PEAT 1

Question 1

For a patient who demonstrates an equinus gait, which of the following muscles should be tested for weakness?

1.Soleus

2.Gastrocnemius

3.Tibialis anterior

4.Tibialis posterior

Answer 1

3.Tibialis anterior

Equinus gait is caused by dorsiflexor weakness or hypotonia (p. 392). The dorsiflexors, including the tibialis anterior muscle, should be tested for weakness or hypotonia (p. 357).

Question 2

The Functional Independence Measure (FIM) and the Barthel Index have been shown to have high concurrent validity with each other as functional measures for patients who have had a stroke. Which of the following conclusions is MOST appropriate about use of the instruments to assess functional status in a patient with a stroke?

1.Either test could be used.

2.Both tests should be used.

3.Neither test should be used.

4.Another test should be used with either of the tests.

Answer 2

1.Either test could be used.

High concurrent validity means the two tests yield very similar results.

Question 3

When providing therapeutic intervention and education to a patient in the confused-agitated stage of recovery subsequent to a traumatic brain injury, the physical therapist assistant should:

1.use animated gestures and voice tones to stimulate the patient’s attentiveness.

2.challenge the patient to recall activities and instructions from the previous session.

3.provide repeated and detailed instructions until the desired response is elicited.

4.be prepared with alternative activities if the patient does not attend to task.

Answer 3

4.be prepared with alternative activities if the patient does not attend to task.

The patient in this stage of recovery will have a short attention span or may not respond to a given instruction or activity.

Question 4

Which of the following activities should be AVOIDED by a patient who is at risk of developing lymphedema?

1.Exercising in a hot environment

2.Exercising with light resistance

3.Exercising in a cool environment

4.Exercising while wearing compression garments

Answer 4

1.Exercising in a hot environment

Patients should avoid hot environments to minimize development of lymphedema.

Question 5

A patient with a recent history of immobilization has a new onset of unilateral leg swelling with dependent edema. This condition is MOST likely due to:

1.congestive heart failure.

2.peripheral arterial disease.

3.deep vein thrombosis.

4.lymphedema.

Answer 5

3.deep vein thrombosis.

Rapid onset of unilateral leg swelling with dependent edema is a symptom of deep vein thrombosis (p. 609).

Question 6

The exercise shown in the photograph is LEAST appropriate for a patient who has which of the following characteristics? (doorway/pec stretch)

1.Anterior glenohumeral instability

2.Forward head posture

3.Limited glenohumeral lateral (external) rotation range of motion

4.Tightness of the pectoralis minor and pectoralis major

Answer 6

1.Anterior glenohumeral instability

The activity shown in the photograph will force the humeral head anteriorly, thus encouraging anterior dislocation. Lateral (external) rotation and abduction should be avoided (pp. 547-548). This activity is appropriate for a patient who has hypomobility, not instability (p. 555).

Question 7

A 60-year-old patient is in outpatient cardiac rehabilitation 2 weeks post myocardial infarction. After the patient exercises for 15 minutes on a stationary bicycle, vital signs are remeasured. The results are shown in the table. Which of the following changes is MOST appropriate?

At rest: 130/80 mmhg; 90 bpm
After 15 minutes of exercise: 140/100 mmhg; 130 bpm

1.Increase the duration of the exercise.

2.Decrease the intensity of the exercise.

3.Switch to bilateral upper extremity aerobic exercise.

4.Add static upper extremity weight-bearing to bicycling.

Answer 7

2.Decrease the intensity of the exercise.

The abnormal exercise heart rate rise of greater than 30 bpm and abnormal rise in diastolic blood pressure (Hillegass, p. 549; Goodman, pp. 267, 773.e329) warrant decreasing exercise intensity (Hillegass, p. 581).

Question 8

A patient reports numbness in the perineal region and mild urinary incontinence. These symptoms are MOST likely caused by which of the following conditions?

1.Sciatic neuropathy

2.Femoral artery occlusion

3.Lumbar spinal stenosis

4.Sacral nerve root impingement

Answer 8

4.Sacral nerve root impingement

Sacral nerve root impingement could include sensory loss in the S2–S5 distribution, which is saddle anesthesia (Magee, p. 554). Involvement of S2–S4 can produce incontinence (Magee, p. 604).

Question 9

Compared with healthy individuals, a patient who has restrictive pulmonary disease is MOST likely to have which of the following changes in lung volumes or capacities?

1.Increased vital capacity and increased residual volume

2.Increased vital capacity and decreased total lung capacity

3.Decreased inspiratory reserve volume and decreased vital capacity

4.Decreased total lung capacity and increased functional residual capacity

Answer 9

3.Decreased inspiratory reserve volume and decreased vital capacity

Restrictive lung diseases result in difficulty expanding the lungs and a reduction in lung volumes.

Question 10

In the exercise in the photograph, which of the following muscles is the agonist? (pt laying prone with arms fully abducted at sides holding dumbbells)

1.Levator scapulae

2.Lower trapezius

3.Middle trapezius

4.Upper trapezius

Answer 10

3.Middle trapezius

Scapular adduction (retraction), as shown in the photograph, is performed by the middle trapezius (p. 608).

Question 11

A patient who has a spinal cord injury demonstrates signs of autonomic dysreflexia. Which of the following actions is MOST appropriate to take?

1.Put an abdominal binder on the patient.

2.Place the patient in supine position.

3.Wrap the patient’s lower extremities.

4.Check the patient’s catheter tube.

Answer 11

4.Check the patient’s catheter tube.

An obstructed catheter tube is considered a noxious stimulus below the level of the lesion, which can cause autonomic dysreflexia.

Question 12

A patient who has type 1 diabetes is riding a stationary bicycle when a hypoglycemic episode occurs. Which of the following clinical manifestations would be the expected physiological response?

1.Muscle weakness, nausea, and vomiting

2.Fruity, acetone-smelling breath and an increased respiratory rate

3.Onset of irritability, nervousness, or emotional lability

4.Polyuria, thirst, and dehydration

Answer 12

3.Onset of irritability, nervousness, or emotional lability

Irritability, nervousness, and a labile mental state are described as mental changes that commonly occur with hypoglycemia

Question 13

A patient correctly demonstrated home exercises to strengthen quadriceps and hip flexors. This data should be included in which section of the documentation?

1.Subjective

2.Objective

3.Assessment

4.Plan

Answer 13

2.Objective

The objective section provides objectively measurable information and observations. If the patient can demonstrate exercises properly, this is an observation and should be documented in this section.

Question 14

In a patient with unilateral hip impairment, a cane is ordinarily used on the:

1.uninvolved side to lessen the muscle force required of the abductors on the involved side.

2.involved side to lessen the muscle force required of the hip abductors on that side.

3.uninvolved side to lessen the muscle force required of the adductors on the involved side.

4.involved side to lessen the muscle force required of the hip abductors on the uninvolved side.

Answer 14

1.uninvolved side to lessen the muscle force required of the abductors on the involved side

Use of a cane on the uninvolved side will help to decrease the force required of the hip abductors on the impaired side when weight-bearing.

Question 15

A patient consistently catches the right toe box of the shoe while walking. Which of the following muscle groups MOST likely needs to be strengthened?

1.Eversion muscles

2.Inversion muscles

3.Dorsiflexion muscles

4.Plantar flexion muscles

Answer 15

3.Dorsiflexion muscles

Muscles that dorsiflex the ankle contract concentrically during the swing phase of gait to prevent plantar flexion and allow the toes to clear the floor. Weakness in these muscles can cause foot drop, causing the toes or shoe catch during swing phase.

Question 16

The plan of care for the patient in the photograph includes the use of biofeedback to assist in postural alignment correction. Where should the physical therapist assistant place the biofeedback sensors to facilitate muscle contractions? (pt sitting in chair with really bad posture; kyphotic; hunchback)

1.Thoracic paraspinals and abdominals

2.Thoracic and lumbar paraspinals

3.Lumbar paraspinals and pectorals

4.Abdominals and pectorals

Answer 16

2.Thoracic and lumbar paraspinals

The biofeedback in this scenario is being used to facilitate a muscle contraction. The postural muscles that are relaxed in the slouched sitting posture shown in the photograph are the lumbar and thoracic paraspinals.

Question 17

A patient with burns to 35% of total body surface area reports drinking large quantities of water throughout the day. Which of the following conditions is the patient at GREATEST risk of developing?

1.Hypermagnesemia

2.Hypercalcemia

3.Hypokalemia

4.Hyponatremia

Answer 17

4.Hyponatremia

Drinking too much water without the appropriate electrolyte balance can cause a severe drop in sodium levels. Low sodium levels are described by the term hyponatremia. (p. 204)

Question 18

Which of the following treatment strategies is MOST appropriate for a patient who has acute carpal tunnel syndrome?

1.Strengthening the wrist flexors

2.Strengthening pinch and grip functions with the wrist in flexion

3.Maintaining a neutral wrist position during work and other activities

4.Applying direct pressure and cross-friction over the anterior aspect of the wrist

Answer 18

3.Maintaining a neutral wrist position during work and other activities

A nonsurgical treatment for carpal tunnel syndrome is to splint the wrist in neutral position so there is minimal pressure in the tunnel. Activities should be modified to keep the wrist in neutral. (Kisner, p. 406)

Question 19

Which of the following areas is MOST susceptible to a pressure injury when a patient is in sidelying position?

1.Heels

2.Malleolus

3.Sacrum

4.Ischial tuberosity

Answer 19

2.Malleolus

The areas of greatest pressure in the side lying position include the malleolus.

Question 20

A patient has akinesia. Which of the following gait dysfunctions is MOST likely to be present?

1.Decreased step length

2.Increased base of support

3.Difficulty attempting to stop

4.Sudden cessation of movement

Answer 20

4.Sudden cessation of movement

Akinesia is a disorder of movement initiation that occurs in patients who have Parkinson disease and manifests as a paucity of natural and automatic movements. Gait akinesia is the sudden cessation of movement in the middle of an action sequence, as if the foot is stuck to the floor.

Question 21

Which of the following tests is used to assess volitional movement of the extremities after an individual has had a cerebrovascular accident?

1.Functional Reach Test

2.Functional Status Index

3.Performance-Oriented Mobility Assessment (Tinetti)

4.Fugl-Meyer Assessment

Answer 21

4.Fugl-Meyer Assessment

The Fugl-Meyer Assessment uses an ordinal scale to assess volitional motor performance in people who have hemiplegia (O’Sullivan, p. 624).

Question 22

A patient using a transtibial prosthesis excessively flexes the right knee during the early stance phase of the gait cycle. Which of the following causes is PRIMARILY responsible for this gait deviation?

1.Socket too far anterior

2.Socket too far posterior

3.Excessive foot inset

4.Excessive foot outset

Answer 22

1.Socket too far anterior

1. The socket being too far anterior (or the foot set too posteriorly) is a primary cause for excessive knee flexion in early stance.
2. The socket being too far posterior (or the foot set too anterior) causes insufficient knee flexion during early stance.
3. Excessive foot inset causes an excessive lateral thrust during midstance.
4. Excessive foot outset causes an excessive medial thrust during midstance.

Question 23

When monitoring the vital signs of a person who has mitral valve prolapse, which of the following findings is MOST likely to be observed?

1.Bradypnea

2.Bradycardia

3.Tachypnea

4.Tachycardia

Answer 23

4.Tachycardia

1. Individuals who have mitral valve prolapse experience dyspnea, not bradypnea, which is slowness or decrease in number of breaths/minute (p. 295).
2. Bradycardia is slowness of heart beat. Individuals who have mitral valve prolapse experience tachycardia, not bradycardia due to dysautonomia. (p. 293)
3. Individuals who have mitral valve prolapse experience dyspnea or difficulty in breathing, not tachypnea or rapid breathing (pp. 293, 295).
4. Tachycardia, which is rapid heart beat, is a clinical sign/symptom of mitral valve prolapse due to dysautonomia (p. 295).

Question 24

Which of the following orthotic irregularities is MOST likely to contribute to a patient exhibiting foot slap during the early stance phase of gait?

1.Inadequate dorsiflexion stop

2.Inadequate dorsiflexion assist

3.Inadequate plantar flexion assist

4.Inadequate transverse plane alignment

Answer 24

2.Inadequate dorsiflexion assist

An inadequate dorsiflexion assist will cause less assistance with dorsiflexion, which could cause foot slap (p. 1310).

Question 25

Transcutaneous electrical nerve stimulation is CONTRAINDICATED for use on a patient:

1.with a demand pacemaker.

2.with a history of stable angina.

3.with terminal cancer.

4.who is pregnant during labor.

Answer 25

1.with a demand pacemaker.

Presence of a demand pacemaker is a contraindication for use of transcutaneous electrical nerve stimulation due to the increased risk for disturbance of the pacemaker.

Question 26

When assessing normal standing posture, where should the gravity line fall?

1. Anterior to the lateral malleolus
2. Posterior to the lateral malleolus
3. Anterior to the greater trochanter
4. Posterior to the greater trochanter

Answer 26

1. Anterior to the lateral malleolus

With ideal standing posture, the vertical line would fall slightly anterior to the lateral malleolus.

Question 27

The symptoms of polyuria, polydipsia, pruritus, and peripheral neuropathy are MOST consistent with which of the following disorders?

1.Type 2 diabetes

2.Lymphedema

3.Myocardial infarction

4.Chronic obstructive pulmonary disease

Answer 27

1.Type 2 diabetes

1. The symptoms of type 2 diabetes include polyuria, polydipsia, pruritus, and peripheral neuropathy (Goodman, p. 511).
2. The clinical presentation of lymphedema includes swelling, pitting edema, fatigue, tightness of the involved extremity, discomfort, loss of mobility/range-of-motion, and fibrotic changes of the dermis (O’Sullivan, p. 536).
3. Signs and symptoms of myocardial infarction include pain similar to that for angina pectoris, heaviness or a tight feeling of the chest, nausea and vomiting, light-headedness, dyspnea, and hypotension (Goodman, pp. 585-586).
4. Clinical presentation of chronic obstructive pulmonary disease includes chronic cough, expectoration, and exertional dyspnea (O’Sullivan, pp. 438-439).

Question 28

Four months after sustaining a fractured humerus, a patient has reached a plateau. Active and passive shoulder motions have improved but remain impaired. The patient reports pain and tenderness when the fracture site is palpated. The patient’s temperature is 98.6°F (37°C). What is the MOST likely cause of the patient’s lack of recent progress?

1.Infection of the fractured bone

2.Nonunion of the fracture

3.Heterotopic ossification

4.Compartment syndrome

Answer 28

2.Nonunion of the fracture

1. Infection at the fracture site can delay healing. If a patient exhibits a fever or increased redness, tenderness, or irritation of the fracture site, the patient should be examined by the physician for possible infection. The patient’s temperature in the scenario is normal.
2. Individuals who have a nonunion fracture often have pain, heat, and tenderness at the fracture site.
3. The hallmark sign of heterotopic ossification is a progressive loss of joint motion at a time when posttraumatic inflammation should be resolving. The scenario above describes improvement with a plateau, not progressive loss of motion.
4. Significant swelling and pain may indicate compartment syndrome. There is no description of swelling in the scenario.

Question 29

A patient reports a history of multiple falls when turning around from a kitchen table to place items into the refrigerator. Which of the following assessments would provide the MOST useful information about the patient’s impairment?

1.Berg Balance Scale

2.Functional Reach Test

3.Timed Walking Test

4.Sharpened Romberg Test

Answer 29

1.Berg Balance Scale

1. The Berg Balance Scale consists of 14 tasks, including an item that is similar to the Functional Reach Test. It is the most appropriate assessment for the patient because it will assess the patient’s ability to rotate at the trunk, reach forward, and shift weight with one foot ahead of the other. (p. 213)
2. The Functional Reach Test is a balance screen and requires the patient to reach as far forward as possible without moving the feet while in a standing position. This closely matches the task that the patient performs in the stem. However, this does not indicate the patient’s balance with trunk rotation nor does it allow the patient to move out of a base of support. (pp. 216-217)
3. The Timed Walking Test is used to assess gait speed. No rotation or reaching elements are tested. (pp. 258-259)
4. The Sharpened Romberg Test is a static test of balance and has no rotation or reaching elements (pp. 208-209).

Question 30

Onset of bloody stools is an indication of which of the following conditions?

1.Acute appendicitis

2.Strangulated hernia

3.Celiac disease

4.Colorectal cancer

Answer 30

4.Colorectal cancer

1. Classic symptoms of acute appendicitis include localized pain in the right lower abdominal quadrant, nausea, vomiting, anorexia, fever, tenderness, and diarrhea. Bloody stools are not a typical symptom. (p. 773.e125)
2. A strangulated hernia occurs when part of the intestine becomes entrapped in the abdominal wall. It will cause severe pain and possible bowel obstruction. Bloody stools are not a typical symptom of strangulated hernia. (pp. 773.e121-773.e123)
3. Celiac disease is a small intestine disease marked by malabsorption and damage to the mucosal lining of the intestine. Common symptoms include weight loss, abdominal distention, flatulence, and muscle wasting. Stools are typically not bloody. (p. 773.e108)
4. Blood in stools is one of the only early signs of colorectal cancer. Any change in bowel habits, especially new onset of bloody stools, should be further investigated. (p. 773.e118)

Question 31

For a patient who had a total shoulder arthroplasty 5 days ago, which of the following interventions would MOST effectively minimize joint adhesions?

1.Active range of motion in the scapular plane

2.Gentle muscle sets with the upper extremity immobilized in a sling

3.Passive range of motion in a pain-free range

4.Joint mobilization using small-amplitude oscillations into tissue resistance

Answer 31

3.Passive range of motion in a pain-free range

During the maximal protection phase of shoulder arthroplasty, only passive range of motion, grade I and II distraction and glides, and pendulum exercises are indicated to maintain joint integrity and mobility (p. 564).

Question 32

A patient is unable to lift the hand away from the back in the position shown in the photograph. Which of the following muscles is MOST likely weak?

1.Supraspinatus

2.Subscapularis

3.Teres minor

4.Infraspinatus

Answer 32

2.Subscapularis

1. The supraspinatus stabilizes the humeral head during the initiation of abduction (p. 464). It is not tested with the arm positioned in medial (internal) rotation and extension, as shown in the photograph. (p. 473)
2. The movement shown in the photograph tests medial (internal) rotation strength (p. 464). The subscapularis is a primary medial (internal) rotator of the shoulder (p. 473).
3. The teres minor is a primary lateral (external) rotator of the shoulder (p. 464). It is not tested with the arm positioned in medial (internal) rotation and extension (p. 472).
4. The infraspinatus is a primary lateral (external) rotator of the shoulder (p. 464). It is not tested with the arm positioned in medial (internal) rotation and extension (p. 472).

Question 33

A patient has been experiencing postural hypotension when moving from supine to sitting position. To reduce the risk of hypotension, which of the following actions should be implemented prior to treatment?

1.Elevate the head of the bed.

2.Place the bed in the Trendelenburg position.

3.Remove the patient’s compression stockings.

4.Encourage the patient to limit consumption of salt

Answer 33

1.Elevate the head of the bed.

Elevating the head of the bed assists in venous return and decreases the risk of hypotension (p. 285).

Question 34

Which of the following problems is MOST important to address in a 10-year-old child who has Duchenne muscular dystrophy?

1.Increased joint mobility

2.Increased ligamentous laxity

3.Decreased ability to walk independently

4.Decreased sensation in the lower extremities

Answer 34

3.Decreased ability to walk independently

As a child with Duchenne muscular dystrophy ages and muscle degeneration progresses, physical therapy is essential in addressing ambulation aids as well as seated mobility options to maximize functional mobility.

Question 35

A physical therapist assistant is instructing a patient in prone shoulder extension using a 5-lb (2.3-kg) weight. What type of muscular contraction of the latissimus dorsi is involved when the patient extends from 0° to 30°?

1.Isometric

2.Isokinetic

3.Concentric

4.Eccentric

Answer 35

3.Concentric

The latissimus dorsi extends, adducts, and medially (internally) rotates the shoulder (p. 614). Moving the shoulder from 0° to 30° of extension will shorten the muscle fibers of the latissimus dorsi. Concentric movements produce increased tension and physical shortening of a muscle as an external resistance is overcome, as when lifting a weight (p. 189).

Question 36

The MOST important precaution for preventing a nosocomial infection is:

1.wearing a mask.

2.wearing gloves.

3.proper hand washing.

4.maintaining a sterile field.

Answer 36

3.proper hand washing.

1. Nosocomial infection is an infection that is acquired incidental to hospitalization for treatment of other conditions (p. 85). Nosocomial infections are commonly transmitted through hand contact rather than through respiratory transmission (pp. 89-90).
2. Wearing gloves will not decrease the incidence of infection if the same gloves are used when treating different patients or if hands are not washed (p. 90).
3. Contact transmission is the most frequent source of nosocomial infection, and occurs primarily because of poor hand washing between treatment of different patients (pp. 89-90).
4. Maintaining a sterile field will not decrease infection if hands are not washed between treatment of different patients (pp. 89-90).

Question 37

Which of the following interventions is MOST appropriate to address impaired muscle tone in a patient who has hypotonicity?

1.Weight-bearing through the involved limb

2.Slow, rhythmic rotation of the involved limb

3.Prolonged ice application over the belly of the involved muscle

4.Static stretching with manual pressure over the tendon of the involved muscle

Answer 37

1.Weight-bearing through the involved limb

Weight-bearing through the involved extremity will create joint approximation, which acts to facilitate muscle activity and cocontraction around a joint. The patient has low tone, and a facilitation technique would be most appropriate in this instance.

Question 38

A patient who lives alone is instructed to practice the activity in the video as a home exercise. Which of the following instructions to the patient would be MOST appropriate? (SLB)

1.Wear a gait belt.

2.Hold on to a table.

3.Use a single-point cane.

4.Stand by a kitchen counter.

Answer 38

4.Stand by a kitchen counter.

For safety during balance training, exercises should be performed near a railing or in parallel bars to allow the patient to grab when necessary. A suitable modification for this home exercise program is to stand near the kitchen counter.

Question 39

Which of the following laboratory reports is MOST useful in determining the effects of chronic diarrhea and vomiting?

1.Complete blood count

2.Renal function tests

3.Serum electrolytes

4.Serum enzymes

Answer 39

3.Serum electrolytes

Body fluid loss associated with chronic diarrhea and vomiting may cause an imbalance in body chemistry that is best determined by serum electrolyte testing (pp. 37, 773.e95).

Question 40

Which of the following structures would be MOST commonly involved in a surgical release for Dupuytren contracture?

1.First metacarpal joint capsule

2.Transverse carpal ligament

3.Annular pulleys

4.Palmar fascia

Answer 40

4.Palmar fascia

Dupuytren contracture typically affects the palmar fascia and interdigital web space. Release of the fascia reduces nodule deformity and associated flexion deformities of the ring and little fingers (4th and 5th digits).

Question 41

Which of the following interventions would be MOST appropriate for pain management?

1.Apply a cold pack with elevation of the residual limb for 15 minutes

2.Apply quadripolar transcutaneous electrical nerve stimulation to the painful area

3.Instruct the patient to discontinue use of the elastic bandaging on the residual limb

4.Instruct the patient to decrease the amount of weight-bearing on the prosthetic side by 25%

Answer 41

2.Apply quadripolar transcutaneous electrical nerve stimulation to the painful area

There is evidence that patients who have phantom limb pain experience relief with transcutaneous electrical nerve stimulation (TENS) because the intervention utilizes the gate theory by stimulating large fiber sensory nerves (Lazaro, p. 888). The electrodes should be placed proximal or distal to areas with sensory loss, but this is easily accomplished with quadripolar TENS, which can be placed anywhere on the extremity and avoiding the distal limb (Michlovitz, p. 350).

Question 42

Which of the following gait deviations on the right lower extremity is MOST likely to result from the improper fit of the prosthesis?

1.Equinus

2.Steppage

3.Trendelenburg

4.Vaulting

Answer 42

2.Steppage

1. An equinus gait occurs when the toes strike first, so this answer is not correct (p. 392).
2. The right extremity will be longer due to being unable to seat in the prosthesis. This will cause the individual to assume a gait pattern that will easily clear the long leg on the right side. The most probable possibilities would vaulting on the left side, excessive hip flexion on the right side (steppage), excessive knee flexion on the right side, or circumduction on the right side (pp. 390-394).
3. A Trendelenburg gait occurs when there is pelvic dropping on the same side due to gluteus medius weakness, so this answer is not correct (p. 392).
4. A vaulting gait on the right side could only occur if the patient had active plantarflexion of the right, but this is not possible on a prosthetic foot, so this answer is not correct (p. 394).

Question 43

Presenting Problem / Current Condition:
Right transtibial amputation 7 weeks ago secondary to complications of peripheral vascular disease
Patient was provided a permanent prosthesis today just prior to the patient’s first physical therapy appointment

Which of the following positioning activities should the patient be instructed to perform for 30 minutes, two times/day?

1.Supine position with a pillow under both knees

2.Supine position with a pillow between the knees

3.Prone position with a pillow under the abdomen

4.Prone position without a pillow under the abdomen

Answer 43

4.Prone position without a pillow under the abdomen

Patients are advised to lie prone in order to both prevent and manage contractures of the residual limb, the most common being hip flexion, knee flexion and hip abduction. It is important to position patients in this position for at least 30 minutes at a time to produce a long duration low-load stretch on the affected limb. This patient demonstrates evidence of knee flexion contracture and developing hip flexion contracture because hip extension required for normal gait should exceed 10°. While no abduction contracture is evident in the scenario, it would also be important to apply positioning out of the most likely contracture position for purposes of prevention.

Question 44

A physical therapist assistant is preparing to enter the room of a patient who has active tuberculosis. Which of the following types of personal protective equipment is MOST appropriate for the assistant to use in this situation?

1.Gloves

2.Over-the-ear surgical mask

3.Goggles

4.Dust-mist respirator

Answer 44

4.Dust-mist respirator

Tuberculosis is an airborne infection, which requires a dust or mist mask (i.e., N-95 respirator).

Question 45

A patient with a hiatal hernia is being seen in physical therapy. Which of the following positions is most important for the patient to AVOID during exercise?

1.Sitting

2.Standing

3.Semi-Fowler

4.Supine

Answer 45

4.Supine

The stomach is more likely to herniate into the thoracic cavity when a patient is in supine position. Therefore, the patient should avoid the supine position during exercise.

Question 46

Which of the following MUST occur in order for the heart to get enough oxygen while a patient is exercising?

1.Decrease in respiratory rate

2.Increase in extraction percentage

3.Increase in coronary blood flow

4.Decrease in myocardium workload

Answer 46

3.Increase in coronary blood flow

An increase in coronary blood flow is the key method to increase oxygen supplied to the heart.

Question 47

Which of the following sequences is MOST appropriate when instructing a patient with a right lower extremity injury to ascend stairs using axillary crutches?

1.Advance the right lower extremity, followed by the left lower extremity, then the crutches.

2.Advance the crutches, followed by the right lower extremity, then the left lower extremity.

3.Advance the crutches and right lower extremity together, followed by the left lower extremity.

4.Advance the left lower extremity, followed by the crutches and the right lower extremity together.

Answer 47

4.Advance the left lower extremity, followed by the crutches and the right lower extremity together.

When ascending stairs, the patient should be instructed to lead with the unaffected limb, which elevates the body, followed by the crutches and the affected extremity together. This allows the affected limb to remain supported by the crutches.

Question 48

A physical therapist assistant is asked to begin partial weight-bearing gait training with a patient. The patient is unable to maintain the weight-bearing precautions because of dementia. The assistant’s BEST course of action is to:

1.continue with the plan of care for 2 more days to see if the patient shows improvement.

2.report the patient’s inability to maintain weight-bearing status to the physical therapist.

3.discontinue the plan of care, and document that gait training is inappropriate for the patient.

4.recommend withholding physical therapy treatment until the patient is able to comply with the weight-bearing precautions.

Answer 48

2.report the patient’s inability to maintain weight-bearing status to the physical therapist.

The physical therapist assistant should consult with the physical therapist if the patient demonstrates an unsafe response to an intervention, such as the inability to maintain weight-bearing status as instructed and may therefore require a discussion regarding the plan of care (Pagliarulo).

Question 49

A patient who has decreased resistance to infection reports paresthesia and heaviness in the right upper extremity and exhibits decreased range of motion in the extremity. The patient’s signs and symptoms are MOST closely associated with which of the following conditions?

1.Gout

2.Lymphedema

3.Osteomyelitis

4.Deep vein thrombosis

Answer 49

2.Lymphedema

1. The signs and symptoms of gout include exquisite joint pain, erythema, warmth, and extreme tenderness. Patients who have gout may also experience chills, fever, and tachycardia. An increased size of the limb, decreased resistance to infection, and sensory disturbances are inconsistent with gout. (Goodman, p. 585)
2. The clinical manifestations of lymphedema include increased size of the limb, sensory disturbances, decreased resistance to infection, and decreased range of motion (Kisner, pp. 1021-1022).
3. The clinical manifestations of osteomyelitis include fever, intense pain, edema, erythema, and tenderness (Goodman, p. 495).
4. The signs and symptoms of deep vein thrombosis, dull aching or severe pain, swelling, and changes in skin temperature and color, specifically heat and redness. Sensory disturbance and decreased resistance to infection are not typically signs of a deep vein thrombosis. (Kisner, p. 367)

Question 50

A patient’s history includes a lower motor neuron lesion. Which of the following should the physical therapist assistant expect to observe while treating this patient?

1.Clonus

2.Atrophy

3.Hyperreflexia

4.Spasticity

Answer 50

2.Atrophy

1. Clonus is a sign of upper motor neuron disease.
2. Atrophy is a sign of a lower motor neuron lesion.
3. Hyperreflexia is a sign of upper motor neuron disease.
4. Spasticity is a sign of upper motor neuron disease.

Question 51

Which of the following tests is MOST likely to identify the presence of peripheral artery disease?

1.Skin temperature

2.Girth measurements

3.Ankle-brachial index

4.Volumetric measurements

Answer 51

3.Ankle-brachial index

The ankle-brachial index is designed to examine the vascular system and is important for individuals who have arterial disease. The ankle-brachial index is a ratio of the lower extremity pressure and upper extremity pressure, and results provide useful information about the potential loss of perfusion in the lower extremities due to peripheral artery disease. (pp. 543-544)

Question 52

Which of the following value ranges is considered NORMAL for ejection fraction of the heart?

1. 5% to 20%
2. 25% to 45%
3. 55% to 75%
4. 80% to 100%

Answer 52

3. 55% to 75%

Ejection fraction measures ventricular contractility. Ejection fraction is determined by stroke volume divided by left ventricle end diastolic volume. Since not all blood should be pumped out of the ventricle during contraction, normal ejection fraction is 55% to 75%.

Question 53

Which of the following conditions is BEST characterized by early-stage joint space narrowing and articular cartilage erosion, and late-stage osteophyte formation and articular cartilage fissuring and eburnation?

1.Osteoporosis

2.Rheumatoid arthritis

3.Osteoarthritis

4.Ankylosing spondylitis

Answer 53

3.Osteoarthritis

1. Osteoporosis is a chronic progressive disease characterized by low bone mass, impaired bone quality, decreased bone strength, and enhanced risk of fractures (p. 1211).
2. Rheumatoid arthritis is a chronic systemic inflammatory disease causing early synovial changes, including pannus formation and articular cartilage eburnation (p. 1318).
3. Osteoarthritis is characterized by early-stage joint space narrowing and articular cartilage erosion with late-stage osteophyte formation and articular cartilage fissuring and eburnation (p. 1305).
4. Ankylosing spondylitis is defined as chronic inflammation of the axial skeleton and sacroiliac joints (p. 1332).

Question 54

A patient has limited elbow extension. Which of the following options BEST describes the active inhibition technique that is appropriate for the patient?

1.With the elbow extended, contract-relax the tight muscle and stretch into elbow flexion.

2.With the elbow extended, contract-relax the tight muscle and stretch into elbow extension.

3.With the elbow flexed, contract-relax the tight muscle and stretch into elbow flexion.

4.With the elbow flexed, contract-relax the tight muscle and stretch into elbow extension.

Answer 54

2.With the elbow extended, contract-relax the tight muscle and stretch into elbow extension.

With a contract-relax procedure, the range limiting target muscle is first lengthened to the point of tissue resistance (p. 103). To stretch the biceps, the elbow would be in end-range extension (p. 646). A contract-relax stretch for the biceps would have the biceps contract and the patient move into elbow flexion against manual resistance from the clinician followed by a stretch into elbow extension (p. 103).

Question 55

A physical therapist assistant is treating an inpatient whose intravenous pump alarm begins to sound. The assistant should FIRST:

1.check the integrity of the intravenous site, retape if leaking, and push the reset button.

2.stop treatment immediately and call nursing staff to check the pump.

3.instruct the patient to begin exercises and contact the nurse.

4.make sure that the patient’s positioning is not obstructing the flow of the intravenous pump.

Answer 55

4.make sure that the patient’s positioning is not obstructing the flow of the intravenous pump.

1. Checking the integrity of the intravenous site is the responsibility of the patients’ nurse.
2. Although calling the nursing staff might be appropriate, it is not necessary to stop the treatment.
3. This is not the first action. The physical therapist assistant should check the patient’s position relative to the intravenous pump first.
4. Often, addressing the patient’s positioning will correct the problem, and further intervention will not be required.

Question 56

What deviation in the frontal plane should be expected upon postural observation of a patient with left thoracic scoliosis?

1.Vertebral spine rotated to the right

2.Right ribs more prominent anteriorly

3.Left shoulder level higher than right

4.Wider intercostal spaces on concavity

Answer 56

3.Left shoulder level higher than right

1. This deviation occurs in the transverse plane.
2. This deviation occurs in the sagittal plane.
3. With a left thoracic scoliosis, the apex is on the left side. The left shoulder may appear higher if there is not adequate compensation by a secondary curve.
4. The intercostal spaces should be wider on the side of the convexity.

Question 57

During a stand-to-sit transfer, which of the following muscle functions is occurring?

1.Concentric quadriceps control of knee flexion

2.Eccentric quadriceps control of knee flexion

3.Concentric iliopsoas control of hip flexion

4.Eccentric iliopsoas control of hip flexion

Answer 57

2.Eccentric quadriceps control of knee flexion

In an eccentric contraction, muscle attachments move farther apart and movement occurs with gravity (such as a lowering motion). Since a stand-to-sit maneuver is a lowering motion with gravity, the muscle contraction must be eccentric. The quadriceps eccentrically control knee flexion.

Question 58

Which of the following types of feedback provides knowledge of results?

1.Number of accurate movements

2.Kinematic accuracy of the movement

3.Directions for accurate completion of the movement

4.Decreasing frequency of reports of movement accuracy

Answer 58

1.Number of accurate movements

1.The number of accurate movements provides knowledge of results about the outcome of the task.
2. Feedback about kinematics accuracy relates the movement pattern to the goal and is termed knowledge of performance.
3. Instruction in the task occurs before the task and is not a description of knowledge of results of the task.
4. Frequency of feedback is occurring during the task and is not a description of knowledge of results of the task.

Question 59

A patient with adhesive capsulitis demonstrates a capsular pattern of limitation. What shoulder motion would be the MOST limited?

1.Medial (internal) rotation

2.Lateral (external) rotation

3.Abduction

4.Adduction

Answer 59

2.Lateral (external) rotation

In a capsular pattern, lateral (external) rotation is most limited, followed by abduction and medial (internal) rotation.

Question 60

The results of a patient’s spirometry test reveal a tidal volume of 500 mL, residual volume of 1300 mL, and vital capacity of 4600 mL. The patient MOST likely has which of the following conditions?

1.Sarcoidosis

2.Cystic fibrosis

3.Diabetes mellitus

4.Systemic lupus erythematosus

Answer 60

2.Cystic fibrosis

1. Sarcoidosis is a condition with restrictive lung dysfunction. All lung volumes are decreased with this condition. (p. 246)
2. Obstructive pulmonary diseases are classified by normal or elevated tidal volume, normal or elevated residual volume, and normal or elevated vital capacity. In this patient, tidal volume and vital capacity are normal, but residual volume is elevated. Cystic fibrosis is an obstructive lung disease. (pp. 128, 202)
3. Diabetes mellitus is a nutritional and metabolic condition that can affect lung function, however, lung volumes would only have mild abnormalities (pp. 227, 230).
4. Systemic lupus erythematous is a connective tissue condition that can cause restrictive lung dysfunction. Lung volumes are decreased with this condition. (p. 245)

Question 61

Which of the following interventions would MOST improve outcomes for a patient who has chronic obstructive pulmonary disease?

1.Aerobic exercise

2.Cessation of smoking

3.Pharmacological management

4.Ventilatory muscle training

Answer 61

2.Cessation of smoking

Smoking cessation is the most important intervention to improve outcomes for patients who have chronic obstructive pulmonary disease.

Question 62

A patient’s wound has an exposed tendon in the wound bed. Which of the following terms should be used to describe the wound?

1.Stage 2

2.Stage 3

3.Full-thickness

4.Partial-thickness

Answer 62

3.Full-thickness

1. Stage 2 is a classification for pressure injuries and is a partial-thickness wound that involves only the epidermis and/or dermis without presence of slough (p. 189).
2. Stage 3 is a classification for pressure injuries and is a full-thickness wound. However, in this stage, no tendon would be visible. (p. 189)
3. Full-thickness wounds penetrate through the dermis and into fat. Slough can be present, and these wounds often involve muscle, tendon, and bone. (p. 11)
4. Partial-thickness wounds involve the epidermis and extend into, but not through the dermis. Therefore, no tendon would be visible in a partial-thickness wound. (p. 11)

Question 63

Which of the following interventions is MOST appropriate to prevent the occurrence of a deep vein thrombosis in a patient who has a complete C6 spinal cord injury?

1.Performing weight-shifting strategies in a wheelchair

2.Active range of motion exercises to the lower extremities

3.Passive range of motion exercises to the lower extremities

4.Positioning the lower extremities in a dependent position

Answer 63

3.Passive range of motion exercises to the lower extremities

1. Weight-shifting does not prevent deep vein thrombosis, although it does prevent pressure injuries.
2. A patient who has a spinal cord injury at the C6 level will not be able to complete active range of motion of the lower extremities.
3. Passive range of motion exercises to the lower extremities is one strategy used to prevent the occurrence of deep vein thrombosis as part of early mobilization.
4. With the lower extremities in the dependent position when seated, pressure to large vessels can cause damage to the lining of the vessels and precipitate the clotting process, which can lead to a deep vein thrombosis.

Question 64

A patient sprained the posterior cruciate ligament 10 days ago. The patient’s rehabilitation program should INITIALLY focus on which of the following interventions?

1.Forward lunges

2.Straight leg raise

3.Unilateral calf raise

4.Prone hamstring curls

Answer 64

2.Straight leg raise

1. In early rehabilitation for posterior cruciate ligament injuries, closed chain exercises are limited to 0° to 45°. In addition, plyometric activities should not begin until 6-8 weeks after injury. (Dutton)
2. Activities that emphasize quadriceps strengthening should be emphasized in early posterior cruciate ligament rehabilitation to help reduce posterior translation of the tibia on the femur and protect the healing posterior cruciate ligament (Dutton).
3. Calf raises are introduced as early as 3 weeks or as late as 5 to 8 weeks after injury for nonoperative posterior cruciate ligament injury rehabilitation (Giangarra; Reider).
4. Hamstring strengthening is delayed 6-8 weeks after injury to decrease the potential stress on the posterior cruciate ligament (Dutton).

Question 65

Which of the following signs or symptoms is MOST likely to occur in a patient who becomes dehydrated during a strenuous cardiac conditioning program?

1.Hypertension

2.Hypotension

3.Weight gain

4.Decreased body temperature

Answer 65

2.Hypotension

In a patient who becomes dehydrated, hypotension occurs secondary to decrease in fluids and consequent increase in heart rate and decrease in blood pressure.

Question 66

A patient who has Guillain-Barré syndrome is MOST likely to exhibit which of the following signs and symptoms?

1.Muscle weakness that progresses from proximal to distal and diminished deep tendon reflexes

2.Muscle weakness that progresses from distal to proximal and diminished deep tendon reflexes

3.Muscle weakness that progresses from proximal to distal and diplopia

4.Muscle weakness that progresses from distal to proximal and diplopia

Answer 66

2.Muscle weakness that progresses from distal to proximal and diminished deep tendon reflexes

1. Although diminished deep tendon reflexes are a common sign of Guillain-Barré syndrome, proximally, not distally, progressing muscle weakness is indicative of this syndrome.
2. Proximally progressing muscle weakness and diminished deep tendon reflexes are two of the common signs and symptoms of Guillain-Barré syndrome.
3. Distally progressing muscle weakness and diplopia are not signs and symptoms of Guillain-Barré syndrome but may be indicative of myasthenia gravis.
4. Although proximally progressing muscle weakness is a common sign of Guillain-Barré syndrome, diplopia is not a symptom of this syndrome.

Question 67

A physical therapist assistant is reviewing postoperative precautions with a patient who had a total hip arthroplasty with an anterolateral surgical approach. Which of the following instructions is MOST appropriate for the patient?

1.When walking backward, lead with the involved leg.

2.When walking, step fully through with the uninvolved leg.

3.Avoid activities that involve standing on the operated leg and rotating toward the involved side.

4.Avoid activities that involve standing on the operated leg and rotating away from the involved side.

Answer 67

4.Avoid activities that involve standing on the operated leg and rotating away from the involved side.

1. Walking backward with the uninvolved leg leading would avoid hip extension, which is also a motion precaution for patients who have had a total hip arthroplasty with an anterolateral surgical approach. Leading with the involved leg will cause hip extension, which is contraindicated.
2. Stepping through with the uninvolved leg would cause hip extension of the involved leg, which is a motion precaution for patients who have had a total hip arthroplasty with an anterolateral surgical approach.
3. Standing on the operated leg and rotating toward the involved side would produce medial (internal) rotation of the involved leg, which is not a motion precaution for patients who have had a total hip arthroplasty with an anterolateral surgical approach.
4. Lateral (external) rotation of the involved extremity is a motion precaution for patients who have had a total hip arthroplasty with an anterolateral surgical approach. This motion would be produced by turning away from the involved leg.

Question 68

Which of the following hand deformities is MOST commonly related to the progression of rheumatoid arthritis?

1.Volar (palmar) subluxation with ulnar drift

2.Volar (palmar) subluxation with radial drift

3.Dorsal subluxation with radial drift

4.Dorsal subluxation with ulnar drift

Answer 68

1.Volar (palmar) subluxation with ulnar drift

1. Chronic inflammation and ligamentous instability causes volar (palmar) subluxation of the wrist with an ulnar drift of the digits.
2. The carpals move into subluxation toward the volar (palmar) aspect of the hand; however, the digits drift toward the ulna, not the radius.
3. The ligamentous instability results in volar (palmar) subluxation of the wrist and ulnar drift of the digits, not dorsal subluxation and radial drift.
4. The carpals move into subluxation toward the volar (palmar) surface of the hand, not the dorsum (back) of the hand. Ulnar drift does occur, but it occurs with volar (palmar) subluxation.

Question 69

When performing mechanical cervical traction to increase the intervertebral space at the C5–C7 levels, which of the following angles of cervical flexion would be MOST appropriate?

1. 0° to 5°
2. 10° to 15°
3. 25° to 30°
4. 40° to 45°

Answer 69

3. 25° to 30°
4. 0° to 5° of flexion is used to increase the intervertebral space at the C1–C5 levels not the C5–C7 levels (Dutton).
5. 10° to 15° of flexion is recommended for zygapophyseal joint separation in general but is not high enough to reach the lower cervical spine (Dutton).
6. 25° to 30° of flexion is recommended to increase the intervertebral space at the C5–C7 levels (Dutton; Cameron).
7. 40° to 45° of flexion falls outside of the recommendation for cervical traction (Dutton).

Question 70

When a cold pack is applied for edema control, what is the correct order of sensations that the patient should experience?

1.Aching, burning, cold, numbness

2.Aching, cold, burning, numbness

3.Cold, aching, burning, numbness

4.Cold, burning, aching, numbness

Answer 70

4.Cold, burning, aching, numbness

Patients will usually experience sensations in the order of cold, burning, aching, then analgesia and numbness.

Question 71

A patient with a diagnosis of left-sided Bell’s palsy would have difficulty:

1.smiling.

2.chewing food.

3.scanning to the left.

4.hearing on the left.

Answer 71

1.smiling.

Bell palsy is a unilateral condition affecting the facial nerve (CN VII), which innervates the facial muscles of expression, so smiling would be difficult (pp. 606, 750).

Question 72

A patient with an ankle-foot orthosis develops a red mark on the skin that does not resolve 1 hour after doffing the orthosis. Which of the following responses by the physical therapist assistant is MOST appropriate?

1.Place the patient on a schedule to check the skin more often.

2.Have the patient continue use of the orthosis and contact the orthotist.

3.Instruct the patient to discontinue use of the orthosis and contact the orthotist.

4.Have the patient wear a larger sock under the orthosis to create a barrier against friction.

Answer 72

3.Instruct the patient to discontinue use of the orthosis and contact the orthotist.

A red mark on the skin is a sign of skin breakdown from an ill-fitting orthosis that requires an adjustment.

Question 73

Which of the following characteristics MOST likely would be associated with the presence of a superficial partial-thickness burn?

1.Extreme pain

2.Eschar

3.Marked edema

4.Dry surface

Answer 73

1.Extreme pain

1. A superficial partial-thickness burn is extremely painful due to irritation of nerve endings in the dermis. Superficial partial-thickness burns damage the epidermis and the papillary layer of the dermis (superficial layer of dermis) where nerve endings reside.
2. Eschar formation occurs with full-thickness burns. With this type of burn, all of the epidermal and dermal layers are destroyed completely. Eschar is dead tissue, consisting of plasma and necrotic cells. Eschar will not be seen with a superficial partial-thickness burn.
3. Substantial edema is a common finding with deep partial-thickness burns. These burns involve destruction of the epidermis into the reticular layer of the dermis (middle layer). The edema is due to broken blisters and destruction of the dermal vascular network, which leaks plasma fluid.
4. Superficial burns cause a dry surface because only the epidermis is injured in these burns.

Question 74

When teaching a patient to produce an effective cough, the physical therapist assistant should do all of the following EXCEPT:

1.instruct the patient to use the abdominal muscles.

2.assess the patient’s voluntary cough.

3.instruct the patient to use pursed-lip breathing.

4.demonstrate a sharp, deep, double cough.

Answer 74

3.instruct the patient to use pursed-lip breathing

Pursed-lip breathing is used to address dyspnea, not to produce an effective cough (pp. 549-550).

Question 75

Following a cerebrovascular accident, a patient has difficulty producing the correct word or sequence of words. The patient MOST likely has which of the following impairments?

1.Apnea

2.Ataxia

3.Aphasia

4.Apraxia

Answer 75

3.Aphasia

1. Apnea is the absence of respiration, usually temporary in duration (p. 58).
2. Ataxia is uncoordinated movement that manifests when voluntary movements are attempted. It may influence gait, posture, and patterns of movement. (p. 389)
3. Aphasia is a communication disorder characterized by an impairment of language comprehension, formulation, and use (p. 604).
4. Apraxia is generally described as the inability to perform purposeful movement which may be related to speech production, as in buccofacial or oral apraxia, but can affect other areas of motor execution, not just speech (pp. 1213-1215).

Question 76

Prior to implementing an exercise program for a healthy 10-year-old patient, a physical therapist assistant collects data on the patient’s heart rate and respiration rate. Which of the following resting values would be expected?

1.Heart rate of 60 bpm, respiratory rate of 12 breaths/minute

2.Heart rate of 60 bpm, respiratory rate of 22 breaths/minute

3.Heart rate of 105 bpm, respiratory rate of 12 breaths/minute

4.Heart rate of 105 bpm, respiratory rate of 22 breaths/minute

Answer 76

4.Heart rate of 105 bpm, respiratory rate of 22 breaths/minute

Normal heart rate values for a healthy 10-year-old child range between 70 and 110 bpm. Normal respiratory rate values for a healthy 10-year-old child range between 15 and 25 breaths/minute. (O’Sullivan, pp. 47, 56; Goodman) The values of 105 for heart rate and 22 for respiratory rate are both within the normal ranges.

Question 77

A patient has weakness during shoulder abduction and reports numbness and tingling in the anterolateral shoulder and upper extremity. Which of the following nerve roots is MOST likely impaired?

1.C5

2.C6

3.C7

4.C8

Answer 77

1.C5

Weakness during shoulder abduction and numbness and tingling in the anterolateral shoulder and upper extremity are consistent with C5 impairment. C5 paresthesias include the anterolateral shoulder and arm. Myotomes for C5 include the deltoid and biceps. The deltoid functions in shoulder abduction.

Question 78

Which of the following actions is MOST appropriate for treating a person who is having a seizure with convulsions?

1.Wait for the convulsions to cease, and then carefully turn the person’s head to one side in case vomiting occurs.

2.Place the person in a supine position, and hold the person tightly to avoid muscle or joint damage by violent convulsions.

3.Keep the person’s mouth open using something firm and not likely to break off.

4.Observe the person’s respirations, and begin rescue breathing if the person does not take a breath in at least 30 seconds.

Answer 78

1.Wait for the convulsions to cease, and then carefully turn the person’s head to one side in case vomiting occurs.

1. Vomiting after a seizure is fairly common, and the head should be turned to one side so that the person does not choke. (Fairchild, p. 334)
2. It is contraindicated to hold a person who is having a seizure tightly or attempt to constrain the convulsions. This could lead to injury to the patient and the physical therapist assistant. (Fairchild, p. 334)
3. Objects and fingers should never be inserted into the mouth during a seizure. Injury to the patient may occur as a result of tissue tears, choking, and gagging. (Fairchild, p. 334)
4. Breathing frequently ceases during full body muscle contractions during the seizure. The convulsion phase is typically over in 60 seconds. Rescue breathing would not be necessary unless breathing is absent after the seizure is over. (Thygerson, p. 287)

Question 79

Which of the following pre-exercise fasting blood glucose levels for a patient who has type 2 diabetes is the HIGHEST level indicating that the patient should eat a snack before exercising?

1.49 mg/dL (2.7 mmol/L)

2.69 mg/dL (3.8 mmol/L)

3.149 mg/dL (8.3 mmol/L)

4.199 mg/dL (11.1 mmol/L)

Answer 79

2.69 mg/dL (3.8 mmol/L)

Additional carbohydrates should be ingested if the pre-exercise blood glucose is less than 100 mg/dL (5.6 mmol/L). Of the options, a blood glucose level of 69 mg/dL (3.8 mmol/L) is the highest level that indicates the patient should eat a snack before exercising.

Question 80

A patient has difficulty maintaining quiet standing balance and demonstrates a loss of balance during small perturbations in a forward direction. Which of the following muscles should be strengthened?

1.Quadriceps

2.Tibialis anterior

3.Abdominals

4.Gastrocnemius

Answer 80

4.Gastrocnemius

1. The quadriceps are activated with backward instability or a perturbation in a posterior direction.
2. The tibialis anterior is activated with backward instability along with activation of the quadriceps and abdominal muscles.
3. The abdominals are activated during backward instability and with rapid or large perturbations.
4. For small perturbations in an anterior direction, muscle activation begins in the gastrocnemius, followed by the hamstrings, and finally by the paraspinal muscles. Therefore, the gastrocnemius should be strengthened.