NBCOT Cardiopulmonary Questions
An OTR® is providing occupational therapy services to a client in acute care who
was diagnosed with a pulmonary embolism. What is the most typical cause of a
pulmonary embolism?
A. Deep vein thrombosis
B. Pulmonary hypertension
C. Pulmonary edema
D. Lung cancer
The right answer is A
Most pulmonary embolisms are caused by a deep vein thrombosis in a lower
extremity.
Smith-Gabai, H. (2011). The pulmonary system. In H. Smith-Gabai (Ed,),
Occupational therapy in acute care (pp. 147-182). Bethesda, MD: AOTA Press; p.
165.
Explanations of Incorrect Answers
B, C, D: Clients with pulmonary hypertension, pulmonary edema, and lung cancer
are not at high risk for pulmonary embolism.
When evaluating a client in a skilled nursing facility, the OTR® notes that the client's
skin has a yellowish cast, the fingernail beds are bluish in color, and the client has
noticeable edema in both lower extremities. What condition would MOST likely
cause these symptoms?
A. Right-sided congestive heart failure
B. Left-sided congestive heart failure
C. Aortic stenosis
D. Aortic insufficiency
The right answer is A
When the right side of the heart fails, blood flows back into the venous system.
Symptoms of right-sided heart failure include cyanotic nail beds, jaundice, and
lower-extremity edema.
Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational
therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 99.
Explanations of Incorrect Answers
B: When the left side of the heart fails, blood flows back into the lungs, causing
difficulty breathing, anxiety, and cerebral hypoxia.
,C, D: Aortic stenosis and aortic insufficiency have symptoms similar to those of
left-sided heart failure.
An OTR® is working with a client with chronic obstructive pulmonary disease
(COPD) on a morning ADL routine. Which treatment strategy BEST describes how
this client can be independent in showering?
A. Use a shower chair, bathe with hot water from a handheld shower, use relaxation
breathing, and inhale on exertion
B. Use a shower chair, bathe with warm water from a handheld shower, use pursed
lip breathing, and exhale on exertion
C. Sit in the tub for support, bathe with hot water from the tub spout, pace by
washing one extremity at a time and then resting, and lean backward in the tub
D. Sit in the tub for support, bathe with cool water from the tub spout, use a fan to
decrease humidity, and rest arms on the sides of the tub
The right answer is B
Using a shower chair, bathing with warm water from a handheld shower, using
pursed lip breathing, and exhaling on exertion all contribute to independent
showering for a client with COPD.
Huntley, N. (2008). Cardiac and pulmonary diseases. In M. V. Radomski & M. C.
Trombly Latham (Eds.), Occupational therapy for physical dysfunction (6th ed., pp.
1295-1320). Baltimore: Lippincott Williams & Wilkins.
Explanations of Incorrect Answers
A: Hot water adds to humidity and makes breathing more difficult. The client should
use pursed lip rather than relaxation breathing techniques and should exhale rather
than inhale on exertion.
C: Using a shower chair takes less energy than getting into and out of a tub. Hot
water adds to humidity and makes breathing more difficult. Leaning forward in the
tub releases the diaphragm and makes breathing easier.
D: Using a shower chair takes less energy than getting into and out of a tub. Cool
water may chill the client and require more energy for tasks. Resting the arms on the
thighs, not on the sides of tub, releases the diaphragm and makes breathing easier.
An OTR® is working with a client who suddenly complains of pressure and tightness
in the chest. The client's symptoms resolve with rest and a nitroglycerin tablet
administered under the tongue. What condition is the client MOST likely to have
experienced during the treatment session?
A. Stable angina
B. Unstable angina
, C. Myocardial infarction
D. Atrial flutter
The right answer is A
Stable angina usually resolves with rest, nitroglycerin, or both.
Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational
therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 83.
Explanations of Incorrect Answers
B: Unstable angina does not resolve with rest or nitroglycerin. It requires emergency
treatment.
C: Myocardial infarction also requires emergency treatment.
D: Atrial flutter is usually treated with other medications, ablation, or cardioversion.
An OTR® is working with an acute-care client who has a ventricular assist device.
Which precaution is essential when engaging this client in occupational activities?
A. Do not administer an exercise stress test to this client.
B. Instruct the client in sterile dressing changes to prevent infection.
C. Educate the client to avoid yearly influenza and pneumonia vaccines.
D. Avoid disconnecting the drive line to the power source during movement.
The right answer is D
A ventricular assist device requires a power source to function properly. The drive
line connects to the power source. If the OTR is not careful, the drive line can
become disconnected during activity.
Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational
therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 104.
Explanations of Incorrect Answers
A: OTRs do not generally administer exercise stress tests.
B: Clients with burns or open wounds (not clients with a ventricular assist device) are
usually instructed in sterile dressing changes by a nurse.
C: Clients with a ventricular assist device are educated by nursing professionals, not
OTRs, to receive yearly vaccines to prevent influenza and pneumonia.
An OTR® is working with a client who is experiencing dyspnea while performing a
daily occupation in sitting. What sitting position would BEST minimize the client's
dyspnea while performing the occupational task?
An OTR® is providing occupational therapy services to a client in acute care who
was diagnosed with a pulmonary embolism. What is the most typical cause of a
pulmonary embolism?
A. Deep vein thrombosis
B. Pulmonary hypertension
C. Pulmonary edema
D. Lung cancer
The right answer is A
Most pulmonary embolisms are caused by a deep vein thrombosis in a lower
extremity.
Smith-Gabai, H. (2011). The pulmonary system. In H. Smith-Gabai (Ed,),
Occupational therapy in acute care (pp. 147-182). Bethesda, MD: AOTA Press; p.
165.
Explanations of Incorrect Answers
B, C, D: Clients with pulmonary hypertension, pulmonary edema, and lung cancer
are not at high risk for pulmonary embolism.
When evaluating a client in a skilled nursing facility, the OTR® notes that the client's
skin has a yellowish cast, the fingernail beds are bluish in color, and the client has
noticeable edema in both lower extremities. What condition would MOST likely
cause these symptoms?
A. Right-sided congestive heart failure
B. Left-sided congestive heart failure
C. Aortic stenosis
D. Aortic insufficiency
The right answer is A
When the right side of the heart fails, blood flows back into the venous system.
Symptoms of right-sided heart failure include cyanotic nail beds, jaundice, and
lower-extremity edema.
Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational
therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 99.
Explanations of Incorrect Answers
B: When the left side of the heart fails, blood flows back into the lungs, causing
difficulty breathing, anxiety, and cerebral hypoxia.
,C, D: Aortic stenosis and aortic insufficiency have symptoms similar to those of
left-sided heart failure.
An OTR® is working with a client with chronic obstructive pulmonary disease
(COPD) on a morning ADL routine. Which treatment strategy BEST describes how
this client can be independent in showering?
A. Use a shower chair, bathe with hot water from a handheld shower, use relaxation
breathing, and inhale on exertion
B. Use a shower chair, bathe with warm water from a handheld shower, use pursed
lip breathing, and exhale on exertion
C. Sit in the tub for support, bathe with hot water from the tub spout, pace by
washing one extremity at a time and then resting, and lean backward in the tub
D. Sit in the tub for support, bathe with cool water from the tub spout, use a fan to
decrease humidity, and rest arms on the sides of the tub
The right answer is B
Using a shower chair, bathing with warm water from a handheld shower, using
pursed lip breathing, and exhaling on exertion all contribute to independent
showering for a client with COPD.
Huntley, N. (2008). Cardiac and pulmonary diseases. In M. V. Radomski & M. C.
Trombly Latham (Eds.), Occupational therapy for physical dysfunction (6th ed., pp.
1295-1320). Baltimore: Lippincott Williams & Wilkins.
Explanations of Incorrect Answers
A: Hot water adds to humidity and makes breathing more difficult. The client should
use pursed lip rather than relaxation breathing techniques and should exhale rather
than inhale on exertion.
C: Using a shower chair takes less energy than getting into and out of a tub. Hot
water adds to humidity and makes breathing more difficult. Leaning forward in the
tub releases the diaphragm and makes breathing easier.
D: Using a shower chair takes less energy than getting into and out of a tub. Cool
water may chill the client and require more energy for tasks. Resting the arms on the
thighs, not on the sides of tub, releases the diaphragm and makes breathing easier.
An OTR® is working with a client who suddenly complains of pressure and tightness
in the chest. The client's symptoms resolve with rest and a nitroglycerin tablet
administered under the tongue. What condition is the client MOST likely to have
experienced during the treatment session?
A. Stable angina
B. Unstable angina
, C. Myocardial infarction
D. Atrial flutter
The right answer is A
Stable angina usually resolves with rest, nitroglycerin, or both.
Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational
therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 83.
Explanations of Incorrect Answers
B: Unstable angina does not resolve with rest or nitroglycerin. It requires emergency
treatment.
C: Myocardial infarction also requires emergency treatment.
D: Atrial flutter is usually treated with other medications, ablation, or cardioversion.
An OTR® is working with an acute-care client who has a ventricular assist device.
Which precaution is essential when engaging this client in occupational activities?
A. Do not administer an exercise stress test to this client.
B. Instruct the client in sterile dressing changes to prevent infection.
C. Educate the client to avoid yearly influenza and pneumonia vaccines.
D. Avoid disconnecting the drive line to the power source during movement.
The right answer is D
A ventricular assist device requires a power source to function properly. The drive
line connects to the power source. If the OTR is not careful, the drive line can
become disconnected during activity.
Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational
therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 104.
Explanations of Incorrect Answers
A: OTRs do not generally administer exercise stress tests.
B: Clients with burns or open wounds (not clients with a ventricular assist device) are
usually instructed in sterile dressing changes by a nurse.
C: Clients with a ventricular assist device are educated by nursing professionals, not
OTRs, to receive yearly vaccines to prevent influenza and pneumonia.
An OTR® is working with a client who is experiencing dyspnea while performing a
daily occupation in sitting. What sitting position would BEST minimize the client's
dyspnea while performing the occupational task?
