FORTINBERRY CH6 Flashcards
1
Q
The BEST example of a statement that would be documented in the assessment portion of a subiective, objective, assessment, and plan
(SOAP) note is
A. Client and spouse participated in a discussion about planning activities of interest for the patient
B. Client complains of difficulty donning night-time splint and requests that the splint be re-examined by the therapist
C. Family was referred to social services for consideration of alternative placement
D. Client demonstrates good understanding of the home program but requires supervision to perform independently
A
D.
Assessment is the PT’s judgment of clients’ progress, limitations, and expected benefit from therapy.
2
Q
Which is the BEST means for documenting a goal statement?
A. Therapist will instruct the patient in overhead dressing techniques.
B. Patient will participate in meal preparation for 15 minutes without breaks.
C. Patient will perform 10 repetitions of active assistive shoulder ladder exercises.
D. Patient will show increased endurance for performing ADLs.
A
B.
Goals should be objective, functional measurable, and action-oriented statements.
3
Q
Which statement would be the MOST appropriate for the PT to document in the plan section of the SOAP note?
A. Client given educational materials to practice correcting posture and trunk balance during daily routine.
B. Client able to respond to verbal instructions and questions with correct responses 3 out of 3 times.
C. Clientindicates that the long-term goal is to return to work on a full-time basis.
D. Client assessed for use of compensatory techniques while cooking in the clinic kitchen.
A
A.
The plan relates to information presented in the “O” and “A” section of the
SOAP note and is a description of the interventions, methods, or approaches used to achieve the goals.
4
Q
Duringa treatment session, a patient with a C5 spinal cord iniur complains of dizziness and a severe headache and is noticed by the PT to be flushed and sweating profusely. The best course of action for the PT to take is to
A. Lie the patient down to rest for about 30 minutes or until symptoms subside
B. Contact the physician and report signs of autonomic dysreflexia
C. Take the blood pressure because of the suspected signs of orthostatic hypotension
D. Assist the patient in taking medication for the symptoms
A
B.
Persons with spinal cord lesions at T6 and above are at risk for autonomic dvsreflexia, which can occur as a result of the individual being overheated, stressed, in pain, or having urinary and bowel complications. Autonomic dysreflexia is considered a medical emergency, and symptoms include hypertension, pounding headache, sweating, flushing, pupil constriction, and nasal congestion.
5
Q
A clientbeing treated in outpatient therapy for extensor tendon repair missed three appointments while sick with the flu. When writing the monthly report, the therapist explained why the client did not achieve her short-term goals in the time frame specified.
Which is the MOST appropriate section of the subjective, objective, assessment, and plan (SOAP) note for this documentation?
A. S
B. O
C. A
D. P
A
C.
In the assessment portion of the SOAP note, the therapist indicates progress in treatment or explains the failure to progress as quickly as anticipated.
6
Q
Aftertalking to nursing, the inpatient rehab PT treated the patient in the room for instruction in safety and adaptive equipment for toileting, along with dressing and grooming activities.
The patient was motivated and worked hard throughout the treatment session. Which is the BEST choice for the subjective portion of the daily SOAP note?
A. Patientwas cooperative and engaged in social conversation throughout the treatment session.
B. Patient reports that the patient feels good today.
C. Patientis unable to move her right upper extremity as well today as vesterdav, although it doesn’t really hurt but feels “tight.”
D. Nursing staff reports that patient is unsafe to toilet independently.
A
C.
The patient’s observations about the right upper extremity are most pertinent to this treatment session because it relates to the entire session. Nursing’s comments are important but do not belong in the S section.
The S section is usually reserved for the patient’s comments.
7
Q
After a stroke, a patient had difficulty picking up pills from the table; difficulty buttoning; and difficulty completing jigsaw puzzles, which was a favorite leisure activity. During part of the treatment session, the patient worked on putting in and removing pieces from a jigsaw puzzle and practiced manipulating different sized coins from a flat table surface. When documenting the treatment, the BEST choice for an obiective statement is
A. Patient worked for 15 minutes placing and removing jigsaw puzzle pieces.
B. Patientworked on tripod grasp using various coins and jigsaw puzzle pieces.
C. Patient worked for 15 minutes on tripod grasp in order to be able to grasp obiects used for leisure activities and ADLS.
D. Patient worked on tripod grasp to be able to perform leisure activities and ADLs.
A
C.
The emphasis is on the performance component and the functional application, not the specific media used in the treatment. Many third-party pavers also want to see the amount of time per Current Procedural Terminology code charged.
8
Q
Which statement would be documented in the
“‘plan” portion of a SOAP note?
A. Problems include decreased coordination, strength, sensation, and proprioception in left upper extremity.
B. Inorder to return to work, patient will demonstrate increase of 10# of grasp in left hand, in 3 weeks.
C. Patient would benefit from further instruction in total hip precautions for lower extremity dressing, bathing, and hygiene.
D. Patient attended job skills group with prompting by nursing and OT staff.
A
B.
Choice A is the problem list, which goes
in the ":A": section; choice C is a justification for further treatment, which goes in the section; choice D is what occurred in treatment, which goes in section
9
Q
The BEST example of a statement that would document the patient’s prognosis is
A. The patient may require prolonged time to perform transfers because of poor motor planning ability.
B. The patient received a home program on energy conservation and work simplification.
C. Compared to the norm, grip strength is within normal limits and age appropriate.
D. The patient performed a stand pivot transfer to and from the wheelchair to bathtub.
A
A.
Prognosis is determined when the PT considers the severity of the patient’s functional limitations and impairments and predicts the possible level of expected improvement or outcome.
10
Q
When discharging a patient with Alzheimer’s to a skilled nursing facility, what is the most important information to share?
A. Summary of cognitive performance
B. Recommendations to a support group
C. Summary of the patient progress
D. Results of the initial examination
A
A.
An update on the patient’s cognitive performance is essential in identifying the performance deficits of someone with a diagnosis of Alzheimer’s.
11
Q
A PT walks into a patient’s room and finds the patient lying on the floor next to the bed. The PT has been previously reprimanded for forgetting to put the bed rails up after treatment. After checking to be sure the patient has no broken bones and is not in severe pain, the therapist helps the patient back into bed, and then leaves the room without reporting the incident. Which terms best describe the PT’s conduct?
A. Legal and ethical
B. Legal but unethical
C. Ethical but illegal
D. Illegal and unethical
A
B.
The behavior was legal because there was no crime and it brought no harm to the patient. Itwas unethical because the therapist was more concerned about the therapist’s needs than the patient’s needs. It also violated the principle of veracity.
12
Q
A PT suspects physical abuse after noticing bruises on the face and back of a child during the treatment session. The appropriate action to take is
A. To ask the child questions about the bruises
B. To confront the parents about the cause for the inflictions
C. To make a report to the appropriate authorities
D. To ignore the bruises because proof of suspicion is difficult
A
C.
Most states mandate that all health care professionals report suspected abuse and neglect of vulnerable individuals.
13
Q
To facilitate effective communication between a physical therapy supervisor and emplovee, the supervisor should
A. Communicate what is expected of the employee
B. Express disappointment regarding the employee’s behavior
C. Offer criticism to stimulate discussion
D. Meet with the emplovee away from the workplace to facilitate a conversation
A
A.
Effective communication by supervisors/managers involves communicating expectations, offering constructive criticism, and expressing interest in an employee’s professional growth.
14
Q
The term that refers to the process of providing information to individuals to assist them in the decision-making process about their own health care is
A. Beneficence
B. Fidelity
C. Autonomy
D. Informed consent
A
D.
Informed consent refers to providing and sharing health care information to individuals so that they can make the best decisions about their treatment or health care.
15
Q
A patient tells the PT how much the services provided have helped in coping with his /her depression. The patient then offers a gift of appreciation to the therapist. The PT’s best response is to say
A. “Ilove the gift, but I need to report it to my administrator in order to follow regulations.”
B. “Thank you, that’s great. What is it?”
C. “Just knowing that you appreciate my help is reward enough. I appreciate the gesture, but I cannot accept the gift.”
D. “Please mail it to my house. I cannot accept the gift on the hospital premises.”
A
C.
It is crucial to take the patient’s feelings into consideration when you have to let them know that it is unethical to accept gifts. By explaining the situation and acknowledging the gesture you are more likely to avoid offending the patient.
16
Q
The single most important measure to prevent the spread of infectious diseases is
A. Handwashing
B. Proper cooking
C. Canning
D. Pasteurization
A
A.
While cooking, canning, and
pasteurization can reduce the chances of food-borne infections, hand washing is acknowledged as the single most important measure to prevent spread of infectious diseases. Hand washing with plain soap aids in the mechanical removal of dirt and microbes present on the hands, including potential pathogens, thus preventing the spread of many infectious diseases.
17
Q
A 30-year-old female patient presents with right calf pain and may have a deep vein thrombosis (DVT). What would be the MOST appropriate initial course of action?
A. Prescribe rest and inactivity until svmptoms subside
B. Treat with RICE protocols until svmptoms subside
C. Treat with massage, muscle stripping, and stretching procedures
D. Referfor medical evaluation
A
D.
Deep vein thrombosis (DVT) is a potentially serious condition that requires special studies to be properly identified and possible anticoagulant therapy for treatment.
Medical referral is indicated as soon as DVT is suspected.
18
Q
The most important step to take upon involvement in an emergency is to
A. Letthe patient know that you have arrived
B. Assess the scene and environment
C. Make sure that vou have plenty of gloves
D. Immediately care for the patient
A
B.
It is imperative for a rescuer to ensure that the scene is safe to enter before providing emergency rescue. This ensures that the rescuer does not become an additional victim.
19
Q
What is the BEST method for controlling bleeding and should be attempted first?
A. Elevation
B. Direct pressure
C. Trauma dressing
D. Tourniquet
A
B.
Direct pressure is the first line of defense for external hemorrhage. If it is unsuccessful, then elevation and pressure applied to pulse pressure points are added sequentially. Tourniquets are used as a last resort.
20
Q
When caring for a fractured, dislocated, or sprained extremity, when is it important to check for pulses, sensation, and motor function?
A. Afterthe splint has been removed at the hospital
B. Before applying a splint
C. Before and after applying a splint
D. During the detailed physical examination of the patient, usually en route to the hospital
A
C.
Pulse, sensation, and motor function are assessed before splinting to assess the integrity of extremity neurovascular function. They are checked again after splinting to ensure that the splint is not applied too tightly.
21
Q
A therapist is treating a 35-year-old man diagnosed, with lumbar disc degeneration, in an outpatient clinic. Through conversation with the patient, the therapist learns that he is also being treated by a chiropractor for cervical dysfunction. What is the best course of action by the therapist?
A. Continue with the current treatment plan and ignore the chiropractor’s treatment.
B. Askthe patient what the chiropractor is doing and try the same approach.
C. Stop physical therapy at once and consult with the referring physician.
D. Contact the chiropractor to coordinate his or her plan of care with the physical therapy plan of care.
A
D.
In the ideal situation, the therapist should coordinate his or her plan of care with the chiropractor in case the problems are related.
22
Q
Which of the following duties cannot be legally performed by a physical therapist assistant?
A. Confer with a doctor about a patient’s status
B. Add 5 pounds to a patient’s current exercise protocol
C. Allow a patient to increase in frequency from 2 times/week to 3 times/week
D. Perform joint mobilization
A
C.
A physical therapist assistant (PTA) can do all of the listed options except change the frequency or duration as prescribed by a therapist or physician. Choice B allows the PTA to work within the protocol established by the physical therapist.
23
Q
The therapist is treating a patient in an outpatient facility for strengthening of bilateral lower extremities. During the initial assessment, the patient reveals that he has a form of cancer but is reluctant to offer an other information about his medical history. After 1 week of treatment, the therapist is informed by the physician that the patient has Kaposi’s sarcoma and AIDS. Which of the following is the best course of action for the therapist?
A. Cease treatment of the patient, and inform him that an outpatient facility is not the appropriate environment for a person with his particular medical condition.
B. Continue treatment of the patient in the gym, avoiding close contact with other patients and taking appropriate universal precautions.
C. Continue treatment of the patient in the gym as before, taking appropriate universal precautions.
D. Cease treatment, but do not confront the patient with the knowledge of his
HIV status.
A
B.
The patient can be successfully treated by using universal precautions. The patient should be treated in a relativelv isolated area because of his weakened immune svstem. The diagnosis of AIDS with Kaposi’s sarcoma is an indication that the patient’s immune system is weak. Gloves should be used if the patient’s sarcomas are open; otherwise, hand washing before and after patient contact is appropriate.
24
Q
A patient’s lawyer calls the therapist requesting his or her client’s clinical records. The lawyer states that he or she needs the records to pay the patient’s bill. What is the best course of action?
A. Tell the lawver either to have the patient request a copy of the records or to have the patient sign a medical release.
B. Faxthe needed chart to the lawyer.
C. Mail a copy of the chart to the patient.
D. Call the patient and tell him or her of the recent development.
A
A.
A patient can obtain his or her medical
records simply by signing a release form. Charts and records should never be given or faxed to an attorney unless the patient has signed a release.
25
A 12-year-old male has been referred to physical therapy after recently being involved in a car accident. The patient's mother has signed all the necessary paperwork for admission to the clinic, including a form allowing release of her son's records to the parties listed. The patient's mother included herself, doctors involved in the patient's care, and their attorney on the list. The patient's stepfather comes to the clinic after the patient is discharged and requests a copy of the stepson's record. Which of the following would be the correct response from the office staff?
A. Give the stepfather a copy of the records.
B. Give the stepfather a copy of the records after he has signed a release form.
C. Inform the patient's stepfather that he is not on the list that authorizes the records to be released to him.
D. Call the patient's mother and get verbal permission to release the records to the stepfather.
C.
The patient's biological father would have the right to access the records whether or not he is on the list, but not the stepfather.
Choice B is incorrect because unless he is on the originallist, he cannot simply sign a form and receive the records. Choice D is incorrect because you cannot verify that you are speaking to the mother.
26
The home health physical therapist arrives late at the home of a patient for a treatment session just as the occupational therapist has finished.
The patient is angry because the sessions are so close together. The patient becomes verbally abusive toward the physical therapist. The most appropriate response to the patient is
A. "I'm sorry I'm late, but you must try to understand that I am extremely busy."
B."I know you are aggravated. It is inconvenient when someone does not show up when expected. Let's just do our best this session and I will make an effort to see that we do not have PT and OT scheduled so close together from now on."
C."You have to expect visits at any time of the day with home health."
D."The OT and I did not purposefully arrive so close together. I apologize, please let's now begin therapy.
B.
Choice B is the most empathetic
response. It also lets the patient know that the therapists will make an effort to prevent the problem from recurring.
27
When should a physical therapist begin discharge planning for a patient admitted to a rehabilitation unit with a diagnosis of a recent stroke?
A. At the first team meeting
B. At the last team meeting
C. Two weeks before discharge
D. Afterthe initial examination by the physical therapist
D.
After the therapist assesses the patient for the first time, he or she needs to begin discharge planning. This is true for an assessment of any patient, not just in the impatient rehabilitation setting.
28
A therapist is performing a chart review and discovers thatlab results reveal that the patient has malignant cancer. When examiningthe patient, the therapist is asked by the patient,
"Did my lab results come back and is the cancer malignant?" The appropriate response for the therapist is
A. To tell the patient the truth and contact the social worker to assist in consultation of the familv.
B."It is inappropriate for me to comment on your diagnosis before the doctor has assessed the lab results and spoken to you first."
C. "The results are positive for malignant cancer, but I do not have the training to determine your prognosis."
D. To tell the patient the results are in, but physical therapists are not allowed to speak on this matter.
B.
A therapist should never comment on such a serious prognosis before the physician has assessed the lab results and consulted with the patient first.
29
A physical therapy technician calls the therapist immediately to the other side of the outpatient clinic. The therapist discovers a 37-vear-old femalelying face down on the floor. Which of the following sequence of events is most appropriate for this situation?
A. Have someone call 911, determine unresponsiveness, establish an airway, and assess breathing (look/listen/feel)
B. Determine unresponsiveness, have someone call 911, establish an airway, and assess breathing (look/listen/feel)
C. Have someone call 911, determine unresponsiveness, assess breathing (look/listen feel), establish an airway
D. Determine unresponsiveness, have someone call 911, assess breathing (look/listen/feel), and establish an airwav
B.
According to the American Heart
Association, a person is determined unresponsive before emergency medical service is activated.
30
Which of the following acts forced all federally supported facilities to increase corridor width to a minimum of 54 inches to accommodate wheelchairs?
A. Americans with Disabilities Act
B. National Healthcare and Resource
Development Act
C. Civil Rights Act
D. Older Americans Act (Title III)
A
The ADA allowed structural
modifications of federal buildings and protection from discrimination based on disability.
31
A patient at an outpatient facility experiences the onset of a grand mal seizure. Which of the following is the most appropriate course of action by the therapist?
A. Assist the patient to a lying position, move away close furniture, loosen tight clothing, and prop the patient's mouth open.
B. Assist the patient to a lying position, move away close furniture, andloosen tight clothing.
C. Assist the patient to a seated position, move away close furniture, and loosen tight clothing.
D. Assist the patient to a seated position, move away close furniture, loosen tight clothing, and prop the patient's mouth open
B.
The person should lie down to prevent head injury. Tight clothing is loosened to make sure that nothing is too constricting, Close furniture is moved away for the patient's safety.
Nothing should be placed in the patient's mouth because of the danger of obstructing the airway.
32
A therapist is instructing a physical therapy student in writing a SOAP note. The student has misplaced the following phrase: Patient reports a functional goal of returning to playing baseball in 5 weeks. Where should this phrase be placed in a SOAP note?
A. Subjective
B. Objective
C. Assessment
D. Plan
A. Any phrase stated by the patient that is relevant information goes into the subjective portion of the note.
33
An acute-care physical therapist is ordered to examine and treat a patient who has suffered a right hip fracture in a recent fall. During the examination, the familv informs the therapist that the patient suffered a stroke approximately 1 week before the fall. The patient's chart has no record of the recent stroke. What should the physical therapist do first?
A. Immediately call the referring physician and request a magnetic resonance scan.
B. Examine and treat the patient as ordered.
C. Immediately call the referring physician and request a computed tomography scan.
D. Immediately call the referring physician for an occupational therapy referral.
B.
Although a stroke may have occurred, the physical therapist can first examine the patient. After the examination has been performed, the therapist will be more informed about the patient's condition and can then contact the physician if necessarv.
34
A physical therapist in an outpatient clinic is urgently called into a room to assist an infant who is unconscious and not breathing. The therapist opens the airway of the infant and attempts ventilation. The breaths do not make the chest rise. After the infant's head is repositioned, the breaths still do not cause the chest to move. What should the therapist do next?
A. Give five back blows.
B. Look into the throat for a foreign body.
C. Have someone call 911.
D. Perform a blind finger sweep of the throat.
A.
Back blows should be followed by chest thrusts with complete airway obstruction when
CPR is performed on an infant. The therapist then should check for a foreign body in the airway. A blind finger sweep of the throat should not be performed on an infant.
35
A physical therapist is setting up a portable whirlpool unit in the room of a severely immobile patient. What is the most important task of the physical therapist before the patient is placed in the whirlpool?
A. Check for a ground fault circuit interruption outlet.
B. Check to make sure the water temperature is below 110° F.
C. Make sure the whirlpool agitator is immersed in the water.
D. Obtain the appropriate assistance to perform a transfer.
A.
A ground fault interruption circuit protects the patient from a potentially life-threatening situation. The other choices are valid concerns, but choice A is the most important.
36
A 37-year-old man fell and struck his left temple area on the corner of a mat table. He begins to bleed profusely but remains conscious and alert. Attempts to stop blood flow with direct pressure to the area of the injury are unsuccessful. Of the following, which is an additional area to which pressure should be applied to stop bleeding?
A. Left parietal bone one inch posterior to the ear
B. Left temporal bone just anterior to the
ear
C. Zygomatic arch of the frontal bone
D. Zygomatic arch superior to the mastoid process
B.
Pressure on the left temporal bone just
anterior to the ear helps to occlude blood flow from the temporal artery.
37
A physical therapist is beginning the examination of a patient with AIDS. The patient was admitted to the acute floor of the hospital on the previous night after receiving a right total hip replacement. The physician has ordered gait training and a dressing change of the surgical site. Of the following precautions, which is the least necessarv?
A. Mask
B. Gloves
C. Handwashing
D. Gown
A.
AIDS is transmitted by blood or bodily fluids. Masks are usually used with airborne precautions. Hand washing should be done between all wound care patients. Gloves are also indicated with all open wounds. Gowns mav not be a necessity but should be used if there is a chance of soiling the clothing with infected fluids.
38
A physical therapist is treating a 17-year-old boy with an incomplete T11 spinal cord injury.
The patient was treated for 2 months in the rehabilitation unit of the hospital before beginning outpatient physical therapy. He is currently ambulating with a standard walker with maximal assist of two. The therapist sets an initial long-term goal of "ambulation with a standard walkerwith minimum assist of 1 for a distance of 50 feet, with no loss of balance, on a level surface—in 8 weeks." If the patient achieves the long-term goal in 4 weeks, which of the following courses of action should be taken by the therapist?
A. Discharge the patient secondary to completion of goals.
B. Set another long-term goal regarding ambulation and continue treatment.
C. Return the patient to the rehabilitation unit of the hospital for more intensive treatment.
D. Call the patient's physician and ask for further instructions.
B.
Because the goals were not completed in a short amount of time, a new long-term goal should be set. Because of the significant progress made in outpatient therapy, there is no need to return to the rehabilitation unit.
39
A physical therapist is ordered to examine a 74-year-old man who has suffered a recent stroke.
The therapist performs a chart review before performing the examination. Which of the following is of the least importance to the physical therapist in assessing the patient's chart?
A. Nursing assessment
B. Physician's orders/notes
C. Respiratory assessment
D. Dietary assessment
D.
All of the choices are important, but the dietary assessment contains the least amount of critical information at this stage of the physical therapy examination.
40
Each of the following choices consists of a list of two summaries of some of the principles in the code of ethics of the American Physical Therapy
Association. Which of the answers is a false summary?
A. Obey regulations governing physical therapists, and (2) maintain high standards when providing therapy.
B. Respectthe rights of patients, and (2) inform people appropriately of the services provided.
C. Maintain high standards when providing therapy, and (2) provide services for the length of time ordered.
D. Assist the public when there are public health needs, and (2) accept fair monetary compensation for services.
C.
"Provide services for the length of time
ordered" is not a summary of one of the principles of the code of ethics. If a physician orders an inappropriate frequency and/or duration, it is the responsibility of the therapist to resolve the dilemma to ensure that the patient is treated with an appropriate frequency and duration.
41
A physical therapist is scheduled to examine the shoulder of a patient with hepatitis B. The therapist notices no open wounds or abrasions and also notices that the patient has good hygiene. The physician has ordered passive range of motion to the right shoulder because of adhesive capsulitis. Which of the following precautions is absolutely necessary to prevent the therapist from being infected?
A. The therapist must wear a gown.
B. The therapist must wear a mask.
C. The therapist must wear gloves.
D. There is no need for any personal protective equipment.
D.
The therapist does not need to wear a gown, gloves, or mask. These precautions are necessarv only if there is a chance that the therapist or his clothing can become contaminated with blood, serum, or feces.
42
A contraindicated activity for a child with osteogenesis imperfecta would be
A. Spontaneous active extremity movement
B. Pull-to-sit maneuver
C. Prone scooter activity
D. Lightweights attached close to joints
B.
A pull-to-sit maneuver would put undue stress on the upper extremities. Rather, the child should be facilitated by supporting the child around the shoulders as he attempts to sit up.
43
The best recommendation for strength training in prepubescent children is
A. No strength training recommended
B. Strength training programs should be the same as adolescents
C. Strength training should be done only for the lower extremities
D. Strength training should be closely supervised, correctly taught, and involve low load high repetition tasks
D.
Strength training in this group should
be closelv monitored because of skeletal immaturity. Proper technique should be taught and reinforced.
44
You are working with a 2-year-old child who has a tumor in the posterior fossa. She demonstrates a significant right torticollis. Which intervention is most likely contraindicated?
A. Facilitated active range of motion
B. Gentle anterior-posterior glides in the upper cervical region
C. Home positioning program
D. Uppertrapezius strengthening
B.
With an ongoing tumor in this area, any passive ROM or mobilization is contraindicated.
45
A patient with an acute infection of the left knee has been admitted to the hospital. A chart review shows that the patient currently has a body temperature of 102.5° F. The physician has ordered for therapy to begin intervention with this patient immediatelv.
What is the most appropriate course of action by the physical therapist?
A. Begin examination of the patient.
B. Begin intervention with ROM first.
C. Begin intervention with ambulation first.
D. Contact the physician as an acute infection is a contraindication to exercise.
D.
Exercise during acute infections can
affect performance and may make the current condition worse. It could also compromise the cardiovascular and immune systems and exacerbate dehvdration.
46
During documentation after an intervention a mistake is made in the note. Which of the following is NOT an appropriate step to make in correcting the mistake?
A. Strike one line through the error so that it is still legible.
B. Write vour initials in the margin near the mistake.
C. Write "mistaken entry" or "error" near the mistake.
D. Use liquid correction fluid or an eraser over the mistake.
D.
Choices A, B, and C should all be
performed each time a documentation error is made. One should never use erasers or liquid correction.
47
A physical therapist has determined that hamstring stretching should be incorporated in the intervention of 75-vear-old female with complaints of low back pain. Which of the following conditions is a contraindication to stretching of the hamstring muscle group?
A. Soreness lasting approximately 2 to 3 hours after therapy
B. Hemophilia
C. Patients age
D. Minimal complaints of pain in the lumbar area
B.
Although soreness lasting 24 hours or more is a concern, and care should be taken because of the age of the patient, it is not a contraindication to stretching. Excessive complaints of pain should be a contraindication.
Hemophiliacs should not be stretched in any joint because of the possibility of effusion.
48
A physical therapist is about to begin intervention of a patient with recent total hip replacement using an anterior approach. Which of the following are contraindicated motions of the hip during early rehabilitation?
A. Hip flexion above 90 degrees
B. Hiphyperextension
C. Hipadduction past neutral
D. Hip internal rotation
B.
Hyperextension is contraindicated because of the anterior approach. This motion would put undue stress on the anterior portion of the hip capsule. Choices A, C, and D are all contraindications for the posterior approach.
49
Which of the following conditions would (not?) be a contraindication to performing manual lymphatic drainage techniques performed over the abdomen?
A. Menstrual period
B. Undiagnosed abdominal pain
C. Crohn's disease
D. Diverticulitis
A.
The menstrual cycle is a concern, but not a direct contraindication. The other conditions involve the digestive tract, and could be worsened with any manual therapy technique.
50
Which of the following is proper placement of a catheter bag?
A. Inthe patient's lap while in a wheelchair
B. On the patient's stomach while in a supine position on hospital bed
C. Hooked onto the therapist's pocket during ambulation
D. Below the waist of the patient
D.
The catheter bag should always be
below the level of the waist. This will keep urine in the catheter line from moving back to the patient's urinary tract. Infections can result if urine is allowed to renter the urinarv tract.
51
The physical therapist is beginning a program of functional electrical stimulation (FES) for a patient with T4 paraplegia in order to promote cardiovascular fitness. At what systolic blood pressure should the exercise be terminated?
A. 140 mm Hg
B. 160 mm Hg
C. 180 mm Hg
D. 220 mm Hg
C.
Exercise should be terminated when systolic blood pressure is 180 mm Hg or above because of the risk of autonomic dvsreflexia.
Systolic blood pressure should be between 180
mm Hg and 80 mm Hg, diastolic between 120 mm Hg and 50 mm Hg, and heart rate between 160 beats/min and 50 beats /min.
52
A physical therapist decides to use cervical traction for a patient with complaints of cervical pain. Which of the following conditions is a contraindication for cervical traction?
A. Hyperthyroidism
B. Hypertension
C. Diabetes
D. Down's syndrome
D.
Studies have shown that 15% of individuals with Down's svndrome have atlantoaxial (C1-C2) instability. Instability in that region is a contraindication to cervical traction.
53
Which of the following positions should be avoided in postpartum patients?
A. Left side-lying
B. Right side-lying
C. Supine with a pillow under the knees
D. Prone with the knees pulled to the chest
D.
The uterus moves superiorly in this position. This could cause an air embolism to enter the vagina and uterus. Eventually the embolism could enter the circulatory system through the placental wound.
54
When disrobing and draping a patient to prepare for intervention, which of the following is the most important advice?
A. Avoid wrinkles in the draping garment.
B. Do not use the patient's clothing for draping.
C. Obtain the patient's consent before disrobing him or her.
D. Askfor appropriate assistance in situations where the gender of the patient could be concern.
C.
All of the above are good advice that needs to be followed, but consent to disrobe is the first and most important choice. Wrinkles can cause areas of pressure, and the patient's clothing could be soiled. Gender situations could obviously be a cause for concern.
55
At which stage of scar tissue formation can maximalload be placed on the scar tissue without risk of failure?
A. Inflammatory phase
B. Granulation phase
C. Fibroplastic phase
D. Maturation phase
D.
The order of scar tissue formation consists of the following: inflammatory phase, granulation phase, fibroplastic phase, and maturation phase.
56
What motions should not be stretched early in rehabilitation after an open rotator cuff repair?
A. Horizontal abduction, extension, and internal rotation
B. Horizontal adduction, extension, and internal rotation
C. Horizontal abduction, flexion, and internal rotation
D. Horizontal abduction, extension, and external rotation
B.
Horizontal adduction, extension, and internal rotation would stretch the tissues that are early in the healing process. Care must be taken not to damage these structures in the anterior capsule.
57
A young patient just starting antidepressant medication is telling you that "life is not worth living." You should tell the patient not to worry since this is
A. experienced by most patients at the beginning of drug therapy
B. only a transient reaction to the medication and of no consequence
C. a good sign because the medication has a period of up to 4 weeks before it can take effect
D. passing but inform the psychiatrist immediately about your conversation
D.
Antidepressants work slowlv (it takes about 4 weeks before antidepressant effects become apparent) but can somewhat "energize" patients early on in drug therapy so that they are more likely to commit suicide. Such suicidal ideas must be mentioned to the treating psychiatrist as soon as possible.
58
A patient who just returned from abroad is being treated for a worm infection. What precautions do you have to take?
A. Reschedule appointment until the patient has stopped taking the worm medication.
B. Wear a mask and change work cloth after therapy.
C. Disinfect toilet after the patient has used it.
D. Do not take special precautions because the drug kills the worms and the eggs.
C.
Antihelminthics kill the worms but do not kill the eggs, which can leave the patient during a bowel movement and remain on the toilet or hands to be spread to others.
Disinfection of the toilet and always informing the individual to wash hands thoroughly is recommended.
59
Your patient is on antipsychotic drug therapy.
During your therapy session you notice a number of adverse reactions. The most severe one requiring immediate attention by a physician is
A. Increased body temperature with some muscle rigidity
B. Dizziness with almost fainting when getting up quickly
C. A sudden but short-lasting tachycardia
D. Appearance of a yellow skin and eyes
A.
This could be the beginning of a malignant hyperthermia, which requires immediate drug treatment since it could be fatal.
The other signs and symptoms are of importance but do not require immediate attention.
60
A patient on clopidogrel therapy is at increased risk of experiencing
A. Internal bleeding episodes
B. Sudden fainting spells
C. Orthostatichypotension
D. Intermittent tachycardia
A.
Clopidogrel interferes with ADP-induced platelet aggregation and can lead to bleeding episodes while the other reactions are unlikely.
61
Smoking involves the inhalation of many compounds that can cause all of the following health problems except
A. Korsakoff-Wernicke syndrome
B. Emphysema
C. Bladder cancer
D. Hypertension
A.
Nicotine can cause increases in blood
pressure and gastritis; tar can cause cancers and emphysema; and CO interferes with oxygen transport in the blood, but alcohol abuse can cause the Korsakoff-Wernicke svndrome (psychosis, memory losses).
62
A patient receiving drug therapy experiences a slight fever and sore throat with some mouth ulcerations. The physician has to be notified since this could present a /an
A. Agranulocytosis
B. Thrombotic thrombocytic purpura
C. Exfoliate dermatitis
D. Churg Strauss syndrome
A.
Agranulocytosis manifests itself with a slight fever and a sore throat possibly with ulcerations caused by a deficiency of granulocytes. Thrombotic thrombocytic purpura exhibits bizarre behavior, hemolytic anemia (dark urine) and jaundice (yellowing of eves and skin) caused by microthrombi.
Exfoliate dermatitis is characterized byredness, scaling, and shedding of the skin. Churg-Strauss syndrome is manifested by rashes and nodules under the skin, later on damaging internal organs caused by vasculitis.
63
A patient receiving drug therapy experiences a cough, fever, and rash across the face spreading to the body. The physician has to be notified since this could present a
A. Phototoxic reaction
B. Epidermal necrosis
C. Stevens-Johnson syndrome
D. Lupus syndrome
C.
Stevens-Johnson syndrome starts with a nonspecific upper respiratory infection, cough. aching, headaches, feverishness followed by a red rash across the face and the trunk of the body spreading later to other parts. Finally the top layer of the skin or epidermis starts to peel off. Epidermal necrolvsis manifests itself with fever followed by a rash, redness, blisters, pain and the peeling of the skin from the underlying dermis. Lupus syndrome manifests itself as an inflammation of the joints, mostly fingers, hands and wrists, caused by an autoimmune reaction.
64
A 78-year-old patient with COPD uses oxygen at all times. At rest, the pulse oximeter reads 91% During a walk with the physical therapist, the pulse oximeter indicates the Osaturation is 86% and the patient indicates fatigue. What is the appropriate action of the physical therapist?
A. Stop walking and turn the oxygen up until the patient recovers.
B. Turn the oxygen up and keep walking.
C. Stop walking and monitor the patient closely.
D. Keep walking and monitor the patient closely.
C.
Normal values are 96%to
1008#37; Oxygen flow rates are prescribed by the physician and should not be altered by the physical therapist. Exercise should be stopped if Osaturation falls 5% below resting value.
65
Which of the following vital sign issues should cause concern?
A. The systolic blood pressure falls during exercise.
B. The pulse rate increased by 15 beats /min with activity and recovered within 2 minutes.
C. The patient reported the activity was rated a 13 on the Rate of Perceived
Exertion Scale (RPE).
D. The 6-year-old child had a resting pulse rate of 90 beats/min.
A.
Systolic blood pressure should always rise as workload increases. The other values are within normallimits for rest or exercise response.
66
Patients with hyperlaxity always
A. Have flat feet
B. Can protect theirjoints with muscle strength
C. Will develop patellar instability
D. Must avoid the butterfly stroke in swimming
B.
Hyperlaxity patients may or maynot have symptoms from their laxity. One certainty is that muscle strength around joints helps stabilize and protect those joints.
67
Postoperative knee braces have been associated with all the following complications except
A. Deep vein thrombosis
B. Peroneal nerve injury
C. Avascular necrosis
D. Ankle edema
C.
Braces can cause many problems from direct pressure or constriction. Avascular necrosis has not been found with bracing.
68
Prophylacticbracing
A. Prevents all injury
B. Can protect ankles and medial collateral knee ligaments
C. Has been shown to decrease ACL injuries
D. Provides psychological benefits only
B.
Prophylacticbracing has been
extensively studied. Only in prevention of ankle sprains and MCL tears has effectiveness been shown.
69
According to the APTA Guide for Physical
Therapist Practice, the following are elements of patient management (in order of process during an initial session)
A. Examination, assessment, impairment, treatment
B. Evaluation, treatment, documentation, assessment
C. Examination, evaluation, diagnosis, prognosis
D. Interview, evaluation, tests and measures, diagnosis
C.
Examination, evaluation, diagnosis, prognosis is the correct order according to the APTA.
70
You are working as part of an interdisciplinary team of an inpatient rehabilitation unit. Your patient suffered a spinal cord injury 3 weeks earlier. She was making progress in functional mobility, but lately has been behaving erratically: missing therapy, falling out of bed twice, and skipping medications. You suspect these may be self-destructive behaviors related to her recent injury. What is the BEST course of action?
A. The patient needs encouragement from
PT as she is clearly depressed.
B. Wait for the next weekly conference, and then discuss with the team, as this is not your area of expertise.
C. You consider self-destructive behaviors as serious, and notify the team with a request for immediate psychiatric assistance.
D. The patient is at risk for suicide; warn the familv to monitor her constantly and recommend they speak to the physician regarding appropriate medications.
C.
You consider self-destructive behaviors
as serious, and notify the team with a request for immediate psychiatric assistance. Choice Cis the best for managing an urgent issue and functioning as a member of the interdisciplinary team. A physical therapist cannot diagnose depression. Treatment is outside the scope of PT practice. Waiting aweek is a very badidea as patient behavior is escalating and likely to cause serious harm. This is an urgent issue. Do not warn family members as you are not qualified to diagnose the condition. Plus this choice puts the problem inappropriately into the familv's hands. The PT should communicate with the physician.
71
Which of the following pieces of legislation guarantees patients the right to make autonomous decisions about their health care?
A. The Americans with Disabilities Act
(ADA)
B. The Emergency Medical Treatment and
Active Labor Act (EMTALA)
C. The Health Insurance Portability and
Accountability Act (HIPPA)
D. The Patient Self-Determination Act
(PSDA)
D.
Autonomy means "self-governance" and refers to an individual's right to make his her own decisions. The term "self-determination" is synonvmous with autonomy. In patient care, this right is protected by a federal statute known as the Patient Self-Determination Act of
1990. The PSDA codifies the rights of hospitalized patients and long-term care residents to participate in treatment decision making and to control the use of extraordinary treatment measures including artificial life support.
72
A physical therapist owns a private practice in a small community located 40 miles from the nearest hospital or outpatient clinic. Her spouse is offered a great job opportunity in another city so they decide to make the move at the end of the month. The therapist informs her office staff that she will be closing the practice in 2 weeks and asks her secretary to call all her patients and cancel their appointments. When she does this, several patients ask where they are supposed to go to finish their therapy sessions.
The secretary replies, "Anywhere you can find another PT!" Given the situation just described, this therapist's patients could file a complaint based on
A. Breach of confidentiality
B. Failure to provide informed consent
C. Fraudulent billing
D. Patient abandonment
D.
Patient abandonment occurs when the
health care professional unilaterally terminates his or herrelationship with a patient improperly or prematurely. By failing to refer her patients to another physical therapist, this therapist has breached her duty to provide care for her patients and could be charged with professional negligence.
73
Which bioethical principle addresses a physical therapist's duty to provide honest information to his or her patients?
A. Beneficience
B. Fidelity
C. Justice
D. Veracity
D.
Veracity refers to telling the truth.
Fidelity refers to faithfulness, justice refers to fairness, and beneficence refers to doing what s bestfor someone else.
74
You are treating an older adult who recently fell at home. The patient sustained no major injuries from the fall; however, your examination indicates that she is at high risk for falling again and your cognitive screening suggests that she probably has mild dementia.
The patient lives alone and desperately wants to stay in her own home. However, you do not believe that she can live safelv in this environment by herself and think it is in her best interests to investigate an alternative living arrangement. What ethical duty does this exemplify?
A. Autonomy
B. Beneficience
C. Disclosure
D. Nonmaleficence
B.
Beneficence is the ethical principle of acting in a way that reflects the best interests of the patient. In this case, the therapist was attempting to do what he/she thought was best in terms of protecting the patient from future risk of physical harm resulting from another fall.
75
You are ambulating a post-op patient up in the hospital corridor using a gait belt and appropriate guarding techniques. Suddenly the patient slips on an unnoticed wet spot on the floor and falls down. Although not seriously injured, the patient is in a lot of pain, has to spend extra davs in the hospital, and requires additional rehab services. The patient's family sues the hospital and receives a financial settlement to cover the costs of additional hospitalization and home care. This settlement is an example of
A. Comparative iustice
B. Compensatory justice
C. Distributive justice
D. Fiduciary justice
B.
This is an example of ordinary negligence that is incident to health care deliver. Premises liability provides for monetary damages on the part of premise owners for injuries incurred by patrons. The concept of justice refers to fair treatment, or equity. Compensatory justice is one type of justice that compensates individuals fairly for injuries or wrongdoings that they have suffered.
The other types of justice listed deal more with fair allocation of health care resources atthe societal or individual level.
76
You are treating a patient who recently underwent total hip arthroplasty when she tells you that she urgently needs to use the bathroom. You immediately take her to the bathroom and, observing all positional precautions, assist her on and off the toilet using her walker, a gait belt, and a raised toilet seat. However, as the patient sits back down in herwheelchair, she states that she felt a "funny sensation" in her hip. You check out her hip position and movements but don't find anything unusual. Before returning to her room, the patient is transported to radiology for a previously scheduled x-ray. The next day one of the nurses informs you that the patient is back in surgery because she " dislocated her hip the previous day in physical therapy. " You do not believe you were responsible for this patient's injury. What is your best defense against liability in this situation?
A. The patient was confused and did not follow instructions well.
B. You followed standard protocol and safety precautions during your treatment session.
C. One of your transporters reported that the radiology techs frequently "mishandle" patients.
D. It was an emergency situation so you are protected from liability by "Good
Samaritan" laws.
B. Liability for professional negligence occurs when health care professionals fail to care for patients in a manner that complies with legal and professional standards of care. To allege negligence on the part of this therapist, the patient would have to provide evidence that the therapist did not follow standard policies and procedures related to patient safety during transfers and that this action was the direct cause for the injury. Thus, the therapist's best defense is not to place the blame elsewhere, but rather emphasize that appropriate standard of care was rendered. The Good Samaritan Laws do not apply to this case because the situation did not place the patient in eminent or serious peril.
77
A male therapist is performing an initial prosthetic check-out on a female patient with a transfemoral amputation. She is complaining of "pinching" from her prosthesis when she bearsweight on it or sits down. To determine whether or not the socket is too tight, the therapist takes the patient into a private treatment room and asks her to undress so he can better palpate the tissues in her groin region. The patient doesn't say anything at that time, but later files a complaint against the therapist for sexual misconduct. What other action could this therapist have taken to protect him from this type of accusation?
A. Askthe patient to sign a specific written consent form for palpation procedures.
B. Distract the patient with some casual conversation to make her feel more comfortable.
C. Request the presence of a female chaperone during the patient's examination.
D. Weargloves while performing the examination.
C.
To protect oneself against allegations of sexual misconduct, health care providers should implement some risk management strategies including: (1) providing same-sex chaperones when conducting intimate, hands-on procedures or upon patient request: (2) implementing a "knock-and-enter" clinic policy;
(3) implementing a general informed consent policy that ensures that patients understand the nature of questions they will be asked and types of therapeutic procedures they may experience; and (4) providing ongoing continuing education to health care professionals and support staff on how to prevent sexual abuse and harassment.
78
You are examining a 9-year-old child with cerebral palsy who appears to have an unusually large number of painful bruises around his wrists and ankles. His mother sees you examining these bruises and tells you that he falls down a lot due to his spasticity and poor balance. However, during your examination the child demonstrates a safe, independent gait using a reverse walker. When you reviewed his medical record you notice two prior emergency room visits to treatlimb fractures. Given vour observations and the patient's prior history of injuries, what are you obligated to do?
A. Call 911 and request immediate assistance from a law enforcement officer.
B. Continue to treat the child and observe for future signs of abuse.
C. Reportvour suspicion of abuse to the appropriate child protective service agency.
D. Request a consult from a medical social worker.
C.
All states have statutes that mandate
health care professionals to report cases of actual or suspected child abuse or neglect to a child/family protective agency that is designated to investigate these types of cases.
Suspicions of abuse mav be based on obiective, credible evidence of possible child, spousal, and/or elder abuse.
79
You are treating an elderly patient who is about to be discharged from the hospital following a recent stroke. The patient has some residual hemiparesis but he is oriented, communicates appropriately, and follows safety precautions when performing transfers and walking. You tell the patient that you want to arrange for continued therapy at home or on an outpatient basis to help him regain more strength and motor control. The patient agrees to this discharge plan; however, his son is present and tells you that his father has already had plenty of therapy and just needs to go home and rest.
Under what circumstances is this patient's son able to act as his father's surrogate decision maker?
A. The son may act as a surrogate decision maker if his father experienced a temporary of permanentloss or consciousness during his hospitalization.
B. The son may act as a surrogate decision maker if his father has exceeded his
Medicare benefits and cannot afford to pay for additional health care services on his own.
C. The son may act as a surrogate decision maker if his father has been declared legally incompetent and has appointed the son to act on his behalf via a durable power of attornev.
D. The son may act as a surrogate decision maker if his father is over 65 and has no spouse or advance directives.
C.
One purpose of The Patient Self-Determination Act of 1990 was to educate patients about their rights to formulate advance directives for their health care. One type of advance directive is a durable power of attorney for health care decisions. This legal document, signed by the patient, delegates health care decisions to an agent, or surrogate, of the patient's choice. The power only becomes operative when the patient is no longer competent to make his or her own decisions (i.e., must be declared legally incompetent in a court of law). In the scenario posed, the therapist would have no reason to believe that this patient was incompetent unless the son provided some evidence to the contrary.
80
According to the Americans with Disabilities Act, what circumstances would legally preclude an from having to hire, or provide accommodations for, a disabled worker?
A. If the employer suspects that the worker's disability is not legitimate
B. If the employer has to spend more than $500 on accommodations
C. If the worker is not qualified to perform the essential job functions
D. If the employment setting is privately owned and employs less than 100 people
C.
The ADA legislation applies to public and private businesses employing 25 or more people on July 26, 1992, or those with 15 or more people on July 26.1994. Title I of the ADA prohibits emplovment discrimination of "a qualified individual with a disability," which means that the job applicant or emplovee can perform the essential job functions, with or without reasonable accommodations. The emplover determines what the essential job functions are and the ADA defines what a disability is. The Equal Employment Opportunity Commission (EEOC) provides definitions for "reasonable accommodations."
81
Your patient presents with dizziness, lip paresthesias, nystagmus, lower extremity paresthesias, and drop attacks. This would be most indicative of
A. A concussion
B. Vertebral basilar insufficiency
C. A labyrinthine syndrome
D. Carotid artery tear
B.
The cardinal signs described in this question are classic signs of vertebral basilar instability. With a labyrinthine involvement you will mostly get dizziness but not all of the cardinal signs. With a carotid artery tear you may lose consciousness because it supplies the higher centers of the brain. A concussion may cause a variety of svmptoms to include loss of consciousness but not drop attacks, lip paresthesias, and lower extremity paresthesias.
82
A physical therapist measures the knee range of motion of a patient status after anterior cruciate ligament reconstruction or repairusing a goniometer. After completing the measurement, the therapist concludes that the patient lacks 20 degrees of knee extension and can flex the knee to 95 degrees. Knee flexion range of motion should be documented in the patients chart as
A. 20 to 95 degrees
B. 95 to 20 degrees
C. 20-0-95 degrees
D. -20-0-95 degrees
A
Goniometrictexts recommend
recording the starting and endingvalues for passive range of motion. The patient's starting point and ending points during the examination is most accurately represented by 20 to 95 degrees of flexion.
83
A physical therapist has been asked to determine whether a ramp to enter a local shopping mall meets the minimum accessibility standards required by law. The maximum grade for wheelchair ramps is best identified as for every inch of rise there should be inches of length.
A. 3
B. 6
C. 9
D. 12
D.
According to code, 12 inches of length is necessary for each 1 inch of rise when making an area accessible.
84
A physical therapist is educating a patient with low back pain about appropriate body mechanics. The patient's symptoms were reproduced with forward bending and sitting.
Which instructions are most appropriate for that patient?
A. Use of a lumbar roll will eliminate your risk of aggravating your back pain during sitting
B. Bend the hips and knees when reaching down, and try to keep the spine neutral to avoid aggravation.
C. Liftinglight weights is not likely to cause any problems, but lifting heavier items should be avoided.
D. Consider placing items you reach for frequently overhead to reduce forward bending.
B.
Good body mechanics cannot guarantee pain control, but the use of good body mechanics is critical regardless of the load (light versus heavy) beinglifted. Heavier items should be placed at waist level not below the waist or overhead.
85
A physician orders gait training for a 14-year-old male with recent open reduction internal fixation of the left femur. Which of the following is not the responsibility of the physical therapist?
A. Determiningweight-bearing status
B. Assessing balance
C. Choosing assistive device
D. Assessing endurance
A.
Weight-bearing status is the physician's responsibility.
86
A 3-year-old male sustains a femur fracture after falling off his bike. He received an open reduction internal fixation (ORIF) yesterday.
The MD writes an order for PT examination and treatment. He is clearedto ambulate non-weight bearing (NWB) on the affected extremity. The patient's insurance, however, will only authorize one piece of equipment.
What is the most appropriate assistive device for this patient?
A. Front wheeled walker
B. Axillary crutches
C. Wheelchair
D. Posterior walker
C.
Due to the patient's age and diagnosis, he will have difficulty maintaining NWB status.
Balancing on a single limb and coordinating and using an assistive device safely will be difficult.
Therefore, to reduce the risk of falling and re-injuring the affected extremity, a wheelchair is the safest device for mobility for this patient.
87
You are a physical therapist that is performing an examination on a 10-week-old infant with a brachial plexus injury. The patient cannot flex his elbow and has residual signs of Horner's syndrome. The appropriate plan of care is
A. Begin passive ROM of the upper extremitv immediately
B. Utilize electrical stimulation to regain biceps function
C. Surgical management
D. Referto a brachial plexus specialty center
D.
If complete return of biceps function has not returned by 2 months of age, the infant should be referred to a brachial plexus specialty center. More urgent referrals are needed for a patient with Horner's syndrome and complete paralvsis.
88
An appropriate physical therapy program for a
2-week-old infant with a brachial plexus injury would include teaching the parents how to support the arm while dressing and moving the infant to prevent further injury, and
A. Functional strengthening
B. Daily PROM exercises including full shoulder abduction and elevation
C. Daily PROM exercises with shoulder abduction and elevation to only 90 degrees
D. Serial sensory testing
C.
The physical therapist can teach
parents to perform ROM exercises. Passive ROM is initiated around week 1, and no later than 3 weeks of age, when soft tissue swelling subsides.
Shoulder abduction and elevation is limited to 90 degrees for the first 3 weeks.
89
A 13-year-old male is referred to physical therapy for left knee pain. During the objective examination, the left hip is found to be limited in flexion, abduction, and internal rotation.
Observation also reveals that the left hip is positioned in external rotation in supine and in standing positions. The appropriate plan of care is
A. Stretching of the hip extensors and external rotators
B. Referralto an orthopedic surgeon
C. TENS and cold pack to the left knee for pain management
D. Strengthening of the quadriceps and gluteus medius
B.
The patient has a suspected left slipped capital femoral epiphysis and should be referred to an orthopedic surgeon. The patient typically presents with an antalgic gait and pain in the groin, often referred to the anteromedial aspect of the thigh and knee, but may have pain only in the thigh or knee. The involved extremity is usually held in external rotation in supine and standing positions and there is decreased flexion, abduction, and internal rotation ROM.
90
Deep vein thrombosis (DVT)
A. Can break off and cause a pulmonary embolism (PE)
B. Usually occurs in people who are highly mobile
C. Is usually prevented by daily administration of a thrombolytic
D. Is a clot that develops in a superficial vein
A.
DVT usually occurs in sedentary or immobilized people due to a decrease in blood flow from inactivity. A serious complication of DVT is pulmonary embolism (PE), whichis when a clot travels to the pulmonary svstem, and blocks blood flow. It is a major cause of death in man hospitals.
91
Which of the following is an incorrect direction for proper inhaler usage?
A. Tilt the head back, open the mouth wide, and inhale a puff from the inhaler.
B. Place the inhaler in the mouth with the lips sealed securely around mouthpiece.
C. Press down on the inhaler (actuate) and inhale at the same time.
D. Hold the breath for approximately 10 seconds.
A.
The mouth and lips should close around
the inhaler (the mouth should not be open wide).
92
Which is NOT a sign of preeclampsia?
A. Increased HR
B. BP >: 140/90
C. Edema
D. Proteinuria
A.
Usually occurring later in second and third trimesters, preeclampsia is a dangerous condition that can affect both mother and baby.
It has an incidence rate of 5% to 88#37:
Preeclampsia is characterized by protein in the urine and high blood pressure. Other symptoms include headaches, swelling, or changes in vision.
93
A football athlete with an incomplete C7 spinal cord injury seeks the PT's opinion about the ability to live independently. The BEST response from the PT would be
A. "You will be able to live independently with modifications such as adapted devices for activities of daily living (ADLs), a wheelchair, and sliding board."
B."You can live alone most of the time, but will require a caregiver for such tasks as driving, cooking, and ADLs."
C. "Persons with this level of spinal cord lesion will require an attendant."
D."Persons with this level of injury can live independently with a manual wheelchair for mobility."
A.
Functional outcomes of a C7 spinal cord
lesion are independence in mobility with a manual or powered wheelchair, independence in transfers with adapted devices or a sliding board, and independence in ADLs with adapted equipment.
94
During an interview with a new patient on the psychiatric unit, the patient asks if they should divorce their spouse. Your best response would be
A.'That's not a decision that I can make. I don't know what it is like to be in vour situation, butwe can talk about it and see if it helps you to make a good decision for vourself."
B. "Why don't you ask your doctor?"
C. "Yes. Your spouse seems to be no good from what vou have told me. Go ahead and divorce.'
D."Ifit were me, I'd dump your spouse."
A.
Giving advice or sending the patientto
her doctor to get the decision made is not appropriate therapeutic behavior. The PT's role is to help the patient to review her options and encourage her to make the best decision she can for herself.
95
During the examination of a patient, the patient says that things are hopeless and "I might as well be dead". In this case you would
A. Ask some questions to find out more.
B. Tell the patient that those thoughts are stupid.
C. Ignore it and change the subject to something brighter.
D. Tell the patient that you have thought about suicide too and that it is normal.
A.
Ethically, it is not appropriate to ignore the comment or judge the patient. Suicidal thoughts are not normal, and sharing such personal information about vourself would create a boundarv issue. It is important to find out more about these feelings to determine what action should be taken to keep the patient safe.
96
In an attempt to establish a home exercise program, the therapist gives a patient written exercises. After 1 week, the patient returns and has not performed any of the exercises. After further questioning, the therapist determines that the patient is illiterate. What is an inappropriate course of action?
A. Go over the exercises in a one-on-one review session.
B. Give the patient a picture of the exercises.
C. Give a copy of the exercises to a literate familv member.
D. Contact the physician for a social services consult.
D.
This answer is correct because patients
need a written home program with diagrams and instructions. One-on-one teaching is also necessary to ensure that the patient understands the program. Bringing in another family member is also definitely advisable to assist the patient with the program at home.
Although a social services consult maybe necessary in the long run, it will not help the patient to perform the exercises over the next several davs.
97
A supervisor in a physical therapy clinic observes a new graduate performing incorrect exercises on a patient. The exercises are not life threatening but are incorrect. What is the best wav to handle this situation?
A. The supervisor should immediately tell the new therapist to stop exercising the patient and instruct the patient and therapist in the correct procedure.
B. The supervisor should tactfully tell the new therapist to come into his or her office and discuss the situation in private.
C. The supervisor should put a note on the new therapists desk to meet with him /her after work.
D. The supervisor should give the new therapist research articles about the correct options.
B.
The supervisor can best handle this situation by discussing the exercise program away from the patient. Correcting the new graduate in front of the patient probably would decrease the confidence of the patient in the treatment and the therapist.
98
The therapist has just returned from an in-service training offering new treatment techniques in wound care. The therapist would like to share the information with interested members of the hospital staff. What is the best way to share this information?
A. Prepare a handout on the new treatment techniques and give it to the members of the hospital staff.
B. Schedule a mandatory in-service training during lunch for the entire hospital staff who participate in some form of wound care.
C. Post bulletins in view of all hospital staff and send memos to the
department heads inviting everyone to attend an in-service training during lunch.
D. Call each department head and invite him or her and their staff to an in-service training during lunch.
C.
Posting the in-service training date on the bulletin board and sending a memo to the department heads is the most effective way to invite everyone interested. Scheduling during lunch often makes it easier for people to attend.
99
A patient is scheduled to undergo extremely risky heart surgery. The patient seems really worried. During the treatment session, the patient and family look to the therapist for comfort. Which of the following is an appropriate response from the therapist to the patient?
A."Don't worry, everything will be okay."
B. "Your physician is the best, and he will take care of vou."
C. "I know it must be upsetting to face
such a difficult situation. Your familv and friends are here to support you."
D."Try not to worry. Worrying increases your blood pressure and heart rate, which are two factors thatneed to be stabilized before surgery."
C.
This answeris the most appropriate.
The therapist cannot guarantee everything will be okay (choice A) or that the physician is the best (choice B). Choice D is too insensitive.
100
A phvsical therapist instructs a hvsical
therapy assistant to teach a patient how to ascend and descend the front steps of her home.
Afterfirst exercising the patient at her home, the assistant realizes that, because of her increased size and severe dynamic balance deficits, training on the steps is unsafe at this time. The assistant contacts the therapist by telephone. Which of the following is the best course of action by the therapist?
A. The therapist should instruct the assistant to attempt step training cautiously.
B. The therapist should instruct the assistant to recruit the family members to assist with step training.
C. The therapist should instruct the assistant to discontinue step training until both of them can be present.
D. The therapist should contact the physician and seek further instructions.
C.
The physical therapist should
tell the assistant to wait until the can both work together with the patient. The family is not qualified to help the assistant during the first attempt at ambulation in this situation.
101
A physical therapist is performing an isokinetic test on a 16-vear-old bov's shoulder.
This particular test compares the right shoulder with the left shoulder. The patient's father asks the physical therapist, "What is the purpose of this test?" How should the therapist respond?
A. "This isokinetic test will show changes in concentric and eccentric strength."
B. "This test will show strength differences between the injured arm and the noninjured arm."
C. "This test shows differences in external rotation strength at specific ranges in the arc of motion."
D."This test will provide muscular torque data, which will help us to determine when to discontinue therapv."
B.
This is the most appropriate response to a person who has not indicated that he or she has a medical background. Ifthe patient's father inquires further, the therapist can be more detailed.
102
A physical therapist in the
rehabilitation unit is ordered to examine and treat a 3-year-old girlwith cerebral palsy. The patient's supportive family is present during the examination. When should the physical therapist explain the treatment plan and possible functional outcomes to the familv?
A. During the examination
B. After the examination
C. Afterthe first full treatment session
D. After the first rehabilitation team conference meeting
B.
The physical therapist can give
his or herideas about the treatment plan and possible functional outcomes after the evaluation. These ideas may change after treatment sessions and team meetings. The family should be continually informed of the patient's progress and expected level of function after discharge.
103
During the history portion of an examination of a geriatric gentleman, the physical therapist is concerned about lapses in medication dosage. What is the most appropriate way to ask the patient about his medications?
A. "Do you take your medications?"
B."Does someone help you with your medications?"
C."How do vou take vour medications?"
D."Howlong have you been taking your medications?"
C.
The physical therapist should
always use open ended questions as in choice C.
If the patient only responds in short answers, some important information mav be left out.
104
The physical therapist is speaking to a group of nurses on proper body mechanics.
Which of the following is inappropriate advice to give to this population regarding body mechanics?
A. Carry heavy objects in your dominant arm onlv.
B. Keep your back straight during lifting.
C. Maintain a wide base of support.
D. Push rather than pull when there is an option of either.
A.
Choices B, C, and D are all
correct suggestions. Heavy objects that cannot be supported with two hands should be alternated between hands to avoid excessive lumbar rotation.
105
A physical therapist is working with a patient on gait training. Verbal cues that are provided only when the patient's performance lies outside what the physical therapist considers safe and acceptable, is an example of
feedback.
A. Concurrent
B. Delayed
C. Bandwidth
D. Immediate
C.
Bandwidth is a type of feedback
that is used during intervention to provide cues or feedback only when the patient's performance lies outside of an acceptable range of safetv. Bandwidth feedback has been shown to be an effective method to enhance skill acquisition.
106
A physical therapist is teaching a 72-year-old patient who has had a knee replacement to walk using a straight cane. Verbal feedback __________
is most beneficial for long-term motor skill acquisition.
A. When provided after every practice trial
B. That is delaved until several trials of the task have been completed
C. That is provided concurrently during the performance of the task
D. When provided at the beginning of every practice trial
B.
Feedback to promote long-term
skill acquisition is most beneficial when it is not provided before or after every trial. Providing feedback as the activity is being performed may enhance immediate performance but has been shown to be less valuable than delayed feedback. Providing feedback less frequently is reported to enhance long-term learning.
107
What is the BEST strategy to communicate with a patient diagnosed with
Wernicke's aphasia?
A. Use a writing board for communication.
B. Attend to nonverbal behaviors and the emotional content of the message.
C. Correct patient errors frequently to assist in his learning strategies.
D. Use easier
"who/what/when"
questions.
B.
Attend to nonverbal behaviors
and the emotional content of the message.
Wernicke's aphasias a receptive aphasia. Use of a writing board or simpler questions will not be successful as that requires receptive communication. Frequent correction is not ideal as the patient cannot process receptive feedback.
108
The PT administered a visual
perceptual assessment tool to a patient with Bell's palsy degeneration at the beginning of therapy and before the family-rehab team meeting. Administering an assessment tool in this fashion measures
A. Interrater reliability
B. Test-retest reliability
C. Standard error of measurement
D. Central tendency
B.
Test-retest reliability is a
measurement of the stability of a test over time.
Test-retest reliability is proven by giving the test to the same individual on two different occasions.
109
Evidence-based practice is the determination of intervention strategies based
A. Extant research findings
B. Research findings, the P's own experiences, and family priorities
C. A PT's expertopinion
D. Other disciplines' practice
B.
Evidence-based practice
includes deciding on an intervention strategy based on research findings, the PT's own experiences, and family priorities. Basing a decision about how to approach intervention solely on research findings without considering one's own experience and the family's priorities does not allow for consideration of all of the unique characteristics and needs of the child and family.
110
Which is MOST likelv to be found in
quantitative research?
A. Lengthy, descriptive, narrative text
B. Open-ended interviewing
C. Small samples chosen according to the goals of the study
D. Standardized tests and scales
D.
Quantitative research answers
questions that require standardized measures.
Qualitative methods lend themselves to the study of small groups with research questions that may be broad and evolve throughout the study process.
111
A local plant asks a therapy teamto perform a study of its workers. The study needs to determine the frequency of lung cancer in workers who insulate the inside area of an electrical oven appliance. Using company files, the therapy team studies all past emplovees with this job description. The employees were initially free of lung cancer, as determined by a routine physician's examination required by the plant. From these files, the team records the frequency with which each one of the employees developed lung cancer. What type of study is the therapy team performing?
A. Historical prospective or historical cohort
B. Retrospective
C. Case control
D. Matched pairs design
A.
In cohort studies, records are
taken at a specific time, and then the subjects are followed over time. The records of the factory are used to determine the frequency of disease. In a case-control study, the people are selected based on whether or not they have a disease; then the frequency of the possible cause of the disease in the past is studied. A retrospective studylooks for causes of disease between two groups regardless of time. A matched pair design means that one control is matched to one case study.
112
A study of the local population was
necessary to determine the need for a new fitness center in the area. The therapists performing the study divided the population by sex and selected a random sample from each group. This is an example of what type of random sample?
A. Systematic random sample
B. Random cluster sample
C. Two stage cluster sample
D. Stratified random sample
D.
A stratified random sample is
taken by dividing the test population into two groups or strata (in this case, male and female) and taking a random sample from each group.
113
A therapist is preparing a poster that will clarify some of the data in an in-service presentation. The poster reflects the mode, median, and mean of a set of data. The data consist of the numbers 2, 2, 4, 9, and 13. If presented in the above order (mode, median, mean), which of the following is the correct list of answers calculated from the data?
A. 4, 2,6
B. 2,4,6
C. 6, 2,4
D. 6, 4, 2
B.
The mean is the average of the set of numbers. The mode is the number that appears most often in the set of data. The median is the middlemost value.
114
An outpatient physical therapist notices
that a large number of patients with impingement of the rotator cuff have been treated in the past 6 months. The clinic finds that most patients are employed at a new auto manufacturing plant. The therapist is invited to the plant to perform an ergonomic assessment and finds that a certain number of the employees must work with their shoulders at 120 degrees of flexion 6 to 8 hours/day. Which of the following recommendations would decrease the frequency of injury?
A. Provide the emplovees with a step stool to perform their tasks.
B. Raise the employees' work surface.
C. Adjust their tasks so that overhead activities are performed with the palm of the hand downward.
D. Adjust the task so heavier tools are used.
A.
A step stool decreases the overall shoulder elevation required. Choice B increases shoulder elevation, and choice C maintains internal rotation with increased elevation. External rotation with elevation decreases the impingement to the rotator cuff muscles. Heaviertools would cause more fatigue of the rotator cuff and increase impingement.
115
When conducting clinical research, external validity refers to your ability to
A. Applythe results of your study to a different population of patients
B. Compare your results to those from similar intervention studies
C. Generalize the results of your study to similar patients who were not in your study
D. Verify that the instruments used are measuring what they are supposed to measure
C.
The study usually only includes
a representative sample of the population from which it was drawn. Thus, to have external validity, the study results should be able to be applied to the general population from which that sample was drawn. Thus, if the investigator uses sampling techniques that create bias, this can adversely affect the external validity of the study.
116
If you wanted to determine how well
the items on a test or surve related to each other, you would be analyzing that instrument's
A. Content validity
B. Internal consistency
C. Intrarater reliability
D. Stability
B.
Internal consistency is a form of reliability that assesses the degree to which a set ofitems in an instrument measure a similar trait.
117
Why is a random sample more desirable than other methods of sampling when designing an experimental study?
A. Confidence intervals tend to be wider.
B. Data are more likely to be normally distributed.
C. Group variances will always be homogenous.
D. Maturation effects of subjects can be avoided.
B.
Random sampling is more likely
to result in a representative sample; thus, the data from that sample are more likely to be normally distributed and not skewed. This is important because one of the underlying assumptions for the use of parametric statistics is normal distribution of data.
118
Which of the following factors is inverselvrelated to statistical power in a research study?
A. Alphalevel that has been set for the study
B. Amount of variance in the outcome
measure(s)
C. Magnitude of the effect size (of the outcome measure)
D. Sample size
B.
Statistical power increases with
larger sample sizes, higher alpha levels, and greater effect sizes; it tends to be lower when data variances are higher.
119
What does the term "alpha level" refer
A. Amount of variance in the first sample
B. Extent to which a statistical conclusion can be generalized
C. Level of significance when testing a hypothesis
D. Power of a statistical analysis
C.
Alpha level refers to the level of
significance used when testing a hypothesis.
This is represented by the p value provided in the data analysis.
120
If you are comparing two or more groups of subjects and accept a null hypothesis when group differences really do exist, vou have
A. Committed a type I statistical error
B. Committed a type II statistical error
C. Committed a random error
D. Drawn an appropriate conclusion
B.
A tvpe I error occurs when one
incorrectly rejects the null hypothesis, and a type II error occurs when one incorrectly accepts a null hypothesis.
121
A test or instrument that has high
specificity is able to accurately identify
A. False negatives
B. False positives
C. True negatives
D. True positives
C.
Specificity is that characteristic
of a diagnostic test that indicates the likelihood that a person who does not have a disease or condition will test negative (i.e., true negative).
122
In order for an instrument to have good predictive validity, the scores must be highly correlated with
A. Anothermeasure that is considered to be the gold standard
B. Occurrence of some type of clinical condition or outcome
C. Scores from the same instrument administered by atleast one other tester
D. Scores from the same instrument repeated at a later time
B.
Predictive validity and
concurrent validity are both forms of criterion validity. Predictive validity is the ability of a test to predict some future performance or occurrence. Concurrent validity is the degree to which one test measure correlates with another measure, usually the "gold standard." The last two responses refer to the definitions for interrater reliability and test-retest reliabilitv.
123
Which of the following clinical
measures exemplifies an ordinal level of measurement?
A. Gaitspeed
B. Heartrate
C. Joint range-of-motion
D. Visual analog pain rating
D.
Most rating scales represent
ordinallevels of measures in that they have scores that are rank ordered but do not represent equally spaced measures as in an interval or ratio level measurement.
124
If you wanted to compare balance
measures in older adults who do and do not have a history of falling, which statistical test would be most appropriate to use?
A. Square dependent (paired) t-test
B. Independent (unpaired) t-test
C. One-way analysis of variance
D. Pearson product moment coefficient
B.
You are comparing two
independent groups on a single, ratio level measure. Thus, a parametric test is appropriate.
In this case, that would be an independent t-test.
125
If you wanted to classify a group of women as having normal bone density, low bone density, or osteoporosis, based on measures of their age, height loss, and activity level, what type of statistical analysis would you use?
A. Analysis of variance
B. Chi square analysis
C. Discriminant analysis
D. Factor analysis
C.
Regression techniques are used
to assess the combined relationship of several independent, or predictor, variables on a single, dependent variable. When that predictor variable is a category or classification, discriminant analvsis is the best type of regression analysis to use. Logistic regression techniques may also be used when the classification contains only two categories.
126
A sampling technique in which you
send a research survey to a small group of subjects who meet your criteria and ask them to share it with others who also meet that criteria is known as
A. Quota sampling
B. Random sampling
C. Snowball sampling
D. Stratified sampling
C.
Snowball sampling is a method
in which a target group of subjects successively recruit additional subjects who meet the same criteria. In random sampling, every individual within a population has an equal chance of being selected to participate in the study.
Stratified samples represent subgroups of a population, from which subjects are randomly recruited. In quota sampling, an equal proportion of subjects are recruited from each subgroup.
127
What is the purpose for doing a power analysis when you are planning an experimental study?
A. To assess the number of dependent variables you can analyze in a single study
B. To decide whether to pose a directional or non-directional research hypothesis
C. To estimate the amount of time you will need to collect sufficient data
D. To help you determine an appropriate sample size
D.
During the planning stage of a
study, a power analysis is used to help determine the optimal number of subjects to recruit in orderto avoid the possibility of committing a type I statistical error. The investigator has little control over any of the other factors that affect power (i.e., group variance, effect size of outcome measure, and alphalevel), with the exception of the alpha level, which is usually set at .05 to reduce the risk of committing a type I error.
128
A portion of our patient satisfaction
survey asks patients to rate the level of importance of various factors when selecting a health care provider. They are asked to use the scale below to rate theirresponses
1 = not important at all
2 = somewhat important
3 = very important
4 = critically important
br> This tvpe of scale is best described as a A. Guttman scale B. Likert scale C. Semantic differential scale D. Visual analog scale
1 = not important at all
2 = somewhat important
3 = very important
4 = critically important
br> This tvpe of scale is best described as a A. Guttman scale B. Likert scale C. Semantic differential scale D. Visual analog scale
B.
This is a classic example of a
Likert scale in which participants are asked to rate their level of agreement with a set of statements. A Guttman scale is a cumulative scale in which a higher rating assumes all levels of measure below it. A semantic differential scale asks respondents to rate perceptions of a concept or characteristic on a 7-point scale that includes opposite descriptors at each end of the scale. A visual analog scale asks respondents to rate perceptions of a phenomenon, such as pain intensity, on a numeric scale, usually from 0 to 10.
129
When might you use a coefficient of variation (CV to describe the variabilitv of a set of measurements?
A. Any time your data are measured at the nominal or ordinal level
B. When you want to compare the variability in multiple variables that have different units of measure
C. When your data have been converted to percentages
D. Whenever your standard deviations are very large
B.
A coefficient of variation (CV) is
a standardized measure of variation that is based on the standard deviation of a measure, divided by its mean, and multiplied times 100.
Thus, it can be used to compare variability in a set of variables, or outcomes, that have different units of measure.
130
What do statistical measures of "central
tendency" represent?
A. The amount of variance in a distribution of numbers
B. The average value in a distribution of numbers
C. The range of a distribution when outliers are removed
D. The shape of a distribution of numbers
B.
Measures of central tendency
are descriptive statistics that represent average values in a distribution of scores. These measures include the mean, median, and mode.
131
You create a box plot like the one in shown in Figure 6-1 to illustrate the distribution of GPAs. What does the line in the middle of the box represent?
A. Mean of the distribution
B. Mode of the distribution
C. 50th percentile of the distribution
D. An outlier
C.
A box plot is a graphic representation of a distribution of scores that illustrates the high, low, and median scores, as well as the boundaries for the 25th and 75th percentiles. The 50th percentile is indicated by the horizontal line within the box.
132
You want to know the average amount
of joint contracture that your patients who have had knee surgery demonstrate at the time of discharge. When you graph your results with a histogram it looks like Figure 6-2. How would vou describe this distribution?
A. Bimodal
B. Normal (bell-shaped curve)
C. Skewed to the right
D. Skewed to the left
C.
When one tail in a curve is
longer than the other, the distribution is said to be skewed. The direction of skewness is determined by the longer tail; in this case, the longer tail is to the right of the curve.
133
To meetthe definition of "reliable" a
test must be both consistent and
A. Cost-effective
B. Efficient to use in a clinical setting
C. Free from error
D. Highly specific
C.
In addition to being consistent,
a measurement must reduce the amount of error in order to be considered reliable. Sources of error may be systematic (e.g. due to poor calibration of an instrument) or random (e.g.. changes in subject performance). Statistical tests such as ICCs take into account these multiple sources of error when estimating the reliability of a measure.
134
If you wanted to graphically illustrate the relationship of two variables, which type of graph would you select?
A. Bargraph
B. Line graph
C. Pie chart
D. Scatterplot
D.
Scatter plots illustrate the
relationship of two variables, one plotted on the x-axis and the other plotted on the y-axis. A line of fit for the data points may also be illustrated.
A perfect relationship is illustrated by a diagonal line from one corner of the graph to the opposite corner.
135
If you wanted to examine the test-retest
reliability of a grip dynamometer, which correlational statistic would be most appropriate to analyze this relationship?
A. Cronbach's alpha
B. Intraclass correlation coefficient
C. Phi coefficient
D. Pearson product moment correlation
B.
An intraclass correlation
coefficient (ICC) is best for determining inter-or intrarater reliability of a numeric measure. A phi coefficient is used to correlate two dichotomous (i.e., categorical) measures.
Cronbach's alpha is used to establish the internal consistency of a multi-itemed instrument. A Pearson correlation coefficient is sometimes used to analvze test-retest reliability, butit cannot account for svstematic measurement errors.
136
What does the scatter plot in Figure 6-3 illustrate about the nature of the relationship between the GPAs of a group of recent graduates and their scores on the national licensure exam?
A. There is a moderate, curvilinear relationship between these variables.
B. There is a strong, positive, linear relationship between these variables.
C. There is aweak, inverse, linear relationship betweenthese variables.
D. There is no relationship between these variables.
B.
Because these dots align
themselves well along a diagonal from the bottom left-hand side of the graph to the upper right hand side of the graph, they indicate a strong, positive correlation. An inverse relationship would be illustrated if the points aligned themselves from the upper left-hand side of the graph to the bottom right-hand side.
In a weak or moderate relationship, the dots would not fit well along a diagonal line, but would be more scattered.
137
What is the diagnostic advantage of having a highly sensitive test?
A. When the test is negative, you can confidently rule in that diagnosis.
B. When the test is negative, you can confidently rule out that diagnosis.
C. When the test is positive, you can confidently rule in that diagnosis.
D. When the test is positive, you can confidently rule out that diagnosis.
B.
According the rules of SpPin
and SNout, a test with high specificity (Sp) that is positive (P) will help rule in (in) a diagnosis, and a test with high sensitivity (Sn) that is negative (N) will help rule out (out) a diagnosis.
138
A study that follows the same group of subiects over an extended period of time to determine the extent to which exposure to certain risk factors actually results in the incidence of a disease /health condition is known as a
A. Case series
B. Cohort study
C. Cross-sectional study
D. Quasi-experimental study
B. A cohort is a group of subjects that are observed or studied over a period of time to determine their risk for developing a certain health condition. A case series follows a few subjects with similar diagnoses to determine how they respond to a certain treatment. A cross-sectional study measures certain traits in a population at one specific point in time. A quasi-experimental study is one that compares two or more groups of subjects that cannot be randomly assigned to their groups because those groups are based on preexisting characteristics such as age, gender, diagnosis, etc.
139
When comparing the means between two groups of subjects, you discover that there is a significant difference between the variances of your outcome measure in those groups. What does this result tell you?
A. You are more likely to have committed a type I statistical error.
B. You are more likely to have committed a tvpe II statistical error.
C. You need to run some additional post hoc tests.
D. You should use a nonparametric statistical test to analvze vour data.
D.
Homogeneity of variance is one
of the underlying assumptions of parametric statistics. When group variances are significantly different, then this assumption has beenviolated and you should run the nonparametricversion of that statistical test, if that option is available.
140
A therapist who is conducting a back
school gives the participants a pretest at the beginning of the first class to determine their baseline knowledge of body mechanics and injury risk factors. She then compares those scores to the score on a quiz she gives during the last class session. What could you conclude from the statistical output displayed in Figure
6-4?
A. Although the p value was very low, the confidence intervals suggest that there was not really a significant difference in the two test scores.
B. On average, there was a significant improvement of 21.4 points between the pretest and posttest scores.
C. On average, there was a negative change of 21.4 points in the students' pretest and posttest scores, but it was not significant.
D. There was greater variability in the posttest scores than there was in the pretest scores.
B.
The p value is less than.001
indicating a significant difference between the pretest and posttest scores. Because the mean of the posttest scores was 21.4 points higher than the mean of the pretest scores, subjects demonstrated significant improvements on the posttest.
141
A surgeon wants to compare functional
outcomes among his total knee arthroplasty patients, some of whom received physical therapy after their hospital discharge and some who did not receive therapy. He wants to measure their knee range of motion, gait speed, and pain ratings before surgery and at 2 months postoperatively. What type of data analysis procedures would be most appropriate to use in this situation?
A. Chi square analysis
B. Multiple linear regression
C. Repeated measures multivariate analvsis of variance
D. Three-way analysis of variance
C.
A multivariate analysis
incorporates tests for more than one dependent variable within the same statistical model. This guards against the risk of committing a type I error when running multiple univariate analyses such as multiple t-tests. The repeated measures designis appropriate because there is only one group of subjects whose measures are being compared at different points in time. The repeated measures model takes into account the fact that each pair of measures will probably be highly correlated.
142
You are comparing the balance scores of older adults who live in the community versus assisted living facilities versus nursing homes. Your analvsis of variance produced a p value of .033. To fully analyze the group differences, what would be your next step?
A. Analvze the descriptive statistics and compare the variances of each group.
B. Rerun the ANOVA and enter age as a covariate.
C. Run a logistic regression to determine the predictive value of the balance scores.
D. Run a post hoc comparison test to determine which groups differed from each other.
D.
The ANOVA resulted in a
significant p value (<: .05), so it tells you that there is a significant difference in the balance scores among these 3 groups of older adults.
However, in order to determine which groups differ from each other, you must then run some post hoc comparisons (post ho indicates tests run after the main analysis). Examples of post hoc comparisons include Scheffe's comparison, Bonferroni t-test, Tukey's honestly significant difference, Newman-Keuls test, Duncan's multiple range test, and Fisher's least significant difference.
143
A study that statistically analves and integrates the results of several studies in order to make a clinical recommendation regarding the overall efficacy of a particular type of treatment would be described as a(an)
A. Delphi study
B. Epidemiologic study
C. Factor analvsis
D. Meta-analysis
D. Ameta-analysis is a statistical procedure used in a systematic review to calculate an overall effect size of the outcomes produced by several studies that included similar dependent variables. A factor analysis is an exploratory method for identifying the constructs reflected in a large set of variables. A Delphi study is a survey method in which decisions on items are based on a consensus of the respondents. An epidemiologic study involves an assessment of the incidence or risk of certain health conditions within a population.
144
A therapist conducted a study to
compare the effects of real versus placebo laser radiation on the joint pain and mobility of patients with arthritic knee joints. Subjects' pain and mobility were measured before and after 2 weeks of dailylaser treatments. The dependent variable (s) in this study was/were
A. Laser intensity
B. Pain and functional ratings
C. Treatment duration (2 weeks)
D. Type of laser treatment received (real versus placebo)
B. The outcomes being measured are the dependent variables in a study. The treatment groups would represent the independent variable.
145
Using a regression analysis, a physical therapy instructor analyzes the effects of multiple predictors of academic success on the students' final GPA. The analysis produces an R2 (coefficient of determination) value of 0.36.
How should the instructor interpret this statistic?
A. The correlation between the predictor variables and GPA is not statisticallv significant.
B. The correlation between the predictor variables and GPA is very strong.
C. The predictor variables account for 36% of the variance in the students' GPAs.
D. The predictor variables are inversely related to students GPAs.
C.
The multiple correlation
coefficient (R) reflects the combined relationship of these predictor variables to GPA.
When squared, the coefficient of determination (R2) reflects the percentage of variance in the dependent variable (in this case, GPA) thatis accounted for by the predictor variables (in this case, 36%. No pvalues are provided to assess the significance of this regression model.
Likewise no Ris provided, although this can be determined by taking the square root of R2, which would be .60, a correlation of only moderate strength.
146
When conducting a qualitative research study, data validity is usually established by
A. Analyzing data at a lower alpha level
B. Increasing the sample size to include a broader varietv of subiects
C. Repeating the observations or interviews multiple times
D. Triangulating data from multiple sources
D.
No statistical tests are used to
analyze qualitative data. Instead, the investigator uses multiple methods to document the same phenomena andlooks for similar themes to emerge from these data sources.
147
Which of the following graphic methods is commonly used to analvze the data in a single-subject research study?
A. Forest plot
B. Limits of agreement graph
C. Receiver operating curve
D. Two standard-deviation band method
D.
The two standard deviation
band method is one way of analyzing the significance of changes that occur in a single subject study. The mean and standard deviation of an outcome measure is calculated from multiple baseline measures. Additional measures taken during and or after the treatment phase are then compared to these baseline measures. Those measures that fall outside the range of normal variance (i.e., two standard deviations) are attributed to the treatment effect. A forest plot is a graphic method used to illustrate the results of meta-analysis studies. Limits of agreement graphs are an alternate method used to illustrate test reliability. Receiver operating curves are used to help determine optimal cut-off scores in studies that establish test validity.
148
The combined effect of two or more
independent variables on one or more dependent variable is known as the effect.
A. Additive
B. Interaction
C. Integrative
D. Regression
B.
The interaction effect is
identified in an ANOVA table using an "X"; for example, the interaction between group and treatment effect would be indicated as "Group X Treatment."
149
One threat to internal validity may occur in a research study where subjects know they are being studied, so they perform differently than usual, producing biased results.
This phenomenon is known as the effect.
A. Hawthorne
B. Maturation
C. Placebo
D. Selection
A.
The Hawthorne effect was
named for an experiment conducted at the Hawthorne plant of the Western Electric
Companv back in the 1920s in which workers' productivity improved no matterwhat the researchers did to change the work environment. This outcome was attributed to the special attention the workers received from the researchers as opposed to the variables that were introduced into the work setting,
150
You have performed a study investigating the influence of gender on cutting mechanics. Your dependent variable is peak knee valgus moment (a continuous variable) and your independent variable is gender (a nominal variable). What is the most appropriate statistic to evaluate your data?
A. Two-factorial ANOVA with repeated measures
B. Independent samples t-test
C. Multiple regression
D. Spearman's rank test
B.
Independent samples t-test is
the most appropriate evaluation. Given the data described, a t-test is the best test. Because the groups are not matched (males and females), an independent samples t-test is best.
