PEAT 4 Flashcards

Question

A physical therapist researcher is developing a study to compare differences in range of motion outcomes in two groups of patients who have had a total knee arthroplasty. Over an 8-week period, one group of patients receives outpatient physical therapy 1 time/week and the other group receives outpatient physical therapy 3 times/week. In this study, what is the dependent variable? 1. Range of motion 2. Frequency of visits 3. Total knee arthroplasty 4. 8 weeks

Answer 1

1 The dependent variable (ROM) is the factor that is caused by the independent variable (frequency of visits).

Answer 2

4 To minimize confusion, the patient should be presented with one new item at a time. The pace of learning should be set by the patient. Visual and auditory input together can promote learning. Concrete examples are easier to understand than metaphors.

Answer 3

2 With venous insufficiency, the limbs would be edematous and the superficial veins would be dilated. If the venous insufficiency is not corrected, ulceration could develop. Options 1 and 3 are ruled out because they indicate no edema. Option 4 is not correct because the condition is relieved by sitting or leg elevation.

Answer 4

2 While nasotracheal suctioning is a viable option to clear a patient's secretions, it is usually the last resort when a patient does not have an artificial airway. So if a manual costophrenic assist doesn't work, then suctioning may be needed. Any patient who has been receiving mechanical ventilation will likely have some respiratory muscle deconditioning. However, with superimposed neuromuscular disease, the respiratory muscle weakness will be further exacerbated. Therefore, providing manual assist at the lower ribs during cough will assist the patient in successfully clearing secretions. Supplemental oxygen can help a patient's ventilatory muscle endurance but does not ensure that the patient will be able to generate enough force during the cough. Inspiratory muscle training would be beneficial for this patient, but not at this acute stage just after removal of ventilation. Once secretions are under control, then muscle training can begin.

Answer 5

2 The best answer would be for the therapist to recommend a team conference. That conference would bring together members of the health care team, as well as the patient and family members, to arrive at joint decision for placement of the patient. The best time for such a meeting would be prior to discharge, because such meetings are difficult to arrange after discharge. Allowing the patient to determine his own discharge environment may be fine if there are no safety concerns; however, a decision whether or not the patient is competent to make that decision must be made first. Scheduling a home visit or the implementation of a treatment plan for home care would be premature until a decision on placement has been made.

Answer 6

2 Data analysis in single-subject research is based on evaluation of measurements within and across design phases, to determine if behaviors are changing and if observed changes during intervention are associated with the onset of treatment. While visual analysis of graphic display of data is the most commonly used data analyses method in single-subject design, statistical analysis provides a more quantitative approach to determine whether observed changes are real or chance occurrences.

Answer 7

2 Macerated tissue results from excessive moisture. A more absorbent dressing would soak up the excessive moisture and prevent the maceration.

Answer 8

3 Three weeks is too early to lift 5-Ib (2.3-kg) objects. Three weeks is too early to sleep on the involved side. Usually by 8 to 12 weeks, a patient who has had an uncomplicated open repair of a rotator cuff 2 weeks ago is able to actively elevate the arm to functional heights. Three months is too early to play golf.

Answer 9

3 Since the patient is non-weight-bearing, transfer abilities and gait examination are less likely to yield information regarding the cause of foot pain. With regard to capillary refill in toes, complications of cast fixation may include swelling and, if severe, compartment syndrome. Improperly fitted casts and/or patients leaving limbs in a dependent position can result in painful swelling that creates occlusion to distal blood flow. Testing capillary refill is an easy test to examine distal extremity perfusion. Blood pressure changes could cause changes in perfusion to distal extremities, but it would be very difficult to measure lower extremity blood pressure with the cast on.

Answer 10

1 The capsular pattern of restriction at the hip is loss of medial (internal) rotation and abduction, followed by a loss of flexion and extension; loss of lateral (external) rotation is insignificant.

Answer 11

2 Options 1, 3, and 4 would provide insufficient orthotic support for the child to walk. A child with an L1 lesion can walk only with support of reciprocating gait orthoses or thoracic lumbar sacral orthosis.

Answer 12

2 Prednisone is a glucocorticoid that exhibits the side effects described in the stem. The primary side effect of penicillin is an allergic reaction, such as skin rashes and difficulty breathing. The primary side effect of aspirin is gastritis. The primary side effect of gold therapy is diarrhea, irritation of oral mucosa, and skin rashes.

Answer 13

2 Exercise is a major contributor in controlling hyperglycemia in type 2 diabetes by improving skeletal muscle glucose transport and whole-body glucose homeostasis. Regular exercise can help the body respond to insulin and is known to be effective in managing blood glucose. Exercise can lower blood glucose and possibly reduce the amount of medication needed to treat diabetes, or even eliminate the need for medication. Exercise has not been shown to improve glycemic control for the person with type 1 diabetes. Patients with degenerative neuromuscular diseases such as multiple sclerosis should use caution when exercising to avoid excessive fatigue, which can result in permanent losses in strength. Respiratory system impairment in individuals with multiple sclerosis and amyotrophic lateral sclerosis may lead to poor tolerance of intense aerobic exercise.

Answer 14

4 Saline-saturated gauze is not advised to control copious amounts of drainage. Semipermeable film cannot absorb copious amounts of exudate. Gauze impregnated with zinc oxide has not been shown to be beneficial. Hydrocolloid paste is the only option given that would be appropriate for managing wounds with high levels of exudate.

Answer 15

2 Excessive prosthetic plantar flexion can cause insufficient knee flexion. A stiff heel cushion can cause excessive knee flexion and therefore buckling. A low prosthetic shoe heel can cause delayed knee flexion. Excessive prosthetic foot inset can cause excessive lateral thrust.

Answer 16

4 Exercises that require a supine position should be performed before eating so that the stomach is relatively empty. The recommended time to remain upright after a meal is 3 hours. Head lifting in supine is the recommended exercise to strengthen the upper esophageal sphincter muscle. If performed in upright, the head falls into gravity and the exercise is no longer resistive. A patient should lie on the left side to reduce reflux, because lying on the right side makes it easier for acid to flow into the esophagus, since the lower esophagus bends to the left and this straightens out with right sidelying.

Answer 17

1 Cyanosis is described in the stem. Although this finding often accompanies cardiac / pulmonary pathology or may occur with hematological or central nervous system disorders, the objective description is cyanosis.

Answer 18

2 Bowel and bladder dysfunction are related to spinal cord/upper motor neuron dysfunction. Smoking and steroids can weaken bone and increase the likelihood for a compression fracture. Hypertension and diabetes are not risk factors for a compression fracture. By themselves, neither emphysema nor hormone replacement therapy increases the likelihood of a compression fracture.

Answer 19

4 Paraffin wax baths are used in the nonflare phases to decrease pain and increase tissue extensibility in patients with rheumatoid arthritis. The increase in collagen extensibility associated with heating may decrease pain perception and increase tolerance for and participation in active exercise. Option 1 is incorrect because cyrotherapy (cold gel pack) decreases tissue extensibility. Options 2 and 3 are incorrect because these modalities are not easily applied over areas with thin soft tissue (hands and fingers). Paraffin allows for even distribution of heat to fingers (all joints).

Answer 20

3 Trunk extension is the safest exercise for patients with osteoporosis and is necessary, given the high risk for kyphosis with vertebral fractures. The other trunk motions are contraindicated for patients with osteoporosis.

Answer 21

4 Changes in heart rate, blood pressure, or respiratory rate can accompany fever, but none of those measurements will help in delineating the cause of the fever. Common causes of immediate postoperative fevers are atelectasis or pneumonia. Ausculation of the lungs would help the therapist in delineating this as a cause of the fever and determining the appropriate physical therapy intervention.

Answer 22

4 In order to best intervene with a patient who has had cardiac dysfunction, a full examination and evaluation are necessary to properly form a treatment plan. An important aspect of the examination is ascertaining the type of angina that the patient experiences so that the therapist will know how to prevent angina with exercise or recognize it if it does occur during the treatment session. The other options provided are all outcomes that would occur after the patient has completed a cardiac rehabilitation program.

Answer 23

2 Contacting the patient's home health nurse is the appropriate first course of action because of the possible safety risk associated with the patient's not taking insulin. Injections and glucose testing would go beyond the scope of practice for physical therapy. Placing the responsibility on the family would not be appropriate because of the gravity of the situation.

Answer 24

2 Objectives must be measurable, and the specific behavior expected should be stated. Understanding, overcoming, and appreciating elude tangible measurement, while listing five techniques is an activity that can be documented and is therefore measurable.

Answer 25

3 The hamstrings are hip extensors that are more active when the hip is in flexion, especially in functional activities such as stair climbing. In this case, the patient flexes the hip, placing the semitendinosus on stretch and increasing its moment arm and increasing its ability to produce hip extension. Therefore, the patient is leaning forward to maximize the ability of the hamstrings to extend the hip during the stair climbing activity. The other muscles listed would not benefit as much from the increased hip flexion.

Answer 26

3 A small sample size can be linked to errors in statistical conclusions because there may not be enough participants to allow application of the findings to all patients in the population of interest. The within-group variance being smaller enables less overlapping of sample distributions. Greater than 80% analysis power is linked with a higher probability that study conclusions are accurate. An inflated alpha level (i.e., noncontrolled) results in a higher level of statistical significance and greater probability of a type 1 error.

Answer 27

3 As learning progresses, feedback should progress from extrinsic (which included tactile, visual, verbal) to intrinsic feedback from the muscle spindle and joint receptors.

Answer 28

2 The QRS complex represents ventricular contraction. Atrial contraction is represented by the P wave. When an area of the ventricle becomes irritable and develops an ectopic foci, the ventricle will depolarize prematurely before the normal conduction sequence (e.g., prior to SA node firing in the atria) and presents as a wide, irregularly spaced QRS complex. In normal ventricular depolarization, the QRS would be narrow and regularly spaced and atrial fibrillation would appear as the P wave changes. Atrial repolarization occurs within the QRS complex and is not normally visible on EKG.

Answer 29

1 Elevation and pressure is the correct next step in controlling bleeding. Removal of the dressing and bandage would potentially irritate the wound and increase the hemorrhage. Elevation and pressure should be applied first, before additional dressings, bandages, and pressure to the brachial artery. While calling the patient's physician to arrange transportation for medical care may be necessary, it does not immediately control the bleeding.

Answer 30

4 The therapist is testing for a positive Babinski sign. When the Babinski sign is positive, the toes flare at the end of the test. The presence of a positive Babinski sign indicates an upper motor neuron lesion such as a spinal cord injury. If no upper motor neuron lesion is present, the toes will flex. The only upper motor neuron lesion is injury to the spinal cord. Peripheral nerve injuries and lesions of the anterior horn cells are lower motor neuron lesions.

Answer 31

4 The photograph shows a standing desk/work station. A patient with stenosis will do better in sitting, not standing. A patient with a deep vein thrombosis will need to move, not be stationary. A scoliosis alone does not warrant a standing work station. Sitting increases intradiscal pressure, so standing is often preferred to sitting.

Answer 32

3 The posterior tibial artery is most likely to be involved in chronic posterior compartment syndrome, which is described in the question. This artery should be palpated posterior to the medial malleolus. The dorsal aspect of the foot is the site for palpation of the dorsalis pedis pulse. The dorsalis pedis artery is not involved in posterior compartment syndrome. The palpation site posterior to the lateral malleolus is used to access the fibular (peroneal) artery. The fibular (peroneal) artery is not involved in posterior compartment syndrome. Palpation in the popliteal fossa is a poor choice of palpation location in association with posterior compartment syndrome. The popliteal artery may be palpated here, but the compartment syndrome manifestations are distal to this site.

Answer 33

1 It has been determined that a critical factor in improving learning is that the subject must do something different on consecutive trials. Therefore the traditional approach for retraining by practicing one skill repeatedly is not the most effective. It is believed that having a patient practice a number of tasks in random order would probably be more successful for long-term retention. The other options do not provide for randomization of the activities and are therefore less likely to provide for long-term retention.

Answer 34

1 The abdominal muscles are active during a sit-up (with the knees extended) up until the spine is completely flexed (head, shoulders, thorax lifted from surface). In order to come to a long-sitting position, however, the hips must be flexed, and the abdominals cannot perform this action because they do not cross the hip joint. Therefore, the hip flexors (iliosoas among others) would have to complete this motion. The inability to achieve a long-sitting position would suggest weakness in the iliopsoas muscle.

Answer 35

3 Corticosteroid-induced myopathies are common after prolonged use of the drug, and they are common in the proximal musculature of the extremities. The other options are the opposite of symptoms commonly found with steroid-induced conditions. Usually there are problems with hypertension, hypocalemia, and increased protein metabolism.

Answer 36

1 A patient who is immobile and restricted to bed is at risk for developing atelectasis (partial collapse of lung tissue), which can then lead to pneumonia. Frequent position changes with deep breathing and coughing will help prevent development of atelectasis. Given that this patient is elderly and does not have a diagnosis of secretion retention, vigorous percussion and vibration is not indicated. Vibration with the head down or standard postural drainage positions will not be tolerated in this elderly patient with chronic congestive heart failure.

Answer 37

4 Extension of the 1st metatarsophalangeal joint is needed in terminal stance. The distal metatarsal is convex. The proximal portion of the articulating phalanx is concave. According to the convex-concave rule, when a therapist moves a concave joint surface on a convex joint surface, the concave joint surface is moved in the same direction as the range-of-motion limitation. Therefore, the appropriate accessory glide is a dorsal glide of the proximal phalanx on the metatarsal. Posterior glide of the talus on the tibia and plantar glide of the 1st proximal phalanx on the metatarsal promote plantar flexion. Posterior glide of the calcaneus on the talus is not as relevant for terminal stance, which involves the 1st M TP joint.

Answer 38

1 The fact that the patient has normal muscle strength of the hip lateral (external) rotators along with limitation of range of motion indicates either tightness of the medial (internal) rotators or hip capsule tightness. The gluteus medius and minimus are medial (internal) rotators of the hip. The trunk shift is a normal substitution pattern found in individuals who lack hip range of motion. The problem is related to the hip, not the trunk. The patient's piriformis shows normal strength, so it is not weak.

Answer 39

2 A patient with a thoracic spinal cord level injury is able to perform independent pressure relief strategies and should complete pressure relief every 15 to 20 minutes.

Answer 40

4 Poor hair growth is characteristic for arterial disease due to inadequate cellular nutrition. The first sign of arterial disease is often loss of hair on the toes. Edema may be present with advanced cases of arterial disease. Increased cyanosis with legs in the dependent position is present in advanced disease. Brownish discoloration at the ankles is characteristic of chronic venous disorders.

Answer 41

3 Options 1, 2, and 4 are neither safe nor appropriate. When descending stairs, it is generally best for the therapist to be positioned below the patient as protection from falling. However, the patient should always descend stairs leading with the involved leg, the right leg in this case, and the cane.

Answer 42

3 Pancreatic cancer is characterized by nonspecific and vague symptoms, which can include nausea, weight loss, pain radiating to the back or back pain alone, and jaundice. Sitting up and leaning forward may provide some relief by taking pressure off the pancreas. Irritable bowel syndrome is characterized by abdominal pain with constipation and diarrhea, nausea and vomiting, but not referred back pain or jaundice. Cholecystitis is an inflammation of the gallbladder and typically produces right upper quadrant abdominal pain. There may be nausea and vomiting, weight loss, and jaundice. However, the pain is referred to the upper back or right shoulder, not the low back. There is also anorexia, nausea and vomiting with appendicitis, but the pain is present generally over the right lower quadrant. Bending forward may worsen the symptoms because of the resultant increase in intraabdominal pressure.

Answer 43

4 Excessive upward rotation of the scapula can result from weakness of the rhomboids and latissimus dorsi (downward rotators). The scapular adduction with medial (internal) rotation and adduction of the arm would require action by those muscles. Option 1 would help strengthen the serratus anterior, an upward rotator of the scapula. Option 2 would activate the upper trapezius as well as the rhomboids, and, since the upper trapezius is also an upward rotator of the scapula, this would not be the best exercise to use. Option 3 would also help strengthen the serratus anterior, which would tend to aggravate the problem.

Answer 44

4 The nodular hyperplasia that occurs with benign prostatic hyperplasia causes obstruction of the urethra, resulting in urinary frequency and urge incontinence. Testicular torsion, orchitis, and testicular cancer are not associated with urinary dysfunction.

Answer 45

1 A squat-pivot transfer avoids full lower extremity extension, thus minimizing lower extremity extensor tone. A sliding-board transfer is not appropriate with a high level of ataxia in the upper extremities. A standing-pivot transfer is not appropriate because it may increase the extensor tone in the lower extremities. A dependent tuck transfer does not encourage active patient participation or promote independence.

Answer 46

4 The research question is one of relationship or correlation between measures, not comparison of group means, so the t test and the Mann-Whitney U test are not appropriate. Because the data for both variables are ranked (ordinal), Spearman rho (Spearman rank correlation coefficient) should be used. This is the nonparametric analog of the Pearson correlation coefficient (r). The Pearson r requires continuous, not ordinal, data.

Answer 47

1 A correlation coefficient of .26 to .49 is considered low.

Answer 48

1 The rib cage would not be able to expand normally during inspiration due to weakness of the external intercostal muscles, which are innervated by thoracic nerve segments. With a spinal cord lesion at the Cs-Cs level, the diaphragm would still receive innervation from the phrenic nerve (Ca). The anterior scalene (Ca-Cs) would be partially innervated and the sternocleidomastoid (C2-C;) would be fully innervated. The abdominal muscles would not be innervated since they receive their innervation from thoracic nerve segments. Paralysis of the abdominal muscles would cause the diaphragm to assume a low resting position.

Answer 49

1 The electrode placement in the photograph is the best placement for the tensor fasciae late. The electrodes are placed over the muscle belly and lined up parallel to the muscle fibers. The sartorius is found more distally and medially and following the direction of the muscle fibers. The rectus femoris is found more distally and central to the thigh. The gluteus minimus is a deep muscle that cannot be easily monitored directly by surface electromyography.

Answer 50

2 Strength increase in muscle is due to a number of factors, including neurological adaptation and muscle fiber hypertrophy with an increase in actin and myosin. Hyperplasia in humans is still controversial. Long-term changes in muscle strength are due to all of the factors listed. However, short-term changes, such as changes in 1 week, are most likely to due to neurological factors such as more efficient motor unit recruitment, autogenic inhibition, and more efficient co-activation of muscle groups.

Answer 51

4 Although all of options are involved in the decision-making process, the determination of contraindications is the first thing to consider, because all other options are unnecessary if the patient has other pathologies that could be a contraindication.

Answer 52

2 Weakness in the pectoralis minor would not cause restriction of the scapula but would likely cause scapular hypermobility. Weakness in the upper trapezius would decrease upward rotation of the scapula during shoulder flexion and abduction. The more the shoulder is elevated, the more noticeable this would be. The decreased scapular movement would increase the predisposition toward impingement. Weakness in the deltoid would cause the humerus to move downward, not upward, during shoulder elevation. Weakness in the rhomboid major would not cause restriction of the scapula, but would likely cause scapular hypermobility.

Answer 53

3 Medical social service staff deal with home situations and financial supports and act as a resource director on behalf of the patient. Social services would be the most appropriate choice to help arrange and coordinate rehabilitative services for the patient while the patient is at home. Although nurses, occupational therapists, physical therapists, and physicians may all be involved with direct patient care, they would not be the most appropriate for this level of discharge planning.

Answer 54

3 Intrarater reliability describes the repeatability of measurements made by one person (repeatability within that person).

Answer 55

4 Regarding chronic low back pain of somatic origin, the patient has a chronic problem, so will most likely require motor-level stimulation, because it provides a longer-lasting analgesia. There is no evidence to indicate that sensory-level stimulation is effective in the treatment of edema. For edema reduction, rhythmic muscle contraction is preferred. lontophoresis is more appropriate than sensory-level electrical stimulation for treatment of a tendonitis, because it involves the delivery of anti-inflammatory medications. Raynaud syndrome is a condition in which the smallest arteries that bring blood to the fingers or toes constrict when exposed to cold or from an emotional upset. Sensory-level stimulation over nerve roots and trunks can increase peripheral vasodilatation.

Answer 56

3 Peripheral vascular disease is a vascular problem, not a pulmonary problem. Congestive heart failure may lead to pulmonary problems, but not obstructive problems. Emphysema is an obstructive lung disease, for which pursed-lip breathing may be beneficial. Sarcoidosis is a restrictive lung disease for which pursed-lip breathing is not beneficial.

Answer 57

4 The history suggests that prolonged improper positioning of the cervical spine resulted in neck pain. A chronic forward head and kyphosis results in hyperextension in the upper cervical spine and excessive flexion in the upper thoracic spine. Further muscle length adaptation occurs with tight anterior muscles and stretched posterior muscles. Treatment should include correction of muscle weakness or imbalance. Rhomboid strengthening and axial neck extension are the only options that are both correct.

Answer 58

4 A common mental state manifestation of hypoglycemia is difficulty speaking and concentrating, whereas in hyperglycemia there is outright confusion. The other options are all signs of hyperglycemia and not signs of hypoglycemia.

Answer 59

3 Neither posterior glide, anterior glide, nor superior glide, would improve abduction. The radiograph shows limitation of glenohumeral motion causing the reduction in shoulder abduction. Inferior glide assists with improving abduction.

Answer 60

1 The restocking of treatment booths with supplies is the only option that does not involve direct patient contact or care and thus is the MOST appropriate activity to delegate to a volunteer. Although volunteers may at times be involved with patient care activities (i.e., transporting patients), the patients in the situations described in options 2, 3, and 4 are at potential risk and would require supervision by someone other than a volunteer.

Answer 61

4 A patient with chronic hemiplegia is unlikely to recover normal function. Compensatory strategies are used when there is a permanent loss of function which prevents reacquiring normal movement patterns. Habituation is a decrease in responsiveness that occurs as a result of repeated exposure to a nonpainful stimulus. In the acute patient, the emphasis is on recovery of normal function, but this patient has a chronic condition. Sensitization is an increased responsiveness following a threatening or noxious stimulus.

Answer 62

2 Because sitting knee extension and the straight-leg raise culminate in essentially identical positions, symptomatic responses to the two types of maneuvers should be similar. If the patient had a symptomatic herniated disc, both positions would result in a similar symptom increase. If the patient had an irritated sciatic nerve, both positions would result in a similar symptom increase. If the patient had a facilitated hamstring, both positions would result in a similar symptom response.

Answer 63

2 The seat width should be slightly wider than the width of the widest body part, and the depth should come to within 1 inch of the popliteal fossa.

Answer 64

4 Regarding the patient being hypertensive, the opposite is likely. Orthostatic hypotension is a potential side effect. Arrhythmias are not listed as a recognized side effect of opioids. Regarding developing diarrhea, gastrointestinal motility is decreased, so the opposite effect of constipation is a frequent problem. Opioids tend to make the medullary chemoreceptors less responsive to carbon dioxide, thus slowing down respiratory rate and inducing a relative hypoxia and hypercapnia. The respiratory response to exercise may be blunted.

Answer 65

4 Gloves are required only during contact with blood or body fluids, not during patient care that does not involve coming in contact with blood or body fluids. Gloves are required whenever changing an infant's diapers, because this activity involves coming into contact with body fluids.

Answer 66

2 The structure indicated by the arrow is the greater tubercle. The arm is medially (internally) rotated in this radiograph.

Answer 67

1 A normal response is 2 or plus (+). Minus (-) or 0 indicates an absent reflex, and minus (-) or 1 indicates a diminished response. Plus (++) or 3 indicates an exaggerated response, and plus [+++) or 4 indicates clonus.

Answer 68

4 The presence of clonus would be on the right side, not the left side. Spasticity would be on the right side, not the left side. This is a case of hemisection of the spinal cord, Brown-Séquard syndrome. The lesion is on the right side of the spinal cord, and it is an upper motor neuron lesion (positive Babinski sign) with damage to the corticospinal tract, posterior columns, and lateral spinothalamic tract. Upper motor neuron spinal cord lesions present with hyperactive tendon reflexes (in this case on the right side), clonus, and spasticity ipsilateral to the side of the lesion. Pressure sensation is lost on the ipsilateral side, and pain and temperature are lost contralateral to the side of the lesion due to the crossing of those fibers in the spinal cord.

Answer 69

4 Option 1 would apply only after the therapist has done further analysis of the situation. Monitoring oxygen saturation is useful but not the most immediate thing to monitor. The therapist should monitor the electrocardiogram and blood pressure of the patient. Although notifying the nurse is something the therapist should do, this should be done after an initial evaluation of the stability of premature ventricular contractions. Onset of premature ventricular contractions can be benign or stable. Less than six contractions/minute is generally stable, while greater than six contractions/minute is considered less stable. A physical therapist should be able to determine this stability.

Answer 70

4 Option 1 is incorrect because the traditional position to drain the right middle lobe is left sidelying, not right sidelying. Option 2 is the traditional drainage position for right middle lobe, but does not take into account the intracranial pressure issues. Option 3 is the traditional drainage position for right middle lobe but does not take into account the intracranial pressure issues. The traditional position to drain the right middle lobe is left sidelying with one-quarter turn toward supine, head of bed down approximately 20°. However, because of the recent craniotomy, the patient's increased intracranial pressure is a major issue to monitor and keep stable. Therefore, this traditional position should be modified to flat sidelying, as described in option 4.

Answer 71

4 Behavioral objectives should be learner centered, outcome oriented, specific, and measurable. Option 4 is the only one that is learner (student) centered and specific to a situation. Options 1 and 3 require action by the clinical instructor, not the student. Option 2, which may be a step in the process, is not as learner centered or outcome centered as Option 4.

Answer 72

2 A nerve root impingement commonly gives radicular pain. One of the most common causes of a capsular pattern in the shoulder is traumatic arthritis following injury to the shoulder. The capsular pattern may gradually develop over time. A painful arc is often associated with a noncapsular pattern such as seen with bursitis or tendonitis at the shoulder. A torn rotator cuff is associated with weakness and loss of active shoulder elevation.

Answer 73

3 The pulse width of 100 microseconds makes it difficult to achieve a strong enough motor response. A 1 to 4 pps frequency may lead to a twitch motor response, but not tetany, which is needed for strengthening. The correct answer requires a frequency that will lead to tetany (something above about 30 Hz) and a long enough pulse width to recruit motor fibers (usually something greater than 200 microseconds). Therefore, of the options, 40 to 50 pps with a pulse width of 350 microseconds is the best. Option 4 describes the typical parameter for conventional transcutaneous electrical nerve stimulation for acute pain management. However, the pulse width of 100 microseconds makes it difficult to achieve a motor response, and the higher frequency of 100 ps leads to rapid fatigue.

Answer 74

3 The test shown in the photograph is the Froment test. Both thumbs (1st digits) should stay extended during the test. If the thumb (1st digit) flexes, it is indicative of weakness of the adductor pollicis with substitution by the flexor pollicis longus, which is usually due to a lesion of the ulnar nerve.

Answer 75

4 Prone with the knee straight would be used to test for a Poor (2/5) grade. Supine with knee bent is used to isolate the gluteus maximus. Seated hip flexion is used to test the hip flexor muscle strength. The most likely cause of laterally bending toward the stance limb is abductor weakness on the stance side. The lateral bending helps compensate for weak abductors. The right abductors would be tested from a left sidelying position for Fair (3/5) or greater strength.

Answer 76

2 Although the Romberg Test is a measure of the role of vision in balance, it alone would not be the most appropriate measure for functional balance. The Berg Balance Scale is an objective measure of static and dvnamic balance abilities and consists of 14 commonlv performed functional tasks; therefore, it is the most appropriate tool to use as a measure of intervention effectiveness. The Fugl-Meyer Assessment is appropriate for cortical strokes and would not be the most appropriate for a cerebellar stroke. It is not as comprehensive in balance tasks as the Berg Balance Scale. The Barthel Index is a more global instrument and is not as focused on functional balance as the Berg Balance Scale.

Answer 77

4 Compression on the median nerve (carpal tunnel syndrome) is occurring, most likely as a result of swelling associated with the individual being in the eight month of pregnancy. In this case, rest and elevation would do the most to decrease the edema and relieve the symptoms. The wrist should not be positioned in full extension. Initial conservative treatment sometimes includes cock-up splinting to hold the wrist in neutral to 10° of extension, but not full extension. Although tendon gliding exercises may be used, heat would not be indicated since it may increase the edema. Resistive exercises for the wrist and fingers may aggravate the compression in the carpal tunnel.

Answer 78

2 The L3 nerve root exits between the third and fourth lumbar vertebrae and supplies sensory information from the region of the medial knee joint line.

Answer 79

3 A physical therapist would be required to perform the initial evaluation, plan of care, reevaluations, modifications to the plan of care, and discharge plans for the patient. The patient who is stable and has an existing program would be the most appropriate patient to be delegated to the assistant. Therefore, the patient who has multiple sclerosis and who has an established gait training program would be the most appropriate. The other three patients are receiving their initial treatments.

Answer 80

2 Option 2 is the definition of validity. Options 3 and 4 refer to reliability measures. Option 1 is incorrect because results can be standardized even though they are not valid.

Answer 81

4 One continuous ramp that is 60 ft (18 m) long is too long of a run without a level area to rest. One continuous ramp that is 30 ft (9 m) long is too steep a slope. Two ramps, each 60 ft (18 m) long, even if connected by a level area, would be unnecessarily long. The rise should not be greater than 30 in (76 cm) for any one run and should be 1 ft (.3 m) in length per each 1 in (2.5 cm) rise.

Answer 82

4 Resistive exercise is contraindicated for a patient with a history of aortic aneurysm, even after surgical repair.

Answer 83

2 Lateral epicondylitis is caused by overuse of the wrist extensors that originate on the lateral epicondyle of the humerus, especially the extensor carpi radialis brevis. If the lateral epicondylitis is at a chronic stage, conditioning of the extensor muscles and sustained grip activities will be most effective in long-term management. A forearm cuff is thought to decrease the muscle loading. lontophoresis would not be appropriate for a home program. Friction massage of the brachioradialis would not be appropriate since the extensor carpi radialis brevis muscle is usually the one affected.

Answer 84

1 When patients have severe symptoms, it is often useful to have increased on and off times to reduce the movement caused by the cycling. Increasing the off time allows for longer recovery time prior to re-initiating the traction and reduces the cycling. As the pain symptoms decrease, the relaxation time can be decreased. Options 2, 3, and 4 do not allow for a longer off or recovery period.

Answer 85

1 Normal range of arterial blood gas is a pH between 7.35 and 7.45. A pH of 7.35 or lower indicates acidemia, also called an acidotic state.

Answer 86

4 The most common initial sign is enlargement of the testis with diffuse testicular pain, swelling or hardness. Back pain may be present, as well as pain referred to the groin or swelling of superficial lymph nodes, but testicular pain and swelling are the most common predominant symptoms initially.

Answer 87

3 Option 1 does not mention the knee position and has the hip flexed, which shortens the rectus femoris. Option 2 has the hip flexed, which shortens the rectus femoris. Prone with the knee in flexion keeps the hip in neutral and does not allow the hip to flex. This position is used in the Ely test. Option 4 has the hip in the correct position, but does not mention the knee position.

Answer 88

4 The closed packed position for the radiocarpal joint is full extension with radial deviation. The closed packed position for the mid carpal joint is extension with radial deviation.

Answer 89

2 The axillary crutches, standard walker, and forearm crutches all require adequate strength in the elbow extensors and latissimus dorsi, especially due to the non-weight-bearing status of the patient. The non-weight-bearing status on the right could indicate any of the options; however, because the patient has weakness of the muscles in the C6-C dermatome, the patient would have difficulty using any assistive device that requires use of the elbow extensors and latissimus dorsi muscles. Therefore, the best option is the wheelchair, because it provides mobility.

Answer 90

2 Pressure thresholds using nylon filaments are the most sensitive and specific. Several studies support the use of the 10-gram (Semmes-Weinstein 5.07) nylon filament as the threshold for protective sensation. Patients unable to feel a 10-gram nylon filament are considered unable to protect their feet from injury and are at risk of ulceration.

Answer 91

2 An overview presented on the first day would imply that the therapist is not going to modify the series to the students' current knowledge level, which may be ascertained from the pretest. It is most important for the physical therapist to know what level of knowledge the students have. Although active participation is important for learning in every session, neither it, nor a complete demonstration of a low back evaluation, is most important to include in the first session.

Answer 92

1 A standard score, or z-score, relates to the number of standard deviation units a score is above or below a mean. Standard scores are often used in developmental measures because they are a useful comparison to a larger or normal group. A standard score of -2.0 is well below the mean because two standard deviation units below the mean indicates that only 2.27% of children have scored lower or, stated conversely, that 97.73% of children scored better. At -1.0 standard deviation units, 84.14% of children scored better.

Answer 93

4 The medial knee is the L3 dermatome. The popliteal fossa is S2 dermatome. The plantar foot is St or S2. A posterolateral disc bulge at L4-L5 will most likely affect the Ls nerve root and the dermatome for the L5 nerve root. The L5 dermatome includes the dorsal aspect of the great toe. The dorsal area of the great toe is consistently included in the L5 dermatome.

Answer 94

1 Lumbar stenosis by definition causes lower extremity symptoms with extension activities, and stenosis is more common in an older population. Gluteal artery claudication would cause buttock pain, not calf pain. This patient is relatively too old for a herniated nucleus pulposus, and most cases of herniated nucleus pulposus do not involve bilateral symptoms. Nothing given in the patient's history would increase the likelihood of a deep vein thrombosis.

Answer 95

3 The key phrase in this question is "interdisciplinary." Of all the options provided, only airway clearance is within the scope of practice for physical therapists. Patients with Guillain-Barré syndrome may experience respiratory muscle fatigue or paralysis and are susceptible to pulmonary infection. Pulmonary hygiene is a critical role in their care.

Answer 96

1 The therapist is shown performing an ulnar glide, which is the same joint motion used for radial deviation. Limited motion in this direction indicates limited ability to perform radial deviation.

Answer 97

2 Although all of the options are serious complications in patients with AIDS, multifocal leukoencephalopathy is the most serious, and death occurs in a few months after it is diagnosed.

Answer 98

1 Poor skin turgor is one of the signs of dehydration. The skin, when lifted up between the fingers, does not return to its original position in a rapid manner.

Answer 99

4 A well-written goal includes an audience (who), behavior (what will be done), condition (under what circumstances), and degree (amount of change. The only option that includes all of these conditions is option 4, "The patient (who) will demonstrate thenar muscle strength (behavior) of Good (4/5) grade (degree) and be able to hold objects in hand while at work (condition)." Options 1, 2, and 3, are each missing one or more of the required elements.

Answer 100

4 Standing-pivot transfer requires standing, which the patient is not able to perform safely. Manual-pivot transfer involves the assistance of another person, so would not allow for independence. Mechanical lift transfer involves the assistance of another person, so would not allow for independence. Sliding transfer is the safest independent technique, because the patient cannot stand without minimal assistance.

Answer 101

3 Pain relief upon forward bending or sitting and pain relief upon standing are more diagnostic for lumbar origin of pain. Cramping pain that occurs at a predictable distance walked is a common presentation and clinical manifestation of vascular limitation. Numbness and tingling that occurs at a predictable distance walked are more indicative of a neurologic cause of pain rather than a vascular cause.

Answer 102

2 Since the patient does not have symptoms while looking straight ahead, the visual acuity (peripheral visual system) does not appear to be at fault. A patient who reports visual blurring with head motion is experiencing oscillopsia. Oscillopsia is a visual instability with head movement in which images appear to move or bounce. It is often due to decreased vestibulo-ocular reflex. No information is given in the question to suggest that the patient is having difficulty with somatosensory input or that indicates musculoskeletal deficits.

Answer 103

4 Option 1 is an inappropriate assistive device for a young adult with paraplegia. Option 2 is the ultimate goal of gait training but would be too difficult for the patient's first attempt. Option 3 is not the most efficient gait aide for a patient with paraplegia. The first-time session of gait training for a patient with paraplegia should be in the parallel bars. A swing-to gait pattern would be the easiest for the patient to learn initially.

Answer 104

4 Stretching should be done during and immediately after the ultrasound treatment. 1 MHz continuous ultrasound provides the greatest thermal effects and would facilitate the stretch.

Answer 105

2 Paroxysmal nocturnal dyspnea is common in severe heart disease. Relieving the breathlessness symptoms by a positional change is suggestive that the problem is pulmonary in origin. Occasional breathlessness may be expected with a change in physical activities, but more history should be taken to determine if the change is expected. Light-headedness is more indicative of a cardiac problem.

Answer 106

1 Understanding a patient's prior level of function is the most critical factor in a patient's history to determine a reasonable prognosis, as this information establishes the baseline for recovery. Although knee range of motion and upper extremity sensory integrity should be monitored, neither is more critical than prior level of function as a determinant of prognosis. Although a cervical collar is a potential intervention, its use is not more critical than prior level of function as a determinant of prognosis.

Answer 107

1 A Charcot joint is painless and usually undetected by the patient secondary to decreased sensation and neuropathy. Because of the increase in blood flow, patients present with erythema.

Answer 108

2 A complete physical therapy evaluation and treatment is contraindicated due to a possible deep vein thrombosis. A physician's order for a Doppler study indicates possible deep vein thrombosis, so the physical therapy should not be conducted until the Doper study is completed and the results analyzed by the physician. Transfer from bed to chair is contraindicated due to possible deep vein thrombosis. The nurse alone should not be providing clearance, until the Doppler study has been completed and interpreted.

Answer 109

2 The goal in option 2 is the only goal that is objective, measurable, and functional. The goals in options 1, 3, and 4 lack function or specific measurable objective information.

Answer 110

3 When the right side of the heart starts to fail, fluid collects in the feet and lower legs, causing pitting edema. Pallor, shiny skin, and absence of hair growth are characteristic of arterial disease, but not associated with congestive heart failure.

Answer 111

4 The presence of black necrotic tissue indicates full-thickness loss of the skin. The cause of the necrosis cannot be determined with the information in the stem.

Answer 112

4 If a person begins exercise when blood glucose is below 100 mg/dL or above 250 mg/dL, significant exercise-related complications may result.

Answer 113

2 Neurological changes that are age related include decreased pain and vibratory sensation. The other changes listed do not normally occur with aging in the absence of pathology.

Answer 114

1 The onset of a Stage I pressure ulcer is characterized by nonblanching erythema and decreased skin temperature over the site of the ulcer. Because blanching is difficult to ascertain in patients with dark skin, use of skin temperature for assessment of pressure ulcers is preferred.

Answer 115

2 In a single-factor experiment, the one-way analysis of variance is applied when three or more independent group means are compared. The descriptor one-way indicates that the design involves one independent variable, which is the case in the present scenario. All subjects were recruited from the same clinic and underwent the same length of treatment. The only difference among the three groups of subjects was the treatment group to which they were assigned.

Answer 116

3 The oculomotor nerve (III) controls the inferiomedial eye muscles. The trochlear nerve (IV) controls inferiolateral eve movement. The abducens nerve (VI) controls lateral eye movement. Damage to this nerve causes the eyeball to deviate medially due to weakness of the lateral rectus muscle. The vagus nerve (X) does not control the eye muscles.

Answer 117

2 Because the patient has significant weakness in both lower extremities, a standing pivot transfer would not be safe. However, since the patient does have fair to normal upper extremity strength and is not totally dependent, a hydraulic lift or two-person lift would not be appropriate because it would not enhance the patient's functional skills. The most appropriate transfer method would be for the patient to use a sliding board transfer to the strongest (right) side.

Answer 118

3 Option 3 is the only one stated clearly in educational terms. The other options are objectives based on observations.

Answer 119

1 Atelectasis occurs when one or more segments or lobes of the lung is collapsed. It often occurs following thoracic or upper abdominal surgery, when the patient has a reduced total lung capacity, functional residual capacity, and residual volume. Bronchiectasis is an abnormal dilation of the bronchi and bronchioles and results in increased residual volumes. The primary symptom of chronic bronchitis is chronic productive cough and results in increased residual volume. Emphysema usually results in significantly increased residual volumes.

Answer 120

3 During pregnancy and postpartum, the stretched abdominal muscles are unable to stabilize the lower back as the legs are raised. Attempting to perform double leg lifts can overwork the abdominal muscles and cause damage to spinal joints.

Answer 121

1 Early learning in the 1st phase of motor learning (the cognitive phase) requires full attention to the task and extrinsic feedback. As the task is learned, feedback can become more intrinsic and less attention to task is required.

Answer 122

1 Option 1 tests the integrity of the tibiofibular syndesmosis. With a positive test result, the patient will have reproduction of symptoms and in this case, anterior ankle pain. Lateral (external) rotation of the tibia may potentially compress the calcaneocuboid joint but would not stress the ligaments. A 5th metatarsal fracture would not present with anterior ankle pain. Option 4 does not load the tibia and/or muscles enough to provoke pain from a stress fracture.

Answer 123

4 During measurement of shoulder abduction, the trunk should be kept straight. If the patient is allowed to laterally flex the trunk, it will give the appearance of increased shoulder abduction, but the motion would be occurring in the spine and not in the shoulder. Upward rotation of the scapula and lateral (external) rotation of the shoulder would normally accompany the motion of shoulder abduction. Medial (internal) rotation of the shoulder would decrease the available abduction.

Answer 124

3 Vital capacity is measured from maximum inhalation to maximum exhalation. Inspiratory capacity measures volume with maximal inhalation. Tidal volume measures total volume of air moved during either inhalation or exhalation over a specific period of time (usually 1 minute) and then divided by the ventilatory rate. Inspiratory reserve volume measures inspiratory volume beyond normal inspiration.

Answer 125

3 The reservoir must be placed below the level of the heart. Notifying the nurse would be sufficient. Notifying the physician is unnecessary.

Answer 126

3 Supine knee extension with hip flexion places a stretch on the sciatic nerve, which involves lower lumbar nerve roots (L-S:). Knee flexion with hip flexion would not place a stretch on the femoral nerve. An upper lumbar radiculitis involves the nerve roots that form the femoral nerve (La-La). The femoral nerve can be stretched or provoked, by extending the hip while flexing the knee. Prone hip extension would place a stretch on the femoral nerve, but there would be less stretch with the knee in extension than in flexion.

Answer 127

4 Normal sitting requires about 105° of hip flexion, so an elevated chair would not be necessary. Reaching would not be as restricted as donning socks. The reacher would not be effective in assisting with shoes and socks and may be overused. Stair climbing requires about 60° to 70° of hip flexion, and step height modification would not be needed. To reach to the foot, approximately 120° of hip flexion is required. If a modified procedure is chosen with the foot across the opposite thigh, at least 110° of hip flexion is still required. With only 105° of hip flexion, the patient would have most difficulty putting on socks.

Answer 128

3 During the swing phase of gait, the foot is dorsiflexed to clear the floor. Muscles active during this phase of gait are the tibialis anterior, extensor hallucis longus, and the extensor digitorum longus. The gastrocnemius, tibialis posterior, and fibularis (peroneus) longs are active during stance phase of gait. Therefore, of the muscles listed, the extensor digitorum longus is the best choice. If only the tibialis anterior was stimulated, the foot would go into inversion and dorsiflexion, which could cause the patient to land on the lateral side of the foot at initial contact, causing injury. Addition of the extensor digitorum longs would bring the foot up into more dorsiflexion and avoid excessive inversion.

Answer 129

3 The most appropriate design would be a two-group pretest-posttest. Both groups are measured at the same times, but only the experimental group receives treatment. Gathering information from patient records may not provide the same accuracy as would be provided if the researcher had performed all of the measurements directly. Measuring ROM only on day 5 would not account for any pretest differences between groups. Measuring the experimental group more frequently than the control group may have an effect on the dependent variable.

Answer 130

4 Patients should be encouraged to express their feelings. Comparisons to other patients who are dying, in an effort to assure the patient he is not alone, takes away from this patient's feelings. Denial of death would not be good for the patient, since he must ultimately cope with the inevitable. Pastoral counseling would be an option, but the therapist should be ready to listen to the patient, encourage expression of feelings, and avoid denial.

Answer 131

4 The location of the painless ulcer is characteristic of a neuropathic (diabetic) ulcer. Loss of sensation renders the patient unaware of the repetitive trauma from altered biomechanics due to weakness of the intrinsics, which leads to hammer toes, and abnormal pressure on the plantar foot when weight-bearing. Increased pain with foot elevation is characteristic of arterial ulcers, which are painful. Normal arterial pulses may be present with a venous ulcer, but arteries are often calcified with advanced diabetes. A neuropathic foot is warm and dry.

Answer 132

1 The therapist is shown performing a volar glide, which is the same joint motion used for finger flexion. Limited motion in this direction indicates limited ability to perform finger flexion.

Answer 133

3 One of the benefits of exercise is improved insulin sensitivity, which reduces the amount of insulin needed. Blood glucose levels decrease during exercise. Patients with diabetes should not exercise before meals because this timing increases the risk of hypoglycemia. Aerobic exercise is just as important for people who have diabetes as for healthy people, so weight training is not preferable.

Answer 134

3 All of these symptoms are indicative of complex regional pain syndrome. Cervical disc disease does not produce swelling in the hand, color and temperature changes, or hyperhidrosis. Raynaud phenomenon results in pain, pallor, and coolness, but no hyperhidrosis. Although carpal tunnel syndrome can also show sympathetic nervous system abnormalities, compression of the median nerve would refer symptoms to the lateral border of the hand (thumb area. With carpal tunnel syndrome, the patient may also display thenar muscle weakness.

Answer 135

1 Evaluation of the patients' retention of the information presented in the program can be enhanced by asking the patients questions about the program information, having the patients ask questions about the program, having the patients demonstrate what they have learned, and testing the patients about the program material. Option 1 is the only option that includes one of these techniques. The other options do not require active participation by the patients and do not address specific interventions.

Answer 136

1 Chronic inflammatory disorders such as rheumatoid arthritis are often associated with morning pain and stiffness that decrease throughout the day with activity. Pain that is worse at the beginning of an activity implies acute inflammation. Constant pain suggests tumors or a visceral cause. Pain that increases throughout the day indicates increased congestion in a joint.

Answer 137

1 Ice massage is used to treat a small area, such as a trigger point in a muscle. Ice is applied to produce analgesia and allow for deep pressure massage over the trigger point and stretching of the muscle. Treating large areas, such as the lower leg (as in option 2), is done more efficiently with cold baths or cold packs than with ice massage. Cryotherapy increases stiffness and decreases tissue extensibility (p 76) and so would not be indicated for stretching hamstrings.

Answer 138

2 Trigeminal neuralgia causes facial pain. All of the signs and symptoms in the question are indicative of a partial nerve lesion affecting the facial nerve. This type of lesion is Bell palsy. A left cerebrovascular accident affects only the lower facial muscles below the eye. Damage to the oculomotor nerve causes paralysis of one or more of the muscles that moves the eyeball.

Answer 139

3 All of the options, except for gentle, active exercises, are precautions or contraindications for this patient.

Answer 140

4 External validity is concerned with the issue of how the results of the research can be generalized.

Answer 141

1 In this stage of hemarthrosis, there is still some bleeding into the joint space, but it is not as extensive as during the acute phase. Therefore the patient will benefit from range-of-motion exercise to prevent contracture. The patient may need active-assist, as there may still be pain or edema in the joint that prevents independent performance of range of motion. The mechanical trauma of weight bearing to tolerance at this stage may impinge on and damage the pathologic synovium within the joint. Resistive range of motion is more appropriate when pain and swelling have subsided and no bleeding is occurring. Continuous immobilization in the extended position will promote contracture in the edematous knee.

Answer 142

1 The Glasgow Outcome Scale is used as a general outcome measure, and in prognostic studies. The Fugl-Meyer Assessment should be used only with patients who have had a stroke. The Rancho Los Amigos Levels of Cognitive Functioning is a descriptive scale that outlines a predictable sequence of cognitive and behavioral recover as a patient emerges from a coma. The Sickness Impact Profile is used to measure general health status and is self-administered; therefore, it would not be useful as a prognostic discharge tool for a patient with a traumatic brain injury.

Answer 143

3 Cauda equina causes lower motor neuron dysfunction, including urinary retention and incontinence. Positive Babinski and clonus responses indicate upper motor neuron dysfunction. A positive prone knee flexion test is more likely with upper lumbar nerve root impairment.

Answer 144

1 With an extension exercise program, centralization indicates that the patient is improving, even though the pain may be just as intense as it was. Even though the patient may feel frustrated, he is actually improving; and therefore the therapist should continue with the extension exercise program. There is no need to call the physician at this point, since the centralization is perfectly normal. Although trunk flexion may be used later in the intervention, it would not be indicated at this point because extension is working.

Answer 145

4 Contract-relax stretching for tight structures is not recommended for soft tissues compromised by rheumatoid arthritis. Grade IV mobilization techniques are contraindicated for soft tissues compromised by rheumatoid arthritis. The elimination of functional activities is not required. Strengthening exercises are the most appropriate intervention for a patient with rheumatoid arthritis in remission.

Answer 146

3 Increased pain with chest-wall palpation is more indicative of a musculoskeletal origin of pain. Increased pain with deep breathing is more indicative of a pulmonary origin of pain. Nitroglycerin (Nitrostat) is a common vasodilator that is prescribed for patients who have angina. Ingestion of a vasodilator will improve myocardial blood flow and help relieve ischemia and its manifestations. Relief of pain with antacid ingestion is more indicative of referred pain from peptic ulcer disease.

Answer 147

1 The most common cause of inwardly pointing or "squinting patellae" is excessive femoral anteversion. Although there is normally 8° to 15° of femoral anteversion, an excessive amount leads to squinting patellae and toeing in. The other options would all have a tendency to cause the patellae to point outward during standing.

Answer 148

4 An outcome measure documents a desired performance or change in the patient's condition over time. This may include a description of the patient's function before, during, and after intervention. Option 4 does not indicate a change or function but is focused on attendance.

Answer 149

3 Complete severance of the spinal cord causes motor and sensory loss on both sides of the body. A lesion of the anterior horn cells causes a lower motor neuron problem and hyporeflexia. The signs and symptoms presented in the question point to a hemisection of the spinal cord on the left side, which gives rise to ipsilateral motor and proprioception loss and contralateral loss of pain and temperature. Also present are hyperreflexia and a positive Babinski sign on the left side. A lesion of the central spinal cord usually spares the motor tracts.

Answer 150

1 Radiation of the pelvic cavity often causes dense pelvic adhesions that can restrict motion due to pain. Of the options, stretching exercises are most specific to address this complication.

Answer 151

4 As the frequency of visits decreases and the time between visits increases, the patient requires a more detailed home program with specific progression instructions.

Answer 152

2 Regarding option 1, a ratio of 75% is considered normal. Regarding option 2, the patient has a mild disease. Advanced obstructive disease can have values of 25%. Nonetheless, the patient has mild morbidity, so special precautions should be used. Regarding option 3, the patient has a mild disease and is not yet showing signs of morbidity, so special precautions should not be necessary. There would be no need to limit heart rate to 60% if the patient tolerates the exercise. An FEV/forced vital capacity ratio of 60% is a mild loss. Avoidance of aerobic exercise should not be required, and special physician approval related to a value of 65% should not be necessary.

Answer 153

2 Jaundice is a sign of liver disease.

Answer 154

1 Patients with AIDS include those who have HIV -1 and a CD4 count below 200 cells/mL. A low neutrophil count or a high ANA or HLA titer are not specific to the presence of HIV.

Answer 155

3 Thrombocytopenia is an acute or chronic decrease in the number of platelets in the circulation. The Ta lymphocyte count is used to assess immune status in patients with HIV or AIDS. The red blood cell count is utilized to assess for presence of anemia, and the white blood cell count would be examined to determine presence of infection or degree of immunosuppression.

Answer 156

3 High blood pressure, cigarette smoking, and hyperlipidemia are direct or primary risk factors for atherosclerosis. Secondary risk factors include age, gender, race, obesity, stress, and activity level.

Answer 157

2 Option 1 does not specify the amount of assistance. Option 2 is a measurable, specific, and objective goal. Option 3 does not specify the device the patient will be using. Option 4 is a goal that is to be achieved by discharge, which would be a long-term goal, not a short-term goal.

Answer 158

2 The pelvic floor muscles are innervated by sacral nerve roots S-S through the pudendal nerve. The inferior gluteal nerve is a motor nerve that innervates the gluteus maximus. The sciatic nerve contains nerve roots from L-S and innervates multiple muscles in the lower leg. The genitofemoral nerve, which is from L-L2, is a cutaneous nerve that is sensory and not motor.

Answer 159

2 Malaise and fatigue are common symptoms during the beginning stages of rheumatoid arthritis. Tension headaches, heat intolerance, and nausea and diarrhea are not associated with rheumatoid arthritis.

Answer 160

3 Exercise has been shown to increase sensitivity of the insulin receptors, leading to a decrease in the amount of insulin required. Administration of medication is dictated by tolerance and efficacy of the medication and would not necessarily be altered by exercise. In patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of 24 to 48 hours after exercise; therefore, an increase in caloric intake, particularly intake of carbohydrates, would be essential.

Answer 161

2 The patient has too much version during the midswing phase. This is probably caused by too much activity in the extensor digitorum longs or extensor hallucis longus. To correct the situation, the tibialis anterior should be facilitated, because it dorsiflexes and inverts but doesn't cause version. The fibularis brevis, an everter, would cause plantar flexion of the foot rather than dorsiflexion. The flexor hallucis longus does not dorsiflex the ankle.

Answer 162

3 Wounds heal via a complex process involving re-epithelialization. With advanced aging, the rate of epidermal proliferation decreases.

Answer 163

3 Option 1 does not ask about function. It is an impairment-related question, not a function-related question. Options 2 and 4 do not ask about function, and even with improvement, neither would relate to function. Option 3 is taken from the Short Musculoskeletal Function Assessment. It addresses function and can be used as an outcome question.

Answer 164

2 For this patient, the first mobilization procedure would be distraction of the glenohumeral joint. The distraction separates the joint surfaces and is used as a test of joint play. The distraction can also help increase joint play. Distraction may also be used in conjunction with the other mobilization techniques listed. Later mobilization techniques would most likely include anterior glide.

Answer 165

2 The only one of the interventions listed that requires precaution because of the total hip replacement is continuous ultrasound. However, that does not mean that ultrasound is contraindicated for this patient. Transcutaneous electrical nerve stimulation may be used over metal implants. Hot packs and massage would not affect the total hip prosthesis.

Answer 166

1 In order to optimally clear the congestion that has developed in the right lower lobe, the patient should be positioned on the left side to allow gravity to help drain the secretions to the proximal airways. This patient is also unconscious and intubated, so in addition to drainage, manual hyperinflation is necessary to provide increased ventilation to help to mobilize secretions, then suctioning to clear the secretions. Suctioning first then hyperventilating while in left-sidelying is less effective than the order suggested in Option 1. Positioning on the right side would not drain the right lower lobe, and since the patient is lying on the right side, the only place to percuss and vibrate would be the left side, which has no pathology. Finally positioning on the left side with deep breathing exercises will not be effective in mobilizing secretions, especially since the patient is unconscious and unable to actively perform deep breathing exercises.

Answer 167

3 Practice and feedback of examination skills, role playing the interview process, and self-paced performance involve active learning with other people in everyday situations. Active learning relies on feeling and intuition rather than logic and reasoning. Readings do not meet the learning needs of active experimentation or concrete experience.

Answer 168

4 Due to the circulatory adaptations needed, patients with uncontrolled hypertension would not be permitted to use full-immersion techniques. Full-immersion hydrotherapv results in improvement of edema due to the effects of water pressure, reduced severity of exercise-induced asthma in comparison to land-based activities, and reduced stress on skeletal areas in osteoporosis.

Answer 169

1 Hypothyroidism would most likely cause the signs and symptoms. Hyperthyroidism causes diarrhea, rather than constipation. Hyperparathyroidism is not associated with bradycardia. Hypoparathyroidism is associated with arrhythmias and either constipation or diarrhea.

Answer 170

4 Neither deep breathing techniques nor a cervical cold pack would be an effective response to this emergency situation. Although the abdominal gait belt might be a contributing factor, it is not the most likely primary cause. This patient scenario is indicative of autonomic dysreflexia, a pathological reflex. The most common cause is bladder distention or urinary retention, which is likely to be caused by a urinary catheter blockage.

Answer 171

3 The tibialis posterior plantar flexes and inverts the foot. This pattern requires the specific action of that muscle. The other patterns do not.

Answer 172

4 Options 1, 2, and 3 are typical with low back pain, and none alone requires immediate referral. Saddle anesthesia around the perineum is a sign of cauda equine syndrome and usually requires immediate treatment by someone other than a physical therapist.

Answer 173

2 Aching pain is transmitted on small, unmyelinated Type C fibers.

Answer 174

2 Capsular restriction would show up in both measurements. In photograph A, there is more knee flexion present with the hip flexed. In this position the rectus femoris is on slack across the hip joint, allowing greater range of knee flexion. In photograph B the rectus femoris is stretched over both the knee joint and the hip joint, so tightness in the rectus femoris would restrict knee flexion. Photograph B also shows hip joint flexion. Hamstring weakness would not affect passive range of motion. Vasts medialis tightness would affect both measurements.

Answer 175

3 The 5.07 monofilament supplies the least amount of force that can be sensed by patients with onlv protective sensation intact. Ability to sense onlv the 6.65 monofilament indicates a loss of protective sensation. Ability to sense the 3.61 and 4.37 monofilaments indicates fully normal sensation.

Answer 176

4 The sympathetic nervous system is responsible for adjustments in preparation for emergency situations (fight of flight). With stimulation of the sympathetic nervous system, the heart rate would rise. Blood flow would be shunted from, not to, the skin. Blood glucose levels would increase, not decrease, in preparation for increased work. Bronchioles would constrict, not dilate.