rate)for 10 minutes,daily
C)Participating in daily activities of living
D)Use of transcutaneous electrical nerve stimulation (TENS)on lower extremities

Question 7

Which of the following activities would be considered an intervention to enhance energy conservation?

A)Pursed-lip breathing.
B)Avoid bending over at the waist during an activity.
C)Use of adaptive equipment to simplify tasks.
D)Practice of yoga postures.

Question 8

Which of the following physiological adaptations occur as a result of moderate- to high-intensity aerobic endurance training?

A)Lower anaerobic threshold
B)Diminished capillary density of muscle
C)Increased oxidative enzyme capacity
D)Hypertrophy of the muscle fiber

Question 9

Which of the following outcomes is NOT considered one of the major outcome areas that need to be measured in pulmonary rehabilitation?

A)Exercise capacity
B)Patient satisfaction
C)Symptoms
D)Health-related quality of life

Question 10

Incorporating a cool-down period into the exercise session is necessary to produce which of the following physiological changes?

A)Increased ventilation
B)Increased blood flow to the muscles
C)Maintenance of elevated blood pressure
D)Reduce risk of bronchospasm

Question 11

Which of the following anatomical areas of the body lose range of motion (ROM)as a result of progressive lung disease,poor posture,and accessory breathing muscle use?

A)Rib cage
B)Shoulders
C)Spine
D)All of the above

Question 12

If a patient is being provided 3 L/min of O₂,which of the following values BEST represents the fraction of inspired oxygen (FiO₂)?

A)25%
B)28%
C)32%
D)34%

Question 13

Which of the following goals would be considered unrealistic for a pulmonary patient?

A)Learning and implementing strategies to relieve dyspnea
B)Increasing activity tolerance
C)Discontinuing supplemental oxygen use
D)Improving oxygen saturation levels during activity

Question 14

Which of the following goals would be MOST associated with improvement in clinical symptoms?

A)The patient will gain sufficient strength,flexibility,and endurance to accomplish identified activities of daily living.
B)The patient will improve coping skills.
C)The patient will learn to employ strategies to manipulate the environment to maximize physical functioning.
D)The patient will decrease the frequency and severity of respiratory exacerbations.

Question 15

Which of the following examination procedures is considered a component of the chest evaluation specific to a pulmonary patient?

A)Documentation of recent weight change
B)Inspection of breathing pattern
C)Posture
D)Balance and gait assessment

Question 16

Which of the following MOST likely contributes to reduced flexibility in a pulmonary patient?

A)Inactivity or increased time sitting
B)Posture-forward lean to assist with breathing
C)Hypertrophy of accessory respiratory muscles
D)All of the above

Question 17

A breathing exercise that improves oxygen saturation by increasing carbon dioxide removal,reducing respiratory rate,and slowing expiratory flow is which of the following breathing retraining interventions?

A)Diaphragmatic breathing
B)Pursed-lip breathing
C)Resistive breathing device
D)Paced breathing

Question 18

Which of the following goals would be MOST associated with improvement in health-related behavior?

A)The patient will be able to recognize early signs of the need for medical intervention.
B)The patient will be compliant with medical and rehabilitation treatments.
C)The patient will learn to employ strategies to manipulate the environment to maximize physical functioning.
D)The patient will employ strategies to relieve symptoms of dyspnea and cough.

Question 19

Long-term outcomes of airway clearance monitored over the rehabilitation period may include which of the following?

A)Improved breath sounds
B)Cost of health services is decreased
C)Decreased atelectasis
D)Subjective improvement in shortness of breath

Question 20

Obesity associated with respiratory disease may result from which of the following conditions?

A)Decreased activity level due to dyspnea and fatigue
B)Malabsorption
C)High energy costs resulting from increased work of breathing
D)Muscle mass depletion

Question 21

Pulmonary function test data are exclusively used when determining a patient candidacy for pulmonary rehabilitation.

Question 22

A patient with moderate lung disease would be anticipated to demonstrate which of the following ventilatory responses to exercise?

A)Patient will become short of breath with usual daily activities and walking pace of 3 to 4 METs.
B)Patient will have shortness of breath only with relatively heavy exercise.
C)Patient will be restricted by symptoms of shortness of breath during most daily activities.
D)Patient may require intermittent or continuous oxygen with activity.

Question 23

Which of the following conditions tends to occur with or contribute to postural changes in a patient with pulmonary disease?

A)Loss of chest mobility
B)Adoption of propping postures
C)Use of accessory breathing muscles of shoulders and cervical and thoracic spine
D)All of the above

Question 24

Which of the following statements provides the BEST explanation about how performing general upper and lower extremity exercise can provide adequate stimulus for improving respiratory muscle endurance and strength?

A)Improves carbon dioxide removal.
B)Slows expiratory flow.
C)Increase both tidal volume and respiratory rate.
D)Increases alveolar ventilation.

Question 25

In addition to vital signs (blood pressure,heart rate,and oxygen saturation),which of the following additional data would be MOST appropriate to collect during a 6-minute walk test with a severe lung disease patient?

A)Amount of supplemental oxygen required to maintain SpO₂ > 88%
B)Dyspnea scale rating
C)Occurrence of arrhythmias
D)All of the above

Question 26

A patient with mild lung disease will demonstrate a forced expiratory volume in 1 second as which of the following?

A)≥ 80% of predicted values
B)<80% of predicted values
C)<75% of predicted values
D)<50% of predicted values

Question 27

A patient with severe lung disease is prescribed an exercise program that consists of interval training with short exercise bouts and rests.Which of the following methods would be MOST appropriate for this patient to advance the aerobic training workload?

A)Decreasing the number of bouts
B)Increasing the length of the exercise bout
C)Increasing the number of rest periods
D)Adding a light load (weighted vest)to the patient during exercise

Question 28

Which of the following precautions is MOST appropriate to recommend for a patient with lung disease and osteoporosis?

A)Avoid arm ergometry.
B)Avoid Valsalva maneuver.
C)Perform bilateral arm movement instead of unilateral movement.
D)Avoid high workloads on a stationary bicycle.

Question 29

Which of the following criteria is appropriate to use when determining the time to advance workloads in an exercise prescription for a patient with moderate lung disease?

A)The patient feels like it is time to advance the workload.
B)Each week the workload should be increased per a schedule.
C)Rating of perceived exertion (RPE)and heart rate decrease and exercise time is maintained.
D)The program can be advanced when cleared by the medical director.

Question 30

Pulmonary patients postsurgery with an incision should follow recommended precautions regarding activity for what period of time?

A)4 weeks
B)6 weeks
C)8 weeks
D)12 weeks