This study guide was designed to help you learn the basics of Cardiopulmonary Rehabilitation. It also contains practice questions for you to benefit from as well. So if you’re ready, let’s get started.
What is Cardiopulmonary Rehabilitation?
It typically includes education, emotional support, and physical activity.
Cardiopulmonary Rehabilitation Practice Questions:
1. What is the restoration of the individual to the fullest medical, mental, emotional, social, and vocational potential of which he or she is capable?
2. What is the overall goal of rehabilitation?
To maximize the functional ability and minimize the impact the disability has.
3. What is the art of medical practice wherein an individually tailored, multidisciplinary program is formulated; attempts to return the patient to the highest possible functional capacity?
4. What are the general goals of pulmonary rehabilitation?
To control symptoms, restore functional capabilities, and improve the quality of the patient’s life.
5. How does an individual maintain homeostasis at rest?
6. What increases in
Oxygen consumption and CO2 production.
7. What refers to the result of an abrupt upswing in both CO2 and VE?
The ventilatory threshold.
8. What does exercise in COPD patients result in?
Respiratory acidosis and shortness of breath.
9. As ventilation increases in a COPD patient, what else increases significantly?
10. What does reconditioning involve?
Strengthening the essential muscle groups, improving the overall oxygen utilization, and enhancing the body’s cardiovascular response to physical activity.
11. What do patients with COPD often have a tendency of developing?
Severe anxiety, hostility, and stress.
12. What are the key ingredients in a good rehabilitation program?
Occupational retraining and job placement.
13. What are 3 examples of rehabilitation program objectives?
The development of diaphragmatic breathing skills, the development of stress management, and focus on group support.
14. What should the patient’s complete history be followed by?
A complete physical examination.
15. In order to determine the patient’s cardiopulmonary status and exercise capacity, what may be performed?
Both PFTs and a cardiopulmonary exercise evaluation may be performed.
16. What are the 2 key purposes that the cardiopulmonary exercise evaluation serves in pulmonary rehabilitation?
(1) It quantifies the patient’s initial exercise capacity, and (2) it determines the degree of hypoxemia or desaturation with exercise.
17. What does the second evaluation allow?
The basis for titrating oxygen during exercise.
18. The actual exercise evaluation involves continuous measurements of parameters during graded levels of exercise on what?
Either an ergometer or treadmill.
19. To allow for steady state equilibration, these graded levels are usually spaced how?
In 3 minute intervals.
20. Work levels are increased progressively until?
Until the patient cannot tolerate a higher level, or until an abnormal/hazardous response occurs.
21. what is the pulse oximeter used as?
It is used as a monitor to warn clinicians of gross desaturation and the patient’s response to oxygen.
22. What are 3 examples of relative contraindications to exercise testing?
(1) Patients who won’t/can’t perform the test, (2) Severe pulmonary HTN/cor pulmonale, and (3) SaO2/SpO2 < 80%.
23. What can an exercise evaluation help differentiate between?
Primary respiratory or cardiac limitations to increased work capacity.
24. What are the 5 safety measures during exercise evaluation?
(1) Physical examination (ECG), (2) qualified physician, (3) emergency resuscitation device, (4) basic/advanced life support techniques (clinicians), and (5) terminated when indicated.
25. When are patients excluded from pulmonary rehabilitation activities?
When their problems limit/preclude participation, and when their condition is complicated by malignant neoplasms (lung cancer).
26. The ideal rehabilitation session should run for about how long?
About 2 hours.
27. What does the Respiratory Therapist initially do during ventilatory muscle training?
They measure the patient’s maximum inspiratory pressure using a calibrated pressure manometer.
28. What is the rate at which a patient should breathe in the manometer?
29. As the level of resistance becomes more tolerable over time, the patient should progressively increase session duration up to how long?
Up to 30 minutes.
30. What is the cornerstone for the physical reconditioning effort?
Breathing control methods.
31. What is the length of the program often dependent on?
Insurance coverage and expected reimbursement.
32. What is a normal class size in pulmonary rehab?
33. What does program viability realistically depend on?
The number of participants.
34. What is the goal of payment for rehabilitation programs?
To obtain as much insurance reimbursement as possible.
35. What are the common outcome measures in the program results?
Exercise tolerance, levels of dyspnea at rest/exertion, quality of life surveys.
36. What is one of the major predictors for improvement in a COPD patient’s health-related quality of life?
Frequent attendance in a maintenance program.
37. What are the major reasons for unsatisfactory outcomes?
Insufficient training, lack of uniformity, inadequate program length, lack of follow-up.
38. Pulmonary rehabilitation has become recognized as a prerequisite for which patients?
For certain emphysema patients who are able to undergo lung volume reduction surgery.
39. What is defined as a comprehensive exercise and educational program designed for patients with cardiovascular diseases?
40. What are the goals of cardiac rehabilitation?
Patient education, physical reconditioning to improve work capacity, weight loss, and to help the patient return to work.
41. What is the goal of a structured cardiac rehabilitation program?
To assist patients in developing a regular pattern of safe exercise to achieve greater performance.
42. What is the age of cardiac patients compared to pulmonary patients?
30 to 60-70; pulmonary – 50 and up.
43. Absolute contraindications for conducting a cardiopulmonary exercise evaluation include all of the following except?
Diastolic blood pressure greater than 110 mm Hg.
44. Attrition in pulmonary rehabilitation programs is most associated with which of the following?
The degree to which patients’ psychosocial needs are met.
45. Below what level of the predicted FEV1/FVC are patients with irreversible airway obstruction considered good candidates for pulmonary rehabilitation?
46. By following the reimbursement guidelines for a comprehensive outpatient rehabilitative facility (CORF), Medicare will reimburse up to what percentage of the allowable charge for a rehabilitation program?
47. A cardiopulmonary exercise evaluation is conducted on a patient before participation in pulmonary rehabilitation for what purposes?
To quantify the patient’s baseline exercise capacity, to develop an exercise prescription (including target heart rate), and to determine how much desaturation occurs with exercise.
48. During exercise, the point at which increased levels of lactic acid production result in an increased VCO2 and VE is referred to as what?
The ventilatory threshold.
49. During inspiratory resistive exercises, the desired load should be about what percentage of the maximum inspiratory pressure?
50. For which of the following patients would you recommend an open-ended format for a pulmonary rehabilitation program?
Those with scheduling difficulties, those who require individual attention, and those who are self-directed.
51. In preparing an outpatient for a cardiopulmonary stress test to be conducted the next day, which of the following instructions would you provide?
The patient should fast for at least 8 hours before testing. The patient should wear loose-fitting clothing and sneakers. The patient should review the drugs with the physician.
52. Knowledge from the clinical sciences is used in pulmonary rehabilitation programming for mainly what purpose?
To quantify the extent of physiological impairment, and to set expectations for reasonable outcomes.
53. Knowledge from the social sciences is used in pulmonary rehabilitation programming for mainly what purpose?
To determine the impact of the disability on the patient or family, and to establish ways to improve the patient’s quality of life.
54. Minimum equipment requirements for the physical reconditioning component of a pulmonary rehabilitation program include which of the following?
Inspiratory resistive breathing devices, rowing machines or upper extremity ergometers, and pulse oximeters (for pulse rate/SaO2).
55. A patient is being considered for participation in a pulmonary rehabilitation program. Which of the following pulmonary function tests would you recommend be performed as a component of the preliminary evaluation?
Lung volumes, including functional residual capacity (FRC), Diffusing capacity (DLCO
56. A patient is being considered for participation in a pulmonary rehabilitation program. Which of the following test regimens would you recommend in order to ascertain the patient’s cardiopulmonary status?
Cardiopulmonary exercise evaluation and Pulmonary function testing.
57. The physical reconditioning component of a pulmonary rehabilitation program usually includes which of the following?
Aerobic exercises for the extremities, timed walking exercise, and ventilatory muscle training.
58. The principal objectives of pulmonary rehabilitation include which of the following?
To control and alleviate the symptoms, to restore functional capabilities as much as possible, and to improve the quality of life.
59. Reconditioning the inspiratory muscles of patients undergoing pulmonary rehabilitation is accomplished through which of the following methods?
Performing inspiratory resistive breathing exercises.
60. A small-group discussion format for pulmonary rehabilitation educational sessions is recommended in order to foster which of the following?
Group interaction, peer support, and group identity.
61. A small pulmonary rehabilitation program class size has which of the following beneficial effects?
It facilitates group interaction, it allows for more individualized attention, it helps to sustain participant motivation, and it reduces the likelihood of attrition.
62. To deal with incidents of hypoxemia, dyspnea, or airway hyperreactivity during physical reconditioning activities, which of the following should be available in the rehabilitation area?
Bronchodilator agents and emergency oxygen.
63. To increase the likelihood that positive patient results are lasting, what must pulmonary rehabilitation programs provide?
Periodic follow-up and reinforcement.
64. To physically recondition a patient and increase exercise tolerance, which of the following must be accomplished?
The body’s overall oxygen utilization must be improved, the patient’s essential muscle groups must be strengthened, and the cardiovascular response to exercise must be enhanced.
65. What are some relative contraindications for cardiopulmonary exercise testing?
Severe pulmonary hypertension or cor pulmonale, known electrolyte disturbances (e.g., hypokalemia), SaO2 or SpO2 less than 85% breathing room air, and untreated or unstable asthma.
66. What are the overall goals of rehabilitation?
To minimize the disability’s impact on the individual or family, and to maximize the functional ability of the individual.
67. What is the first step in evaluating patients for participation in a pulmonary rehabilitation program?
Complete patient history.
68. What is the level of involvement of the respiratory therapist in cardiac rehabilitation?
Our involvement is significantly less than in pulmonary rehabilitation.
69. What is the term used to describe the restoration of individuals to the fullest possible medical, mental, emotional, social, and vocational potential?
70. Which of the following are differences between cardiac and pulmonary rehabilitation?
Cardiac patients are typically younger, reimbursement is easier to obtain with cardiac rehabilitation, and breathing exercises are not essential to cardiac patients.
71. Which of the following medical professionals are commonly involved in cardiopulmonary rehabilitation programs?
Respiratory Therapists, Nurses, and Cardiologists.
72. Which of the following elements should be considered in most pulmonary rehabilitation programs?
The individual’s needs, the patient’s education, the patient’s personality, and the patient’s attitude.
73. Which of the following is NOT a factor affecting the cost of a pulmonary rehabilitation program?
The patient’s health insurance.
74. Which of the following is NOT a reasonable expectation for a pulmonary rehabilitation program?
Reversal of the disease process.
75. Which of the following measures during cardiopulmonary exercise evaluation are most useful in differentiating between exercise intolerance of cardiac versus ventilatory origin?
PaCO2 and PaO2.
76. Which of the following occur when the ventilatory threshold is exceeded during exercise?
Metabolism becomes anaerobic, and fatigue increases.
77. Which of the following outcome measures is considered a major predictor for improvement in a COPD patient’s health-related quality of life?
Frequent attendance in a maintenance program.
78. Which of the following patients are NOT good candidates for pulmonary rehabilitation?
Unstable cardiovascular patients who require monitoring, and patients with malignant neoplasms involving the lungs.
79. Which of the following topics should be covered in a rehabilitation education session on respiratory home care?
Self-administration of therapy, care of the home equipment (e.g., cleaning), and safe use of the home care equipment.
80. Which of the following would you not expect to observe after a chronic obstructive pulmonary disease (COPD) patient completes a sound pulmonary rehabilitation program?
A permanent increase in forced expiratory volume in 1 second (FEV1) and forced expiratory flow (FEF25%-75%).
81. While you are assisting in a treadmill cardiopulmonary stress test procedure, the patient complains to you of severe shortness of breath and some chest pain. Which of the following actions would you recommend at this time?
Terminate the procedure at once and notify the physician.
82. What are the 2 types of pulmonary rehabilitation that improve ventilation?
Diaphragmatic breathing and Pursed-lip breathing.
83. What is the goal of cardiopulmonary rehab?
Achieving and maintaining the individual’s maximum level of independence and functioning in the community.
84. Under the Psychosocial support component of cardiopulmonary rehab, these two factors are common with patients who have chronic pulmonary diseases?
Depression and hostility.
85. What can cause or aggravate physical problems associated with cardiopulmonary rehab?
86. What are the two major aims of a cardiopulmonary rehab?
(1) To control and alleviate disease symptoms, and (2) to help patients achieve optimal levels of activity.
87. What happens with cardiac output during exercise in healthy adults?
At low workloads, both SV and HR contribute to increased output and It increases linearly with increasing workload.
88. What is the normal breathing reserve?
89. What happens to the end-expiratory lung volume during exercise in patients with COPD?
It will increase.
90. What is the result of a moderate/high workload that further increases in cardiac output?
It increases heart rate.
91. What is required for a 6-minute walk test?
100-foot corridor, lap counter, and countdown timer.
92. How often should intensity be increased in pulmonary rehab?
Every 5th session.
93. What happens to the blood flow to the brain during intense exercise?
Absolute blood volume stays the same but percentage of blood flow to brain decreases.
94. What structure is the pacemaker of the heart?
95. What are the two most common risks associated with starting a new exercise program?
Sudden cardiac events and orthopedic injury.
96. Which of the following structures receive the highest percentage of blood flood during heavy exercise?
Muscle (70-85%) and skin (5-20%).
97. What causes the large amount of blood shunting to the skeletal muscles during high-intensity exercise?
Massive vasoconstriction, vasodilation to skeletal muscles, and increase in oxygen demand.
98. By how much will cardiac output increase during heavy exercise?
Cardiac output increases from 5L/min to 25 L/min and increases 20 L/min.
99. What causes an increase in cardiac output in late stages of exercises?
Heart rate alone.
100. What factor contributes to the initial increase in cardiac output in the onset of moderate-intensity exercise?
The stroke volume increases first and eventually flatlines. The heart rate increases after the stroke volume flatlines due to the sympathetic nervous system.
101. What causes the cardiac output to increase in the early stages of exercise?
Stroke volume and heart rate.
102. What is the volume of blood generally contained within the CVS?
103. Why does intense exercise increase cardiac output by 5-fold?
There is an increased demand for nutrients and oxygen exchange in skeletal muscles.
104. What does the p wave represent?
105. Before you begin exercising, your stroke volume and heart rate increase due to what effect from the autonomic nervous system?
106. Which organ has an increase in absolute blood volume but no increase in relative blood volume during blood flow distribution from resting to during exercise?
The heart; it stays at 4-5% although cardiac output increases from 5 L to 25 L per minute.
107. What are the two main factors that influence blood flow?
Blood pressure and resistance.
108. What part of the brain regulates the signals to vasodilate and/or vasoconstrict blood vessels?
109. What are two actions necessary specifically for blood to be able to flow into capillaries?
Distention and elastic recoil which the aorta inflates and then deflates driving blood flow.
110. Which of the following terms refers to the resistance of the heart pumping blood into circulation?
Afterload aka aortic pressure.
111. What law explains the control of blood flow determined by pressure and resistance?
112. Which of the following variables does not vary in relation to TPR?
113. Where would you find the lowest pressure within the blood flow system?
114. Where is the greatest pressure in the venous system?
115. What is the heart rate in an untrained individual at rest?
Higher than an untrained.
116. What is the major rate-limiting step in peak aerobic power?
Cardiac output when there is not enough oxygen, you can’t continue exercise.
117. What are the two influencing factors that
Blood pressure and resistance.
118. Which receptors are sending afferent info back to the cardiovascular system (CVS) during exercise?
Chemoreceptors (chemicals), baroreceptors (pressure), and thermoreceptors (heat and cold).
119. When observing local blood flow in active muscles, which of the following is the most potent vasodilation?
120. What is the consumption of oxygen when you increase exercise intensity via changes in either grade or work rate?
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121. What happens to blood pressure during exercise?
Systolic goes up and diastolic stays the same.
122. What are the driving factors for max ventilation with exercise?
Tidal volume and frequency.
123. What drives oxygen uptake during exercise?
Work rate and the amount of metabolic needs.
124. What respiratory volume significantly expands with increasing exercise?
125. Which of these causes the decline in pulmonary ventilation that occurs with aging?
A decrease in tidal volume.
126. What happens to ventilation rate with anticipation to exercise?
It increases slightly.
127. What do the oxygen and CO2 gradients promote?
Increased gas exchange.
128. What is the most important signal to consider when using Rate of Perceived Exertion scale?
129. What is the pressure of oxygen and CO2 in the systemic veins when it leaves the muscles and heads toward the right atrium of the heart?
PO2 = 40 mmHg and PCO2 = 46mmHg.
130. Where do we want to shift the ventilation threshold?
To the right.
131. What drives oxygen and CO2 diffusion in blood?
So there you have it. That wraps up our study guide on Cardiopulmonary Rehabilitation. Again, this is a topic that each Respiratory Therapist and medical professional should be familiar with.
Hopefully this guide can help make the learning process easier for you. Thank you so much for reading and as always, breathe easy my friend.
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The following are the sources that were used while doing research for this article:
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020. [Link]
- Jardins, Des Terry. Cardiopulmonary Anatomy & Physiology: Essentials of Respiratory Care. 7th ed., Cengage Learning, 2019. [Link]
- Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019. [Link]
- Tessler, Joseph. “Cardiac Rehabilitation – StatPearls – NCBI Bookshelf.” National Center for Biotechnology Information, 2 June 2020, www.ncbi.nlm.nih.gov/books/NBK537196.
- “Physiological Basis of Cardiopulmonary Rehabilitation in Patients with Lung or Heart Disease.” PubMed Central (PMC), 1 June 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4487369.
- “Cardiac Rehabilitation Past, Present and Future: An Overview.” PubMed Central (PMC), 1 Mar. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3839175.
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