Test bank for essentials of cardiopulmonary physical therapy 4th edition by ellen hillegass isbn 978

Test Bank for Essentials of Cardiopulmonary Physical Therapy, 4th Edition, by Ellen Hillegas

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Chapter 07: Cardiopulmonary Implications of Specific Diseases Hillegass: Essentials of Cardiopulmonary Physical Therapy, 4th Edition MULTIPLE CHOICE 1. Which of the following hormones MOST likely functions to reduce energy intake and induce

weight loss? a. Leptin b. Ghrelin c. Neuropeptide Y d. Orexin ANS: A

Some of the hormones that signal satiety include cholecystokinin, peptide YY, and glucagon-like petide-1, which are produced in the gut, and leptin, which is mostly secreted by adipocytes; these hormones tend to reduce energy intake and induce weight loss.

2. A gastric hormone that signals hunger and is involved in long-term regulation of body weight

BEST describes which of the following hormones? a. Neuropeptide Y b. Orexin c. Ghrelin d. Insulin ANS: C

Some of the hormones that signal hunger include ghrelin, a gastric hormone that appears to be involved in long-term regulation of body weight, and neuropeptide Y and orexin, which are produced in the hypothalamus; these hormones stimulate food intake and may suppress energy expenditure.

3. Sleep deprivation is associated with which of the following chronic conditions? a. Obesity b. Type II diabetes mellitus (DM) c. Cardiovascular disease d. All of the above ANS: D

Sleep deprivation appears to affect both sides of the energy balance equation, increasing appetite and decreasing energy expenditure. It appears that short sleep duration results in metabolic changes, including decreased leptin and increased ghrelin, that may contribute to the development of obesity, insulin resistance, type 2 DM, and cardiovascular disease.

4. 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 ANS: B

18.5 to 24.9 kg/m2 is the range that classifies normal weight.

5. Which of the following measurements is MOST associated with very high disease risk? a. Female gender, BMI = 27.8 kg/m2, and waist circumference = 40 inches b. Female gender, BMI = 18.0 kg/m2, and waist circumference = 32 inches c. Male gender, BMI = 37.4 kg/m2, and waist circumference = 38 inches d. Male gender, BMI = 28.2 kg/m2, and waist circumference = 42 inches ANS: C

Very high disease risk relative to BMI and waist circumference in males is BMI = 35.0 to 39.9 kg/m2 and any circumference or BMI = 30.0 to 34.9 kg/m2 and waist circumference >40 in. In females, it is a BMI of 30.0 to 34.9 kg/m2 and waist circumference >35 inches or BMI of 35.0 to 39.9 kg/m2 and any circumference measure.

6. Which of the following components secreted by adipose tissue is considered a cytokine that

may promote atherosclerosis and increase insulin resistance? a. Adiponectin b. Angiotensinogen c. Interleukin 6 d. Resistin ANS: C

Adiponectin, angiotensinogen, and resistin are hormones (proteins or enzymes) whereas interleukin 6 and tumor necrosis factor alpha are considered cytokines.

7. 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 ANS: A

Sleep apnea (complete absence of airflow) or hypopnea (temporary reduction of respiratory flow of at least 50%) is most likely caused by excess fat accumulation in the neck, which may cause pharyngeal lumen narrowing.

8. Which of the following pathological conditions is MOST likely to occur secondary to

obesity-related chronic daytime alveolar hypoventilation (PaCO2 45 mm Hg, PaO2 <70 mm Hg)? a. Respiratory alkalosis b. Hypercapnia c. Metabolic acidosis d. Anemia ANS: B

Chronic daytime alveolar hypoventilation would lead to retention of CO2 resulting in respiratory acidosis and hypercapnia. Hypoventilation also leads to hypoxemia. In response to hypoxemia, red blood cells will be produced resulting in polycythemia.

9. Which of the following strategies would MOST likely be an appropriate primary intervention

for extreme obesity that is consistent with a stepped-care approach?

a. b. c. d.

Caloric restriction Increased physical activity Bariatric surgery Medications

ANS: C

A stepped-care approach involves choosing the level of intervention based on severity of obesity. Caloric restriction, increased activity, diet modifications, and stress management would be appropriate for mild to moderate obesity; all of the lifestyle modifications plus medications would be appropriate for severe obesity; all lifestyle modifications, medications, and bariatric surgery would be appropriate for extreme obesity. Bariatric surgery would be the primary intervention most likely at an extreme level.

10. What percentage of sustained weight loss is BEST associated with reducing many of the

medical risk factors and complications associated with obesity? a. 2% of baseline weight b. 4% of baseline weight c. 8% of baseline weight d. 12% of baseline weight ANS: C

A goal of 5% to 10% sustained weight loss is associated with reducing many of the medical risk factors and complications associated with obesity. This percent weight loss is associated with clinically significant effects on several hormonal, metabolic, and cardiovascular risk factors.

11. Research evidence supports which of the following interventions as being the MOST likely

have the greater short- and long-term weight loss among obese and overweight adults? a. Moderate-intensity activity b. Diet modifications c. Moderate-intensity activity plus diet modifications d. Behavior modifications ANS: C

Meta-analyses of randomized clinical trials assessing the effectiveness of exercise plus diet versus diet only have revealed that combination treatment results in significantly greater short- and long-term weight loss than diet interventions alone among obese and overweight adults.

12. Which of the following would MOST likely cause obese persons to have dyspnea on exertion

and their exercise capacity to be reduced? a. Elevated blood pressure and resting heart rate b. Reduced capacity to increase blood flow and oxygen to exercising muscles c. Ventilatory limitation in uncomplicated obesity d. Elevated absolute oxygen consumption at a given exercise load ANS: B

Obese individuals commonly experience dyspnea on exertion and their exercise capacity is reduced. These impediments are rarely caused by ventilator limitations in uncomplicated obesity; rather the major limiting factor is probably a reduced capacity to increase blood flow and oxygen delivery to the exercising muscles.

13. Which of the following parameters of exercise is initially MOST appropriate to include in an

exercise prescription for an obese patient who is referred for physical therapy to improve cardiovascular function? a. Moderate-intensity exercise [40% to 60% of heart rate reserve (HRR)] b. 30 minutes of accumulate exercise per day c. Only weight-bearing activities d. Low-intensity exercise (<40% of heart rate reserve) ANS: A

Moderate-intensity exercise (40% to 60% of HRR) is most appropriate due to it being lower than the anaerobic threshold, in order to utilize predominantly FFAs as fuel. Thirty minutes is not enough; 45 to 60 minutes is recommended. Non-weight-bearing activities are good for those with joint arthritis; low intensity is not sufficient to effect stimulus to effect a change in weight management.

14. Which of the following factors is NOT considered to be recognized as a metabolic risk factor

associated with metabolic syndrome (MetS)? a. Visceral obesity b. Dyslipidemia c. Elevated C-reactive protein d. Insulin resistance ANS: C

The most common factors associated with metabolic syndrome include central or visceral adiposity, dyslipedemia, hypertension, insulin resistance, and impaired glucose tolerance.

15. Impaired glucose tolerance is defined by which of the following values? a. Blood glucose of 85 mg/dL after ingestion of 75 g glucose during a 2-hour oral

glucose tolerance test b. Blood glucose of 100 mg/dL after ingestion of 75 g glucose during a 2-hour oral

glucose tolerance test c. Blood glucose of 130 mg/dL after ingestion of 75 g glucose during a 2-hour oral

glucose tolerance test d. Blood glucose of 210 mg/dL after ingestion of 75 g glucose during a 2-hour oral

glucose tolerance test ANS: C

Impaired glucose tolerance is defined as blood glucose >120 mg/dL but <200 mg/dL after ingestion of 75 g glucose during a 2-hour oral glucose tolerance test (OGTT).

16. Visceral adipose tissue (VAT)-induced increments of free fatty acids stimulate the production

of which of the following? a. High-density lipoproteins b. Low-density lipoproteins c. Interleukin-6 d. Leptin ANS: B

VAT induces incremental increases in free fatty acids that stimulate the liver to produce more LDL cholesterol, in particular the small, dense particles that are more easily embedded in atherosclerotic plaques, while producing less HDL cholesterol that normally removes cholesterol from these plaques.

17. Which of the following cells are most impaired or less responsive to insulin when insulin

resistance occurs? a. Skeletal muscle cells b. Liver cells c. Adipose cells d. All of the above ANS: D

Insulin resistance causes cells, particularly in muscle, liver, and adipose tissue, to be less responsive to the effects of insulin.

18. Measurement of the average level of glucose that a red blood cell has been exposed to during

its life cycle of about 120 days is BEST recorded by which of the following tests? a. Impaired fasting glucose test b. Impaired glucose tolerance test c. Glycosylated hemoglobin test (Hb A1c) d. Fasting glucose level ANS: C

The measurement of glycosylated hemoglobin is considered the gold standard as an indicator of the degree of glycemic control achieved by an individual over the preceding 2- to 3-month period. During hyperglycemia, some hemoglobin molecules become glycosylated (bound with glucose), which is a relatively irreversible process. The level of Hb A1c within the RBC reflects the average level of glucose that the cell has been exposed to during its life cycle.

19. The process in which hypoglycemia stimulates the release of glucagon to promote the

breakdown of glycogen is BEST termed by which of the following? a. Glycogenolysis b. Gluconeogenesis c. Ketogenesis d. Lipolyosis ANS: A

A number of counterregulatory hormones also participate in the regulation of glucose metabolism to prevent hypoglycemia and maintain adequate cellular fuel sources for energy production. Glucagon release is stimulated by hypoglycemia and in the liver it promotes the breakdown of glycogen to glucose, which is termed glycogenolysis.

20. In a person with type II DM, ketones are formed from the metabolism of what? a. Proteins b. Glycogen c. Free fatty acids (FFAs) d. Glucose ANS: C

In DM, insulin deficiency results in an inability to utilize glucose as fuel, impaired protein metabolism, and increased fat mobilization with increased levels of FFAs in the blood. When the FFAs are metabolized in the liver, ketone bodies are formed.

21. Microvascular disease manifested as slowed digestion of food in the stomach in a person with

diabetes mellitus involves which of the following structures? a. Kidney b. Nerve c. Eye d. Skin ANS: B

About 60% to 70% of patients with DM have diabetic neuropathy due to structural damage to nerve fibers induced by metabolic and vascular factors; it is manifested as an impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, erectile dysfunction, autonomic dysfunction, or other nerve problems.

22. Microangiopathies refer to the thickening or damage to which of the following components of

the vascular system? a. Artery b. Vein c. Arterioles d. Capillary beds ANS: D

CVD develops as a result of atherosclerosis (macroangiopathies) that commonly manifests as CAD, stroke, and peripheral arterial disease (PAD). Abnormalities of the small blood vessels are termed microangiopathies, which are caused by thickening or damage to the capillary basement membrane.

23. Which of the following pathological conditions associated with diabetes manifests as a

reduced awareness of the signs and symptoms of hypoglycemia? a. Hypertension b. Congestive heart failure c. Autonomic neuropathy d. Coronary artery disease ANS: C

Autonomic neuropathy results from damage to vagal and sympathetic neurons as well as their supporting glia. Diabetic autonomic neuropathy results in a reduced awareness of the signs and symptoms of hypoglycemia.

24. If there is an excess of circulating insulin in a person with type I DM at the onset of physical

activity, which of the following impairments may subsequently occur? a. Impaired production of hepatic glucose and mobilization of free fatty acids. b. Impaired peripheral glucose uptake by skeletal muscle. c. Hyperglycemia will develop post exercise. d. Catecholamine levels rise promoting ketone body production.

ANS: A

In persons with type 1 DM, if the plasma insulin concentration is elevated the excess of insulin in relation to need at the onset of physical activity will prevent the large increase in peripheral glucose uptake induced by exercise to be matched by an increased hepatic glucose production and impede the mobilization of FFAs for gluconeogenesis, leading to exercise-induced hypoglycemia.

25. A patient with type II diabetes mellitus has arrived in your clinic today for aerobic training on

a treadmill. Prior to any exercise, blood sugar was 250 mg/dL, no ketones were detected, and insulin dose was taken. How should the physical therapist proceed? a. Recommend that the patient not to exercise and reschedule the appointment. b. If the patient feels good, proceed with low-intensity exercise for 10 minutes and recheck the blood sugar. c. Proceed with the patient’s normal routine of exercise and recheck the blood sugar post exercise. d. Have the patient sit and rest in the clinic and recheck the blood sugar 30 minutes later.

ANS: B

If BG values are 250 to 300 mg/dL and the patient is using insulin, she or he should check for ketosis. If no ketones are detected and the blood glucose (BG) is stable or falling, or if the patient is taking oral medications, and she or he feels good and is well hydrated, the individual can proceed with low- to moderate-intensity exercise for 10 to 15 minutes and then should recheck the BG level. If BG has risen, terminate the exercise. If BG has dropped, then continue the exercise and monitoring of BG regularly.

26. In patients with end-stage renal disease, which of the following exercise recommendations has

been demonstrated to be the MOST beneficial? a. Low to moderate aerobic exercise sessions the day after dialysis b. Low-resistance exercise session the day after dialysis c. Low-resistance training during the first 1 to 2 hours of dialysis d. Patients with end-stage renal disease (ESRD) on dialysis should not exercise ANS: C

For patients with ESRD, compliance is highest when exercise sessions are performed during dialysis, which is well tolerated when performed within the first 1 to 2 hours of a dialysis session. The intensity is typically low.

27. Which of the following exercise prescription parameters should be considered that would be

unique to a patient with ESRD receiving dialysis three times per week? a. Mode b. Intensity c. Timing d. Duration ANS: C

Exercise prescription incorporates four parameters: mode, intensity, duration, and frequency.

In dialysis patients, a fifth exercise parameter should also be considered: the timing of exercise relative to the patient’s dialysis treatment.

28. Slow progressing fibrosis and vascular obliteration of the skin, subcutaneous tissues, and

often the visceral organs BEST describe which of the following connective tissue diseases?

a. b. c. d.

Rheumatoid arthritis Systemic lupus erythematosus Scleroderma Ankylosing spondylitis

ANS: C

Systemic sclerosis or scleroderma produces slowly progressive fibrosis and vascular obliteration of the skin, subcutaneous tissues, and often the visceral organs. It is known most for its pulmonary complications.

29. Cardiovascular disease is the MOST common cause of death in patients with which of the

following types of connective tissue diseases? a. Rheumatoid arthritis b. Systemic lupus erythematosus c. Scleroderma d. Ankylosing spondylitis ANS: B

Cardiovascular disease is the most common cause of death in patients with systemic lupus erythematosus. Pericarditis can be found in 62% of patients; more than 50% of patients have valvular disease.

30. Major pulmonary complications occur in patients who have had a stroke primarily due to

which of the following residual effects? a. Poor trunk posture associated with the hemiparesis b. Muscular hypo- or hypertonicity associated with a stroke c. Facial and pharyngeal muscle weakness d. Physical inactivity ANS: C

The major pulmonary complications associated with a stroke occur when the facial and pharyngeal muscles are affected, causing impairments in secretion management, proper swallowing, airway protection, and cough effectiveness.

31. The presence of an irreversible hypoventilation due to weakness of the intercostal muscles and

diaphragm MOST likely occurs in which of the following neurological disorders? a. Parkinson’s disease b. Amyotrophic lateral sclerosis c. Multiple sclerosis d. Myasthenia gravis ANS: B

Patients with amyotrophic lateral sclerosis develop irreversible hypoventilation resulting from weakness of the intercostal muscles and diaphragm, but the insidious onset of gradually developing dyspnea may delay the diagnosis. Nocturnal hypoventilation can occur despite only mild respiratory muscle dysfunction and normal gas exchange.

32. The MOST common cardiovascular problem in patients with human immunodeficiency virus

(HIV) is which of the following? a. Pericardial effusion b. Biventricular hypertrophy

c. Hypertension d. Cardiac arrhythmias ANS: A

CV complications also occur in many patients with HIV and are fatal in some patients. The most common CV problem seen in HIV, particularly in children with AIDS, is pericardial effusion, which may be induced by opportunistic infection or malignancy, but more often no definitive cause can be identified.

33. Which of the following cardiac complications is the leading cause of death in persons with an

eating disorder such as anorexia nervosa and bulimia? a. Cardiac arrhythmias b. Hypotension c. Decreased cardiac mass d. Mitral valve prolapse ANS: A

Cardiac complications occur in 80% of patients with an eating disorder and include bradycardia and other cardiac arrhythmias, hypotension, decreased cardiac mass, and mitral valve prolapse. Arrhythmias are the leading causes of death.

34. A 75-year-old patient who is 1 week status post-multilevel laminectomy lumbar surgery is

scheduled for an inpatient rehabilitation physical therapy session at 12 noon for 30 minutes.

The patient has a history of type II diabetes mellitus. Her blood glucose 10 minutes before the physical therapy session was 75 mg/dL and the patient feels tired and weak. What should the physical therapist do next? a. Explain to the patient that feeling tired and weak is normal after surgery and encourage the patient to attend the therapy session as scheduled at 12 noon. b. Explain to the patient that fatigue could be related to low blood sugar and encourage the patient to eat lunch instead of attending the therapy session. c. The patient’s blood sugar is low. Encourage the patient to eat lunch, communicate with the nurse about insulin dose, and reschedule the therapy session later in the afternoon. d. The patient’s blood sugar is low. Provide the patient with some graham crackers to consume during transport to the therapy session to remain on time.

ANS: C

This scenario is common when a number of patients on an inpatient rehabilitation unit are being scheduled for therapy sessions. A diabetic patient probably should not be scheduled for therapy close to lunch if blood sugars are not well controlled. BG is low and thus this patient needs to eat specifically some carbohydrates prior to attending the therapy session. Her insulin dose should be adjusted and BG monitored more frequently in afternoon. The therapy session should be rescheduled for later after the patient consumes carbohydrates. Low BG is not considered a medical emergency justifying cancelation of therapy that day.

35. Which of the following signs and symptoms MOST likely is manifested in a patient whose

blood glucose is recorded as moderately elevated? a. Irritability and abrupt mood changes b. Nausea and vomiting c. Tachycardia d. Increased thirst and hunger

Test Bank for Essentials of Cardiopulmonary Physical Therapy, 4th Edition, by Ellen Hillegas

ANS: D

Signs and symptoms associated with hypoglycemia (moderately reduced) include irritability and abrupt mood changes, weakness, dizziness, numbness or tingling of lips and tongue, and nausea and vomiting. Hyperglycemia (moderate) is associated with frequent urination, dry mouth, increased thirst and hunger, and flu-like achiness.

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