National Physical Therapy Examination (NPTE) Practice Exam

In a patient with a newly fitted pacemaker, what monitoring protocol is the most appropriate during therapy?

1. Continue working with the patient to 80% heart rate maximum.

2. Take pulse and respiratory rate regularly throughout the session.

3. Do not exercise this patient as it is a contraindication.

4. Use the rate of perceived exertion (RPE) scale to monitor exertion.

The correct answer is: Use the rate of perceived exertion (RPE) scale to monitor exertion.

Utilizing the rate of perceived exertion (RPE) scale to monitor exertion is particularly appropriate for a patient with a newly fitted pacemaker due to the need for individualized assessment of their exercise tolerance. The RPE scale allows for subjective feedback from the patient regarding how hard they feel they are working during exercise, which can be beneficial in gauging their capacity without relying solely on heart rate metrics. This is especially important as the pacemaker may not allow for a typical heart rate response to exercise, making traditional heart rate monitoring less reliable. Using RPE can help ensure that the patient is not overexerting themselves while still allowing for an effective rehabilitation process. It's essential to provide a safe environment for the patient, ensuring they are working within their personal limits based on their own perception of effort and fatigue. This method acknowledges the potential variability in heart rate responses in pacemaker patients and empowers them to participate actively in their recovery. Other options do not align as well with current guidelines. For instance, aiming for 80% of the maximum heart rate may be inappropriate due to the pacemaker's impact on heart rate response. Regularly checking pulse and respiratory rate could be useful but may not provide the most reliable indicators of the patient’s exercise