GILES & SAUNDERS

Question 1

A physical therapist instructs a client rehabilitating from a tibial plateau fracture to ascend a curb using axillary crutches. The client is partial weightbearing and uses a three point gait pattern when ambulating. When ascending a curb the therapist should instruct the client to lead with the__________?
1. uninvolved lower extremity
2. involved lower extremity
3. axillary crutches
4. right axillary crutch and right lower extremity

Answer 1

1. When ascending a curb a client should lead with uninvolved lower extremity in order to avoid placing unnecessary force on the involved extremity.

Question 2

A physical therapist attempts to transfer a moderately obese client from a wheelchair to a bed! The therapist is concerned about the size of the client, but is unable to secure another staff member to assist with the transfer. Which type of transfer would allow the therapist to move the client with the greatest ease?
1. dependent standing pivot
2. hydraulic lift
3. sliding board
4. assisted standing pivot

Answer 2

2. A hydraulic lift can be a safe and efficient mode to transfer large or dependent clients with little physical exertion.

Question 3

A therapist conducts a goniometric assessment of a client’s upper extremities.
Which of the following values is most indicative of normal passive glenohumeral abduction?*
1. 80 degrees
2. 120 degrees
3. 155 degrees
4. 180 degrees

Answer 3

2. Passive shoulder complex flexion is approximately 180 degrees; however glenohumeral abduction is 120 degrees with approximately 60 degrees of motion occurring at the scapulothoracic joint.

Question 4

A physical therapist designs a therapeutic exercise program for a client with sway-back. The most appropriate exercise is_____?
I. lower abdominal strengthening
2. hip flexor strengthening
3. anterior pelvic tilts
4. lower back strengthening

Answer 4

1. Swayback is synonymous with excessive lordosis. Individuals with weakness of the abdominal muscles often present with an anterior pelvic tilt and thus a lordotic posture.

Question 5

A physical therapist monitors a client’s respiration rate during exercise. Which of the following would be considered a normal response?
1. the respiration rate declines during exercise before the intensity of exercise declines
2. the respiration rate does not increase during exercise
3. the rhythm of the respiration pattern becomes irregular during exercise
4. the respiration rate decreases as the intensity of the exercise plateaus

Answer 5

4. As the intensity of exercise plateaus, a client will accommodate to the level of exercise and his/her respiration rate will tend to decrease.

Question 6

A physical therapist reviews the results of a pulmonary function test. Assuming normal values, which of the following measurements would you expect to be the greatest?
1. vital capacity
2. tidal volume
3. residual volume
4. inspiratory reserve volume

Answer 6

1. Vital capacity is defined as the amount of air that can be exhaled following a maximal inspiratory effort. Vital capacity varies directly with height and indirectly with age.

Question 7

A client involved in a motor vehicle accident sustains an injury to the posterior cord of the brachial plexus. Which muscle would not be affected by the injury?
a. infraspinatus
2. subscapularis
3. latissimus dorsi
4. teres major

Answer 7

1. The infraspinatus muscle is innervated by the suprascapular nerve (C4, C5, C6) which extends from the superior trunk of the brachial plexus.

Question 8

While treating a client bedside, a therapist notices that an improperly positioned bedrail has partially occluded the tubing of an IV line. The therapist’s most immediate response should be to________?
1. contact nursing
2. contact the referring physician
3. reposition the bedrail
4. document the incident

Answer 8

3. Repositioning the bedrail is an immediate and appropriate response that is within the therapist’s scope of practice.

Question 9

A physical therapist designs a training program for a client without cardiovascular pathology. The therapist calculates the client’s age predicted maximal heart rate as 175 beats per minute. Which of the following would be an acceptable target heart rate for the client during cardiovascular exercise?
1. 93 beats per minute
2. 122 beats per minute
3. 169 beats per minute
4. 195 beats per minute

Answer 9

2. An acceptable target heart rate during cardiovascular exercise is between .6 - .8 of the age predicted maximal heart rate.

Question 10

While preparing a sterile field for wound debridement, a therapist accidentally places a nonsterile object on the sterile base. The most appropriate action ‘is to____________?
1. remove the nonsterile object from the sterile base and continue with treatment
2. continue with treatment; however, be sure no other supplies come in contact with the nonsterile object
3. remove all of the items to be used from the sterile base and replace them with similar items that are sterile
4. discard the entire sterile field and establish a new sterile field

Answer 10

4. Once a nonsterile object is placed within a sterile field, the entire sterile field should be considered nonsterile.

Question 11

A client rehabilitating from a fractured right humerus is examined in physical therapy. The therapist determines goniometrically that the client can actively flex his right shoulder to 173 degrees. Which of the following entries would be the most appropriate to illustrate the therapist’s findings
1. right shoulder flexion range of motion 0-173 degrees
2. right shoulder range of motion is within normal limits .
3. right shoulder flexion active range of motion to 173 degrees
4. right shoulder active range of motion to 173 degrees

Answer 11

3. Although the client can flex his right shoulder to 173 degrees, this does not indicate the starting position was equal to 0. Documentation must specify whether the range of motion was active or passive.

Question 12

A therapist works with a client placed in isolation. The therapist is required to wear a mask while treating the client, but is not required to wear gloves or a gown. This type of isolation could be termed___________?
1. strict isolation
2. contact isolation
3. respiratory isolation
4. blood/body fluid precautions

Answer 12

3. Protective asepsis for respiratory isolation includes a mask. Examples of conditions that may require respiratory isolation include measles, mumps, and pertussis.

Question 13

A 13ear-old female diagnosed with cerebral palsy is referred to physical therapy.
The client exhibits slow, involuntary, continuous writhing movements of the upper and lower extremities. This type of motor disturbance best describes__________?
1. spasticity
2. ataxia
3. hypotonia
4. athetosis

Answer 13

4. Athetosis refers to involuntary movements characterized as slow, irregular and twisting. This type of motor disturbance makes it extremely difficult to maintain a static body position.

Question 14

A client, who is status post stroke and demonstrate Wernicke’s aphasia, is learning how to perform a sit to stand transfer. To enhance the client’s ability to learn the transfer, the physical therapist should avoid___________
when instructing the client?
I. using a mirror for visual feedback
2. providing detailed instructions
3. using repetition
4. demonstrating

Answer 14

2. Wernicke’s aphasia refers to an inability to comprehend written or spoken words. As a result of this condition it is inappropriate to provide detailed instructions.

Question 15

A physician refers a client rehabilitating from a fractured femur to physical therapy for gait training. Which of the following would not be the responsibility of the physical therapist?
1. assessing balance
2. determining weightbearing status
3. selecting an assistive device
4. assessing endurance

Answer 15

2. Determining weightbearing status is the responsibility of the referring physician.

Question 16

The Occupational Safety and Health Administration establishes regulations for health care facilities, which are designed to protect their employees. Which of the following regulations is not accurate?
1. Provide proper containers for the disposal of waste and sharp items.
2. Educate employees on the methods of transmission and the prevention of hepatitis B and HIV.
3. Require all employees to receive the hepatitis B vaccine.
4. Provide education and follow up care to employees who are exposed to communicable diseases.

Answer 16

3. Although it is strongly recommended that health care employees receive the hepatitis B vaccine, it is not mandated by OSHA.

Question 17

A client status post total hip replacement is referred to physical therapy for gait training. The client has not been weightbearing on the involved lower extremity since surgery and appears to be somewhat anxious. The most appropriate setting to begin ambulation activities is _________?
1. in the parallel bars
2. in the parallel bars with a rolling walker
3. in the physical therapy gym with a straight cane
4. in the physical therapy gym with a walker

Answer 17

1. The parallel bars provide the most stable setting for the client to begin ambulation activities.

Question 18

A client involved in a motor vehicle accident sustains a Colles’ fracture and an intertrochanteric hip fracture. The client has been cleared for touch down weight bearing by her physician. Which assistive device would be the most appropriate for the client?
1. straight cane
2. axillary crutches
3. rolling walker
4. walker with a platform attachment

Answer 18

4. A walker with a platform attachment will provide the stability the client requires while avoiding significant pressure on both of the fracture sites.

Question 19

A therapist instructs a 55 year-old trauma victim with bilateral lower extremity* paralysis to transfer from a wheelchair to a mat table. The client has normal upper extremity strength and has no other known medical problems. The most appropriate transfer technique is a___________?
1. dependent standing pivot
2. sliding board transfer
3. two person carry
4. hydraulic lift

Answer 19

2. A sliding board transfer is possible based on the client’s upper extremity strength. The transfer will allow the client to maintain a high level of independence.

Question 20

A therapist elects to utilize joint mobilization to increase the extensibility of the ulnohumeral joint. Which position of ulnohumeral joint would be inappropriate for joint mobilization?
1. 15 degrees extension, 15 degrees pronation
2. 70 degrees flexion, 10 degrees supination
3. 30 degrees flexion, 25 degrees supination
4. full extension and supination

Answer 20

4. Full extension and supination is the close packed position of the ulnohumeral joint.

Question 21

A therapist instructs a client to make a fist. The client can make a fist, but is unable to flex the distal phalanx of the ring finger. This clinical finding can best be explained by__________?
1. a ruptured flexor carpi radialis tendon
2. a ruptured flexor digitorum superficialis tendon
3. a ruptured flexor digitorum profundus tendon
4. a ruptured extensor digitorum communis tendon

Answer 21

3. The flexor digitorum profundus is responsible for flexing the distal interphalangeal joint of the four fingers and assisting with flexion of the proximal interphalangeal and metacarpophalangeal joints.

Question 22

A client with a confirmed posterior cruciate ligament tear is able to return to full. dynamic activities following rehabilitation. Which of the following does not serve as a secondary restraint to the posterior cruciate ligament?
1. iliotibial band
2. popliteus
3. lateral collateral ligament
4. medial collateral ligament

Answer 22

1. The iliotibial band serves as a secondary restraint to the anterior cruciate ligament not the posterior cruciate ligament.

Question 23

A mine month old infant with cerebral palsy is unable to roll from prone to supine.
This developmental activity typically occurs by
_____________?
1. 3 months
2. 5 months
3. 7 months
4. 9 months

Answer 23

2. Rolling from prône to supine usually occurs in the fifth month, while rolling from supine to prone occurs in the sixth month.

Question 24

A physical therapist working in a school system develops long term goals as part of an Individualized Educational Plan for a child with Down’s Syndrome. The most appropriate time frame for these goals is.______________?
1. one month
2. four months
3. six months
4. one year

Answer 24

4. An Individualized Education Plan articulates the goals and objectives of special education services for a given school aged child. The plan is for a one year period.

Question 25

A physical therapist administers ultrasound over a client’s anterior thigh. After one minute of treatment, the client reports feeling a slight burning sensation under the sound head. The therapist’s most appropriate action is to_____________?
1. explain to the client that what she feels is not out of the ordinary when using ultrasound
2. temporarily discontinue treatment and examine the amount of coupling
3. discontinue treatment and contact the referring physician
4. continue with treatment utilizing the current parameters.

Answer 25

2. A client report of a slight burning sensation under the soundhead can be due to inadequate coupling, loosening of the crystal or hot spots due to a high beam nonuniformity ratio.

Question 26

A client is positioned on a treatment table in prone with two pillows under her hips.
This position most likely would be used to perform postural drainage techniques to the_____________?
1. anterior basal segment of the lower lobes
2. lateral basal segment of the lower lobes
3. right middle lobe
4. superior segment of the lower lobes

Answer 26

4. The optimal position for the superior segments of the lower lobes is described as having the client lie on his/her abdomen with two pillows under the hips. The therapist claps over the middle back at the tip of the scapula on either side of the spine.

Question 27

A client eight weeks post myocardial infarction is involved in a phase II cardiac rehabilitation program at a local hospital. What event usually signifies the completion of a phase II program?
1. echocardiogram
2. initiation of a high level aerobic exercise program
3. low level treadmill test
4. maximal treadmill test

Answer 27

4. A phase II cardiac rehabilitation program begins with the completion of a low level treadmill test and ends with a maximal treadmill test.

Question 28

A client being treated in an outpatient orthopedic clinic begins to demonstrate signs and symptoms of stroke, including sudden weakness of the arm and leg, unexplained dizziness, and loss of vision. Recognizing the symptoms of a stroke the therapist begins to administer first aid. Which of the following would not be considered appropriate first aid management?
1. monitor the airway, breathing, and circulation
2. remove mucus from the mouth with a piece of cloth wrapped around a finger
3. position the client in supine and slightly elevate the legs.
4. immediately contact medical assistance

Answer 28

3. Positioning the client in supine with the legs elevated would be inappropriate first aid management. This position may be warranted in a client with hypovolemic shock.

Question 29

Pharmacological agents eventually must be eliminated from the body to prevent an excessive accumulation of a specific drug. Where is the major site for drug (excretion?
1. gastrointestinal tract
2. kidneys
3. liver
4. saliva

Answer 29

2. The kidneys are the primary site of drug excretion, while the gastrointestinal tract and lungs are secondary sites.

Question 30

A therapist designs an exercise program for a pregnant woman. Which of the following exercises would be inappropriate?
1. pelvic floor isometrics
2. squatting
3. standing push-ups
4. bilateral straight leg raising

Answer 30

4. Bilateral straight leg raising is contraindicated for a pregnant woman due to the excessive increase in abdominal pressure and the strain on the low back.

Question 31

A physical therapist treats a client with generalized upper and lower extremity weakness following a prolonged hospitalization. As part of the client’s treatment program, the therapist designs an aquatic program emphasizing upper and lower extremity range of motion, Which physical property of water allows the client to move with greater ease?
1. buoyancy
2. specific gravity
3. specific heat
4. thermal conductivity

Answer 31

1. Buoyancy makes the body appear to weight less in water than it does in air and as a result clients tend to move with greater ease when immersed in water.

Question 32

A therapist examines a grossly obese client referred to physical therapy with a hip flexor strain. Which modality would have the greatest ability to elevate the temperature of fatty tissue to potentially dangerous levels?

1. diathermy
2. hot packs
3. paraffin
4. pulsed ultrasound

Answer 32

1. Diathermy is considered a deep heating agent while the remaining options are superficial heating agents.

Question 33

A 66 year-old female is referred to physical therapy with rheumatoid arthritis.
During the initial examination the therapist notes increased flexion at the proximal interphalangeal joints and hyperextension at the metacarpophalangeal and distal interphalangeal joints. This deformity commonly is known as_________?
1. boutonniere deformity
2. mallet finger
3. swan neck deformity
4. ulnar drift

Answer 33

1. The deformity is most frequently encountered in clients with rheumatoid arthritis or after trauma. It is caused by damage to the central tendinous slip of the extensor hood.

Question 34

A therapist discusses the importance of proper nutrition with a client diagnosed with congestive heart failure. Which of the following substances would be most restricted in this client’s diet?
1. cholesterol
2. potassium
3. sodium
4. triglycerides

Answer 34

3. Clients with congestive heart failure may present with breathlessness, weakness, abdominal discomfort and edema in the lower extremities resulting from venous stasis. Since sodium serves to retain water it is often restricted in a client’s diet.

Question 35

A physician reduces a comminuted tibia fracture using an external fixation device.
Which stage of bone healing is associated with the termination of external fixation?
1. hematoma formation
2. cellular proliferation
3. callus formation
4. clinical union

Answer 35

4. Clinical union provides the necessary bony support to terminate external fixation. Callus formation represents the first stage in which bony union occurs, however does not offer adequate support.

Question 36

A62 year-old male diagnosed with ankylosing spondylitis is referred to physical therapy. The client’s referral is for instruction in a home exercise program. Which of the following exercises would you expect to be the most appropriate for this client?
1. partial sit ups
2. posterior pelvic tilts
3. spinal extension
4. straight leg raises

Answer 36

3. Ankylosing spondylitis is a form of rheumatic disease characterized by.
   inflammation of the spine resulting in back pain. Since a client with ankylosing spondylitis often exhibits postural changes such as forward head, increased thoracic kyphosis and loss of lumbar curvature, spinal extension exercises are often a component of a treatment regimen.

Question 37

A client diagnosed with piriformis syndrome is referred to physical therapy for one visit for instruction in a home exercise program. After examining the client, the therapist feels the client’s rehabilitation potential, is excellent, but is concerned that one visit will not be sufficient to meet the client’s needs. The most appropriate action is to_________?
1. schedule the client for treatment sessions, as warranted, based on the results of the initial examination
2. explain to the client that recent health care reforms have drastically reduced the frequency of physical therapy visits covered by third party payers
3. explain to the client that she can continue with physical therapy beyond the initial session, but will be liable for all expenses not covered by her insurance
4. contact the referring physician and request approval for additional physical therapy visits

Answer 37

4. It is an appropriate action to request additional physical therapy visits from a referring physician.

Question 38

A male client with limited shoulder range of motion explains that he has difficulty wiping himself after going to the bathroom. How much shoulder range of motion is required to successfully complete toileting activities?
1. 50 degrees horizontal abduction, 30 degrees abduction, 45 degrees medial
‘rotation
2. 30 degrees horizontal abduction, 45 degrees adduction, 65 degrees medial
rotation
3. 80 degrees horizontal abduction, 40 degrees abduction, 90 degrees medial rotation
4. 90 degrees horizontal adduction, 75 degrees abduction, 60 degrees medial rotation

Answer 38

3. Full shoulder medial rotation is necessary to reach the perineum.

Question 39

A therapist completes lower extremity range of motion activities with a spinal cord injured client. While ranging the client, the therapist notices that the client’s urine is extremely dark and has a distinctive foul smelling odor. Which of the following is the most appropriate action?
1. verbally report the observation to the client’s physician
2. verbally report the observation to the client’s nurse
3. document and verbally report the observation to the client’s nurse
4. document and verbally report the observation to the director of rehabilitation

Answer 39

3. Any change in color or odor of urine is significant and should therefore be reported and documented.

Question 40

An eight year-old female with a 25 degree scoliotic curve is fitted for a Milwaukee brace. The brace will likely be worn until_________?
1. the scoliotic curve does not increased within one year period
2. the client resumes all recreational and athletic activities
3. the client is pain free for six months
4. spinal growth ceases

Answer 40

4. An orthotic device such as the Milwaukee brace is designed to facilitate improved alignment in the developing spine and therefore should be used until spinal growth ceases.

Question 41

Clients with abnormal conduction patterns often can be treated successfully using antiarrhythmic medication, Which of the following side effects of antiarrythmics would not require immediate medical attention?
1. dizziness
2. insomnia
3. shortness of breath
4. coughing up blood

Answer 41

2. Dizziness, shortness of breath and coughing up blood are all symptoms that place a client’s safety in immediate jeopardy.

Question 42

A physical therapist uses a S.O.A.P. formal for all his daily documentation. Which of the following would not be found in the assessment section of a S.O.A.P. note?
1. short and long term goals
2. discussion of a client’s progress in therapy
3. client’s equipment needs and equipment ordered
4. client’s rehabilitation potential

Answer 42

3. Equipment needs and equipment ordered are typically included in the plan section of a S.O.A.P. note.

Question 43

A rehabilitation manager designs a system to monitor the productivity of staff therapists. Which piece of data would be the least beneficial to accomplish the (manager’s objective?
1. number of generated timed treatment units
2. results of client satisfaction survey data
3. total hours of direct client treatment time
4. number of regular payroll hours

Answer 43

2. Productivity is a term used to describe the efficiency of a given worker or group of workers. Although measures of quality are often examined concurrently they are not used to determine productivity.

Question 44

A 52 year-old; self referred male is examined in physical therapy. The client states that over the last three months he has experienced increasing neck stiffness and pain at night. He also communicates that within the past week he has had several episodes of dizziness. The client has a family history of cancer and has smoked two packs of cigarettes a day for the last twenty years. The client denies any other significant past medical history and lists the date of his medical examination as 10 years ago. The therapist’s most appropriate action is to______
?
1. treat the client conservatively and document any changes in the client’s status
2. inform the client that he is not a candidate for physical therapy
3. refer the client to an oncologist
4. refer the client to his primary care physician

Answer 44

4. The self-referred client offers a medical history that presents several significant issues including episodes of dizziness, neck stiffness with pain at night and a family* history of cancer. Based on the client’s history and the date of the medical examination he should be referred to a physician.

Question 45

Therapists use a wide variety of measurement methods in their daily documentation. These measurements usually are categorized as subjective or objective methods. Which of the following measurement methods would not be considered objective?
1. duration of attention
2. goniometric measurements
3. rating on a perceived exertion scale
4. time required to perform a selected activity

Answer 45

3. A perceived exertion scale is a subjective scale where clients rate their exercise intensity.

Question 46

Therapists often begin the interview process with a new client by using open-ended questions. Which of the following questions would not be considered open-ended?
1. What makes your pain better?
2. Is your back more painful at night?
3. How does exercise affect your back?
4. Describe your activities in a typical day.

Answer 46

2. Open-ended questions guide the discussion, but do not restrict information to categories. Closed-ended questions are more impersonal and provide a limited number of response options.

Question 47

A client is referred to physical therapy following surgery to repair a torn rotator cuff. The physician referral does not include postoperative guidelines and also does not classify the extent or size of the tear. The therapist’s most appropriate action is to
?
I. consult various medical resources that discuss physical therapy management of rotator cuff repairs.
2. consult various protocols of other surgeons in the area
3. contact the referring physician and discuss the client’s care
4. discuss the client’s care with other staff members who are more experienced in treating rotator cuff repairs

Answer 47

3. Direct personal contact with the referring physician is necessary to plan an effective care plan.

Question 48

A client with chronic shoulder instability is scheduled to have an open Bankart procedure. As part of the surgery, the subscapularis is removed and ten reattached to the anterior capsule. In order to protect the subscapularis postoperatively, which of the following shoulder motions initially should be most limited?
1. flexion
2. abduction
3. internal rotation
4. external rotation

Answer 48

4. A Bankart lesion is an avulsion of the capsule and glenoid labrum off the * anterior rim of the glenoid resulting from traumatic anterior dislocation of the shoulder. Since the subscapularis is placed on stretch with external rotation this motion is initially limited after surgery.

Question 49

A client paralyzed from the waist down discusses accessibility issues with an employer in preparation for her return to work. The client is concerned about her ability to navigate a wheelchair in certain areas of the building. What is the minimum space required to turn 180 degrees in a standard wheelchair?
1. 32 inches
2. 48 inches
3. 60 inches
4. 72 inches

Answer 49

3. According to the Americans with Disabilities Act Accessibility Guidelines the distance necessary for a 180 degree turn using a wheelchair is 60 inches.

Question 50

A client is scheduled to undergo a transtibial amputation secondary to poor healing of an ulcer on his left foot. In addition, the client is two months status post right knee replacement due to osteöarthritis. Given the client’s past and current medical history, the physical therapist can expect which of the following tasks to be the most difficult for the client following his amputation?
1. rolling from supine to sidelying
2. moving from sitting to supine
3. moving from sitting to standing
4. ambulating in the parallel bars

Answer 50

3. All of the listed tasks are reasonable expectations for the client, however moving from sitting to standing would be the most difficult.

Question 51

A therapist wears sterile protective clothing while treating a client. Which area of the protective clothing would not be considered sterile even before coming in contact with a nonsterile object?
1. gloves
2. sleeves of the gown
3. front of the gown above waist level
4. front of the gown below waist level

Answer 51

4. Due to the probability associated with incidental contact, the front of the gown below waist level is considered to be non sterile.

Question 52

A physical therapist conducts goniometric measurements on a client in supine.
When measuring elbow flexion the therapist’s stabilizing force should be directed at the?
1. radioulnar joint
2. olecranon
3. distal humerus
4. proximal humerus

Answer 52

3. Stabilization should occur on the distal humerus to prevent shoulder flexion.

Question 53

A client two days status post transfemoral amputation demonstrates decreased strength and generalized deconditioning. Which of the following positions should be utilized when wrapping the client’s residual limb?
1. sidelying
2. standing
3. supine
4. prone

Answer 53

3. A supine position will ensure client safety and allow the therapist full access to the residual limb.

Question 54

A client who underwent a transtibial amputation one week ago complains of phantom sensation. Which of the following treatment options would be (inappropriate?
1. tell the client to leave the residual limb exposed to the air at all times
2. discuss the option of a temporary prosthesis with the client’s physician
3. begin residual limb wrapping
4. teach the client to tap and massage the residual limb

Answer 54

1. Leaving the residual limb exposed to the air at all times would result in increased edema and a misshapened residual limb.

Question 55

A therapist transports a client with multiple sclerosis to the gym for her treatment session. The client is wheelchair dependent and uses a urinary catheter. When transporting the client, the most appropriate location to secure the collection bag is?
1. in the client’s lap
2. on the lower abdomen
3. on the wheelchair armrest
4. on the wheelchair leg rest

Answer 55

4. Positioning of the collection bag on the wheelchair leg rest will allow for it to be below the level of the bladder.

Question 56

A physical therapist examines a client with multiple sclerosis. The client has poor to fair strength in her legs, good arm strength, and moderate truncal ataxia. The safest means for the client to ambulate in her home would be _____? this technique?
1. with a single point cane
2. with a walker
3. while holding onto furniture or walls
4. with axillary crutches

Answer 56

2. The client’s balance and strength require the stability provided by the walker.

Question 57

A physical therapist attempts to examine the extent of ataxia in a client’s upper extremities. The preferred method to examine and document ataxia is
1. manual muscle test
2. sensory test for light touch
3. functional assessment for rolling in bed
4. finger to nose

Answer 57

4. Ataxia refers to defective muscular coordination with active movement. A gross measure of upper extremity ataxia can be assessed through a finger to nose test.

Question 58

A physical therapist treats a client with Parkinson’s disease. In order to improve the client’s motor control, the therapist should incorporate which of the following techniques into the treatment session?
1. alternating isometrics
2. rhythmic initiation
3. manual resisted exercise
4. lumbar stabilization exercises in quadruped

Answer 58

2. Rhythmic initiation is a particularly effective technique to improve motor control in clients with Parkinson’s disease since they often have difficulty initiating
   movement.

Question 59

A physical therapist examines a client diagnosed with cerebellar degeneration.
Which of the following signs/symptoms is not characteristic of cerebellar degeneration?
1. limb ataxia
2. nystagmus
3. dysmetria
4. hypertonia

Answer 59

4. Clients with cerebellar degeneration often exhibit hypotonia, not hypertonia.

Question 60

A therapist attempts to improve neck and upper back extension in an infant with . developmental delay. When passively placed in prone prop, the infant quickly falls into the prone position. The therapist plans to position the child and then use toys and play objects to get the child to look up. Which position would be the most appropriate to meet the therapist’s treatment objective?
1. prone prop
2. prone over a gymnastic ball
3. prone over a wedge
4. quadruped

Answer 60

3. Prone over a wedge positioning allows for the facilitation of head and back extension through visual tracking or upper extremity movement occurring during therapeutic play.

Question 61

An eleven month old child with cerebral palsy attempts to maintain a quadruped position. Which reflex would interfere with this activity if it did not integrate appropriately?
1. Gallant reflex
2. symmetrical tonic neck reflex
3. plantar grasp reflex
4. positive support reflex

Answer 61

2. Head positioning is the stimulus for the symmetrical tonic neck reflex. When. the head is flexed, upper extremities flex and lower extremities extend. When the head extends the upper extremities extend and the lower extremities flex. The reaction of the extremities would not allow for maintaining a hands and knees position.

Question 62

A male therapist is treating a 16 year-old female for a low back strain. During the treatment session the client makes several sexually suggestive remarks. The therapist ignores the remarks, but the client reiterates them during the next treatment session. The most appropriate therapist action is to_.
?
1. continue to ignore the client’s remarks . 2.explain to the client that her remarks are offensive
3. document the client’s behavior in the medical record
4. transfer the client to another therapist’s schedule

Answer 62

2. Inappropriate behavior is unacceptable and should not be tolerated. The therapist needs to make the client aware that her behavior is inappropriate and offensive.

Question 63

A therapist attempts to schedule a client for an additional therapy session after completing the initial examination. The physician referral indicates the client is to be seen two times a week. The therapist suggests several possible times to the client, but the client insists she can only come in on Wednesday at 4:30. The therapist would like to accommodate the client, but already has two clients scheduled at that time. The most appropriate action is to.
_?
1. schedule the client on Wednesday at 4:30
2. attempt to move one of the client’s schedule on Wednesday at 4:30 to a different time
3. schedule the client with another therapist on Wednesday at 4:30
4. inform the referring physician the client only will be seen once this week in therapy

Answer 63

3. Scheduling with another therapist will allow the client to be seen two times a week as indicated on the referral and will accommodate the client’s schedule.

Question 64

A physical therapist develops a series of long and short term goals for a client.
Which of the following is not a necessary component of a properly written goal?
1. audience
2. degree
3. behavior
4. priority

Answer 64

4. Well written goals contain four distinct elements: audience, behavior, condition, and degree.

Question 65

A physical therapist consults with an orthotist regarding the need for an ankle-foot Orthosis for a stroke client. The client has difficulty moving from sitting to standing when wearing a prefabricated ankle-foot orthosis. The therapist indicates the client has poor strength at the ankle, intact sensation and does not have any edema or tonal influence. The most appropriate type of ankle-foot orthosis for the client would incorporate.
?
1. an articulation at the ankle joint
2. tone reducing features
3. metal uprights
4. dorsiflexion assist spring

Answer 65

1. An articulation at the ankle joint would allow the tibia to advance forward over the fixed foot. This would assist with weight shifting during the sit to stand transfer.

Question 66

A physical therapist establishes safe exercise intensity parameters for a phase I impatient cardiac rehabilitation program. Which parameter would be the most appropriate for the phase I program?
1. a maximum heart rate increase of 20 beats per minute above resting
2. a maximum heart rate increase of 30 beats per minute above resting
3. a maximum heart rate increase of 40 beats per minute above resting
4. a maximum heart rate increase of 50 beats per minute above resting

Answer 66

1. A maximum heart rate increase of 20 beats per minute above resting is considered a safe guideline for a client participating in a phase I program.

Question 67

A physical therapist provides preoperative instruction for a client scheduled for anterior cruciate ligament reconstructive surgery. During the treatment session, the client expresses to the therapist a sincere fear of dying during surgery. The therapist’s most appropriate response would be
1. This surgery is done many times every day.
2. I have never had a client of mine die yet.
3. Surgery can be a very frightening thought.
4. You will be back to athletics before you know it.

Answer 67

3. The response “surgery can be a very frightening thought” is an empathetic response that demonstrates respect for the client’s feelings.

Question 68

Premature ventricular contractions are the most commonly observed form of arrhythmias. Which of the following does not assist in precipitating PVCs?
1. anxiety
2. tobacco
3. alcohol
4. sodium

Answer 68

4. Anxiety, tobacco, alcohol and caffeine consumption can all serve to precipitate preventricular contractions. Sodium has not been shown to have any direct correlation.

Question 69

A physical therapist using an electrical stimulation device attempts to quantify several characteristics of a monophasic waveform. When measuring phase charge? the standard unit of measure is?
1. coulomb
2. ampere
3. ohm
4. seconds

Answer 69

1. Phase charge is represented by the area under a single phase waveform. The unit of measure is the coulomb.

Question 70

A physical therapist instructs a client in ambulation activities using axillary
Crutches. What two points of control should be used when guarding the client?
1. the client’s thorax and hip
2. the client’s shoulder and hip
3. the client’s shoulder and thorax
4. the client’s elbow and hip

Answer 70

2. Guarding should occur with one hand positioned on the client’s shoulder and the other on the hip. If a gait belt is used the lower hand should grasp the gait belt with the forearm in a supinated position.

Question 71

There can be many adverse effects when clients are fit incorrectly for a wheelchair.
Which of the following could result from a wheelchair with excessive seat depth?
1. decreased trunk stability
2. increased weightbearing on the ischial tuberosities
3. decreased balance
4. increased pressure in the popliteal area

Answer 71

4. Increased pressure in the popliteal area can lead to skin irritation and circulatory compromise.

Question 72

A therapist assesses the functional strength of a client’s hip extensors while observing a client move from standing to sitting. What type of contraction occurs in the hip extensors during this activity?
1. concentric
2. eccentric
3. isometric
4. isotonic

Answer 72

2. The gluteus maximus and the hamstrings function as primary hip extensors.
   These muscles function in an eccentric fashion when moving from standing to sitting.

Question 73

A rehabilitation manager develops a quality assurance program that examines the extent to which physical therapists conform to accepted professional practices.
This type of quality assurance program is most concerned with?
1. structure
2. process
3. outcome
4. product

Answer 73

2. Quality assurance programs which focus on process explore the methods, actions and operations used to bring about a specific result.

Question 74

A client referred to physical therapy with chronic low back pain has failed to make any progress toward meeting established goals in over three weeks of treatment.
The therapist has employed a variety of treatment techniques, but has yet to observe any sign of subjective or objective improvement in the client’s condition. The most appropriate action would be to?
1. transfer the client to another therapist’s schedule
2. re-examine the client and establish new goals
3. continue to modify the client’s treatment plan
4. alert the referring physician of the client’s status

Answer 74

4. The physician should be informed about the client’s lack of progress. The client may be discharged from physical therapy or referred back to the physician.

Question 75

A client with cardiopulmonary pathology is referred to physical therapy. The therapist documents the following clinical signs: pallor, cyanosis, and skin coolness. These clinical signs are most consistent with
1. cor pulmonale
2. anemia
3. atelectasis
4. diaphoresis

Answer 75

2. Anemia refers to a reduction in the number of circulating red blood cells.
   Additional symptoms include vertigo, weakness, headache and general malaise.

Question 76

A physician instructs a client to take nonprescription or over the counter medication as part of his treatment program. Which of the following statements about over the counter medication is not accurate?
1. The Food and Drug Administration classifies drugs as prescription or nonprescription.
2. Over the counter medications are available without a prescription and can be purchased directly by consumers.
3. Over the counter medications usually contain low doses of their active ingredient.
4. Potentially harmful effects are not possible with over the counter medications.

Answer 76

4. Although over the counter medications contain low doses of their active ingredients, harmful effects can occur.

Question 77

A pregnant client in her third trimester completes a series of exercises in supine. In order to prevent vena cava compression during the exercise session the therapist should?
1. place a folded towel under the right side of the client’s pelvis
2. place a folded towel under the left side of the client’s pelvis
3. complete the exercises in sidelying
4. elevate the client’s feet 12 inches

Answer 77

1. This position will tend to lessen the effects of uterine compression on abdominal vessels and improve cardiac output by turning the client slightly to the left.

Question 78

A therapist completes an upper extremity manual muscle test on a client diagnosed with rotator cuff tendinitis. Assuming the client has the ability to move the upper extremities against gravity, which of the following muscles would not be tested with the client in a supine position?
1. pronator teres
2. pectoralis major
3. lateral rotators of the shoulder
4. middle trapezius

Answer 78

4. Muscle testing of the middle trapezius should occur with the client in the prone position.

Question 79

A physical therapist is working with a child who has cerebral palsy with spastic diplegia. All of the following could be used to improve the child’s ability to ambulate except.?
1. stretching and range of motion
2. strengthening of underlying weak muscles
3. bilateral lower extremity activities such as “bunny hopping”
4. trunk and pelvis dissociation activities

Answer 79

3. A client with spastic diplegia often utilizes mobility strategies such as “bunny hopping due to the lack of dissociation of the lower extremities from each other as well as the trunk from the pelvis. These activities should be discouraged and the focus should instead be on dissociation and reciprocal movement patterns.

Question 80

Atwo year old with T10 spina bifida receives physical therapy for gait training.
The preferred method when first teaching the child how to maintain standing is with the use of?
1. bilateral HKAFOs and forearm crutches
2. a parapodium and the parallel bars
3. bilateral KAFOs and the parallel bars
4. bilateral AFOs and the parallel bars

Answer 80

2. For thoracic and high level lumbar lesions the parapodium provides the necessary amount of support and is optimal to assist with standing activities. The parallel bars are the most stable assistive device to initiate standing and to utilize during formal gait training.

Question 81

A physical therapist instructs the parents of a premature infant on proper positioning. The physical therapist should educate the parents to avoid placing their infant‚in supine?
1. lower extremity extension
2. slight neck flexion
3. hands towards midline
4. scapular protraction

Answer 81

1. Premature infants do not have the prolonged intrauterine environment which assists in the development of flexion. There is a high risk for the infant to develop excessive extension and therefore should not be positioned in full extension in the supine position.

Question 82

A 45 year-old female with psoriasis is referred to physical therapy. The client has several lesions on the posterior portion of the thigh extending into the popliteal fossa. The most appropriate therapeutic modality to treat the client’s condition is
1. iontophoresis
2. moist heat
3. ultrasound
4. ultraviolet

Answer 82

4. Ultraviolet light combined with topical psoralens has proven to be effective in treating psoriasis.

Question 83

A therapist reviews a technical manual for an electrical stimulation unit. The manual discusses several inherent electrical terms such as voltage, current and resistance. Which of the following terms is commonly used to express current?
1. ampere
2. coulomb
3. kilohm
4. megohm

Answer 83

1. Ampere is the standard unit of measure for current.

Question 84

A client files suit against a physical therapist claiming that she was injured as a result of a specific treatment technique. In legal proceedings, which of the following would have the most impact on what actually happened at the time of the alleged negligent act?
1. the client’s recollections
2. the therapist’s recollections
3. the referring physician’s initial examination
4. the physical therapist’s daily documentation

Answer 84

4. Although a variety of subjective and objective data are admissible in a court of law, formal documentation is often paramount.

Question 85

A therapist instructs a client to ascent stairs using axillary crutches. Which of the following statements most accurately reflects proper guarding technique?
1. the therapist is positioned posterior and lateral on the affected side behind the client
2. the therapist is positioned anterior and lateral on the affected side in front of the client
3. the therapist is positioned posterior and lateral on the nonaffected side behind the client
4. the therapist is positioned anterior and lateral on the nonaffected side behind the client

Answer 85

1. This position affords the therapist with the best opportunity to protect the client
   in the event of a fall.

Question 86

A physical therapist prepares a client education program for an individual with: chronic venous insufficiency. Which of the following would not be appropriate to include in the client education program?
1. wear shoes that accommodate to the size and shape of your feet
2. observe your skin daily for breakdown
3. wear your compression stockings only at night
4. keep your feet elevated as much as possible throughout the day

Answer 86

3. Clients with chronic venous insufficiency must wear compression stockings during periods of activity such as ambulation in order to avoid venous stasis and promote return to the heart.

Question 87

A 72 year-old female six weeks status post stroke is scheduled for discharge from the hospital in one week. At the present time the client is unable to ambulate and required maximal assistance to complete most transfers. Prior to her hospital admission the client lived alone in an apartment on the first floor. The most appropriate discharge plan would be?
1. home with no support services
2. a nursing home
3. home with physical therapy three times per week
4. home with a home health aide during the day.

Answer 87

2. The client’s dependence with ambulation and transfers eliminate home care as a viable option.

Question 88

A therapist instructs a client in breathing exercises to improve ventilation and oxygenation, The therapist’s treatment objective emphasizes the expansion of a selected area of the chest wall during inspiration. The most appropriate breathing exercise to achieve the desired outcome is?
1. deep breathing
2. diaphragmatic breathing
3. segmental breathing
4. abdominal breathing

Answer 88

3. Segmental breathing can be an effective treatment technique designed to direct activity toward selected areas of the lung.

Question 89

A graded exercise test is performed on a client with pulmonary disease. During the test the therapist identifies that the client’s systolic blood pressure has decreased by 20 mmHg. The most appropriate action is to.
1. continue the graded exercise test
?. discontinue the graded exercise test
3. assess the client’s respiration rate
4. assess the client’s forced expiratory volume in one second

Answer 89

2. A decrease in systolic blood pressure of greater than 10 mmH or failure of systolic blood pressure to rise with an increase in work load are indications to discontinue a graded exercise test.

Question 90

A 16 year old complete C5 spinal cord injured client is two weeks status post injury. The client presently tolerates only 30 degrees on the tilt table secondary to orthostatic hypotension, Which transfer would be the most appropriate to utilize when moving the client from bed to the tilt table?
1. hydraulic lift
2. sliding transfer with draw sheet
3. two person lift
4. dependent standing pivot transfer

Answer 90

2. A sliding transfer with drawer sheet is the only transfer which will allow the client to maintain a position of less than 30 degrees elevation.

Question 91

It is essential to maintain a sterile field once it has been established. Which of the following activities would not be in violation of a sterile field?
1. sneezing while standing in front of a sterile field
2. reaching across a sterile field
3. turning your back to the field
4. allowing a sterile object to touch another sterile object

Answer 91

4. Sterile objects which touch each other are still considered sterile.

Question 92

Residual limb wrapping is often a necessary component of a treatment program following lower extremity amputation. Which of the following is not characteristic of a properly applied bandage?
1. smooth and wrinkle free
2. emphasizes angular turns
3. provides pressure distally
4. encourages proximal joint flexion

Answer 92

4. Encouraging proximal joint flexion can lead to contractures.

Question 93

A therapist determines that a client rehabilitating from ankle surgery has consistent difficulty with functional activities that emphasize the frontal plane. Which of the following activities would be the most difficult for the client?
1. anterior lunge
2. 6 inch lateral step down
3. 6 inch posterior step up
4. 8 inch posterior step down

Answer 93

2. The frontal plane divides the body into front and back halves. Movements in the frontal plane occur as side to side movements such as abduction or adduction.
   Rotary motion in the frontal plane occurs around an anterior-posterior axis.

Question 94

A client rehabilitating from a radial head fracture is examined in physical therapy.
During the examination, the therapist notes that the client appears to have an elbow flexion contracture. Which of the following would not act as an appropriate active) exercise technique to increase range of motion?
1. contract-relax
2. hold-relax
3. maintained pressure
4. rhythmic stabilization

Answer 94

3. Maintained pressure is an effective technique that can be used to increase range of motion by facilitating local muscle relaxation; however it is a passive technique.

Question 95

A therapist monitors a client’s pulse after ambulation activities. The therapist notes that at times the rhythm of the pulse is irregular. When assessing the client’s pulse rate, the therapist should measure the client’s pulse for
?
1. 10 seconds
2. 15 seconds
3. 30 seconds
4. 60 seconds

Answer 95

4. An irregular pulse should be taken for 60 seconds in order to achieve an accurate
   measurement.

Question 96

A therapist adjusts the height of the parallel bars in preparation for client-ambulation. When at the appropriate height, the parallel bars should provide
1. 5-15 degrees of elbow flexion
2. 15-25 degrees of elbow flexion
3. 30-40 degrees of elbow flexion
4. 35-45 degrees of elbow flexion

Answer 96

2. The parallel bars should be adjusted to provide 15-25 degrees of elbow flexion with a client in standing and holding the parallel bars six inches anterior to his/her hips.

Question 97

Standard postural drainage positions for specific lung segments utilize a variety of client positions, including sitting, sidelying, supine, and prone. Postural drainage of the ____________ typically is administered with the client in sitting?
1. anterior basal segments of the lower lobes
2. posterior segments of the upper lobes
3. posterior basal segments of the lower lobes
4. right middle lobe

Answer 97

2. Postural drainage to the posterior segments of the upper lobes is performed with the client sitting, leaning over a pillow at a 30 degree angle.

Question 98

When evaluating a client for a wheelchair, a therapist determines that the client’s hip width in sitting and the measurement from the back of the buttocks to the popliteal space are each 16 inches. Given these measurements, which of the following wheelchair sizes would best fit this client?
1. seat width 16 inches, seat depth 14 inches
2. seat width 18 inches, seat depth 18 inches
3. seat width 16 inches, seat depth 18 inches
4. seat width 18 inches, seat depth 14 inches

Answer 98

4. Seat width = hip width + 2 inches; Seat depth = posterior buttock-to the popliteal
   space - 2 inches.

Question 99

A client recently admitted to the hospital with an acute illness is referred to physical therapy. During a scheduled treatment session the client asks what effect anemia will have on his ability to complete a formal exercise program. The most appropriate therapist response is?
1. you may feel as though your muscles are weak
2. you may experience frequent nausea
3. your aerobic capacity may be reduced
4. you may have a tendency to become fatigued

Answer 99

4. Anemia is defined as a reduction in the number of circulating red blood cells per cubic millimeter. Symptoms of anemia include pallor of the skin, vertigo and general malaise.

Question 100

When performing range of motion exercises with a client who suffered a head injury, a physical therapist notes that the client lacks full elbow extension and classifies the end feel as hard. The most likely cause is?
1. heterotopic ossification
2. spasticity of the biceps
3. anterior capsular tightness
4. triceps weakness

Answer 100

1. Heterotopic ossification refers to abnormal bone growth in tissue. Signs and symptoms include decreased range of motion, local swelling and warmth.
   Heterotopic ossification often occurs in clients following a head injury.

Question 101

A client rehabilitating from injuries sustained in a motor vehicle accident is referred to physical therapy for gait training with an appropriate assistive device. The therapist attempts to instruct the client using axillary crutches, but feels the assistive* device does not offer the client enough stability or support. Which of the following assistive devices would be the most appropriate for the client?
1. walker
2. cane
3. Lofstrand crutches
4. parallel bars

Answer 101

1. A walker provides more stability than axillary crutches and is more functional than the parallel bars.

Question 102

A therapist attempts to develop a problem list after examining a client with a (transtibial amputation. Which of the following would be the most appropriate entry in the client problem list?
1. donning and doffing prosthesis required verbal cues
2. donning and doffing prosthesis requires verbal cues and minimal assist of 1
3. dependence with donning and doffing prosthesis
4. independent donning and doffing prosthesis in one week

Answer 102

3. The problem list should summarize the significant findings of the client as determined by the subjective and objective examination. Since the problem list relates back to the subjective and objective portion of the note each entry should be described in broad terms.

Question 103

The director of rehabilitation in an orthopedic private practice prepares a list of interview questions for applicants applying for a vacant position. Which of the following would be an acceptable interview question?
1. Are you in good health?
2. How much weight can you lift?
3. Have you held a position like this in the past?
4. Have you ever filed a workers’ compensation claim?

Answer 103

3. Questions asked during interviews should only relate to the functions associated with a given job and should not probe into an applicant’s past medical or social history.

Question 104

A 42 year-old female who is unable to satisfactorily control the retention and release of urine uses a catheter. Which type of urinary catheter would not be appropriate for the client?
1. indwelling urinary catheter
2. external urinary catheter
3. foley catheter
4. suprapubic catheter

Answer 104

2. External catheters are applied over the shaft of a penis and are therefore inappropriate for females.

Question 105

A client ambulating with an IV in place should be instructed to grasp the IV pole at what level?
1. a level where the infusion site is above heart level
2. a level where the infusion site at heart level
3. a level where the infusion site is below heart level
4. a client with an IV in place should not participate in ambulation activities

Answer 105

2. In order to promote optimal fluid flow from an IV when ambulating, a client should grasp the pole so the infusion site is at heart level.

Question 106

A therapist monitors a 6 foot 3 inch, 275 pound, male’s blood pressure using the brachial artery. Which of the following is most important when selecting an appropriate size blood pressure cuff?
1. client age
2. percent body fat
3. somatotype
4. extremity circumference

Answer 106

4. The width of a bladder should be approximately 40% of the circumference of the midpoint of the limb. Bladder width for an average size adult is 5-6 inches.

Question 107

Accurate, clear and concise documentation is becoming increasingly important for all health care providers. Which of the following suggestions to improve documentation would not be useful?
1. avoid empty or open lines between entries in the medical record
2. make sure all entries in the medical record are typewritten
3. use abbreviations that have been standardized or accepted by a specific facility or the profession
4. co-sign the entries of other medical personnel when necessary according to state and facility requirements

Answer 107

2. Although typewritten entries in the medical record are acceptable, they are not required.

Question 108

A client informs his therapist that he has to use the bathroom immediately after being transported outside the hospital to practice car transfers. The therapist’s most appropriate response to meet the client’s physical need is to
?
1. ask the client if it is an emergency
2. complete the transfer training as quickly as possible and allow the client to use the bathroom
3. transport the client back into the hospital to use the bathroom
4. instruct the client that in the future he should use the bathroom before beginning physical therapy

Answer 108

3. The only viable solution to meet the client’s physical need is to allow him to use the bathroom.

Question 109

A therapist’examines a client seven days status post total hip replacement. The client’s medical record indicates the surgeon utilized an anterolateral surgical approach. Which of the following motions would be the most important to restrict during the initial phase of rehabilitation?
1. knee extension
2. knee flexion
3. hip external rotation
4. hip internal rotation

Answer 109

3. A client status post total hip replacement using an anterolateral surgical approach would be most restricted in external rotation. Failure to restrict external rotation may result in hip dislocation or subluxation.

Question 110

A therapist monitors a client’s pulse rate using the radial artery. Which of the following general statements regarding pulse rate is not accurate?
1. pulse rate is inereased with physical exertion
2. pulse rate is decreased during relaxation or sleep
3. pulse rate is decreased with anxiety or stress
4. pulse rate is higher in children than adults

Answer 110

3. Pulse rate is increased with anxiety or stress.

Question 111

A client informs her therapist how frustrated she feels after being examined by her physician. The client explains that she becomes so nervous; she can not ask any questions during scheduled office visits. The therapist’s most appropriate response is to?
1. offer to go with the client to her next scheduled physician visit
2. offer to call the physician and ask any relevant questions
3. suggest that the client write down questions for the physician and bring them with her to the next scheduled visit
4. tell the client it is a very normal response to be nervous in the presence of a physician

Answer 111

3. Suggesting the client write down questions for the physician is a practical and realistic option that will assist her in future interactions.

Question 112

A physical therapist observes an electrocardiogram of a client on beta blockers.
Which of the following ECG changes could be facilitated by the beta blockers?
1. bradycardia
2. tachycardia
3. increased AV conduction time
4. ST segment sagging

Answer 112

1. Beta blockers decrease heart rate and the force associated with myocardial contraction.

Question 113

A therapist instructs a client with acute Achilles tendinitis in a home exercise program. As part of the program, the therapist attempts to reduce the inflammation in the involved region. Which of the following modalities would bet the most beneficial to achieve the therapist’s goal?
1. continuous ultrasound
2. pulsed ultrasound
3. ice massage
4. whirlpool

Answer 113

3. Ice massage is an accessible and effective cryotherapeutic agent that is often incorporated into a home exercise program to reduce inflammation.

Question 114

An athlete is forced to contemplate knee surgery after spraining the anterior cruciate ligament while playing soccer. Which situation would provide the most direct support for an anterior cruciate ligament reconstruction?
1. grade III ACL and grade I PCL injury
2. grade III ACL sprain with lateral meniscal involvement
3. grade II ACL sprain with medial meniscal involvement
4. functional instability

Answer 114

4. Many individuals are able to continue to function at high levels despite a variety of ligamentous and meniscal injuries; therefore functional instability provides the most direct support for an anterior cruciate ligament reconstruction.

Question 115

A therapist asks a client who has been inconsistent with his attendance in physical therapy, why he is having difficulty keeping scheduled appointments. The client responds that it is difficult to understand the scheduling card that lists the appointments. The therapist’s most appropriate action would be to?
1. contact the referring physician to discuss the client’s poor attendance, in therapy
2. make sure the client is given a scheduling card at the conclusion of each session
3. write down the client’s appointments on a piece of paper in a manner that the client can understand
4. discharge the client from physical therapy

Answer 115

3. In order to determine if the client’s poor attendance in therapy is due to difficulty understanding the scheduling card, the information must be presented in a manner that the client can understand.

Question 116

A client status post coronary artery bypass graft is exercising in a phase I cardiac rehabilitation program. While exercising, the client’s pulse rate is measured as 125 beats per minute and her respiration rate is 32 breaths per minute. Based on the client’s vital signs, the therapist’s most immediate response should be to
1. stop the exercise session and continue to monitor the client’s vital signs
2. continue with the exercise session and continue to monitor the client’s vital signs
3. notify the referring physician of the client’s vital signs
4. document the client’s response to exercise in the medical record

Answer 116

1. Although resting levels of heart rate and blood pressure were not provided, a heart rate of 125 beats per minute and a respiration rate of 32 breaths per minute . exceed typical values.

Question 117

A therapist reviews the medical chart of a client diagnosed with a fracture of the dower thoracic spine. The chart indicates the client has worn an anterior control thoracolumbar-sacral-orthosis for eight weeks. What is the primary purpose of the anterior control TLSO?
1. prevent thoracic flexion
2. prevent thoracic extension
3. prevent lumbar flexion
4. prevent lumbar extension

Answer 117

1. TLSOs prevent thoracic flexion and are most commonly prescribed in cases of fracture or compression of the body of the lower thoracic or upper lumber vertebrae. TLSOs are sometimes referred to as a “Jewett brace’

Question 118

Which of the following can be used to examine and objectively document motor return in a client with hemiplegia?
1. Tinetti Balance and Gait Assessment Scale
2. Somatosensory Organization Test
3. Functional Independent Measure
4. Fugl-Meyer Assessment of Motor Performance

Answer 118

4. The FugI-Meyer has been proven to have good validity and reliability for assessing motor function and balance in clients with hemplegia.

Question 119

A therapist palpates proximally along the lateral border of the fifth metatarsal of a client’s foot. Which bone would be palpable as the therapist continues to palpate proximally along the lateral border of the foot?
1. cuboid
2. second cuneiform
3. third cuneiform
4. navicular

Answer 119

1. The cuboid is located on the lateral aspect of the foot immediately posterior to the styloid process of the fifth metatarsal.

Question 120

A therapist establishes the following short term goal for client rehabilitating from total knee replacement surgery. Client will ambulate with walker 50% weightbearing and moderate assist of 1 for 20 feet within one week. Three days later, the client successfully achieves the established goal. Which of the following would be the most appropriate revision of the short term goal?
1. ambulate with walker 25% WB and moderate assist of 1 for 25 feet within one week
2. ambulate with walker 50% WB and moderate assist of 2 for 30 feet within one week
3. ambulate with walker 50% WB and minimal assist of 1 for 30 feet within one
week
4. ambulate with the walker 25% WB and minimal assist of 1 for 10 feet within one week

Answer 120

3. The therapist should not alter the client’s weightbearing status without prior physician approval.

Question 121

Clients who are unable to meet their daily nutritional needs independently often require the use of a feeding device. A feeding device such as a nasogastric tube can be utilized for a variety of purposes. Which of the following does not accurately describe a potential use of the nasogastric tube?
1. administer medications directly into the gastrointestinal tract
2. obtain gastric specimens
3. remove fluid or gas from the stomach
4. obtain venous blood samples

Answer 121

4. A nasogastric tube is a plastic tube that enters the body through a nostril and terminates in a client’s stomach. As a result the tube is not used for obtaining venous samples.

Question 122

All ambulation aids provide varying amounts of stability and support. Many of the aids also have distinct disadvantages, usually resulting from the shape and configuration of the device. Which of the following ambulation aids most likely would cause injury to axillary vessels and nerves when used improperly?
1. walker
2. axillary crutches
3. Lofstrand crutches
4. parallel bars

Answer 122

2. Clients using axillary crutches often lean forward on the crutches to support the body during periods of standing. This activity can lead to damage in the axillary region.

Question 123

A therapist conducts a goniometric assessment of the wrist and hand. When determining the available range of motion for thumb flexion, the therapist should align the axis of the goniometer over the
?
1. dorsal aspect of the first carpometacarpal joint
2. palmar aspect of the first carpometacarpal joint
3. midway between the dorsal aspect of the first and second carpometacarpal joints
4. midway between the palmar aspect of the first and second carpometacarpal joints

Answer 123

2. Carpometacarpal flexion occurs in a frontal plane around an anterior-posterior axis with the client in the anatomical position.

Question 124

A therapist examines a client status post amputation. Which amputation level would be most susceptible to a hip flexion contracture?
1. transfemoral
2. knee disarticulation
3. long transtibial
4. short transtibial

Answer 124

1. Frequent prone positioning is important for clients with transfemoral and transtibial amputations; however clients with transfemoral amputations are more susceptible to a hip flexion contracture.

Question 125

A therapist examines a client with post-polio syndrome, Given the client’s diagnosis, which of the following is the least important component of the examination?
1. strength
2. sensation
3. endurance
4. functional mobility

Answer 125

2. Post-polio syndrome is a term used to describe symptoms that occur years after the onset of poliomyelitis. The condition is believed to result as remaining motor units become more dysfunctional. Sensation is typically not affected by post-polio syndrome.

Question 126

When observing a client ambulating, a therapist notes that the client’s gait has the following characteristics: narrow base of support, short step length bilaterally, and decreased trunk rotation. This gait pattern is often observed in clients with a diagnosis of?
1. stroke
2. Parkinson’s disease
3. post-polio syndrome
4. multiple sclerosis

Answer 126

2. Clients with Parkinson’s disease often exhibit difficulty initiating movement, rigidity, absence of equilibrium responses and diminished associated reactions.

Question 127

A therapist attempts to assess a client’s fine motor coordination following wrist surgery. Which of the following tasks would require the greatest fine motor coordination?
1. stacking large blocks
2. assembling small pins, collars and washers
3. turning cards
4. picking up large heavy objects

Answer 127

2. Assembling small bolts, nuts and washers are activities used in a number of assessment measures which examine fine motor coordination such as the Purdue Peg Board Test.

Question 128

A variety of factors can influence blood pressure. Which individual would you expect to have the lower systolic blood pressure?
1. 10 year old
2. 30 year old
3. 50 year old
4. 70 year’old

Answer 128

1. Approximate blood pressure by age; 10 years old 90/60 mmHg, 30 years old
   115/75 mmHg, 50 years old 125/82 mmH, 70 years old 135/88 mmg.

Question 129

A therapist designs a cardiovascular training program for a 29 year-old male rehabilitating from a lower extremity injury. The client has no known cardiovascular pathology and has been cleared for exercise by his physician. The client’s maximum heart rate during exercise should be calculated as
1. 170 beats per minute
2. 180 beats per minute
3. 191 beats per minute
4. 201 beats per minute

Answer 129

3. Age predicted maximum heart rate = 220-age. Maximum heart rate = 220-29 =
   191.

Question 130

Physical therapy aides can play an important role in the daily operation of a physical therapy department. Which of the following activities would not be appropriate for an aide to perform?
1. cleaning and maintaining exercise equipment
2. transporting clients
3. preparing a treatment area
4. implementing an exercise program

Answer 130

4. The physical therapy aide is a non licensed worker who is trained under the direction of a physical therapist. Aides are involved in client related and non-client related duties, however, would not be responsible for implementing an exercise program.

Question 131

A therapist prepares to complete an assisted standing pivot transfer with a client that requires moderate assistance. In order to increase a client’s independence with the transfer, which of the following instructions would be the most appropriate?
1. I want you to help me perform the transfer.
2. Try to utilize your own strength to complete the transter.
3. Only grab onto me if it is absolutely necessary.
4. Use the power in your legs to assist you during the transfer.

Answer 131

2. “Try to utilize your own strength to complete the transfer is a direct statement which should present the client with a clear understanding of the therapist’s obiective. It also places the client in an active instead of a passive position.

Question 132

A therapist assesses the ligamentous integrity of a client’s knee by completing a series of special tests. The most accurate way to determine if the client’s ligamentous integrity is compromised is to?
1. compare the millimeters of ligamentous laxity to established norms
2. instruct the referring physician to order radiographs
3. compare the ligamentous laxity in the involved knee to the uninvolved knee
4. compare the ligamentous laxity to other clients in the clinic without knee pathology

Answer 132

3. Since all clients have different degrees of ligamentous laxity it is essential to establish a baseline with the uninvolved extremity prior to assessing the involved extremity.

Question 133

A therapist examines a 48 year-old male with degenerative joint disease. The referring physician indicates that the client should be seen in physical therapy three times per week. During the examination the client indicates that the car ride to therapy takes approximately 50 minutes and that child care duties make frequent physical therapy visits impossible. The therapist’s most appropriate action is to?
1. reduce the number of weekly visits and notify the referring physician
2. transfer the client to another therapist’s schedule
3. ask the client to discuss the matter with his physician
4. treat the client three times per week

Answer 133

1. The length of the car ride makes therapy three times a week unrealistic. If reducing the number of therapy visits jeopardizes the outcome of care, it may be appropriate to find therapy services within a more narrow geographic radius,

Question 134

A therapist instructs a client with a lower extremity amputation to wrap her residual* limb. Which of the following would be the least acceptable method of securing the bandages?
1. clips
2. safety pins
3. tape
4. velcro

Answer 134

1. Clips often provide poor anchors and can cut the skin. Safety pins are also of questionable value, however are not as dangerous as clips.

Question 135

A client uses transcutaneous electrical neuromuscular stimulation for pain modulation. Which set of parameters best describes conventional TENS?
1. 50-100 ps, short phase duration, low intensity
2. 100-150 ps, short phase duration, high intensity
3. 150-200 ps, long phase duration, low intensity
4. 200-250 pps, short phase duration, low intensity

Answer 135

1. Conventional TENS utilizes a pulse rate of 50-100 pps, short pulse or phase duration and low intensity to deliver sensory level stimulation.

Question 136

A therapist observes a client’s skin shortly after applying moist heat to the lower back. The therapist identifies several signs of heat intolerance including uneven blotching and a surface rash. The most appropriate action is to?
1. continue with present treatment
2. select an alternate superficial heating agent
3. limit moist heat exposure to five minutes
4. discontinue the moist heat and document the findings

Answer 136

4. Treatment should be discontinued when there is any sign of heat intolerance. It is important to document the incident in order to alert other possible providers to the client’s reaction and to make the incident part of the permanent medical record.

Question 137

A therapist works with a client rehabilitating from a traumatic brain injury on a mat program. The program emphasizes various developmental positions to prepare a client for ambulation activities. Which developmental position would be the most demanding?
1. hooklying
2. quadruped
3. kneeling
4. modified plantigrade

Answer 137

4. The modified plantigrade position requires clients to possess control of equilibrium and proprioceptive reactions. The position offers a small base of support and high center of gravity with weightbearing occurring through the lower extremities.

Question 138

A severely disabled client is referred to physical therapy for gait training. The client exhibits good balance and coordination and has normal upper extremity strength. The client currently is using a wheelchair for the majority of her transportation and occasionally uses a swing to gait pattern with Löfstrand crutches.
The client reports being frustrated by the lack of speed using the swing to gait and would like to learn an alternate gait pattern. What gait pattern would be the most appropriate for the client?
1. two point alternating
2. three point
3. four point alternating
4. swing through

Answer 138

4. A swing through gait pattern relies on the same principles as a swing to gait pattern, however allows a client to bring the lower extremities beyond the point to which the assistive devices were advanced.

Question 139

A therapist prepares a client status post stroke with global aphasia for discharge from a rehabilitation hospital. The client will be returning home with her husband and daughter. The most appropriate form of education to facilitate a safe discharge is to?
1. perform hands on training sessions with the client and family members
2. videotape the client performing transfers and ADLs
3. provide written instructions on all ADLs and functional tasks
4. meet with family members to discuss the client’s present status and abilities

Answer 139

1. Hands on training sessions provide unique opportunities for the therapist to assess the competence of family members in a structural environment.

Question 140

A therapist is required to transfer a 250 lb. dependent client from a mat table to a wheelchair. The therapist is concerned about her ability to independently transfer the client, but is unable to locate another staff member to offer assistance. The most appropriate action would be to.?
1. instruct the client to take a more active role in the transfer
2. attempt to complete the transfer independently but stop immediately if body mechanics are compromised
3. inform the nursing staff to complete the transfer
4. wait until another staff member is available to assist with the transfer

Answer 140

4. Therapists should never place their personal safety in jeopardy.

Question 141

A client successfully completes ten anterior lunges. The therapist would like to modify the activity to maximally challenge the client in the sagittal plane. Which of the following modifications would be the most appropriate?
1. anterior lunge with concurrent bilateral elbow flexion to 45 degrees with five pound weights
2. anterior lunge with concurrent bilateral shoulder flexion to 90 degrêes with five pound weights
3. anterior lunge with concurrent unilateral shoulder flexion to 90 degrees with a five pound weight
4. anterior lunge with concurrent bilateral shoulder abduction to 45 degrees with five pound weights

Answer 141

2. The sagittal plane divides the body into left and right halves. Motions in the sagittal plane include flexion and extension. Bilateral shoulder flexion would create the largest forward movement and would therefore provide the greatest challenge for the client.

Question 142

A therapist teaches a client positioned in supine to posteriorly rotate her pelvis. The client has full active and passive range of motion in the upper extremities, but is unable to achieve fall shoulder flexion while maintaining the posterior pelvic tilt.
Which of the following could best explain these findings?
1. capsular tightness
2. latissimus dorsi tightness
3. pectoralis minor tightness
4. quadratus lumborum tightness

Answer 142

2. Shortening of the latissimus dorsi often presents as a limitation of shoulder flexion or abduction due to the muscles origin on the external lip of the iliac crest and its insertion on the intertubercular groove of the humerus.

Question 143

A clinical instructor asks a student to complete three selected joint mobilization techniques on a client diagnosed with adhesive capsulitis. Which learning domain is emphasized with the desired task’?
1. cognitive
2. psychomotor
3. affective
4. psychosocial

Answer 143

2. The psychomotor domain is directed toward physical activity. The six categories of objectives in the psychomotor domain according to Bloom’s taxonomies are reflex movements, basic fundamental movements, perceptual abilities, physical abilities, skilled movements and non discursive communications.

Question 144

A client sustains a deep laceration on the right thigh after falling into a modality cart. The laceration causes immediate and excessive bleeding. The therapist should first?
1. apply direct pressure over the laceration
2. examine the lower extremity
3. put on gloves
4. contact the chief physical therapist

Answer 144

3. The first and most appropriate action is to put on gloves. Although direct pressure over the laceration is necessary, a therapist must always protect him/herself first.

Question 145

As part of the initial examination, a physical therapist develops long term goals for a client who has complete quadriplegia at the C5 level. All of the following are appropriate long term goals for this client except.?
1. complete lower extremity self range of motion in bed independently
2. eat independently with adaptive equipment
3. propel a manual wheelchair 15 feet on level surfaces independently
4. direct a caretaker to perform a car transfer

Answer 145

1. Self range of motion of the lower extremity is a realistic goal at the C7 spinal injury level, but not at CS.

Question 146

A client with paraplegia is interested in earning how to perform a wheelie to assist with community mobility. The client is independent with basic wheelchair propulsion. When instructing the client to perform a wheelie, the therapist first should teach the client to?
1. make small adjustments (forward and backward) after being placed in the wheelie position
2. move into the wheelie position
3. perform turns while holding the wheelie position
4. statically hold the wheelie position after being place in it by the therapist

Answer 146

4. This activity requires the least skill and will provide the client with the opportunity to gain a sense of balance before moving to more difficult activities.

Question 147

Physical therapists and physical therapist assistants perform many of the same functions in the clinic. Which of the following activities would not be appropriate for a physical therapist assistant to perform?
1. application of superficial modalities
2. instruction of a client in gait training
3. complete documentation in the medical record
4. modification of an established plan of care

Answer 147

4. A physical therapist assistant can modify a specific intervention procedure when necessitated by a change in client status, however cannot alter an established plan of care.

Question 148

A client sustains a traction injury to the brachial plexus in a motor vehicle accident and has resultant C5 and C6 nerve root involvement. Which of the following muscles would be most affected by the injury?
1. flexor carpi ulnaris
2. levator scapulae
3. pectoralis minor
4. pectoralis major

Answer 148

4. The upper fibers of the pectoralis major are innervated by the lateral pectoral nerve C5 C6 C7.

Question 149

A physical therapist observes a burn on the dorsal surface of a client’s arm. The therapist notes that the wound appears to involve the epidermis and most of the dermis. The wound area is mottled red with a number of blisters. The therapist informs the client that healing should take place in less than three weeks. This description is most indicative of a
?
1. superficial burn
2. superficial partial thickness burn
3. deep partial thickness burn
4. full thickness burn

Answer 149

2. A superficial partial thickness burn involves both the epidermis and a portion of the dermis. Healing typically occurs in approximately three weeks with little or no scarring.

Question 150

A group of physical therapists develop a research project which examines the effect of increased abdominal muscle strength on forced vital capacity and forced expiratory volume. In order to conduct the study, the therapists are required to have the approval of the Hospital Institutional Review Board. The primary purpose of the committee is to?
1. protect the hospital from unnecessary litigation
2. ensure that established client care standards are not compromised
3. examine the design of the research project
4. assess the financial ramifications of the research project

Answer 150

2. Institutional review boards are responsible for assuring the welfare and safety of clients and establishing that ethical, moral and legal standards are not compromised by proposed research activity.

Question 151

Members of a community health task force evaluate a proposal for a new adolescent screening program. Several members of the task force raise questions as to the validity of the screening instrument. Which measure of validity examines the instrument’s ability to identify diseased persons by comparing true positives?
1. adaptability
2. selectivity
3. sensitivity
4. specificity

Answer 151

3. Sensitivity can be calculated by taking the number of individuals the instrument identified as diseased, who were diseased, and dividing by the known prevalence of the condition in the group.

Question 152

A client who had difficulty controlling the release and retention of urine uses a urinary catheter. Upon beginning to examine the client, the therapist notices that the collection bag is almost completely full. The most appropriate action is to
1. continue with the examination and periodically monitor the collection bag
2. disconnect the collection bag during the examination
3. empty the collection bag
4. contact the client’s nurse and request assistance

Answer 152

4. Failure to allow for adequate flow of urine into a collection bag can lead to serious medical complications.

Question 153

A therapist discusses the importance of proper skin care with a client and his family. Which of the following sites is least likely to develop a pressure ulcer in a wheelchair dependent client?
1. scapula
2. ischium
3. heel
4. elbow

Answer 153

4. The elbow is not typically in direct contact with a given component of a wheelchair and is therefore not likely to be the site of a pressure ulcer.

Question 154

A group of physical therapists conducts scoliosis screenings on adolescents as past of physical therapy week. The most appropriate action after identifying an adolescent with a moderate scoliotic curve is to.
?
d. refer the adolescent for further orthopedic assessment
2. educate the adolescent as to the causes of scoliosis
3. devise and exercise program for the adolescent
4. instruct the adolescent in the importance of proper posture

Answer 154

1. An adolescent with a moderate scoliotic curve should be referred to a physician for further assessment.

Question 155

A therapist orders a wheelchair for a client recently admitted to a rehabilitation hospital. How many inches above the chair seat is the armrest on a standard adult wheelchair?
1. 5 inches
2. 7 inches
3. 9 inches
4. 11 inches

Answer 155

3. Nine inches above the chair seat allows the typical user to sit upright with the shoulders level while bearing weight on the forearms positioned on the armrests.

Question 156

A therapist designs a treatment program for a client with a traumatic head injury.
The client currently is classified as confused agitated. Which of the following guidelines would be the least beneficial when developing the treatment program?
1. The therapist should emphasize previously learned skills and avoid teaching only new skills
2. The therapist should maintain a calm and focused affect.
3. The therapist should concentrate on one specific activity for each treatment session.
4. The therapist should schedule the client at the same time and same place each
day.

Answer 156

3. Clients in the confused-agitated stage have a short attention span and therefore require numerous activities.

Question 157

A therapist orders a wheelchair for a client with C7 complete quadriplegia. Which of the following wheelchairs would be the most appropriate for the client?
1. electric wheelchair with chin controls
2. manual wheelchair with handrim projections
3. manual wheelchair with friction surface handrims
4. manual wheelchair with standard handrims

Answer 157

3. Friction surface handrims assist a client without a strong grasp.

Question 158

A therapist checks the water temperature of the hot pack machine after several clients report the heat being very strong. Which of the following temperatures would be acceptable?
1. 71 degrees Celsius
2. 88 degrees Celsius
3. 130 degrees Fahrenheit
4. 190 degrees Fahrenheit

Answer 158

1. Hot packs should be stored in water that is approximately 160 degrees
   Fahrenheit or 71 degrees Celsius.

Question 159

A physical therapy department plans a study to examine rehabilitation outcomes in clients who have undergone anterior cruciate ligament reconstruction. The study will include a sample of clients from 25 orthopedic surgeons in the local region. If the therapists compile a list of all eligible clients and select every third client to participate in the study, what type of sampling was used?
1. simple random sampling
2. stratified sampling
3. systematic sampling.
4. cluster sampling

Answer 159

3. Systematic sampling requires a list of all individuals in a defined population.
   Members of the population are automatically selected once the first subject has been chosen.

Question 160

A therapist prepares to mobilize the glenohumeral joint by placing the joint in its resting position. Which of the following explanations best describes why this position is used commonly for joint mobilization?
1. joint compressive forces are minimal in the resting position
2. assessment manipulations are performed easily in the resting position
3. there is maximal congruency in the articular surfaces in the resting position
4. oscillations are performed easily in the resting position

Answer 160

1. The resting position is a position in which the capsule has the greatest laxity. As a result there is maximal joint traction and joint play.

Question 161

A physical therapist designs a research study in which it is desirable to limit the risk when making a conclusion or inference from the study. Which of the following levels of significance would be the most appropriate for the study?
1. .05
2. .01
3. 1.0
4. 10

Answer 161

2. Rejecting the null hypothesis at the .01 level indicates the researcher is taking a
   1% risk of encountering a Type I error.

Question 162

A client who has completed six months of therapy receives a referral for eight additional weeks of physical therapy. The therapist feels the client has plateaued and is not a realistic candidate for continued therapy. The therapist’s most appropriate action is to
?
1. continue the client in physical therapy for eight additional weeks
2. re-examine the client and develop new short and long term goals
3. conduct a four week trial to determine if the client has made objective progress
4. contact the referring physician and discuss the concerns regarding the client’s rehabilitation potential

Answer 162

4. The therapist should not provide additional services when he/she believes the client will no longer benefit from therapy.

Question 163

A therapist uses palpation to assess upper lobe expansion during quiet and deep breathing. Which of the following descriptions most accurately describes proper hand placement when palpating the upper lobe?
1. place the palms firmly against the chest wall and hook the fingers over the posterior axillary fold
2. place the palms of the hand firmly over the anterior aspect of the chest from the fourth rib cranially and hook the fingers around the trapezii
3. place the thumbs over the spine of the scapulae so that the fingers reach around the anterolateral aspects of the neck
4. extend the thumbs over the posterior midline of the back and hook the fingers around the anterior axillary fold

Answer 163

2. It is often necessary to examine upper, middle and lower lobe expansion during quiet and deep breathing.

Question 164

A therapist presents an in-service entitled “Preventing Pressure Ulcers to a group of physical therapy aides. As part of the in-service, the therapist identifies risk actors associated with the development of pressure ulcers. Which of the following would not be considered a significant risk factor?
1. nutritional deficiencies
2. incontinence
3. psychological stress and depression
4. vocational dysfunction

Answer 164

4. Vocational dysfunction is not associated with pressure sores. Other risk factors include diminished sensation, infection, spasticity and disuse atrophy.

Question 165

A client suffers a chemical burn on the cubital area of the elbow, Which position would be the most appropriate for splinting of the involved upper extremity?
1. elbow flexion and forearm pronation
2. elbow flexion and forearm supination
3. elbow extension and forearm pronation
4. elbow extension and forearm supination

Answer 165

4. Splinting in elbow extension and forearm supination will effectively limit contractures and maximize functional use of the upper extremity.

Question 166

Electromyography is performed on a client to objectively determine the extent of pathology after sustaining a brachial plexus injury. Which of the following responses is most indicative of a normal muscle at rest?
1. electrical silence
2. spontaneous potentials
3. polyphasic potentials
4. occasional motor unit potentials

Answer 166

1. The process of electromyography involves asking a client to move a particular muscle so that voluntary potentials can be recorded. There should not be any recorded electrical activity in a muscle at rest.

Question 167

A client with a C7 nerve root injury is examined in physical therapy. Which of the following objective findings would be most indicative of C7 involvement?
1. paresthesias over the little finger
2. weak triceps and wrist flexor muscles
3. paresthesias over the thumb
4. weak biceps and supinator muscles

Answer 167

2. C7 level: Motor - triceps, wrist flexors, finger extensors; Sensation - middle finger; Reflex - triceps.

Question 168

A physical therapist examines a client diagnosed with acromioclavicular joint dysfunction. The therapist instructs the client to abduct his arm in a coronal place to 180 degrees. Which portion of the range of motion would you most expect to .. elicit pain in the acromioclavicular joint?
1. 30-70 degrees
2. 50-90 degrees
3. 90-120 degrees
4. 120-180 degrees

Answer 168

4. Acromioclavicular dysfunction often results in a painful are from 120 - 180 degrees of abduction. A painful arc from 90 - 120 degrees may be indicative of subacromial bursitis, calcium deposits or tendinitis of the rotator cuff muscles.

Question 169

A physical therapist employed in a skilled nursing facility frequently treats cognitively impaired elderly clients. Which of the following guidelines is not recommended when working with this particular population?
1. encourage the use of hands on treatment
2. explain frequently, consistently, and repetitively when necessary
3. change the client’s environment and staff frequently
4. simplify commands and label items for easy recognition

Answer 169

3. Changing the client’s environment and staff frequently will yield to greater levels of stress and cognitive dysfunction.

Question 170

A therapist completes a quantitative gait analysis on a client rehabilitating from a dower extremity injury. As part of the examination the therapist measures the number of steps taken by the client in a 30 second period. This measurement technique can be used to measure
?
1. acceleration
2. cadence
3. velocity
4. speed

Answer 170

2. Cadence is defined as the number of steps taken by a person per unit of time.

Question 171

Members of a health promotion task force design a program that annually will screen individuals in selected retirement communities for osteoporosis. Which screening tool would be the most cost effective and reliable to incorporate as part of the program?
1. physical activity survey
2. dietary analysis
3. measuring height
4. urinalysis screening

Answer 171

3. Osteoporosis refers to a disease process that results in a reduction of bone mass.
   Screening by measuring height can provide an inexpensive method to screen for this disease.

Question 172

A cardiac client undergoes a low-level symptom limited exercise treadmill test that begins at 1.5 MET and progresses to 4 METs. Which of the following activities would require an energy expenditure of approximately 4 METs?
1. sitting quietly at rest
2. level walking at 1 mph
3. level walking at 3 mph
4. level walking at 5 mph

Answer 172

3. Walking at 3 mph, bicycling at 6 mph or playing golf while pulling a bag cart are activities which required 3-4 METs.

Question 173

A physical therapist prepares a client for prosthetic training. Which of the following amputations would require the highest energy expenditure when using the appropriate prosthesis?
1. bilateral transtibial amputations
2. unilateral transtibial amputation
3. unilateral transfemoral amputation
4. Syme’s amputation

Answer 173

3. A client walking at a comfortable pace with a transfemoral prosthesis requires nearly 50% more oxygen than normal.

Question 174

client rehabilitating from a total hip replacement is scheduled for home physical therapy. The therapist assigned to the case attempts to schedule the client, but the client indicates that she will be unavailable for the next week due to a death in the family. The most appropriate therapist action is to?
1. insist that the client participate in physical therapy
2. discharge the client secondary to noncompliance
3. document the conversation with the client and notify the physician
4. ask the physician to convince the client to begin physical therapy immediately

Answer 174

3. It is important to document any delay in the initiation of physical therapy services and to notify the referring physician.

Question 175

A therapist positions the client in prone with the knee flexed to 70 degrees prior to completing a manual muscle test of the hamstrings. To isolate the biceps femoris the therapist should ?
1. place the thigh in slight lateral rotation and the leg in slight lateral rotation on the thigh
2. place the thigh in slight medial rotation and the leg in slight medial rotation on the thigh
3. position the knee in 100 degrees of flexion
4. position the knee in 120 degrees of flexion

Answer 175

1. The test for the lateral hamstrings is described with the knee in 50-70 degrees of flexion with the thigh in slight lateral rotation and the leg in slight lateral rotation on the thigh. Pressure should be applied against the leg proximal to the ankle in the direction of knee extension.

Question 176

A therapist reviews a client’s blood gas analysis. The therapist identifies that the aCO2 is elevated and the pH is below the normal level. These findings are most representative of?
1. respiratory acidosis
2. respiratory alkalosis
3. metabolic acidosis
4. metabolic alkalosis

Answer 176

1. Respiratory acidosis is caused by retention of carbon dioxide due to pulmonary insufficiency. Signs and symptoms include dizziness, tingling, and syncope.

Question 177

A therapist strongly suspects a client is intoxicated after arriving for his treatment session. When asked if he has been drinking, the client indicates he consumed six or seven alcoholic beverages before driving to therapy. The therapist’s most appropriate action is to?
1. continue to treat the client, assuming he can remain inoffensive to other clients
2. modify the client’s present treatment program to minimize the effects of alcohol
3. contact a member of the client’s family to take the client home
4. instruct the client to leave the clinic

Answer 177

3. The client is likely to be intoxicated if he has consumed six or seven beers.
   Contacting a member of the family will prevent the possibility of the client attempting to drive.

Question 178

A therapist instructs a client to complete a biceps strengthening exercise using a ten pound dumbbell in standing. The exercise requires the client to maximally flex her elbow twelve times without moving the trunk. While observing the client performing the exercise, it becomes apparent that the client is unable to maintain her trunk in a stationary position. Which of the following modifications would be the most appropriate?
1. decrease the number of repetitions to six
2. decrease the dumbbell weight to five pounds
3. instruct the client to perform the exercise while sitting on a stool
4. no modifications are necessary

Answer 178

2. Reducing the weight to five pounds will allow the client to maintain the integrity of the originally prescribed exercise, while allowing the client to perform the exercise correctly.

Question 179

A therapist prepares to apply a sterile dressing to a wound after debridement. The therapist begins the process by drying the wound using a towel. The therapist applied medication to the wound using a gauze pad and then applies a series of dressings which are secured using a bandage. Application of the would not require the use of sterile technique?
1. bandage
2. dressings
3. medication
4. towel

Answer 179

1. A bandage is used to secure underlying dressing and therefore does not come in direct contact with the wound.

Question 180

A therapist interviews a client in an attempt to gather information to assist with discharge planning. The client is rehabilitating from an intertrochanteric fracture sustained six weeks ago after a fall. The client has moderate dementia, but has no other significant past medical history. Which of the following situations would present the client with the largest barrier toward living independently?
1. The client resides alone and has no outside support from family or friends.
2. The client is no longer able to drive and relies on a neighbor for all cooking, cleaning and shopping.
3. The client has a two story home.
4. The client resides with a woman who has rheumatoid arthritis.

Answer 180

1. A client with moderate dementia can not live independently without assistance and frequent supervision. Without adequate support the client’s safety is jeopardized.

Question 181

A therapist examines a client diagnosed with Guillain-Barre syndrome. All of the following are signs/symptoms associated with this syndrome except.?
1. difficulty breathing
2. areflexia
3. weakness
4. absent sensation

Answer 181

4. Guillain-Barre is an acute polyneuropathy causing rapid, progressive loss of motor function. Although mild sensory loss can be evident, absent sensation is extremely rare.

Question 182

A physical therapist examines a 42 year-old self-referred female. The client describes the onset of a variety of medical problems approximately one month ago.
The client’s reported problems include right lower extremity weakness, decreased balance and blurred vision. The physical therapy examination confirms the client’s complaints, in addition to identifying decreased pinprick sensation and ankle clonus in the right lower extremity. The suspected diagnosis of this client is
1. diabetes
2. multiple sclerosis
3. stroke
4. Parkinson’s disease

Answer 182

2. Multiple sclerosis is a progressive disease of the central nervous system marked by intermittent damage to the myelin sheath. Blurred vision and muscle weakness are common symptoms associated with this condition.

Question 183

A 78 year-old male, one month status post open reduction and internal fixation of an intertrochanteric fracture is referred to physical therapy. The client has pain with active movement and decreased hip range of motion. Which of the following modalities would be contraindicated for the client?
1. moist heat
2. pulsed ultrasound
3. cryotherapy
4. shortwave diathermy

Answer 183

4. Internal or external metal objects are contraindications for shoitwäve and microwave diathermy.

Question 184

A physical therapist performs a wheelchair evaluation for a client with multiple sclerosis. The client recently fell while ambulating and sustained a fracture of the right tibia. Since the client is presently unable to bear weight through the involved extremity, the client has difficulty transferring from a chair to a bed. Which of the following wheelchair prescriptions is most appropriate for the client?
1. light weight wheelchair, removable armrests, removable elevating leg rests
2. light weight wheelchair, removable armrests, nonremovable leg rests
3. light weight wheelchair, nonremovable armrests, removable elevating leg rests
4. standard wheelchair, nonremovable armrests, and leg rests

Answer 184

1. Removal armrests will assist the client when transferring from wheelchair to bed. Elevating legrests can limit the amount of time the involved leg is in a dependent position.

Question 185

A therapist positions a client in sidelying and performs a talar tilt test. A positive talar tilt test would be most indicative of a?
1. calcaneofibular ligament injury
2. ligamentous instability
3. deltoid ligament injury
4. excessive tibial torsion

Answer 185

1. The talar tilt test is performed with client in supine with the knee flexed to 90 degrees. The foot should be maintained in a neutral position while the foot is moved from side to side into abduction and adduction. A positive test is indicated by excessive adduction.

Question 186

A physical therapist treats a client who is status post traumatic brain injury. The client is classified as level four on the Ranchos Los Amigos Level of Cognitive .
Functioning Scale. Which of the following would be the least appropriate to include in the client’s physical therapy session?
1. redirection to tasks
2. random practice, using a variety of tasks
3. repetition of instructions
4. ambulation in busy environments

Answer 186

4. Clients that are confused-agitated are often over stimulated by busy environments.

Question 187

According to the Motor Control/Task Oriented Approach, a physical therapy treatment session always should include?
1. tone reducing activities
2. positioning
3. functional activities
4. developmental positions

Answer 187

3. The Motor Control/Task Oriented Approach theorizes that movement is organized around a goal behavior. It also believes that strategies for moving are elicited when a client interacts with the environment during a functional task.

Question 188

A therapist completes a daily progress note utilizing a S.O.A.P. format. Which of the following entries would not belong in the objective section?
d. will receive continuous ultrasound to the right anterior shoulder at 1.5 W/cm? for 5 minutes
2. incision on the left anterior forearm covered with steri-strips
3. left lower extremity range of motion within normal limits
4. tenderness to palpation in LI-L2 area

Answer 188

1. The word “will” denotes future tense. This entry is most appropriate in the plan section of a S.O.A.P. note.

Question 189

A physical therapist is treating a client with Parkinson’s disease. The client has trouble initiating movement and is unable to ambulate independently. The client reports that he has fallen on three separate occasions within the last two months while attempting to ambulate. Which assistive device would be the most appropriate for this client?
1. rolling walker
2. walker
3. axillary crutches
4. small base quad cane

Answer 189

1. A rolling walker will provide the client with the necessary stability to ambulate safely. The wheels will allow for a smoother more coordinated gait pattern.

Question 190

A client with muscle weakness and compromised balance uses a four-point gait pattern with two canes. When ascending stairs the most practical method is to
1. use the handrail with the right hand and place the two canes in the left hand
2. use the handrail with the left hand and place the two canes in the right hand
3. place one cane in each hand and avoid using the handrail
4. place the two canes in the left hand and avoid using the handrail

Answer 190

1. When ascending stairs clients should follow the normal flow of traffic. Since the client does not have unilateral weakness it is most appropriate to ascend the stairs on the right. This necessitates holding the canes with the left hand and grasping the handrail with the right.

Question 191

A physical therapist receives a referral for a client who is one week status post head injury. In the client’s medical record it notes that the client demonstrates decorticate posturing. This type of posturing is characterized by
1. upper extremity extension and lower extremity flexion
2. upper extremity flexion and lower extremity flexion
3. upper extremity extension and lower extremity extension
4. upper extremity flexion and lower extremity extension

Answer 191

4. Decorticate posturing is characterized by abnormal flexor responses in the upper extremity and extensor responses in the lower extremities. The posture is usually indicative of a lesion at or above the upper brain stem.

Question 192

A twelve month-old child with cerebral palsy demonstrates an abnormal persistence of the positive support reflex. During therapy this would most likely interfere with?
1. sitting activities
2. standing activities
3. prone on elbows activities
4. supine activities

Answer 192

2. The positive support reflex promotes extension of the lower extremities and trunk with weightbearing through the balls of the feet. This reflex normally integrates at two months of age.

Question 193

A physical therapist treats a client with limited shoulder range of motion. The therapist feels that the client’s range of motion limitation is due to pain and not a specific tissue restriction. Which mobilization grade would be most appropriate to treat this client?
1. Grade I, II
2. Grade II, III
3. Grade III, IV
4. Grade IV, V

Answer 193

1. Grade I or II oscillation or slow intermittent grade I or II sustained joint distraction are primarily utilized for pain.

Question 194

A therapist assesses the hip range of motion of a client with excessive anteversion.
Which of the following clinical findings is common in a client with anteversion?
1. increased hip lateral rotation and decreased medial rotation
2. increased hip medial rotation and decreased lateral rotation
3. increased hip abduction and decreased adduction
4. increased hip flexion and decreased extension

Answer 194

2. Anteversion refers to the degree of angulation of the neck of the femur. In adults the mean is 18-15 degrees. Clients with excessive anteversion often exhibit more than 60 degrees of hip medial rotation and decreased lateral rotation.

Question 195

A client diagnosed with lateral epicondylitis is referred to physical therapy. The therapist elects to use iontophoresis over the lateral epicondyle. Which type of current would the therapist use to administer the treatment?
1. direct
2. alternating
3. pulsatile
4. interferential

Answer 195

1. Direct current is necessary to ensure a unidirectional flow of ions.

Question 196

A client with hemiplegia is ambulating with an ankle-foot orthosis. The therapist notes that the client’s involved foot frequently drags during the initial swing phase of gait. To treat this problem most effectively the therapist should emphasize
1. eccentric strengthening of the hamstrings
2. eccentric strengthening of the gluteus medius
3. concentric strengthening of the plantar flexors 4. concentric strengthening of the iliopsoas/rectus femoris

Answer 196

4. The hip is required to flex during the initial swing to allow for proper clearance and advancement of the limb during gait. Normally, dorsiflexion also occurs.
   Without the use of the dorsiflexors the hip flexors need to be strengthened in order to attain proper clearance.

Question 197

A physical therapist uses the upper extremity DIE proprioceptive neuromuscular facilitation pattern and is resisting elbow extension with the goal of increasing the client’s ability to extend her wrist. This is an example of.?
1. reciprocal excitation
2. successive induction
3. irradiation
4. quick stretch

Answer 197

3. When resistance is applied against a strong component of a pattern it can result in irradiation or overflow of impulses to the weaker muscle groups in that pattern.

Question 198

A client who has suffered a stroke four weeks ago is beginning to show the ability to produce movement patterns not dictated solely by limb synergies. According to Brunnstrom, this client is in which stage of recovery?
1. two
2. three
3. four
4. six

Answer 198

3. Stage 4 in Brunnstrom’s six stages of recovery for hemiplegia consists of a client’s progression to allow for movements performed outside of synergy patterns.

Question 199

A therapist works with a client to improve bed mobility. Which of the following techniques will most effectively increase the client’s hip stability?
1. lower trunk rotation in the hooklying position
2. bridging
3. assisted hip and knee flexion in supine
4. hip abduction and adduction in the hooklying position

Answer 199

2. Bridging causes the muscles of the low back and hip extensors to isometrically contact. This action promotes hip stability.

Question 200

A therapist completes a posture screening and a gross range of motion examination on a client referred to therapy with patellar tendinitis. The therapist determines that the client has extremely limited lower extremity flexibility, most notably in her hip flexors. What common structural deformity often is associated with tight hip flexors?
1. scoliosis
2. kyphosis
3. lordosis
4. spondylosis

Answer 200

3. Clients with tight hip flexors often exhibit an increased lordosis. Shortness of the hip flexors is seen in standing as lumbar lordosis with an anterior pelvic tilt or it can be assessed using the Thomas test.