Free ACSM Certified Clinical Exercise Specialist Practice Test

1. You are asked to perform risk stratification on a 50 year old female with no known history of heart disease and no family history. She does not smoke. Her BMI is 27 kg/m2 and waist circumference is 34 inches. Her last blood pressure reading was 145/92 mm Hg. Fasting blood glucose on last physical was 115 mg/dL. Cholesterol information is unknown. What category for risk stratification does she fall into?

a. You are not able to fully assess risk without additional information.
b. Low risk
c. Moderate risk
d. High risk

2. All of the following are true statements about exercise stress tests EXCEPT:

a. There is an 80 percent sensitivity level for determining the presence of coronary artery disease (CAD) using an exercise stress test.
b. Error on the technician's part can lead to a negative reading.
c. Sensitivity of the stress test is compromised if the patient does not reach maximal exertion.
d. Hypokalemia can cause abnormal ST changes that can cause a false positive stress test in the absence of coronary artery disease (CAD).

3. Which of the following best describes how an ECG would look in a patient with sinus bradycardia?

a. Abnormal sinus rhythm and heart rate of more than 80 beats per minute
b. Abnormal sinus rhythm and heart rate of less than 60 beats per minute
c. Normal sinus rhythm and heart rate of more than 80 beats per minute
d. Normal sinus rhythm and heart rate of less than 60 beats per minute

4. An ECG reveals that a patient has first degree heart block. What would be the most appropriate plan for initiating an exercise program?

a. An exercise program would need to be deferred until a pacemaker is placed.
b. An exercise program can commence as planned because typically no treatment is needed for this disorder.
c. An exercise program can commence with supervision from a cardiologist.
d. An exercise program can commence with ECG monitoring.

5. What is the definition of ejection fraction?

a. The percentage of blood that enters the ventricle during diastole that is pumped out of the ventricle during systole
b. The percentage of blood in the ventricle during systole that is pumped out of the ventricle during diastole
c. The volume of blood that is left in the ventricles after each contraction
d. The volume of blood that is left in both ventricles after diastole

Answers & Explanations

1. C. The woman described has at least two known risk factors putting her at moderate risk. If it is unclear whether someone has additional risk factors, the clinician should make a judgment to assume the missing or unclear risk factors are present. This is to err on the conservative side. In this woman's case, it will be assumed that her cholesterol readings would be considered a risk factor. Low risk individuals do not show any symptoms of heart disease and have one or fewer risk factors. Moderate risk individuals also do not show symptoms but have two or more risk factors. High risk individuals are experiencing symptoms and/or have a history of heart disease or pulmonary disease. Risk factors considered for stratification would include past history of cardiac disease, family history, diabetes, pregnancy, high cholesterol, hypertension, lack of physical activity, smoking, or age (older than 45 for males and 55 for females).

2. A. The interpretation of an exercise stress test requires proper training and experience. An error on the technician's part can alter the results. Sensitivity and specificity are terms used to predict the presence or absence of coronary artery disease (CAD). Sensitivity refers to the number of tests where CAD is detected. The percentage stands at approximately 70 percent of correct detections. There are factors such as not reaching maximal exertion, using an incorrect number of leads on the ECG machine, or inability to detect other symptoms that may not surface on an ECG that can decrease the sensitivity. Specificity refers to how often it is determined that CAD is not present. This percentage is about 84 percent, meaning that of those who tested, that percentage did not have symptoms of CAD. Factors that can cause the test to be falsely positive include hypokalemia, mitral valve prolapsed, use of digitalis, or any defect in the conduction system.

3. D. Sinus bradycardia is a type of sinus arrhythmia. This essentially means heart rhythm is considered normal but the heart rate is slow at less than sixty beats per minute. Sometimes a slow heart rate is indicative of a person who is extremely physically fit. It can also mean that the sinus node is not functioning properly to keep the appropriate rhythm. On an ECG, one would see a normal sinus rhythm but the heart rate would record as low. There are different causes for sinus bradycardia including hypothermia, hypothyroidism, or a myocardial infarction. Often times, there are no obvious symptoms unless the heart rate falls below 40 beats per minute. The symptoms in this case may include fatigue, weakness, and even fainting.

4. B. A first degree heart block is not a life threatening condition and does not typically require medical treatment. This occurs when the electrical impulses slowly travel through the AV node. The normal length of time for this to occur is 0.2 seconds or less. This is called the PR interval. The heart continues with its normal rhythm. A second degree heart block occurs when the travel time of the electrical impulses are even longer and the heart skips a beat. Third degree heart block is also known as complete heart block. This occurs because electrical impulses are not able to move from the upper to the lower chambers. The ventricles can still pump blood, however, it takes longer. Complete heart block is a more serious condition and a pacemaker will need to be implanted as soon as possible.

5. A. Ejection fraction (EF) refers to the percentage of blood that enters the ventricle during diastole that is pumped out of the ventricle during systole. The diastolic phase is phase where the heart is ay rest and systole is the phase where the heart is contracting. A normal EF falls somewhere in the range of 50-75 percent but averages around 60 percent. The left ventricle is the side that is the main pumping chamber and because of this, EF is measured only on the left side. A low EF can be caused by damage resulting from a myocardial infarction, issues with the valves, or uncontrolled hypertension. If the EF is less than 40 percent, systolic heart failure is present. This means less blood is being pumped by the heart and this causes the pressure within the heart to increase and the chambers of the heart enlarge to try to allow more blood to enter. Fluid begins to accumulate in the lungs making breathing difficult.


Last Updated: 03/01/2017

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