Fundamental Orthopedic Management for the Physical Therapist Assistant, 4th Edition Test Bank

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Chapter 01: Patient Supervision and Observation During TreatmentMULTIPLE CHOICE1.Who is responsible for carrying out prescribed selected interventions, patient supervision, datacollection, and appropriate supervision of a patient during physical therapy?a.Physical therapist (PT)b.Physical therapist assistant (PTA)c.Nursing assistantd.Medical doctorANS:BThe PTA is responsible for carrying out prescribed selected interventions, patient supervision,data collection skills, and appropriate problem-solving and clinical decision making.REF:P. 32.Which of the following is NOT a purpose of the clinical patient supervision process?a.To gather relevant information and datab.To establish and enhance rapport, trust, and confidencec.To prescribe interventions the patient requiresd.To assist in the management of the patientANS:CPTAs do not prescribe interventions for the patient. The PTA observes, documents, anddiscusses patient observations with the PT.REF:P. 43.Select the open-ended question.a.What is your pain level today on a scale of 1-10?b.When did the pain begin?c.Tell me about the time that you injured knee.d.When did you take your last pain medication?ANS:CThe open-ended question leads the patient to say more than yes or no. Open-ended questionsprovide much richer details about the incident or experience.REF:P. 64.Which of the following statements is true regarding the working environment of PTAs?a.PTAs work in isolation with their patient assignments.b.PTAs work with a team of experts in all areas of a patient’s care.c.PTAs work only with the PT in providing therapy.d.PTAs are the most important people on the rehabilitation team when providingtherapy.ANS:B

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The PTA must be aware of the key members of the rehabilitation team. Occupationaltherapists, PTs, nurses, respiratory therapists, psychologists, and audiologists are only a few ofthe important members of the rehabilitation team. The PTA does not work in isolation.REF:P. 45.Which of the following statements would be used in a discussion with a patient?a.Your blood pressure is 150/90, which indicates hypertension and could lead to acerebral vascular accident if you don’t take your medications.b.Your blood pressure is higher than normal today, 150/90. Did you take your bloodpressure medication this morning?c.The doctor prescribed a beta-blocker for you a month ago. Has that been helpingyour blood pressure?d.The combination of your calcium-channel blocker and beta-blocker do not seem tobe controlling your blood pressure. Let’s call the doctor.ANS:BThe PTA should learn to communicate openly, freely, and in a professional manner. The PTAmust employ appropriate and professional medical terminology with professional people—butuse familiar (lay) terms to describe the same condition to a patient or a family member.Avoiding the use of medical jargon (hypertension, beta-blocker, calcium-channel blocker)with patients is required by PTAs.REF:P. 46.How can a PTA demonstrate accountability in their practice?a.Maintain timely documentation about patient interventions.b.Maintain good rapport with patients.c.Continue their education past their initial degree.d.Report all findings to the supervising PT so that modifications can be made inresponse to changes in patient status.ANS:DPTAs are responsible for reporting all findings to the supervising PT so that modifications canbe made in accordance with changes in patient status.REF:P. 67.Which type of questioning would you use to find facts or obtain specific responses from apatient about an injury to a limb or joint?a.Open-ended questionsb.Closed-ended questionsc.A paused.Neutral phraseANS:BFigure 1-1. Closed-ended questions are used to find out specific details, direct the discussion,or elicit specific responses from the patient.REF:P. 88.Which of the following is an example of prompting during a physical therapy session?

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a.“When you walk up the steps, which foot will you move first?”b.“All right, now pick up your right foot and put it on the next step.”c.Point to the step and touch the patient’s right leg.d.Observe the behavior of the patient to see if they will lift up the correct foot whilewalking up the steps.ANS:APrompting a patient to perform a task can be viewed as the presentation of a question.Prompting allows patients to decipher information, solve problems, and provide solutions toactivities they must overcome during recovery. Cues are directions.REF:P. 99.Who holds the ultimate responsibility for the patient’s physical therapy?a.PTAb.Medical doctorc.Nursed.PTANS:DTo minimize the confusing array of treatment protocols, the PTA must effectively andefficiently communicate with the supervising PT to clarify differences in patient care, alwaysremembering that the PT has the ultimate responsibility for the interventions provided.REF:P. 1010.Which of the following actions should you take if you have a disagreement with the PT?a.Refuse to provide the treatment or intervention on the PT’s plan of care.b.Change the treatment for the day and then report to the PT what was done at theend of the day.c.Follow the plan of care no matter what changes are observed in the patient anddocument later.d.Discuss your findings and rationale with the PT to learn and provide better care.ANS:DA full understanding of the rationale and purpose of PT interventions allows forimproveddelivery of care and safe and effective care. PTAs cannot change the plan of care bythemselves.REF:P. 1011.What type of behavior is the PTA using in the following example?The PTA quickly agrees to the patient’s request to slow down and stop the treatment for theday instead of discussing the purpose and benefits of the treatment.a.Dominanceb.Submissionc.Hostilityd.WarmthANS:B

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Figure 1-2. Submission is defined as being passive. People who show submissive behavior arewilling to take a back seat and are quick to comply and reluctant to try to exert influence.REF:P. 812.What type of behavior is the PTA using in the following example?The PT insists the patient continue treatment for the full time limit even when the tearfulpatient reports a fear of continuing exercise of a particular joint.a.Dominanceb.Submissionc.Hostilityd.WarmthANS:CA dominant PTA would try to sway the patient to think or behave in a certain way. In thisexample, the PTA ignores the patient’s complaints and feelings and continues with thetreatment.REF:P. 813.In the basic dimensional model, which behaviors would be seen in a warm but submissiveperson?a.Stubborn, argumentativeb.Sincere, open, candid, responsivec.Talks little, doesn’t listen welld.Appeases; compromise leads to lack of focusANS:DFigure 1-3, B. The submissive-warm person demonstrates a lack of organization, appeasingbehavior, and compromises.REF:P. 814.In the basic dimensional model, which behaviors would be seen in a dominant-hostile person?a.Stubborn and argumentativeb.Sincere, open, candid, responsivec.Talks little and doesn’t listen welld.Appeases; compromise leads to lack of focusANS:AFigure 1-3, B. The dominant-hostile person would be stubborn and argumentative, takingfixed positions and sticking to them, talking a lot rather than listening, and being pushy andarrogant.REF:P. 815.In the basic dimensional model, which behaviors would be seen in a dominant-warm person?a.Stubborn and argumentativeb.Sincere, open, candid, responsivec.Talks little and doesn’t listen welld.Appeases; compromise leads to lack of focus

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ANS:BFigure 1-3, B. The dominant-warm person is sincere, open, and candid; listens; isopen-minded and flexible.REF:P. 816.In the basic dimensional model, which behaviors would be seen in a submissive-hostileperson?a.Talks a lot rather than listens and is belligerent.b.Sincere, open, candid, responsivec.Talks little and doesn’t listen well and avoids issuesd.Appeases; compromise leads to lack of focusANS:CFigure 1-3, B. The submissive-hostile person talks little, doesn’t listen well, avoids or ignoresissues, is uninvolved, quiet, and backs down easily.REF:P. 817.When can a PTA adjust or modify a program of treatment?a.When the PTA observes certain signs and symptoms in the patient.b.After seeking input and direction from the supervising PT.c.The PTA cannot ever change the plan of care.d.None of the above.ANS:BThe PTA, with direction and input from the supervising PT, can adjust or modify the programof treatment.REF:P. 918.The PTA’s clinical decision-making process should begin witha.taking orderly and specific steps to notify the supervising PT.b.recognizing that a problem exists.c.adjusting the program according to the patient’s needs.d.asking the PT to assess the patient.ANS:BThe clinical decision-making process used by the PTA involves recognizing that a problemexists, then taking orderly and specific steps to notify the supervising PT and adjusting theprogram accordingly.REF:P. 919.Which of the following behaviors exemplifies a well-adapted PTA?a.Constantly asks about the rationale for treatmentb.Establishes themselves as an eager learnerc.Is open to innovative ways of managing various pathologic conditionsd.All of the aboveANS:D

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The well-adapted PTA views any apparent roadblocks as learning opportunities. The PTA isadvised to take advantage of the broad knowledge and experience of manyPTs, constantlyinquire about the rationale and scientific basis for a particular program, and establish him-orherself as an eager learning participant who is open to innovative ways of managing variouspathologic conditions.REF:P. 1020.Why do PTAs and PTs use general scales of measurement?a.To standardize assessment and more accurately measure patient progressb.To shorten the amount of time needed to document the patient’s conditionc.To demonstrate knowledge of medical terminologyd.None of the aboveANS:AGeneral scales are used to standardize assessment and more accurately measure patientprogress.REF:P. 4

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Chapter 02: The Role of the Physical Therapist Assistant in Physical AssessmentMULTIPLE CHOICE1.Which health care provider is defined as “a technically educated health care provider whoassists the physical therapist in the provision of select PT interventions?”a.Physical therapist assistant (PTA)b.Physical therapist (PT)c.Nursing assistantd.Medical doctorANS:AThis is the definition of the PTA as defined by theGuide to Physical Therapy Practice(2ndEd.).REF:P. 142.Which of the following is the responsibility of the PT alone?a.Observationb.Assessmentc.Examinationd.EvaluationANS:DEvaluation is the specific process reserved solely for the PT, in which clinical judgments aremade from this base of data obtained during the examination.REF:P. 143.Which of the following statements is NOT included in the Clinical Performance Instrument(CPI) by the American Physical Therapy Association (APTA) related to the PTA’s role?a.Participates in patient status judgments within the clinical environment based onthe plan of care established by the PT.b.Obtains accurate information by performing selected data collection consistentwith the plan of care established by the PT.c.Discusses the need for modifications to the plan of care established by the PT.d.Makes clinical judgments based on the assessment and examination of the patient.ANS:DIt is the role of the PT to make clinical judgments based on the assessment and examination ofthe patient.REF:P. 144.In theNormative Model of PTA Education(2007), which of the following is NOT an expectedperformance theme?a.Interventionsb.Communicationc.Diagnosisd.Resource management

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ANS:CDiagnosis is not one of the five PT performance expectation themes for PTA education. Thefive include interventions, communication, education, resource management, and careerdevelopment.REF:P. 155.Which of the following contains the cardinal signs of inflammation?a.Swelling, pallor, cool skin temperatureb.Swelling, pain, redness, heatc.Fever, pain, redness, and warmthd.Pain, fever, cool skin temperatureANS:BThe commonlyaccepted and normal cardinal signs and symptoms of inflammation arelocalized heat, redness, swelling, and pain (with a resultant loss of function in the injuredarea).REF:P. 156.How long does acute inflammation last, assuming the precipitating condition, agent, or eventis removed?a.12-24 hoursb.1-2 daysc.3-5 daysd.4-6 daysANS:DUnder normal circumstances, signs of acute inflammation persist for 4-6 days, assuming theprecipitating condition, agent, or event is removed.REF:P. 167.When is pain from acute inflammation felt by the patient during range of motion (ROM)exercises?a.Before tissue resistance (before “end” ROM)b.At the same time end ROM is reachedc.After ROM exercises are overd.Never felt by the patient during ROMANS:APain before tissue resistance felt before “end” ROM is an indication of acute inflammation.Pain at the same time end ROM is reached is an indication of a subacute inflammatory state.Pain reported as a stretching sensation at the limit of ROM is a sign of inflammation in thechronic state.REF:P. 168.Which of the following reports of pain is indicative of chronic inflammation?a.Pain reported before tissue resistance (before “end” ROM)b.Pain reported as a stretching sensation at the limit of ROMc.Pain reported at the same time ROM is reached

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d.Pain is not seen with chronic inflammationANS:BPain before tissue resistance felt before “end”ROM is an indication of acute inflammation.Pain at the same time end ROM is reached is an indication of a subacute inflammatory state.Pain reported as a “stretching sensation” at the limit of ROM is a sign of inflammation in thechronic state.REF:P. 169.Your patient has an oral temperature of 101.6°F. Which other signs and symptoms will youlook for in your patient assessment?a.General malaise and increased pulseb.Strong appetite and dry skinc.Decreased pulse and respirationsd.Paleness in the affected jointANS:AThe clinical signs and symptoms of fever vary based on the underlying cause andstage; theymight include general malaise, headache, increased pulse and respirations, general chills,shivering, piloerection, loss of appetite, pale skin, nausea, irritability, and restlessness.REF:P. 1610.Which is themost effective means of controlling the transmission of infectious agents?a.Isolating infected patientsb.Hand washing by the caregiver and patientc.Disinfecting treatment areas routinelyd.B and CANS:DThe importance of hand washing by the caregiver and patient cannot be overstated as aneffective means of controlling the transmission of infectious agents. In addition, treatmentareas should be properly cleaned and disinfected as a routine procedure.REF:P. 1611.Which of the following actions would be considered discretionary caution by the PTA whenperforming pool ROM exercises with a patient experiencing a fever of 102.8°F?a.Notify the PT and ask to omit the exercises until the fever resolves.b.Continue with the prescribed walking activities.c.Omit therapy during times the patient has a fever.d.Increase the walking exercises to help break or resolve the fever.ANS:ADiscretionary caution is applied with any patient with a fever, because of stresses on thecardiopulmonary and immune systems and the possible further complications related todehydration. The PTA should be familiar with specific exercise techniques contraindicated inthe presence of diseases transmitted via water or air.REF:P. 17

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12.Which type of redness indicates acute inflammation caused by a bacterial infection?a.Superficial tenderness or hardness of the areab.Red streaksc.Flushed cheeksd.None of the aboveANS:BRed streaks might indicate an acute inflammation caused by a bacterial infection (strep, staph,or both). Superficial tenderness or hardness in an area may be a sign of superficialthrombophlebitis.REF:P. 1813.What technique would you use to assess deep vein thrombosis (DVT)?a.Patient sits in a comfortable position and lifts knee to chest.b.Patient points toes toward the floor and reports any pain in the thigh area.c.Patient points toes upward (dorsiflex) for assessment of pain in the calf.d.Patient holds foot in neutral position and you squeeze the calf.ANS:CA commonly used quick assessment technique to rule out the presence of a DVT is theHoman sign. It is performed by gentle passive stretching of the ankle into full dorsiflexion andassessing for pain in the calf.REF:P. 1814.What are the risk factors for DVT?a.Prolonged bed rest or prolonged air travelb.Varicose veins, fractures, and age under 60c.Oral contraceptive use and high cholesterol leveld.Obesity and fallingANS:ABox 2-1. Risk factors for DVT. Prolonged bed rest and air travel are risk factors. Items listedthat are not risk factors are age under 60, high cholesterol level, and falling.REF:P. 1815.Which term is defined as the excessive pooling of fluid in the spaces between tissues(interstitial spaces)?a.Fractureb.Infectionc.Edemad.HemorrhageANS:CEdema refers to excessive pooling of fluid in the spaces between tissues (interstitial spaces).The main consideration for the PTA is measurement of the edematous part or extremity.REF:P. 1916.Which signs and symptoms would be seen with congestive heart failure (CHF)?

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a.Swelling in one ankle without a change in breathing or muscle strengthb.Swelling in both ankles with fatigue and shortness of breathc.No swelling in either ankle, but fatigue and normal respirationsd.Weakness without a change in respirationsANS:BBilateral pitting edema in the distal lower extremities is a common manifestation in CHF.Other signs include a decreasein tolerance to exercise (fatigue, shortness of breath, andmuscle weakness). These symptoms need prompt consultation with the supervising PT.REF:P. 1917.Which of the following is the PTA’s best response to a patient reporting new pain since thelast therapy session?a.“Well, some pain is to be expected after our therapy sessions”b.“Really? I didn’t think the last session was that difficult for you”c.“That pain is normal and should be expected. Take your pain medication beforeand after our therapy sessions and you should feel better”d.“Tell me about the pain, is it sharp or burning? When do you have the pain?”ANS:DThe PTA’s role in assessing pain is to gather data that present a clear picture of any change inpain since the last visit, and to elicit responses of the patient in terms of how interventions todate have affected pain, patterns of pain, and the characteristics of pain. All pain is considered“real” by the PTA and should be investigated and reported to the PT.REF:P. 2318.Which of the following are the signs and symptoms of a heart attack?a.Pain or pressure under the breastbone, neck or jaw with pain in the left arm andshoulderb.Indigestion and pain in the lower abdomen after exercisec.Pain between the shoulder blades and the inside of the left or right armsd.A and CANS:DFigure 2-6. Early warning signs of a heart attack. Indigestion and pain in the lower abdomenare not warning signs of a heart attack.REF:P. 2419.What should a PTA do when a patient experiences “red flag” pain symptoms during therapy?a.Call the doctor immediately and report the painb.Continue the therapy session using cautionc.Stop any intervention that could be contraindicated and report the findings to thePTd.Ask the patient when he had his last pain medication and contact the nurse todeliver a pain medicationANS:C

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The PTA must be keenly aware of pain that sends a “red flag” signal. The PTA should notproceed with any interventions or data collection techniques that are potentiallycontraindicated and should immediately report the findings to the supervising PT.REF:P. 2320.Which symptoms are exhibited during intermittent claudication?a.Bilateral pain in the calves or thighs described as cramping that goes away withrestb.Unilateral pain in one calf described as cramping that goes away after walkingc.Bilateral pain in calves or thighs that goes away with walkingd.Unilateral pain in buttocks or thighs that worsens when the patient restsANS:AIt is typically described as aching or cramping that is localized in the regionaffected by theimpaired circulation (calves, thighs, buttocks bilaterally) and is rapidly improved after theaggravating activity is discontinued (such as after resting).REF:P. 23

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Chapter 03: Differential Diagnosis and Emergent ConditionsMULTIPLE CHOICE1.The process of providing a label that correlates specific signs and symptoms to an identifiabledisease or disorder is:a.evaluation.b.diagnosis.c.consideration.d.prognosis.ANS:BMultiple sources have used this definition of diagnosis.REF:P. 382.The process of comparing and contrasting patient data points with the goal of appropriateexclusion and inclusion that terminate with the development of intervention strategies is:a.examination.b.prognosis.c.intervention.d.differential diagnosis.ANS:DExamination is the use of tests and measures to screen the patient. Prognosis isthe predictionof outcomes. Intervention is the action taken by the physical therapist (PT) or physicaltherapist assistant (PTA) to resolve the patient’s problem. Differential diagnosis is the processof using patient data to develop intervention strategies.REF:P. 393.What is the term for a comprehensive screening of the patient that includes specific tests andmeasures?a.Examinationb.Prognosisc.Interventiond.Differential diagnosisANS:AExamination is the use of tests and measures to screen the patient. Prognosis is the predictionof outcomes. Intervention is the action taken by the PT or PTA to resolve the patient’sproblem. Differential diagnosis is the process of using patient data to develop interventionstrategies.REF:P. 394.What is the term for a prediction of the outcome of the physical therapy episode of care withthe establishment of a plan of care (POC)?a.Examinationb.Prognosis

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c.Interventiond.Differential diagnosisANS:BExamination is the use of tests and measures to screen the patient. Prognosis is the predictionof outcomes. Intervention is the action taken by the PT or PTA to resolve the patient’sproblem. Differential diagnosis is the process of using patient data to develop interventionstrategies.REF:P. 415.Which of the following is not a minimum skill for a PTA?a.Collect data on patient’s current condition and compare results to previouslycollected datab.Communicate to the PT when there are significant changes in patient statusc.Develop the POCd.Use clinical problem solving skills to determine if the patient is safe andcomfortable with the interventionANS:CThe PT is responsible for the development of the POC. The PTA is expected to have all of theother skills listed (see Table 3-1).REF:P. 426.The PTA is expected to have which of the following basic assessment skills?a.Assessment of range of motionb.Ability to do manual muscle testingc.Proficiency in anthropometric measurementd.All of the aboveANS:DThe PTA is expected to be competent in all of the above skills.REF:P. 437.Which type of diagnosis emphasizes the influence of a disease or disorder on the patient’sfunctional status at the system level and on the interrelationship between the system and thepatient as a whole?a.Physical therapy diagnosisb.Medical diagnosisc.Nursing diagnosisd.Functional diagnosisANS:AA medical diagnosis labels a disease or disorder on a cellular, tissue, or organ level. Aphysical therapy diagnosis emphasizes the impact of the disorder on the patient’s functionalstatus.REF:P. 418.Which of the following is not true about vital signs?

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a.They provide an objective overview of the patient’s cardiopulmonary functionb.They may be influenced by exercise, disease, stress, and agec.Baseline vital signs data should be obtained prior to initiation of a POCd.During an episode of care, vital signs are no longer measured or usefulANS:DVital signs should be measured periodically during care. Altered vital signs mayindicate anadverse response to care and must be evaluated.REF:P. 489.What percentage of patients undergoing orthopedic surgery develops an infection?a.1%b.2-5%c.10%d.12-15%ANS:BTwo to five percent of patients undergoing orthopedic surgery develop an infection.REF:P. 4810.The signs and symptoms of redness, edema, pain, and increased skin temperature mayindicate:a.inflammation or infection.b.infection only.c.inflammation only.d.a prognosis.ANS:ABoth inflammation and infection may be indicated by redness, edema, pain, and increasedskin temperature. The health care team needs to evaluate these signs and symptoms todetermine if infection is present.REF:P. 4811.An abnormal response to musculoskeletal trauma that involves the excessive collection of redand white blood cells and fibrin resulting in a partial or complete occlusion of a vessel is:a.inflammation.b.tumor.c.venous thrombosis.d.tachycardia.ANS:CVenous thrombosis is caused when an excessive collection of white and red blood cells andfibrin occlude a blood vessel. If a deep vessel is involved, the thrombosis is referred to as adeep vein thrombosis (DVT).REF:P. 4812.DVT usually occurs in which location?a.Upper extremities

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