du++on 2 Flashcards
(100 cards)
1
Q
You are stretching the pectoralis minor muscle of a patient diagnosed with thoracic outlet syndrome. All of the following are correct statements about the pectoralis minor, except:
A. It is supplied by the medial pectoral nerve only
B. It inserts into the middle third of the clavicle
C. It arises from ribs 3 through 5
D. It is a small somewhat triangular muscle
A
Correct Answer: B
Rationale: The pectoralis minor inserts into the medial border and superior surface of the coracoid process of the scapula
2
Q
You are designing a strengthening program for a patient with weak hip muscles. Each of the following muscles can produce movement of the hip, except:
A. Rectus femoris
B. Obturator internus
C. Quadratus femoris
D. Vastus medialis
A
Correct Answer: D
Rationale: The vastus medialis does not cross the hip joint.
3
Q
You are applying massage to a muscle within the femoral triangle. Which of the following muscles is not found in the femoral triangle?
A. Adductor magnus
B. Adductor longus
C. Pectineus
D. Sartorius
A
Correct Answer: A
Rationale: The adductor magnus is not found within the femoral triangle.
4
Q
You are part of a rehab team that is to recommend environmental modifications to a 76 year-old patient’s bathroom at his home. The patient, who is wheelchair dependent, is scheduled to be discharged next week. All of the following would be appropriate recommendations, except:
A. Bathroom sink not greater than 40 inches from floor to bottom of mirror or paper dispenser
B. Grab bars by the toilet should be 1¼-1½ in diameter
C. Minimum width of doorway to be 32 inches
D. Horizontal grab bars to be positioned at 40 inches from floor level
A
Correct Answer: D
Rationale: horizontal grab bars in tub should be positioned at 33-36 inches from floor level
5
Q
. You are teaching a patient who fractured his right tibia how to use crutches using a four-point gait pattern. Which of the following describes this pattern?
A. (L) crutch, (R) foot, (R) crutch, (L) foot
B. (R) crutch, (L) foot, (L) crutch, (R) foot
C. (L) crutch, (R) foot, (L) foot, (R) crutch
D. (L) crutch, (L) foot, (R) crutch, (R) foot
A
Correct Answer: B
Rationale: With the 4-point gait pattern the crutch is moved with the opposite leg
6
Q
You are instructing a patient that is partial weight bearing on the left lower extremity to ascend stairs using axillary crutches. Your first instruction should be:
A. place your left leg on the first step
B. place your left leg and right crutch on the first step
C. place your right leg on the first step
D. place your right leg and left crutch on the first ste
A
Correct Answer: C
Rationale: Remember the adage: Up with the good, down with the bad–when going up the stairs lead with the good (uninvolved) leg, when going down the stairs lead with the bad (involved) leg.
7
Q
You are asked by a colleague who must take an important phone call to continue postural drainage activities on a patient. When you enter the room, the patient is positioned in sidelying. Which of the following lung segments is most likely being treated based on the patient’s position?
A. posterior basal segment of the lower lobes
B. apical segment of the upper lobes
C. lateral basal segment of the lower lobes
D. anterior segment of the upper lobes
A
Correct Answer: C
Rationale: This is the position best suited to treat the basal segment of the lower lobes.
8
Q
You have been asked to provide an assistive device to a 90-year-old female who lives alone and is partial weight bearing on the right lower extremity. Her upper extremity strength is 3+/5. Which assistive device would you recommend for this patient?
A. Lofstrand crutches
B. axillary crutches
C. large base quad cane
D. walker
A
D
Rationale: A walker would be the safest assistive device for this patient as it provides the widest base of support.
9
Q
You have been asked to provide a recommendation for a wheelchair for a patient with C4 tetraplegia. Which wheelchair would be the most appropriate for the patient?
A. manual wheelchair with friction surface handrims
B. manual wheelchair with handrim projections
C. power wheelchair with sip-and-puff controls
D. power wheelchair with joystick controls
A
C
Rationale: A patient with a diagnosis of C4 tetraplegia would not be able to independently operate a manual wheelchair or joystick controls.
10
Q
You are treating a 60-year-old male diagnosed with Parkinson’s disease. Due to the effects of the disease, the patient is unable to perform basic activities of daily living without assistance from family members. Your most appropriate treatment objective is:
A. improve upper and lower extremity strength
B. improve respiratory capacity
C. improve initiation of movement
D. improve upper and lower extremity range of motion
A
C
Rationale: While the other alternatives are reasonable objectives, improving initiation of movement is more specific to Parkinson’s disease.
11
Q
You are treating a patient who is rehabilitating from a spinal cord injury. The patient’s feet often become dislodged from the wheelchair footrests due to significant lower extremity spasticity. The most appropriate modification to address this problem would be to attach:
A. fixed leg rests and foot plates
B. elevating footrests
C. heel loops and/or toe loops
D. detachable swing-away legrests
A
Correct Answer: C
Rationale: Of the options listed, attaching heel loops and/or toe loops would best address the spasticity issue.
12
Q
You are applying a manual assisted cough technique on a supine patient with a T 6-7 spinal cord injury. Which of the following is the most appropriate location for yuor hand placement?
A. diaphragm
B. upper abdomen area
C. xiphoid process
D. umbilicus region
A
Correct Answer: B
Rationale: The clinician should place both hands flat against patient’s upper abdomen directly below the xiphoid process. With each cough the clinician applies manual pressure inwardly and superiorly
13
Q
An extremely obese patient has a diabetic ulcer on his right foot. Although the ulcer is in a chronic state of tissue inflammation, it is is not infected. The patient is unable to ambulate without applying pressure to the region. Which of the following interventions would be the most beneficial for this patient?
A. Whirlpool 10 minutes followed by sharps debridement
B. Fit the patient with an orthotic to offload pressures on the involved region
C. Review the role of glucose levels and impact on tissue healing with the patient
D. Prescribe axillary crutches for the patient and instruct them on NWB gait using the crutches
A
Correct Answer: C
Rationale: The focus of your intervention should be to use patient education to prevent the ulcer worsening. Given the patient’s extreme obesity, ambulation would not be a priority at this time
14
Q
Upon examination of a patient, you detect a restricted right joint facet at the T8 level. Following a joint mobilization to the involved joint, which of the following movements would be the best movement to teach the patient to stretch the joint?
A. Trunk rotation to the left and trunk extension
B. Trunk rotation to the left and trunk flexion
C. Trunk rotation to the right and trunk extension
D. Trunk rotation to the right and trunk flexion
A
Correct Answer: B
Rationale: The combination of trunk rotation to the left and trunk flexion will stretch the right joint facet
15
Q
Your patient, who has a history of severe chronic obstructive pulmonary disease (COPD), is getting discharged to home. The patient’s family are very concerned about the patient’s ability to breath easily once they are discharged. Which of the following would be the best instruction for this patient?
A. Deep breathing exercises combined with postural stabilization training and education about body mechanics
B. Encourage the patient to cough regularly and deeply to clear airway passages
C. Encourage the patient to cough
D. None of the above would be appropriate
A
Correct Answer: A
Rationale: Deep breathing exercises combined with postural stabilization training and education about body mechanics would be the most appropriate intervention from this list.
16
Q
A patient presents with dysfunction of the medial longitudinal arch due to depression of the subtalar joint. The appropriate shoe insert for this patient is:
A. scaphoid pad
B. Heel lift
C. pad over the transverse arch
D. Thomas heel
A
Correct Answer: A
Rationale: The scaphoid pad is designed to prevent depression of the subtalar joint by posting the sustentaculum tali and the navicular tuberosity.
17
Q
You are working with a child with Down Syndrome who frequently uses a W sitting position. The main reason to discourage sitting in this manner is that it may:
A. cause femoral anteversion and knee strain
B. delay the development of normal sitting
C. increase abnormally low tone
D. increase abnormally high tone
A
Correct Answer: A
Rationale: The W sit position fixes the hip in ananteverted position while simultaneously placing strain on the ligaments of the knee.
18
Q
Which of the following end-feels is always an absolute CONTRAINDICATION for joint mobilization?
A. empty end-feel.
B. soft end-feel.
C. springy end-feel.
D. firm end-feel.
A
Correct Answer: A
Rationale: An empty end feel highlights that the patient is unable to tolerate further motion due to severe pain.
19
Q
All of the following are indications for mechanical traction, except
A. Spinal nerve root impingement
B. Hypomobility of spinal joints
C. Joint instability
D. Muscle spasm or guarding
A
Correct Answer: C
Rationale: Traction should not be performed in the presence of joint instability.
20
Q
You are designing an aerobic exercise program for a healthy 64 year old using the age-adjusted target heart range method. Which of the following heart rates would be the most appropriate for this patient? A. 160 bpm B. 150 bpm C. 140 bpm D. 130 bpm
A
Correct Answer: D
Rationale: The patient’s max heart rate is calculated at 220-64=156. The appropriate range would be 60-90% of 156 – 93.6 to 140.4.
21
Q
You are progressing a patient with a diagnosis of traumatic brain injury through a developmental sequence while performing dynamic activities. The patient is currently performing activities in the quadruped position. Which of the following would be the next posture to attain in the developmental sequence?
A. prone on elbows
B. Tall kneeling
C. Standing
D. Long sitting
A
Correct Answer: B
Rationale: Tall kneeling follows the quadruped position in the developmental sequence
22
Q
You are designing a program to improve coordination for patient with a history of cerebellar disease. Which of the following exercises would be the best to include? A. McKenzie B. Frenkel’s C. Borg’s D. Rhythmic stabilization
A
Correct Answer: B
Rationale: Frenkel’s exercises are designed to improve coordination.
23
Q
You are treating a hemiplegic patient status post traumatic brain injury. You are trying to promote elbow extension in the patient using the asymmetrical tonic neck reflex. Which of the following actions would best facilitate elbow extension?
A. Have the patient turn the head to the involved side
B. Have the patient turn the head to the uninvolved side
C. Have the patient flex the neck
D. Have the patient extend the neck
A
Correct Answer: A
Rationale: The asymmetrical tonic neck reflex may produce extension of the involved upper extremity by turning the patient’s head toward the involved side
24
Q
You are instructing a patient how to rise from a chair so that they can begin ambulation using a walker. Which of the following instructions should you give the patient?
A. While holding the walker with one hand push up on the chair with the other hand
B. Push up on the chair with both hands and reach for the walker once you are standing
C. Place both hands on the walker and pull yourself into the standing position
D. Push up on the chair using both hands and reach for the walker while rising
A
Correct Answer: B
Rationale: It is important that the patient does not reach for the walker until they are standing to prevent the walker from tipping over.
25
```
Which of the following breathing techniques decreases the patient’s respiratory rate, prolongs the expiratory phase, and increases the excretion of carbon dioxide?
A. Pursed lip breathing
B. Diaphragmatic breathing
C. Stacking breaths
D. Segmental breathing
```
Correct Answer: B
Rationale: Diaphragmatic breathing is designed to decrease the patient’s respiratory rate, prolongs the expiratory phase, and increases the excretion of carbon dioxide.
26
You are explaining Ohm’s law to a physical therapy student. As the current flow is directly proportional to the voltage and inversely proportional to the resistance, all of the following are true, except:
A. When resistance decreases, current increases
B. When voltage increases, current increases
C. When voltage is 0, current is 0
D. When voltage increases, current decreases
Correct Answer: D
Rationale: When voltage decreases, current decreases.
27
. You are instructing a patient about precautions following a total hip replacement involving an anterolateral surgical approach. Which of the following motions should the patient avoid during the initial phase of rehabilitation?
A. Hip external rotation
B. Hip internal rotation
C. Hip flexion
D. All of these motions would be safe to perform
Correct Answer: A
Rationale: Failure to avoid external rotation of the hip can result in hip dislocation or subluxation following and anterolateral approach
28
```
You are treating a patient with right hemiplegia . You give the patient a comb and ask him to comb his head. Instead the patient uses the comb to brush his teeth. How would you document this finding?
A. Ideomotor apraxia
B. Ideational apraxia
C. Dyspraxia
D. Aphasia
```
Correct Answer: B
Rationale: Ideational apraxia involves errors in concepts and sequencing of tasks
29
```
. You are treating a patient who has suffered a CVA eight weeks ago. The patient is demonstrating Isolated joint movements that are performed with coordination. According to Brunnstrom, which stage of recovery is the patient in?
A. Three
B. Four
C. Five
D. Six
```
Correct Answer: D
Rationale: Isolated joint movements are performed with coordination in stage six.
30
. You are treating a patient who demonstrates a 5° limitation in knee extension. You decide to use a joint mobilization technique to regain the last 5° of extension. Which of the following mobilization techniques would be indicated?
A. Anterior glide of the tibia on the femur
B. Posterior glide of the tibia on the femur
C. Inferior glide of the patella
D. Superior glide of the patella
Correct Answer: A
Rationale: Although a superior glide of the patella is involved in knee extension, there is little engagement of the patella during the last 5° of extension. Therefore the best answer is anterior glide of the concave tibia on the convex femur.
31
```
You are treating a patient with a diagnosis of pulmonary disease. Which of the following breathing techniques would help the patient perfom ADLs without dyspnea
A. Paced breathing
B. Diaphragmatic breathing
C. Stacking breaths
D. Segmental breathing
```
Correct Answer: A
Rationale: Paced breathing uses a combination of pursed-lip breathing and diaphragmatic breathing performed at the normal 1:2 ratio of inspiration to expiration during functional activities
32
You are treating a patient with a diagnosis of an avulsion fracture of the ischial tuberosity. Which of the following would be the most likely mechanism of injury?
A. Forceful extension of the hip with the knee extended
B. Forceful flexion of the hip with the knee extended
C. Forceful extension of the hip with the knee flexed
D. Forceful flexion of the hip with the knee flexed
Correct Answer: B
Rationale: Forceful flexion of the hip with the knee extendedplaces significant forces through the hamstrings, which can result in an avulsion fracture.
33
You are treating a patient diagnosed with multiple sclerosis . All of the following would be included in your design for the intervention, except:
A. Scheduling late morning sessions
B. Aggressive stretching
C. Energy conservation and stress management techniques
D. High intensity exercise
Correct Answer: D
Rationale: Fatigue is a common component associated with multiple sclerosis therefore the exercise should be at a moderate level and not high-intensity.
34
You are designing a strengthening program for a patient recovering from an anterior shoulder dislocation. Which of the following muscle groups should be emphasized?
A. Shoulder adductors and internal rotators
B. Shoulder abductors and external rotators
C. Shoulder adductors and external rotators
D. Shoulder abductors and internal rotators
Correct Answer: A
Rationale: The shoulder adductors and internal rotators provide support for the anterior joint capsule
35
```
You are currently treating a patient who recently underwent an above knee amputation. According to the psychiatrist report, the patient is in the third stage of the grieving process. Which stage of the grieving process is the patient most likely exhibiting?
A. Bargaining
B. Anger
C. Depression
D. Acceptance
```
Correct Answer: A
Rationale: The five stages of grieving are (in order from first to last) denial, anger, bargaining, depression, and acceptance
36
```
You are treating a patient who traumatically dislocated the tibia directly posteriorly. Which of the following structures is the least likely to be injured?
A. Tibial nerve
B. Common fibularis (peroneal) nerve
C. Anterior cruciate ligament
D. Popliteal artery
```
Correct Answer: B
Rationale: The common fibularis (peroneal) nerve travels over the lateral aspect of the knee and is therefore the least likely to be injured.
37
You are treating a patient who recently suffered a stroke and has been diagnosed with right sided homonymous hemianopsia. Which of the following statements is true about placement of objects in the early rehabilitation period?
A. The objects should be placed on the left side of the patient
B. The object should be placed on the right side of the patient
C. The object should be placed on both sides of the patient
D. The object should be placed slightly to the right of the patient
Correct Answer: A
Rationale: Initially, the objects should be placed on the left side of the patient As perception improves, the objects should be moved into the area of the deficit.
38
You are treating a patient who underwent a left total knee replacement five weeks ago. Range of motion measurements for the left knee are 85° actively and 95° passively for flexion, and -12° of full passive extension and -18° of full active extension. Which of the following should you address first?
A. The lack of passive left knee extension
B. The lack of active left knee extension
C. The lack of passive left knee extension
D. The lack of passive left knee flexion
Correct Answer: C
Rationale: You should address the lack of passive left knee extension first because the patient has to achieve passive knee extension before she can gain full active knee extension.
39
You are treating a patient who requires a whirlpool treatment. Because the patient is severely immobile, you need to set up a portable whirlpool unit in the patient’s room. Which is the most important factor you must consider before this patient is placed in the whirlpool?
A. Make sure the whirlpool unit is plugged into a ground fault circuit interruption outlet
B. Check to make sure the water temperature is below 100°F
C. Obtain the appropriate assistance to perform the transfer
D. Check to make sure the patient is stabilized properly in the chair
Correct Answer: A
Rationale: A ground fault interruption circuit protects the patient from a potentially life-threatening situation
40
You have been asked to tape an athlete’s ankle prophylactically before a basketball game to prevent ankle sprain. In what position should the ankle be slightly positioned in before taping to provide the most protection?
A. Inversion, plantarflexion, adduction
B. Eversion, dorsiflexion, abduction
C. Eversion, plantarflexion, adduction
D. Inversion, dorsiflexion, abduction
Correct Answer: D
Rationale: This position limits inversion, plantarflexion, and adduction.
41
You have been asked to fabricate a splint for a one-month-old infant with congenital hip dislocation. In what position should the hip be replaced while in the splint?
A. Flexion and abduction
B. Flexion and adduction
C. Extension and adduction
D. Extension and abduction
Correct Answer: A
Rationale: This is the most stable position.
42
You have decided to use a whirlpool treatment to decrease spasticity of a muscle in conjunction with passive exercise. Which of the following whirlpool temperatures would be the most appropriate to help achieve this?
A. Warm: 96-99 deg F (35.5-37 deg C)
B. Cool: 67-80 deg F (19-27 deg C)
C. Cold: 55-67deg F (13-19 deg C)
D. Very cold: 32-55 deg F (0-13 deg C)
Correct Answer: A
Rationale: The most appropriate temperature would be warm.
43
All of the following are true statements about learning and teaching, except:
A. Learning refers to the ways people acquire, process, store and apply new information
B. To identify realistic goals, instructors must be skilled in assessing a patient’s readiness or a patient’s progress toward goals
C. Motivation plays a critical role in learning
D. Incentives, including privileges and receiving praise from the educator should be used sparingly
Correct Answer: D
Rationale: Incentives, including privileges and receiving praise from the educator motivate learning
44
All of the following are true statements about motivation, except:
A. Interesting visual aids, such as booklets, posters, or practice equipment, motivate learners
B. Internal motivation is longer lasting and more self-directive than is external motivation
C. Success is more predictably motivating than is failure
D. All are true statements about motivation
Correct Answer: D
Rationale: All are true statements.
45
All of the following are true statements about Maslow’s hierarchy of needs, except:
A. It is based on the concept that there is a hierarchy of biogenic and psychogenic needs that humans must progress through
B. The higher needs in this hierarchy only come into focus once all the needs that are lower down in the pyramid are mainly or entirely satisfied
C. Growth forces create upward movement in the hierarchy, whereas regressive forces push prepotent needs further down the hierarchy
D. Maslow’s hierarchy is often depicted as a pyramid consisting of three levels, with the lower levels referred to as being needs.
Correct Answer: D
Rationale: Maslow’s hierarchy is depicted as a pyramid consisting of five levels with the lower levels being referred to as deficiency needs
46
All of the following are considered to be one of Bloom’s domains of educational activities, except:
A. Cognitive
B. Affective
C. Psychomotor
D. Mental
Correct Answer: D
Rationale: All are considered to be one of Bloom’s domains of educational activities, except Menta
47
Which of the following statements is not true about the analytical/objective learner?
A. He/she processes information in a step-by-step order
B. he/she is able to use facts and easily understand the relationships between them
C. he/she perceives information in an abstract, conceptual manner
D. He/she processes information all at once
Correct Answer: D
Rationale: The intuitive/global leaner processes information all at once, and not in an ordered sequence.
48
All of the following factors can be used to improve compliance with learning and participation, except:
A. Involving the patient in the intervention planning and goal setting
B. Promoting perceived benefits
C. Promoting high expectations regarding final outcome
D. Having the patient work through the pain to increase tolerance levels
Correct Answer: D
Rationale: The PT should strive to keep the exercises pain-free or with a low level of pain.
49
You are presenting at a local community center where you are educating the public about physical therapy. Which of the following statements about physical therapy is incorrect?
A. Physical therapists are the only professionals who provide physical therapy
B. Physical therapists are professionally educated at the college or university level and are required to be licensed in the state (or states) in which they practice
C. Graduates from 1960 to the present have successfully completed professional physical therapist education programs accredited by the APTA
D. Physical therapists practice in a broad range of inpatient, outpatient, and community-based settings
Correct Answer: C
Rationale: Graduates from 1960 to the present have successfully completed professional physical therapist education programs accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE).
50
Which program is designed to provide services to seniors and the disabled whose needs would otherwise require them to live in a nursing home?
A. Home Health Agency (HHA) program
B. The Medicaid Waiver for the Elderly and Disabled (ED Waiver) program
C. The ADA program
D. None of these programs
Correct Answer: B
Rationale: The Medicaid Waiver for the Elderly and Disabled (ED Waiver) program is designed to provide services to seniors and the disabled whose needs would otherwise require them to live in a nursing home.
51
All of the following are considered to be the focus of a home health physical therapist except:
A. Securing scatter rugs
B. Assessing the need for a raised toilet seat
C. Building outside ramps
D. Addressing equipment needs
Correct Answer: C
Rationale: A home physical therapist makes recommendations about outside ramps but is not responsible for building them.
52
All of the following are true statements about the Early Intervention Program (EIP), except:
A. It was created by Congress in 1986 under the Individuals with Disabilities Education Act (IDEA)
B. To be eligible for services, children must be under 3 years of age and have a confirmed disability or established developmental delay
C. Confirmed disability or established developmental delays can include physical, cognitive, communication, socialemotional, and/or adaptive impairments
D. All are true statements
Correct Answer: D
Rationale: All are true statements
53
All of the following are true statements about correct clinical documentation, except:
A. All documents must be legible and should be written in black or blue ink, typed and/or transcribed
B. Empty lines should not be left between one entry and another, nor should empty lines be left within a single entry
C. Correction fluid/tape or similar products can be used to correct text in the medical records
D. Any mistake should be crossed out with a single line through the error, initialed, and dated by the clinician
Correct Answer: C
Rationale: Correction fluid/tape or similar products should never be used to correct text in the medical records.
54
You have been asked to prepare a departmental budget that must include expenditures for the purchase of expensive equipment (i.e., over $300-500) with a life span of 3-5 years, repair needs, plans for purchasing buildings, and the means to finance each over lengthy time periods. What type of budget is this?
A. Operating
B. Capital
C. Zero-based
Correct Answer: B
Rationale: This type of budget is a capital budget
55
You have been asked to give a presentation on hamstring injury prevention for a group of high school athletes. Which of the following would be your most important consideration?
A. Typing up an outline
B. Using a PowerPoint presentation
C. Injecting humor into your presentation
D. Assessing the needs of your target audience
Correct Answer: D
Rationale: It is always critical to assess the needs of your target audience prior to designing a presentation.
56
You have been treating a patient who was placed on non weight-bearing status following surgery to his right knee. Within the first couple of sessions, it became clear to you that the patient was being noncompliant with the weightbearing status. Of the following, which would be your most appropriate action?
A. Contact the orthopedic surgeon
B. Inform a family member
C. Emphasize to the patient the importance of maintaining the non-weight-bearing status and the consequences of ignoring those restrictions
D. Refuse to treat the patient until he becomes compliant
Correct Answer: A
Rationale: Addressing the issue with the patient may improve compliance. However, if the patient continues to ignore the restrictions, you should contact the orthopedic surgeon
57
You are treating a patient with a diagnosis of status post shoulder dislocation. During the examination, the patient asks when she can stop wearing the sling. Your appropriate course of action would be to:
A. Tell the patient that you will be able to make that determination following your examination
B. Contact the patient’s physician to determine what instructions were given to the patient
C. Make a determination based on how the referring physician usually treats these conditions
D. Tell the patient she can stop wearing the sling once her arm feels comfortable
Correct Answer: B
Rationale: The patient’s physician is responsible for determining when the sling can be discontinued
58
You have been asked to prepare a presentation on lifting techniques for a group of steelworkers. To maximize learning during the presentation, which of the following media should you include?
A. Instruction, handouts
B. Instruction, statistics, handouts
C. Instruction, demonstration
D. Instruction, handouts, demonstration
Correct Answer: D
Rationale: By providing instruction, handouts, and demonstrations you are providing verbal, written, and visual information
59
Your physical therapy aide approaches you after checking the water temperature of the hot pack machine. Which of the following temperatures would not cause you concern?
A. 70°C
B. 71°C
C. 120°F
D. 200°F
Correct Answer: B
Rationale: Hot packs should be stored in water that is approximately 71°C or 160°F.
60
The ratio of cardiac compression to breaths during two-man cardiopulmonary resuscitation is:
A. 30 to 2
B. 10 to 1
C. 15 to 1
D. 15 to 2
Correct Answer: D
Rationale: This is the correct ratio of cardiac compression to breaths during two-man cardiopulmonary resuscitation according to the new American Heart Association recommendations. A ratio of 15:1 was previously recommended.
61
A patient at risk for complex health and social problems, requiring multiple services including discharge planning, targeting, assessment, care planning, service implementation, monitoring and reassessment, as well as monitoring adequacy, quality and appropriateness, requires the services of a _______________to facilitate these activities:
A. Physical therapist
B. Occupational therapist
C. Physician
D. Case manager/coordinator
Correct Answer: D
Rationale: It is the case manager’s/coordinator’s role to work with patients and/or families to obtain and monitor health, financial and social services. In addition, the case manager/coordinator provides assessments and develops and implements care planning.
62
Based on a health fair screening, with the permission of the parent, a PT observes there is an obvious spinal curvature in a 13 year old female. It is the PT’s responsibility to:
A. Diagnose scoliosis
B. Suggest to the parent the child might have scoliosis C. Refer the child for physical therapy services
D. Recommend follow up with the child’s primary care physician
Correct Answer: D
Rationale: This is the most appropriate answer. It is not the role of the PT to make a diagnosis or to suggest a diagnosis to a parent. Referring a child for physical therapy services before referring the child to a primary care physician would also be inappropriate.
63
A claim is denied by a third party payer citing duplication of rehabilitation services. All of the following may account for this denial except:
A. There may have been duplicate CPT codes used between services without documentation of clear delineation of the goals
B. There may not have been adequate coordination of service delivery between disciplines
C. There was clear and accurate coding from the facility delivering the care
D. There were different codes for services but overlap in documentation
Correct Answer: C
Rationale: Claims are rarely denied when clear and accurate coding is provided by a facility. All of the other responses infer some form of overlap or duplication of services
64
. During a PT/client interview, a patient is relating his problems in narrative, and the PT demonstrates third person voice. Third person voice:
A. Is the best choice because it appropriately distances the professional from the narrative
B. Is not the best choice because it appropriately distance the professional from the narrative
C. Should be replaced by first person voice so the pt can communicate sympathy during the narrative
D. Should be replaced by second person voice so the pt is restating the narrative while expressing empathy
Correct Answer: A
Rationale: The third person voice provides appropriate distancing with expression of an appropriate level of interest, to effectively obtain necessary information from an interview.
65
5. A patient’s family complains a department that there has been a problem with miscommunication between the therapist and patient. A common for this is most likely:
A. Discomfort or uneasiness
B. Educational differences
C. Language
D. Political leanings
Correct Answer: C
Rationale: Language differences are one of the most frequent reasons for miscommunication. As therapists learn how to communicate appropriately with lay individuals, educational differences should not be a problem. Discussions regarding political leaning should be avoided, and if a patient is uncomfortable or uneasy, these feelings do not usually lead to miscommunication.
66
. Each discipline is required to document in the medical record section identified for that discipline. This type of documentation record facilitates communication between different healthcare professionals and is called:
A. Integrated
B. Source Oriented
C. Problem oriented
D. Narrative
Correct Answer: B
Rationale: Source oriented documents are divided by service or discipline. Integrated records combine all services into consecutive running entries. Problem oriented records were developed by Dr. Weed decades ago, and identified sets of problems that individual disciplines documented if they played a role in the management of that problem. The SOAP note commonly used in PT documentation today, is a hold over from the problem oriented record. Narrative is a format for health information entries that uses paragraph formatting.
67
A team meeting to discuss a patient’s care and progress includes the physician, case manager, PT, OT, and nurse with the team sharing information and setting goals in order to prevent duplication of services. This is an example of which type of approach:
A. Interdisciplinary
B. Transdisciplinary
C. Multidisciplinary
D. Mixed disciplinary
Correct Answer: A
Rationale: Interdisciplinary (involving two or more academic disciplines that are considered distinct) is the correct answer. Transdisciplinary approaches involve collaboration, consensus building, regular and open communication, and expanding roles across discipline boundaries. Multidisciplinary refers to the combining of several disciplines at once
68
In the absence of or in between team meetings, the best way to communicate patient progress with other members of the healthcare team is through:
A. The patient’s physician
B. Documentation in the medical record
C. Seeking out individual team members for oral reports D. Individual phone calls or email to team
Correct Answer: B
Rationale: Documenting in a medical record is the most efficient method of communicating a patient’s progress to the other members of the healthcare team. All of the other responses convey information to individual members of the healthcare team and will require further dissemination.
69
A facility employs a culturally diverse physical therapy staff. An Asian patient demonstrates hostile behavior toward a Caucasian PT and demands to be changed to an Asian PT, insisting that the Asian PT is smarter. This is an example of:
A. Ethnocentrism
B. Cultural bias
C. Prejudice
D. Discrimination
Correct Answer: A
Rationale: Although all of the responses could be considered somewhat correct, ethnocentrism (the belief that one’s culture is superior to all others) is the correct answer.
70
. In an acute care setting, the best time to enter the PT “Plan of Care (POC)” in the medical record is:
A. At the PT’s convenience so it can be thorough and clear to the other member of the healthcare team
B. By the next PT/patient session so any other PT could assume care in the absence of the evaluating PT C. Immediately after completing the initial examination and evaluation to ensure timely communication of findings
D. By the end of the first day of the initial examination and evaluation regardless of when the session was conducted
Correct Answer: C
Rationale: The entire healthcare team involved in a patient’s care uses the medical record and therefore entries must be made in a timely fashion.
71
In order to affect the best therapeutic outcomes, at the outset of care, the best action a therapist should take is:
A. Determine goals based on examination findings
B. Provide primarily evidenced based interventions
C. Involve the patient in goal setting
D. Implementing interventions that generally work for them
Correct Answer: C
Rationale: Whenever possible, the patient should always be involved in goal setting
72
A PT is observed with an older adult, attempting to transition the patient from sit to stand in order to initiate gait training. The best method to accomplish this is:
A. Part to whole approach
B. Instruction to “stand up”
C. Independent discovery by patient
D. Lifting the patient to stand
Correct Answer: B
Rationale: Automatic or routine activities, are performed as “whole” activities. Breaking an activity down into parts, can be confusing to the client, as automatic activities are completed in parts. If the client has any processing deficits, they respond to simple, single step instructions for which there is motor memory.
73
A patient has limited respiratory reserve and motor control deficits following major trauma and hospitalization. The third party payer has approved a 7 day rehab stay during which the patient needs to achieve an appropriate functional level to return home. The best intervention training strategy and patient instruction includes emphasizing:
A. Therapeutic activities including repetitive appropriate functional tasks
B. Therapeutic activities including incremental activities of daily living
C. Therapeutic exercise focusing on increasing resistance
D. Therapeutic exercise focusing on aerobic capacity
Correct Answer: A
Rationale: Repetition of functional tasks needed by an individual for return to home, incorporate strengthening and aerobic capacity while focusing on client needs. From a third party payer perspective, especially for Medicare, emphasis on function is encouraged and presents as relevant for the patient.
74
Your patient is being treated for a humeral fracture. Her husband wants to look at her medical record. As her physical therapist you should:
A. Give him the husband the chart as he has a right to view the information as a family member
B. Deny the husband access to the chart unless written permission is granted by his wife
C. Let the husband look at the chart with your supervision
D. Not let the husband view the chart in case he may misinterpret the information within the chart
Correct Answer: B
Rationale: Based on privacy guidelines, the husband cannot have access to his wife’s chart unless the wife issues permission
75
You have been asked to instruct a new group of nurse aides in how to perform a safe transfer. You plan a session that includes some demonstration and practice. Effective documentation of this session should include:
A. The lesson objectives and the activities used
B. The lesson objectives, the activities and modifications needed, and the outcomes of the session
C. The length of time it took for the group to learn the activities
D. The ability of the group to learn new skills and their level of satisfaction
Correct Answer: B
Rationale: This would be the most appropriate answer—to include the objectives, activities, modifications, and the outcomes
76
You are performing an ultrasound at the L3 level of the lumbar spine for low back pain on a female patient when the patient suddenly informs you that she is looking forward to having her second child. On further investigation, you discover that the patient is in the first trimester of pregnancy. Which of the following is your best course of action?
A. Modify the ultrasound settings and continue with the treatment
B. Cease treatment, notify the patient’s orthopedic physician, and document the mistake
C. Continue as before
D. Send the patient to the gynecologist for an immediate sonogram
Correct Answer: B
77
When using electrical stimulation with a unit that plugs into the wall, the therapist must take many different safety precautions. Which of the following precautions is unlikely to increase the safety of the patient and therapist?
A. Never placing the unit in close proximity to water pipes while treating the patient
B. Never using an extension cord when using a plug-in unit
C. Always adjusting the intensity of stimulation during the off portion of the cycle
D. Not using the unit in an area where there are puddles
Correct Answer: C
78
A patient is referred to physical therapy with the diagnosis of a recent complete tear of the anterior cruciate ligament. The patient and the physician have agreed to avoid surgery for as long as possible and the therapist has been asked to provide the patient with a home exercise program and instructions about activities based on this decision and diagnosis. Which of the following is the best advice?
A. The patient should not worry and should continue to perform any activity until his knee gives out again.
B. The patient should not perform any athletic activity involving his knee again.
C. The patient should wear a brace and compete in only light athletic events
D. The patient should work hard at strengthening his hamstrings, but should wait until the ratio of his hamstring: quadriceps measured isokinetically is equal before returning to athletic activities
Correct Answer: C
Rationale: This is the best course of action. The brace will provide some protection and the light activity level is a good starting point prior to further progression
79
You read a clinical study investigating the relationship between ratings of perceived exertion (RPE) and type of exercise: upper extremity (UE) isokinetics versus lower extremity (LE) isokinetics. The study reports a correlation of 0.40 with the UE isokinetics and a correlation of 0.85 with the LE isokinetics. From these findings, you could determine:
A. leg isokinetic exercises are highly correlated with RPE while arm isokinetic exercises are only moderately correlated.
B. both UE and LE isokinetic exercises are only moderately correlated with RPE.
C. both UE and LE isokinetic exercises are highly correlated with RPE.
D. The common variance of both types of testing is only .45.
Correct Answer: A
Rationale: This is the correct answer based on the correlation values.
80
You are interviewing a physical therapist for a job vacancy. As the interviewer, you should AVOID discussing:
A. Your company’s health insurance, continuing education, and vacation benefits.
B. work hours associated with the position.
C. Parking arrangements for employees
D. the applicant’s marital status
Correct Answer: D
Rationale: During an interview, you cannot enquire as to an applicant’s marital status.
81
. A male physical therapist is examining a female of Arabic descent. During the examination, the patient does not make eye contact with the therapist. The most appropriate action is to:
A. ask the patient if she would prefer a female therapist
B. continue with the examination
C. Discontinue the examination
D. Ask the patient to pay attention
Correct Answer: B
Rationale: This would not be an appropriate reason to alter or discontinue the examination.
82
A therapist is observed incorporating motor learning principles while emphasizing direct teaching of task specific activities. The therapist is employing the following strategy:
A. Fading feedback
B. Knowledge of results
C. Neurodevelopmental facilitation
D. Neuromotor task training
Correct Answer: D
Rationale: Neuromotor task training encourages a patient to explore the environment and to solve specific movement problems, through therapist selected tasks. It is based on motor control and motor learning principles
83
For communication purposes, the following describes the most appropriate position for the therapist and client/patient:
A. If the client/patient is sitting, the therapist should be standing
B. If the client/patient is sitting, the therapist should be sitting
C. If the client/patient is standing, the therapist should be sitting
D. If the client/patient is supine, the therapist should be supine
Correct Answer: B
Rationale: From a patient/therapist interaction perspective, the patient and therapist should be as close to eye level as possible. This prevents the patient from assuming awkward postures such as neck extension and promotes eye contact which facilitates communication in western culture.
84
A therapist is focusing on intrinsic feedback for motor learning. The expectation for learning is based on:
A. Verbal instructions from the therapist
B. Tactile cues or tactile guidance
C. Somatosensory information from the limbs
D. Verbal description of the task from the patient
Correct Answer: C
Rationale: Intrinsic refers to the client’s internal feedback and sensory systems. This type of feedback has been found to be effective as a motor learning strategy.
85
. A PT will be screening falling risk of community dwellers at a local senior citizen center health fair. 15 minutes, in a limited space, are planned for each participant. The documented results of which of the following tests and measures will most clearly communicate to the participants and other healthcare providers the participant’s fall risk status in the total allotted time?
A. Functional Reach test; Barthel Index; Six Minutes Walk test
B. Timed Get-Up-and –Go test; Functional Reach test
C. Get-Up-and -Go, SF 36, FIM
D. OASIS; BERG balance; Functional Reach test
Correct Answer: B
Rationale: The Timed Get Up and Go test and Functional Reach are reliable and valid for the geriatric population. They take only minutes, and can easily be administered in most settings. As the outcomes are numeric and there are established norms, clients can take the information to the appropriate healthcare professional for follow up care.The Barthel Index is an ADL
oriented questionnaire, the Six Minutes Walk Test screens for aerobic capacity and distance that can be accomplished over six minutes, the SF 36 is a quality of life instrument, not fall risk, the FIM is used for inpatient rehabilitation outcomes, the OASIS is a questionnaire used in home health, and the BERG Balance, although it does assess fall risk, can take up to 15 minutes to administer by itself.
86
In a completed documentation utilization review audit, the following entry is identified in the plan of care in on a completed patient initial examination and evaluation. Patient will demonstrate competence with home instructions by verbalizing and demonstrating them to the therapist. Relative to this statement and its placement, the statement is an example of:
A. An intervention and therefore should be in the intervention section
B. An intervention and belongs in the long term goal or outcomes section
C. A goal or outcome and therefore belongs in the intervention section
D. A goal or outcome and therefore belongs in the goal or outcomes section
Correct Answer: D
Rationale: The statement is an example of a goal/outcome as it does not describe ‘how’ and therefore belongs in the goal/outcome section.
87
In 4 weeks, increase LLE quadriceps strength from 3-/5 to 4/5 in order to facilitate stability in weight bearing during stance phase of gait and prevent loss of balance, is an example of a patient goal that is:
A. poorly written as it does not include functional elements
B. poorly written as it does not state that it is the patient’s goal
C. well written as it contains the impairment based goal and functional goal
D. well written as it emphasized the impairment based goal
Correct Answer: C
Rationale: This is the correct response as the written goal is objective and contains an impairment based and functional goal
88
The relationship between CPT/HCPCS coding and ICD 9 coding in PT documentation is that:
A. ICD 9 procedural coding must match the CPT/HCPCS diagnostic coding for reimbursement and determination of appropriateness of procedures
B. ICD 9 diagnostic coding must be disease specific in order to determine CPT/HCPCS coding
C. CPT/HCPCS procedural coding must match the ICD 9 diagnostic coding to determine appropriateness of procedures
D. CPT/HCPCS diagnostic coding is critical in determining the correct ICD 9 coding to ensure appropriateness of procedures
Correct Answer: C
Rationale: The Current Procedural Terminology (CPT) codes (developed, maintained and copyrighted by the AMA) and the Healthcare Common Procedure Coding System (HCPCS) numbers (codes used by the Centers for Medicare and Medicaid Services) provide a uniform language that accurately describes medical, surgical, and diagnostic services. The ICD-9 (International Classification of Diseases, 9th Revision) coding system is used to code signs, symptoms, injuries, diseases, and conditions (not procedures). The critical relationship between an ICD-9 code and a CPT/HCPCS code is that the diagnosis supports the medical necessity of the procedure.
89
A traveling PT has moved from one Medicare region, Region I, to Medicare Region V for an outpatient assignment. Because the regions are both Medicare, relative to documentation and reimbursement for PT services the following best describes the PT’s responsibilities: The documentation content requirements:
A. Are the same, but the services reimbursed may be different
B. Are the same, but the services reimbursed are determined by the regional intermediary
C. Varies by region, but the services reimbursed are the same
D. Varies by region, but the services reimbursed are determined by the regional intermediary
Correct Answer: B
Rationale: Although the documentation content requirements do not change from Medicare region to region, the regional intermediary determines the reimbursement from Medicare
90
Authentication of medical record entries is verified by:
A. External audit
B. Internal audit
C. Health information management
D. Written or electronic signature
Correct Answer: D
Rationale: The authentication of a medical record entry is verified by a written or electronic signature
91
A PT intervention session was denied by the payer. During the resulting internal audit, which of the following was most likely identified as the reason for the denial?
A. Patient self report of progress in the S section matched all goals
B. Information in the O section was objective and measurable
C. The assessment component clearly identified patient progress
D. The plan component identified areas of treatment focus
Correct Answer: A
Rationale: Once a patient self reports that all of their PT goals have been met by description of their activities, they no longer qualify for skilled PT services. B – D are all appropriate for the designated SOAP note sections
92
All the following are examples of non CPT verbiage except:
A. Transfer training
B. Bed mobility training
C. Total assist lift x 2 bed to stretcher
D. Therapeutic activities
Correct Answer: D
Rationale: The American Medical Association CPT verbiage matches the CPT numbered codes categories for interventions. Therapeutic activities is the only category listed that corresponds to a CPT code. The other activities listed are interventions or descriptions that would be documented under the CPT codes for therapeutic activities.
93
During a focused review by a Medicare intermediary, one of the primary long term goals for an outpatient was to return to golf. Based on Medicare principles, this goal is considered:
A. Acceptable as it is functional, is patient centered and should be reimbursable
B. Acceptable as it is leisure oriented, is patient centered and should be reimbursable
C. Unacceptable as it is leisure oriented although it is patient centered and non-reimbursable
D. Unacceptable as it is an incremental activity of daily living and non-reimbursable
Correct Answer: C
Rationale: Medicare does not consider leisure activities appropriate justification for skilled PT services. This information is consistent with published CMS guidelines
94
Assessment tools or instruments should be used for baseline documentation during patient’s examination and evaluation. Some of the advantages and disadvantages of using assessment tools are:
A. Provide objective data and systematic approach to data collection; improve reliability, but documented scores can not be compared over time
B. Provide objective data and systematic approach to data collection, improve reliability, but may not capture or document the abilities because of a ceiling effect
C. Provide subjective data and systematic approach to data collection; improve reliability, but documented scores can not be compared over time because of a ceiling effect
D. Provide subjective data and systematic approach to data collection; adds flexibility, but documented scores can not be compared over time
Correct Answer: B
Rationale: The use of standardized assessment tools, especially those are both reliable and valid, facilitate justification of skilled PT services, and provide baselines and outcome information to show patient progress as they can be compared over time. However, there may be components of certain tools that are not sensitive enough to capture deficits or changes
95
A patient is difficult to arouse from a somnolent state, is frequently confused when awake, and repeated stimulation is required to keep the patient awake. The correct term to document this state of arousal is:
A. Coma
B. Stupor
C. Obtunded
D. Lethargic
Correct Answer: C
Rationale: The statement defines an obtunded state.
96
Based on a Medicare medical record audit, the auditor has determined that the record does not contain goals directed toward essential functions. This means that the following element was not included in the documented goals:
A. What the patient has to do for self care to function B. What the patient wants to do relative to function
C. What the therapist wants the patient to do
D. What the patient’s leisure activities are
Correct Answer: D
Rationale: Medicare does not consider leisure activities appropriate justification for skilled PT services. This information is consistent with published CMS guidelines.
97
The following practice variable enhances long-term retention and learning of a new task:
A. Blocked practice
B. Guided learning
C. Part to whole learning
D. Random practice
Correct Answer: D
Rationale: Under conditions where the environment is dynamic and the individual is required to adapt to variations in the surroundings, random practice schedules are superior to the other types of practice sessions for learning and retention of a new task
98
A Spanish speaking patient with involved family is receiving PT from an English speaking PT. They are able to communicate during treatment sessions by gesturing, demonstration and tactile cueing. The patient and her Spanish speaking family require home instruction. The best course of action is:
A. Demonstration with patient and family, having them demonstrate, reinforced by pictures
B. Giving the patient and family the standard English home instructions with pictures
C. Giving the patient and family a Spanish translated version of the home instructions
D. Demonstration to the patient and trusting the patient to communicate with family
Correct Answer: A
Rationale: Given the fact that the patient and family are able to communicate during treatment sessions by gesturing, demonstration and tactile cueing, the same method
99
Consideration for a PT in directing the type of patient/client instruction may include all of the following except:
A. Potential learning barriers
B. Support systems
C. Transitioning across settings in a continuum of care D. No benefit from PT is possible
Correct Answer: D
Rationale: All would be considerations except in the case where no benefit from PT is possible
100
A 38 yo patient is actively participating in his PT, but has not been adherent to home exercise instruction. Which of the following would not be a justification for this behavior? Provision of:
A. 4 pages of pictures and descriptions including 20 exercises to be done daily, multiple reps
B. Exercises that could easily be incorporated into the patient’s daily routine
C. Unclear understanding of the instructions
D. Increased pain and excessive fatigue after completion
Correct Answer: B
Rationale: All of the responses would be a justification for non-compliance except in the case where the patient’s exercises could easily be incorporated into his daily routine.
