NPTE Cardiopulmonary Practice Questions

10 Free NPTE Cardiopulmonary Practice Questions (2026)

10 NPTE-PT-style cardiovascular and pulmonary practice questions covering 22 to 27 scored items per the official FSBPT blueprint. Heart failure and cardiac rehabilitation (Phase I, Phase II, and Phase III), COPD and pulmonary rehab, post-cardiac surgery, peripheral vascular disease, and LVAD management. NPTE prep written and reviewed by a licensed Doctor of Physical Therapy.

Why cardiopulmonary matters

Cardiovascular and pulmonary systems account for 22 to 27 scored items on the NPTE-PT — roughly 11 to 14 percent of the exam. While not the largest content area, cardiopulmonary questions are heavily weighted toward clinical decision-making in high-acuity scenarios: post-cardiac surgery precautions, exercise prescription with comorbidities, and differential diagnosis between cardiac and pulmonary origins of dyspnea. Wrong answers here often involve missing safety considerations, which is exactly what the NPTE is designed to test.

0 of 10 answered
Heart Failure — Assessment
Question 1 of 10
A 68-year-old male with a history of congestive heart failure (NYHA Class III, ejection fraction 30%) is referred to physical therapy for cardiac rehabilitation phase III. Resting heart rate is 84 bpm and resting blood pressure is 118/74 mm Hg. He reports fatigue and dyspnea with moderate exertion. A recent ECG showed normal sinus rhythm without ST segment changes. During the initial evaluation, which of the following is MOST important to assess to guide exercise prescription and determine prognosis?
COPD — Differential Diagnosis
Question 2 of 10
A 62-year-old male with a history of smoking and chronic obstructive pulmonary disease (COPD) presents to an outpatient physical therapy clinic with complaints of increased shortness of breath, persistent cough with purulent sputum, and lower extremity edema. He reports these symptoms have progressively worsened over the past week. Vital signs include heart rate 102 bpm, blood pressure 142/88 mm Hg, and oxygen saturation 88% on room air. Auscultation reveals coarse crackles in both lung bases. Which of the following is the MOST likely primary diagnosis?
Post-Cardiac Surgery
Question 3 of 10
A 70-year-old female is 3 days post-op following a CABG. The physical therapist is initiating Phase I cardiac rehab. Resting heart rate is 92 bpm, blood pressure is 124/78 mm Hg, and morning lab values show hemoglobin 9.8 g/dL, hematocrit 29%, and platelets 145,000. The patient has a history of COPD and presents with mild sternal pain (3/10 on NPRS) with coughing. Which of the following interventions is MOST appropriate to initiate during this exercise session?
Peripheral Vascular Disease
Question 4 of 10
A 66-year-old patient with a history of smoking, coronary artery disease, and diabetes presents to physical therapy with complaints of leg pain that occurs after walking two blocks. The pain is relieved by 5 minutes of rest. Resting heart rate is 76 bpm and blood pressure is 138/82 mm Hg. Recent arterial blood gas analysis was within normal limits. During the initial examination, which of the following tests is MOST important to perform to confirm a diagnosis of peripheral arterial disease?
COPD — Pathophysiology
Question 5 of 10
A 65-year-old male with a 40-year history of smoking presents to physical therapy with complaints of increasing dyspnea on exertion. He reports a chronic cough with sputum production. Recent pulmonary function testing showed reduced lung volume with FEV1/FVC ratio of 0.55. Resting heart rate is 88 bpm, blood pressure is 132/80 mm Hg, and SpO2 is 92% — decreasing to 88% with minimal exertion. Auscultation reveals scattered wheezes bilaterally. Which of the following is the MOST likely primary cause of his dyspnea?
LVAD — Exercise Prescription
Question 6 of 10
A 71-year-old male with heart failure (HFrEF, ejection fraction 22%) and a left ventricular assist device (LVAD) supporting his left ventricle is participating in an outpatient cardiac rehabilitation program. He reports a Borg Rating of Perceived Exertion (RPE) of 10/20 (“light”) during a 6-minute walk test at a self-selected pace. Resting heart rate is 78 bpm. Auscultation reveals a normal LVAD hum, and Doppler ultrasound indicates a mean arterial pressure (MAP) of 75 mm Hg. Which of the following is the MOST appropriate intervention to improve his aerobic capacity?
Heart Failure — Assessment
Question 7 of 10
A 61-year-old male is referred to physical therapy following a recent diagnosis of heart failure with preserved ejection fraction (HFpEF, ejection fraction 55%). Resting heart rate is 82 bpm and blood pressure is 144/86 mm Hg. He reports shortness of breath with mild exertion and ankle swelling at the end of the day. During the initial examination, which of the following is MOST appropriate to assess the severity of his dyspnea?
Post-Cardiac Surgery — Complications
Question 8 of 10
A 68-year-old male presents to outpatient physical therapy three weeks following a coronary artery bypass graft (CABG) surgery. He reports persistent sternal pain with coughing and lifting objects heavier than 5 pounds. During the examination, the physical therapist observes slight gapping at the inferior aspect of the sternal incision. Palpation reveals a subtle clicking sensation upon deep inspiration. Which of the following is the MOST appropriate course of action?
PVD — Intervention
Question 9 of 10
A 69-year-old male with a history of smoking, stable angina, and diabetes presents to physical therapy with intermittent claudication in his left calf, classified as Rutherford Category 2. Resting heart rate is 74 bpm, blood pressure is 136/84 mm Hg (SBP within his baseline range), and ABI is 0.65 in the left leg. After a thorough examination, the physical therapist initiates a supervised exercise therapy (SET) program. Which of the following is the MOST appropriate initial intervention to improve his walking distance?
COPD — Examination Findings
Question 10 of 10
A 63-year-old male with a 30-year history of smoking and diagnosed with moderate COPD is referred to physical therapy for pulmonary rehabilitation. Resting heart rate is 86 bpm, blood pressure is 130/82 mm Hg, and SpO2 is 93% on room air. During the initial examination, the patient reports significant dyspnea on exertion (DOE). Which of the following examination findings, including heart sound abnormalities and auscultation patterns, would be MOST indicative of a pulmonary, rather than cardiac, origin of the patient’s DOE?
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Cardiopulmonary is 11–14% of the NPTE — clinical reasoning errors here often involve missing safety considerations
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About This Content Area

NPTE Cardiopulmonary Content Breakdown

Cardiovascular and pulmonary systems represent 22 to 27 scored items on the NPTE-PT per the official FSBPT blueprint. While the count is smaller than musculoskeletal, cardiopulmonary questions carry disproportionate weight in clinical safety scenarios — the NPTE exam format guide breaks down how all 13 content areas are weighted — patients post-CABG, with LVADs, in acute COPD exacerbation, or with peripheral arterial disease all require precise judgment about exercise prescription, contraindications, and when to escalate care. The NPTE consistently tests whether you can recognize warning signs and respond appropriately, not just whether you know the textbook condition. Try our free 20-question timed NPTE practice test to see how your reasoning holds up across all content areas under exam conditions.

What the cardiopulmonary section covers
→Heart failure (HFrEF, HFpEF) and cardiac rehabilitation phases
→COPD, asthma, and pulmonary rehabilitation
→Post-cardiac surgery (CABG, valve repair) and sternal precautions
→Peripheral arterial and venous disease
→LVAD management and exercise prescription
→Auscultation, ABI, 6MWT, and Borg scale interpretation
→Airway clearance techniques and oxygen therapy
→Differential diagnosis: cardiac vs pulmonary origin of dyspnea

The most commonly missed cardiopulmonary questions involve scenarios where multiple comorbidities collide — a COPD patient post-CABG, an LVAD patient in outpatient rehab, a diabetic with claudication. Standard textbook protocols often need modification when conditions overlap. Knowing the AACVPR guidelines for each population individually is not enough. The NPTE tests whether you can integrate them.

The pattern to recognize

Cardiopulmonary NPTE questions frequently include one answer choice that is correct for a healthier patient but wrong because of a comorbidity or recent surgery. Resisted shoulder exercises are appropriate generally — not 3 days post-CABG. Aggressive interval training builds capacity — not for an LVAD patient at baseline. Read every scenario for what makes this patient different from the textbook case.

For more practice, work through our 10 NPTE musculoskeletal questions (the largest content area on the exam), the 10 NPTE neuromuscular questions (the second largest), or read the full NPTE study guide for a complete content-area breakdown.

Essential Knowledge

Cardiopulmonary Fundamentals Every NPTE Candidate Must Know

The NPTE assumes you can integrate cardiac and pulmonary physiology with clinical scenarios. Below are the fundamentals most commonly tested — useful both for these practice questions and for broader NPTE prep with flashcards or a question bank.

ECG Interpretation Basics

The NPTE expects physical therapists to recognize basic ECG findings before exercise. The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. The ST segment connects the QRS complex to the T wave — ST segment elevation or depression can indicate cardiac ischemia or infarction. Atrial fibrillation appears as an irregularly irregular rhythm with no discernible P waves. Ventricular tachycardia is a wide-complex rhythm at high heart rate — when sustained, it is a contraindication to exercise and warrants immediate physician contact.

Resting heart rate above 100 bpm (tachycardia), below 50 bpm (bradycardia), or sudden changes during an exercise session all warrant pause and reassessment. Many NPTE questions hinge on whether you recognize when to stop, not just when to continue.

Cardiac Anatomy & Physiology Quick Reference

The heart has four chambers — right atrium, right ventricle, left atrium, left ventricle — separated by valves. Blood flows from systemic venous return into the right atrium, through the tricuspid valve into the right ventricle, out through the pulmonary valve to the lungs, back to the left atrium, through the mitral valve into the left ventricle, and out through the aortic valve to systemic circulation.

Stroke volume (the volume ejected per beat) times heart rate equals cardiac output. Ejection fraction — the percentage of left ventricle blood ejected per beat — is the single most important number in heart failure classification. Normal ejection fraction is 50% or greater; HFrEF (reduced) is below 40%; HFpEF (preserved) is at or above 50% but with clinical heart failure.

Systolic blood pressure (SBP) reflects the pressure during left ventricle contraction (systole); diastolic reflects the pressure during relaxation. During exercise, SBP should rise progressively. A failure of SBP to rise, or a drop of more than 10 mm Hg, is an indication to stop exercise per AACVPR guidelines.

Lab Values That Affect Exercise Safety

Before mobilizing inpatients — especially post-cardiac surgery patients — physical therapists should review the morning lab values. Key thresholds: hemoglobin below 8.0 g/dL warrants discussion with the medical team before significant exercise; hematocrit below 25% similarly warrants caution. Platelets below 20,000 are generally a contraindication to anything beyond passive range of motion; platelets between 20,000 and 50,000 require gentle activity only. Arterial blood gas analysis can reveal acid-base disturbances that contraindicate exercise.

Resting SBP above 180 mm Hg or below 90 mm Hg is generally a contraindication to exercise initiation. Heart rate above 120 bpm at rest, or new-onset atrial fibrillation with rapid ventricular response, also warrants holding the exercise session.

Cardiac Rehab Phases I, II, and III

Phase I cardiac rehab is the inpatient phase — typically 1-5 days post-surgery or post-MI. Goals: early mobilization, prevention of deconditioning, basic patient education. Activity is low-intensity (RPE 11 or below, heart rate not to exceed resting +20 bpm).

Phase II is the outpatient supervised phase — typically 4-12 weeks. Patients exercise under monitored conditions with ECG telemetry. Exercise intensity progresses based on heart rate response, RPE, and patient symptoms. Phase II is where most coronary artery disease and CABG patients see the greatest functional gains.

Phase III is the long-term maintenance phase — community-based, less intensively monitored. The goal is lifelong exercise habits to prevent secondary cardiac events. Phase III programs often run in community settings and may include physical therapist assistant (PTA) supervision under a PT’s plan of care.

Recognizing Ischemia, Angina, and Infarction

Stable angina is predictable chest pain or pressure that occurs with exertion and resolves with rest or nitroglycerin. It reflects reversible cardiac ischemia. Unstable angina is angina at rest, new-onset angina, or angina that has changed in pattern — and is a medical emergency. Both reflect underlying coronary artery disease.

Myocardial infarction (heart attack) occurs when ischemia progresses to actual tissue death. Classic symptoms include chest pressure, pain radiating to the left arm or jaw, shortness of breath, and diaphoresis — though presentation in women, older adults, and patients with diabetes is often atypical. Any new chest pain during an exercise session warrants immediate stop and medical evaluation.

Pulmonary edema — fluid accumulation in the lungs from left ventricle failure — presents with sudden dyspnea, frothy sputum, and bibasilar crackles. It is a medical emergency requiring immediate physician contact and termination of any exercise session in progress.

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