NPTE EXAM 2 QUESTIONS AND ANSWERS
During the initial screening of a patient, the physical therapist notes contusions in
various states of healing on the chest, back, and face, as well as multiple scars. The
patient reports falling often. Which of the following courses of action should the therapist
take FIRST?
1. Take the patient's dietary history to assess for mineral deficiency.
2. Ask the patient if bruising was caused by being hit, kicked, or abused.
3. Instruct the patient in safe movement patterns to avoid falls.
4. Report the patient's caregivers to the appropriate authorities. - Answers - 2. Ask the
patient if bruising was caused by being hit, kicked, or abused.
Multiple lesions in various stages of healing in a broad number of areas is a sign of
possible abuse. In the interest of patient protection, the issue should be pursued,
because the patient may not be forthcoming with an admission that abuse has taken
place.
A patient has the deformity shown in the photograph. Which of the following shoe
modifications is MOST likely to be beneficial for this patient?
1. High toe box
2. Metatarsal pad
3. Rocker bar
4. Metatarsal bar - Answers - 1. High toe box
Rationale
1. The photograph depicts a hammer toe (p. 1003). A high toe box would allow space
for the hammer toe and would decrease irritation (pp. 1289, 1292).
2. A metatarsal pad transfers stress from the metatarsal heads to the metatarsal shafts,
reducing plantar pressure (p. 1290). The photograph shows pressure on the dorsum of
the hammer toe, which would not be relieved by a metatarsal pad.
3. Rocker bars affix to the sole of the shoe proximal to the metatarsal heads to reduce
the distance the patient travels during stance phase and to shift the load from the
metatarsophalangeal joints to the metatarsal shaft (pp. 1291-1292). The photograph
shows pressure on the dorsum of the hammer toe, which would not be relieved by a
rocker bar.
4. A metatarsal bar is placed posterior to the metatarsal heads on the sole of a shoe to
assist in transferring stress from the metatarsophalangeal joints to the metatarsal shafts
during late stance (p. 1292). The photograph shows pressure on the dorsum of the
hammer toe, which would not be relieved by a metatarsal bar.
A patient reports significant hypersensitivity to light touch in the left foot and ankle
region following minor trauma. A physical therapist notes warmth, swelling, and redness
over the entire foot and ankle. Which of the following interventions is MOST
appropriate?
,1. Continuous ultrasound
2. Gait training, non-weight-bearing on the left
3. Deep friction massage
4. Progressive weight-bearing activities - Answers - 4. Progressive weight-bearing
activities
Rationale
1. The apparent diagnosis is complex regional pain syndrome type I, or reflex
sympathetic dystrophy (p. 410). Patients who have complex regional pain syndrome
often have hypersensitivity to heat and/or cold and, therefore, would not likely tolerate
use of thermal modalities such as continuous ultrasound (p. 412).
2. The apparent diagnosis is complex regional pain syndrome type I, or reflex
sympathetic dystrophy (p. 410). Non-weight-bearing gait would promote more swelling
due to disuse of the muscle pump (p. 412).
3. The apparent diagnosis is complex regional pain syndrome type I, or reflex
sympathetic dystrophy (p. 410). Retrograde massage is recommended in complex
regional pain syndrome; deep friction massage may increase edema (p. 412).
4. The apparent diagnosis is complex regional pain syndrome type I, or reflex
sympathetic dystrophy (p. 410). Range of motion and therapeutic exercises (including
weight-bearing exercises) may encourage a decrease in sympathetic tone, enhance
circulation, help to maintain range of motion and strength, and increase functional use
of the extremity (p. 412).
A patient reports an insidious onset of swelling of 1 month's duration on the dorsum of
the left foot. Which of the following conditions is the MOST likely cause?
1. Heart failure
2. Chronic venous insufficiency
3. Lymphedema
4. Lipedema - Answers - 3. Lymphedema
1. Dependent edema is one of the early signs of right-sided heart failure. The edema is
usually symmetric and occurs in the feet and ankles (Goodman, Differential Diagnosis;
Goodman, Pathology, pp. 591-592).
2. Edema associated with chronic venous insufficiency usually presents in a gaiter
distribution creating the appearance of an inverted bottle at the calf. Acute onset of
swelling at the dorsum of the foot, as described in the stem, is not typical of chronic
venous changes. (Goodman, Pathology, pp. 655-656)
3. Lymphedema is usually unilateral with typical presentation distally on the extremity
(dorsum of the foot or hand) (Goodman, Differential Diagnosis; Goodman, Pathology,
pp. 680-682).
4. Lipedema is a symmetrical swelling of both legs, extending from hips to ankles.
Lipedema onset is primarily proximal to distal. (Goodman, Pathology, pp. 702-704).
A patient maintains the posture shown in the photograph throughout the gait cycle and
reports a sense of numbness in both legs when walking. The MOST probable
explanation for this posture is that the patient is:
,1. using the trunk position to advance the lower extremity.
2. unable to disassociate trunk movements from pelvic or limb movement.
3. attempting to decrease the demand on the hip extensors.
4. substituting visual input for impaired proprioception in the lower extremities. -
Answers - 4. substituting visual input for impaired proprioception in the lower
extremities.
1. A backward trunk lean, not forward, is associated with compensations to advance the
lower extremity (pp. 1008-1009).
2. Walking in a forward leaning posture does not require disassociation of trunk
movements from the pelvis or lower extremities (p. 1007).
3. Hip extensors are less in demand when leaning backward, not forward. With weak
hip extensors, the trunk would be displaced posteriorly relative to the lower extremities.
(pp. 1008-1009)
4. The patient leans forward to improve stability in the forward progression in gait. In
addition, the head is flexed and held with a downward gaze because the patient is
relying on visual input due to decreased sensory input. (pp. 1006-1007)
Changes in the level of which hormone are MOST likely to contribute to development of
chondromalacia patella in a pregnant woman?
1. Calcitonin
2. Progesterone
3. Relaxin
4. Insulin - Answers - 3. Relaxin
1. The role of calcitonin is to decrease plasma calcium concentration. There are no
receptors on tendons that would alter their function in any way in response to changes
in calcitonin levels. Calcitonin should not alter the way muscles and bones interact in a
way that would cause chondromalacia, because any calcium changes in the muscle will
occur in every muscle, so no imbalance should occur. (pp. 1012-1013)
2. The hormone progesterone is secreted by the placenta during pregnancy and has no
known action on tendon laxity. It would not alter the way muscles and bones interact in
a way that would cause chondromalacia. (p. 1061)
3. Chondromalacia is a roughening of the cartilage behind the kneecap, and relaxin
causes an increase in tendon and ligament laxity, exacerbating any friction between the
patella and the femur (p. 1062).
4. Insulin promotes glucose uptake. Although insulin receptors are found in most
tissues, any insulin changes in the muscle or tendon will occur in every muscle or
tendon, so no imbalance should occur in the interaction of muscles and bones such that
chondromalacia would develop. (pp. 988-989)
A physical therapist is reviewing the laboratory report of a patient who received a
diagnosis of pneumonia 2 weeks ago. The patient's white blood cell count is currently
9,000 cells/mm3. Which of the following conditions does this value indicate for the
patient?
1. Anemia
, 2. Development of leukocytosis
3. Immunosuppression
4. Resolution of the pneumonia infection - Answers - 4. Resolution of the pneumonia
infection
1. Anemia would be diagnosed from iron and hemoglobin levels.
2. Leukocytosis is a total white blood cell count of greater than 11,000-15,000/mm3
(above normal range).
3. Immunosuppression causes leukopenia, which is a white blood cell count less than
4000/mm3.
4. The patient's white blood cell count is within the normal range of 4500-11,000/mm3,
so the infection has resolved.
Which of the following fall prevention strategies is MOST appropriate for a resident of a
nursing home who has dementia, poor balance, and often wanders?
1. Place the patient in bed, with the side-rails up and secured.
2. Place the patient in a wheelchair with a seat belt that the patient is unable to remove
independently.
3. Seat the patient in a geriatric recliner to reduce the likelihood of wandering.
4. Use an electronic monitor that will remotely alert staff when the patient gets out of
bed. - Answers - 4. Use an electronic monitor that will remotely alert staff when the
patient gets out of bed.
1. The use of side-rails is a restraint. Their use on the bed of a mobile person may lead
to a number of negative consequences, such as increasing the distance the patient
could fall from the bed, creating an obstruction of vision, and creating a sense of being
trapped. The use of side-rails with a patient who has dementia is a restraint and
requires a physician's order.
2. Lap cushions, trays, and seat belts are considered restraints if the patient is unable to
remove them independently.
3. Geriatric recliners are considered restraints when they restrict a patient's normal
mobility.
4. The use of restraints has become a concern for nursing home caregivers, who must
comply with Medicare guidelines and foster prevention of elder abuse. An electronic
monitoring device is not a restraint. This option would facilitate safety through improved
supervision and would allow the patient to maintain functional mobility.
One day after lumbar laminectomy surgery, a patient refuses to wear a
thoracolumbosacral orthosis because of a painful and itching rash that extends in a
narrow path from the central low back along the iliac crest to the right lateral trunk.
Which of the following conditions is MOST likely present?
1. Herpes zoster
2. Infected surgical incision
3. Contact dermatitis
4. Allergic response to medication - Answers - 1. Herpes zoster
During the initial screening of a patient, the physical therapist notes contusions in
various states of healing on the chest, back, and face, as well as multiple scars. The
patient reports falling often. Which of the following courses of action should the therapist
take FIRST?
1. Take the patient's dietary history to assess for mineral deficiency.
2. Ask the patient if bruising was caused by being hit, kicked, or abused.
3. Instruct the patient in safe movement patterns to avoid falls.
4. Report the patient's caregivers to the appropriate authorities. - Answers - 2. Ask the
patient if bruising was caused by being hit, kicked, or abused.
Multiple lesions in various stages of healing in a broad number of areas is a sign of
possible abuse. In the interest of patient protection, the issue should be pursued,
because the patient may not be forthcoming with an admission that abuse has taken
place.
A patient has the deformity shown in the photograph. Which of the following shoe
modifications is MOST likely to be beneficial for this patient?
1. High toe box
2. Metatarsal pad
3. Rocker bar
4. Metatarsal bar - Answers - 1. High toe box
Rationale
1. The photograph depicts a hammer toe (p. 1003). A high toe box would allow space
for the hammer toe and would decrease irritation (pp. 1289, 1292).
2. A metatarsal pad transfers stress from the metatarsal heads to the metatarsal shafts,
reducing plantar pressure (p. 1290). The photograph shows pressure on the dorsum of
the hammer toe, which would not be relieved by a metatarsal pad.
3. Rocker bars affix to the sole of the shoe proximal to the metatarsal heads to reduce
the distance the patient travels during stance phase and to shift the load from the
metatarsophalangeal joints to the metatarsal shaft (pp. 1291-1292). The photograph
shows pressure on the dorsum of the hammer toe, which would not be relieved by a
rocker bar.
4. A metatarsal bar is placed posterior to the metatarsal heads on the sole of a shoe to
assist in transferring stress from the metatarsophalangeal joints to the metatarsal shafts
during late stance (p. 1292). The photograph shows pressure on the dorsum of the
hammer toe, which would not be relieved by a metatarsal bar.
A patient reports significant hypersensitivity to light touch in the left foot and ankle
region following minor trauma. A physical therapist notes warmth, swelling, and redness
over the entire foot and ankle. Which of the following interventions is MOST
appropriate?
,1. Continuous ultrasound
2. Gait training, non-weight-bearing on the left
3. Deep friction massage
4. Progressive weight-bearing activities - Answers - 4. Progressive weight-bearing
activities
Rationale
1. The apparent diagnosis is complex regional pain syndrome type I, or reflex
sympathetic dystrophy (p. 410). Patients who have complex regional pain syndrome
often have hypersensitivity to heat and/or cold and, therefore, would not likely tolerate
use of thermal modalities such as continuous ultrasound (p. 412).
2. The apparent diagnosis is complex regional pain syndrome type I, or reflex
sympathetic dystrophy (p. 410). Non-weight-bearing gait would promote more swelling
due to disuse of the muscle pump (p. 412).
3. The apparent diagnosis is complex regional pain syndrome type I, or reflex
sympathetic dystrophy (p. 410). Retrograde massage is recommended in complex
regional pain syndrome; deep friction massage may increase edema (p. 412).
4. The apparent diagnosis is complex regional pain syndrome type I, or reflex
sympathetic dystrophy (p. 410). Range of motion and therapeutic exercises (including
weight-bearing exercises) may encourage a decrease in sympathetic tone, enhance
circulation, help to maintain range of motion and strength, and increase functional use
of the extremity (p. 412).
A patient reports an insidious onset of swelling of 1 month's duration on the dorsum of
the left foot. Which of the following conditions is the MOST likely cause?
1. Heart failure
2. Chronic venous insufficiency
3. Lymphedema
4. Lipedema - Answers - 3. Lymphedema
1. Dependent edema is one of the early signs of right-sided heart failure. The edema is
usually symmetric and occurs in the feet and ankles (Goodman, Differential Diagnosis;
Goodman, Pathology, pp. 591-592).
2. Edema associated with chronic venous insufficiency usually presents in a gaiter
distribution creating the appearance of an inverted bottle at the calf. Acute onset of
swelling at the dorsum of the foot, as described in the stem, is not typical of chronic
venous changes. (Goodman, Pathology, pp. 655-656)
3. Lymphedema is usually unilateral with typical presentation distally on the extremity
(dorsum of the foot or hand) (Goodman, Differential Diagnosis; Goodman, Pathology,
pp. 680-682).
4. Lipedema is a symmetrical swelling of both legs, extending from hips to ankles.
Lipedema onset is primarily proximal to distal. (Goodman, Pathology, pp. 702-704).
A patient maintains the posture shown in the photograph throughout the gait cycle and
reports a sense of numbness in both legs when walking. The MOST probable
explanation for this posture is that the patient is:
,1. using the trunk position to advance the lower extremity.
2. unable to disassociate trunk movements from pelvic or limb movement.
3. attempting to decrease the demand on the hip extensors.
4. substituting visual input for impaired proprioception in the lower extremities. -
Answers - 4. substituting visual input for impaired proprioception in the lower
extremities.
1. A backward trunk lean, not forward, is associated with compensations to advance the
lower extremity (pp. 1008-1009).
2. Walking in a forward leaning posture does not require disassociation of trunk
movements from the pelvis or lower extremities (p. 1007).
3. Hip extensors are less in demand when leaning backward, not forward. With weak
hip extensors, the trunk would be displaced posteriorly relative to the lower extremities.
(pp. 1008-1009)
4. The patient leans forward to improve stability in the forward progression in gait. In
addition, the head is flexed and held with a downward gaze because the patient is
relying on visual input due to decreased sensory input. (pp. 1006-1007)
Changes in the level of which hormone are MOST likely to contribute to development of
chondromalacia patella in a pregnant woman?
1. Calcitonin
2. Progesterone
3. Relaxin
4. Insulin - Answers - 3. Relaxin
1. The role of calcitonin is to decrease plasma calcium concentration. There are no
receptors on tendons that would alter their function in any way in response to changes
in calcitonin levels. Calcitonin should not alter the way muscles and bones interact in a
way that would cause chondromalacia, because any calcium changes in the muscle will
occur in every muscle, so no imbalance should occur. (pp. 1012-1013)
2. The hormone progesterone is secreted by the placenta during pregnancy and has no
known action on tendon laxity. It would not alter the way muscles and bones interact in
a way that would cause chondromalacia. (p. 1061)
3. Chondromalacia is a roughening of the cartilage behind the kneecap, and relaxin
causes an increase in tendon and ligament laxity, exacerbating any friction between the
patella and the femur (p. 1062).
4. Insulin promotes glucose uptake. Although insulin receptors are found in most
tissues, any insulin changes in the muscle or tendon will occur in every muscle or
tendon, so no imbalance should occur in the interaction of muscles and bones such that
chondromalacia would develop. (pp. 988-989)
A physical therapist is reviewing the laboratory report of a patient who received a
diagnosis of pneumonia 2 weeks ago. The patient's white blood cell count is currently
9,000 cells/mm3. Which of the following conditions does this value indicate for the
patient?
1. Anemia
, 2. Development of leukocytosis
3. Immunosuppression
4. Resolution of the pneumonia infection - Answers - 4. Resolution of the pneumonia
infection
1. Anemia would be diagnosed from iron and hemoglobin levels.
2. Leukocytosis is a total white blood cell count of greater than 11,000-15,000/mm3
(above normal range).
3. Immunosuppression causes leukopenia, which is a white blood cell count less than
4000/mm3.
4. The patient's white blood cell count is within the normal range of 4500-11,000/mm3,
so the infection has resolved.
Which of the following fall prevention strategies is MOST appropriate for a resident of a
nursing home who has dementia, poor balance, and often wanders?
1. Place the patient in bed, with the side-rails up and secured.
2. Place the patient in a wheelchair with a seat belt that the patient is unable to remove
independently.
3. Seat the patient in a geriatric recliner to reduce the likelihood of wandering.
4. Use an electronic monitor that will remotely alert staff when the patient gets out of
bed. - Answers - 4. Use an electronic monitor that will remotely alert staff when the
patient gets out of bed.
1. The use of side-rails is a restraint. Their use on the bed of a mobile person may lead
to a number of negative consequences, such as increasing the distance the patient
could fall from the bed, creating an obstruction of vision, and creating a sense of being
trapped. The use of side-rails with a patient who has dementia is a restraint and
requires a physician's order.
2. Lap cushions, trays, and seat belts are considered restraints if the patient is unable to
remove them independently.
3. Geriatric recliners are considered restraints when they restrict a patient's normal
mobility.
4. The use of restraints has become a concern for nursing home caregivers, who must
comply with Medicare guidelines and foster prevention of elder abuse. An electronic
monitoring device is not a restraint. This option would facilitate safety through improved
supervision and would allow the patient to maintain functional mobility.
One day after lumbar laminectomy surgery, a patient refuses to wear a
thoracolumbosacral orthosis because of a painful and itching rash that extends in a
narrow path from the central low back along the iliac crest to the right lateral trunk.
Which of the following conditions is MOST likely present?
1. Herpes zoster
2. Infected surgical incision
3. Contact dermatitis
4. Allergic response to medication - Answers - 1. Herpes zoster
