DPT 770 Midterm Review

In the hospital, you are scheduled to see a patient who was admitted for increased shortness of breath at rest and weight gain secondary to heart failure. At the start of your visit, your patient reports they continue to be short of breath at rest with dyspnea 1/10. Vitals WNL.

How do you best proceed with this patient?

• Clear to continue while managing dyspnea symptoms

• Hold off on therapy until they are no longer short of breath at rest

• They are not cleared for therapy during their time in the hospital

• Cleared with no restrictions

Answer explanation

HF patients will be in the red zone in the hospital. As their vitals are WNL and dyspnea is only 1/10 you are cleared pending symptoms, especially maintaining dyspnea at 4 or below.

You are scheduled to see a 65 year-old patient in the hospital who was admitted for symptoms of myocardial infarction and then proceeded to have a coronary artery bypass graft x 2 to treat the occluded arteries. Upon initial evaluation you find the following resting vital signs:

Heart Rate - 65bpm

BP - 130/72 mmHg

RR - 18 breaths/min

SpO2 - 97%

What is the maximum heart rate you can achieve with this patient?

• 95 bpm

• 85 bpm

• 162 bpm

• 150 bpm

Answer explanation

Post CABG in hospital is Resting Heart Rate + 30bpm OR <120 bpm

Which cardiomyopathy patient is statistically at the highest risk for exercise-related events, and thus requires the most attention/supervision

• CHF

• CAD

• PAD

• DMII

Answer explanation

* Myers J. (2008). Principles of exercise prescription for patients with chronic heart failure. Heart failure reviews, 13(1), 61–68. https://doi.org/10.1007/s10741-007-9051-0

· Slide 19

You are performing treadmill training with a patient with a history of PAD. Your patient reports they are beginning to have pain. How should you respond?

• Tell them to stop, rest, and let the pain dissipate

• Tell them to stop, and call the physician

• Have them continue, but at a slower pace/intensity to see if it relives the pain

• None of the above

Answer explanation

initial claudication phase is noted, you should continue at the same pace, speed until reaching 3 out of 4 on the claudication scale (absolute claudication point)

You have a CAD patient who presents to rehab post MI. They have a resting HR of 76bpm. In the absence of a stress test, what is the highest HR intensity that would be appropriate to exercise this patient at?

• 110bpm

• 105bpm

• 96bpm

• 100bpm

Answer explanation

In the absence of a stress test, you continue RHR + 20 as the max intensity

Which phase of cardiac rehab lasts 6-12 weeks, with the degree of safety monitoring determined by the level of risk?

• Phase I

• Phase II

• Phase III

• Phase IV

Answer explanation

Per slides 2-7 in CRII – part 1

While treating a patient who recently had a cardiovascular event, your aim is to progress their exercise to match their allowed maximum heart heart threshold. Which of the following is an appropriate progression (in the absence of a stress test) for a stable cardiovascular patient?

• Cleared to start 40-80% HRR once discharged from hospital

• Progress 10 bpm after 1 week and then 20bpm every week until target HR reached

• Progress 10bpm 2-3 weeks after event and then 10 bpm every week until target HR reached

• Progress 10bpm 4 weeks after event and then 10bpm every 2 weeks until target HR reached

While treating a patient in the ICU, which of the following devices would most likely limit your patients ability to full participate in therapy for ambulation?

• Swan-Ganz Catheter

• Mechanical Ventilator

• Intra-aortic Balloon Pump

• Implantable Cardioverter Defibrillator (ICD)

Answer explanation

Patients are cleared for ambulation with the other 3 devices. Patients on a ventilator are most likely sedated and limited on ability to perform ambulation.

In an acute setting, you are treating a patient with a recent valve replacement and history of atrial fibrillation. During your treatment you note the following vitals at rest:

HR: 78bpm; BP 132/80; RR 17breaths/min; SpO2 98%

During your treatment you get the patient up and walking and the present with the following vital signs:

HR: 118bpm; BP 146/82; RR 20 breaths/min; SpO2 97%

Along with the attached EKG.

How do you proceed with this patient?

• Continue as all vital signs are cleared

• Stop and adjust treatment as this is not a normal EKG response

• Stop and adjust treatment as this is not a normal heart rate response

• Call a code and do not proceed with this patient

Answer explanation

The EKG shows afib, which is known and the heart rate is below 120 so you are cleared to continue at low intensity.

However, they recently had cardiovascular surgery and this is not an appropriate heart rate response after surgery as you need to maintain RHR + 30bpm

You are treating a patient in the hospital who recently had chest pains and signs of occluded arteries, treated with blood thinner medication. Which of the following would most likely cause their blood pressure to be elevated during your treatment?

• Orthostatic Hypotension

• Arterial Line transducer is too high

• Blood thinner medication

• Exercises in physical therapy

Answer explanation

The other three options would all cause a potential lower blood pressure. Exercise would cause an increase in blood pressure.