Acute Care and Critical Care Physical Therapy
Chapter Exam Questions
Course Introduction
This course provides an in-depth exploration of the principles and practices of physical therapy within acute and critical care environments. Students will examine the roles and responsibilities of physical therapists in managing patients with complex and unstable medical conditions, including those in intensive care units. Emphasis is placed on patient assessment, clinical decision-making, and the development of individualized intervention strategies to optimize functional outcomes. Topics include monitoring vital signs, managing lines and tubes, early mobilization, respiratory care, and the prevention of complications such as deconditioning and pressure injuries. The course combines theoretical knowledge with case studies and practical skills to prepare students for effective interdisciplinary collaboration and evidence-based practice in acute and critical care settings.
Recommended Textbook
Essentials of Cardiopulmonary Physical Therapy 4th Edition by Ellen Hillegass
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Chapter 1: Anatomy of the Cardiovascular and Pulmonary Systems
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Q1) The right upper lobe bronchus divides into which of the following?
A)Lateral and medial segment
B)Superior segment to the upper portion
C)Apical,posterior,and anterior segments
D)Lower lobe bronchus to the medial basal segment
Answer: C
Q2) During the administration of suctioning procedures,which of the following may cause an adverse response in the patient?
A)An elicited parasympathetic response
B)The catheter is inserted to the carina level
C)A cough is stimulated
D)The use of a nasal trumpet during suctioning
Answer: A
Q3) The point at which the nerves,vessels,and primary bronchi penetrate the parenchyma of each lung is termed the: A)root.
B)fissure.
C)hilus.
D)segment.
Answer: C
3
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Chapter 2: Physiology of the Cardiovascular and Pulmonary Systems
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Q1) Which of the following improves 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.
Answer: C
Q2) 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%.
Answer: C
Q3) 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.
Answer: A
Page 4
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Chapter 3: Ischemic Cardiovascular Conditions and Other Vascular Pathologies
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Q1) A pathological permanent dilation of an artery wall that is usually uniform in shape,but can resemble a sac or outpouching,is termed:
A)stenosis.
B)aneurysm.
C)atherosclerosis.
D)bruit.
Answer: B
Q2) Which of the following interventions would result in the highest survival rate from ventricular fibrillation sudden cardiac arrest?
A)Entry into emergency medical system within 15 minutes
B)Administration of CPR within 10 minutes
C)Immediate CPR and AED shock within 3 to 5 minutes
D)AED shock within 15 minutes
Answer: C
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Chapter 4: Cardiac Muscle Dysfunction and Failure
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Q1) 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 setup the same.
Q2) An accumulation of fluid in the lungs along with hypoxemia and tachypnea BEST describes which of the following pulmonary edema stages?
A)Stage I
B)Stage II
C)Stage III
D)Stage IV
Q3) Which of the following causes is MOST related to right heart failure?
A)Pulmonary embolus
B)Myocardial infarction
C)Hypertension
D)Aortic valve dysfunction
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Chapter 5: Restrictive Lung Dysfunction
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Q1) Exudative pleural effusion is characterized by high protein content and accumulates due to changes in permeability of the pleural surfaces.Which of the following is a cause of exudative pleural effusion?
A)Congestive heart failure
B)Cirrhosis
C)Bacterial pneumonia
D)Pulmonary emboli
Q2) Which of the following spinal cord levels if injured would result in diaphragmatic dysfunction?
A)C4-5
B)T1-2
C)T4-5
D)T7-8
Q3) Which of the following chemotherapeutic drugs is used as an anti-inflammatory agent to treat rheumatoid arthritis and may lead to interstitial lung disease?
A)Cytarabine
B)Methotrexate
C)Melphalan
D)Azathioprine
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Page 7
Chapter 6: Chronic Obstructive Pulmonary Diseases
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Q1) Chronic obstructive pulmonary diseases (COPD)are diseases of the airways that produce obstruction to expiratory airflow.Which of the following problems relates to COPD?
A)Inflammation of mucosal lining of airways
B)Retained secretions
C)Bronchial constriction related to spasm of the smooth muscle
D)All of the above
Q2) Which of the following signs are associated with lung hyperinflation noted in obstructive lung diseases?
A)Elevation of shoulder girdle
B)Horizontal ribs
C)Low,flattened diaphragm
D)All of the above
Q3) Which of the clinical manifestations distinguishes chronic bronchitis?
A)Presence of a chronic cough for 6 months in 1 year
B)Presence of a chronic cough for 3 months in 2 successive years
C)Evidence of hypersecretion of mucus in the large airways
D)Gland-to-bronchial wall thickness ratio (Reid index)is 3
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Chapter 7: Cardiopulmonary Implications of Specific Diseases
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Q1) Which of the following pathological conditions is MOST likely to occur secondary to obesity-related chronic daytime alveolar hypoventilation (PaCO ³45 mm Hg,PaO <70 mm Hg)?
A)Respiratory alkalosis
B)Hypercapnia
C)Metabolic acidosis
D)Anemia
Q2) Obstructive sleep apnea hypopnea syndrome (OSAHS)is MOST likely caused by which of the following bodily changes?
A)Excess fat accumulation in the neck causing pharyngeal lumen narrowing
B)Excess fat accumulation in the abdomen causing the diaphragm to be elevated
C)Excess fat accumulation in the abdomen restricting chest wall expansion
D)Increased work of breathing due to rapid shallow breathing
Q3) Which of the following body mass index (BMI)values indicates normal weight?
A)<18.5 kg/m²
B)18.5 to 24.9 kg/m²
C)25.0 to 29.9 kg/m²
D)30.0 to 34.9 kg/m²
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Chapter 8: Cardiovascular Diagnostic Tests and Procedures
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Q1) Elevated CK-MB levels in a patient after a hip surgery confirms the patient experienced some level of myocardial injury.
A)True
B)False
Q2) Specificity of a diagnostic test is one method of determining the accuracy of a test.Which of the following statements BEST defines specificity?
A)The proportion of those individuals without the disease with a true negative test
B)The proportion of those individuals with the disease who have a true positive test
C)The proportion of individuals who had a positive test and actually have the disease
D)The proportion of individuals who had a negative test and truly do not have the disease
Q3) Which of the following biomarkers is MOST conclusive for myocardial injury?
A)CK-MB
B)CK-MM
C)CK-BB
D)All of the above
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Chapter 9: Electrocardiography
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Q1) Which of the following ECG leads should be scanned to look for the presence of ventricular hypertrophy?
A)V1,V2,V3
B)V4,V5,V6
C)V1,V5,V6
D)I,II,aVR
Q2) Which of the following components of the ECG impulse represents the ventricular depolarization?
A)P wave
B)P-R segment
C)QRS complex
D)ST segment
Q3) The presence of a significant Q wave (one-third the size of the QRS complex)on an ECG indicates which of the following?
A)Acute infarction
B)Ischemia
C)Digitalis toxicity
D)Previous infarction
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Chapter 10: Pulmonary Diagnostic Tests and Procedures
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Q1) A patient who is noted to have an improvement in FVC and forced expiratory volume in 1 second 5 to 20 minutes after the administration of a bronchodilator is MOST likely to have which of the following pulmonary conditions?
A)Pneumonia
B)Pulmonary fibrosis
C)Asthma
D)Moderate to severe emphysema
Q2) Cytological testing identifies viruses as having a simple central core of DNA or RNA encapsulated by a protein coat.This BEST describes which of the following classification schemes?
A)Morphology
B)Habitat
C)Structure
D)Taxonomy
Q3) Which of the following conditions BEST describes respiratory alkalosis?
A)High bicarbonate level (HCO -)
B)Low partial pressure CO (PaCO )
C)Hypocapnia
D)Low bicarbonate level (HCO -)
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Page 12
Chapter 11: Cardiovascular and Thoracic Interventions
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Q1) Which of the following advantages of video-assisted thoracoscopic surgery over a thoracotomy is MOST related to recovery in the activities domain within the International Classification of Functioning (ICF)model?
A)Reduced hospital length of stay
B)Improved pulmonary functioning
C)Early patient mobilization and recovery
D)Less pain postoperatively
Q2) Patients with claudication pain after a peripheral vascular intervention have better long-term outcomes and fewer amputations?
A)True
B)False
Q3) Common risk factors for thoracic aortic aneurysms include which of the following factors?
A)Hypertension
B)Hypercholesteremia
C)Prior tobacco use
D)All of the above
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Chapter 12: Thoracic Organ Transplantation: Heart, Heart
Lung, and Lung
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Q1) Which of the following patient characteristics indicates end-stage cardiopulmonary disease?
A)Marked decrease in cardiopulmonary function.
B)Require multiple medications and/or oxygen to complete daily activities.
C)Unable to work full-time.
D)All of the above.
Q2) Which of the following goals is appropriate at discharge of a lung transplant recipient?
A)The patient will be modified independent with basic activities of daily living.
B)The patient will demonstrate independence in secretion clearance.
C)The patient will demonstrate a 10% increase in the 6-minute walk distance.
D)All of the above goals are appropriate for a lung transplant recipient.
Q3) Which of the following is considered a relative contraindication to lung transplant?
A)Continued abuse of alcohol,tobacco,or narcotics
B)Age 65 years or older
C)Significant chest wall or spinal deformity
D)Absence of consistent support system
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Page 14
Chapter 13: Monitoring and Life Support Equipment
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Q1) Which of the following statements is TRUE about mean arterial pressure (MAP)readings?
A)The MAP reading does not vary significantly with motion artifact or movement.
B)The MAP is useful clinically as it relates to cardiac output and systemic vascular resistance.
C)An MAP value of <60 mm Hg may indicate inadequate tissue perfusion.
D)All of the above are true statements.
Q2) During the process of taking a patient's blood pressure,the Korotkoff sound that increases in intensity with a distinct tapping is associated with which of the following clinical interpretations?
A)Systolic pressure
B)Blood flow increasing as artery compression is decreasing
C)Diastolic pressure in <13 years of age
D)Diastolic pressure in adults
Q3) Low central venous pressure (CVP)indicates which of the following clinical abnormalities?
A)Fluid overload
B)Right ventricular failure
C)Dehydration
D)Tricuspid insufficiency
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Chapter 14: Cardiovascular Medications
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Q1) Which of the following classes of antiarrhythmic agent drugs act as membrane depressants affecting the fast sodium channels?
A)Class I
B)Class II
C)Class III
D)Class IV
Q2) A patient presents with pulmonary congestion in which cardiac output is normal,but left ventricular filling pressure is elevated.Which of the following pharmacological therapies would be MOST appropriate?
A)Observation
B)Volume replacement
C)Diuretics
D)Use of circulatory assist agents
Q3) A patient who presents with clinical symptoms of heart failure is BEST identified by which of the following heart failure stages?
A)Stage I
B)Stage II
C)Stage III
D)Stage IV
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Chapter 15: Pulmonary Medications
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Q1) Long-acting beta adrenergic agonists (LABAs)provide which of the following benefits?
A)Prescribed as a reliever medication.
B)Provides quick relief from symptoms of shortness of breath.
C)Prevents or decreases symptoms of bronchospasm.
D)Used as a maintenance drug and provides stable airways day to day.
Q2) Which of the following medication classes would be MOST appropriate to prescribe if the goal was to have a steroid-sparing effect in a patient with asthma?
A)Corticosteroids
B)Mast cell stabilizers
C)Methylxanthines
D)Leukotriene inhibitors
Q3) Which of the following characteristics or effects is MOST associated with ephedrine?
A)Short duration of action.
B)May induce peripheral vascular constriction.
C)Demonstrates strong alpha receptor activity.
D)Classified as a selective sympathomimetic.
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Chapter 16: Examination and Assessment Procedures
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Q1) Which of the following techniques during lung sound auscultation is considered an error in technique?
A)Placing the bell or diaphragm directly against the chest wall
B)Asking an alert patient to sit up or rolling a comatose patient onto the side to auscultate the posterior lobes
C)Auscultating over areas of the chest wall that are accessible and convenient
D)Shutting the door to the patient's room and lowering the volume of the TV
Q2) Which of the following general appearances BEST indicates the presence of low oxygenation and perfusion in the periphery?
A)The patient is leaning forward on the knees or some object to breathe.
B)The patient is using accessory muscles around neck and shoulders to breathe.
C)The patient has noticeable bluish color at the lips and fingernail beds.
D)The patient is resting in a semi-Fowler's position and is not able to tolerate lying flat.
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Chapter 17: Interventions for Acute Cardiopulmonary Conditions
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Q1) A patient presents 2 weeks post an embolic stroke and aspiration pneumonia.She is lethargic and does not appear to follow commands consistently.Which of the following breathing techniques would BEST improve the patient's overall ventilation to lung areas on the hemiparetic side?
A)Upper chest inhibiting technique
B)Counter rotation
C)Scoop technique
D)Unilateral costal expansion
Q2) Which of the following conditions would be a relative contraindication to postural drainage?
A)Increased intracranial pressure
B)Open wounds or burns on thorax
C)Rib fractures
D)Osteoporosis
Q3) Adequate inspiratory volumes for an effective cough are noted to be at least which of the following?
A)Inspiration equivalent to tidal volume inspiration
B)40% of patient's predicted vital capacity
C)50% of patient's predicted vital capacity
D)60% of patient's predicted vital capacity
Page 19
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Chapter 18: Interventions and Prevention Measures for
Individuals With Cardiovascular Disease, or Risk of Disease
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Q1) 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
Q2) 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
Q3) 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
Page 20
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Chapter 19: Pulmonary Rehabilitation
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Q1) 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%
Q2) 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
Q3) 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
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Page 21
Chapter 20: Pediatric Cardiopulmonary Physical Therapy
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Q1) Which of the following characteristics is MOST associated with cyanotic lesions of the heart?
A)Flow is known as left to right.
B)Associated with polycythemia.
C)Pulmonary blood flow is increased.
D)Associated with low stroke volume.
Q2) A fetus will not survive if born during which of the following periods of lung maturation?
A)Pseudoglandular period
B)Canalicular period
C)Terminal saccular period
D)Alveolar period
Q3) Which of the following techniques would be considered an intervention used as a tone-inhibiting technique to facilitate proper breathing mechanics in a pediatric patient?
A)Lying supine over a ball
B)A corner stretch
C)Positioning the child in flexion with rhythmic rocking
D)Manual facilitation of the spinal extensors during sitting
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Chapter 21: The Lymphatic System
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Q1) Besides cancer,which of the following conditions is the MOST significant risk factor for the development of lymphedema?
A)Smoking
B)Type 2 diabetes
C)Obesity
D)Increasing age
Q2) If family heredity is present explaining primary lymphedema,it is referred to as which of the following?
A)Lymphedema praecox
B)Lymphedema trada
C)Milroy disease
D)Lymphatic filariasis
Q3) The lymphatic system is similar to the venous system in which of the following ways?
A)The presence of one-way valves
B)The ability of a vessel to contract via the autonomic nervous system
C)Immune defense
D)Key function is waste removal
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Chapter 22: Outcome Measures:a Guide for the Evidence
Based Practice of Cardiopulmonary Physical Therapy
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Q1) Which of the following clinical symptoms would lead to the end of a modified shuttle walk test or 6-minute walk test?
A)Patient is unable to continue per self-report.
B)Oxygen saturation is below a safe level for continued exertion.
C)Patient attains 85% of maximal predicted heart rate.
D)All of the above are valid reasons to end the test.
Q2) Which of the following risk factors should be present when the completion of an ankle-brachial index is indicated?
A)Diabetes
B)High HDL
C)Anorexia
D)Asthma
Q3) Which of the following variables collected at the time of a patient's initial evaluation is considered a demographic data factor?
A)Blood pressure
B)Hemodynamic regulation
C)Blood lipid levels
D)Comorbidities
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