NPTE Review

Question 1

A physical therapist working with a patient who is borderline hypotensive can minimize orthostatic hypotension by:

1. loosening tight legwear and footwear before gait training.
2. elevating the head during a hypotensive episode.
3. instructing the patient to perform ankle pumps before standing.
4. encouraging the patient to consume meals prior to therapy.

Answer 1

Your Answer: 2
Correct Answer: 3
You have incorrectly answered the question.

Question 2

A patient is unable to fully extend the right knee because of a 20° knee flexion contracture. Which of the following compensations during the swing phase of the left . Hiking of the hip on the left

2. Plantar flexion of the left foot
3. Lateral trunk lean to the left

4.    Dropping of the pelvis on the left extremity is expected?

Answer 2

. Hiking of the hip on the left

2. Plantar flexion of the left foot
3. Lateral trunk lean to the left
4. Dropping of the pelvis on the left

Your Answer: 3
Correct Answer: 1
You have incorrectly answered the question.

1. A knee flexion contracture on the stance limb would make it more difficult to clear the opposite leg during mid-swing. Hip hiking on the left may be performed to attempt to "shorten" the swing leg.
2. Plantar flexion of the swing leg (left) would effectively lengthen the limb, causing further difficulty in clearing the limb.
3. Lateral trunk lean is seen towards the stance side, not the swing side, to reduce abduction demand.
4. Dropping of the pelvis to the left would effectively lengthen the swing leg, and may be seen in midstance to reduce abduction demands

Question 3

A patient underwent surgical decompression and repair of a large rotator cuff tear 2 weeks ago. Which of the following interventions is LEAST appropriate at this time?

1. Maximal elbow isometric exercises
2. Active elbow flexion and extension through full range
3. Pendulum exercise
4. Passive shoulder flexion to 90°

Answer 3

Your Answer: 2
Correct Answer: 1
You have incorrectly answered the question.

1. Maximal exercises are not indicated at this stage of recovery at the elbow.
2. Active range motion at the hand, wrist, and elbow is part of the rehabilitation protocol.
3. Pendulum exercises are a form of passive range of motion permitted at the shoulder in this early stage of healing.
4. Limited passive range of motion of the shoulder is permitted during the early stage of healing.

Question 4

A patient with C3 spinal cord injury is working with a physical therapist to select an appropriate power wheelchair. The wheelchair that the patient is trying out has the following features: power-elevating leg rests, power recline, and chest strap. When the patient performs pressure relief by reclining the wheelchair, spasticity increases in the patient’s lower extremities. The patient should try a wheelchair with:

1. lateral hip guides.
2. non-elevating leg rests.
3. foot straps.
4. power tilt.

Answer 4

Your Answer: 2
Correct Answer: 4
You have incorrectly answered the question.

1. Lateral hip guides will not provide pressure relief.
2. Non-elevating leg rests will not provide pressure relief or address the patient's spasticity.
3. Foot straps would fixate the feet and could cause injury to the patient if the patient reclined and spasticity increased.
4. Power tilt provides pressure relief and is less likely than recline to elicit spasticity.

Question 5

A patient, who has many risk factors for coronary artery disease and is presently not taking any cardiac medications, is interested in beginning an exercise program at a gym to improve cardiac health. The BEST self-assessment of exercise intensity during the exercise sessions of this patient is:

1. change in systolic blood pressure.
2. MET (metabolic equivalent) level.
3. rating of perceived exertion.
4. respiratory rate.

Answer 5

Your Answer: 2
Correct Answer: 3
You have incorrectly answered the question.

1. A change in systolic blood pressure is expected but cannot be easily self-assessed.
2. Metabolic equivalents (MET) levels are a measure of workload but are not useful in self-assessment. Understanding metabolic equivalent (MET) levels requires specialized knowledge.
3. Rating of perceived exertion (RPE) is a valuable self-assessment tool and can easily be shown to the patient during exercise to gather an accurate assessment of exercise intensity.
4. Respiratory rate is not used to prescribe exercise intensity.

Question 6

The parent of a child with myelomeningocele at L2 asks a physical therapist to provide information regarding the child’s prognosis for walking. The therapist should respond by telling the parent that the child will MOST likely be able to:

1. walk with ankle-foot orthoses throughout the home and school.
2. walk with knee-ankle-foot orthoses throughout the home and school.
3. walk with knee-ankle-foot orthoses within the home.
4. stand using a parapodium; walking will not be possible.

Answer 6

Your Answer: 4
Correct Answer: 3
You have incorrectly answered the question.

1. Walking in the home and community using only ankle-foot-orthoses would be possible for a child with a L4–L5 myelomeningocele, not a L2 lesion.
2. A child with a L3–L4 myelomeningocele would be expected to achieve community ambulation using knee-ankle-foot orthoses, not a child with L2 myelomeningocele.
3. A child with L1–L2 level myelomeningocele would be expected to walk short distances in the home.
4. Standing in parapodium would be an appropriate prognosis for a child who has a thoracic–level myelomeningocele. A child with an L2 myelomeningocele is expected to achieve ambulation over short distances with orthoses.

Question 7

An active 75-year-old patient is admitted to the hospital following a fall at home. All workup is negative and comorbidities are limited to osteoarthritis, cataracts, and hypertension. Which of the following statements is the MOST accurate prognosis?

1. Patient should return to the previous level of function within 1 week.
2. Patient will be independent with a walker on all surfaces in 3 weeks.
3. Patient will need to use a wheelchair at home to avoid falls.
4. Patient should be transferred to a skilled nursing facility for safety.

Answer 7

Your Answer: 4
Correct Answer: 1
You have incorrectly answered the question.

1. A prognosis is the predicted optimal level of improvement in function reached in a certain time period. For some patients a prognosis may be difficult to establish initially because of complex new problems. In these patients, the prognosis may be established after some treatment and evidence of improvement has occurred. For other patients, like the one in the question, the issues are not complex. The patient has not developed a new illness and will most likely wish to go home. The patient has common illnesses of older persons and will benefit by gait and balance training while in the hospital, with the anticipation of going home to resume normal activities.
2. There is no mention of a gait dysfunction in the question, therefore assuming the patient needs a walker is inappropriate.
3. The patient needs to be given an opportunity to ambulate safely before turning to a wheelchair.
4. The patient's workup is negative, the patient was active before, and the comorbidities are clear. With gait and balance retraining while in the hospital, the patient should be able to resume normal activity.

Question 8

Electromyographic biofeedback recorded from the quadriceps femoris during a unilateral squat provides information regarding which of the following factors related to the muscle?

1. Endurance
2. Length
3. Activity
4. Force

Answer 8

Your Answer: 4
Correct Answer: 3
You have incorrectly answered the question.

1. EMG biofeedback reflects the amplitude of muscle activation. The EMG signal does not contain any information about muscle endurance.
2. The EMG is a recording of the voltage changes associated with the activation of skeletal muscle fibers. The EMG signal does not contain any information about muscle length.
3. The EMG is a recording of the voltage changes associated with the activation of skeletal muscle fibers. The patient can get auditory and/or visual feedback about the amplitude of muscle activity without intermediate feedback from the therapist.
4. No direct information is contained within the EMG regarding the force that a muscle produces. The relationship between EMG and muscle force holds only under carefully controlled isometric conditions, not for the nonisometric contraction described here.

Question 9

While pivoting on a planted foot with an extended knee, an athlete feels a pop and falls to the ground. Upon standing, the athlete reports that the knee feels unstable. Which of the following tests is MOST likely to detect the pathological condition of the knee?

1. Varus stress test
2. McMurray test
3. Patellar compression test
4. Lachman test

Answer 9

1. The varus stress test is for a lateral collateral ligament problem. The mechanism of injury described in the stem does not indicate a lateral collateral ligament problem. (pp. 871-872)
   
   2. The McMurray test is used to evaluate menisci, and the given history, specifically the lack of stability, does not point to a meniscal injury (p. 879).
   3. The patellar compression test is used to evaluate the patellofemoral joint, and the mechanism of injury described in the stem does not indicate a patellofemoral problem (p. 906).
   4. The Lachman test is used to evaluate the integrity of the anterior cruciate ligament, and this history indicates damage to the anterior cruciate ligament (pp. 872, 912).

Question 10

A physical therapist is treating a patient with biofeedback to alter the overactivity of the upper trapezius during shoulder flexion. The patient has improved by 50% but continues to inappropriately recruit the upper trapezius muscle. Which of the following courses of action for biofeedback should the therapist take NEXT?

1. Decrease the sensitivity (gain).
2. Increase the sensitivity (gain).
3. Maintain the same sensitivity (gain).
4. Modify the sensitivity (gain) until visible motor contraction is reached.

Answer 10

Your Answer: 4
Correct Answer: 2
You have incorrectly answered the question.

1. The sensitivity should be set higher to be more sensitive or selective to the firing of motor fibers so the patient can respond to inappropriate motor recruitment.
2. The sensitivity or “gain” should be increased as the patient learns to decrease, or “train out” muscle recruitment. With increased sensitivity, the patient will work "harder" to not recruit the muscle (inhibition). The patient is attempting to learn how to decrease muscle firing/motor unit activity during voluntary movement.
3. The same sensitivity would not be as effective. The patient has already learned to decrease recruitment of the upper trapezius by 50%, therefore to continue toward the goal of “completely training out” this recruitment, the sensitivity should be increased. With increased sensitivity, the patient will work "harder" to not recruit the muscle (inhibition). The patient is attempting to learn how to decrease muscle firing/motor unit activity during voluntary movement.
4. Biofeedback does not produce a visible muscle contraction like neuromuscular electrical stimulation, it only helps with recruitment of motor units (contracting muscle) and displays the activity of the muscle being monitored. Furthermore, this patient should decrease motor unit recruitment, not increase, therefore, eliciting a visible muscle contraction would not be helpful, as this increases the activity of the motor units.

Question 11

A patient reports insidious onset of mild low back pain that began 1 week ago without a history of trauma. Which of the following symptoms would MOST suggest immediate referral to a physician?

1. Back pain increases with the lower extremity raised and neck flexed in sitting.
2. Pain centralizes with trunk extension.
3. Percussion over the costovertebral angle causes pain.
4. Back pain increases with pressure applied lateral to the anterior superior iliac spines.

Answer 11

Your Answer: 1
Correct Answer: 3
You have incorrectly answered the question.

1. Neck flexion along with a straight leg raise may indicate irritation to the dura and may indicate a disc lesion. If the pain was very severe, it may warrant a referral, but it is a common sign found with disc lesions and may not warrant an immediate referral. (Cook, p. 302)
2. Centralization of pain with trunk extension would be managed with an extension exercise program, not a referral to a physician (Cook, p. 299).
3. Percussion over the costovertebral angle (Murphy test) is a sign of a kidney disorder. A patient with this sign should be referred, since the problem may not be musculoskeletal. (Goodman)
4. This compression test is a common test for sacroiliac pain and would not warrant an immediate referral (Cook, p. 330).

Question 12

In a study of changes in muscle strength, several physical therapists performed manual muscle tests on volunteer subjects. The results of the tests are BEST categorized as which of the following types of data?

1. Reliable data
2. Ratio data
3. Interval data
4. Ordinal data

Y

Answer 12

Your Answer: 3
Correct Answer: 4
You have incorrectly answered the question.

1. Data from manual muscle tests should not be considered reliable unless the reliability of the test has been established.
2. Manual muscle test scores do not provide known or equal distances between scores, nor do they provide an absolute 0, so cannot be considered ratio data.
3. Manual muscle test scores do not provide known or equal distances between scores, so cannot be considered interval data.
4. Manual muscle tests scores are considered ordinal because they label strength measures in rank order but do not provide known or equal distances between the scores.

Question 13

A patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH) would MOST likely have complications involving which of the following systems?

1. Neuromuscular
2. Integumentary
3. Cardiovascular
4. Musculoskeletal

Answer 13

Your Answer: 1
Correct Answer: 3
You have incorrectly answered the question.

1. Syndrome of inappropriate antidiuretic hormone secretion results in fluid volume excess. Fluid loss would be more likely to result in neuromuscular symptoms, such as tetany or tingling. (p. 192)
2. The skin may be warm or cool if edema is present, but there should be no concern with skin integrity in this condition. (p. 192)
3. Syndrome of inappropriate antidiuretic hormone results in fluid volume excess, so it may cause hypertension and arrhythmias, which require monitoring as activity levels change. Also the physical therapist may observe distended neck veins or a visible jugular pulse. (pp. 184, 192, 464-465)
4. Syndrome of inappropriate antidiuretic hormone secretion results in fluid volume excess. Fluid loss would be more likely to result in musculoskeletal symptoms, such as weakness. (p. 192)

Question 14

Which of the following observations indicates an improvement in a patient with dysdiadochokinesia?

1. Decreased resting tremor
2. Increased one-foot standing balance
3. Increased typing speed
4. Decreased horizontal nystagmus

Answer 14

Your Answer: 2
Correct Answer: 3
You have incorrectly answered the question.

1. A resting tremor is most prominent at rest and may decrease or disappear with voluntary movement. Resting tremor is not a component of dysdiadochokinesia (p. 220).
2. Single limb support is not related to dysdiadochokinesia (p. 220).
3. Dysdiadochokinesia is characterized by the inability to perform quick, alternating movements. Typing speed is dependent on the ability to place and lift the fingers quickly (p. 220).
4. Nystagmus is the rhythmic oscillation of the eyes and is not a component of dysdiadochokinesia (p. 212).

Question 15

A physical therapist is preparing to give instructions in the use of a new standing device to the family of a 3-year-old child who has myelomeningocele. Which of the following actions should the therapist perform FIRST?

1. Ask the family what problems they would have with using a standing device.
2. Give the family product literature and a video about the standing device.
3. Ask the family what method would be best for them to learn to use the standing device.
4. Show the family how to place the child into the standing device.

Answer 15

Your Answer: 1
Correct Answer: 3
You have incorrectly answered the question.

1. It is the therapist's responsibility to ensure that the family is comfortable with techniques and activities. Therapists should ask the family how they would best learn a therapeutic technique. Until the family members can use the equipment, they may not be able to identify what would be difficult for them.
2. Although a video may be a useful way of presenting information, it may not be effective for a particular family. Therapists should ask the family how they would best learn a therapeutic technique.
3. It is the therapist's responsibility to ensure that the family is comfortable with techniques and activities. Therapists should ask the family how they would best learn a therapeutic technique.
4. Although demonstration is a useful technique for teaching family members, it may not be most effective for a particular family. Therapists should ask the family how they would best learn a therapeutic technique.

Question 16

A newborn’s Apgar test evaluates heart rate, color, and which additional clinical characteristics?

1. Respiration, temperature, and weight
2. Reflex irritability, temperature, and weight
3. Respiration, muscle tone, and weight
4. Respiration, muscle tone, and reflex irritability

Answer 16

Your Answer: 1
Correct Answer: 4
You have incorrectly answered the question.

1. Temperature and weight are not parameters used in scoring physiological function for the Apgar.
2. Temperature and weight are not parameters used in scoring physiological function for the Apgar.
3. Weight is not a parameter used in assigning an Apgar score.
4. The Apgar scores the newborn based on these five parameters.

Question 17

Which of the following strategies is MOST effective for helping a patient with limited recall learn to do three exercises independently?

1. Allow the patient to perform the exercises through a partial range of motion.
2. Have the patient complete the exercises in a group setting.
3. Decrease the goal to one exercise done with supervision.
4. Gradually reduce the number of verbal cues

Answer 17

. This does not meet the goal of learning three exercises. Practice of parts may help with complex tasks, but practice of the full task with fading feedback is important for learning.

2. This does not meet the goal of learning three exercises.
3. This does not meet the goal of learning three exercises.
4. Gradually reducing the feedback (fading schedule) forces the subject to use internal processes of error detection, and results in better delayed retention

Question 18

A patient has aspiration precautions. Which of the following factors is MOST likely to affect the patient’s condition?

1. Liquids are aspirated more easily than solids.
2. Solids are aspirated more easily than liquids.
3. Cold food is easier to swallow than warm food.
4. Hyperextension of the neck facilitates swallowing.

Answer 18

our Answer: 4
Correct Answer: 1
You have incorrectly answered the question.

1. Dysphagia can lead to aspiration. Dysphagia can be assessed at bedside. Aspiration is more likely to occur with thin liquids. Therefore, treatment is to thicken the liquids or use thicker solutions and then progress to thinner liquids as the patient's swallowing function improves. (Gillen, p. 638)
2. Aspiration is more likely to occur with thin liquids (Gillen, p. 638).
3. Moist, warm food is more easily swallowed (Gillen, p. 638).
4. To facilitate swallowing, posture should be aligned with the chin tucke

Question 19

During treatment with continuous ultrasound over the upper trapezius at 1 MHz frequency with 1.25 W/cm2, a patient reports increased pain and a burning sensation under the ultrasound head. Which of the following courses of action is MOST appropriate for the physical therapist?

1. Discontinue the treatment and call a company representative.
2. Use a different ultrasound head.
3. Change to pulsed mode.
4. Decrease intensity.

Answer 19

Your Answer: 1
Correct Answer: 4
You have incorrectly answered the question.

1. Treatment may be appropriately modified by decreasing the intensity and does not need to be discontinued.
2. Changing to a pulsed mode would not create a thermal effect with the ultrasound treatment, which is the purpose of continuous ultrasound. Changing the intensity first would be more appropriate.
3. Pulsed mode would be less therapeutic than continuous model; therefore decreasing the intensity with continuous mode is more appropriate.
4. Because the treatment site is soft tissue and not a bony prominence, the symptoms would not be persistent pain. Also, the 1.25 W/cm2 setting is an appropriate setting. Therefore, reducing the intensity is an appropriate modification.

Question 20

A physical therapist is asked to analyze physical therapy notes in the medical record to assess peer performance. This process is MOST likely to be performed during which of the following activities?

1. Productivity analysis
2. Quality assurance
3. Utilization review
4. Accreditation review

Answer 20

Your Answer: 1
Correct Answer: 2
You have incorrectly answered the question.

1. Productivity analysis is a measure of financial efficiency of labor costs; reviewing physical therapy notes does not reflect efficiency but quality (Nosse, pp. 421-422).
2. Peer review of patient care notes is a measure of quality (Nosse, pp. 323-324).
3. Utilization review is an external review of necessity of patient care, not a review of the quality of patient notes (Pagliarulo, p. 136).
4. The accreditation process is a voluntary process of quality measurement against an external set of standards (Nosse, pp. 112-113).

Question 21

A physical therapist is working with a patient who has complete loss of vestibular function. As a compensatory strategy, the therapist should work with the patient on exercises that will:

1. facilitate agility.
2. improve gaze stability.
3. improve coordination.
4. increase muscle strength.

Answer 21

Your Answer: 3
Correct Answer: 2
You have incorrectly answered the question.

1. Facilitating agility is not a mechanism for recovery in patients with complete loss of vestibular function.
2. Improving gaze stability is a well-studied mechanism for recovery from loss of vestibular function.
3. Improving coordination is not a mechanism for recovery in patients with complete loss of vestibular function.
4. Increasing muscle strength is not a mechanism for recovery in patients with complete loss of vestibular function

Question 22

When a stationary exercise bicycle is used to emphasize strengthening a weak hamstring muscle, which modification to the equipment should be made?

1. Install toe clips on the pedals.
2. Increase the flywheel resistance.
3. Raise the handlebars.
4. Tilt the seat forward.

Your Answer: 2
Correct Answer: 1
You have incorrectly answered the question.

Answer 22

Your Answer: 2
Correct Answer: 1
You have incorrectly answered the question.

1. The installation of toe clips will allow the patient to create greater force for knee flexion and thereby emphasize hamstring strengthening.
2. Increasing the resistance of a bike without toe clips will simply increase resistance to the quadriceps and not impact hamstring strength.
3. Raising the handlebars of a bike will have no impact on the emphasis on contraction of the hamstring muscle group.
4. Tilting the seat forward on a bike will have no impact on the emphasis on contraction of the hamstring muscle group

Question 23

patient with multiple sclerosis wants to transfer independently. The patient progressed from moderate to minimal assistance for transfers within 3 days; however, no progress has been made in the past 2 weeks. The physical therapist should:

1. discharge the patient without further intervention.
2. provide the patient with a home program and re-evaluate in 1 month.
3. increase the patient’s treatments to 5 times/week for 2 weeks.
4. decrease the patient’s treatments to 1 time/week until the goal is achieved

Answer 23

Your Answer: 3
Correct Answer: 2
You have incorrectly answered the question.

1. Because the course of exacerbation, relapse, and natural improvement in multiple sclerosis, it is important to provide the patient with a home program instead of discharging.
2. Because the course of exacerbation, relapse, and natural improvement in multiple sclerosis, it is important to provide the patient with a home program instead of discharging.
3. Increasing the patient's frequency of treatment would likely overfatigue the patient and cause little change in status.
4. Treating the patient 1 time/week would be more of a maintenance program that could be provided for with a home exercise program.

Question 24

A patient’s electrocardiogram shows a new ST-segment displacement from baseline and a sinus rhythm of 70 bpm. What is the MOST likely diagnosis?

1. Bradycardia
2. Anxiety reaction
3. Acute myocardial infarction
4. Congestive heart failure

Answer 24

Your Answer: 2
Correct Answer: 3
You have incorrectly answered the question.

1. Bradycardia is below 60 bpm (p. 340).
2. Anxiety reaction would usually include an increased heart rate (p. 341).
3. Acute myocardial infarction is associated with either ST elevation or ST depression (p. 357).
4. Congestive heart failure is not usually associated with ST elevation

Question 25

A patient has recurrent lateral patellar subluxations. While testing the patient’s patellar mobility, the physical therapist notes that the apex of the patella rotates medially during a passive medial patellar glide. Which of the following structures around the patella are tight?
1. Superolateral

2. Superomedial
3. Inferolateral
4. Inferomedial

Answer 25

Medial glide would stress lateral structures. The apex (inferior pole) of the patella is moving, however the base of the patella (superior) is not, causing patellar rotation. Therefore, superolateral structures are tight, holding back this portion of the patella.

2. With a medial glide, these structures would be put on slack.
3. Medial glide would stress lateral structures. However, with the apex (inferior pole) of the patella allowed to move (causing the rotation observed), the inferolateral structures are not restricted.
4. With a medial glide, these structures would be put on slack.

Question 26

A child with myelomeningocele and a history of hydrocephalus begins to exhibit irritability, lethargy, and vomiting. Which of the following is the MOST likely cause of these symptoms?

1. Tethered cord
2. Urinary tract infection
3. Arnold-Chiari malformation
4. Shunt malfunction

Answer 26

Your Answer: 2
Correct Answer: 4
You have incorrectly answered the question.

1. Signs and symptoms of tethered cord include changes in bowel and bladder function, increased spasticity, back pain, etc., but not irritability, lethargy, and vomiting (Umphred, p. 423).
2. Signs and symptoms of urinary tract infection include urinary frequency, dysuria, and pyuria. Urinary tract infection is not associated with lethargy and vomiting (Paz, p. 227).
3. Signs and symptoms of Arnold-Chiari malformation are weakness, pain, sensory changes, vertigo, diplopia, and ataxia but not irritability, lethargy, and vomiting (Campbell, pp. 716-717).
4. Irritability, lethargy, and vomiting are all signs and symptoms of shunt malfunction (Campbell, pp. 716-717).

Question 27

A patient with a flaccid upper extremity and downward rotation of the scapula is MOST at risk for which type of glenohumeral joint dislocation?

1. Posterior
2. Anterior
3. Inferior
4. Superior

Answer 27

Your Answer: 2
Correct Answer: 3
You have incorrectly answered the question.

1. The most common type of subluxation is an inferior subluxation. Weakness and the weight of a heavy arm result in downward rotation of the scapula, not a posterior subluxation.
2. The most common type of subluxation is an inferior subluxation. Weakness and the weight of a heavy arm result in downward rotation of the scapula, not an anterior subluxation.
3. The most common type of subluxation is an inferior subluxation. Weakness and the weight of a heavy arm result in downward rotation of the scapula.
4. The most common type of subluxation is an inferior subluxation. Weakness and the weight of a heavy arm result in downward rotation of the scapula, not a superior subluxatio

Question 28

nzyme (ACE) inhibitor. During this transfer, the physical therapist should monitor the patient for the possibility of a:

1. rise in systolic and a drop in diastolic blood pressure.
2. rise in systolic and diastolic blood pressure.
3. drop in systolic and diastolic blood pressure.
4. drop in systolic and a rise in diastolic blood pressur

Answer 28

Your Answer: 2
Correct Answer: 3
You have incorrectly answered the question.

1. The characteristic drop in both systolic and diastolic blood pressure eliminates this option.
2. The characteristic drop in systolic and diastolic blood pressure eliminates this option.
3. Orthostatic hypotension (a drop in systolic and often diastolic blood pressure) is a concern in those individuals who have been in supine position for a period of time and are taking antihypertensive agents.
4. The characteristic drop in both systolic and diastolic blood pressure eliminates this option.

Question 29

During warm-up on a stationary bike, a patient reports feelings of fatigue. Following the activity, the physical therapist observes the patient sitting in a chair with elbows resting on the knees. The physical therapist should examine the patient for which of the following?

1. Trunk muscle weakness
2. Poor sitting posture
3. Lower extremity weakness
4. Use of accessory muscles for breathing

Answer 29

Your Answer: 1
Correct Answer: 4
You have incorrectly answered the question.

1. The preferred posture after the activity reflects the patient's need to improve breathing and minimize fatigue. It is not an indication of trunk muscle weakness.
2. The preferred posture after the activity reflects the patient's need to improve breathing and minimize fatigue. It is not an indication of poor sitting posture.
3. The preferred posture after the activity reflects the patient's need to improve breathing and minimize fatigue. It is not an indication of lower extremity weakness.
4. Fatigue which was evident during warm-up may have worsened after the activity. This position increases the effectiveness of the pectoralis and serratus anterior muscles to act as accessory muscles of inspiration by reverse action, thereby improving breathing and minimizing fatigue.

Question 30

Prolonged bed rest would MOST likely cause an increase in which of the following cardiovascular parameters?

1. Cardiac output
2. Resting systolic blood pressure
3. Blood volume and viscosity
4. Resting and submaximal heart rates

Answer 30

1. Cardiac output declines from decreases in blood volume and decreases in stroke volume.
   
   2. Resting systolic blood pressure declines due to decreases in blood volume from profound diuresis.
   3. Blood volume declines from profound diuresis.
   4. Resting and submaximal heart rates begin to increase within a few days of complete bed rest and result in lowered cardiac efficiency.

Question 31

A physical therapist testing a patient for ideomotor apraxia should have the patient:

1. state where her limb is in different positions in space.
2. select an object from an array of similarly shaped objects.
3. touch her nose, then touch a target 2 ft (.6 m) away.
4. sign her name as part of an activity and on comman

Answer 31

Your Answer: 3
Correct Answer: 4
You have incorrectly answered the question.

1. Identifying where the limb is in space is a test of joint position sense, not apraxia.
2. Selecting an object from an array of similarly shaped objects is a test of figure-ground discrimination. A positive result would indicate a perceptual dysfunction, which suggests a spatial relations syndrome.
3. Touching the nose then a target 2 ft (.6 m) away is the unilateral finger-to-nose test, which is a test of coordination and motor function, not perceptual function.
4. Ideomotor apraxia is the inability to perform purposeful movements when there is no loss of sensation, strength, coordination, or comprehension. Frequently, patients will be unable to perform a motor task on command but will be able to when they are left on their own.

Question 32

A patient has completed a 12-week strength and conditioning program. Which of the following measures would be MOST appropriate to assess change in fitness and conditioning from week 1 to week 12?

1. Resting respiration rate before starting exercise
2. Amount of time until the heart rate returns to baseline after exercise
3. Amount of time until the onset of perspiration during exercise
4. Amount of increase in diastolic blood pressure during exercise

Answer 32

Your Answer: 1
Correct Answer: 2
You have incorrectly answered the question.

1. This is a physiological measure that is less likely to change as a result of training after 12 weeks.
2. How quickly the heart rate returns to normal after exercise is an outcome measure of fitness and conditioning.
3. This is not a quantifiable measure and also may vary as a result of other factors, i.e., hydration.
4. Diastolic blood pressure increases are actually a contraindication to exercise and require medical consultation. Therefore, any increase in diastolic blood pressure is not an indicator of improvement.

Question 33

A patient reports multiple myalgias, fatigue, weight gain despite decreased food intake, and frequently feeling cold. The physical therapist should expect information from which of the following tests to be MOST helpful in managing the patient’s care?

1. Rheumatoid factor
2. C-reactive protein
3. Fasting blood glucose level
4. Thyroid stimulating hormone level

Answer 33

Your Answer: 3
Correct Answer: 4
You have incorrectly answered the question.

1. Rheumatoid factor is appropriate for determining the presence of rheumatoid arthritis or other inflammatory conditions. A patient who has rheumatoid arthritis would be more likely to report arthralgias than myalgias. (p. 452)
2. C-reactive protein is a nonspecific indicator of inflammation or infection. It wouldn't provide the most pertinent information with this diagnosis. (pp. 248, 465)
3. Fasting blood glucose levels determine the amount of sugar (glucose) in the blood. This is an appropriate test for diabetes. Fatigue and weight loss are associated with diabetes; however, polyuria and polydipsia are often reported. The patient's report of myalgias and impaired thermoregulation is more consistent with hypothyroidism. (pp. 425-426)
4. The patient is describing symptoms of hypothyroidism. When hypothyroidism is present, the blood levels of thyroid hormones can be measured directly and are decreased. The main tool for the detection of thyroid disease is the measurement of thyroid stimulating hormone. (pp. 417, 420)

Question 34

A patient who is performing a vigorous treadmill test is MOST likely to have an immediate increase in which of the following physiologic responses?

1. Respiration rate to raise blood pH levels
2. Respiration rate to lower blood pH levels
3. Rate of excretion of hydrogen ions by the kidneys to raise blood pH levels
4. Rate of excretion of hydrogen ions by the kidneys to lower blood pH levels

Answer 34

our Answer: 2
Correct Answer: 1
You have incorrectly answered the question.

1. Vigorous exercise produces lactic acid, which would lower the pH of blood unless compensatory mechanisms are in place. Increasing the rate of respiration reduces the alveolar PCO2, resulting in more alkalinity in the blood to prevent an imbalance.
2. Lactic acid pushes the blood ion concentration in the direction of becoming more acidic. The increase in respiration rate helps compensate by increasing blood alkalinity (higher pH).
3. This process increases the alkalinity of blood, but at a much slower rate than the increase in respiration rate.
4. Excretion of hydrogen ions would increase pH levels but at a slower rate

Question 35

Which of the following exercise guidelines would be BEST for an otherwise healthy adult patient undergoing radiation treatment for breast cancer?

1. Postpone exercise until 1 month after radiation treatments end.
2. Initiate exercise activities 1 hour after radiation treatments.
3. Walk on a treadmill at a level of 6/20 on the Borg scale.
4. Walk on a treadmill at a moderate level of intensity.

Answer 35

Your Answer: 3
Correct Answer: 4
You have incorrectly answered the question.

1. Low to moderate intensity exercise during the weeks of radiation treatment can help manage treatment-related symptoms such as fatigue. Ideally exercise should take place during the period when treatment sessions are being conducted. (p. 173)
2. Current guidelines recommend clients should be advised not to exercise within 2 hours of radiation therapy, because an increase in circulation with exercise may increase the effects of these treatments (p. 173).
3. A level of 6/20 is no exertion and would not be of benefit (p. 173).
4. Radiation therapy can cause scarring to the heart and lungs. Aerobic exercise should be kept at a low to moderate intensity. (p. 173)

Question 36

Which of the following skin conditions may have an associated arthritic component?

1. Stasis dermatitis
2. Seborrheic keratosis
3. Herpes zoster
4. Psoriasis

Answer 36

Your Answer: 3
Correct Answer: 4
You have incorrectly answered the question.

1. Stasis dermatitis is a result of venous insufficiency. It is not associated with arthritis. (p. 401)
2. Seborrheic keratosis is a benign tumor of the skin that is usually associated with hormonal therapy or inflammatory dermatoses. (pg. 410)
3. Herpes zoster is a viral infection of a nerve root with associated vesicular eruption of the skin in the nerve's dermatome. This condition is associated with postherpetic neuralgia, not arthritis. (pp. 404-405)
4. Approximately 10% of people with psoriasis develop arthritic symptoms referred to as psoriatic arthritis. (pg. 421-422)

Question 37

Which of the following conditions is associated with the GREATEST risk for developing stress urinary incontinence?

1. Multiple sclerosis
2. Post multiparous delivery
3. Post herpes zoster
4. Diabetes mellitus

Answer 37

our Answer: 1
Correct Answer: 2
You have incorrectly answered the question.

1. Seventy percent to 90% of people with multiple sclerosis develop bladder dysfunction or a neurogenic bladder. This disorder is caused by damage to the nerves that control the urinary tract. Development of stress incontinence is typically related to insufficient strength of pelvic floor musculature.
2. Stress incontinence is essentially due to insufficient strength of the pelvic floor musculature. Pelvic floor dysfunction is most often caused by a weakening of the pelvic floor structures as a result of childbirth or overstretching of the muscles.
3. Herpes zoster is an infection that may cause urinary incontinence as a result of an upper motor neuron (spinal cord) lesion. It causes neurogenic bladder, not stress incontinence.
4. Diabetes mellitus is a common cause of neurogenic bladder dysfunction causing overflow incontinence. Also called cystopathy, the neurogenic bladder is considered a form of autonomic neuropathy. It begins with selective damage to autonomic afferent nerves, leaving motor function intact but impairing the sensation of bladder fullness and, therefore, resulting in decreased urinary frequency. As this neuropathy progresses, autonomic efferent nerves become involved, leading to incomplete bladder emptying, urinary dribbling, and overflow incontinence. This process does not lead to stress incontinence.

Question 38

Which of the following conditions is an absolute CONTRAINDICATION to a patient’s participation in aquatic physical therapy?

1. Advanced peripheral neuropathy
2. Chronic venous insufficiency
3. History of seizure disorder
4. Severe kidney disease

Answer 38

Your Answer: 3
Correct Answer: 4
You have incorrectly answered the question.

1. Patients with advanced peripheral neuropathy such as patients with heat intolerant multiple sclerosis may fatigue with immersion in temperatures greater than 33°C (p. 291). Therapeutic exercise performed in water is typically done in water that is warmer than 33°C. (p. 295)
2. Small open wounds [from chronic venous insufficiency] may be covered by waterproof dressings (p. 292).
3. Patients with controlled epilepsy require close monitoring during immersed treatment and must be compliant with medication prior to treatment (p. 292).
4. Patients with severe kidney disease will be unable to adjust to fluid loss during immersion (p. 292).

Question 39

13-year-old male patient who is morbidly obese has a recent onset of left knee pain. His left hip is in slight flexion, adduction, and lateral (external) rotation. Examination shows no medial (internal) hip rotation and abduction, with increasing pain on abduction. Which of the following conditions is MOST likely present?

1. Weakness in the left hip abductor musculature
2. Left slipped capital femoral epiphysis
3. Avascular necrosis of the left femoral head
4. Dislocated left hip

Answer 39

Your Answer: 1
Correct Answer: 2
You have incorrectly answered the question.

1. Weakness in left hip abductor would not account for hip flexion and external rotation positioning, which are indicative together of slipped capital femoral epiphysis.
2. This patient demonstrates the clinical indicators of slipped capital femoral epiphysis, including deficits in hip internal rotation and abduction (pp. 776, 1411).
3. The clinical indicators of the patient are not indicative of Legg-Calvé-Perthes disease, in which there is a vascular necrosis of the femoral head (pp. 228, 776).
4. Other than demonstrating pain with hip abduction, the patient does not demonstrate the clinical indicators of a dislocated hip (p. 226).

Question 40

Which of the following methods is the MOST effective way to encourage a patient who is learning a new movement pattern?

1. Describe how incorrect attempts differ from the correct movement before proceeding with the next trial.
2. Describe each component of the desired movement before beginning practice.
3. Provide feedback at the same point in each of the patient's attempts.
4. Provide frequent feedback during the initial trials of the movement.

Answer 40

Incorrect attempts corrected early may reduce ability to learn a task.

2. Explanation of each component of movement may cause confusion during early learning of a motor task.
3. Providing feedback at the same point is not as effective as frequent feedback during early learning.
4. Early in learning, visual feedback is easily brought to conscious attention and is important. Too little feedback in the initial stages of movement will delay learning.

Question 41

A patient who sustained an ulnar collateral ligament sprain of the thumb (1st digit) 1 week ago is referred for physical therapy. Which of the following actions is MOST appropriate when continuous ultrasound is being administered?

1. Immerse the wrist and the hand in water.
2. Apply 10% hydrocortisone to the skin.
3. Apply mineral oil between the skin and the sound head.
4. Utilize a stationary technique in direct contact with the skin

Answer 41

Your Answer: 4
Correct Answer: 1
You have incorrectly answered the question.

1. Ultrasound consists of acoustic waves which travel poorly through air, but pass readily through water. Because the hand and wrist are small anatomical areas with an irregular surface, immersion in water is an effective means of delivery of ultrasound.
2. Application of 10% hydrocortisone to the skin would not ensure optimal delivery of US to an irregular surface area of the body.
3. Mineral oil is a poor conductor of sound waves. Oil could also result in damage to the sound head due to overheating because the sound waves are blocked.
4. Holding the ultrasound head stationary results in delivery of sound waves that are too intense. The concentrated energy can cause periosteal pain.

Question 42

in which of the following conditions is a nerve conduction velocity test MOST appropriate?

1. Carpal tunnel syndrome
2. Cerebrovascular accident
3. Myotonia
4. Duchenne muscular dystrophy

Answer 42

Your Answer: 4
Correct Answer: 1
You have incorrectly answered the question.

1. Nerve conduction velocity testing is most useful in the evaluation of peripheral nerve or lower motor neuron status. Carpal tunnel syndrome is the only one of the conditions listed that directly involves a peripheral nerve (pp. 1008-1009).
2. A cerebrovascular accident is a CNS disorder not a peripheral nerve disorder (p. 711).
3. With myopathic disorders, motor and sensory nerve conductions are generally normal unless neural tissue is also affected (p. 1014).
4. Duchenne muscular dystrophy is primarily a muscle disorder (p. 554).

Question 43

Laboratory findings of decreased red blood cell count and increased erythrocyte sedimentation rate are MOST indicative of:

1. rheumatoid arthritis.
2. scleroderma.
3. osteoarthritis.
4. fibromyalgia.

Answer 43

Your Answer: 2
Correct Answer: 1
You have incorrectly answered the question.

1. Increase in erythrocyte sedimentation rate and possible anemia are clinical indicators of rheumatoid arthritis (p. 465).
2. Scleroderma is indicated by the presence of Raynaud phenomenon, not the laboratory findings given in the stem (p. 470).
3. Osteoarthritis can result from a myriad of metabolic and endocrine diseases but is not indicated by the laboratory findings given in the stem (p. 411).
4. Fibromyalgia is indicated by the presence of trigger points, fatigue, headache, etc., not the laboratory findings given in the stem (pp. 459-461).

Question 44

patient is performing a therapeutic exercise program while being monitored by telemetry. The physical therapist observes a premature ventricular contraction (PVC) every other heartbeat. This patient is experiencing:

1. bigeminy.
2. couplets.
3. multifocal PVCs.
4. ventricular tachycardia.

Answer 44

Bigeminy occurs when every other beat is a premature ventricular contraction (PVC) (p. 416). Bigeminy is described in the stem.

2. A couplet occurs when 2 premature ventricular contractions are together with no normal heartbeat between them. (p. 417)
3. Multifocal premature ventricular contractions occur when more than one PVC is present, and the two do not appear similar in configuration. (p. 272)
4. Ventricular tachycardia is a series of 3 or more premature ventricular contractions in a row. (p. 272)

Question 45

A physical therapist is guarding a patient during gait training. The BEST hand placement for the therapist to use on the gait belt is with:

1. the wrist fully flexed.
2. the forearm supinated.
3. the forearm pronated.
4. a two-handed grasp.

Answer 45

our Answer: 4
Correct Answer: 2
You have incorrectly answered the question.

1. This hand placement would result in a weaker grip and decreased control.
2. This is the strongest grip available and would allow the therapist better control.
3. This hand placement would result in a weaker grip and decreased control.
4. This hand placement applies too much pressure through the belt in one direction.

Question 46

A physical therapist is evaluating a 9-year-old child with Duchenne muscular dystrophy who is ambulating household distances. The MOST likely long-term mobility outcome for this patient is independent mobility with:

1. knee-ankle-foot orthoses.
2. forearm crutches.
3. a manual wheelchair.
4. a motorized wheelchair.

Answer 46

Your Answer: 1
Correct Answer: 4
You have incorrectly answered the question.

1. The progressive weakness precludes walking even with orthoses.
2. The severity of this progressive weakness disorder makes use of forearm crutches unrealistic.
3. The motor disorder advances to the extent that the upper limbs are not strong enough to propel a wheelchair manually.
4. The progressive muscle weakness with Duchenne muscular dystrophy typically requires long-term use of a motorized wheelchair for mobility.

Question 47

When an individual experiences an increase in blood pressure, which of the following reflexive responses should occur?

1. Increased cardiac contractility and respiratory rate
2. Bradycardia and vascular constriction
3. Tachycardia and vascular dilation
4. Vascular dilation and a decrease in cardiac output

Answer 47

Your Answer: 1
Correct Answer: 4
You have incorrectly answered the question.

1. An increase in blood pressure would activate the baroreceptor reflex; however, the baroreceptor reflex does not increase contractility or affect respiration.
2. An increase in blood pressure would result in bradycardia; however, vascular dilation, not constriction, would be present.
3. An increase in blood pressure would result in vascular dilation; however, bradycardia, not tachycardia, would be observed.
4. The increase in blood pressure would activate the baroreceptor reflex, resulting in reflexive dilation of peripheral vasculature and bradycardia. This results in a decrease in cardiac output.

Question 48

Which of the following reasons provides the BEST rationale for using a single-subject design in a physical therapy treatment study?

1. Information and data can be obtained retrospectively from the medical record.
2. The results can be generalized from the participant to the population.
3. Measurement of data can be randomly performed at any time during the intervention.
4. Experimental treatments can be geared to the patient's specific problem.

Answer 48

Your Answer: 1
Correct Answer: 4
You have incorrectly answered the question.

1. Single-subject designs are prospective, not retrospective.
2. Single-subject designs lack generalization.
3. Data collection from even a single subject is systematized, controlled, and not random.
4. This is a strength of single-subject designs

Question 49

Which of the following is the MOST appropriate method to receive informed consent from a patient who is not fluent in English and is unaccompanied by an interpreter?

1. Instruct the patient to sign the English language informed consent forms after discussing the information.
2. Provide a verbal translation of the consent forms.
3. Provide informed consent forms that are translated into the patient’s language.
4. Request that the patient have the informed consent forms translated into the patient’s language before signing

Answer 49

Your Answer: 4
Correct Answer: 3
You have incorrectly answered the question.

1. The patient is not able to understand the English language consent forms being signed. Informed consent forms must be presented using terms and languages that are comprehensible.
2. The informed consent must be written in the language the patient can understand. With verbal consent there is no written documentation to corroborate that the verbal translation is accurate.
3. Physical therapists are obligated to provide information in a language the patient can understand.
4. Obtaining informed consent is the therapist's responsibility, not the patient's.

Question 50

A patient who had coronary artery bypass surgery is being instructed in the signs and symptoms of myocardial infarction. Which of the following principles of patient education is MOST important to ensure that the patient understands the information the therapist provides?

1. Invite the patient to ask questions about the information.
2. Provide a comprehensive medical explanation of each of the signs, symptoms, and implications.
3. Provide the patient with research articles about myocardial infarction.
4. Recommend that the patient write down the signs and symptoms as the therapist instructs.

Answer 50

Your Answer: 4
Correct Answer: 1
You have incorrectly answered the question.

1. Explicitly inviting the patient's questions will help ensure that the therapist's information is understood.
2. This provides the patient with too much information and results in overload such that the patient may not remember any of the information.
3. This provides information that is probably too difficult for most patients to understand.
4. It would be more appropriate for the therapist to provide the information in written form rather than have the patient write it down. Writing down the information doesn't ensure the patient understands the information, just that the patient has the information.

Question 51

A patient with multiple sclerosis has experienced several falls over the last few weeks. The patient has motor and sensory impairments with gaze-evoked nystagmus and vertigo. Which of the following assessment strategies should be used to determine the MOST likely cause of the falls?

1. Evaluate the patient standing with feet parallel on and off a foam surface with the eyes open and closed.
2. Measure the distance the patient can reach forward with one arm without taking a step.
3. Determine the amount of time the patient takes to rise from a chair, walk 32.8 ft (10 m), and return to sit in the chair.
4. Observe the patient standing with one foot in front of the other with eyes open, then with eyes closed.

Answer 51

our Answer: 3
Correct Answer: 1
You have incorrectly answered the question.

1. The therapist should determine which sensory system is contributing to the patient’s postural dyscontrol. Assessing sensory conditions of vision, vestibular function, and somatosensation in a systematic fashion, such as by conducting the Clinical Test for Sensory Interaction on Balance (CTSIB), will help determine which system is contributing to the balance dysfunction (Umphred, pp. 660-662).
2. This describes the Functional Reach test, which is a screening tool to determine likelihood of falling in the future. This patient has already experienced several falls, so no new information would be gained by using this test (Umphred, p. 664; Shumway-Cook, p. 275).
3. This test measures balance using a functional approach; it does not differentiate among possible sources of dysfunction contributing to the balance problem (Umphred, p. 668; Shumway-Cook, p. 274).
4. This describes the Sharpened Romberg test, which measures balance only in quiet standing; it does not differentiate among possible dysfunctions in the various contributing systems (Umphred, p. 662).

Question 52

Pelvic floor exercises would be MOST appropriate for a patient with which of the following conditions?

1. Functional incontinence
2. Overflow incontinence
3. Stress incontinence
4. Urge incontinence

Answer 52

Your Answer: 1
Correct Answer: 3
You have incorrectly answered the question.

1. Functional incontinence is incontinence due to mobility, dexterity, or cognitive deficits.
2. Overflow incontinence is caused by a neurological condition that results in disruption of the activity of the detrusor muscle. This is a lower motor neuron problem, for which pelvic floor exercise would not be an appropriate intervention.
3. Stress incontinence is involuntary leakage of urine during coughing, sneezing, or exertion. It can be treated with pelvic floor exercises.
4. Urge incontinence is characterized by an increased frequency or desire to void with a decrease in volume. Pelvic floor exercises would not be the most appropriate intervention for this condition

Question 53

A patient is 3 days post transfemoral amputation with the surgical site healing normally. Which of the following findings is MOST expected when examining drainage from the wound?

1. Dark red blood
2. Bright red blood
3. Viscous yellow exudate
4. Serosanguineous exudate

Answer 53

our Answer: 2
Correct Answer: 4
You have incorrectly answered the question.

1. Dark red venous blood drainage should be reported to the surgeon for further assessment as it indicates an inflamed wound. There should not be active bleeding 3 days post amputation.
2. Bright red arterial blood drainage should be reported to the surgeon for further assessment as it indicates an inflamed wound. There should not be active bleeding 3 days post amputation.
3. Thickened yellow drainage is indicative of an infected wound.
4. Serosanguineous drainage in small or medium amounts is typical and indicative that the wound is beginning to heal.

Question 54

Which of the following actions would MOST reduce a physical therapist’s risk of being sued for medical malpractice?

1. Consistently obtaining written informed consent before initiating treatment
2. Maintaining accurate medical records
3. Establishing excellent communication and rapport with patients
4. Relying more on objective test findings than on subjective findings

Answer 54

Your Answer: 2
Correct Answer: 3
You have incorrectly answered the question.

1. Physical therapists are expected to obtain informed consent. This activity is not likely to have a significant impact on whether the therapist will be sued for medical malpractice.
2. Physical therapists are expected to engage in documentation. This activity is not likely to have a significant impact on whether the therapist will be sued for medical malpractice.
3. Better communication between patient and professional is encouraged to prevent situations that lead to malpractice cases.
4. Physical therapists are expected to perform examinations and obtain objective and subjective information and to perform evaluations which require decision making. This activity is not likely to have a significant impact on whether the therapist will be sued for medical malpractice

Question 55

A patient is in good health except for hypertension that is controlled with a beta-blocker. What is the BEST means of monitoring the patient’s cardiovascular tolerance?

1. Electrocardiogram
2. Rating of perceived exertion
3. Pulse oximetry
4. Heart rate

Answer 55

our Answer: 3
Correct Answer: 2
You have incorrectly answered the question.

1. Beta-blockers may cause changes in electrocardiogram, which that would make this option unreliable (p. 216).
2. A rating of perceived exertion scale can be used as an indicator of exercise intensity with patients who take medications that affect heart rate (p. 306).
3. Bronchospasm, which is a side effect of beta-blockers (p. 102), may affect pulse oximetry readings.
4. Beta-blockers decrease both resting and exercise heart rates, which would make this option unreliable (p. 102

Question 56

Twenty patients who were referred for treatment of pain received transcutaneous electrical nerve stimulation (TENS) for 2 months, after which 12 reported relief. Given these results, which of the following conclusions is MOST appropriate?

1. TENS was shown to have a significant effect on pain for 60% of patients.
2. There was no treatment effect, since the points in time over the 2-month period when the patients experienced relief of pain are unknown.
3. TENS might be a useful treatment for pain, although another study accounting for the effects of maturation is needed.
4. TENS is a reliable treatment modality for pain reduction

Answer 56

Your Answer: 2
Correct Answer: 3
You have incorrectly answered the question.

1. No statistical tests were performed to conclude if the difference between the responders and non-responders was significant.
2. Some patients reported pain relief posttreatment. Thus, TENS could have led to this effect.
3. Although TENS could have led to this effect, time is still a confounding variable that also could have led to this effect.
4. The results were from one study. The study would have to be replicated to determine the reliability of the treatment

Question 57

A patient with low back pain reports being unsure when or how the pain began. The pain has become progressively worse and is constant with little fluctuation in intensity. Which of the following actions is MOST appropriate for a physical therapist?

1. Question the patient further for an exact mechanism of injury.
2. Consider this information unreliable because it is subjective.
3. Suspect a possible underlying medical disease.
4. Treat the symptoms of the pain because no injury is obviou

Answer 57

Your Answer: 1
Correct Answer: 3
You have incorrectly answered the question.

1. Although understanding the etiology of the back pain might be useful, this information is not as important as the constant and worsening characteristics of the pain.
2. Subjective information should not be assumed to be unreliable.
3. Back pain described as progressively worsening and unaffected by rest or activity would suggest a possible systemic problem.
4. Even though a specific injury has not be determined, the pain concerns should be considered prior to treatment.

Question 58

A patient with a transtibial amputation who has been wearing a prosthesis has local redness and tenderness in the residual limb, malaise, and sudden onset of chills and fever. The patient has MOST likely developed which of the following conditions?

1. Cellulitis
2. Dermatitis
3. Folliculitis
4. Keratitis

Answer 58

our Answer: 2
Correct Answer: 1
You have incorrectly answered the question.

1. Cellulitis signs/symptoms include pain, redness, tenderness, edema, and at times, fever, chills, tachycardia, headache, and hypotension (p. 66).
2. Generally, dermatitis includes the presence of papules, vesicles, blisters, or ulcerations. This patient does not present with any of the aforementioned signs (p. 517).
3. Folliculitis is a bacterial infection of hair follicles that produces individual pustules, each pierced by a hair (p. 329). This patient does not present this way.
4. Keratitis is a corneal inflammation (p. 537). This condition would not affect the patient's residual limb

Question 59

A 10-month-old infant with cerebral palsy has an obligatory symmetric tonic neck reflex. The reflex would MOST interfere with which of the following activities?

1. Rolling from supine to prone position
2. Crawling reciprocally
3. Eye-hand coordination
4. Head control in midline

Answer 59

Your Answer: 4
Correct Answer: 2
You have incorrectly answered the question.

1. Symmetric tonic neck reflex is not initiated with head turning and would not prevent the infant from rolling from supine to prone position.
2. Symmetric tonic neck reflex causes arm flexion when head is flexed and thus interferes with the ability to crawl reciprocally.
3. Symmetric tonic neck reflex is stimulated by head position flexion or extension and does not interfere with hand-eye coordination.
4. Symmetric tonic neck reflex is stimulated by head position in flexion or extension. Midline control is not impaired.

Question 60

Which of the following is an ABNORMAL response to vigorous aerobic exercise in a healthy adult with normal vital signs at rest?

1. Respiratory rate increases to 40 breaths/minute.
2. Arterial oxygen saturation decreases from 95% to 85%.
3. Diastolic blood pressure does not change.
4. Systolic blood pressure increases to 180 mm Hg.

Answer 60

Your Answer: 3
Correct Answer: 2
You have incorrectly answered the question.

1. Significant increases in respiratory rate are expected to accommodate for increased oxygen consumption.
2. Oxygen saturation should not decrease below 90% in a normal individual during exercise.
3. Diastolic blood pressure changes of 10 mm Hg or more above or below resting values are considered abnormal responses to exercise. No change in diastolic blood pressure is expected.
4. Systolic blood pressure increases greater than 220 mm Hg are considered abnormal.

Question 61

A patient had a split-thickness skin graft 1 week ago for a partial-thickness burn injury to the upper extremity. The surgeon has requested range-of-motion exercises for the patient. Currently, the patient is able to actively move the upper extremity through one-third of the range of motion for shoulder flexion. Based on this finding, what is the MOST appropriate action for the physical therapist to take at this time?

1. Defer any range-of-motion exercises until the patient is able to participate more actively.
2. Begin active assistive range-of-motion exercises.
3. Begin bed mobility training to facilitate increased use of the upper extremity.
4. Continue with active range-of-motion exercises.

Answer 61

our Answer: 4
Correct Answer: 2
You have incorrectly answered the question.

1. Deferring any range-of-motion exercises is not a practical choice, as contracture will develop postoperatively.
2. Because this patient cannot achieve full range of motion by himself, active assistive range of motion is indicated to prevent contracture postoperatively.
3. Although bed mobility training is a creative way to possibly increase upper extremity range of motion, given the acuity of the patient's surgical wound, the patient would need more range of motion for this intervention to be more beneficial.
4. Continuing with only active range of motion would not facilitate adequate increases in range of motion and would not prevent contractures.

Question 62

Active motion testing of the atlanto-occipital joint can BEST be performed by requesting that the patient perform which of the following gross cervical motions?

1. Flex and extend the head on the neck.
2. Side bend and rotate to the opposite side.
3. Side bend right and left.
4. Rotate right and left.

Answer 62

Your Answer: 4
Correct Answer: 1
You have incorrectly answered the question.

1. The motion of the atlanto-occipital (OA) joint is flexion/extension of the head on C1.
2. This motion occurs at C1–C2.
3. This motion does not occur at the OA joint.
4. This motion does not occur at the OA joint

Question 63

The MOST likely etiology for increased low back pain with coughing or sneezing is:

1. disc herniation.
2. adherent nerve root.
3. poor posture.
4. spinal stenosis.

Answer 63

Your Answer: 4
Correct Answer: 1
You have incorrectly answered the question.

1. Coughing or sneezing will increase intradiscal pressure causing pain during this activity if disc herniation is present. Increased pressure results from a space occupying lesion such as a herniation (p. 1293).
2. Coughing or sneezing will not increase low back pain associated with a nerve root adherence. Pain associated with nerve root adherence would be affected by positions that compress the nerve (p. 1337).
3. Low back pain associated with poor posture is related to stress on tissue from prolonged or straining positions; coughing or sneezing will not increase this pain (p. 1295).
4. Pain from spinal stenosis is related to postural position and activity; coughing or sneezing would not increase this pain (pp. 1295, 1342).

Question 64

During an examination, a physical therapist finds that a patient with chronic obstructive pulmonary disease has a weak wet cough. Which of the following techniques is MOST appropriate to help this patient clear secretions?

1. Abdominal thrusts
2. Postural drainage
3. Huffing
4. Manual or mechanical percussion

Answer 64

Your Answer: 4
Correct Answer: 3
You have incorrectly answered the question.

1. Abdominal thrusts or Heimlich-type assistance is primarily used in patients with low neuromuscular tone or flaccid abdominal muscles (Watchie, p. 325).
2. Postural drainage facilitates drainage of secretions to the level of the segmental bronchus only. In addition, a cough is needed to clear secretions. (Watchie, p. 329)
3. Huffing helps stabilize collapsible airways present with chronic obstructive pulmonary disease (Watchie, p. 323).
4. Percussion helps mobilize secretions from the periphery of the lungs; however, it does not improve the strength of the patient's cough (DeTurk, p. 519).

Question 65

A hospital physical therapist discovers that her child’s day-care provider has been admitted to the same hospital and placed on contact isolation precautions. The therapist is concerned that her child may have been exposed to a health risk. The therapist should:

1. ask the day-care provider's nurse about the patient's medical status.
2. contact the day-care provider's physician to ask about the diagnosis and the potential risk to the child.
3. discuss her concerns with the day-care provider and ask whether the child requires screening by a physician.
4. examine the pertinent portions of the day-care provider's medical record to obtain objective data on the diagnosis.

Answer 65

our Answer: 2
Correct Answer: 3
You have incorrectly answered the question.

1. This physical therapist is not involved with the day-care provider's case and has no right to information about that case. Discussing the day-care provider's medical status is a violation of patient confidentiality and HIPAA laws.
2. This physical therapist is not involved with the day-care provider's case and has no right to information about that case. Contacting the day-care provider's physician is a violation of patient confidentiality HIPAA laws.
3. The therapist can talk with the patient, who can make the decision what to disclose to the therapist.
4. This physical therapist is not involved with the day-care provider's case and has no right to information about that case. Examining the day-care provider's medical record is a violation of patient confidentiality HIPAA laws.

Question 66

Which of the following interventions would be MOST appropriate for the patient who prefers to sit as illustrated?

1. Stretching of the gastrocnemius
2. Strengthening of the upper trapezius
3. Stretching of the hamstrings
4. Strengthening of the quadriceps

Answer 66

Your Answer: 2
Correct Answer: 3
You have incorrectly answered the question.

1. Gastrocnemius tightness cannot be determined in the photograph.
2. Strength of the upper trapezius cannot be determined in the photograph.
3. In the photograph, the pelvis is posteriorly rotated and the knees are flexed indicating the hamstrings are shortened.
4. Strength of the quadriceps cannot be determined in the photograph.

Question 67

A patient had a right-sided cerebrovascular accident. The physical therapist should expect that the patient may exhibit which of the following impairments?

1. Apraxia, alexia, and a tendency to overestimate personal abilities
2. Dysphagia, signs of depression, and receptive aphasia
3. Impulsiveness, poor safety awareness, and difficulty with spatial relationships
4. Expressive aphasia, distorted body image, and poor judgment

Answer 67

1. While overestimating personal abilities may be typical of patients who have right brain injury, apraxia and alexia (inability to read written words) typically associated with the pariteal and temporal lobes on the left side. are typically associated with left brain injuries (pp. 724-725).
   
   2. While dysphagia and signs of depression may be associated with lesions on either side of the brain, receptive aphasia (Wernicke aphasia) typically is associated with left brain injuries (p. 725).
   3. Patients with right brain injury demonstrate difficulty with spatial-perceptual tasks and tend to be described as impulsive; safety is a concern (p. 724).
   4. While poor judgment and distorted body image are typically associated with right brain injury, expressive aphasia (Broca aphasia) is typically associated with left brain injury (p. 725).

Question 68

A physical therapist is instructing a patient who has pneumonia in home postural drainage positioning for the superior segments of the lower lobes. Which of the following positions is MOST appropriate?

1. Prone lying on a bed with two pillows under the pelvis
2. Sitting on a chair, leaning forward over a folded pillow
3. Lying supine on a bed with pillows under the knees
4. Sitting in a recliner, leaning slightly backward

Answer 68

our Answer: 4
Correct Answer: 1
You have incorrectly answered the question.

1. This position will drain the superior segments of the lower lobes.
2. This position drains the posterior segments of the upper lobes.
3. This position drains the anterior segments of the lower lobes.
4. This position drains the apical segments of the upper lobes.

Question 69

Which of the following methods is BEST for a physical therapist to use to determine the impact of pain on the lifestyle and daily functioning of a patient with chronic pain?

1. Observe the patient during simulations of usual daily tasks and note any signs of pain.
2. Have the patient rate changes in pain on a 0-10 scale during exercise in physical therapy.
3. Administer a standardized disability questionnaire.
4. Have trained observers watch the patient perform activities at home.

Answer 69

Your Answer: 1
Correct Answer: 3
You have incorrectly answered the question.

1. Efforts to simulate tasks have not been found to be reliable. Pain is a subjective experience, and observation may not provide accurate data on the patient's pain level.
2. This provides information on patient's pain at the moment and the response to treatment, but does not provide information on how it changes or affects the patient's lifestyle and ability to function in his or her role in society. This is more of an acute than chronic pain measurement.
3. All of the standard impact-of-pain instruments are self-report because only the patient "knows" the impact of pain on lifestyle. The most critical issue is whether or not a patient can complete any of them or only one of them. Some are questionnaires; others are diaries. Selection would be dependent on the skills of the patient.
4. Although use of trained observers is a plausible alternative, there is no standardized measurement using this strategy for data collection, probably because of the expense and extensive training that would be required. Pain is a subjective phenomenon, and observers are not able to watch what a patient feels.

Question 70

A patient sustained a cerebrovascular accident and is now exhibiting significant weakness on the right side. The physical therapist has determined that a dependent pivot transfer is appropriate for the patient at this time. Which of the following concepts is the MOST important aspect of this transfer?

1. The therapist should lift the patient only high enough so that the patient's buttocks clear the wheelchair.
2. The patient should place the arms around the therapist's neck.
3. The therapist should be positioned behind the patient to help lift the patient.
4. The patient should perform a sitting push-up in order to lift the buttocks.

Answer 70

Your Answer: 2
Correct Answer: 1
You have incorrectly answered the question.

1. In this type of transfer, the patient is not brought to a complete standing position. The patient is only lifted to the point that the buttocks can clear the wheelchair and move to the treatment table or bed.
2. The patient should place arms around the therapist's upper back, NOT the therapist's neck. This is an important safety issue for the therapist.
3. The therapist should not be behind the patient in this transfer. A therapist may be behind a patient in maximally dependent transfers, such as two-man lifts.
4. The patient is not pushing up in this type of transfer. The patient is placing the arms around the therapist's upper back. If the patient was pushing up with the arms, it would be a different type of transfer, such as sliding board or push-up transfer.

Question 71

For a patient with a complete T10 spinal cord injury to achieve stability while standing with crutches, the patient should maintain which of the following positions?

1. Hips posterior to the ankles
2. Shoulders posterior to the hips
3. Ankles plantar flexed
4. Knees hyperextended

Answer 71

Your Answer: 4
Correct Answer: 2
You have incorrectly answered the question.

1. Due to weakness of hip extension, a patient with spinal cord lesion at T10 will be unstable in standing unless the hips are positioned in front of the gravity line (which places the hips anterior to the ankles).
2. Due to weakness of hip extension, a patient with spinal cord lesion at T10 will be unstable in standing unless the hips are positioned in front of the gravity line. This position will place most of the weight on the feet through the heels. This position allows the patient to rest on the Y ligament of the hip allowing the patient to remain upright. This position creates hyperextension at the hips.
3. Plantar flexion of the ankles while standing would also cause the hips to flex, decreasing stability. Typically, the ankle is locked in 5° to 10° of dorsiflexion.
4. The knees would typically be locked into neutral with the ankles locked in 5° to 10° of dorsiflexion and hips hyperextended. This allows the patient to rest on the anterior Y ligaments of the hips.

Question 72

Pharmacological treatment with nitroglycerin is MOST often used by patients with which of the following conditions?

1. Hypertension
2. Bronchoconstriction
3. Cardiac arrhythmia
4. Stable angina pectoris

Answer 72

Your Answer: 2
Correct Answer: 4
You have incorrectly answered the question.

1. Stable angina is often treated with nitroglycerin. Hypertension is managed pharmacologically with beta blockers, alpha blockers, angiotensin-converting enzyme (ACE) inhibitors, diuretics, vasodilators, or calcium channel blockers.
2. It is not unusual for patients to be taking a combination of drugs for pulmonary diseases; however, nitroglycerin would not be indicated. Among the conditions enumerated, stable angina is the one that is treated with nitroglycerin.
3. Cardiac arrhythmias are alterations in the electric conduction of the heart from the normal beat. While numerous pharmacological (and non-pharmacological) treatment options exist, nitroglycerin is not the best option. Stable angina, however, is treated with nitroglycerin.
4. Nitroglycerin's primary indication is for the acute and prophylactic management of stable angina

Question 73

A 2-year-old child has spastic quadriplegic cerebral palsy, with persistence of primitive reflexes, no selective control of movement, and frequent respiratory infections. Which of the following elements is MOST critical to include in the physical therapist’s examination?

1. Modified Ashworth scale
2. Auscultation of heart sounds
3. Assessment of oral-motor control and feeding
4. Assessment of anticipatory postural adjustments

Answer 73

our Answer: 4
Correct Answer: 3
You have incorrectly answered the question.

1. The modified Ashworth scale is used to access muscle spasticity (O'Sullivan, p. 172). Testing of child's spasticity level would be included but not critical.
2. Auscultation of heart sounds would not be a major component of this patient's evaluation.
3. Oral-motor control could be a factor in respiratory infections because poor feeding is associated with weak suck, poor coordination of swallowing mechanism, and hypoactive gag reflex (O'Sullivan, p. 1283).
4. Anticipatory postural adjustments are learned through movement experience, which would be absent in this child, who does not have volitional control and displays primitive reflexes (Campbell, pp. 104-105).

Question 74

Which of the following methods is MOST appropriate to determine maximal oxygen consumption in a patient with multiple sclerosis who has impaired balance?

1. Lower extremity cycle ergometer test
2. Upper extremity ergometer test
3. 6-minute walk test
4. Treadmill stress tes

Answer 74

Your Answer: 2
Correct Answer: 1
You have incorrectly answered the question.

1. Cycle ergometer tests are appropriate for patients with multiple sclerosis. Cycle ergometer tests are used to estimate maximal oxygen consumption from submaximal exercise. Cycle ergometer tests eliminate the need for balance, which may be affected in a person with multiple sclerosis. (Durstine, p. 322)
2. Upper extremity ergometer testing could be performed; however, muscular fatigue is more likely to occur before achieving cardiopulmonary maximum (Durstine, p. 322).
3. Walking tests are used to estimate maximal oxygen consumption from submaximal exercise, but require balance and ability to walk, which may be affected in a person with multiple sclerosis (Hillegass, pp. 109, 723).
4. Treadmill stress tests are used to determine maximal oxygen consumption and cardiovascular functional capacity. Treadmill stress tests are not the most appropriate for a patient with multiple sclerosis, who may have impaired balance. (Durstine, p. 322)

Question 75

A patient with a chronic skin ulcer displays decreased blood pressure and skin turgor, as well as a weak, rapid pulse. A physical therapist should suspect a decreased dietary intake of:

1. protein.
2. water.
3. vitamin B.
4. carbohydrates.

Answer 75

Your Answer: 3
Correct Answer: 2
You have incorrectly answered the question.

1. Too much protein may lead to greater water needs; too little will prevent the development of a wound bed. Protein level does not have a direct effect on heart rate or blood pressure.
2. Water aids in hydration of the wound site, and dehydration will result in elevated heart rate and decreased blood pressure.
3. Vitamin B is critical in the rebuilding / remodeling stage; vitamin B level does not affect heart rate or blood pressure.
4. Carbohydrates are important for overall energy needs but do not directly affect heart rate or blood pressure.

Question 76

he owner of a physical therapy clinic also owns a medical supply company and requests all patients purchase supplies solely from that company. To fully demonstrate ethical conduct, a physical therapist employed by the clinic should take which of the following actions?

1. Refer patients to another specified vendor for equipment.
2. Offer to help patients decide which equipment to purchase.
3. Inform patients that purchasing equipment is not necessary.
4. Make full disclosure to patients regarding the joint venture.

Answer 76

Your Answer: 2
Correct Answer: 4
You have incorrectly answered the question.

1. The answer is not necessary ethically, if the relationship between clinic and vendor is disclosed.
2. This answer is partially correct, but the therapist must also disclose the relationship between clinic and vendor.
3. Patients should be guided on what type of equipment to purchase, but the relationship of clinic to vendor must be disclosed.
4. Principle 7D of the Code of Ethics for the Physical Therapist stipulates that physical therapists shall fully disclose financial interests in products or services recommended to patients (APTA).

Question 77

A patient with ankylosing spondylitis reports having had a diagnostic test that showed “increased uptake” in the spine and pelvis. Which of the following tests was MOST likely performed?

1. Computed tomography
2. Plain film radiography
3. Magnetic resonance imaging
4. Bone scan

Answer 77

Your Answer: 3
Correct Answer: 4
You have incorrectly answered the question.

1. Computed tomography is useful for imagining bone, but it usually represents the bone geometry and density, not uptake (p. 115).
2. Plain film radiographs are used to assess bones, but they do not show "increased uptake" (pp. 6-8).
3. Magnetic resonance imagining is used to assess soft tissue; however, the results are not referred to as "increased uptake" (p. 131).
4. A bone scan is done by injecting a patient with a radiopharmaceutical substance and then scanning for areas of "increased uptake," which would indicate areas of increased osteoclastic and osteoblastic activity (p. 31).

Question 78

Which of the following patellar mobilizations will BEST facilitate active terminal knee extension for a patient who has had the knee immobilized for 6 weeks?

1. Inferior glide
2. Medial glide
3. Superior glide
4. Lateral glide

Answer 78

Your Answer: 1
Correct Answer: 3
You have incorrectly answered the question.

1. The patella must glide downward with knee flexion. Therefore, performing mobilization downward would not increase knee extension, but encourage knee flexion.
2. Patellar alignment is mitigated by the bony anatomy and retinacular attachments that give it an overall lateral pull. However, for the knee to fully extend, the patella must glide superiorly. The patella glides much more superiorly/inferiorly than laterally. The primary movement is superior glide.
3. The patella glides superiorly with terminal knee extension therefore, a mobilization to increase superior glides would facilitate knee extension.
4. For knee extension to occur, the patella must track superiorly: the fact that it moves laterally is a function of bony and ligamentous anatomy. The primary movement is superior glide

Question 79

A physical therapist is treating a teenaged athlete who sustained a hematoma from a blow to the anterior thigh 2 weeks ago. The patient exhibits moderate knee pain with knee flexion greater than 90°. The patient has a palpable mass in the quadriceps muscle. The MOST likely diagnosis for this patient is:

1. patellofemoral syndrome.
2. femoral hairline fracture.
3. quadriceps tendon rupture.
4. myositis ossificans.

Answer 79

Your Answer: 2
Correct Answer: 3
You have incorrectly answered the question.

1. A normal diastolic blood pressure response is one in which a change (increase or decrease) is no greater than 10 mm Hg. There is no documented relationship of decreasing heart rate with increasing or decreasing diastolic blood pressure. (O'Sullivan, p. 560)
2. Beta blockers decrease both resting and exercise heart rates. This option is opposite the effect of the medication. (O'Sullivan, pp. 540-541)
3. Propranolol (Inderal) is a nonselective beta-adrenergic antagonist and competes with the catecholamines epinephrine and norepinephrine for beta receptor binding sites, thereby preventing the catecholamines from binding. Beta blockers decrease both resting and exercise heart rates. (Hillegass, p. 473)
4. Beta blockers decrease both resting and exercise heart rates. This would limit the heart's ability to increase the pulse rate as the systolic blood pressure rises. (O'Sullivan, pp. 540-541; Hillegass, p. 473)

Question 80

A patient with left hemiparesis has a strong tendency to push the trunk to the left. Which of the following techniques should the physical therapist use to assist the patient to transfer from wheelchair to bed?

1. Have the patient keep hands clasped together.
2. Instruct the patient to push up from the wheelchair with the right upper extremity.
3. Stand on the patient's left side and push the patient's trunk to the right.
4. Ask the patient to stop pushing.

Answer 80

Your Answer: 2
Correct Answer: 1
You have incorrectly answered the question.

1. A patient with pusher syndrome associated with left hemiparesis will use the right upper extremity to push over to the left side. Push off is minimized if the hands are clasped together. It is important to limit pushing with the sound extremity.
2. This problem is worsened if the patient is allowed to push on the wheelchair armrest.
3. Efforts by the therapist to increase symmetry by pushing the trunk to the right will only make the patient push harder to the left.
4. Simply commanding the patient to stop pushing will not be effective, because the patient with pusher syndrome generally has distorted sensory input and is not aware of the extent that he or she is pushing off balance

Question 81

A patient has a 6-week-old surgical scar that is freely mobile and is completely closed. The scar is soft, is slightly raised to palpation, and is pink with a silvery white appearance. These findings indicate:

1. a normally healing scar.
2. retarded scar healing.
3. possible scar inflammation.
4. excessive keloid formation.

Answer 81

Your Answer: 4
Correct Answer: 1
You have incorrectly answered the question.

1. A normally healing scar at 6 weeks will be pink or pale in color, flexible, less than 2 mm in height, and within the borders of the wound (p. 377).
2. A scar with retarded healing at 6 weeks would still show signs of not being approximated, and not fully granulated or epithelialized, i.e., the scar is not achieving the maturation phase of healing (pp. 375, 376).
3. Signs of inflammation would include a red color, warmth, and induration (firm, inflexible tissue), but not the signs given in the stem (p. 109).
4. Keloids would be firm or inflexible, highly raised, and outside the wound borders (pp. 376-377).

Question 82

A patient with left hemiparesis has a strong tendency to push the trunk to the left. Which of the following techniques should the physical therapist use to assist the patient to transfer from wheelchair to bed?

1. Have the patient keep hands clasped together.
2. Instruct the patient to push up from the wheelchair with the right upper extremity.
3. Stand on the patient's left side and push the patient's trunk to the right.
4. Ask the patient to stop pushing.

Answer 82

Your Answer: 2
Correct Answer: 1
You have incorrectly answered the question.

1. A patient with pusher syndrome associated with left hemiparesis will use the right upper extremity to push over to the left side. Push off is minimized if the hands are clasped together. It is important to limit pushing with the sound extremity.
2. This problem is worsened if the patient is allowed to push on the wheelchair armrest.
3. Efforts by the therapist to increase symmetry by pushing the trunk to the right will only make the patient push harder to the left.
4. Simply commanding the patient to stop pushing will not be effective, because the patient with pusher syndrome generally has distorted sensory input and is not aware of the extent that he or she is pushing off balance.

Question 83

When instructing an individual with mental retardation, which of the following teaching techniques is MOST appropriate?

1. Emphasize verbal feedback.
2. Provide instruction using a single method.
3. Practice, review, and facilitate overlearning of concepts and techniques.
4. Practice a series of portions of a task rather than the complete functional task.

Answer 83

Your Answer: 4
Correct Answer: 3
You have incorrectly answered the question.

1. Visual feedback, whether through pictures or demonstration, is the most effective means to achieve retention.
2. Individuals with mental retardation are more likely to retain information presented using multiple modalities.
3. The literature reports that long-term retention of skills requires repetition and overlearning.
4. Portions of a task or “splinter skills” are less meaningful to an individual with mental retardation and less likely to be transferred to new situations

Question 84

Neurapraxia resulting from ice massage is MOST likely to occur when the therapy is administered:

1. over the insertion of the lateral collateral ligament of the knee.
2. for the treatment of medial epicondylalgia.
3. over the piriformis muscle origin and insertion in the hip.
4. for treatment of posterior dislocation of the shoulder.

Answer 84

our Answer: 2
Correct Answer: 1
You have incorrectly answered the question.

1. Applying cold directly over the superficial main branch of a nerve, such as the peroneal nerve at the lateral knee, may cause a nerve conduction block (Cameron, p. 137).
2. When applying ice to the posterolateral elbow, the physical therapist should monitor for signs of radial nerve conduction block (Cameron, p. 137). The treatment of medial epicondylalgia would involve applying ice massage to the common flexor origin at the anteromedial elbow (Moore, p. 746).
3. The piriformis muscle is a deep muscle of the hip (Moore, p. 565). Therefore, the possibility of affecting the nerve is minimal.
4. Ice would be indicated in the treatment of posterior shoulder dislocation to control inflammation, edema, and pain (Cameron, p. 132). Nerves are deep to the muscle bulk of the trapezius and posterior deltoid when applying ice massage to this region (Moore, p. 700).

Question 85

Which of the following findings is MOST important to assess in a patient who is 2 days post modified radical mastectomy?

1. Pain limiting range of motion in the involved upper extremity
2. Chest wall adhesions
3. Atrophy in the involved upper extremity
4. Sensory loss in the involved upper extremity

Answer 85

Your Answer: 4
Correct Answer: 1
You have incorrectly answered the question.

1. This is most important, because pain limiting range of motion can lead to a frozen shoulder and more pain.
2. Chest wall adhesions are likely to occur in this type of patient, but not as soon as 2 days after surgery.
3. Atrophy in the upper extremity may occur from disuse due to pain or swelling, but is unlikely to be seen as soon as 2 days after surgery.
4. Sensory loss may happen as a result of swelling, but range of motion of the shoulder is most important to assess first, because the pain limiting range of motion can lead to a frozen shoulder

Question 86

Which of the following terms is MOST appropriate to describe wound exudate that is green and foul-odored?

1. Serous
2. Proteinaceous
3. Sanguineous
4. Purulent

Answer 86

our Answer: 2
Correct Answer: 4
You have incorrectly answered the question.

1. Serous is described as clear fluid without blood, pus, or debris (Taber's, p. 2116).
2. Proteinaceous exudate is exudate composed of a high proportion of protein (Taber's, p. 1928). It is not typically green in color or foul-odored (Paz, p 303).
3. Sanguineous drainage is bloody, bright red (Taber's, p. 2079; Paz, p. 303).
4. Purulent is green in color with an odor (Paz, p. 303)

Question 87

A physical therapist is performing sit-to-stand transfer training with a patient in a hospital room. The patient is currently admitted for acute renal failure and has electrocardiogram monitoring in place. During the transfer training, the therapist notes new onset of one unsustained, unifocal premature ventricular contraction. Which of the following actions is MOST appropriate for the therapist to take at this time?

1. Discontinue transfer training and call the nurse immediately.
2. Discontinue transfer training and switch to passive range-of-motion exercises.
3. Allow the patient to rest and continue with transfer training, while monitoring the electrocardiogram.
4. Allow the patient to rest and measure the patient’s blood pressure

Answer 87

Your Answer: 4
Correct Answer: 3
You have incorrectly answered the question.

1. An unsustained unifocal premature ventricular contraction is a stable electrocardiograph change associated with activity, and therefore modification of the current intervention is not necessary.
2. An unsustained unifocal premature ventricular contraction is a stable electrocardiograph change associated with activity, and therefore modification of the current intervention is not necessary.
3. An unsustained unifocal premature ventricular contraction is a stable electrocardiograph change associated with activity. Treatment can continue with continued monitoring.
4. Because this type of premature ventricular contraction is stable and there is no report of dizziness in the stem, taking blood pressure is not necessary at this time.