NPTE SAMPLE QUESTIONS 3

1. In splinting or immobilization, the functional position of the hand includes wrist:

a. extension, phalangeal flexion, and thumb abduction
b. extension, phalangeal extension and thumb abduction
c. extension, phalangeal flexion and thumb adduction
d. flexion, phalangeal flexion and thumb adduction

2. During pregnancy, which of the ff is contraindicated?

a. curl-ups
b. bridging
c. double leg lifts
d. deep breathing with forced expiration

3. A target heart rate is determined for individual entering a training program in order to:
a. regulate exercise intensity
b. estimate energy expenditure
c. control blood pressure and specific heart rate
d. ensure participants exercise at maximal capacity

4. A herniated nucleus pulposus at the L3-L4 disc produces which of the ff clinical findings?
a. numbness in the back of the calf & dorsiflexor weakness
b. numbness in the anteromedial thigh & knee & quadriceps weakness
c. numbness & weakness in the thigh, legs, feet &/or perineum
d. numbness in the back of the calf & atrophy of gastroc & soleus

5. The intervention for a patient with limitation of shoulder flexion and medial rotation includes
mobilization. Which glide is the most appropriate for
mobilizing this shoulder to specifically increase the restricted motion?
a. Posterior
b. Anterior
c. Medial
d. Lateral

6. Which of the following techniques is MOST appropriate for patient with low postural tone?
a. Slow regular rocking while sitting on the treatment bolster
b. Continuous pressure to the skin overlying the back muscle
c. Low frequency vibration to the back muscle
d. Joint approximation applied through the shoulder to the trunk

7. Which skin change is associated with aging has the GREATEST effect on wound healing?
a. reduction in sensation
b. decrease elasticity of the skin
c. decrease epidermal proliferation
d. change in pigmentation

8. Which of the ff technique is MOST effective in teaching an IDDM patient about foot care?
a. Reassure that the pt that no infection will occur if the directions are followed, then
demonstrate procedure
 b. Tell patient how foot care is performed, then watch patients performance
c. Watch pt perform foot inspection & caution him that amputation results from unattended
skin problems
d. Have pt demonstrate a foot inspection, then give feedback on pts performance

9. For a child with DMD, the MOST appropriate PT goal would be:
a. prevention of contractures & determine method of mobility
b. preservation of strength & muscle tone
c. inhibition of abnormal tone & facilitation of normal movement & position reaction
d. facilitation of normal movement & improvement of strength

10. A patient with complete long thoracic nerve injury would have difficulty in:
c. putting hand in the back pocket
d. bending toward involved side
e. taking a deep breath
f. reaching forward above head

11. Outcomes of prenatal exercise program would not include:

a. improved body mechanics
b. application of relaxation technique
c. improve ligament flexibility
d. strengthen pelvic floor musculature

12. Utilization review & peer review are activities that are part of a comprehensive
a. policy & procedure manual
b. quality improvement program
c. audit cycle
d. performance evaluation

13. Which of the ff is the BEST documentation exercise of a goal?

a. the PT will reduce pts hip flexion contracture to neutral
b. the pt will ambulate 75 feet independently in 3 weeks
c. the PT will reduce pts pain from 7/10 to 3/10
d. the pt will understand how to increase ADL in 4 weeks

14. Patient has a limited ankle dorsiflexion ff ORIF of distal tibia. Radiographs reveal that the fracture
is well healed. Treatment with passive
mobilization should include:
a. posterior glide of talus on tibia
b. lateral glide of calcaneus on tibia
c. posterior glide of tibia on talus
d. anterior glide of talus on tibia

15. A pt who has recently & successfully completed a 12 week program of phase III cardiac rehab will
MOST likely demonstrate a decrease in
a. CO2 elimination in maximal work
b. cardiac output in maximal work
c. stroke volume at a given level of sub maximal work
 d. heart rate at a given level of sub maximal work

16. The demographic information on the subject in a research study list a mean age of 32 & median of
35. The difference between the median & mean
indicates
a. the value of standard deviation score
b. the value of the Z-score
c. that the distribution is skewed
d. that the two measures should be average

17. Rocking in a quadruped position could be included in PT intervention for a 40-year old pt to
increase ROM at the:
a. hip joint, 1 month total hip replacement
b. distal radioulnar joint, 2 weeks post fracture of the distal radius
c. glenohumeral joint, 2 months post rotator cuff tear
d. hip joint, 1 week post subcapital fracture of the femoral neck

18. A therapist is treating a young athlete with gastrocnemius muscle strength of fair plus (3+/5). In
the prone position, which of the ff exercises is the
MOST appropriate, to maximize strengthening?
a. resistive exercises with the knee bent
b. resistive exercises with the knee straight
c. active exercises with the knee bent
d. active exercises with the knee straight

19. Redness on the inferior aspect of the patella upon removal of a patellar-tendon bearing prosthesis
indicates that the residual limb:
a. is not far enough into the prosthesis & fewer socks should be worn
b. is not far enough into the prosthesis & additional socks should be worn
c. has slipped too far into the prosthesis & fewer socks should be worn
d. has slipped too far into the prosthesis & addnl socks should be worn

20. A PT is evaluating a pt with an acute lumbar disc protrusion & a right lateral shift of the thoracic
spine. Which of the ff findings would be the BEST
indicator that the sx will respond positively to PT intervention?
a. The pain is referred only in the buttock & not the thigh
b. The patient prefers standing & walking than sitting
c. There is a decrease in lumbar lordosis
d. Repeated backward bending centralizes the pain

21. A therapist evaluates a pt who has lateral epicondylitis. The pt reports a subjective pain of 8/10.
The pt also reports pain & shows weakness with
resisted wrist extension. The therapist decides to use ice massage as an intervention. The MOST
appropriate length of time for the ice massage is:
a. ten minutes
b. until the area turns red & pt reports burning sensation
c. until the pt reports that the area feels numb
d. no longer than five minutes
22. Ff spinal jt mobilization procedure, a pt calls the therapist & reports a minor dull ache in the
treated area of the back that lasted for 2-3 hrs. Based on
this sx, the therapist should:
a. consider a possible neurological lesion in the area
b. refer the pt back to the physician
c. inform the pt that the response is common
d. add strengthening ex to the home program

23. In order to conduct an experimental study on pain in postsurgical orthopedic pts, a therapist
randomly assigns pt into two groups. One group is treated
with TENS, heat & ex; the second receives heat & ex only. In this experimental design, TENS is
the:
a. continuous variable
b. dependent variable
c. discrete variable
d. independent variable

24. A 90-yr-old pt with chronic CHF has been non-ambulatory & a nursing home resident in the past
yr. The pt was recently admitted to the hospital ff an
episode of dehydration. Which of the ff plans for prophylactic respiratory care is MOST
appropriate?
a. turning , coughing & deep breathing q 1-2 waking hrs
b. vigorous percussion & vibration 4 times / day
c. gentle vibration, with the foot of the bed elevated once a day
d. segmental postural drainage using standard positions throughout the day

25. Which diagnostic procedure is LEAST likely to confirm suspected disc herniation in a pt with low
back pain?
a. MRI scan
b. CAT scan
c. Radiograph
d. Myelogram

26. To help the students apply newly learned skill to clinical practice, the MOST effective action for
the clinical instructor to take is to:
a. point out possible pt situations & discuss how the skill would apply to them
b. have the students research reference materials & compile a list of the steps required in the
acquisition of the skill
c. prepare a list if indications & contraindications for the skill
d. have the students provide eg. of pt situations where the skill would be appropriately applied

27. It is important to perform cool-down exs immed ff a general aerobic program PRIMARILY in
order to prevent:
a. venous pooling
b. cardiac arrhythmia
c. decrease body temperature
d. muscle tightening

28. The intervention for a pt who has right sciatic pain caused by piriformis compression would NOT
include:
 a. instruction in mild self-stretching in sitting with the right hip & knee flexed & pressure
applied in the medial direction to the distal thigh with the left arm
b. contract-relax ex to the hip ext-rotators performed with the pt sidelying & the right hip &
knee posned in 90 deg of flexion
c. active resistive strengthening ex to the piriformis with the pt prone & the knee flexed
d. applic of cold to the area of sciatic nerve irritability

29. A PT is assigned in the planning & implementation of services for all members of the community.
The therapist FIRST step would be:
a. develop a brochure for distribution to the community
b. organize a health fair to provide screening for the community
c. evaluate existing services & community resources
d. initiate contacts in the medical community to establish prescriptive relationships

30. To prevent contractures in a pt with an AKA (transfemoral), emphasis should be placed on

designing a positioning program that maintains ROM in
the hip:
a. flexion & abduction
b. extention & adduction
c. adduction & lateral rotation
d. flexion & medial rotation

31. After a long-term history of bilateral LE vascular insufficiency an otherwise healthy pt had a right
AKA. For this pt, which of the ff is the MOST
impt factor in establishing long-term goals for fxnl walking?
a. Status of the wound at the amputation site
b. ROM of the right hip
c. Condition of the left lower extremity
d. Ability to maintain upright posture

32. A pt is referred to PT complaining of severe pain in the right hip & groin area, which increases
during walking. The pt complains of tenderness when
the therapist palpates the area over the right greater trochanter. The MOST likely cause of the pts
s/sx is:
a. sacroiliac joint derangement
b. a hip fx
c. a strain of the add longus muscle
d. hip bursitis

33. A PT is conducting a 12-min walk test with a pt who has COPD & uses 2L/min of O2 by nasal
cannula. The pts resting O2 saturation is 91% & the
resting heart rate is 110 bpm. The O2 flow should be increased if the
a. pts CO2 level starts to increase
b. pt starts to complain of SOB
c. pts O2 saturation falls below 87%
d. pts heart rate is greater than 150 bpm

34. When working with a neurological pt to ensure that PT services are adequately documented, it is
MOST impt to record changes in:
a. muscle tone
 b. functional abilities
c. cognitive status
d. quality of movt

35. A pt has R hemiparesis resulting from TBI. When assessing motor control in the R LE with the pt
standing, the PT finds that the pt cannot extend the
hip while flexing the knee or flex the hip while extending the knee. In which of the ff fxnl
activities will this problem be MOST apparent?
a. Shifting weight while standing
b. Walking sideways
c. Walking backward
d. Moving from sitting posn to standing posn

36. A pt was injured in a motor vehicle accident two days ago, resulting in quadriplegia at C6 level.
When providing PROM to the UE, which of the ff is
MOST critical in order to optimize long-term hand fxn?
a. Passive wrist & finger extension ex to gain maximum stretch of the finger flexors
b. Passive wrist & finger flexion ex to gain maximum stretch of the finger extensors
c. Holding the wrist in flexion when passively extending the fingers
d. Holding the wrist in extension when passively extending the fingers

37. An athlete sustained a severe inversion sprain of the R ankle while playing basketball. To provide
strapping support for the ankle, pressure & support
should be applied over the tendons of the:
a. flexor digitorum longus & tibialis posterior
b. gastrocnemius & FHL
c. peroneus longus & brevis
d. tibialis ant & tibialis post

38. In which of the ff conditions would a nerve conduction velocity test be MOST important?
a. Carpal tunnel syndrome
b. Cerebrovascular accident
c. Myotonia
d. DMD

39. When training a pt to increase muscle activity with the use of EMG biofeedback, the therapist
should adjust the unit so that sensitivity:
a. starts low & increases as the pt shows an increase in muscle activity
b. starts high & decreases as the pt shows an increase in muscle activity
c. remains at approximately mid-range during the entire tx period
d. is not set, since this is not necessary for this form of biofeedback

40. A pt with leukemia has developed thrombocytopenia ff a bone-marrow transplant. Which of the ff
measures are indicative of the status of the
thrombocytopenia?
a. T4 lymphocyte count
b. Red blood cell count
 c. Platelet count
d. White blood cell count

41. During a postural examination, the PT notes that the pts patella both point inward when viewed
from the front of the pt. The MOST likely cause of
this problem is excessive:
a. femoral anteversion
b. weakness of the vastus medialis
c. genu varum
d. medial tibial tortion

42. A PT is evaluating a pt who has a vascular lesion in the brainstem affecting the oculomotor nerve.
During the cranial nerve examination, which of the
ff would be the MOST significant sign?
a. Inability to close the eyelid
b. Medial strabismus
c. Ptosis of the eyelid
d. Constricted pupil

43. For a pt with IDDM who is completing a cardiovascular fitness program, what change in diabetic
management is MOST likely to be instituted as
fitness increase?
a. Switching to oral rather than injected medication
b. Decreasing caloric intake for 2-3 hrs ff ex sessions
c. Decreasing the amount of insulin taken daily
d. Increasing the amount of insulin taken daily

44. An elderly pt presents with a sacral pressure ulcer measuring 6 in x 6 in. The wound has moderate
serous fluid drainage & is loosely covered with
necrotic & fibrotic tissue, although there are no indications of infection present. The BEST
method of debridement would be:
a. daily vigorous scrubbing of the wound
b. wet-to-dry dressings with normal saline 2 times a day
c. daily wet-to-dry dressings with 1:1 diluted povidone-iodine (Betadine)
d. whirlpool jet agitation 2 times a day

45. A pt is referred to PT for tx of tenosynovitis. The pt complains of pins & needles sensation on
the palmar surface of the first three fingers. The
PTs examination reveals a (+) Tinels sign at the wrist & good (4/5) grade thumb opposition.
Based on these findings, the therapist should suspect:
a. median nerve compression at the wrist
b. ulnar nerve compression distal to the elbow
c. tenosynovitis of APL
d. Thoracic outlet syndrome

46. A pt has disuse atrophy of the anterior compartment muscle ff cast removal after a fx of the tibia.
The pt has poor (2/5) strength in the ankle
dorsiflexors. ES is to be used to enhance DF strength in conjunction with ex. Initially, which of
the ff waveform characteristics are MOST
appropriate to stimulate the muscles?
 a. Monophasic pulse with a freq of 110 pps & on/off cycle ratio of 3:1
b. Biphasic pulse with a freq of 30 pps & an on/off cycle ratio of 1:5
c. Direct current waveform with an on/off ratio of 1:1
d. Interferential waveform with a beat freq of 1 pps

47. A pt is referred to PT with a 20 deg knee flexion contracture ff arthroscopic knee surgery a month
ago. All of the ff interventions are approp
EXCEPT
a. stretching of the semimembranosus muscle
b. strengthening of vastus medialis
c. inferior gliding of the patella
d. mobility of the posterior capsule of the knee joint

48. A pt with a complete SCI is sitting in a wheelchair on a custom made cushion. Pressure relief
activities should be performed:
a. when the pt shows signs of pressure sores
b. every 15 to 20 min
c. every 1-2 hrs
d. if the pt does not have an approp cushion

49. During an _eval, a pt lacks 10 deg of passive ankle dorsiflexion. The same deg of limitation is
present whether the knee is flexed or extended. The
muscle MOST likely contributing to this restriction is the:
a. gastrocnemius
b. tibialis anterior
c. plantaris
d. soleus

50. Which of the ff assignments is MOST approp for the PT to delegate to a volunteer?
a. Restocking tx booths with linens, US gel, massage lotion
b. Attending a pt who is on a tilt table while the therapist takes a phone call
c. Transporting a pt who complains of dizziness back to his room
d. Transferring a pt from the mat to a wheelchair

51. A pt sustained a severe brain stem injury one week ago & has demonstrated minimal change since
the incident. The pts cognitive status is MOST
likely to include:
a. a decrease level of arousal
b. a decrease level of intelligence
c. an increase level of agitation
d. an increase level of impulsivity

52. The hospital administrator asks members of the rehabilitation department to develop a
comprehensive program to help reduce the risk of low back
injuries. Which of the ff would be the FIRST step necessary to develop this program?
a. Include all employees in a lumbar extension ex class
b. Design a program that meets each depts fxnl needs
c. Perform an ergonomic analysis on each workstation
d. Provide pamphlets on proper body mechanics
53. To maximize continuity of pt care, the PT should begin discharge planning when the:
a. physician refers the pt for discharge
b. therapist makes the discharge _eval of the pt
c. discharge planner request info pertinent to the pts discharge status
d. therapist performs initial _eval of the pt

54. The PT is positioning a pt for postural drainage. In order to BEST drain the posterior segment of
both lower lobes, the pt should be placed in which
of the ff positions?
a. Prone, head down at 45 deg angle
b. Supine, flat surface
c. Side lying, head elevated 30 deg angle
d. Sitting, leaning forward

55. A MMT of a pt who sustained a gunshot wound just superior to the elbow joint reveals specific
muscle weakness from a partial median nerve injury.
The PT intervention for this pt would MOST likely include strengthening activities for wrist
flexion & forearm:
a. pronation, finger flexion, thumb adduction
b. pronation, finger flexion, thumb opposition
c. supination, finger abduction, thumb opposition
d. supination, finger abduction, thumb extension

56. A pt who has a piriformis syndrome is referred to PT for _eval & intervention. The pts history
includes THR on the R side 2 yrs ago. Because of the
THR, which of the ff should only be used with precaution?
a. TENS
b. Continuous US
c. Hot packs
d. Massage to the R hip

57. A pt presents with adhesive capsulitis of the shoulder jt. The ROM examination reveals restricted
ext rot & abd of the shoulder. The FIRST
mobilization procedure that should be done for this pt is:
a. posterior glide c. anterior glide
b. distraction d. external rotation

58. A pt sustained a severe TBI 3 mos ago. During the exam of passive ROM, the therapist notices
decrease passive knee extension & mod hams
spasticity. Palpation reveals a firm mass on the lateral aspect of the jt. The therapist should refer
the pt to a physician for an _eval of probable:
a. Osteogenic sarcoma
b. Patellar fracture
c. Osteomyelitis
d. Heterotopic ossification

59. A pt complains of anterolat shoulder pain with insidious onset. Examination shows full passive
ROM, pain on passive lateral rot, & pain on resistive
int rot. These signs are consistent with a diagnosis of:
a. bicipital tendonitis
 b. supraspinatus tendonitis
c. subscapularis tendonitis
d. infraspinatus tendonitis

60. A measurable objective for a community education program ex techniques would be for
participants to:
a. Understand the importance of a sufficient warm-up period
b. List five stretching techniques that can be use when warming up
c. Overcome LE problems & adhere to a regular ex program
d. Appreciate the effects of increasing intensity of ex on heart rate

61. During MMT of the hip flexors in the sitting position, a pt exhibits lateral rotation & abduction of
the thigh as resistance is applied. The PT should
suspect substitution by:
a. sartorius
b. tensor fascia latae
c. adductor longus
d. semimembranosus

62. A PT is treating a pt who has lymphedema in the R LE. The therapist decides to use mechanical,
intermittent pneumatic compression as an
intervention, using a sleeve that covers the foot, leg & thigh. The therapist measures BP at 135/85
mm Hg. At first tx session the MOST approp
inflation pressure for the sleeve is:
a. 20 mm Hg
b. 60 mm Hg
c. 100 mm Hg
d. 140 mm Hg

63. A pt is entering a cardiac rehab program. The PT should FIRST asks the pt to:
a. describe the correct aspect of ex demonstrated by the therapist
b. list problems assoc with poor nutritional habits
c. identify the harmful effects of smoking with regards to cardiac disease
d. describe the type of angina that the pt experience

64. A PT receives a tel phone call from a woman who identifies herself as a friend of one of the
therapists patients. She wants to know how the pt is
doing & if he will be able to up & down the stairs, bec she wants to take him home for a weekend
visit. What should the therapist do?
a. Discuss the pts program & fxnl status with the caller
b. Invite the caller to observe the pts next therapy session
c. Refuse to discuss the pts status unless the pts permission is obtained
d. Refer the caller to the pts social worker

65. The parents of a 1-mos-old child with myelomeningocele report that the child has been
increasingly irritable & has changed sleeping patterns over the
past three days. The child has also been vomiting. Which of the ff is the MOST approp action for
the therapist to take?

a. Refer to immed medical follow-up

 b. Instruct the parents to monitor head circumference daily
c. Advise the parents to watch the child for worsening sx
d. Take the head circumference measurements to compare at subsequent visits

66. A therapist is setting up a home program of ES for a pt who has bells palsy. Which of the ff
muscles be stimulated as part of the home program?
a. Sternocleidomastoid
b. Masseter
c. Temporalis
d. Frontalis

67. A pt is lying supine with his hips & knees extended & hands behind his head. The pt is able to
raise his head, shoulder & thorax from the tx table, but
is unable to to come to a complete long-sitting posn. The PT should target which muscle for
strengthening program?
a. Iliopsoas
b. External abdominal oblique
c. Quadratus lumborum
d. Upper rectus abdominus

68. A 14-month-old child with spastic diplegia is up on his tiptoes with his toes curled when held in
supported standing. This posn is characteristic of a:
a. proprioceptive placing rxn
b. moro reflex
c. plantar grasp reflex
d. traction response

69. A therapist is developing a gait training prog for a pt ff a THA of the R hip. The proper
instructions & rationale for crutch training utilizing one crutch
include holding the crutch in:
a. R hand to decrease activity in the R hip abductors
b. R hand to facilitate act in the R hip abd
c. L hand to decrease act in the R hip abd
d. L hand to facilitate act in the R hip abd

70. Following trauma at C5 spinal cord level, a pt was admitted to the hospital. 24 hrs later the pt
shows no reflexes, sensation, or voluntary motor
activity below level of injury. These findings indicate:
a. the presence of spasticity
b. decerebrate rigidity
c. spinal shock
d. a lower motor neuron lesion

71. A R handed woman is being examined by the PT for R sided weakness in her UE & LE. Her
muscle tone is hypotonic & she is ataxic during walking.
She has a hx of hpn & alcoholism. Passive ROM with DTR showing hyporeflexia. She has an
intention tremor when she tries to pick up an object
from a table, & exhibits difficulty performing the finger to nose test. Where is the MOST probable
area of the lesion?
 a. R side, cervical spinal cord
b. L side, cerebral hemisphere
c. L side, substantia nigra
d. R side, cerebellar hemisphere

72. A pt received a gunshot wound to the distal post thigh that resulted in complete severance of the
common peroneal nerve. Which of the ff ex is
necessary in the early rehab period to prevent contracture formation?
a. Active plantarflexion, inversion & toe extension
b. Passive dorsiflexion, eversion & toe extension
c. Active dorsiflexion, eversion & toe flexion
d. Passive plantarflexion, eversion & toe flexion

73. A pt with mild closed head injury & bil femur fx requires instruction in a LE ex program. In order
to plan the most effective teaching methods for this
pt, what would be the MOST critical to assess at the initial visit?
a. Comprehension of written, verbal & demonstrated instructions
b. Short term memory capacity
c. Any personality changes compared to the pts pre-morbid status
d. Any personality changes compared to the pts pre-morbid status

74. A pt with R above-knee prosthesis will be able to maintain the knee in extension while weight
bearing if the center of gravity of the body is shifted so
that the gravitational line falls:
a. post to the axis of the R knee jt
b. lat to the axis of the R knee jt
c. ant to the axis of the R knee jt
d. med to the axis of the R knee jt.

75. In order for a pt with bilateral BKA to maximize balance in a wheelchair, the rear wheels should
be positioned more:
a. laterally
b. posteriorly
c. anteriorly
d. inferiorly

76. An initial PT evaluation is performed on an elderly patient who is 1-day post total left hip
arthroplasty (non-cemented) using a posterior-lateral
approach. The patient has no complicating medical history and was active and independent
preoperatively. Which of the following activities is NOT
an appropriate goal for the first week of therapy?
a. Active-assistive positioning of the (L) hip to 60 degrees of flexion
b. Active, (L) hip abduction in sidelying
c. Independent bed mobility with use of a trapeze
d. Walking with moderate assistance with a standard walker, to 25 feet (7.6 meters)

77. A patient with frequent tension headaches has been referred to physical therapy for instruction in a
program of progressive relaxation exercises.
Which of the following is MOST essential in a program of progressive relaxation to reduce muscle
tension?
 a. Release of tension by suggestion and persuasion
b. Passive exercise in quite surrounding to relieve tension
c. General massage using deep stroking and kneading of tense muscle
d. Recognition of the sensations of tension and release

78. On the 4th day of PT tx, a pt who has had an ORIF for a hip fx develops a large ecchymosis over
the unaffected hip. The pt MOST likely developed.
a. A hemangioma
b. A complication of anti-coagulant therapy
c. A hematocele
d. Deep vein thrombophlebitis

79. A patient who is exercising on a bicycle ergometer in the cardiac rehabilitation unit is being
monitored with electrocardiogram leads. During the
exercise, the S-T segment becomes depressed by 2 mm. If the cardiologist has given no specific
guidelines, the PT should:
a. Terminate the session immediately
b. Reduce the resistance load
c. Instruct the patient to slow down
d. Direct the patient to continue as before

80. A patient slips, falls, and cuts her arm in the clinic. The cut is bleeding and the patient is alert and
well oriented. In performing first aid for the patient,
the FIRST action that the PT should take is to:
a. Don a pair of gloves
b. Clean the cut with an antiseptic
c. Check the patients B.P.
d. Cover the cut with sterile dressing

81. A physical therapist is working with a patient who is aware that he is terminally ill. What is the
MOST appropriate intervention when the patient
wants to talk about his prognosis?
a. Discourage discussion of death or dying
b. Refer the patient for pastoral counseling
c. Relate the therapists experiences with other patients
d. Encourage the patients _expression of feelings

82. Prior to starting an exercise training program, a patient with cardiac problems who is receiving
beta-blocking medication should receive an
explanation of the:
a. Greater benefits from cardiovascular exercise to be achieved at lower rather than at higher
metabolic level
b. Need to use measures other than heart rate to determine intensity of exercise
c. Need for exercise training sessions to be more frequent but of shorter duration
d. Need for longer warm-up periods and cool-down periods during an exercise sessions

83. A clean, well granulating stage II pressure ulcer with minimal serous drainage is MOST
appropriately dressed with:
a. A non-adherent dressing
b. A packed dressing
 c. Topical medication only
d. Dry-to-dry gauze

84. A physical therapist examines a patient who complains of foot pain while jogging. The
examination shows that the patient has excessive foot
pronation and forefoot varus. The therapist decides to try a temporary orthotic insert in the
patients running shoe. Which of the following would be
the MOST appropriate orthotic insert?
a. A lateral forefoot post under the fifth metatarsal head
b. A lateral rearfoot post under the calcaneus placing it in everted position
c. A wedge placed under the instead of the medial foot just beneath the head of the talus
d. A medial post just proximal to the first metatarsal head

85. A patient with chronic adhesive capsulitis of the shoulder is to be treated with joint mobilization to
increase joint range of motion. Which of the
following would be the MOST appropriate to increase shoulder abduction?
a. Distraction with inferior glide
b. Anterior glide with internal rotation
c. Superior glide with approximation
d. Distraction with posterior glide

86. An 8-year-old child who has juvenile RA is developing (B) knee flexion contracture. Which of the
following would be the LEAST appropriate?
a. Exercises to increase joint mobility
b. Ultrasound to the hamstring insertions to increase tissue extensibility
c. Progressive weight bearing by walking in a therapeutic pool to increase endurance
d. Exercise to increase quadriceps strength

87. Although knee motion occurs primarily in one plane, tibial rotation is possible when the knee is
positioned in 90 degrees or more of flexion because
in this position the:
a. Condyles of the femur glide posteriorly on the condyles of the tibia
b. Hamstrings act as rotating force
c. Patella deviates inferiorly
d. Tension on the ligaments is decreased

88. A PT is screening a young adult patient for a possible thoracic, (L) lumbar structural scoliosis.
The postural deviation commonly seen with this
diagnosis would be:
a. Spinous processes of the thoracic spine rotated to the right
b. High (L) shoulder
c. Posteriorly protruding scapula to the
d. Prominent posterior rib cage

89. A postural correction program for a patient with forward head, kyphosis, and increase lumbar
lordosis would include all of the following EXCEPT:
a. Strengthening the scapular protractors
b. Strengthening the thoracic erector spinae muscles
c. Lengthening the short sub occipital muscles
d. Lengthening the lumbar erector spinae muscles
90. A patient in the eight-month of pregnancy presents with numbness and tingling of the (L) hand
except the fifth digit. She demonstrates edema of the
hand and fingers, a positive Tinels sign at the wrist, and a Good (4/5) muscle test grade of the
wrist and finger flexors. The MOST appropriate
intervention would be:
a. A wrist splint to position the wrist in full extension
b. A hot pack followed by tendon gliding exercises
c. Resistive exercises for the wrist and finger flexors
d. Frequent rest and elevation of the (L) upper extremity

91. An exercise program for a patient with Parkinsons disease would MOST likely include exercise
to:
a. Decrease movement of the upper extremities and trunk
b. Increase trunk flexor strength
c. Improve balance reactions and reciprocation
d. Stretch back extensor muscle

92. If a BK prosthesis has an excessively firm heel wedge, the pt is MOST likely to walk with:
a. excessive knee flexion in early stance
b. premature knee flexion in late stance
c. Insufficient knee flexion in early stance
d. Excessive knee flexion in late stance

93. A pt who has COPD is being treated with a regimen that includes pursed lipped breathing ex. The
PRIMARY purpose of the pursed lipped breathing
is to:
a. help prevent collapse of pulmonary airways during exhalation thereby reducing air trapping
b. decrease the removal of CO2 during ventilation
c. increase the residual volume of respiration so that more O2 is available for body metabolism
d. stimulate further mobilization of mucous secretions to higher air passages where they can be
expectorated

94. A pt with a dx of cervical radiculopathy reports numbness of the little finger. The therapist
would MOST likely find a diminished DTR in the:
a. biceps brachii
b. deltoid
c. triceps brachii
d. brachioradialis

95. A therapist is planning a pt education program for a grp of pts with chronic LBP. To increase the
likelihood that the pts will utilize the proper
mechanics at the work site, the therapist should:
a. asks the pts to demonstrate use of proper body mechanics
b. provide a reference list of articles describing body mechanics
c. asks pts to describe actions they do that increases their back pain
d. provide information on the frequency of low back injuries due to improper body mechanics

96. A pt presents with hemiparesis & demonstrate a foot drop during swing phase of gait. It would be
MOST approp to administer FES to the tibialis ant
& the:
 a. gastrocnemius
b. Tibialis posterior
c. Extensor digitorum longus
d. peroneus longus

97. A PT is treating a pt with iontophoresis. If the current is set at 4mA, the duration at 15 minutes, &
the dexamethasone solution at .04%, with an
electrode area of 4 cm2, how would the therapist record the current dosage?
a. 0.16 mA-mg
b. 16 mA/cm
c. 0.60 mg/min
d. 60 mA-min

98. An elderly pt has diabetic neuropathy. Upon examination he shows marked medio-lateral
instability of the L ankle while walking. The pt also has
fluctuating edema & glove-and-stocking sensory loss in both legs. The MOST approp orthotic aid
would be:
a. a double-upright ankle foot orthosis
b. hip to toe shoes
c. a prefabricated plastic, solid ankle-foot orthosis
d. a spiral ankle foot orthosis

99. A 25-yr old pt with cystic fibrosis has been experiencing successful mobilization of thickened
secretions by standard percussion & postural drainage.
During the current tx session, the pt coughs up sputum that has small, brownish streak of blood.
The PT should:
a. percuss more vigorously in an attempt to clear out any other blood that is present in the
airways
b. perform postural drainage in upright positions for this type of pt only
c. continue tx with little modification unless more blood is noted
d. stop the tx & send the pt to the emergency room

100. Which of the ff should be recommended for a pt ff a medial meniscectomy if the PT plans is to
ex the quadriceps femoris against accommodating
resistance?
a. Knee bends through half of the range
b. Knee extension with the sandbag in the ankle
c. Knee extension on an isokinetic ex device
d. Straight leg raising with a sling suspension

101. In a suction-socket prosthesis, the primary fxn of the valve in the lower & medial part of the
socket is to permit air to:
a. remain during the stance phase of gait
b. remain during the swing phase of gait
c. escape during the swing phase of gait
d. escape during the stance phase of gait

102. A pt with chronic venous insufficiency of the LE would MOST likely exhibit:
a. normal superficial veins, no edema, ulceration & patches of gangrene around the toes
b. dilation of superficial veins, edema, stasis ulceration
 c. no edema, cold, hairless LE, faint dorsalis pedis pulse
d. dilation of superficial veins, edema made worse during sitting or leg elevation

103. FF removal of a long-leg cast, a pt has limited knee flexion. The MOST approp direction of
patellar mobilization would be:
a. distal
b. lateral
c. proximal
d. medial

104. Which LE PNF pattern is MOST approp for a pt who needs strengthening of the tibialis
posterior?
a. Hip extension, abduction & medial rotation with ankle plantarflexion &eversion
b. Hip flexion, adduction, & lateral rotation with ankle dorsifllexion & inversion
c. Hip extension, adduction & lateral rotation with ankle plantarflexion & inversion
d. Hip flexion, abduction & medial rotation with ankle dorsiflexion & eversion

105. A pt is referred to PT with a dx of LBP. Radiographic studies, including MRI, have ruled out
presence of disc pathology. The pt c/o continuous back pain that radiates towards the thorax &
anteriorly into the abdominal region. The therapist should consider which of the ff areas as a potential
source of discomfort?
a. Dura mater
b. Diaphragm
c. Kidney
d. Urinary bladder

106. An adult pt who was involved in a motor vehicle accident has sustained multiple traumas,
including fx ribs on the right side. The pt is unconscious,
intubated, & on a mechanical ventilator in ICU. Chest radiographs show the development of an
infiltrate in the lower lobe during the past two
days. Rales & ronchi are heard over the lower lung fields. Which chest program is MOST
appropriate ?
a. Manual hyperventilation & suctioning while posn on the L side
b. Positioning supine for suctioning, ff by manual hyperventilation while posn on the L side
c. Suctioning, percussion & vibration while posn on the side
d. Positioning on the L side for deep breathing exercises only

107. A pt who has RA comes to PT with signs of muscle atrophy, ecchymosis, puffy cheeks & a dx of
osteoporosis. This pt is MOST likely receiving a
high dosage of:
a. penicillin
b. prednisone
c. aspirin
d. gold salts

108. A PT is examining a pt who has difficulty making a fist. The muscle test show the ff: flexors of
the 2nd to 5th digits at the PIP are normal (5/5);
flexors of the 2nd & 3rd digits at the DIP are normal (5/5); flexors of the 4th & 5th digits at the
DIP are poor (2/5). These findings are consistent with
a lesion of the:
 a. median nerve C8-T1
b. median nerve C5-C6
c. ulnar nerve C5-C6
d. ulnar nerve C8-T1

109. An elderly man who lives alone fell in his home, sustaining a hip fx, which necessitated a THR.
The pt was previously able to perform all ADLs
independently. He has been admitted to a SNF for rehabilitation. The pts goal is to return home.
His family believes he should be admitted to a
long-term care facility for his own safety once acute rehab is completed. The PTs MOST approp
action is to:
a. advise the family that the pt should determine his own discharge environment
b. recommend a team conference with the pt & his family to discuss discharge plans
c. schedule a home visit to determine if home modifications are needed before discharge
d. implement a tx plan with a long-term goal of discharge to home

110. During LE ex, a pt with incomplete C6 quadriparesis reports a new onset of tingling & numbness
in both hands. MMT reveals that overall strength
has decreased by one grade. In this situation, the PTs MOST approp course of action is:
a. modify the ex program to accommodate change in strength
b. apply an ice massage prior to ex
c. continue LE therapeutic ex & use facilitation techniques to stimulate more activity
d. discontinue all exercises & notify the physician

111. In early management of a pt with a partial PNI, the goal of the PT intervention will MOST likely
be to prevent:
a. nerve degeneration
b. spasticity & increase muscle tone
c. muscle atrophy
d. contractures & adhesions

112. A PT is developing an educational program for individuals with LE peripheral neuropathies due
to diabetes. Which of the ff is the MOST impt
information for the PT to recommend for the prevention of injury to the foot?
a. Orthosis to support the extremity
b. use of proper footwear
c. Moisturizing the skin to prevent dryness
d. Exercise parameter

113. Elevating a pts LE for less than 1 minute produces a noticeable pallor of the foot, followed by
delayed reactive hyperemia in a dependent posn.
These signs are indicative of:
a. an intact circulatory system
b. arterial insufficiency
c. venous insufficiency
d. acute arterial occlusion

114. While ascending stairs, an elderly pt leans forward with increase hip flexion. Which of the ff
muscles are being used to the BEST advantage with
 this forward posture?
a. Rectus femoris
b. Tensor fascia latae
c. Gluteus maximus
d. Lumbar paraspinal

115. A PT is treating a pt with moderately well controlled type I diabetes. One of the goals is to help
regulate her insulin dosage through the ex. In
establishing an ex program, the therapist should be aware that regular ex will generally:
a. lower blood glucose levels & decrease amt of insulin required
b. lower blood glucose levels & increase amt of insulin required
c. raise blood glucose levels & decrease amt of insulin required
d. raise blood glucose levels & increase amt of insulin required

116. A PT recognizes that departmental education materials are written on a reading level that is too
difficult for some of the pts. The PT can help the pts
to better understand the materials by:
a. including illustrations & a larger print
b. including illustrations & a simpler sentence structure
c. reducing the # of syllables & lengthening the sentences
d. using a larger print format to present specific medical terminology

117. An inpatient PT dept has only one PT & one PTA on duty due to staff illness. A pt with which of
the ff is MOST approp for the PT to delegate
to the assistant?
a. Ataxia, who is undergoing a trial to determine an approp assistive device
b. Hemiparesis, whose initial _eval has not been completed
c. MS, who is receiving gait training with a rolling walker
d. Alzheimers disease, who is easily agitated during the initial gait training

118. During inspiration, a pt demonstrates increased upper chest expansion with retraction of the
epigastric area. The PT should suspect weakness of the:
a. scalene muscle
b. diaphragm
c. rectus abdominis
d. intercostals muscles

119. The brother of a pt who was recently discharged from the hospitals outpatient PT dept
telephones on the pts behalf to request a copy of the pts
medical record. The therapist should explain to the pts brother that the medical record is the
property of the:
a. pts family & can be released to the brother upon request
b. pts insurer now & that the request for a copy must be made in writing to the insurer
c. hospital & the pt & can be released only with written authorization from the patient
d. hospital & can be released only with written authorization from the pts physician

120. A PT is examining a pt for a possible LE weakness. PROM is within normal limits. The pt is
seated. When the pt tries to dorsiflex & invert his R
foot, he is unable to move it through the full ROM & is unable to take any resistance applied by
the therapist. During the subsequent gait
 examination, the therapist would MOST likely expect the pt to display which of the ff?
a. Normal gait, with no deviations
b. Increased R hip flexion during swing phase
c. Throwing the trunk backward, on the R side, shortly after initial contact
d. Lateral bending toward the R side during midstance

121. A pt is referred for PT with a dx of chondromalacia patella. The PT decides to include quad
setting & SLR as part of the home ex program because:
a. the vastus medialis muscle is primarily responsible for terminal knee extension
b. quad setting & SLR help improve patellar tracking
c. petello-femoral compression forces are increased when the knee is extended
d. the vastus medialis muscle is preferentially activated during SLR

122. A pt with LBP has been undergoing tx for two sessions. The pt tells the therapist that today the
pain is centralizing with the extension ex, but is as
intense as it was at the fist tx session. The pt is frustrated by this rxn. The therapist most approp
response would be:
a. continue with the present program
b. eliminate the extension ex
c. consult the pts physician about the situation
d. progress to trunk flexion exercises

123. Which of the ff statements does NOT document pt outcome?

a. The pt propelled his wheelchair independently after 4 weeks
b. The pt demonstrated independent performance of home program after 2 weeks
c. The pt walks 100 feet with minimal assistance after one week
d. The pt attended PT sessions 3x a week for 2 weeks

124. Which of the ff is the MOST likely caused of reduced vital capacity in a pt who has quadriplegia
at C5-6 level?
a. Decreased antero-lateral chest expansion resulting from paralysis of the external intercostals
muscle
b. Inability of the pt to generate a negative intrapleural pressure secondary to a denervated
diaphragm
c. A relatively high resting posn of the diaphragm resulting from paralysis of abdominal
muscles
d. Reduced rib cage elevation due to paralysis of the ant scalene & SCM muscles

125. An attorney calls the PT dept seeking information on the status of his client, a pt who is
undergoing rehab ff total knee surgery. The pts PT should:
a. refer the attorney to the pts insurance carrier
b. describe the pts current status
c. require written authorization from the pt to release information
d. obtain verbal permission from the pt to release information
126. Involving interdisciplinary team members in making decisions about continuity of patient care
has all of the following benefits EXCEPT:
a. promoting each individuals commitment to, & responsibility for, the decisions that have
been made by the group
b. discouraging one or two members from being in control & having all the authority
c. enabling decisions regarding quality of care to be made quickly
d. promoting quality of care by including several aspects of the patients care

127. Instruction in energy conservation & joint protection should be provided to the patient with
rheumatoid arthritis because:
a. the joints may be predisposed to damage by overuse
b. fatigue often masks joint pain
c. phagocytes remove more pannus in resting joint
d. activity of the antigen-antibody complex is diminished with rest

128. In which of the following is independence the MOST realistic long-term goal for a patient with a
complete spinal cord lesion at C8?
a. Effective cough technique
b. Rolling from side to side
c. Transfer from bed to wheelchair
d. Ambulation with forearm crutches

129. A PT examines a pt with MS who is in a period of exacerbation. The pt is independent with bed
mobility, can sit unassisted at the edge of the bed, &
requires physical assistance to stand with a walker. Which of the following ADL activities is the
MOST important for the initial intervention?
a. Wheelchair propulsion up to 10 foot ramp
b. Wheelchair transfers
c. Walking with an assistive device
d. Tub transfers

130. When examining a pt who had a baby 3 days ago by vaginal delivery, the PT notices that the pt
has a 2-cm diastasis of the rectus abdominis. To
address this problem, the pt should:
a. perform partial sit-ups, supporting her abdominal muscles with her hands while lifting her
head in the supine position
b. not perform exercises until the diastasis heals spontaneously
c. perform sit-ups with the knees bent & arms behind the head
d. perform partial sit-ups, with the legs straight & arms in front

131. To minimize skin irritation during functional electrical nerve stimulation, the PT should use:
a. lower intensity, larger inter-electrode distance & larger electrodes
b. lower intensity, larger inter-electrode distance & smaller electrodes
c. higher intensity, smaller inter-electrode distance & smaller electrodes
d. lower intensity, smaller inter-electrode distance & larger electrodes

132. A pt is doing active & resistive exercises on a mat table in the PT dept. After 15 minutes, the pt
becomes short of breath, begins coughing &
expectorates pink, frothy sputum. At this point, the PT should first stop the tx, then:
 a. assess vital signs, let the pt rest a few minutes with the feet elevated, & then resume with a
less vigorous program
b. sit the pt up, assess vital signs & call a nurse or physician for further instructions
c. lay the pt supine, transfer the pt to stretcher & return the pt to the nursing unit
d. lay the pt down flat, call for assistance & begin cardiopulmonary resuscitation

133. When evaluating a wheelchair positioning of a child with CP, the PT should FIRST examine the
position of the childs:
a. pelvis
b. legs
c. head
d. spine
134. A pt who sustained a mild CVA 3 weeks ago is being prepared by the PT for discharge to home
& an adult day program. To facilitate the discharge
plan, the MOST appropriate health professional for the therapist to consult with is the:
a. skilled nursing coordinator
b. occupational therapist
c. medical social worker
d. primary physician

135. For a pt with a R middle lobe pneumonia, the proper bronchial drainage position is supine with
the body:
a. one-quarter turned to the L & the foot of the bed raised 14 inches
b. one-quarter turned to the R & bed flat
c. three-quarters turned to the L & head of the bed raised 14 inches
d. three-quarters turned to the R & foot of the bed raised 14 inches

136. To avoid the appearance of increased motion, which movement must be prevented during
goniometric measurement of shoulder abduction?
a. Upward rotation of the scapula
b. Medial rotation of the shoulder
c. Lateral rotation of the shoulder
d. Lateral flexion of the trunk to the opposite side

137. A pt who received organ transplantation 4 yrs ago demonstrates progressive weakness & is
referred to PT for strengthening exercises. In reviewing
the medical history, the therapist learns the the pt takes a prednisone & immunosuppressive
drugs. Which of the following would the therapist
MOST likely need to consider?
a. Isokinetic strengthening will be preferable for this pt
b. The pt may have limited ROM from increased bone mass
c. The pt will need to be treated in an isolation room
d. Muscle strengthening may be limited in this pt

138. A PT examines a high school athlete in the training room. After removing the adhesive strapping
from the athletes ankle, the therapist discovers
that the athlete has developed an open weepy rash on the instep of the foot. The therapist should
FIRST:
a. apply moist heat to the foot
b. send the pt to the hospital emergency room
 c. use more pre-wrap with the next joint taping
d. refer the pt to the team physician

139. A pt who sustained a L BKA 2 yrs ago & a R BKA 3 weeks ago is being evaluated for possible
ambulation with prosthesis. Which of the following
factors is MOST relevant?
a. Size of the R residual limb scar
b. Length of the R residual limb
c. Proficiency in previous prosthetic use
d. Severity of phantom pain

140. The results of a developmental screening of a 4-month-old infant indicate a possible R hip
dislocation. The presence of which of the following are
the MOST consistent with this diagnosis?
a. Pelvic obliquity, apparent pain on movt of the R hip, & decreased hip abduction on the L
side
b. Asymmetrical gluteal folds, femoral telescoping, & limited hip abduction on the ride side
c. Decreased active movt of the R hip, increased femoral neck retroversion, & atrophy of the
gluteus maximus on the R side
d. Hip flexion contracture on the R side, apparent leg length discrepancy, & inability to
tolerate supported sitting

141. A 14-month-old child with brachial nerve palsy has motor & sensory loss in the R upper
extremity in the areas innervated by C5 & C6. Which of the
following activities is MOST difficult to accomplish with the affected UE?
a. Pushing a wagon
b. Carrying a teddy bear in the crook of the arm
c. Holding a raisin in the palm of the hand
d. Grasping a cup

142. A PT is treating a pt who has been diagnosed with a nerve root impingement on his R side due to
narrowing of the intervertebral foramen between
L4 & L5. The therapist decides to use mechanical, lumbar traction as an intervention. Which of
the following positions, on a traction table, would be
the MOST appropriate to relieve pressure on the nerve root?
a. Supine, hips & knees flexed
b. Supine, with hips & knees straight & laterally shifted to the R
c. Prone, hips & knees straight
d. Sidelying on the R, with a bolster between the table & pt

143. A prone standing board has been recommended for a 5 y/o child with severe hypotonia. The
PRIMARY purpose for the use of a prone stander is to:
a. promote weight bearing
b. reinforce an exaggerated positive support reflex
c. prevent hip dislocation
d. increase hip & knee ROM

144. A pt who is transported to the PT dept in a wheelchair complains of severe, bilateral LE pain. A
purple discoloration of both feet observed. The pain is relieved when the pts feet are raised just above
the horizontal plane. These signs are MOST indicative of:
 a. arterial insufficiency
b. intermittent claudication
c. venous insufficiency
d. a psychosomatic episode
145. A pt who completes a Phase I cardiac rehabilitation program should be expected to achieve:
a. independence in self-monitored walking
b. increased aerobic capacity to physical activity
c. modification of risk factors
d. increased blood pressure at a given workload

146. A PT has been working with a pt who has a spinal cord injury. To document that the pt has been
educated about skin care, the therapist should
record that the pt:
a. is unable to tolerate more than 1 ht in a wheelchair
b. has good strength of the scapular depressors & elbow extensors
c. is able to state 3 causes of skin breakdown
d. is able to perform 10 push-ups in the wheelchair

147. A pt has difficulty palpating the carotid pulse during exercise. The pt should be instructed in
alternate methods of self-monitoring, because repeated
palpation is likely to result in:
a. increasing the heart rate
b. decreasing the heart rate
c. an irregular heart rhythm
d. increasing systolic BP

148. A pt complains of pain lateral to the coracoid process. When palpating the shoulder to assess the
possible cause of the pain, starting at the coracoid
process & moving laterally, the PT would expect to find the following sequence of structures:
a. lesser tuberosity, biceps tendon, greater tuberosity
b. greater tuberosity, biceps tendon, lesser tuberosity
c. lesser tuberosity, coracobrachialis tendon, greater tuberosity
d. greater tuberosity, coracobrachialis tendon, lesser tuberosity

149. A factor that MUST be considered in designing an exercise program for a pt with angina pectoris
is that, when the arms are exercised:
a. angina occurs at a lower heart rate than when exercising the legs
b. heart rate & BP rise more steeply in relation to workload than when exercising the legs
c. pulmonary ventilation increases less rapidly than when exercising the legs
d. angina occurs at higher workloads than when exercising the legs

150. A pt spilled boiling water on the R arm when reaching for a pan on the stove. The forearm,
elbow, & lower half of the upper arm appear blistered &
red, with some subcutaneous swelling & pain on touch. To facilitate optimal function, the PT
should PRIMARILY emphasize:
a. ROM exercises to the R hand, wrist & elbow
b. application of compression dressings
c. sterile whirlpool to the R UE
d. splinting of the R arm in full elbow extension
151. A PT wishes to study the effect of cold compression on PROM in a group of 10 patients. The
plan is to apply this compress to the hamstring muscles
once a day for 5 days. Which of the following experimental designs is the MOST appropriate for
this type of study?
a. For both the experimental & control groups, gather data from pt record
b. For both the experimental & control groups, measure ROM of both groups on day 5
c. For both the experimental & control groups, measure ROM on days 1 and 5
d. For the experimental groups, measure ROM everyday. For the control group, measure ROM
on days 1 and 5

152. During an examination of elbow strength using MMT, the pt supinates the forearm when
attempting elbow flexion. Which of the following muscles
is MOST likely doing the major part of the work?
a. biceps brachii
b. brachialis
c. supinator
d. brachioradialis

153. A PT is treating a pt for LOM ff knee surgery several weeks ago. The pts passive knee extension
is lacking 15 deg from full extension, & knee
flexion is limited to 95 deg. Both movts have capsular end-feel. Which of the ff mobilization
techniques is the MOST appropriate for increasing
knee flexion?
a. Anterior glide of tibia on femur
b. Posterior glide of tibia on femur
c. Superior glide of patella
d. Posterior glide of femur on tibia

154. A pt has pain, swelling & tenderness in the medial border of the hand. The pt also shows changes
in the color & temperature of the skin,
hyperhydrosis & progressive joint stiffness in the wrist & hand. The MOST likely cause of the
pts s/sx is:
a. Cervical disc disease
b. Raynauds phenomenon
c. Reflex sympathetic dystrophy
d. Carpal tunnel syndrome

155. When considering a special test for orthopedic assessment of a client, the validity of the test is
important because the:
a. Results of the test can be standardized
b. Test measures what it is supposed to measure
c. Results of the test are reproducible
d. Test can be accurately performed by someone else

156. A pt sustained a Colles fracture 8 wks ago & has been in a cast since that time. Immediately
after cast removal, the PT intervention for the wrist
hand should MOST appropriately include:
a. Passive & active assistive ROM exercises
b. Progressive resistive exercises
c. Grade 4 mobilization techniques
 d. Return to pre-fracture level of activity

157. A pt with TBI is receiving outpatient PT. The therapist notices that the pt becomes agitated
during therapy sessions. To which of the ff professionals
should the pt be referred for assessment & dx?
a. Occupational therapist
b. Neuropsychologist
c. Vocational counselor
d. Speech-language pathologist

158. While a pt is walking in the parallel bars, the PT observes that the pelvis drops down on the side
opposite the stance extremity. This gait deviation is
an indication of weakness of the hip:
a. abductors of the swing extremity
b. adductors of the swing extremity
c. abductors of the swing extremity
d. adductors of the stance extremity

159. A client on a weight loss program has been walking 3days/wk for 15 mins for the past 3 wks. To
progress the ex program, which of the ff will
MOST likely accomplish the weight loss goal?
a. Maintain the current walking speed & increase the duration to 30 mins
b. Increase the walking speed & keep the duration to 15 mins
c. Walk 4 days/wk & decrease the duration to 10 mins
d. Changing from walking 3 days to jogging 1 day/wk for 20 mins

160. When treating a pt with AS, the muscle requiring the MOST emphasis for strengthening
exercises are the:
a. Pectorals
b. Hip flexors
c. Back extensors
d. Abdominals

161. A 3-month-old child has motor & sensory loss in the R UE in the areas innervated by the C5 &
C6 spinal nerves. The cause of this birth injury
MOST likely is:
a. Hemiplegia
b. Erb-Duchenne paralysis
c. SCI
d. Klumpkes paralysis

162. During examination of the jaw-opening pattern of the pt with TMJ problem, the PT notes early
protrusion of the mandible. Which of the ff
mandibular movts MOST likely cause the protrusion?
a. Condylar translation
b. Mandibular depression
c. Condylar rotation
d. Lateral glide
163. A pt with MS is referred for PT at home. Before going home, the pt requires training in bathing,
dressing & eating. Adaptive devices maybe needed
 to accomplish this. The PT should recommend that the pt be seen by:
a. a social worker
b. an orthotist
c. an occupational therapist
d. a home health nurse

164. A CP child who has been receiving PT once a wk for the past month. During the 4th visit, the PT
instructs the parents in a daily exercise program for
the child, including stretching techniques. The BEST method to ensure correct implementation &
carry-over of the program is for the therapist to:
a. reassess the pts ROM one month after instructing the parents
b. review the parents written notes on the childs progress
c. demonstrate the exercises for the parents & ask them to return for a program check in one
week
d. ask the parents to demonstrate the exercises & to return for a program check in one week

165. An otherwise healthy in-patient is referred to PT ff THA (?). The pt reports persistent low energy
levels. What medical record information will
provide the GREATEST clarification of the complaint?
a. CO2 value
b. Hematocrit value
c. Creatinine level
d. Blood urea nitrogen (BUN) level

166. Excessive upward rotation of the R scapula is noted when the pt attempts to perform shoulder
flexion. Which of the ff exercises is MOST approp to
help correct the excessive scapular rotation?
a. scapular protraction against resistance with the arm at 90 deg of flexion
b. Bilateral scapular elevation with the UE at 180 deg of flexion
c. Wall push-ups with an isometric hold at the end range with the elbows extended
d. Bilateral scapular adduction with the arms medially rotated & adducted across the back

167. A pt with PD has just been admitted to the rehabilitation unit. The pt is dependent in all transfers
& requires moderate assistance of one person to
walk 30 feet with standard walker. In order to facilitate good carry-over for activities, instruction
of the family in transfers should occur:
a. during a home visit after the pt is discharge
b. just prior to discharging the pt
c. early in the rehab program
d. when the family feels ready to take the pt home

168. A pt had final approval & checkout of a permanent prosthesis 2 wks ago. The pt now complains
to the PT that the prosthesis is too heavy. The pt
will benefit MOST from:
a. an evaluation of socket fit by the prosthetist
b. a prescription from the physician for a lighter weight prosthesis
c. reevaluation of hip strength by the PT
d. adding a fork strap attachment to the prosthesis
169. A pt with L hemiparesis is being discharged from the rehab center. The PT has been unsuccessful
in getting the familys cooperation to instruct them
in transfers, bed mobility, & safety precautions. The MOST approp action for the PT to take is
to:
a. educate the pt so he can tell others how to assist her
b. contact social services & arrange for a team & family meeting
c. refer the pt for home care & document approp interventions
d. write a home program & give it to the family

170. A pt has a history of neck pain that is aggravated by long periods of sitting. The pain becomes
progressively worse by evening. ROM & strength of
the neck & shoulder are within normal limits. Sensation & reflexes are intact in both UE. The pt
has a forward head & excessive thoracic kyphosis.
The MOST approp ex program would include:
a. stretching of the neck flexors & pectoral strengthening
b. upper traps strengthening & pectoral stretching
c. pectoral strengthening & rhomboid stretching
d. rhomboid strengthening & axial neck extension

171. A pt is being examined for medial epicondylitis. With this dx, the therapist would MOST likely
expect to find pain over the:
a. origin of flexor digitorum profundus with resisted finger flexion
b. origin of pronator teres muscle with active pronation
c. medial epicondyle with passive wrist flexion
d. insertion of the triceps brachii with passive elbow extension

172. In treating a pt who has had recurrent anterior shoulder dislocation, the therapist should AVOID
which of the ff extreme shoulder motions?
a. Adduction & external rotation
b. Abduction & external rotation
c. Hyperextension & internal rotation
d. Abduction & internal rotation

173. During the examination of a pt with carpal tunnel syndrome, the PT will MOST likely find:
a. paresthesia of the medial palmar surface of the hand
b. weakness of finger extension of the lateral three digits
c. paresthesia of the lateral three digits
d. weakness in wrist flexion & ulnar deviation

174. Upon removal of a wet-to-dry dressing from a draining wound, the PT observes that the skin
immediately surrounding the wound is macerated.
What should the therapist recommend for future wound care?
a. Continue using current dressing type
b. Make the dressing more absorbent
c. Leave the dressing on longer between dressing changes
d. Change to a pressure type dressing

175. A pts severe knee sprain resulted from medial rotation of the femur on the tibia with
simultaneous application of a valgus force while the foot was
placed on the ground. Which structures are MOST likely to be involved?
 a. MCL, medial meniscus, ACL
b. MCL, LCL, PCL
c. LCL, medial meniscus, ACL
d. MCL, lateral meniscus, PCL

176. A pt with GBS experiencing progressive paralysis is admitted to the ICU. As a member of the
interdisciplinary team managing this pts care, the
MOST approp PT intervention would be to:
a. alter pts mechanical ventilation settings
b. develop pts medication schedule
c. perform airway clearance techniques
d. discuss the pts medical prognosis with the family

177. A pt is performing a phase I cardiac rehab ex session. The PT should terminate low-level activity
in which of the ff value changes from resting
level?
a. the diastolic BP increases to 120 mm Hg
b. the respiratory rate increases to 20 breaths per minute
c. the systolic BP increases by 20 mm Hg
d. the HR increases by 20 bpm

178. A PT is preparing to teach a pt who has GBS to transfer from wheelchair to a mat table. The pt
weighs 150 lbs, she has Poor (2/5) grade in both of
her LE, & Fair (4/5) grade in her L UE. Her UE has Normal (5/5) strength. Which of the ff
would be the MOST approp, assisted transfer for the
initial session this pt?
a. Two person lift on her side
b. Sliding board transfer on her side
c. A hydraulic lift from her wheelchair to the mat
d. Full, standing pivot transfer to her side

179. A pt with complete C4 quadriplegia is working on a program to increase tolerance to the upright
position. While on the tilt table, the pt begins to
complain of a pounding headache, with flushing & profuse sweating. The therapist should
FIRST:
a. lower the tilt table to a flat position
b. remove pt from tilt table & return to room
c. check the pts catheter
d. check the pts BP

180. In PT program planning for geriatric patients, an important age-related change that should be
taken into consideration is:
a. the inability to learn new motor tasks
b. decrease pain sensation
c. decrease motivation
d. the inability to select alternative movt strategies

181. To achieve maximum reaction of lymphedema following a mastectomy in the UE by means of

massage, it is MOST important that:
a. local heat be applied before the massage
 b. the upper arm be massage before the forearm
c. the hand be massaged before the forearm
d. the massage strokes occur in a centrifugal direction

182. A 6-year-old child with spastic diplegia is walking in the parallel bars with increased trunk & hip
flexion. What would be the MOST appropriate
assistive device
a. Standard walker
b. Forearm crutches
c. Posterior rolling walker
d. Bilateral quad canes

183. A PT is teaching a pt with T12 paraplegia to fall. The pt walks with bilateral KAFO & bilateral
forearm crutches using swing-to gait. The MOST
appropriate method to use to prevent injury would be:
a. have the pt wear a helmet & practice on a soft padded surface
b. give the pt written instructions & illustrations on falling
c. demonstrate & guide the pt through the correct process of falling
d. demonstrate the correct method of falling

184. A pt with dx of complete SCI at C4-C5 demonstrate a weak cough mechanism. Which of the
techniques would be MOST effectively augment
coughing?
a. Manual pushing against the upper abdomen
b. Positioning the pt in prone
c. Pursed-lipped breathing
d. Interrupting the expiratory air stream

185. A pt is referred for recommendation regarding purchase of a W/C. The measurements of the pt
while sitting are 16 inches across the widest point of
the hips & 18 inches from the rear of the buttocks to the popliteal crease. Which of the ff W/C
dimensions are BEST suited for this pts neds?
a. Seat width & seat depth of 18 inches
b. Seat width of 18 inches & seat depth of 16 inches
c. Seat width & seat depth of 16 inches
d. Seat width of 16 inches & seat depth of 18 inches

186. A PT is designing an exercise program for a healthy, elderly individual. Which of the following
types of exercise is MOST stressful to the
cardiovascular system?
a. Upper-limb ergometry
b. Spinal ROM exercise
c. Quadriceps setting exercise
d. Lower-limb diagonal PNF patterns

187. Which of the following techniques is MOST important prior to discharge for a pt who has had
MI?
a. Ascend a flight of stairs before discharge
b. Perform prescribed exercises without angina
c. Return to normal daily activity level
 d. Take a radial pulse reliably before discharge

188. A PT is evaluating a pt for a wheelchair prescription. The pt, who lives alone in a small
apartment, has bilateral LE weakness & is unable to stand to
transfer. Trunk strength & UE strength are normal & the pt can transfer independently with a
sliding board. The MOST appropriate prescription for
this pt is a wheelchair with:
a. fixed, adjustable-height arm rests & detachable foot rests
b. removable arm rests & detachable swing-away leg rests
c. fixed arm rests & removable leg rests
d. desk-style removable arm rests & fixed elevating leg rests
189. A pt is undergoing a treadmill stress test. The appearance of abnormally wide, irregularly spaced
QRS complexes on the ECG represents:
a. ventricular depolarization
b. premature ventricular contractions
c. atrial fibrillation
d. atrial repolarization

190. A pt who is on bed rest exhibits orthostatic hypotension upon standing will MOST likely
experience:
a. increase venous tone in the LE
b. inadequate ventricular filling during diastole
c. decrease hydrostatic pressure in the capillary beds
d. parasympathetic stimulation of the heart

191. Treatment of a pt with hemophilia who has a subacute hemarthrosis of the knee will initially
include:
a. active assistive ROM exercise to the knee
b. instruction of the pt for weight bearing to tolerance
c. gentle resistive ROM exercise to the knee
d. continuous immobilization of the knee in an extension splint

192. Which of the following is the MOST appropriate intervention for a pt with juvenile RA who is
experiencing painful swelling of both knees?
a. Resistive exercises
b. Stretching to prevent contractures
c. Gentle, active exercises
d. Walking program

193. Which of the following is the MOST appropriate home program for a pt with chronic lateral
epicondylitis?
a. Using a forearm cuff to increase loading on the extensor tendons
b. Performing exercises for wrist strength & stretching
c. Administering iontophoresis with dexamethasone & xylocaine
d. Doing friction massage of the brachioradialis tendon

194. A PT who works in a home health agency is treating a pt with DM. He tells the PT that he no
longer takes his insulin. The PT should:
a. instruct the pt in proper technique for injecting insulin
b. contact the pts home health insurance
 c. tell the pts family to report this information to the physician
d. have the pt perform a urine glucose test while the therapist is in the home

195. Which of the following methods is appropriate for handling a 1-year-old child with CP who
exhibits strong extensor tone in the trunk & extremities?
a. Carrying the child in a sitting position
b. Carrying the child over ones shoulder
c. Keeping contact with the back of the childs head
d. Picking the child up under the arms

196. A pt with L hemiparesis exhibits shoulder subluxation on the affected side. The pt has a demand-
type cardiac pacemaker. Which of the following
interventions should be used only with extreme caution?
a. Manual resistive exercise on the non-affected side
b. Active exercise on the affected UE
c. FES to the affected
d. Biofeedback to the affected side

197. A 5-year-old pt with a closed head injury is exhibiting behavior consistent with the
confused/agitated level of cognitive function. During PT
intervention, the pt becomes combative. Which of the following techniques would be MOST
effective in calming the pt?
a. Providing brief moving touch to the face & turning on the pts favorite musical tape
b. Maintaining touch to the shoulders & brightening the room by opening curtains
c. Removing the pt from the current tx environment & placing the pt in a quiet setting
d. Wrapping the pt in a blanket & rocking the pt rapidly

198. The MOST appropriate therapeutic exercise to stretch the neck muscles for the pt with an acute,
sided torticollis is:
a. R rotation & R lateral flexion
b. L rotation & R lateral flexion
c. L rotation & L lateral flexion
d. R rotation & L lateral flexion

199. A PT evaluates a 65-year-old pt with psoriasis for tx with ultraviolet radiation. The pts history
includes the following: THA 1 year ago; penicillin
allergy; calcium supplements since menopause; daily tetracycline use for the past 2 weeks for a
urinary tract infection. Which of these factors should
alert the therapist to use extra caution when applying ultraviolet light?
a. Arthroplasty with a metal implant
b. Daily tetracycline use
c. Penicillin allergy
d. Long-standing calcium supplement use

200. Which of the following instructions is MOST appropriate for teaching a pt with C6 quadriplegia
to transfer from a wheelchair to a mat?
a. Keep your fingers extended, to give a broader base of support
b. Rotate your head & shoulders in the same direction to the desired hip motion
c. Rotate your head & shoulders in the direction opposite to the desired motion
d. Keep both hands next to your knees to lock your elbows
1. A. The functional position of the wrist and hand describes the position from which the optimal
function is most likely to occur. This position is described
as: (1) slight wrist extension, (2) slight ulnar deviation, (3) fingers flexed at the MCP, PIP & DIP
joints & (4) thumb slightly abducted.
2. C. During pregnancy & 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 muscle & cause damage to spinal joints.
3. A. Exercise intensity can be expressed as O2 uptake during activity. HR & O2 uptake have a
relatively linear relationship. Therefore utilizing a target HR
will ensure that the appropriate exercise intensity being achieved. Estimation of energy expenditure
requires measurement of O2 consumption that is then
calculated into calories metabolized during the activity. BP cannot be controlled at specific HR.
Exercising at maximal capacity does not achieve aerobic
training benefits and is unsafe for the majority of patient populations.
4. B. Pressure on the L3-L4 root causes numbness in the anteromedial thigh & knee & quads weakness.
Numbness in the back of the calf & dorsi flexor
weakness is indicative of L4, L5 & S1 nerve root involvement. Numbness & weakness in the thighs,
legs & feet &/ perineum is indicative of L2 through
S1 nerve root involvement. Numbness in the back of the calf & atrophy of the gastrocnemius &
soleus.
5. A. The most appropriate mobilization technique for increasing both shoulder flexion & medial
rotation would be posterior (dorsal) glide. Lateral glide
may be used as a general joint distraction technique. Medial glide would not be appropriate to
increase flexion & medial rotation. Anterior glide is used
to increase extension & lateral rotation.
6. D. Options a, b, c are techniques used to decrease postural tone, which is not indicated for this pt.
Option d is the most appropriate technique for improving low postural tone.
7. C. Wounds heal via a complex process involving re-epithelialization. With advance aging, the rate of
epidermal proliferation decreases.
8. D. Learning the process of foot care is a psychomotor skill & effective strategies to teach
psychomotor skills include repeat demonstration by the pt of the
skill followed by feedback from the therapist to highlight what was performed correctly & what
areas need improvement, if any. Reassurance about
prevention of infection with proper foot care would primarily be a cognitive skill & does not ensure
that the pt can effectively perform proper foot care
Options b &c not include feedback that informs the pt about their performance.
9. A. Goals of PT intervention for a child with DMD are to retard the development of contracture &
muscle weakness, which could lead to functional
limitations, and thus, disability. The PT would also play a role in determining the appropriate use of
assistive devices that could help maintain the childs
mobility such as wheelchairs, walkers & orthoses. Muscle tone changes & declines in strength
cannot be prevented since they are results of the disease
process.
10. D. The long thoracic nerve innervates the serratus anterior muscle. Reaching forward above the head
(shoulder flexion) would require the action of serratus anterior, & long thoracic nerve would affect the
motion. The serratus anterior muscle also works in conjuction with the upper & lower trapezius
muscle to upwardly rotate the scapula (abduct) during shoulder flexion. Putting the hand in the back
pocket would require scapular adduction. Side bending & deep breathing would not require scapular
motion.
11. C. During pregnancy, the ligaments soften due to hormonal influences, & allow some degree of
separation between joint surfaces. Additional stretching of the ligaments could result in joint
instability or injury, & would not be a goal of treatment. The remaining options are all appropriate
interventions.
12. B. According to the Standards of PT Practice there should be a written plan of continuous
improvement of quality of care. This includes ongoing review & evaluation of the PT services
provided. Utilization & peer review are two types of review processes.
13. B. A goal should include the following elements: (1) Audience: who will exhibit the skill, (2)
Behavior: what the person will do, (3) Condition: under
what circumstances (the position, the equipment that must be available for the pt to perform the
behavior), (4) Degree: how well will the behavior be
done, (5) Time span: set an anticipated specific time span in which the goal will be achieved, & (6)
Measurable: the outcome must be measurable. Option
b meets all the criteria while the other responses do not.
14. A. The trochlea of the talus is convex. Therefore, during dorsiflexion of the ankle, the talus moves
posteriorly relative to the tibia. To facilitate the
movement of dorsiflexion one would need to perform a posterior glide of the talus on the tibia.
15. D. Aerobic conditioning that occurs during the 12 wks of cardiac rehab will result in a decrease HR
both at rest & with exercise. CO2 elimination & CO
would both increase with maximal work. The stroke volume would increase during submaximal
work.
16. C. A normally distributed sample has a median & mean that are equal in value. In that type of
distribution, the median & mean would be at the halfway
point. One half of the scores (50 percent) would be distributed above the median & one half below.
If the median & mean are not of equal value, the
distribution is skewed. If the median is of a higher value than the mean, the distribution to the left, if
lower it is skewed to the right. The standard
deviation is a measure of the variability of the mean. The Z score is a standard score with a mean of
zero & a standard deviation of one. Averaging the
two measures would not be appropriate or meaningful.
17. C. Increasing hip flexion is usually contraindicated for THA at 1 month. The quadruped position
would not be allowed for a pt at 2 weeks post distal
radius fracture, as the splint/fixator would likely by used. Increaing hip flexion would be a potential
precaution for a pt one week after post subcapital
femoral neck fracture. There are no precautions for the pt 2 months following a rotator cuff tear as
the motions in quadruped rocking would be snonymous
with the glenohumeral motions that need to be increased & are achieved in a closed chain position.
18. B With a muscle grade of Fair plus, the pt should not need active assistive exercise. Resistive
exercise against gravity would be most appropriate to
strengthen this muscle. Since the gastrocnemius in a shortened position & lessen its ability to
produce tension. Therefore, exercising with the knee
straight put the gastrocnemius on a stretch, increasing its ability to produce tension.
19 . D. The residual limb is pistoning up & down because the socket diameter is too large or the
suspension system is inadequate, resulting in skin friction.
The addition of more socks will enhance the fit.
20. D. The fact that backward bending is centralizing the pain is an indicator that the nucleus of the dics is
being moved centrally, & the pressure is being
Taken off of the nerve root. Centralization of the pain is also a good indicator for PT intervention.
21. C. Ice massage is usually applied to control pain, edema or inflammation. In this case, the ice would
be used for pain relief & to reduce inflammation, if
 present. The dosage for ice massage is determined by the pts response, & usually applied until the
pt experiences analgesia or reported numbness over
the area of the massage. Although 5 to 10 minutes maybe a usual time for the response to occur, the
dosage depends on the pts response, not an exact
time. The pt will usually feel the following, sequential sensations during the massage: cold,
burning, aching, & then finally numbness. The desired effect
is numbness, not aching. The skin may turn white; however, the desired effect is numbness or pain
reduction & not skin color.
22. C. Joint mobilization procedures may cause some soreness. The therapist should inform the pt of this
response to tx. The pt should re-evaluate the pt &
could alter the tx by waiting an extra day before the next tx or by decreasing the dosage. There
would not a need to refer to the physician. The additional
exercises would not alter the response & there would be no indication of neurological involvement
wit the reported sx.
23. D. The independent variable can be thought of as the cause or tx & the dependent variable can be
thought of as the effect or response. In this case the
TENS is the tx or independent variable. Continuous & discrete variables are methods of quantifying
variables.
24. A. A pt who is bed-bound & immobile will be prone to developing atelectasis (partial collapse of lung
tissue), which can then lead to pneumonia.
Frequent position changes with deep breathing & coughing will help prevent development of
atelectasis. Given that this pt is elderly & does not have dx
of secretion retention, vigorous percussion & vibration is not indicated. Vibration with the head
down or standard postural drainage positions will not be
tolerated in this elderly pt with chronic CHF.
25. C. Radiographs are in orthopedics to detect bony abnormalities. Soft tissue defects such as dics
herniations would not show up on the radiograph. MRI
scans are used to assess degenerative diseases, infarction, tumor, hemorrhage & congenital
anomalies. Myelography is used to assess bone displacement,
disc herniation, cord compression or tumor. Computed tomography (CAT scan) is used to assess the
density, displacement or abnormality of the
ventricular system & gray & white matter.
26. D. Behavioral objectives should be learner centered, outcome oriented, specific, & measurable.
Option d is the only one that is learner (student) &
specific to a situation. Options a & c require action by the clinical instructor, not the student. Option
c, which may be a step in the process, is not as
learner centered or outcome centered as option d.
27. A. During aerobic exercise, there is vascular dilation that occurs in order to optimize blood flow & the
venous system relies on muscular pumping in
order to return blood back to the heart. Without a cool-down period, there would be no muscular
pumping & therefore blood would pool in the venous
system. Cardiac arrhythmia may occur as well, but is less likely in someone without cardiac disease.
Cessation of activity by itself would result in gradual
decrease in body temperature & specific exercises are not necessary. Muscle tightening may occur as
a result of metabolites accumulating in the
circulatory system, but this would occur as a result of the venous pooling.
28. C. The piriformis muscle functions as an external rotator of the hip, & it is thought that the tight
piriformis muscle may compress the sciatic nerve cause pain. Passive internal rotation & resisted
external rotation may be painful. Intervention would call for stretching of the piriformis muscle, not
strengthening it. Modalities such as ice may also be helpful to decrease the inflammation.
29. C. The most appropriate first step (pre-planning) would be to evaluate existing services within the
community & work out a budget for the project. Options a & b, although important, are things that
would most likely be done after the practice is up & running. Option d maybe done early on in the
planning process, but would follow option c.
30. B. Following an AKA (transfemoral), the residual limb has tendency to develop contractures in the
hip flexors & abductors. Therefore, it is particularly important that the pt be positioned so as to
maintain full ROM in hip extension & adduction.
31. C. The L limb must function as the main support limb. Any tx strategy for ambulation must ensure
that the remaining limb is optimally functioning & that the limb is healthy. While the other factors are
relevant, the integrity of the remaining limb is the greatest concern for this pt establishing long term,
functional goals.
32. D. S/sx of hip bursitis include the following severe pain over the bursa area, with pain aggravated by
active motion including activities such as walking. S/sx of a sacroiliac joint derangement include pain
directly over the region of the joint & in the low back, in addition to pain with walking. S/sx of hip
fracture will include the following: severe pain in the groin area & tenderness occurs in the area
anterior to the femoral neck. An adductor longus muscle strain would not cause tenderness over the
greater trochanter.
33. C. A fall on O2 saturation below 87% is equivalent to a partial pressure of 55 mm Hg of O2 in the
blood, which is considered to be moderately hypoxemic (low O2 levels). This situation would require
increased O2 levels in order to be rectified. A rise is carbon dioxide level would not be alleviated by
increased oxygen levels. Complaints of SOB can come from a variety of causes & would not
necessarily be alleviated by increased oxygen levels. An increased HR to 150 bpm maybe a normal
response to this activity & would not necessarily require increased O2 levels.
34. B. All documentation about PT services should readily translate the physical findings (impairments)
into functional abilities/ limitations.
35. C. Of the four options, backward walking is the only one that requires hip extension with concurrent
knee flexion & hip flexion with knee extension.
36. C. This pt needs to have functional benefits of tenodesis by allowing the finger flexors to shorten with
the wrist extended; therefore, PROM of the finger flexors should be performed with the wrist in non-
functional position of flexion. People with C6-7 quadriplegia use the tenodesis grasp. This allows the
fingers to flex with wrist extension & to open with wrist flexion.
37. C. With an inversion injury, the tendons of peroneus longus & brevis can become strained. Swelling
with an inversion strain usually occurs over the anterolateral part of the ankle. Compression & support
is most beneficial by placing tape stirrups on the lateral side of the ankle, over the tendons of the
peroneus longus & brevis & pulling the ankle into slight eversion.
38. A. Nerve conduction velocity testing is most useful in the evaluation of peripheral nerve or lower
motor neuron status. Therefore, since carpal tunnel syndrome is the only one of the conditions that
directly involves a peripheral nerve; it would be the most appropriate choice. A CVA is an upper
motor neuron disorder. Both myotonia & DMD are primary muscle disorders.
39. B. Increasing the sensitivity makes the biofeedback unit more sensitive to electrical potentials from
muscles. As the sensitivity is decreased, it takes more electrical activity to trigger the biofeedback unit
(i.e., provide an audio or visual cue to the pt). For use in muscle re-education, the unit should be most
sensitive during the initial tx so the pt is able to recruit enough motor units to trigger the unit. As the
pt is able to recruit more motor units, the sensitivity is decreased which would require the pt to
activate more motor units.
40. C. Thrombocytopenia is an acute or chronic decrease in the number of platelets in the circulation. The
T4 lymphocyte count is used to assess immune status in patients with HIV or AIDS. The re blood cell
count is utilized to assess for presence of anemia & the white blood cell count would be examined to
determine presence of infection or degree of immunosuppression.
41. A. The most common cause of inwardly pointing or squinting patellae is excessive femoral
anteversion. Although there is normally 8-15 degrees of femoral anteversion, an excessive amount
leads to squinting patellae & toeing-in. The other options would all have a tendency to cause the
patella to point outward during standing.
42. C. The occulomotor nerve innervates the levator palpebrae superioris muscle that elevates the upper
eyelid & the papillary constrictor muscle. Therefore, a lesion of the occulomotor nerve would make it
difficult, if not impossible, for the pt to fully raise the lid (open the eye) & would cause a condition
termed ptosis. In addition, the eye may not react to light & therefore may not show papillary
constriction when light is directed into the eye. Inability to fully close the eye would be seen with a
lesion of the facial nerve (Bells palsy). Medial strabismus would be caused by damage to the
abducens nerve, innervating the lateral rectus causing a medial strabismus.
43. C. Exercise has been shown to increase sensitivity of insulin receptors therefore leading to a decrease
in the amount required. Administration of medication is dictated by tolerance & efficacy of the
medication & would not necessarily be altered by exercise. In patients with moderate hyperglycemia,
exercise can lead to hypoglycemia for periods of 24 - 48 hrs after exercise, therefore increasing caloric
intake, particularly carbohydrates, would be essential.
44. B. Wet-to-dry dressings are indicated for necrotic tissue needing debridement. The moderate amount
of drainage would require more frequent (i.e., bid) dressing changes. Vigorous scrubbing of the
wound could damage friable tissue. Betadine can be cytotoxic. Whirlpool would not be effective in
removing necrotic tissue.
45. A. The median nerve supplies sensory innervation to the palmar surface of the thumb, index & middle
fingers. A positive Tines sign (eliciting a paresthesia while tapping over the carpal tunnel at the wrist)
& weakness of the opponens pollicis muscle are indicative of carpal tunnel syndrome. Ulnar nerve
compression would cause sensory & motor changes in the little & ring fingers not the thumb.
Tenosynovitis of the APL muscle would most likely reveal a positive Finklesteins test (stretching of
the abductor muscle) with pain over the dorsum of the hand. Thoracic outlet syndrome would most
likely revealed with special tests that cause alteration of radial pulse.
46. B. The most efficient stimulus would be one that causes tetany in the muscle (s) without causing
fatigue. The biphasic waveform at 30 pps best fir this stimulus. The 100 pps stimulus rate may cause
fatigue, which would be undesirable. The interferential waveform at the frequency of 1 pps is too low
& the direct current would not be appropriate because it would not cause tetany. In addition an on/off
cycle of 1:5 would allow adequate recovery time for the muscles between successive contractions.
47. C. A 20 degrees knee flexion contracture means that the knee is unable to complete the last 20 degrees
of extension. This limitation of motion can be caused by several factors including tightness of the
hamstrings (semimembranosus), restriction in the posterior capsule of the knee, & weakness in the
quadriceps femoris muscle (vastus medialis). Restriction of patellar movement may also be a factor,
however the proper glide technique to increase knee extension would be a superior (not inferior) glide
of the patella.
48. B. A pt with thoracic spinal cord level injury is able to perform independent pressure relief strategies
and should be completed every 15 to 20 minutes.
49. D. The soleus originates on the tibia & fibula & inserts onto the calcaneus, crossing only the ankle
joint. Therefore, it will have an effect on the ankle whether the knee is flexed or extended. The
gastrocnemius & plantaris both have origins on the femur & insert onto the calcaneus crossing both
the knee & ankle joints. Therefore, they will be placed on stretch with the knee extended & will
potentially limit ankle dorsiflexion to a greater extent with the knee extended. The tibialis anterior is a
dorsiflexor of the ankle & while weakness in this muscle may limit active dorsiflexion, it would not
affect passive dorsiflexion.
50. A. The restocking of tx booths with supplies is the only option which does not involve direct pt
contact or care, & thus is the MOST appropriate activity to delegate to a volunteer. Although
volunteers may at times be involved with pt care activities (i.e., transporting patients), the patients in
 the above situations pose a potential risk & would require supervision by someone other than a
volunteer.
51. A. A state of alertness to the internal & external environment must be maintained for a motor or
mental activity to occur. The brainstem reticular activating system brings about this state of general
arousal. To proceed from a state of general arousal to one of selective attention requires the
communication of information to & from the cortex, the thalamus, & the limbic system & its
modulation over the brainstem & spinal pattern generators.
52. C. The first step in preparing any education experience is to determine what the needs of the audience
are. Since prevention of low back injury is the ultimate goal, assessment of the employees
workstations is an important first step in planning the educational program. Simply instructing all
employees in lumbar extension exercises is inappropriate without a thorough evaluation of their
physical needs. Option b cannot be done unless an assessment of the functional needs has been
performed. Providing pamphlets are useful teaching adjunct but would not be the first step to prevent
low back pain effectively in this population.
53. D. The Standards of Practice of PT state that the PT is responsible for establishing a plan of care for
the pt based on the evaluation of the examination data & pt needs. The plan of care includes plans for
discharge. The implication is that the long-term goals for the pt (discharge plans) are determined when
the therapist first sees the pt. It is anticipated that modifications of the plan of care is to be expected
depending on the response of the pt to the intervention.
54. A. The best position for the pt, to drain the posterior segment of both lower lobes would be prone
lying with the head down & the lower extremities & hips elevated to about 45 degrees.
55. B. The median nerve innervates the following muscles in the forearm: (1) pronator teres & quadratus,
(2) flexor digitorum superficialis, (3) flexor digitorum profundus (index & middle fingers), (4) thenar
muscles (abductor pollicis brevis, opponens pollicis, flexor pollicis brevis). Therefore, a lesion of the
median nerve would affect those muscle & their accompanying actions: forearm pronation, finger
flexion & thumb opposition. Thumb adduction is accomplished by the adductor pollicis (ulnar nerve).
Finger abduction is performed by the dorsal interossei (ulnar nerve). Forearm supination is the action
of the supinator (radial nerve) & biceps brachii (musculocutaneous nerve).
56. B. The only one of the above interventions that requires precaution because of THR is continuous US.
However that does not mean that US is contraindicated for this pt. TENS may be used over metal
implants. Hotpacks & massage would not affect the total hip prosthesis.
57. B. For this pt, the first mobilization procedure would be distraction of the glenohumeral joint. The
distraction separates the joint surfaces & 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.
58. D. Heterotopic ossification occurs in 10% to 20% of patients with TBI. The abnormal bone formation
occurs in the soft tissue surrounding major joints. Patients with spasticity are at increased risk. Loss of
ROM is characteristic for this problem. Osteogenic sarcoma is less likely. A patellar fracture would
not present as a lateral mass.
59. C. Pain with resisted medial (internal) rotation & pain with passive lateral (external) rotation is
indicative of subscapularis tendonitis. Bicipital tendonitis is suspected if resisted supination is painful
when the pts arm is at the side & the elbow is flexed to 90 degrees. Painful resisted abduction &
resisted lateral (external) rotation is indicative of supraspinatus tendonitis. Pain on resisted lateral
(external) rotation is indicative of infraspinatus tendonitis.
60. B. Objectives must be measurable & the specific behavior expected should be stated. Understanding,
overcoming, & appreciating elude tangible measurement, while listing five techniques is an activity
that can be documented & is therefore measurable.
61. A. The sartorius flexes, externally rotates & abducts the hip joint. With resisted hip flexion, the
sartorius will be recruited to perform all three actions giving the observed substitution pattern. The
tensor fascia latae is a medial (internal) rotator flexor of the hip, so substitution by it would involve
 medial (internal) rotation & abduction. The adductor longus would adduct the hip. Substitution by the
semimembranosus would cause hip extension.
62. B. The recommended dosage for mechanical, intermittent pneumatic compression pressure is between
30 and 80 m Hg, (higher for the LE than UE). It is also recommended that the pressure be below the
diastolic pressure. Pressures below 30 mm Hg are not considered to be effective. Pressures above
diastolic can be used with caution. For the first tx, it would be most appropriate to use a pressure that
is considered effective, yet not so high as to cause a potential problem for the pt. If the pt responds
positively to the intervention, the higher pressure could be instituted.
63. D. In order to best intervene with a pt who has had cardiac dysfunction, a full examination &
evaluation is necessary to properly form a tx plan. An important aspect of the examination is
ascertaining the type of angina that the pt experience so that the therapist will know how to prevent
angina with exercise or recognize it if it does occur during the tx session. The other options provided
are all outcomes that would occur after the pt has completed a cardiac rahab program.
64. C. According to the Guide to PT Practice, Information relating to PT/patient relationship is
confidential & may not be communicated to a third party not involved in that pts care without the
prior written consent of the pt. Option c is the only one that fits these criteria.
65. A. Sixty percent of children with myelomenigocele develop hydrocephalus after surgical closure of
their lesion. Early warning signs of hydrocephalus include irritability; changes in sleep patterns, &
changes in appetite & weight. 80 - 90% of children who acquire hydrocephalus will require a
cerebrospinal fluid shunt. These children require ongoing follow-up by a physician. Given the
seriousness of this childs sx, the child should immediately be referred for medical follow-up.
66. D. Bells palsy involves the facial nerve. The frontalis is the only muscle listed that is innervated by
the facial nerve. The SCM is innervated by spinal accessory nerve, & the masseter & temporalis are
innervated by the trigeminal nerve.
67. A. The abdominal muscles are active during sit-ups (with 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 & the abdominals cannot perform this action because they
do not cross the hip joint. Therefore, the hip flexors (iliopsoas among others) would have to complete
this motion. The inability to achieve a long-sitting position would suggest weakness in the iliopsoas
muscle.
68. C. The plantar grasp reflex is characterized by curling of the toes when the child is held supported in
standing. The reflex is normal up to 9 months of age. Delayed integration of this reflex can result in
delayed, independent ambulation.
69. C. Placing a crutch in the L hand reduces the magnitude of the hip abductor force needed to prevent
the pelvis from dropping on the L side during the stance phase on the . Pushing down on the crutch
of the limb reduces the amount of hip abductor force needed, which in turn reduces the
compression force on the hip joint. This effect is desirable in patients who have hip abductor
weakness or hip pain.
70. C. Spinal shock occurs as a reaction to SCI & is characterized by an absence of all reflex activity
below the level of the lesion. Depending on the extent of the lesion, the pt may lose all or some of
their sensation & motor activity below the level of the lesion. Spasticity is associated with
hyperreflexia & increased muscle tone. Spasticity would be expected to develop following the spinal
shock stage. Decerebrate rigidity involves sustained contraction of the UE &LE in extension. With a
LMNL, the loss of sensation & motor activity would be confined to a much smaller region (depending
on the exact lesion) & would not affect all levels below the lesion.
71. D. The pts s/sx are reflective of a sided cerebellar hemisphere lesion. That is, cerebellar lesions
commonly produce hypotonia, hyporeflexia, ataxia & an intention tremor. Cerebellar lesions also
produced ipsilateral s/sx in the extremities. A sided lesion of the spinal cord (Brown-Sequard
syndrome) would produce weakness with spasticity & hyperreflexia. A L sided cerebral hemisphere
 lesion would present similar to a sided cervical spinal cord lesion. A lesion of the substantia nigra
would produce s/sx like as those seen with PD with rigidity & resting tremor.
72. B. The common peroneal nerve innervates the following muscles: peroneus longus & brevis, tibialis
anterior, extensor digitorum longus & brevis, peroneus tertius & extensor hallucis longus. Because of
the complete severance, all of those muscles would be affected & would not be able to actively
contract until regeneration has taken place. Therefore, the pt would completely lose ankle
dorsiflexion, eversion & toe extension. Those motions have to be performed passively in order to
maintain ROM. Option b is the only one that contains all of the correct actions.
73. A. Option a is the best answer. In option b, if the pt does not initially understand the information, then
having short-term memory is irrelevant. For option c, hearing & vision are obviously important but
the most critical component is comprehension.
74. C. Status alignment for knee stability is established by pistoning of the knee so that the lateral
reference line falls anterior to the knee joint.
75. B. The COG of a person with bilateral AKA is more posterior than the COG of a person with their LE
intact. Setting the back wheels more posteriorly will make the pt more stable in the chair. This
adjustment prevents the wheelchair from tipping backward.
76. B. Although protocols depend on the surgeon & the approach, it is generally recommend that anti-
gravity hip abduction exercises not begin until 5 to 6 weeks post surgery. Patients are taught to avoid
excessive hip flexion, usually beyond 80 degrees. Bed mobility & ambulation would be started 1 to 2
days post operatively.
77. D. Posterior muscle tension is implicated in the development of tension headaches. Positive imagery
recommended as a self-tx technique, but the awareness of tension & the appreciation of its absence are
foundational. Massage & passive exercise may be relaxing, but the pt must be aware of the sensations
of tension to prolong the benefit.
78. B. Anticoagulation therapy inhibits the synthesis & function of clotting factors can lead to bruising
(ecchymosis) or more severely hemorrhage. A hemangioma is a benign liver tumor. DVT would result
in redness, swelling & warmth in the affected area & most commonly occurs in the calf muscle, not
the hip region. A hematocele is a blood cyst.
79. A. An S-T segment depression of greater than 1mm is indicative of MI. Continuing the exercise
session could place the pt at serious risk for continued ischemia, which could ultimately lead to MI.
Therefore the best response for the therapist would be to stop the exercise session immediately &
inform the cardiologist of the pts response. All of the other options would continue to place the pt at
risk.
80. A. Infection control requires that the wound not be contaminated further, & that the health care
workers protect themselves from dse by avoiding contact with body fluids. In this case the pt does not
appear to be in life threatening danger, & so the wound should be attended to. Therefore, checking the
pts BP would not be the first thing to do. Once the gloves are donned, cleaning the wound & covering
it with a sterile dressing would be appropriate.
81. D. Patients should be encouraged to express their feelings. Comparisons to other pt who are dying in
an effort to assure the pt he is not alone, takes away from this pts feelings. Denial of death would not
be good for the pt, since he must ultimately cope with the inevitable. Pastoral counseling would be an
option, but the therapist should be ready to listen to the pt, encourage _expression of feelings & avoid
denial.
82. B. The pt taking beta-blocking medication will experience a lower HR & BP response during exercise
as compared to a pt who is not taking this medication. Since the HR is lower than anticipated, using
HR to monitor exercise intensity may not be as accurate. Another measure, such as the Borg Scale
(rating of perceived exertion) would be more beneficial. However, even though HR & BP would be
lower, the pt actually achieves the same metabolic levels during exercise & therefore altering the
frequency or duration of exercise is unnecessary. The time for warm-up & cool-down exercises does
not to be altered.
83. A. A non-adherent dressing is best choice because any adherence of the dressing to the fragile
granulating tissue could cause additional trauma. This is superficial wound, so there wound be no
need to pack the wound. Since there is some drainage, a covering is preferential to topical medication
only.
84. D. Pronation of the foot can be cause by a variety of factors including calcaneal eversion & forefoot
varus. Correction of the pronation by an orthosis could include a medial post (wedge) placed just
proximal to the metatarsal heads or a medial post under the calcaneus. This approach involves
bringing the ground up to meet the foot. A post under the fifth metatarsal head would accentuate the
problem, as would a rearfoot post placing the calcaneus in an everted position. If the pt has excessive
forefoot varus, a wedge may be placed in the instep in addition to the medial wedge proximal to the
metatarsal heads to distribute the load; however a wedge in the instep by itself would not be the best
intervention.
85. A. Since most of the joint contracture/adhesion forms in the anterior-inferior portion of the capsule, tx
to mobilize that portion of the capsule is of primary concern. Inferior glide would stretch the inferior
portion of the capsule. 8
86. B. Options a, c &d are acceptable interventions for this pt. The epiphyseal areas (growth areas of
bones) in children should not be exposed to ultrasound. The application of US over the knee joint
(hamstring insertion) could expose the epiphyseal areas to the US.
87. D. When the knee is extended the medial & lateral collateral ligaments are taut. During knee flexion
the ligaments slacken. Therefore there is very little tibial rotation when the knee is extended (closed
packed position) & approximately 40deg of axial rotation with the knee flexed. Although the femoral
condyles may glide posteriorly (depending on the direction of rotation) on the tibia & hamstrings may
rotate the tibia, the reason the motion is available is due to laxity in the collateral ligaments. Other
ligaments such as the cruciates & the joint capsule may add to the stability in the closed packed
position.
88. D. Scoliosis deformities are named relative to the convexities of the curves, with the apex of the curve
defining the vertebral level. In the thoracic, L lumbar scoliosis, there is a convex curve to the in
the thoracic spine & a convex curve to the L in the lumbar spine. In the thoracic spine, the body of the
vertebrae rotates to the (convex side) & the spinous process rotate toward the L (concave side).
Along with this transition, the ribs rotate posteriorly on the convex side causing the scapula to become
more prominent on the convex side & causing the shoulder to be elevated on the convex side.
89. A. With this particular posture, the pts scapula would be in a protracted (abducted) position, therefore
the scapular protractors are already overactive & would require stretching not strengthening. The
kyphosis suggests that the thoracic erector spinae muscles are weak & need strengthening. The lumbar
lordosis indicates shortened lumbar erector spinae muscles. Forward head posture suggest that the
cervical spine is flexed & the occiput is extended, therefore stretching of suboccipital muscles would
be indicated. A TEST-TAKING HINT: Although EXCEPT questions are rarely used on the NPTE, be
alert for this type of question & read the responses so that you select the unrelated response.
90. D. 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 &
elevation would do the most to decrease the edema & relieve the sx. The wrist should not be
positioned in full extension. Initial conservative tx sometimes includes cock-up splinting to hold the
wrist in neutral to 10 degrees 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 & fingers may aggravate the compression in the carpal tunnel.
91. C. Patients with PD are characterized by rigidity, bradykinesia, tremor, lack of associated movements,
impaired balance reactions & a flexed posture (kyphosis). Therefore intervention should be directed
toward full ROM & correction of kyphotic posture through back extensor strengthening exercises,
balance exercises, & exercises that promote reciprocal movement. Option c is the only one that
includes appropriate exercises.
92. A. Upon heel contact, the heel section compresses partially absorbing the ground impact & thus
permitting a controlled plantarflexion. If the heel is too stiff, upon initial contact, the knee flexes too
soon & excessively on initial contact. An excessively firm heel wedge would not be a factor in late
stance.
93. A. A pt with COPD has premature collapse of the airways upon exhalation, which leads to air trapping
& ultimately poor gas exchange. Breathing out through pursed-lips slows the airflow & creates a
backpressure which helps to prevent the airways from collapsing while exhaling. By exhaling more
fully through pursed-lips, more CO2 is removed. By preventing airway collapse & air trapping in the
lungs, the residual volume is actually decreased. Pursed-lipped breathing helps with ventilation, but
does not necessarily assist with secretion mobilization.
94. C. The dermatome providing sensation to the little finger is innervated by the C8 nerve root. The
triceps brachii is the only one of the muscles listed that is also innervated by the C8 nerve root. The
biceps brachii, deltoid, & brachoiradialis are innervated by the C5, C6 & sometimes C7 nerve roots.
95. A. Evaluation of the pts retention of information presented in the program can be enhance by asking
the patients questions about the program information, having the pts ask questions about the program,
having the pts demonstrate what they have learned & testing the pt about the program material. Option
a is the only one that utilizes one of these techniques. The other options do not require active
participation by the pts, they do not address specific interventions.
96. C. During the swing phase of gait, the foot is dorsiflexed to clear the foot. Muscles active during this
phase of gait are the tibialis anterior, extensor hallucis longus & extensor digitorum longus. The
gastrocnemius, tibialis posterior & peroneus longus are active during the stance phase of gait.
Therefore, of the muscles listed, the EDL is the best choice. If only the tibialis anterior was stimulated
the foot would go into inversion & dorsiflexion, which could cause the pt to land on the lateral side of
the foot at initial contact causing them injury. Addition of the EDL would bring the foot up into more
dorsiflexion & avoid excessive inversion.
97. D. The current dosage for iontophoresis is calculated by multiplying the current (4mA) by the
duration (15 minutes). In this case the calculation would yield a value of 60 mA-min. None of the
other options use the correct values.
98. A. The double upright metal AFO would provide the best support for the mediolateral instability &
would aloe for changes in leg volume. The plastic, solid AFO would not provide as much mediolateral
support & because of its confirmation to the leg it would not be advisable for pts who are
experiencing changes in leg volume due to edema. High top shoes would not provide enough support.
The spiral AFO would nor provide needed stability to the ankle & the design would not be indicated
when a pt has fluctuating edema
99. C. Hemoptysis or the coughing up of blood can be benign or severe & can be a common occurrence in
the cystic fibrosis population secondary to the pathophysiological processes in their pulmonary
system. In general, a small amount of hemoptysis that occurs occasionally or is non-persistent
hemoptysis is benign. The brownish color indicates either venous blood or old blood. In this situation,
if the hemoptysis does not persist, then it is appropriate to continue tx without modification. If the
blood was larger in amount & fresher (denoted by a bright red color), then the tx should be
discontinue. The presence of blood in the sputum should not warrant more vigorous chest percussion,
until it is deemed appropriate to continue with the session. Since this situation is benign scenario,
alteration of drainage position is not necessary, & there is no need to send the pt to the emergency
room.
100. C. Isokinetic exercise device utilize accommodating resistance throughout the ROM. The other
exercises are not forms of accommodating resistance.
101. D. Air is released during the stance phase of gait, which results in a negative pressure inside the
socket to provide a suction suspension during swing phase.
102. B. With venous insufficiency, the limbs would be edematous, the superficial veins would be
dilated & if not corrected ulceration could develop. Options a & c are ruled out because they indicate
no edema. Option d is not correct because the condition is relieved by sitting or leg elevation.
103. A. In order to improve knee flexion, the PT needs to address patellar tightness. During flexion at
the knee, the posterior motion of the tibia causes the ligamentum patellae to pull the patella distally &
posteriorly. Patellar mobilization in the distal direction would assist with increasing knee flexion.
104. C. The tibialis posterior plantar flexes & inverts the foot. This pattern requires the specific action
of that muscle. The other patterns do not.
105. C. Pain that is experienced in the thoracic spine can be caused by a variety of pathologic
conditions. LBP can be either mechanical or non-mechanical in nature. Pathology in the kidney may
refer pain to the lumbar spine (ipsilateral flank), or upper abdomen. Pathology in the urinary bladder
refers to the subpubic or thoracolumbar region. The diaphragm is innervated by C3, C4 &C5 with the
pain normally confused to the C4 dermatome. The negative MRI has ruled out possible involvement
of the dura mater.
106. A. In order to optimally clear the congestion that has developed in the lower lobe, the pt would
need to be positioned on the L side to allow gravity to help drain the secretions to the proximal
airways. This pt is also unconscious & intubated so in addition to drainage, manual hyperinflation is
necessary to provide increase ventilation which would help mobilize secretions followed by
suctioning to clear out secretions. Suctioning first then hyperventilating while in L sidelying is less
effective than the order suggested in option a. Positioning on the side would not drain the lower
lobe, & since also the pt is laying on the side, the only place to percuss & vibrate would be on the L
side, which has no pathology. Finally, positioning on the L side with deep breathing will not be
effective in mobilizing secretions, especially since the pt is unconscious & unable to actively perform
deep breathing exercise.
107. B. Prednisone is a glucocorticoid that exhibits these side effects. The primary side effect of
penicillin is an allergic reaction such as skin rashes & difficulty breathing. The primary side effect of
aspirin is gastritis. The primary side effect of gold therapy is diarrhea, irritation of oral mucosa & skin
rashes.
108. D. The weakness in the flexors of the 4th & 5th digits at the DIP joint (2/5). The other fingers
show normal strength (5/5). This weakness would indicate a problem with the flexor digitorum
profundus, since the distal joints are involved. The FDP is innervated by both median & ulnar nerves.
The median nerve innervates the FDP muscles flexing the index & middle fingers. The ulnar nerve
innervates the FDP muscles flexing the ring & little fingers. Therefore, since the ring & little fingers
are involved, The lesions would have to be involving the ulnar nerve. The FDP to the 4th & 5th
fingers is innervated by the ulnar nerve roots C8 & T1.
109. B. 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 pt & family members, to arrive at
joint decision as to the placement of this pt. The best time for such meeting would be prior to
discharge, because after discharge it is difficult to arrange such meetings. Allowing the pt to
determine his own discharge environment may be fine if there is no safety concerns, however a
decision whether or not the pt is competent to make that decision must be made first. Scheduling a
home visit or the implementation of a tx plan for home care would be premature until a decision on
placement has been made.
110. D. Sudden tingling of the hands & weakness of muscle groups are alarming signs of cord
compression. The concern is that the spinal cord sustaining further injury. The exercise may be
exacerbating or causing these signs. This is considered a medical emergency & the physician should
be immediately advised.
111. D. The primary PT goal in this case would be joint protection & the prevention of contractures &
adhesions, usually through splinting. There is no evidence to suggest that PT can prevent nerve
 degeneration & muscle atrophy, as they are the normal effects of a peripheral lesion. Spasticity would
not be present in lower motor neuron injury.
112. B. While all of the above would help prevent injury to a diabetic foot, the most important
information to provide is about proper footwear. Ensuring properly fitting footwear would alleviate
risk of skin breakdown as well as providing appropriate cushioning to the articular cartilage of the foot
joints that are prone to injury from repetitive trauma & compression. Orthoses may not be necessary
for all patients. Despite moisturizing the skin, if there is improper protection, skin breakdown can still
occur. Exercising within appropriate parameters will not be beneficial if the pts footwear is not
supportive or properly fitting.
113. B. An intact circulatory system can sustain adequate blood flow to an elevated limb. A limb with
arterial insufficiency may not be able to sustain adequate blood flow against gravity. The vasodilation,
caused by local mechanisms, occurs in response to ischemia. An acute arterial occlusion creates
pallor, but because blood flow is blocked, the reactive hyperemia is impaired.
114. C. The gluteus maximus is a hip extensor that is more active during resisted motions or when the
hip is in flexion, especially in functional activities such as stair climbing. In this case, the pt flexes the
hip placing the gluteus maximus on stretch increasing its ability to produce tension. Therefore, the pt
is leaning forward to maximize the ability of the gluteus maximus to extend the hip during the stair
climbing activity. The other muscles listed would not be benefit as much from the increased hip
flexion.
115. A In patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of 24 to
48 hrs after exercise. Exercise has been shown to increase sensitivity of the insulin receptors therefore
leading to a decrease in the amount of insulin required.
116. B. A larger print will not simplify the meaning, nor will lengthening the sentences. Only option b,
the choice of illustrations & a simpler sentence structure, is correct.
117. C. A PT would be required to perform the initial evaluation, plan of care, re-evaluations,
modifications to the plan of care, & discharge plans for the pt The pt who is stable & on an existing
program would be most appropriate pt to be delegated to the assistant. Therefore, the pt who ha
multiple sclerosis 7 who is on an established gait training program would be the most appropriate. The
other three patients are receiving their initial treatments.
118. B. Normally, as the diaphragm descends with inspiration, it places increased pressure on the
abdominal contents with a resultant distension of the epigastric area. Weakness of the diaphragm
would decrease the distension & may result in a compensatory increase in upper chest expansion to
improve ventilation. The scalene muscles act to elevate or stabilized the clavicle during inspiration.
The rectus abdominus is a stabilizer during inspiration & assists with forced expiration. The
intercostals muscles act to stabilize the thoracic cage during ventilation.
119. C. The medical record is owned by the hospital subject to the pts interest in the information it
contains. Unless restricted by state or federal law or regulation, a hospital shall furnish to a pt, or a
pts representative parts of the hospital record upon request in writing by the pt or their representative.
Option c is the only correct answer in this case, since it specifies that the pt must authorize the release
of information.
120. B. The anterior tibialis shows poor (2/5) grade strength during the examination. Because this
muscle is active during swing phase of gait & shortly after initial contact, one would expect to see gait
deviations showing up at those times. Specifically, the anterior tibialis maintains dorsiflexion of the
foot during swing phase & controls plantarflexion after initial contact. During swing phase, weakness
of the anterior tibialis would cause the pt to increase the amount of hip & knee flexion to prevent toe
drag. With weak hip abductors, the pt would be expected to have excessive pelvic rotation. To
compensate the pt would laterally bend toward the weak (right) side during midstance to help prevent
the excessive hip drop. Throwing the trunk backward after initial contact may be due to weakness of
hip extensors (gluteus maximus).
121. B. The pts sx would be aggravated by exercises that cause increases in patellofemoral joint
reaction forces. One of the goals of tx would be to promote proper patellar tracking. Isometric
exercises such as quadriceps setting & SLR are most often used for strengthening with a dx of
chondromalacia patella because they produce smaller patellofemoral joint reaction forces than some
other forms of quadriceps exercises, & thus are less painful. The vastus medialis is one of the muscles
active during quad setting. This muscle tends to pull the patella medially during contraction & thus
acts as a dynamic medial stabilizer, which promotes proper patellar tracking. The vastus medialis is
not preferentially recruited during a SLR, nor it is the only muscle responsible for terminal knee
extension. Patello-femoral compression forces are generally less during SLR than when doing
extension exercises with the knee bent.
122. A. With an extension exercise program, centralization indicate that the pt is improving, even
though the pain may be just as intense as it was. Even though the pt may feel frustrated, he is actually
improving; & 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 intervetion, it would not be indicated at this point because extension is
working.
123. D. An outcome measure documents a desired performance or change in the pts condition over
time. This may include a description of the pts function before, during & after intervention. Option d
does not indicate a change or function, but is focused on attendance.
124. A. The rib cage would not be able to expand normally during inspiration due to weakness of the
intercostals muscles, which are innervated by thoracic nerve segments. With a spinal cord lesion at the
C5-6 level, the diaphragm would still receive innervation from the phrenic nerve (C4). The anterior
scalene (C4-6) would be partially innervated & the SCM (C2-3) 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.
125. C. Information relating to the PT/pt relationship is confidential & may not be communicated to a
third party not involved in that pts care without the prior written consent of the pt. Option c is the
only one that fits these criteria.
126. C. Inclusion of all members of the health care team into decision-making is important for the pt &
provides for continuity of care for the pt. However, the team approach has some pitfalls such as
arranging meetings between team members, which may be atime consuming process. The team
concept would also assume that the team reaches a consensus that requires more time than relying on
individual decisions that can be made quickly. Therefore, Option c is the best answer to this question.
The other three options are advantages of the team concept.
127. A. RA is a chronic inflammatory dse that affects many body systems including the joint space.
Destruction & subluxation of joints can occur over time secondary to the inflammation that occurs in
the synovium. Fatigue is a common sx that accompanies RA. Therefore, the pt must get enough rest to
avoid excessive fatigue & to protect the joints from overuse damage. Therefore education on energy
conservation & joint protection is essential to minimize joint deformity. However, the pt must realize
that some activity is good for them to prevent contractures & to maintain strength & endurance.
Fatigue & joint pain can & often do co-exist in pts with RA. The pannus in the joints is actually
increased with rest. Rest does not appear to change the activity of the antigen-antibody complex.
128. C. This pt would have functional use of the triceps & finger flexors & would therefore, be
independent for all wheelchair transfers to all surfaces. Coughing would not be limited & would not
be a goal. Rolling would be easily achievable as a short-term goal. Ambulation with forearm crutches
would not be a reasonable expectation for this pt.
129. B. PT intervention should focus on helping the pt obtain maximal functional independence.
Wheelchair transfers are the means to enable the pt to be independently mobile & will be a
requirement before more difficult tasks are performed such as ascending a 10-foot ramp. The pt is
 presumambly too weak to walk at this point in time. Tub transfer is important, but the wheelchair will
be the best means to get the pt to the tub. Therefore, for the initial intervention session wheelchair
transfers would be the most important.
130. A. Raising just the head activates only the recti muscles, & supporting the abdominal muscle with
the hands provides external support to the stretched abdominal muscles. This is the optimal position to
initiate strengthening following delivery for a pt with diastasis rectus abdominus. Doing exercise
would not be appropriate. With no support of the abdominal muscles, option c & d would be too
aggressive at this time.
131. A. Several things can be done to decrease the current density & the possibility of skin irritation.
These include decreasing the intensity of the stimulation, increasing the inter-electrode distance & the
use of larger electrodes.
132. B. The presence of dyspnea & the pink, frothy sputum would suggest the presence of CHF &
resultant pulmonary edema. CHF can occur from poor cardiac muscle function as a result of MI.
Pulmonary edema occurs from the backflow of blood from the heart into the pulmonary vessels,
increasing pulmonary capillary pressure. The increase in pulmonary capillary pressure increases fluid
movement into the alveoli, which are normally dry. These leads to the presence of pink, frothy sputum
that can be expectorated along the shortness of breath (dyspnea). Positions that increase blood flow to
the heart, such as lying flat, will increase the s/sx. Therefore, the pt should be positioned with the head
up or as in this problem; the pt should be placed in a sitting position to help alleviate the sx. Laying
the pt down flat, supine or with the legs elevated would exacerbate the pts problems.
133. A. The assessment of posture in a wheelchair begins with the pelvis & its relationship to its
adjacent segments. The orientation & range of mobility of the pelvis in all three planes will in turn
determine the alignment & support needed at the trunk, head & extremities.
134. C. Medical social services deal with home situations, financial supports & acts, as a resource
director on behalf of the pt. Social services would be the most appropriate choice to help arrange &
coordinate rehabilitative services for this pt while they are at home. Although nurses, occupational
therapist, PT & physicians may all be involved with direct pt care, they would not be the most
appropriate for this level of discharge planning.
135. A. In order to place the middle lobe in an optimal position to drain secretions, a pt would need
to be positioned as stated in option a. Another way this position may be stated is left sidelying with a
quarter turn towards supine. The other positions do not optimally drain this lobe.
136. D. During measurement of shoulder abduction, the spine should be kept straight. If the pt is
allowed to laterally flexion the trunk it will give the appearance of increased shoulder abduction, but
the motion would be occurring in the spine & not in the shoulder. Upward rotation of the scapula &
lateral rotation of the shoulder would normally accompany the motion of shoulder abduction. Medial
rotation of the shoulder would decrease the available abduction.
137. D. An adverse side effect of prolonged prednisone use, in this case for 4 yrs, is muscle
degeneration & therefore achieving increases in muscle strength may be limited. Since muscle
strengthening may be limited, then isokinetic exercise would not necessary be more beneficial.
Prednisone may lead to a decrease in bone density, not an increase. Four yrs after transplantation, the
pt will have been out in the community & the need for an isolation room in unnecessary.
138. D. The open weeping rash may be infected. Skin infections are easily spread in training room
environment, & if not attended to correctly may infect more people. If an infection were suspected,
the precise dx would be made by means of a culture. Therefore the most appropriate action would be
to refer the pt to the team physician. Moist heat increases the infection by increasing blood flow. An
emergency room visit would not be indicated at this time. Occluding the wound with more pre-wrap
creates an environment ideal for infection.
139. C. The previously amputated L limb must function as the main support limb. Any tx strategy for
ambulation must ensure that the L limb is functioning optimally. While the other factors are relevant,
the previous ability of the pt to ambulate is the greatest concern.
140. B. Physical findings of congenital hip dislocation include asymmetric skin folds of the buttocks &
adductor region; limitation of passive hip abduction; leg length inequality; & telescoping of the flexed
& adducted thigh on the pelvis.
141. B. The C5 & C6 myotomes include the biceps brachii, brachialis, brachioradialis & deltoid
muscles. The elbow flexors & supinators (C5-6) are used to carry a teddy bear in the crook of the arm.
Pushing a wagon requires the use of the triceps (C7-8). Holding a raisin requires presence of wrist
flexors (C6-8). Grasping a cup requires finger, thumb & wrist muscles (C6-8, T1).
142. A. In order to open up the intervertebral foramen, it would be best to flexion or at least flatten the
lumbar spine prior to applying the traction. Of the above options, positioning the pt supine with the
hips & knees flexed would be the best way to do this. Laterally bending the trunk to the L would also
open up the foramen, but this is not one of the options. Supine with hips & knees straight & then
laterally shifted to the would tend to close down the intervertebral foramen. Prone would also close
the foramen. Sidelying with a bolster under the lumbar spine also tend to close the foramen.
143. A. Prone standers are used frequently for children who cannot achieve or maintain upright
standing. The benefits from the physiologic changes associated with weight bearing & from the social
& perceptual opportunity to see the environment from an upright position.
144. C. With arterial insufficiency, elevation increases ischemia & therefore pain. Intermittent
claudication is a phenomenon associated with metabolic demands exceeding the capability of the
vascular system to supply adequate blood flow. Placing the limb in a dependent position increases
swelling & therefore possibly pain with venous insufficiency. An objective sign such as purple
discoloration rules out a psychosomatic episode.
145. A. The primary PT goal of phase I cardiac rehabilitation is to achieve a safe & independent level
of activity that can be carried out at home. Increasing aerobic capacity cannot happen until phase III,
when cardiac tissue has healed fully. Modification of risk factors is a life-long process & will not be
achieve during a short inpatient stay. Systolic BP, when exercising, during the inpatient stay should
only rise approximately 20 mm Hg above resting.
146. C. Option c is the only one stated clearly in educational terms. The other options are objectives
based on observations.
147. B. Pressure receptor (baroreceptors) are present in the carotid sinus & these receptors respond
changes in BP. An increase in blood pressure that is sensed by these receptors will stimulate the
parasympathetic system to decrease the rate & force of contraction of the heart in order to help lower
the pressure. An increase in BP that is sensed by these receptors will stimulate the parasympathetic
system to decrease the rate & force of contraction of the heart in order to help lower the pressure.
Repeated palpation in the carotid sinus area may stimulate an increase in BP & cause this reaction.
Therefore increased HR & BP are incorrect. Irregular heart rhythms generally result from electrolyte
imbalance &/or ischemia to the conduction system of the heart.
148. A. Starting at the coracoid process & moving laterally, one would palpate the following structures:
(1) lesser tuberosity, (2) biceps tendon & (3) greater tuberosity. Any other order of structure palpation
would be incorrect.
149. B. HR & systolic BP responses are higher for any given workload when performed with the UE as
compared to the LE. Angina is determined by a certain myocardial workload that is represented by the
product of HR & systolic BP. Therefore option a cannot be a conclusive statement. Pulmonary
ventilation has less definitive responses but in general would be similar in that UE exercise would
cause a greater ventilatory response than LE exercise would. Since HR & BP would be higher at any
given workload with UE exercise , then angina would most likely occur at a lower workload.
150. A. The pt will be reluctant to move the limb because it is painful. ROM is essential to regain &
maintain a functional ROM. In this case, The PTs primary goal is to restore function with ROM
exercises. Compression dressings, whirlpool, & splinting, are all acceptable aspects of care that help
in restoration of ROM. However, functional ROM would be the primary goal.
151. C. 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 tx. Gathering information from pt records
may not provide the same accuracy as if the researcher had performed all the measurements directly.
Measuring ROM only on day 5 would not account for any pretest differences between groups.
152. A. The biceps brachii is both an elbow flexor & supinator, & it is most effective as a supinator
with the elbow flexed to about 90 degrees (approximately the muscle testing position). The brachialis
does not cause supination (only flexion). The supinator does not flexion the elbow. The
brachioradialis would move the forearm to a midposition rather than fully supinating it. Therefore,
when the elbow both flexes & supinates the biceps brachii would be the most likely muscle causing
this action.
153. B. During normal knee extension, the tibia moves posterior relative to the femur. Therefore,
posterior gliding of the tibia would promote knee flexion. Superior glide of the patella could be used
to increase knee extension. Posterior glide of the femur on the tibia would be used to increase knee
extension.
154. C. All of these sx are indicative of reflex sympathetic dystrophy syndrome. Cervical disc dse does
not produce swelling in the hand, color & temperature changes, or hyperhydrosis. Raynauds
phenomenon results in pain, pallor, & coolness, but no hyperhydrosis. Although carpal tunnel
syndrome can also show sympathetic nervous system abnormalities, compression of the median nerve
would refer sx to the lateral border of the hand (thumb area). With carpal tunnel syndrome, the pt may
also display thenar muscle weakness.
155. B. Option b is the definition of validity. Options c & d refer to reliability measures. Results can be
standardized even though they are not valid.
156. A. The primary PT goal at this time is to restore ROM. Therefore, the most appropriate
intervention for that goal is passive & active assistive ROM exercises. Although gentle joint
mobilization techniques may be indicated, grade 4 techniques at this time would not be. Progressive
resistive exercises would come later in the plan of care. Although the long-term goal would be to
return to normal activities, the short-term goal would not.
157. B. Because the problem is a behavioral disorder, the most appropriate person to assess this pt
would be a neuropsychologist. The neuropsychologist is trained to assess intellectual, emotional &
coping functions of the pt as well as levels of depression & anxiety. They could also provide
consultation to the rehab team members as to how to deal with the problem.
158. C. The abductors are particularly active during the midstance phase (single limb support) of gait to
prevent the contralateral pelvis from excessive lateral tilting. Weakness of the hip abductors,
particularly the gluteus medius, causes the hip to drop down on the side opposite the weakness. For
example, weakness in the gluteus medius would show up during stance phase on the by excessive
downward movement (lateral tilt) of the L pelvis. The hip adductors are active during terminal stance
& through mid-swing & would not play a role in controlling the lateral rotation of the pelvis. The hip
abductors show little activity during swing phase.
159. A. The optimal exercise duration for achieving weight loss with a walking program is 40 to 60
minutes of continuous aerobic activity. Therefore once a pt is safely tolerating 15 minutes, the best
progression is to increase the duration while maintaining the same intensity or walking speed.
Increasing walking speed should only be performed once the pt can consistently tolerate 20 to 30
minutes of exercise. Decreasing the duration while increasing the frequency of exercise would not
accomplish the goal 40 to 60 minutes of continuous exercise. A pt who has been walking for only 15
minutes 3 times/wk would not be ready to begin jogging & jogging one time per wk would be too low
of an exercise frequency in general to achieve by training benefit.
160. C. Trunk ROM exercises & strengthening to minimize thoracic kyphosis are essential. Persons
with ankylosing spondylitis tend to assume flexed postures. Disproportionately strong pectorals, hip
flexors, or abdominals could worsen the kyphosis.
161. B. A brachial plexus injury that affects the C5 & C6 nerve root is termed Erb-Duchenne paralysis.
A lesion affecting the C8 & T1 roots is termed Klumpkes paralysis. Hemiplegia & spinal cord injury
would be caused by trauma to the CNS & would not normally affect just the C5 & C6 nerve roots.
162. A. The protrusion component involves the arthrokinematic movement of anterior condylar
translation. Mandibular depression (jaw opening) involves both condylar rotation and anterior
translation. However, this question is asking only about the protrusion component. Lateral glide
involves anterior translation on the contralateral side and spin on the ipsilateral side.
163. C. The occupational therapist would be the most appropriate members of the health care team to
teach the patient the needed self-care skills. The occupational therapist would also be able to provide
the patient with information regarding modifications to the home environment that would increase the
patients independence. The occupational therapist could teach the patient how to use adaptive devices
and help with the fabrication of splints or self care aides.
164. D. The therapist should observe the parents performing the program as instructed to ensure correct
implementation. The parents should return in one week for another demonstration to determine if they
can correctly repeat the program as previously instructed.
165. B. The hematocrit value provides the percentage of red blood cells in plasma. A decrease in the
number of red blood cells (anemia) would lead to a decreased oxygen carrying capacity in the blood
and therefore less oxygen to the tissues would lead to fatique. The CO2 value would be examined to
assess a patients respiratory status while creatinine and BUN levels are examined in relation to
kidney function.
166. D. Excessive upward rotation of the scapula can result from weakness of the rhomboids and
latissimus dorsi (downwards rotators). The scapular adduction with medial 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 c also help strengthen the serratus anterior, which would tend to aggravate the
problem.
167. C. The family should be involved in all stages of planning and treatment. Family involvement can
shorten the rehabilitation process and the patients return to the community. It is important to have the
family involved early in the rehabilitation process rather than wait until the patient is ready to be
discharge.
168. C. A complaint of heaviness likely reflects weakness. The complaint is not the fit or comfort of the
prosthesis, so Option 1 is incorrect. The expense of obtaining a lighter prosthesis is not justified
without determining if the solution is strengthening of the muscle groups, which controls the
prosthesis. A fork strap attachment will assist with suspension, but will not reduce the weight of the
prosthesis.
169. B. Of the options above, a social worker (social services) would be the most appropriate person to
intervene in this case. The social worker is trained to help resolve family issues that arise and would
be the best person to lead a team of caregivers and family members in deciding the appropriate action
in this case. Educating the patient would only put more burden on them without guaranteeing results.
A referral for home care may be appropriate, but the social worker would be the best person to make
such contact. Writing a home program for the family would not address the need to instruct family
members in person.
170. D. 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.
171. B. The lesion is most likely a tendonitis involving a muscle or muscles that originate from the
medial epicondyle of the humerus (i.e., pronator teres, palmaris longus, flexor carpi radialis and
ulnaris, and flexor digitorum superficialis). Pain would be elicited with active contraction of the
involved muscle (or muscles) or when the muscle (s) is/are passively stretched. Resisted wrist flexion
and pronation would cause pain over the origin of the pronator teres. Option 1,3 and 4 do not meet the
criteria for eliciting pain.
172. B. The mechanism that creates an anterior dislocation of the shoulder is forced abduction and
lateral (external) rotation of the shoulder. This frequently results in a tear of the anterior portion of the
capsule. Abduction and external rotation may subject the patient to recurrent subluxations and/or
dislocations, and should therefore be avoided.
173. C. In carpal tunnel syndrome there is pain and paresthesias in the median nerve distribution of the
hand, which includes the lateral three digits. There is weakness of the abductor pollicis brevis, but not
of the wrist flexors or finger extensors.
174. B. Macerated tissue results from excessive moisture. A more absorbent dressing would soak up
the excessive moisture and prevent the maceration
175. A. A combination of valgus, flexion and external rotation forces applied to the knee while the foot
is planted on the ground results in damage to the ACL, MCL and median meniscus.
176. C. 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-Barre
syndrome may experience respiratory muscle fatique or paralysis and are susceptible to pulmonary
infection. Pulmonary hygiene is a critical role in their care.
177. A. During Phase I (inpatient) cardiac rehabilitation, vital sign parameters with activity that warrant
termination are: diastolic blood pressure of 110 mm Hg or greater, systolic blood pressure above 210
mm Hg or an increase greater than 20 mm Hg from resting and a heart rate that increases beyond 20
beats per minute above resting. The normal resting respiratory rate can range between 121 to 20
breaths per minute in adults, so an increase to 20 breaths per minute with low- level activity would not
be a reason to terminate the activity.
178. B. Because this patient has significant weakness in (B) 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 be enhancing the patients functional skills. The most appropriate transfer method would be for the
patient to use a sliding board transfer to her strongest side.
179. C. These are signs of autonomic dysreflexia. Among the most common cause is a distended or
irritated bladder. The FIRST step is to remove the noxious stimulus.
180. B. 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.
181. B. Massaging the upper arm before the forearm helps reduce the proximal resistance of lymphatic
flow, which will optimize the flow of fluid or edema from the distal areas. This has been referred to as
the uncorking effect. Local heat would cause vasodilation & may increase edema. Massaging the
forearm would not allow the uncorking effect to occur. The massage strokes should be from distal
to proximal (centripetal) direction.
182. C. The use of posterior walker has been found to encourage a more upright posture during gait &
to promote better gait characteristics than does the use of an anterior walker. A standard walker ,
forearm crutches & bilateral quad canes all emphasize trunk & hip flexion, which is already increased
for this child.
183. C .If patients are skilled in falling, they are less likely to become injured during a fall. The pt
demonstrating or performing the task best understanding of a skill. To accomplish this, the pt should
be given a demonstration of proper falling technique & then the pt should be allowed to practice while
being guided & guarded by the therapist> Without first demonstrating & then allowing the pt to
 practice, the pt could be placed at risk for injury. Therefore, options a, b &d are not adequate to ensure
pt safety.
184. A. In order to cough effectively, the abdominal muscles must contract to expel air forcefully. This
pt does not have this ability; therefore manual force against the abdomen would mimic the action of
the abdominal muscles. The prone position would not assist the cough mechanism in this pt. Both
pursed-lipped breathing & interrupting the expiratory air stream would decrease the force of
exhalation & decrease cough effectiveness.
185. B. The seat width be slightly wider than the width of the widest body part, & the depth should
come to within 1 inch of the popliteal fossa.
186. A. HR & systolic BP responses are higher for any given workload when performed with the UE as
compared to the LE. Spinal motion does not create much stress on the cardiovascular system. The
quadriceps setting & diagonal patterns are performed with the LE & would produce less
cardiovascular stress.
187. D. There is normal, linear relationship between HR & exercise intensity in patients who are not on
beta-blocker medication or who are on non-rate responsive pacemakers. Therefore, teaching patients
to take their pulse reliably before discharge is important learning objective to ensure safety with
exercise upon discharge. Ascending a flight of stairs before discharge is only appropriate if the patient
needs to negotiate stairs at home, but not as important as pulse monitoring. Performing exercises
without angina can be achieve by monitoring HR with exercise; therefore, taking a pulse is necessary.
Returning to normal daily activity immediately after an MI is an unreasonable objective, as it will take
6 to 8 weeks for the myocardium to heal; therefore, activity levels will need to be tempered in order to
protect the heart while it is healing.
188. B. In order to facilitate transfers utilizing a sliding board, the pt will need both removable arm
rests & detachable swing-away leg rests. Fixed arm rests make sliding board transfers extremely
difficult & unsafe. Any other options would not be optimal for this particular pts needs.
189. B. The QRS complex represents ventricular contraction. Atrial contraction is represented by the
p wave. When an area of the ventricle becomes irritable & develops an ectopic foci, the ventricle
will depolarize prematurely before the normal conduction sequence (e.g., prior to SA node firing in
the atria) & presents a wide, irregularly shaped QRS complex. In normal ventricular depolarization,
the QRS would be narrow & regularly spaced & atrial fibrillation would appear as the p wave
changes. Atrial repolarization occurs within the QRS complex & is not normally visible on EKG.
190. B. Orthostatic hypotension from bed rest occurs as a result of decreased venous tone, which will
lead to a pooling of blood in the LE upon standing. The pooling of blood in the LE will reduce the
amount of blood returning to the heart decreasing ventricular filling & ultimately decreasing cardiac
output. This results in drop in BP with resultant dizziness. With pooling of blood in the LE, the
hydrostatic pressure would increase. To compensate for the decrease in CO, the sympathetic system
(not the parasympathetic) would stimulate the heart.
191. A. The stage of hemarthrosis will mean that there is still some bleeding into the joint space, but
not as extensively, therefore the pt will benefit from ROM exercise to prevent contracture. The pt may
need active-assist, as there may still be pain or edema in the joint that prevents independent
performance of ROM. The mechanical trauma of weight bearing to tolerance at this stage may
impinge & damaged the pathologic synovium within the joint. Resistive ROM is more appropriate
when pain & swelling have subsided & no bleeding is occurring. Continuous immobilization in the
extended position will promote contracture in edematous knee.
192. C. All of the options, except for gentle, active exercises, are precautions or contraindications for
this patient.
193. B. Lateral epicondylitis is caused by overuse of wrist extensors that originate on the lateral
epicondyle of the humerus, especially the ECRB. If the lateral epicondylitis is at a chronic stage,
conditioning of the extensor muscles & sustained grip activities will be most effective in long term
management. A forearm cuff is thought the muscle loading. Iontophoresis would not be appropriate
 for a home program. Friction massage of the brachioradialis would not be appropriate since the ECRB
muscle is usually the one affected.
194. B. Contacting the pts home nurse is the appropriate first course of action because of the possible
safety risk associated with the pt not taking their insulin. Injections & glucose testing would go
beyond the scope of practice of PT. Placing the responsibility on the family would not be appropriate
because of the gravity of the situation.
195. A. The sitting position promotes visual attending, use of the UE, & social interaction. A child who
exhibits extensor posturing should be carried in a symmetric position that does not allow axial
hyperextension & keeps the hips & knees flexed.
196. C. ES for patients with demand-type pacemakers is often listed as contraindication. However, even
though it is often listed as contraindication in textbooks, research studies apparently have not
substantiated the suspected risks. Nonetheless, it should only be applied with caution & close
supervision in these patients. Exercise, unless very strenuous, would be indicated in this pt.
Biofeedback introduces no electrical signals into the body & therefore would not be contraindicated.
197. C. Sensory inputs such as intermittent music & touching the face, rocking the pt rapidly &
brightening the room elicit arousal. When a child becomes agitated & confused, it is appropriate
reduce the general amount of environment stimulation. Decreasing auditory & visual activity in the
room may help the child focus.
198. D. Isolated contraction of the SCM muscle would cause the head to rotate to the L & side bend
(lateral flexion) to the . To stretch the muscle, the opposite actions would be performed on the pt by
the therapist: rotation of the head to the & lateral flexion to the L.
199. B. Caution should be used in patients who are taking tetracycline, because the drug will enhance
the effects of ultraviolet radiation. Ultraviolet is not contraindicated in these patients, however the
dosage of the ultraviolet would probably have to be adjusted to some lower level. The penicillin
allergy, calcium supplements & metal implants would not be affected by the ultraviolet light. It should
be noted that although UV radiation therapy is not common in todays practice of PT, therapist should
nonetheless be aware of the precautions; & be able to advise patients who maybe using UV radiation
at home.
200. C. The position described creates the necessary force to move the lower body in this transfer given
the level of SCI. Finger extension against resistance would be difficult for a pt with C6 quadriplegia.
The pts hands would be kept near the thigh or hips with one hand on the mat & one on the
wheelchair.