TEST BANK for Pierson and Fairchild’s Principles and Techniques of Patient Care 6th Edition by Sher by StudyGuide

TEST BANK: Pierson and Fairchild’s Principles and Techniques of Patient Care 6th Edition by Sheryl Fairchild, Roberta O'Shea. Chapter 01: Preparation Patient Care Activities MULTIPLE CHOICE 1. Which of the following is protected information under HIPAA’s Privacy Rule? A. Demographic data relating to the individual’s past, present, or future physical or mental health condition B. The provision of healthcare to the individual C. The past, present, or future payment for the provision of healthcare to the individual D. All of the above ANS: D All of the above are considered examples of individually identifiable health information. HIPAA’s Privacy Rule protects this information, allowing patients more access to it and more control over its use. PTS:

2. Which of the following describesTsE taS ndTaB rdApNroKcSedEuLreLsEtoRb.eCuO seMd for correcting a note in a handwritten medical record? A. Use correction fluid to completely cover the inaccurate note, and write the correction on the following line. B. Strike through the error with multiple lines of red ink, and provide a signature next to the correction. C. Draw a single line through the inaccurate information, making certain the material remains legible, and date and initial the correction. D. Write over the incorrect word or phrase to improve its legibility, or block out the information with a felt pen. ANS: C Careful and proper correction of an entry will help avoid accusations of tampering, changing the entry for self-serving reasons or intent, or capricious alteration of the medical record, especially if litigation is involved or being considered. When correcting a note, draw a single line through the inaccurate information, but be certain the material remains legible. Date and initial the correction, and add a note in the margin stating why the correction was necessary. Use black ink for all corrections and entries. PTS:

3. What information should be included in the setting of functional goals for a patient? A. All exercises expected to be used to achieve the functional outcome. B. The time frame, the need for assistance or equipment, the objective data to be

measured, and the desired functional outcome. C. Only the objective data to be measured, for the sake of brevity. D. The facility and all modalities expected to be used for treatment. ANS: B Goals of treatment should be established cooperatively with the patient and the caregiver. They must be stated in objective, measurable terms and should indicate who will perform the activity, by what means the goal will be accomplished, the need for equipment or assistance, the time frame in which to accomplish the goal, and the functional outcome expected. PTS:

4. Which of the following statements might a therapist avoid to facilitate appropriate communication with a patient who has a visual impairment? A. “Let’s go over the plan one step at a time.” B. “Did you hear about the big fire?” C. “I’ll see you later.” D. “I want you to walk through this sequence of exercises.” ANS: C Even the experienced caregiver may feel awkward or embarrassed when communicating with a person with a health condition, especially if an expression related to the impairment is used during the conversation. The expression about “seeing,” therefore, may be best Ri.llCreOcM avoided. In most instances the peT rsE onST wiBthAiN mKpS aiE rmLeLnE tw ognize these statements as expressions and components of the usual communication pattern, but you may want to consider how you can limit the use of such expressions. PTS:

5. Which of the following has been reported as a top reason for malpractice in the physical therapy setting? A. Failure to monitor B. Failure to empathize C. Failure to schedule appropriately D. Failure to provide pain relief ANS: A “Failure to monitor” (11.6 percent), “wrong procedure or treatment” (8.4 percent),”failure to supervise” (7.9 percent), and “improper management” (5 percent) were among the top reasons for malpractice reported in the physical therapy setting between 1991 and 2004. PTS:

6. Which entity routinely surveys facilities and has standards that deal with organizational quality of care issues and the safety of the environment in which care is provided? A. American Physical Therapy Association B. Joint Commission

C. World Health Organization D. Third-party payers ANS: B Joint Commission is a private, nonprofit organization whose purpose is to encourage the attainment of uniformly high standards of institutional medical care. The Joint Commission team currently surveys facilities using a “tracer methodology”: a survey team enters a facility, selects a number of patients, and follows the patients’ course throughout the facility. PTS:

7. What categories of information constitute the documentation of a SOAP note? A. Samples, obstacles, actions, progress B. Subjective, objective, actions, progress C. Samples, obstacles, assessment, plan D. Subjective, objective, assessment, plan ANS: D Information about the patient and the plan of care is contained in SOAP notes, which are written in the following format: subjective, objective, assessment, and plan. The SOAP notes should contain important, relevant information about the patient; they should indicate and clearly reflect the patient’s condition and subsequent changes in condition; and they should be written frequently so that information is reported promptly and regularly. PTS:

8. Which is true concerning nonverbal communication? A. It may be even more effective than verbal communication in some situations. B. It’s difficult to misinterpret. C. It does little to enhance the patient’s level of understanding. D. It’s most important when simple activities are being taught. ANS: A Non-verbal communication makes up the majority of human communication and may be even more effective than verbal communication; however, care must be taken to use it in an appropriate manner. For example, touch must be used in a therapeutic, caring way, and the caregiver must avoid any suggestion of sexual implications. PTS:

9. Which term is used to describe a dynamic process in which the practitioner makes clinical judgments based on gathered data and identifies problems pertinent to patient management? A. Assessment B. Examination C. Evaluation

D. Treatment ANS: C Evaluation is the dynamic process in which the practitioner makes clinical judgments based on data gathered during the assessment and examination. PTS:

10. What is stereognosis? A. The ability to recognize the form (shape) of an object by touch B. The ability to differentiate two blunt points when they are simultaneously applied to the skin C. The sense by which position, weight, and movement are perceived D. Sensation and awareness about the movements and position of body parts ANS: A Stereognosis refers to the ability to distinguish the form of an object by touch. For example, stereognosis allows a patient who is grasping a key with the eyes closed to distinguish the object as a key rather than a marble, pencil, or spoon. PTS:

11. What is the term used for a type of medical event during which no harm occurs either due to intervention by an individual or due to chance? A. Sentinel event B. Potential adverse event C. Active event D. Latent event ANS: B A potential adverse event, often referred to as a “close call” or a “near miss,” is one during which no harm occurs either due to intervention by an individual or due to chance. A sentinel event, on the other hand, is one during which an injury is caused due to the medical management process. PTS:

12. Which group of physiologic changes is commonly associated with aging? A. Altered visual acuity, loss of bone density, decreased balance B. Advanced wound healing, increased strength, increased tactile sense C. Altered mental capacity, increased proprioception, increased muscle elasticity D. Increased connective tissue elasticity, altered hearing acuity, improved physical condition ANS: A Physiologic changes associated with aging commonly include decreased skin integrity, loss of bone density, decreased strength, worsened physical condition, decreased tissue elasticity, decreased balance, and altered acuity of senses.

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13. What hospital emergency code represents infant and child abduction? A. Code blue B. Code orange C. Code gray D. Amber alert ANS: D An amber alert represents infant and child abduction. Code blue represents heart or respiratory stoppage. Code orange represents hazardous material spill or release. Code gray alerts staff to a combative person. PTS:

14. What is the single most important recommendation to prevent the spread of infection in a health care setting? A. Do not leave patients unattended. B. Routinely evaluate equipment. C. Perform hand hygiene before and after patient treatment. D. Avoid storing potentially hazardous equipment or materials in a location where there is a risk of a patient accessing them. ANS: C Performing hand hygiene before and after treating each patient to reduce cross-contamination and transmission of disease is the single most important activity for preventing the spread of infection. PTS:

15. According to the APTA guidelines, for which elements should documentation be performed? A. Initial evaluation and reexamination only B. Initial evaluation and discharge summary only C. Initial evaluation, reexamination, and discharge summary only D. All patient visits (including initial evaluation and reexamination) and discharge summary ANS: D The documentation of patient care is an important component of the written record maintained for each patient. All patient visits should be documented, and a discharge or discontinuation summary should be written following the end of a patient’s total care. PTS:

16. Which four-phased system of medical record keeping uses a common list of patient problems as its base in addition to a series of progress notes to assess the effectiveness of treatment plans? A. POMR B. SOAP C. HIPAA D. NVC ANS: A The problem-oriented medical record (POMR) uses the following four phases to enhance quality of care: • Formation of a database (current and past information about the patient) • Development of a specific, current problem list (problems to be treated by various practitioners) • Identification of a specific treatment plan (developed by each caregiver) • Assessment of the effectiveness of the treatment plans PTS: 1 17. Which of the following defines cultural diversity? A. Differences in race, ethnicity, language, nationality, or religion among various groups within a community, organization, or nation B. An awareness of the nuances of one’s own and other cultures C. A set of academic and interpeTrsEoS naTlBskAilNlsKtS haEt L alL loEwRi. ndCivOiM duals to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups D. The shared values, norms, traditions, customs, art, history, folklore, and institutions of a group of people ANS: A Cultural diversity describes the differences in race, ethnicity, language, nationality, or religion among various groups within a community, organization, or nation. A city is said to be culturally diverse if its residents include members of different groups. PTS:

18. What is needed before a caregiver is able to educate an adult patient’s family about the treatment program and activities? A. Physician permission B. Patient permission C. Supervisor permission D. Family member permission ANS: B The caregiver has the responsibility to educate the patient and family about the treatment program and activities, but patient confidentiality must be respected and the patient’s permission must be obtained before the sharing of information with the family.

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19. What knowledge of the patient should a therapist have before the patient visit begins? A. Physician request for treatment B. Medications prescribed C. Past medical history D. All of the above ANS: D Before seeing a patient, the therapist should do a comprehensive review of the patient’s medical record, including the physician’s notes on the past medical history, current history, physical findings, and diagnosis; test results; physician request for treatment; nursing notes; medications prescribed; and any consultations to other medical/surgical specialties. PTS:

20. Which are examples of individually identifiable health information? A. Hair style and eye color B. Hand preference and leg dominance C. Address and date of birth D. All of the above ANS: C ST Individually identifiable health inTfoErm atB ioA n NinKcS luE deLsLmEaR ny.C coOmMmon identifiers, such as name, address, date of birth, and Social Security number. Care must be taken to avoid leaving paperwork that includes patient identifiers in a public area and to avoid open discussion of patients in a public area. Information such as eye color or hand preference is not specific enough to identify an individual. PTS:

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Chapter 02: Approaches to Infection Control Test Bank MULTIPLE CHOICE 1. Which of the following is the absence of disease-producing microorganisms? A. Sepsis B. Asepsis C. Contamination D. Isolation ANS: B Asepsis is the absence of microorganisms that produce disease. It might also be defined as the prevention of infection by maintaining sterile conditions. Sepsis, conversely, is the presence of pathogenic microorganisms or their toxins in blood or tissues. PTS:

2. Microorganisms move from place to place by various means in a cyclical manner. What are the five elements in the cycle of iT nfEeS ctT ioB n?ANKSELLER.COM A. Reservoir, exit, transmission, infection, and susception B. Isolation, wound, contamination, infection, and sterilization C. Infection, contamination, decontamination, transmission, and exit D. Susception, reservoir, wound, isolation, and exit ANS: A Microorganisms require a place where they can grow and reproduce (reservoir), a means by which they can leave the host (exit), a mode of passage from one person to another (transmission), the ability to enter a person (infection), and a host who is susceptible to them (susception). PTS:

3. What are the most common modes of transmission of pathogenic microorganisms? A. Gloves, masks, and gowns B. Tables, chairs, and beds C. Water and food D. Contact, droplet, airborne ANS: D The primary means of transmission of pathogenic microorganisms are through contact, droplets, and the air. The healthcare worker must be aware of the barriers (such as gloves, masks, and gowns) used to prevent transmission of pathogens via each of these modes.

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4. What is the term used to describe practices that render and keep objects and areas free of all microorganisms, preventing the spread of infection to a patient? A. Surgical asepsis B. Medical asepsis C. Hospital asepsis D. Clinical asepsis ANS: A Surgical asepsis techniques are used to exclude all microorganisms before they can enter a surgical wound or contaminate a sterile field prior to or during surgery. Techniques of medical asepsis, on the other hand, are designed to keep pathogens confined to a specific area, object, or person. PTS:

5. What is the most important activity that caregivers should perform before and after contact with a patient to control infection? A. Documentation B. Hand hygiene C. Linen changing D. Gown changing ANS: B The most common method of pathogen transmission is by direct contact; therefore, the habitual use of proper hand hygiene techniques is the single most effective way to protect the patient and the caregiver. PTS:

6. Which of the following are advantages of hand rubbing with alcohol-based rubs? A. It is more accessible than sinks. B. It requires less time to use than soap and water. C. It causes less damage to the skin than soap and water when an emollient has been added. D. All of the above are advantages. ANS: D Hand rubbing, especially using alcohol-based rubs from a wall-mounted dispenser, has several advantages over hand washing. For example, it requires less time to use, it is more effective than soap and water, it is more accessible than sinks, it reduces bacterial counts on hands significantly, and it often causes less damage to the skin than soap and water. PTS:

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Test Bank 7. Which list of diseases describes those that are more commonly transmitted through contact? A. Herpes simplex virus, Staphylococcus aureus, VRE, and C. difficile B. Strep throat, meningitis, pneumonia, and influenza C. The common cold, pertussis (whooping cough), smallpox, and mumps D. Measles, varicella (chickenpox), and M. tuberculosis ANS: A Microorganisms are transferred directly from one infected person to another or indirectly where the transfer of an infectious agent occurs through an object, medical equipment, a furniture surface, or a person. The herpes simplex virus, Staphylococcus aureus, VRE, and C. difficile are all diseases that can be transmitted by contact. The modes of transmission other than contact are the droplet and airborne modes. PTS:

8. What is the proper clothing application sequence for aseptic isolation? A. Gown, mask, cap, then gloves B. Mask, gloves, gown, then cap C. Cap, mask, gown, then gloves D. Gloves, gown, mask, then cap ANS: C Refer to Procedure 2-4. The gown and then gloves should be applied last in the sequence. LeEcR Moreover, hand washing should bTeEpSeT rfoBrA mN edKfSirEstL .T hn.iqCuOeM s are detailed for both one-person and two-person methods of donning gloves. Given the proximity of the hands to the patient during procedures, utmost care should be devoted to keeping the gloves sterile. PTS:

9. Which of the following precautions is not recommended in the treatment of a patient who is in protective isolation? A. Apply protective clothing carefully and in the appropriate sequence. B. Move and perform patient care quickly to reduce the amount of exposure to pathogens. C. Do not enter the patient’s room with protective clothing or equipment that has been worn to treat patients in another area of the hospital. D. Remember to perform proper hand washing before applying and after removing protective clothing. ANS: B A standard precaution to follow when treating a patient who is in protective isolation is to avoid causing excessive air currents in the patient’s room. It is recommended that the healthcare provider move slowly and arrange linen or equipment carefully instead of quickly. PTS:

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10. According to standard precautions for contact transmission, what protocol is used for items that are removed from the patient’s room? A. Items must be disinfected or placed in a bag labeled “biohazard.” B. No items should be removed from the room until the patient has been discharged. C. The carrier should take care only to perform appropriate hand washing before removing items. D. The handler must wear a gown and gloves when removing items, but the items need no preparation. ANS: A Patient care items (e.g., thermometer, stethoscope, blood pressure cuff) should remain in the room. But if any item has to be removed, it must be disinfected or placed in a bag labeled “biohazard.” PTS:

11. According to standard isolation precautions for airborne transmission, what is the recommended architecture for a patient’s room? A. Cohort B. Private or cohort, preferably more than 3 feet between beds C. Private D. Private isolation room with a closed door ANS: D A patient subject to airborne precautions may transmit infectious agents that remain infectious over long distances when suspended in the air. Rooms for these patients should be private airborne infection isolation rooms (AIIRs), and the door must remain closed. PTS:

12. In applying an alcohol-based hand rub, what is the appropriate step to take after rubbing the product briskly over all surfaces of the hands? A. Rinse the hands with water after every use. B. Continue to rub until the hands are dry. C. Rinse the hands with soap and water after every use. D. Use a paper towel to wipe residual hand rub from the hands. ANS: B After applying the hand rub over the hands, the appropriate step is to continue to rub the hands together until they are dry. Do not rinse the hands with water. It may require 25 to 30 seconds for the hands to become dry depending on the product. After several hand rubs, the hands may become sticky and a hand wash should be used to cleanse them. PTS:

13. What is the recommended length of time for hand washing with ordinary soap and water? A. 0–10 seconds

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Test Bank B. 10–15 seconds C. 15–30 seconds D. More than 30 seconds ANS: C Although hand washing is not the most effective method for decontaminating hands, it is the preferred method when hands are visibly dirty, soiled, or considered to be contaminated. Hand washing for 15 to 30 seconds using ordinary soap and water will remove transient bacteria from the hands due to the mechanical action of the friction while rubbing and scrubbing during the wash. PTS:

14. Which of the following objects is a potential host site for the survival of pathogens? A. Bar soap B. Sink rims C. Faucet handles D. All of the above ANS: D Bar soap is not regularly used in hospitals because it is considered easily contaminated. Pathogens can survive on a bar of soap, even if it has been rinsed before being replaced in the holder. Other objects that may contaminate hands during hand washing are the sink rims and basin, water that splashes from the sink, towel dispenser, faucet handles, and EiR operating lever of a dispenser of T soE apS. TABvA oiN dK coSnE taLctLw th.tC heOseMitems whenever possible, or at least recognize that they are likely to be contaminated. PTS:

15. What is a form of surgical asepsis, designed to keep an area and objects free from pathogens, that often uses a nonabsorbent, sterile towel as its base? A. Sterile field B. Isolation C. Decontamination zone D. Disinfection area ANS: A As the term indicates, a sterile field is designed to maintain the sterility of objects contained within the field, such as dressings or bandages, and to prevent contamination of the objects, which in turn could contaminate the patient. The sterile field is a form of surgical asepsis designed to keep the area free from pathogens. Usually a nonabsorbent, sterile towel or the inside of the outer cover or wrapping of a package for carrying sterile supplies is used as the base for the sterile field. PTS:

16. What is the proper protocol for disposing of sharp instruments? A. They may be placed in ordinary waste baskets.

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Test Bank B. Needles should be broken or bent before disposal. C. They should be put into specially designated containers without manipulation. D. Needles should be recapped before being deposited into ordinary waste baskets. ANS: C Sharp instruments and needles should be disposed of in the proper containers without attempting to recap, bend, break, or otherwise manipulate them before disposal. PTS:

17. When should hand washing be performed? A. Before and after patient contact B. After sneezing, coughing, or nose blowing C. After removing gloves D. Hand washing should be performed after all of the above activities. ANS: D Hand hygiene is crucial for preventing the spread of pathogens. It should be performed before and after patient contact, toileting, eating, and contact with wounds, dressing, specimens, bed linen, and protective clothing. It should also be performed after sneezing, coughing, nose blowing, or removing gloves. PTS:

ER 18. Which of the following is appropT riE atS eT wB ithAN reK spSeE ctLtoLm ai. ntC aiO niM ng a sterile field? A. A sterile field must not be left unattended. B. It’s acceptable to turn your back to a sterile field as long as you remain in the same room. C. Talking is allowed across a sterile field, but sneezing, coughing, and reaching across it must be avoided. D. The base of a sterile field should be slightly moist. ANS: A Do not leave the field unattended, even if it is covered with a sterile towel or other sterile item. In your absence, the field can become contaminated. Moreover, do not turn your back to the field because contamination of the objects in the field can occur when you are not able to observe the field. Talking, sneezing, coughing, and reaching across a sterile field should be avoided. The air currents or moisture droplets from your nose or mouth can convey pathogens onto the field. Finally, the base and the area surrounding the field should be void of moisture because moisture is likely to contain microorganisms. PTS:

19. For which of the following procedures might it be unnecessary to wear gloves? A. Controlling bleeding B. Performing oral or nasal suctioning C. Measuring blood pressure or temperature D. Handling or cleaning contaminated instruments

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ANS: C Gloves should be worn routinely in situations in which it is necessary to control bleeding, perform a venipuncture, do oral or nasal suctioning, perform endotracheal intubation, change a contaminated dressing, or handle or clean contaminated instruments or equipment. Usually it is not necessary to wear gloves to measure blood pressure or temperature; however, if there are other reasons to wear gloves when performing either of these two procedures, they should be worn. PTS:

20. In which of the following scenarios is protective eyewear most important? A. Around a patient associated with airborne precautions B. In the transportation of a patient subject to contact precautions C. During times when blood splashes or sprays of other body fluids are likely D. When a patient is performing upper extremity exercises ANS: C Protective eyewear, such as goggles, facial shield, or eyewear with side shields, should be worn to prevent fluids from entering the eyes. It is especially important that protective eyewear be worn when blood splashes or spurts are likely to occur and when other body fluids are likely to be sprayed or splashed onto the face. PTS:

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Chapter 03: Assessment of Vital Signs Test Bank MULTIPLE CHOICE 1. What is the most generally accepted average value for normal body temperature? A. 98.6 °F B. 96.4 °F C. 94.2 °F D. 92.0 °F ANS: A Depending on the source, an accepted normal range for human oral core or body temperature is 96.8 to 99.3 °F (36 to 37.3 °C). The average temperature of 98.6 °F (37 °C) is the most generally accepted single value. Slight variations from these norms may occur in individuals; therefore, it is important to establish a norm for each patient by repeatedly measuring temperature. PTS:

2. For patients unable to maintain a thermometer in the mouth, which secondary source may be used to obtain a body temperature measurement? A. The rectum or ear canal B. The axilla or posterior knee C. The forehead D. The palm ANS: A For unconscious patients or for those patients unable to maintain the thermometer/probe in the mouth, a rectal or ear canal measurement should be used. The axillary or inguinal folds are the least desirable sites because air currents may reduce the accuracy of the measurement. Therefore, measurement at these sites should be used only when measurement at the other sites is neither possible nor safe. If the temperature is measured at one of these secondary sites, it should be so noted on the patient’s record. PTS:

3. When would a temperature measurement taken from the ear canal be least accurate? A. After a meal B. Immediately after the individual has been lying on the ear C. 2 to 3 minutes after the ear canal has been exposed to the air D. 10 minutes after the ear canal has been exposed to the air

Test Bank ANS: B When the individual has been lying on the ear, that ear should not be used for measurement until it has been exposed to the air for 2 to 3 minutes so that the ear canal temperature can become stable. If the temperature of the ear canal is not permitted to acclimate, a falsely high reading may occur. PTS:

4. What is the normal resting pulse range for an adult? A. 40–80 beats per minute B. 60–100 beats per minute C. 80–120 beats per minute D. 100–140 beats per minute ANS: B The accepted normal range for the resting pulse is 60 to 100 beats per minute in the adult, 100 to 130 beats per minute in the newborn, and 80 to 120 beats per minute in the child 1 to 7 years old. PTS:

5. Which of the following indicates a rapid heart rate (greater than 100 beats per minute)? A. Bradycardia B. Thready C. Strong and regular D. Tachycardia ANS: D Tachycardia indicates a rapid heart rate (greater than 100 beats per minute). Bradycardia indicates a slow heart rate (below 60 beats per minute). A heart that beats irregularly and with a weak force is defined as thready. PTS:

6. What device measures the level of blood oxygen saturation, monitors pulse rate, and calculates heart rate? A. Pulse oximeter B. Sphygmomanometer C. Stethoscope D. Respirator ANS: A A pulse oximeter measures the level of blood oxygen saturation, monitors pulse rate, and calculates heart rate. The pulse oximeter is placed over the tip of the forefinger or ring finger (or in some cases the earlobe). PTS:

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Test Bank 7. What is a normal blood oxygen saturation reading at or near sea level? A. 80–85 percent B. 85–90 percent C. 90–95 percent D. 95–100 percent ANS: D The normal blood oxygen saturation reading at or near sea level is between 95 and 100 percent. Hypoxemia should be suspected for readings below 90 percent. PTS:

8. What systolic/diastolic value of blood pressure is recognized as normal for an adult? A. 180/110 B. 160/100 C. 140/90 D. 120/80 ANS: D The accepted normal blood pressure values in adults are systolic, 120 millimeters of mercury (mm Hg) or less; and diastolic, 80 mm Hg or less. When the resting systolic pressure is consistently measured at more than 140 mm Hg or the resting diastolic pressure consistently measures more than 90 mm Hg, the person is usually considered to be stage 1 hypertensive. A consistent reading of 180/110 is indicative of stage 3 hypertension. PTS:

9. How should the arm be positioned when blood pressure is measured at the brachial artery? A. Above the level of the heart B. At the level of the heart C. Below the level of the heart D. Near the patient’s chest ANS: B The patient may sit, stand, or lie for blood pressure measurements, but the upper extremity must be supported with the forearm and arm at the approximate level of the heart to prevent inaccurate measurements. If the extremity is positioned in a dependent (hanging) position, the hydrostatic pressure of the blood will be increased and may erroneously increase the value of the patient’s blood pressure. PTS:

10. What is the normal respiration rate for an adult at rest? A. 4–10 respirations per minute B. 7–13 respirations per minute C. 12–18 respirations per minute D. 15–25 respirations per minute

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Test Bank ANS: C Depending on the source used, the accepted normal range for respiration at rest is 12 to 18 respirations per minute for adults and 30 to 50 respirations per minute for infants. Resting values above 20 or below 10 respirations per minute are considered abnormal for adults. PTS:

11. Which of the following is an adventitious or abnormal breath sound that is heard most often in patients with COPD, asthma, chronic bronchitis, CHF, or pulmonary edema? A. Pleural rubs B. Wheezing C. Tracheal breath sound D. Bronchial breath sound ANS: B Wheezes occur as a result of air flowing through a narrowed airway and are heard during expiration. They occur in COPD, asthma, chronic bronchitis, CHF, and pulmonary edema and can be heard anywhere in the lungs where there is obstruction. Pleural rubs are found in a pneumothorax or when the patient has a pleural effusion. Tracheal and bronchial breath sounds are potentially normal breath sounds. PTS:

12. Which of the following should beTiE ncSluTdBedAN inKaS nE inLitL iaE l aRs. seCssOmMent of pain? A. The onset and pattern of the pain B. The exact location of the pain C. A description of the pain in words such as “burning” or “tingling” D. All of the above ANS: D The clinician should document the onset and temporal pattern of pain. The patient should be asked to point to the exact location of pain on the body, either to the clinician or on a pain questionnaire. And the patient should be asked to describe the pain, because words can provide valuable clues as to the cause. For example, patients who describe their pain as “burning” or “tingling” are likely to have a neuropathic cause of pain. An assessment of pain intensity should also be provided, including an evaluation of the present pain intensity and when the pain is at its least and its worst. PTS:

13. Which of the following heart rate measurement options will provide the smallest margin of error? A. Measuring the rate for 6 seconds and multiplying that value by 10 B. Measuring the rate for 10 seconds and multiplying that value by 6 C. Measuring the rate for 15 seconds and multiplying that value by 4 D. Measuring the rate for 30 seconds and multiplying that value by 2 ANS: D

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Test Bank The margin of error decreases in direct proportion to the increase in the length of time used to measure the heart rate. If you measure the rate for 30 seconds and multiply that value by 2, the margin of error is ±2 beats per minute. Conversely, if you measure the rate for 10 seconds and multiply that value by 6, the margin of error is ±6 beats per minute. PTS:

14. Which of the following describes the period when the greatest amount of pressure is exerted on the walls of the arteries during one’s heartbeat? A. Systole B. Diastole C. Syncope D. Hypertension ANS: A Systole is the period of the heartbeat when the greatest amount of pressure is exerted on the walls of the arteries. It usually indicates the contractile phase of the heartbeat. Conversely, diastole is the period when the least amount of pressure is exerted on the walls of the arteries during the heartbeat, usually indicating the resting phase of the heart. PTS:

15. What term is used to describe labored or difficult breathing? A. Apnea B. Anoxia C. Dyspnea D. Orthopnea ANS: C Dyspnea is defined as labored or difficult breathing. Apnea is the absence of breathing. Anoxia is the absence of oxygen in the tissues. Orthopnea is a condition in which breathing is easier when the person is seated or standing. PTS:

16. Where should a stethoscope be placed to listen for bronchial breath sounds? A. In the neck region B. Between the scapulae C. Over the periphery of both lung fields D. Over the manubrium of the sternum ANS: D Bronchial breath sounds are loud, tubular sounds best heard over the manubrium of the sternum. These sounds are abnormal if heard in the peripheral lung fields (the normal site of the soft and low-pitched vesicular breath sounds). Tracheal breath sounds are best heard in the neck region. Bronchovesicular sounds are best heard between the scapulae. PTS:

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17. What is the appropriate method for assessing a patient’s pulse at the brachial artery? A. Use your thumb and apply significant pressure on the artery. B. Use two or three fingertips to apply gentle pressure on the artery, avoiding use of the thumb. C. Use one finger with significant pressure applied on the artery. D. Use the pad of the thumb, placed gently over the artery. ANS: B Two or three fingertips should be placed gently over the artery. The thumb should be avoided because you may perceive your own pulse rather than that of the patient, and the thumb’s pad is less sensitive than that of each of the other fingers. Excessive pressure should also be avoided because it may occlude the artery. An exception to light pressure is an attempt to palpate the popliteal artery. Very firm, deep pressure may be required to locate the popliteal artery and its pulse. PTS:

18. Which of the following patients would be expected to have the lowest pulse? A. An athletic resting male 65 years of age B. An exercising female 21 years of age C. An anxious, resting female 21 years of age D. A resting female 65 years of age, battling an infection ANS: A Pulse rates tend to be lower in older individuals, males, and well-trained individuals compared to younger individuals, females, and individuals battling infection or stress. PTS:

19. Where may the pulse of the brachial artery be located with the greatest ease? A. At the wrist on the volar forearm, medial to the stylus process of the radius B. Inferior to the angle of the mandible, anterior to the sternocleidomastoid muscle C. Medial to the biceps in the antecubital fossa D. On the lateral aspect of the proximal shaft of the humerus ANS: C The pulse of the brachial artery will be found medial to the biceps in the antecubital fossa or on the medial aspect of the midshaft of the humerus. The carotid pulse is located inferior to the angle of the mandible, and the radial pulse is located at the wrist on the volar forearm. PTS:

20. Which description of pain is most indicative of muscle pain? A. Cramping, dull, aching B. Sharp, bright, lightning-like C. Deep, nagging, dull

3-6

Test Bank D. Throbbing, diffuse ANS: A Muscle pain will likely be characterized by the patient as cramping, dull, and aching. Nerve pain is commonly sharp, bright, and lightning-like. Bone pain is deep, nagging, and dull. Vasculature pain is described as throbbing and diffuse. PTS:

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Chapter 04: Body Mechanics Test Bank MULTIPLE CHOICE 1. At what level is the approximate center of gravity (COG) of a standing person? A. The iliac crest B. The navel C. The first lumbar segment D. The second sacral segment ANS: D An object’s COG is located where the mass of the object is located; it is the heaviest area to move or the most difficult to adjust to a new position. The COG of a standing person is located approximately at the level of the second sacral segment in the center of the pelvis. PTS:

2. What equation is used to determine torque? A. Force × distance B. Acceleration × time C. Mass × acceleration D. Time/distance ANS: A Torque is the expression of the effectiveness of a force in turning a lever system; it is the product of a force multiplied by the perpendicular distance from its line of action to the axis of motion. PTS:

3. How should patients breathe when performing physical activities, specifically lifting? A. Shallowly B. Normally C. Slowly D. Breath should be held ANS: B

Test Bank When lifting, patients and caregivers should breathe normally to avoid the potentially adverse effects of the Valsalva phenomenon or maneuver. This phenomenon can occur when an individual holds the breath and air is trapped in the thorax, which increases intrathoracic pressure. This increased pressure can affect the circulatory system by decreasing the return of venous blood to the right side of the heart, which decreases cardiac output and increases peripheral blood pressure. PTS:

4. In an attempt to lift an object, which two measures are recommended for proper body mechanics? A. Increasing your base of support, positioning your COG near the object’s COG B. Decreasing your base of support, positioning your COG near the object’s COG C. Increasing your base of support, positioning your COG far from the object’s COG D. Decreasing your base of support, positioning your COG far from the object’s COG ANS: A Before you attempt to lift, pull, reach for, or carry an object, you must do two things for proper body mechanics: position yourself so your COG and the object’s COG are as close as possible, and increase your base of support (BOS). PTS:

5. Which of the following would incTrE eaSseTaBnAinNdKivSidEuLalL’sEbRa. seCoOf M support (BOS)? A. Placing the feet farther apart in an anterior-posterior stance B. Placing the feet farther apart in a medial-lateral stance C. Using crutches, canes, or a walker D. All of the above ANS: D When you place your feet farther apart in an anterior-posterior stance (i.e., one foot ahead of the other foot) or in a medial-lateral stance (i.e., with the feet farther apart in a sideways direction), you increase your BOS. Moreover, a patient’s BOS can be improved when crutches, canes, or a walker is provided to aid with ambulation or stability. PTS:

6. For removing groceries, tools, or other items from the trunk of a car, which of the following body mechanics principles is recommended? A. Bend at the waist and lift B. Bend your hips and knees slightly C. Keep the object away from your body during lifting D. Avoid bending the knees ANS: B Care should be used in removing groceries, tools, or other items from the trunk of a car. Do not bend at the waist and lift; bend your hips and knees slightly, and move the object close to you before lifting it.

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Test Bank

PTS:

7. Which muscle group is most important for movements and lifts that require extra effort? A. Scapular stabilizers B. Core stabilizers C. Ankle stabilizers D. Knee stabilizers ANS: B Core stability is essential for the maintenance of an upright posture, especially for movements and lifts that require extra effort, such as lifting a heavy patient from the supine position to sitting. Without core stability the lower back is not supported from inside and can be injured by the strain caused by a heavy lift. PTS:

8. How should objects above shoulder or head height be approached? A. Standing on your toes with arms stretched above your head B. Standing on a rolling chair C. Standing on a wide-based footstool or ladder D. By jumping and grasping quickly ANS: C Reaching for an object above youTr E shSoT ulBdA erNoK rS heEaL dL wE illRb.eCleOsM s strenuous if the object is lowered or if you raise your position by standing on a wide-based footstool or ladder. These actions approximate the COG of the object and your COG, allow the use of shortened extremity lever arms, and decrease strain to back structures. PTS:

9. Through which anatomical structure should a plumb line run during ideal postural alignment? A. Lateral malleolus B. Scapula C. Greater trochanter D. Bodies of the thoracic vertebrae ANS: C Ideal postural alignment requires that the plumb line run as follows: slightly anterior to the lateral malleolus, slightly anterior to a midline through the knee, through the greater trochanter, midway through the trunk (through the bodies of the lumbar vertebrae), through the shoulder joint, through the bodies of the cervical vertebrae, and through the lobe of the ear. PTS:

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Test Bank 10. For a person seated at a workstation for prolonged periods, at what angle should the elbows, knees, and hips be bent? A. 125 degrees B. 110 degrees C. 90 degrees D. 75 degrees ANS: C When seated at a workstation for prolonged periods, keep elbows, knees, and hips level and bent at 90 degrees; feet should be flat on the floor or supported at a slight incline, forearms should be supported by armrests, and the back should be supported by the chair back or a lumbar roll. PTS:

11. Which lift involves placing the object to be lifted on the thigh of the flexed lower extremity and moving it close to the body before the flexed lower extremity begins rising to standing? A. Straight leg lift B. One-leg stance lift C. Deep squat lift D. Half-kneeling lift ANS: D To perform the half-kneeling lift,TthEeSlT iftBerAaNliK gnSsEthLeLbEoR dy.bCyOkMneeling on one knee positioned behind and on one side of the object, and positions the opposite lower extremity to one side of the object with the foot flat and the hip and knee flexed approximately 90 degrees. The object is grasped and lifted with the upper extremities, placed on the thigh of the flexed lower extremity, and moved close to the body before the flexed lower extremity begins rising to standing. PTS:

12. Which lift involves picking up an object in a manner similar to the way a golfer removes a golf ball from the cup? A. Straight leg lift B. One-leg stance lift C. Deep squat lift D. Half-kneeling lift ANS: B The one-leg stance lift can be used for light objects that can be lifted easily with one upper extremity. The lifter faces the object, with the body weight shifted onto the forward lower extremity. To pick up the object, the weight-bearing lower extremity is partially flexed at the hip and knee while the non-weight-bearing lower extremity is extended to counterbalance the forward movement of the trunk. PTS:

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Test Bank

13. What recommendation is helpful for reducing the body stress of an employee whose work requires a standing posture? A. Wear high-heeled shoes. B. Take a break every 4 hours to stretch the low back. C. Stand on a cushioned mat in the work area. D. Wear shoes without significant arch support. ANS: C For activities that require prolonged standing, the use a cushioned mat and low-heeled shoes with good arch supports is recommended. A brief exercise routine including back stretches should be performed every hour. PTS:

14. How are compressive forces directed to intervertebral discs during lumbar lordosis? A. Anteriorly B. Posteriorly C. Laterally D. Superiorly ANS: A Compression forces to intervertebral discs are directed anteriorly rather than posteriorly during lumbar lordosis, a direction that reduces the potential for a posterolateral rupture of the disc. PTS:

15. In coordinating a lifting activity with others, how should directions be given? A. As brief, concise, and action-oriented commands B. In the form of elaborate and detailed explanation C. Mostly with the use of hand gestures D. As quickly and loudly as possible ANS: A Instructions and directions should be brief, concise, and action oriented (e.g., “lift now,” “push down,” “stand up”). It may also be helpful to lead into the action command by using phrases such as “ready”; “one, two, three”; “first, I want you to . . . ”; or “on the count of 3, lift.” Additionally, those involved in the task should be asked if they have any questions about their role or the expected outcome. PTS:

16. Which trunk position has the greatest potential to cause damage in the act of lifting or reaching for an object? A. Neutral lordosis B. Trunk extension C. Simultaneous trunk flexion and rotation

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Test Bank D. Side bending ANS: C Simultaneous trunk flexion (bending) and rotation (twisting) should be avoided when you lift or reach for an object. This position has the greatest potential to damage structures of the lumbar spine, specifically the intervertebral discs. PTS:

17. In which plane does an individual’s vertical gravity line lie? A. Mid-sagittal B. Scapular C. Transverse D. None of the above ANS: A The vertical gravity line is an imaginary line that bisects the body in the sagittal plane beginning at the head and continuing through the pelvis and specifically through the COG. It indicates the vertical positioning of one’s COG. PTS:

18. What area of the spine is host to most injuries caused by lifting? A. Cervical B. Thoracic C. Lumbar D. Sacrococcygeal ANS: C The lumbar area of the spine is where most injuries due to lifting or associated activities (e.g., shoveling, raking, or reaching above the head) occur. Stress to the lumbar spine can be caused by the posture a person uses to lift, the weight or size of the object lifted, the repetitiveness of the activity, the physical condition of the structures of the lumbar area, or the sustainment of a flexed lumbar spine. PTS:

19. For a person sitting at a computer terminal, at what level should the vision display be directed? A. 40 degrees above horizontal B. 15 degrees above horizontal C. 10 degrees below horizontal D. 35 degrees below horizontal ANS: C For a person seated at a computer terminal, the vision display terminal should be directed about 10 degrees below horizontal to facilitate the best cervical spine posture.

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Test Bank PTS:

20. Which posture is recommended for performing activities below the waist, such as removing clothes from a front-loading dryer? A. Flexing forward at the hips with the knees extended B. Rotating at the spine while squatting C. Flexing at the hips while rotating at the spine D. Sitting, stooping, or kneeling ANS: D Bending at the waist should be avoided when one is working, washing the face, brushing the teeth, or performing activities below the waist (e.g., bathing children in a bathtub, removing clothes from the washer or dryer). Twisting motions, especially twisting while performing trunk flexion, has the significant potential to damage structures of the lumbar spine. Sitting, stooping, or kneeling should be performed when one is working below the waist instead. PTS:

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Chapter 05: Positioning and Draping Test Bank MULTIPLE CHOICE 1. In general, how frequently should a dependent patient’s positioned be changed? A. At least every 2 hours B. At least every 4 hours C. Twice per day D. Once per day ANS: A Frequent changes in the dependent patient’s position, at least every 2 hours, are necessary to prevent contractures and relieve pressure to the skin, subcutaneous tissue, and the circulatory, neural, respiratory, and lymphatic systems, as well as other structures. PTS:

2. Which areas are especially prone to pressure sores in a patient who is wheelchair dependent? A. The mandible and knees B. Acromions and dorsal surfaces of the feet C. Ischial tuberosities and olecranon processes D. Tibial tubercles and the occiput ANS: C Wheelchair-bound patients who sit for long periods of time need appropriate seating surfaces that safely reduce pressure while providing adequate support and stability. Areas at particularly high risk to the seated person include ischial tuberosities, olecranon processes, the back of the knees if resting against the seat, and the heels and feet. PTS:

3. Which exercises would help a patient bound to a wheelchair alleviate pressure on the ischial tuberosities? A. Biceps curls and knee extensions B. Wheelchair push-ups and weight shifts C. Ankle pumps and neck curls D. Trunk extension isometrics ANS: B

Test Bank Patients who have good upper body strength should be taught to do wheelchair push-ups to alleviate pressure on the ischial tuberosities. Leaning side to side to alleviate ischial tuberosity pressure is another option if the patient is unable to perform push-ups from the arm supports. PTS:

4. Who must be notified immediately of physical or drug-induced restraints used for a patient? A. The patient’s family and physical therapist B. The patient’s occupational and physical therapists C. The patient’s case manager and nurses D. The patient’s attending physician ANS: D The attending physician must be notified as soon as possible if he or she did not order the restraint or seclusion. These orders are good for no longer than 4 hours for adults, 2 hours for those ages 9–17, and 1 hour for children under age 9. The total time limit of an order is 24 hours, after which time a new order may be prescribed. PTS:

5. What is a potential adverse effect of the placement of a small bolster behind the knees of a supine patient? A. Quadriceps and hip extensor contractures B. Erector spinae and ankle dorsiflexor contractures C. Iliopsoas and hamstring contractures D. Hip adductor and extensor contractures ANS: C A small pillow or bolster can be placed behind the knees to relieve lumbar lordosis and promote comfort in the supine patient. However, this position should not be maintained for a prolonged period because the item behind the knees will encourage hip and knee flexion and may contribute to lower extremity contractures of the iliopsoas (hip flexor) and hamstring (knee flexor) muscles. PTS:

6. Which areas of a supine patient are at greatest risk for pressure sores? A. Occipital tuberosity, spines of the scapula, sacrum, and heels B. Acromions, lateral epicondyles, anterior iliac crests, and metatarsal heads C. Posterior iliac crests, mandibular condyles, patellae, and medial malleoli D. Inferior angles of the scapula, tibial tubercle, and transverse processes of the vertebrae ANS: A

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Test Bank The areas of greatest pressure when the patient is supine are the occipital tuberosity, spine and inferior angle of the scapula, spinous processes of the vertebrae, olecranon process, posterior iliac crests, sacrum, and posterior calcaneus. Other possible pressure areas, depending on how the patient is positioned, are the medial epicondyle of the humerus, head of the fibula, greater trochanter of the hip, and lateral malleolus if excessive external rotation of the hip occurs. PTS:

7. If a supine patient has a flaccid upper extremity, how should the hand be positioned? A. Below the heart B. Above the elbow C. Near the side of the body D. Palm up ANS: B If a patient has a flaccid upper extremity, the hand should be placed higher than the elbow to prevent dependent edema. PTS:

8. Which areas of a prone patient are at greatest risk for pressure sores? A. Occipital tuberosity, sternum, sacrum, and heels B. Dorsum of the feet, spines ofTthEeSsT caBpA ulN aeK, S paEteLllLaeE, R an.dCsO piMnous processes of the vertebrae C. Acromion processes, forehead, crests of the tibias, and dorsum of the feet D. Ears, greater trochanters, ischial tuberosities, and heels ANS: C The areas of greatest pressure when the patient is prone are the forehead or lateral ear, tip of the acromion process, anterior head of the humerus, sternum, antero-superior iliac spine, patella, crest of the tibia, and dorsum of the foot. PTS:

9. Which area of pillow placement is most likely to contribute to a contracture of the hamstring muscles in the prone patient? A. Anterior to the thighs B. Anterior to the abdomen C. Posterior to the knees D. Anterior to the ankles ANS: D The use of a pillow under the anterior portion of the patient’s ankles will relieve stress on the hamstring muscles and feet and will allow the pelvis and lower back to relax. However, a pillow placed anterior to the ankles will cause knee flexion and may contribute to a contracture of the hamstring muscles. To avoid the development of a contracture, this position should not be maintained for a prolonged period.

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Test Bank

PTS:

10. Which areas of the side-lying patient are at greatest risk for pressure sores? A. Sternum, iliac crests, patellae, and lateral ears B. Lateral ears, lateral ribs, greater trochanters, and humeral epicondyles C. Occipital tuberosity, transverse processes of vertebrae, sacrum, and heels D. Forehead, spines of the scapulae, lesser trochanters, and fibular heads ANS: B The areas of greatest pressure when the patient is in a side-lying position are the lowermost lateral ear, lateral ribs, lateral acromion process, lateral head of the humerus, medial or lateral epicondyles of the humerus, greater trochanter of the femur, lateral condyle of the femur, malleolus of the fibula, medial condyle of the femur, and malleolus of the tibia if the uppermost lower extremity is positioned directly over the lowermost. PTS:

11. Which position is most detrimental to a patient with a transfemoral amputation? A. Prolonged trunk extension B. Prolonged hip adduction C. Prolonged hip extension D. Prolonged hip flexion ANS: D For the patient with a transfemoral amputation, prolonged hip flexion (e.g., from placement of a pillow under the residual limb of a supine patient) should be avoided. This position promotes the development of a contracture of the patient’s hip flexor muscles. If those muscles become contracted, the patient is likely to experience difficulty using a prosthetic for ambulation. PTS:

12. Which positions are most detrimental to a patient with a transtibial amputation? A. Prolonged hip and knee extension B. Prolonged hip and trunk extension C. Prolonged hip and knee flexion D. Prolonged hip adduction and knee extension ANS: C For the patient with a transtibial amputation, prolonged hip and knee flexion (as with placement of a pillow under the residual limb of a supine patient) should be avoided. This position promotes the development of a contracture of the patient’s hip flexor and knee flexor muscles. If these muscles become contracted, the patient will experience difficulty using a prosthetic for ambulation. PTS:

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Test Bank 13. Which positions of the involved upper extremity are most detrimental to a patient with hemiplegia? A. Prolonged shoulder adduction and internal rotation, and elbow flexion B. Prolonged shoulder abduction and internal rotation, and elbow extension C. Prolonged shoulder adduction and external rotation, and elbow flexion D. Prolonged shoulder abduction and external rotation, and elbow extension ANS: A When the patient’s upper extremity is involved, the following should be avoided: prolonged shoulder adduction and internal rotation; elbow flexion; forearm supination or pronation; wrist, finger, or thumb flexion; and finger and thumb adduction. These positions, although possibly ones of comfort, are the most likely to lead to soft tissue contractures caused by muscle spasticity, reduced function of the opposing muscles, and lack of active motion. PTS:

14. Which positions of the involved lower extremity are most detrimental to a patient with hemiplegia? A. Prolonged hip extension and internal rotation, and ankle dorsiflexion B. Prolonged hip flexion and internal rotation, and knee extension C. Prolonged hip flexion and external rotation, and ankle plantarflexion D. Prolonged hip extension and external rotation, and ankle dorsiflexion ANS: C When a patient’s lower extremity is involved, prolonged hip and knee flexion, hip external rotation, and ankle plantarflexion and inversion should be avoided. These positions are those most likely to lead to soft tissue contractures caused by muscle spasticity, reduced function of the opposing muscle, and lack of active motion. PTS:

15. What activity is especially important for a patient with rheumatoid arthritis unless the joints are in a state of acute inflammation? A. Resistance training for all joints B. Forceful and frequent passive stretching of the involved joints C. Prolonged immobilization D. Gentle and frequent active or passive movement of the involved joints ANS: D Prolonged immobilization of the affected extremity joints should be avoided in a patient with rheumatoid arthritis, particularly joints maintained in flexion. Gentle, careful, and frequent active or passive movement of the involved joints should be performed several times per day unless the joints are in a state of acute inflammation. The uninvolved joints should be exercised actively. PTS:

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Test Bank 16. Concerning burned or grafted burn areas, what should be avoided? A. Positions of comfort B. Positions of mild stress or tension to the wound or graft C. Frequent position changes D. Active motion of the involved joints ANS: A It is important to avoid prolonged positioning of the joints that have been affected by the burn or graft used to repair the wound. It is particularly important to avoid positions of comfort. A position of comfort for the patient with a burn is the position that does not produce stress or tension to the wound or graft. Moreover, the patient should be encouraged to perform gentle, careful, and frequent movement of the involved joints and should exercise the uninvolved joints. PTS:

17. Following a total knee replacement, in what position is it important to keep the affected extremity at rest? A. Knee flexion B. Knee extension C. Hip flexion D. Hip extension ANS: B CpOoMrtant to keep the affected For the patient who has had a totaTl E knSeTeBreApN laK ceSmEeL ntL ,E it R is.im knee in extension. This is not a comfortable position for the patient initially, but it will enhance future restoration of motion. PTS:

18. Following a total hip replacement, what device is often used for proper positioning? A. An adduction pillow to prevent excessive hip adduction B. A continuous passive motion machine C. Lateral towel rolls to maintain hip adduction D. A full-length leg cast ANS: A For the patient who has undergone a total hip replacement, the affected limb must be restricted from excessive hip adduction, rotation, and flexion. An adduction pillow can be used to prevent excessive adduction, and a wedge or rolled towel will assist in preventing excessive hip rotation. PTS:

19. Why is patient draping important? A. To provide for the modesty of the patient B. To maintain appropriate body temperature C. To provide access to areas to be treated while protecting other areas

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Test Bank D. All of the above ANS: D The primary reasons to appropriately drape or clothe a patient are to expose or free an area to be treated; provide for modesty; maintain a comfortable body temperature; and protect the skin and clothing from becoming soiled or damaged. PTS:

20. What information should a caregiver provide a patient before draping techniques are performed? A. The planned treatment B. The specific position in which the person is to be treated C. The specific application of the linen items, gown, robe, or other clothing desired D. All of the above ANS: D Before treatment, the caregiver should inform the patient that clothing may need to be removed and why such removal is necessary. The patient should be told how the body will be protected by linen or substitute garments. Additionally, the patient should be informed about the appropriate treatment position to maintain the usefulness of the draping. PTS:

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Chapter 06: Basic Exercise Test Bank MULTIPLE CHOICE 1. Which cardinal plane divides the body into left and right components? A. Sagittal B. Frontal C. Coronal D. Transverse ANS: A The sagittal plane is a vertical plane that divides the body into left and right components. The frontal (or coronal) plane is a vertical plane that divides the body into front (anterior) and back (posterior) components. The transverse plane is a horizontal plane that divides the body into upper and lower components. PTS:

2. In which cardinal plane does rotaT tioEnSoTcB cuAr?NKSELLER.COM A. Sagittal B. Frontal C. Scapular D. Transverse ANS: D Rotation occurs in the transverse plane, that which divides the body into upper and lower components. Flexion and extension occur in the sagittal plane. Side bending and most types of abduction/adduction occur in the frontal (coronal) plane. PTS:

3. Which type of motion involves no voluntary contraction of muscle and, therefore, will not help prevent muscle atrophy? A. Passive range of motion (PROM) B. Active range of motion (AROM) C. Active assistive range of motion (AAROM) D. All of the above involve voluntary muscle contraction ANS: A Passive range of motion (PROM) is the movement of a joint or body segment by a force external to the body, within an unrestricted and normal range of motion without active, voluntary muscle contraction by the patient.

Test Bank

PTS:

4. What planes of motion are most closely associated with proprioceptive neuromuscular facilitation (PNF)? A. Straight planes B. Frontal and sagittal planes only C. Transverse and sagittal planes only D. Diagonal planes ANS: D PNF is a treatment technique that uses various stimuli to affect the muscle or joint proprioceptors to facilitate or alter movement responses. PROM and AROM can be performed in the traditional anatomic planes. They can also be performed in diagonal planes of motion using the patterns of PNF. PTS:

5. Which end feel would be described as “firm”? A. When soft tissues are compressed, as in elbow flexion B. When joint capsules or ligaments are stretched, as in hip rotation C. When a bony block is reached, as in elbow extension D. When no end feel is elicited because the patient does not permit full motion to occur ANS: B End feels are described as “soft” when soft tissues are compressed or stretched (as in elbow or knee flexion), “firm” when joint capsules or ligaments are stretched (as in hip rotation), “hard” when a bony block or resistance is encountered (as in elbow extension), and “empty” when no end feel is elicited because the patient does not permit full motion to occur, usually because of acute pain. PTS:

6. What degree of hip flexion is contraindicated for a patient who has recently undergone a total hip replacement posteriorly? A. 40 degrees B. 75 degrees C. 90 degrees D. 115 degrees ANS: D If the replacement was done posteriorly, then hip adduction past neutral, hip flexion past 90 degrees, and internal hip rotation past neutral on the affected side should be avoided to prevent dislocation. PTS:

7. Which are not examples of multijoint muscles?

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Test Bank A. B. C. D.

Rectus femoris and parts of the hamstrings Biceps brachii and long head of the triceps brachii Extensor digitorum and flexor digitorum Gastrocnemius and soleus

ANS: D Muscles that cross more than one joint must be identified and given special consideration when PROM is performed. Some examples of multijoint muscles are the biceps and triceps, extrinsic finger flexors and extensors, the quadriceps (rectus femoris), the hamstrings, and the gastrocnemius. The soleus muscle is considered to cross only one joint, the ankle. PTS:

8. Which diagonal pattern involves hip flexion, adduction, and external rotation; ankle dorsiflexion and inversion; and toe extension? A. D1 flexion of the lower extremity B. D1 extension of the lower extremity C. D2 flexion of the lower extremity D. D2 extension of the lower extremity ANS: A The diagonal patterns are named according to the position of the proximal joint (i.e., the shoulder or the hip) at the conclusion of the pattern. D1 flexion of the lower extremity mimics the motion of kicking a soccer ball with the inside of the foot, including all of the listed motions. PTS:

9. Which type of muscle contraction describes a relative shortening of the muscle? A. Concentric B. Eccentric C. Isometric D. Isokinetic ANS: A When a muscle contracts concentrically, its fibers cause a relative shortening of the muscle. When a muscle contracts eccentrically, its fibers allow a relative lengthening of the muscle. An isometric muscle contraction produces little or no observable joint motion and no significant change in the length of the muscle. PTS:

10. Which type of muscle contraction describes a controlled and consistent speed of contraction? A. Isotonic B. Isometric C. Isokinetic D. None of the above

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Test Bank

ANS: C Isokinetic exercise is possible when specific equipment is used. Isokinetic exercise equipment controls the speed of the patient’s contractions and produces a variable resistance to the muscle as it contracts through its arc or ROM. Published studies indicate that isokinetic exercise strengthens muscle more efficiently than other forms of resistive isotonic (concentric or eccentric) exercise. PTS:

11. In general, according to the length-tension curve of a muscle, during which portion of a muscle’s range is it capable of developing the greatest tension during an isotonic contraction? A. Beginning ranges B. Midranges C. End ranges D. Tension develops equally throughout a muscle’s range ANS: B When a patient performs an isotonic contraction, the maximal resistance available to be used is the resistance that can be overcome through the part of the range where the muscle has the weakest contractile capacity. Most muscles have the weakest contractile capacity at the beginning and the end of the ROM, and most muscles tend to develop their greatest tension during the midportion of the range. PTS:

12. If a joint or soft tissue is painful when moved through its range, or when inflammation is present in the area, which type of exercise should be used to maintain muscle tone? A. Isokinetic B. Isotonic C. Isometric D. Eccentric ANS: C No observable joint motion should occur when an isometric muscle contraction is performed. Therefore, isometric exercise may be used if a muscle is immobilized, if a joint or soft tissue is painful when moved through its range, or if inflammation is present in the area. PTS:

13. What pathology would cause an abnormal bony end feel? A. Meniscus tear B. Acute subacromial bursitis C. Frozen shoulder D. Osteophyte formation

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Test Bank ANS: D For some motions, such as elbow extension, a bony end feel is considered normal. However, when the bony end feel comes well before the normal end of ROM, pathology such as osteophyte formation may be present. A meniscus tear will produce a springy block end feel. Acute subacromial bursitis may cause an empty end feel. A frozen shoulder and other chronic conditions cause hard capsule end feels. PTS:

14. What symptoms indicate a positive vertebral artery occlusion test? A. Numbness or tingling of the hands B. Dizziness, diplopia, or visual disturbances C. Jaw pain and distal muscle weakness D. Fever and difficulty breathing ANS: B Before using PROM on the cervical spine, the caregiver should evaluate the ability of the vertebral artery to maintain adequate blood flow to the brain using the vertebral artery occlusion test. Positive findings include complaints of dizziness, diplopia, light-headedness, or visual disturbances. PTS:

15. Which type of range-of-motion eT xeErcSisTeBisAm t aEpL prLoE prRia.teCaOt M the site of an unhealed NoKsS fracture? A. PROM B. AROM C. AAROM D. All of the above are appropriate ANS: A Passive range-of-motion (PROM) exercise is used to counteract the negative aspects of immobilization, evaluate joint range and flexibility, provide sensory stimulation and awareness, and reduce stress on the cardiopulmonary system. PROM is the most appropriate choice because an unhealed fracture may be disrupted by active muscle contractions. PTS:

16. In which condition is full lengthening of the extrinsic finger flexors contraindicated? A. Spinal cord injury with C6 nerve root sparing B. Radial head fracture C. Medial epicondylitis D. Shoulder impingement ANS: A

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Test Bank The patient with a spinal cord injury that has spared the C6 nerve root may benefit from tightness or limited range of the extrinsic finger flexors. Limited range of the finger flexors, when combined with active wrist extension, can provide the person with a passive grasp known as a “tenodesis” grasp. PTS:

17. When a person is supine, how do the shoulder extensors function from 0 to 90 degrees of active shoulder flexion? A. Isometrically B. Concentrically C. Eccentrically D. None of the above ANS: B When a person is supine and performs active shoulder flexion through the shoulder’s full normal range, the shoulder flexors function concentrically from 0 to 90 degrees of flexion and the shoulder extensors function eccentrically from 90 to 180 degrees of flexion. PTS:

18. How should patients be instructed to breathe when performing active resistive exercises? A. Slowly B. Normally C. Rapidly D. Breath should be held ANS: B The Valsalva maneuver, caused by holding one’s breath during resistance exercise, should be avoided to prevent the possibility of serious complications that could lead to a cerebrovascular accident or even death. Patients should be instructed and reminded to avoid holding the breath and to breathe normally during the exercise program, particularly when performing resistive isometric exercise. PTS:

19. What is an example of a muscle setting exercise, a type of isometric contraction? A. Biceps curls B. Squats C. Gluteus maximus squeezes D. Hamstring stretching ANS: C Muscle setting is a form of isometric exercise that can be beneficial in maintaining some muscle tone, maintaining contractile awareness, and allowing exercise of an immobilized, innervated muscle. The patient is instructed to contract or tighten (set) a specific muscle or muscle group (i.e., the gluteals) without producing joint motion or changing the length of the muscle.

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Test Bank

PTS:

20. How should the hands of a caregiver be placed during an attempt to facilitate a muscle contraction? A. Directly over the contracting muscles B. Directly over the muscles that are required to relax C. Directly lateral to the contracting muscles D. Over the distal portion of the muscle tendons ANS: A Hand placement by the caregiver should provide a tactile contact and stimulus to the major muscles involved in producing the desired extremity movement. The caregiver’s grasp should contact the skin surface overlying the muscle bellies that are to contract and avoid contact with the muscle or muscles that are to relax during the exercise. PTS:

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Chapter 07: Features and Activities of Wheelchairs Test Bank MULTIPLE CHOICE 1. What distance is used to determine proper wheelchair seat height? A. The distance from the user’s ankle to upper thigh, plus 2 inches B. The distance from the user’s heel to popliteal fold, minus 2 inches C. The distance from the user’s heel to popliteal fold, plus 2 inches D. The distance from the user’s heel to upper thigh, minus 2 inches ANS: C Proper wheelchair seat height is determined by the distance from the user’s heel to the popliteal fold with the addition of 2 inches to allow for clearance of the footrest. The average adult wheelchair seat height is 19.5–20.5 inches. PTS:

2. How much weight are standard adult wheelchairs designed to carry? A. Less than 200 pounds B. Less than 250 pounds C. Less than 275 pounds D. Less than 300 pounds ANS: A Standard adult wheelchairs are designed for persons who weigh less than 200 pounds. Heavy-duty adult wheelchairs should be used for persons weighing more than 200 pounds or those who perform vigorous functional activities. PTS:

3. What distance is used to determine proper wheelchair seat depth? A. The distance from the user’s posterior buttock to the popliteal fold, minus 2 inches B. The distance from the user’s posterior buttock to the patella, minus 2 inches C. The distance from the user’s posterior buttock to the patella, plus 2 inches D. The distance from the user’s posterior buttock to the popliteal fold, plus 2 inches ANS: A Proper wheelchair seat depth is determined by the distance from the user’s posterior buttock, along the lateral thigh, to the popliteal fold, with the subtraction of 2 inches to avoid pressure from the front edge of the seat against the popliteal space. The average adult wheelchair seat depth is 16 inches.

Test Bank PTS:

4. How should the inferior angles of the scapulae be positioned relative to the top of the back upholstery of a properly fitted wheelchair? A. About one hand width above the back upholstery B. About one fingerbreadth above the back upholstery C. About two fingerbreadths below the back upholstery D. About one hand width below the back upholstery ANS: B Proper fit for a standard seat back will allow you to place four fingers, with your hand held vertically, between the top of the back upholstery and the floor of the user’s axilla. The inferior angles of the scapulae should be positioned approximately one fingerbreadth above the back upholstery when the user sits with an erect posture. PTS:

5. What adverse effect may a user experience if the footplates of the wheelchair are too low? A. Increased pressure to the distal posterior aspect of the thigh B. Increased pressure to the ischial tuberosities C. Decreased trunk stability D. Increased pressure to the greater trochanters ANS: A If the footplates are too low, the uTsE erSmTaB yAeN xpKeS rieEnLceLiEnR cr. eaCseOdMpressure to the distal posterior aspect of the thigh, decreased function of the upper extremities when propelling the chair, and unsafe mobility due to lack of sufficient clearance of the footplate from the floor or ground surface. PTS:

6. How should a patient using both upper extremities for wheelchair propulsion be taught to navigate up a particularly steep ramp or incline? A. Facing forward, moving in a straight line B. Facing backward, moving in a straight line C. Facing forward, moving in a zigzag fashion D. Facing backward, moving in a zigzag fashion ANS: C It may be necessary to instruct the person to zigzag or angle up or down an incline, especially if the incline is particularly steep. This is done by propelling oneself up or down the incline at an angle to the right for several feet and then at an angle to the left for several feet. This pattern is continued until the top or bottom of the incline is reached. PTS:

7. Which wheelchair feature is important for a patient who will perform a lateral swinging or sliding transfer in the sitting posture?

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Test Bank A. B. C. D.

Fixed armrests Removable armrests Desk or cutout armrests Adjustable armrests

ANS: B Removable or reversible armrests are recommended for users who will perform a lateral swinging or sliding transfer in the sitting posture. The armrest can be reversed to temporarily narrow the distance between the armrest panels and is usually secured to the frame by a pin-in-hole lock. PTS:

8. Which wheelchair dimension should be examined if excessive pressure to the greater trochanters is noted? A. Seat depth B. Back height C. Armrest height D. Seat width ANS: D If the seat is too narrow, the person may experience difficulty changing position because there is insufficient space to adjust position; excessive pressure to the greater trochanters because they are likely to contact the armrest panel; and difficulty wearing bulky outer garments, orthoses, or braces becT auEsS eT thB erA eN wK ilS l nEoL t bLeEsR uf.fiC ciOenMt space for the object to fit between the user’s hip or thigh and the armrest panel. PTS:

9. What distance is used to determine proper wheelchair seat width? A. The distance between the most lateral aspects of the user’s buttocks, plus 4 inches B. The distance between the most lateral aspects of the user’s buttocks, plus 1.5 inches C. The distance between the most lateral aspects of the user’s buttocks D. The distance between the most lateral aspects of the user’s buttocks, minus 2 inches ANS: B Proper seat width is measured by the widest aspect of the user’s buttocks, hips, or thighs, plus approximately 1½ inches. This will provide space for bulky clothing, orthoses, or clearance of the trochanters from the armrest side panel. Average seat width is 18 inches. PTS:

10. Which actions enable the user to produce the quickest right turn of the wheelchair? A. Hold the left handrim, and push forward on the right handrim. B. Pull back on the left handrim, and push forward on the right handrim. C. Hold the right handrim, and pull back on the left handrim. D. Push forward on the left handrim, and pull back on the right handrim.

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Test Bank ANS: D Holding the right handrim while pushing forward on the left handrim will produce a right turn; however, simultaneously pulling back on the right handrim and pushing forward on the left handrim will cause the chair to turn more quickly. PTS:

11. When propelling a wheelchair up an incline, in which direction should the patient lean? A. Backward B. Forward C. To either side D. It is not necessary for the patient to lean in any direction ANS: B It is important for the patient to lean forward to move the COG forward and to decrease the possibility of tipping backward when propelling a wheelchair up an incline. PTS:

12. How should a patient in a wheelchair be instructed to react to a backward fall? A. Place one forehand across the knees and thighs. B. Reach backward for protection with one hand. C. Reach backward for protection with both hands. D. Raise both upper extremities T abEoS veTtBhA eN heKaS d.ELLER.COM ANS: A When the chair tips backward, instruct the person to prevent the knees and thighs from hitting the face by placing one forearm across them with the hand holding the opposite armrest. The patient should not attempt to reach backward for protection because this will increase the speed of the fall and the possibility of injury to the upper extremities and head. PTS:

13. How does the “amputee” wheelchair differ from standard wheelchairs? A. The seat is lowered approximately 2 inches. B. The rear wheel axles are positioned 2 inches posterior to their normal position. C. The seat is widened approximately 2 inches. D. The rear wheel axles are positioned 2 inches anterior to their normal position. ANS: B On the wheelchair adapted for an amputee, the rear wheel axles are positioned approximately 2 inches posterior to their normal position to widen the base of support of the chair and compensate for the missing weight of the user’s lower extremities. PTS:

14. How does the “hemiplegic” wheelchair differ from standard wheelchairs? A. The seat is lowered approximately 2 inches.

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Test Bank B. The rear wheel axles are positioned 2 inches posterior to their normal position. C. The seat is widened approximately 2 inches. D. The rear wheel axles are positioned 2 inches anterior to their normal position. ANS: A On the wheelchair adapted for a patient with hemiplegia, the seat is lowered approximately 2 inches to allow better use of the user’s lower extremities in propelling the chair. PTS:

15. What is a potential disadvantage of a sling or hammock seat cushion? A. Internal rotation of the femurs B. Difficult lateral sitting transfers C. A tendency for the pelvis to slide forward D. All of the above ANS: D A sling or hammock seat tends to cause internal rotation of the femurs, posterior pelvic tilt, forward head, and a tendency for the pelvis to slide forward. These are undesirable factors that may adversely affect the person’s function. In addition, lateral sitting transfers may be more difficult to perform from this type of seat. PTS:

SoTsBt A 16. Which wheelchair feature would T beEm beNnK efS icE iaL lL wE heRn.thCeOuM ser has only one functional upper extremity and no functional lower extremities? A. One-arm drive B. Adjustable armrests C. Removable leg rests D. Scissor locks ANS: A The one-arm drive chair may be used for independent propulsion when the user has only one functional upper extremity and no functional lower extremities. Two handrims are attached to the same wheel. The outer, larger rim propels the far-drive wheel and the inner, smaller rim propels the near-drive wheel. PTS:

17. Which wheelchair feature would be most beneficial for a user who has poor trunk stability? A. Elevating leg rests B. Toggle locks C. Chest and lap belts D. Removable armrests ANS: C

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Test Bank The chest belt is attached to the frame of the chair at mid-chest level to increase trunk stability, prevent the user from falling out of the chair, and maintain the body upright. It may be combined with a lap belt for greater security. Vertical extensions for locks would also benefit users with impaired trunk control. PTS:

18. When a wheelchair user performs a “wheelie” or “pop-up,” which wheels are elevated? A. Both caster wheels B. Both drive wheels C. Both rear wheels D. Only one caster wheel ANS: A Caster wheels are located on the front of the wheelchair. Drive or rear wheels are located posteriorly. Elevation of both caster wheels (known as a “wheelie” or “pop-up”) is necessary so that the wheels can clear objects on the floor, sidewalk, or ground and to ascend or descend curbs and curb cutouts. PTS:

19. Which of the following wheelchair maintenance activities is not recommended? A. Lubrication of the cross-brace center pin every 6 months B. Wiping the chair down dry afTteEr S exTpB osAuN reKtS oE raL inL, E snRo. wC , oOrMother moisture C. Immersing the chair in water or spraying it with a hose to remove debris D. Periodic lubrication of armrest posts with a silicon spray ANS: C The chair should not be immersed in water or sprayed with a hose. This may cause unwanted breakdown or rust of the chair parts. It should be wiped dry after exposure to rain, snow, or other types of moisture, and it should also be lubricated regularly in the appropriate areas. PTS:

20. Which of the following is not an advantage of a chair cushion? A. Helps distribute pressure to reduce skin breakdown B. Provides support for the pelvis C. Adds comfort D. Eliminates pressure to the ischial tuberosities ANS: D Although chair cushions help to distribute pressure and reduce skin breakdown, they do not eliminate the pressure to the ischial tuberosities. Therefore, regular pressure-reducing exercises should still be performed by the user. PTS:

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Chapter 08: Transfer Activities Test Bank MULTIPLE CHOICE 1. Which type of transfer assistance is used when a caregiver is positioned close to the patient with his or her hands on the patient or safety belt? A. Standby assistance B. Contact guarding C. Minimal assistance D. Moderate assistance ANS: B Contact guarding is used when it is very likely the patient will require protection during the performance of an activity. The caregiver is positioned close to the patient with hands on the patient or safety belt. PTS:

BhAeNnKthSeEpL 2. What type of transfer assistance iT s uEsS edTw atL ieE ntRp. erCfoOrM ms only 25 to 49 percent of the activity? A. Minimal assistance B. Moderate assistance C. Maximal assistance D. Dependent assistance ANS: C Maximal assistance denotes 25–49 percent assistance from the patient. A patient who is able to perform 50–74 percent of the activity requires moderate assistance. Minimal assistance is used when a patient performs 75 percent or more of the activity. A dependent patient requires total physical assistance. PTS:

3. What level of assistance is used if a patient requires only verbal cues to perform an activity safely and within an acceptable time frame? A. Standby assistance B. Contact guarding C. Minimal assistance D. Moderate assistance ANS: A

Test Bank Under standby or supervision assistance, the patient requires verbal or tactile cues, directions, or instructions from another person positioned close to, but not touching, the person in order to perform the activity safely and within an acceptable time frame. PTS:

4. What type of footwear should be used when one is performing a standing transfer? A. Shoes with smooth leather soles B. Sandals C. Slippers D. Non-skid shoes or socks ANS: D The patient should wear proper shoes to perform a standing transfer. Slippers, sandals, shoes with smooth leather soles, or regular socks without shoes will decrease safety and should be avoided. PTS:

5. What reaction might a patient with a spinal cord injury experience after transferring from supine to sitting? A. Syncope B. Hip dislocation C. Hypertension D. Radiculopathy ANS: A Syncope is a temporary suspension of consciousness as a result of cerebral anemia. A patient with a spinal cord injury may experience this when transferring from a supine to a sitting position because the blood pressure may not adapt quickly to the positional change. PTS:

6. During an upward movement transfer of a supine patient, how should the patient’s lower extremities be positioned? A. Fully extended on the bed B. Crossed with one ankle on top of the other C. With the hips and knees flexed and feet flat on the bed D. With both hips fully adducted ANS: C To initiate an upward movement of a supine patient, ask the patient to perform a bridging exercise by flexing the hips and knees so that the feet rest flat on the bed or mat. This will reduce friction between the extremities and the bed or mat surface and will position the patient so that he or she can assist by lifting the pelvis or pushing with the legs. PTS:

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Test Bank 7. In the transfer of a patient from supine to prone, how should the patient’s lowermost upper extremity be positioned? A. Folded across the chest B. In 90 degrees of flexion C. In 90 degrees of abduction D. Tucked along the patient’s side ANS: D The arm over which the patient will roll should be positioned either close along the side, with the shoulder externally rotated, elbow straight, palm up, and the hand tucked under the pelvis; or with the shoulder flexed so that the arm rests next to the ear with the elbow straight. The other, contralateral upper extremity remains by the side. PTS:

8. In transferring a patient with a recent total hip replacement from a chair to a bed, which motions should be avoided? A. Adduction of the replaced hip beyond midline B. Excessive internal or external rotation C. Hip flexion beyond 60–90 degrees D. All of the above ANS: D A patient with a recent total hip replacement must not pivot on that extremity when standing, flex the surgical hip or T thE eS trT unBkApN asKt S 60E–L9L 0E deRg. reC esO, M or adduct the hip past neutral at any time during the transfer in order to protect the integrity of the surgery. PTS:

9. How should the wheelchair be positioned to perform a standing, dependent pivot transfer to the bed? A. At the head of the bed, parallel to the length of the bed B. At the foot of the bed, parallel to the length of the bed C. At the foot of the bed, at an angle of 45–60 degrees to the bed D. Midway between the head and foot of the bed, at an angle of 45–60 degrees to the bed ANS: D The wheelchair should be positioned parallel or at an angle of 45–60 degrees to the bed midway between the head and foot of the bed. The wheelchair should not be positioned at the head or foot of the bed to avoid the need for additional upward or downward transfers. PTS:

10. Where should a caregiver not allow a patient to place his or her upper extremities during a standing, dependent pivot transfer? A. Around the caregiver’s neck B. Around the caregiver’s upper back

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Test Bank C. Around the caregiver’s middle back D. Across the patient’s chest ANS: A The patient should be discouraged from holding onto the caregiver during transfers, but a patient who insists or is in the habit can hold the caregiver’s middle or upper back with the upper extremities. The patient should not be allowed to grab hold around the caregiver’s neck to prevent undue strain to the caregiver’s spine. PTS:

11. During a standing, assisted pivot transfer, where should a caregiver’s left leg be placed if the patient has significant right knee weakness? A. Posterior to the weak knee B. Anterior to the weak knee C. Lateral to the weak knee D. Near the patient’s stronger side ANS: B When the patient transfers, leading with the left (stronger) extremity, for example, stabilize the weaker (right) knee by placing your left foot next to the lateral area of the right foot and by placing your left knee on the medial side of the right knee. This position will prevent buckling of the weak knee. PTS:

12. In standing from a seated position, how should the patient’s feet be positioned if one is significantly weaker than the other? A. With the stronger foot posterior to the weaker foot B. With the weaker foot posterior to the stronger foot C. They should be positioned level with each other, less than a shoulder width apart D. They should be positioned level with each other, more than a shoulder width apart ANS: A The patient should position the feet about a shoulder width apart with the stronger foot posterior to the weaker or most affected foot. This position allows the stronger lower extremity to raise the body most effectively. PTS:

13. To perform an assisted sitting transfer with a transfer board, where should the board be positioned? A. Directly under the buttocks B. Under the posterior portion of the buttocks C. Beneath the thigh and over the drive wheel D. Beneath the thigh and in front of the drive wheel ANS: C

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Test Bank The transfer board should be positioned under the patient’s thigh, in front of the drive wheel, so that it extends from the wheelchair seat to the bed. The wheelchair will usually need to be angled next to the bed with its armrest removed for this placement. The transfer board should not be placed only under the buttocks. This can result in the patient sliding forward off of the transfer board during the transfer. PTS:

14. Where should the caregiver be positioned during a transfer board transfer? A. Directly behind the patient B. Directly in front of the patient C. Slightly in front and to one side of the patient D. Slightly behind and to one side of the patient ANS: C The caregiver should be positioned slightly in front of and to one side of the patient in order to best guide the extremities, maintain proper body mechanics, and avoid impeding the patient’s movement. PTS:

15. If a patient is transferring to the right from a wheelchair to bed, where should the buttocks be positioned before the transfer? A. In the middle of the wheelchaTirEsS eaTt BANKSELLER.COM B. Toward the back of the wheelchair seat, behind the drive wheel C. To the right side of the wheelchair seat, behind the drive wheel D. Toward the front of the wheelchair seat, in front of the drive wheel ANS: D Moving forward in the wheelchair seat will allow the patient to transfer across the least distance to the bed. Moreover, ensuring that the patient is positioned in front of the drive wheel will prevent the wheel from hindering the transfer. PTS:

16. Which transfer is sometimes referred to as the “quad pivot”? A. One-person dependent B. Two-person dependent C. Sitting, independent D. Sitting, assisted ANS: A The one-person lift transfer, sometimes referred to as the “quad pivot,” can be used when a patient is unable to stand or is unable to perform any type of assisted transfer, and when the assistant is sufficiently strong and skilled to perform the lift. PTS:

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Test Bank 17. Where should the caregiver position a patient’s upper extremities when a mechanical lift is used? A. Folded over the abdomen B. Around the outside of the sling C. Holding onto the spreader bar D. Above the head ANS: A The patient’s upper extremities should be folded over the abdomen to avoid getting caught in the sling chains. The patient should also be cautioned not to reach for or grasp the spreader bar when being raised to prevent injury from the mechanical device. PTS:

18. Which movement is recommended during the transfer of a patient with low back trauma or discomfort? A. Segmental rolling B. Logrolling C. Full trunk flexion D. Full trunk rotation ANS: B When turning, patients with low back trauma may experience less discomfort if they “logroll” (i.e., roll the entire body simultaneously) rather than rolling segmentally (i.e., rolling the shoulders and upper trT unEkSfT irsBt,AthNeKnSthEeLpL elE viRs,.aC ndOtMhen the lower extremities). Moreover, these patients should avoid excessive lumbar rotation, trunk side bending, and trunk flexion. PTS:

19. What is the primary precaution to observe during the transfer of a patient with a burn wound? A. Avoidance of dizziness or vertigo B. Avoidance of quick motions in any direction C. Avoidance of shear forces across the burn or graft site D. Avoidance of active motion by the patient ANS: C The primary precaution is to avoid creating a shear force across the surface of the burn wound, graft site, or area from which the graft was taken. Sliding creates a shear force, causing friction and disruption of the healing process. PTS:

20. What should a caregiver grasp to guard a patient during transfers? A. The patient’s belt B. The patient’s shirt C. A safety belt or sling

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Test Bank D. The patient’s arms ANS: C Caregivers should not guard patients using the patients’ clothing or grasping their arms. Clothing can become loose, and injury to the upper extremities is likely if the arms are grasped. Safety belts, slings, or the trunk should be held instead. PTS:

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Chapter 09: Assistive Devices, Patterns, and Activities Test Bank MULTIPLE CHOICE 1. What degree of elbow flexion is recommended with the use of parallel bars or axillary crutches? A. 0 to 10 degrees B. 10 to 15 degrees C. 20 to 25 degrees D. 25 to 40 degrees ANS: C The patient should have approximately 20 to 25 degrees of elbow flexion when grasping the handpiece while keeping the shoulders level and relaxed. This slight amount of elbow flexion will allow the patient to efficiently lift or support the body by extending the elbows. PTS:

2. What device benefits a person whToEnS eeTdB sA toNaK ccSoE mLmLoE daRte.sCloOwMly to an upright position? A. Parallel bars B. Tilt table C. Supported suspension ambulatory aid D. Forearm crutches ANS: B A tilt table may benefit a person who needs to physiologically accommodate to an upright position due to any of a variety of conditions, such as prolonged recumbence. It is particularly useful because it can be elevated gradually and maintained at any position between horizontal and completely vertical. PTS:

3. At what level should the handgrip of a walker be placed? A. The patient’s fingertips B. The patient’s waist C. The patient’s olecranon process D. The patient’s wrist crease ANS: D The handgrip of the walker should be placed level with the patient’s wrist crease, ulnar styloid process, or greater trochanters, with the walker positioned in front of and along the patient’s sides and with the patient’s arms straight along the sides.

Test Bank

PTS:

4. For forearm crutches, what is the proper location for the top of the forearm cuff? A. 1 to 1.5 inches distal to the olecranon process B. 1 to 1.5 inches proximal to the ulnar styloid process C. 5–6 inches distal to the olecranon process D. 5–6 inches proximal to the ulnar styloid process ANS: A The top of the forearm cuff should be located approximately 1 to 1.5 inches distal to the olecranon process when the patient grasps the handpiece with the cuff applied to the forearm and the wrist in neutral flexion-extension. PTS:

5. Which gait pattern describes the simultaneous, reciprocal forward placement of the assistive device and the patient’s opposite lower extremity? A. Modified three-point pattern B. Two-point pattern C. Three-point pattern D. Four-point pattern ANS: B The two-point pattern is a relativeTlyEsStaTbB leApN atK teSrnEaLnL dE caRn.bC eO peMrformed more rapidly than the four-point pattern. However, it requires coordination by the patient to move one upper extremity and its opposite lower extremity forward simultaneously. PTS:

6. Which guarding position provides the greatest sense of security for patients as they descend from an elevation? A. Behind the patient B. To the left side of the patient C. To the strongest side of the patient D. In front of the patient ANS: D Guarding from either the front or back can provide safety for the patient, but most patients have a greater sense of security when someone is in front of them as they descend from an elevation. PTS:

7. Which stance should be avoided when one is guarding a patient who is descending stairs? A. One foot one step below the other B. One foot two steps below the other C. Both feet on the same step parallel to each other

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Test Bank D. A widened stance ANS: C Guarding caregivers should not stand with the feet parallel to each other and on the same step directly below and in front or to the side of the patient. This position will be unstable if the patient falls forward because it does not provide a wide anteroposterior base of support. PTS:

8. If a patient is using bilateral crutches and has been instructed to bear only partial weight on the left lower extremity, what should he or she lift first when ascending a curb? A. The right lower extremity B. The left lower extremity C. Either crutch D. Both crutches simultaneously ANS: A To ascend a curb, the patient should place the stronger (right) lower extremity onto the curb and elevate the body while simultaneously raising the crutches and the PWB lower extremity onto the curb. PTS:

9. What action should accompany the lowering of axillary crutches down from a curb? A. Extension of the strongest hip B. Extension of the strongest knee C. Flexion of the strongest hip and knee D. Extension of the trunk ANS: C If the patient does not flex the hip and knee of the supporting extremity to lower the body, the distance between the top of the axillary rest and the axilla will increase greatly when the crutches are placed down off the curb and the stability of the crutches will be reduced significantly. PTS:

10. What should a patient using bilateral axillary crutches do in the event of a forward fall? A. Use only one crutch to help break the fall B. Use both crutches to help break the fall C. Release both crutches so that they fall to each side D. None of the above ANS: C The patient should be taught to release the crutches, allowing them to fall to each side, and reach toward the floor with the upper extremities. The person should “break” the fall with the upper extremities and lower the body to the floor. Landing on one or both crutches may cause additional injuries.

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Test Bank

PTS:

11. Which muscle group functions to decelerate the limb between the midswing and initial contact phases of gait? A. Quadriceps B. Hamstrings C. Hip flexors D. Gluteus medius/minimus ANS: B The hamstrings perform hip extension and knee flexion; therefore, between the gait phases of midswing and initial contact, they work eccentrically to decelerate the limb. PTS:

12. Which gait pattern is typically associated with a non-weight-bearing lower extremity? A. One-point gait B. Two-point gait C. Three-point gait D. Four-point gait ANS: C The three-point gait pattern is used when one lower extremity is required to be non–weight bearing. This pattern requires bilaT teE raSl T asB siA stN ivK eS deEvL icL esEoRr . aC wO alM ker. The walker or crutches and the NWB extremity are advanced, and then the patient steps up to the front rail of a walker or through the crutches. PTS:

13. How much space should there be between the top of an axillary rest and the floor of the axilla when the crutch tip is 2 inches lateral and 4 to 6 inches anterior to the toe of the shoe? A. 2 inches B. 4 inches C. 6 inches D. The axillary rest should be in direct contact with the axilla ANS: A More than 2 inches of space between an axillary rest and the axilla in the resting position will cause an unnecessary decrease in stability. Less than 2 inches of space, on the other hand, may cause discomfort or tissue breakdown at the axilla. PTS:

14. Pistol grip, offset shaft, quad, hemi, and crab are all types of which assistive devices? A. Axillary crutches B. Forearm crutches C. Canes

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Test Bank D. Walkers ANS: C Types of canes include “J,” “T,” pistol grip, offset shaft, three- or four-legged, and four-footed (sometimes referred to as quad, hemi, or crab canes). PTS:

15. Which gait pattern describes the repetitive, alternating, reciprocal forward movement of assistive devices and the person’s opposite lower extremities? A. One-point gait B. Two-point gait C. Three-point gait D. Four-point gait ANS: D The four-point gait pattern requires the use of bilateral assistive devices. The pattern uses an alternating and reciprocal forward movement of the assistive device and the patient’s opposite lower extremity (i.e., right crutch, then left foot, then left crutch, then right foot). PTS:

16. What percentage of a patient’s height is used to estimate ideal crutch length? A. 55 percent B. 66 percent C. 77 percent D. 88 percent ANS: C If the height of the patient is known, it may be multiplied by 77 percent (e.g., 70 inches × 0.77 = 53.90, or 54 inches), or 16 inches may be subtracted from the height (e.g., 70 inches – 16 inches = 54 inches) to estimate the ideal overall crutch length (i.e., axillary rest to tip). PTS:

17. When performing activities on parallel bars, how much space should be provided between each of the patient’s hips and the bar? A. 0 to 2 inches B. 2 to 4 inches C. 4 to 6 inches D. 6 to 8 inches ANS: B Less than 2 inches of space between the patient’s hips and the bar will tend to hinder normal movement. Greater than 4 inches, however, will decrease the efficiency of the upper extremity muscles attempting to provide stability. PTS:

9-5

Test Bank

18. What should a patient using bilateral axillary crutches do in the event of a backward fall? A. Release the crutches and quickly flip them to the side B. Reach backward with both upper extremities C. Maintain an extended trunk position D. Look backward toward the floor ANS: A The patient falling backward should release the crutches and quickly flip them to the side; the crutches must not fall to the floor behind the body. The patient should also tuck the chin toward the chest, reach forward with both upper extremities, and maintain a semiflexed trunk position so that the buttocks and trunk contact the floor before the back of the head. PTS:

19. For a patient with a weaker right lower extremity, what is lifted first when the patient ascends stairs with a cane? A. The cane B. The cane and right lower extremity simultaneously C. The left lower extremity D. The right lower extremity ANS: C When ascending stairs with a cane, the patient with a weaker right lower extremity faces .eCr OexMtremity first. The left the stairs and moves up one step T wE ithStThB eA st N roK ngSeE r,LleLftElR ow extremity is then used to elevate the body as the right lower extremity and cane ascend simultaneously onto the same step. PTS:

20. In determining proper walker height for a patient, where are the rear tips of the walker positioned? A. Slightly ahead of the toes B. Opposite the midportion of the feet C. Next to the patient’s heels D. 2 inches behind the heels ANS: B In determining proper walker height, the walker should be positioned in front of the patient so that the rear tips of the walker are opposite to the midportion of the feet. The patient then grasps the handpieces and the height of the walker is adjusted to allow approximately 20 to 25 degrees of elbow flexion. PTS:

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Chapter 10: Special Equipment and Patient Care Environments Test Bank MULTIPLE CHOICE 1. What photoelectrical device measures the oxygen saturation of blood? A. Endotracheal tube B. Arterial monitoring line C. Swan-Ganz catheter D. Oximeter ANS: D An oximeter measures the oxygen saturation (SaO2) of the patient’s blood by recording the different modulations of a transmitted beam of light affected by reduced hemoglobin (Hgb) and oxyhemoglobin. Usually, the oximeter is attached to a patient’s finger or ear. PTS:

2. What device measures pulmonary artery pressure (PAP)? A. Suprapubic catheter B. Swan-Ganz catheter C. Endotracheal tube D. Nasogastric tube ANS: B A Swan-Ganz catheter is a long tube inserted into a vein (usually the basilic or subclavian vein) and terminating in the pulmonary artery. A monitor attached to the catheter measures the pulmonary artery pressure. PTS: 1 3. How is a bed positioned for a patient in Fowler’s position? A. The lower component is higher than the upper component. B. The upper and lower components are level, and also in line with the middle component. C. The upper and lower components are raised while the middle remains stationary. D. The upper and lower components are lowered while the middle remains stationary. ANS: C On some beds, the lower component will become flexed whenever the upper component is raised. This action creates hip and knee flexion, or Fowler’s position, which is more comfortable for the patient and tends to prevent sliding down in the bed.

Test Bank PTS:

4. Which bed oscillates in a cradle-like motion to reduce the amount of prolonged pressure on the patient’s skin? A. Air-fluidized support bed B. Low air loss therapy bed C. Post-trauma mobility bed D. Standard adjustable bed ANS: C Post-trauma mobility beds (e.g., Keane, Roto-Rest) are designed to maintain a seriously injured patient in a stable position and maintain proper postural alignment through the use of adjustable bolsters. The bed oscillates from side to side, in a cradle-like motion, to reduce the amount of prolonged pressure on the patient’s skin. PTS:

5. What can be used to continuously measure blood pressure or obtain blood samples without the need for repeated needle punctures? A. A line B. B line C. C line D. D line ANS: A The A line (arterial monitoring line) is a catheter that is inserted into an artery—typically the radial, dorsal pedal, axillary, brachial, or femoral artery—to measure blood pressure or obtain blood samples. PTS:

6. Which of the following is a graphical record of the heart’s electrical action? A. EKG B. ETT C. INR D. MI ANS: A An EKG (or ECG) is the graphical record of the heart’s electrical action derived by amplification of the minutely small electrical impulses normally generated by the heart. ETT refers to an endotracheal tube. INR refers to an international normalized ration. MI refers to a myocardial infarction. PTS:

7. What information can be found using an ICP? A. Intravenous pressure B. Intrathoracic pressure

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Test Bank C. Intracranial pressure D. Intermittent capsule pressure ANS: C The ICP monitor measures the intracranial pressure exerted against the skull by brain tissue, blood, or cerebrospinal fluid (CSF). It is used for patients who have experienced a closed head injury, a cerebral hemorrhage, a brain tumor, or an overproduction of CSF. PTS:

8. What level of oxygen saturation in the blood should be maintained when a patient exercises? A. Minimum of 70 percent B. Minimum of 80 percent C. Minimum of 90 percent D. Minimum of 95 percent ANS: C During exercise or physical activity, a minimum of 90 percent saturation should be maintained to avoid hypoxemia and possible respiratory dysfunction. If the SaO2 falls below 90 percent and remains there, the patient’s nurse or physician should be notified and the treatment should be discontinued. PTS:

9. Which of the following values is most closely concerned with the body’s ability to fight acute or chronic disease or infection? A. RBC count B. WBC count C. Hgb D. Hct ANS: B The white blood cell (WBC), also known as a leukocyte, is one of the body’s defense mechanisms for fighting acute or chronic disease or infection. A person with a decreased WBC count caused by an immunosuppressed condition must be monitored carefully, and the caregiver must be certain to perform thorough hand hygiene, apply protective garments, and follow precautions before treatment to reduce the possibility of cross-contamination. PTS:

10. What condition describes a significant decrease in an individual’s red blood cell count? A. Polycythemia B. Anemia C. Hypoxemia D. Tachypnea ANS: B

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Test Bank Anemia occurs when the RBC count is decreased significantly, and polycythemia occurs when the RBC count is increased significantly. Hypoxemia is deficient oxygenation of the blood. Tachypnea refers to very rapid respirations. PTS:

11. Which hemoglobin (Hgb) level would be a contraindication for any treatment requiring physical activity? A. Greater than 16 g/dL B. Greater than 8 g/dL C. Less than 16 g/dL D. Less than 8 g/dL ANS: D Anemia, trauma, surgery, or dietary iron deficiency may cause a decrease in Hgb, the protein that transports oxygen in the blood. A person with low Hgb will have a reduced tolerance to physical activity and will require frequent rest periods. Those whose Hgb is less than 8 g/dL should not participate in treatment requiring physical activity. PTS:

12. Which medication is an anticoagulant? A. Heparin B. Warfarin C. Aspirin D. All of the above ANS: D Anticoagulants are a class of medications used to prevent clots in high-risk patients. Several commonly prescribed anticoagulants are heparin, warfarin (Coumadin), Plavix, Lovenox, and Arixtra. Aspirin is also considered an anticoagulant. PTS:

13. What type of exercise is recommended if a patient’s INR is between 4.0 and 5.0? A. Heavy resistive and aerobic exercise B. Only light exercise; resistive exercises should be avoided C. Low-intensity resistive exercises D. Only limited bed mobility; all other physical activity should be deferred ANS: B If INR is between 4.0 and 5.0, resistive exercises should be avoided and only light exercise (rating of perceived exertion less than or equal to 11) should be permitted. Bed rest should be considered if a patient’s INR is 6.0 or higher. PTS:

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Test Bank 14. Which mode of oxygen delivery is most frequently used for patients who require longer periods of low to moderate concentrations of oxygen? A. Nasal cannula B. Oronasal mask C. Tent D. Tracheostomy catheter ANS: A The nasal cannula has two plastic tips that are inserted into the patient’s nostrils. It is used most frequently for patients who require low to moderate oxygen concentrations (e.g., patients with COPD). The oronasal mask is used for shorter periods when higher concentrations are desired. Tent delivery is often reserved for restless, very young, or uncooperative patients. PTS:

15. Which treatment is used for patients who experience ESRD? A. Traction B. Dialysis C. External fixation D. Internal fixation ANS: B Dialysis is used for patients who experience acute or end-stage renal disease (ESRD). The OaMl level of fluids and objectives of dialysis are to preveTnE t iS nfTeB ctA ioN n,KrS esE toLreLtE heRn.oCrm electrolytes, control the acid-base balance, remove waste and toxic materials, and assist in or replace normal kidney function. PTS:

16. Which hospital unit is designated by the acronym SICU? A. Special intensive care unit B. Surgical intervention and cardiac unit C. Surgical intensive care unit D. Sensory integration care unit ANS: C The SICU is the surgical intensive care unit. MICU (medical), RICU (respiratory), TICU (trauma), and NICU (neurological or neonatal) are also acronyms for intensive care units. PTS:

17. What is a normal blood glucose level? A. 30 mg/dL B. 90 mg/dL C. 180 mg/dL D. 540 mg/dL

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Test Bank ANS: B A range of 70–115 mg/dL is normal for blood glucose. Critical values for blood glucose are levels below 40 mg/dL (hypoglycemia) and above 500 mg/dL (hyperglycemia). PTS:

18. Which platelet count permits the performance of resistive exercises? A. 20,000/mm3 B. 40,000/mm3 C. 60,000/mm3 D. 80,000/mm3 ANS: D Resistive exercise is recommended only for patients who have a platelet count higher than 70,000/mm3. Light exercise is permitted for a count between 50,000/mm3 and 70,000/mm3. No exercise, however, is recommended if the platelet level is below 50,000/mm3. PTS:

19. How often does a PCA system allow a patient to self-administer a dose of medication? A. Every 2 minutes B. Every 6 minutes C. Every 30 minutes D. Every hour ANS: B A patient-controlled analgesia (PCA) system allows a patient to self-administer a small predetermined dose of pain medication intravenously on demand, as frequently as every 6 minutes. The unit will not deliver more medication than the premeasured dose each time the patient activates the button. PTS:

20. What kind of breathing would benefit a person experiencing hyperventilation? A. Pursed-lip breathing B. Deep breathing C. Rapid, shallow breathing D. Breath holding ANS: A If hyperventilation occurs, the person may benefit from relaxation techniques such as abdominal-diaphragmatic or pursed-lip breathing. If hypoventilation occurs, the person may benefit from deep-breathing techniques and an upright, trunk-supported position. PTS:

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Chapter 11: Basic Wound Care and Specialized Interventions Test Bank MULTIPLE CHOICE 1. Which phase of wound healing serves as the body’s initial local defense response to injury or trauma? A. Inflammatory B. Proliferative C. Remodeling D. Maturation

ANS: A The inflammatory process initiates wound healing. Its function is to limit tissue damage, remove injured or damaged cells, and repair the injured tissue. It is the body’s initial local defense response to injury or trauma, and it begins immediately after injury or trauma. Proliferative and remodeling (maturation) phases follow the inflammatory phase. PTS:

2. The vascular, exudates, and reparative phases occur in which stage of wound healing? A. Inflammatory B. Proliferative C. Remodeling D. Maturation

ANS: A The inflammatory phase of wound healing involves a vascular stage, during which hyperemia occurs. The exudates stage follows the vascular stage, characterized by the passage of fluid through vessel walls to deposit healing factors. Finally, the reparative stage marks the time when damaged cells are replaced and true wound healing begins. PTS:

3. What percentage tensile strength does scar tissue possess compared with the tissue that it replaces? A. 50 percent B. 80 percent C. 100 percent D. 125 percent

Test Bank

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ANS: B Scar tissue typically has only 80 percent of the tensile strength of the tissue that it replaces. The tensile strength of the tissue covering a wound is created by the collagen tissue organized during the remodeling phase of tissue healing. PTS:

4. What factors affect wound healing time? A. Nutritional status B. Hydration C. Age D. All of the above

ANS: D A person with poor nutritional status and dehydration will require a longer healing time. Moreover, a wound in an older adult may not heal as rapidly as a similar wound in a younger adult due to differences in circulation and metabolic responses to the wound. Infection and the presence of chronic illness will also delay healing. PTS:

5. Which layer of the skin is damaged with a first-degree burn? A. Epidermis B. Dermis C. Subcutaneous fat layer D. All of the above

ANS: A The skin has three major components: the epidermis, or upper layer; the dermis, or middle layer; and the subcutaneous fat, or deep layer. When the upper layer of the epidermis is affected, the burn is termed a first-degree burn. PTS:

6. According to the rule of nines, what percentage of the total body area is each upper extremity assigned? A. 9 percent B. 18 percent C. 27 percent D. 36 percent

Test Bank

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ANS: A The rule of nines helps to describe burn damage by assigning specific values to the body surface as follows. For adults: head and neck, 9 percent; each upper extremity, 9 percent; each lower extremity, 18 percent; front trunk area, 18 percent; back trunk area, 18 percent; and genital area, 1 percent. PTS:

7. What stage of pressure ulcer involves exposed bone, tendon, or muscle? A. Stage I B. Stage II C. Stage III D. Stage IV

ANS: D Stage IV pressure ulcers involve full-thickness tissue loss; moreover, exposed bone, tendon, or muscle is visible or palpable. Stage III ulcers also involve full-thickness tissue loss; however, bone, tendon, or muscle is not exposed. PTS:

8. What stage of pressure ulcer may present as an intact serum-filled blister? A. Stage I B. Stage II C. Stage III D. Stage IV

ANS: B Stage II pressure ulcers may present as an intake or open/ruptured serum-filled blister. They also represent a partial-thickness loss of dermis presenting as a shallow open ulcer with a reddish pink wound bed, without slough. PTS:

9. Which type of debridement uses a scalpel or scissors to remove necrotic tissue? A. Sharp B. Mechanical C. Chemical D. Autolysis

ANS: A

Test Bank Sharp debridement is the most rapid method, and a scalpel or scissors are used to remove thick adherent eschar and other devitalized tissue. Surgical or sharp debridement is most often performed when there is a high amount of necrotic tissue (>70%). PTS:

10. Which type of debridement uses an occlusive dressing in conjunction with self-produced enzymes? A. Sharp B. Mechanical C. Chemical D. Autolysis

ANS: D The use of a patient’s self-produced (endogenous) enzymes as the active enzymatic debridement agent is known as autolysis (or autolytic debridement) and is performed with a very occlusive dressing. PTS:

11. Which term describes redness of the skin caused by congestion of the capillaries in the lower layers of the skin? A. Eschar B. Erythema C. Maceration D. Slough

ANS: B Eschar refers to a dry scab or devitalized tissue. Maceration is the softening of a solid or tissue by soaking. Slough is a term used for a mass of dead tissue in, or cast out from, living tissue. PTS:

12. Which of the following is used to for the most accurate measurement of hand edema or muscle atrophy? A. Girth measurement with plastic measuring tape B. Measurement with a metal ruler C. Goniometric measurement D. Volumetric measurement

ANS: D

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Test Bank

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Volumetric displacement, using a volumeter, is a method for measuring changes in the distal aspect of an extremity caused by edema or muscle atrophy. The technique is more accurate than girth measurement due to the irregular shape of the hand and foot. PTS:

13. Which of the following is most closely associated with lymphedema? A. Rough, dry skin B. Weak immune system function C. Respiratory distress D. Excessive eschar

ANS: B Lymphedema patients have a high risk of developing skin infections because of the decreased flow of high-protein lymph fluid and their weakened immune system. Meticulous skin and nail care is important, therefore, to prevent bacterial, viral, and other infections. PTS:

14. Which type of amputation denotes the removal of the entire pelvis and distal structures? A. Hemicorpectomy B. Hemipelvectomy C. Hip disarticulation D. Symes disarticulation

ANS: A A hemicorpectomy is the removal of the entire pelvis and distal structures. A hemipelvectomy is the removal of half of the pelvis. A hip disarticulation is removal at the hip joint with pelvis left intact. A Symes disarticulation is the removal of the ankle joint. PTS:

15. What circulation test uses a treadmill to check for arterial insufficiency? A. Rubor of dependency test B. Ankle-brachial test C. Venous filling time test D. Claudication test

ANS: D The claudication test measures the length of time a patient can walk on a level-grade treadmill at one mile per hour until claudication (e.g., calf pain) occurs.

Test Bank PTS:

16. How often should “wet to wet” dressings be changed? A. Every 4 hours B. Every 8 hours C. Every 12 hours D. Daily

ANS: B “Wet to wet” dressings need to be changed every 8 hours to maintain a moist wound base. These dressings are a safe choice for stage II, stage IV, and unstaged wounds. PTS:

17. What are the goals for an infected wound? A. Maintain a moist wound bed, and soften and remove eschar. B. Protect the surrounding tissue, absorb exudate, and contain infection. C. Maintain a moist wound bed, and protect surrounding tissue. D. Maintain a moist wound bed, and absorb exudates. ANS: B Moist wound bed. Moist The goals for an infected wound T doEnSoT tB inA clN udKeSmEaLinLtaEinRi. ngCaOm wound beds should, however, be maintained for wounds that appear necrotic or with granulation. PTS:

18. Which is not a contraindication for lymphedema treatment? A. Acute infection B. Recent trauma or a burn C. Active cancer D. Congestive heart or kidney failure

ANS: B Lymphedema treatment is often indicated after trauma or a burn. Another contraindication is if the patient has recently undergone radiation treatment. Such an instance would require medical clearance before lymphedema treatment is performed. PTS:

19. Which of the following is an aspect of chest physical therapy (CPT)? A. Postural drainage B. Percussion and vibration

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Test Bank

11-7

C. Airway clearance D. All of the above

ANS: D In some facilities, a physical therapist will be responsible for all aspects of CPT, including postural drainage, percussion and vibration, and airway clearance (e.g., suctioning and cough techniques). PTS:

20. At which site is a pressure ulcer most likely to develop? A. Anterior thigh B. Heels C. Abdomen D. Biceps

ANS: B A pressure ulcer is a localized injury to the skin or underlying tissue. It usually occurs over a bony prominence such as the heel or ischial tuberosity. PTS:

Chapter 12: Incidents and Emergencies Test Bank MULTIPLE CHOICE 1. Which condition occurs most frequently when a person attempts to stand rapidly from a stooped, kneeling, recumbent, or sitting position? A. Orthostatic hypotension B. Hypoglycemia C. Acidosis D. Autonomic hyperreflexia

ANS: A Orthostatic (postural) hypotension is a drop in blood pressure associated with dizziness, syncope, and blurred vision that can occur upon standing. Older adults, persons who use antihypertension medication, and persons who have been immobilized in a recumbent position are most likely to demonstrate this condition. PTS:

2. Which condition occurs in individuals with a relatively recent complete injury to the upper portion of the spinal cord? A. Orthostatic hypotension B. Hypoglycemia C. Acidosis D. Autonomic hyperreflexia

ANS: D Autonomic hyperreflexia (dysreflexia) occurs in individuals with a relatively recent complete injury to the cervical and upper thoracic portions of the spinal cord down to the T6 level. Signs and symptoms include severe hypertension, bradycardia, profuse diaphoresis above the lesion, headache, red skin blotches, and piloerection (“goosebumps”). PTS:

3. At what rate should chest compressions be performed during cardiopulmonary resuscitation (CPR)? A. 60 times per minute B. 80 times per minute

Test Bank

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C. 100 times per minute D. 120 times per minute

ANS: C The AHA has changed the guidelines for the first time since its inception (1962) by instructing bystanders (those not trained in Basic Life Support) to compress the victim’s chest at a rate of 100 times per minute to a depth of 2 inches until paramedics arrive or the helper is unable to continue administrating the compressions. PTS:

4. In which position should a person in shock be placed? A. Supine with the head slightly lower than the lower extremities B. Sitting with the upper body supported C. Prone D. Side lying with the legs flexed toward the chest

ANS: A The person in shock should be placed supine with the head slightly lower than the lower extremities. If there are head and chest injuries or if respiration is impaired, it may be necessary to place the person supine, body flat, or with the head and chest elevated slightly. PTS:

5. How should a seizing person be handled? A. All extremities should be restrained during the seizure B. Motions of the lower extremities should be restricted C. Head motion should be restrained D. Convulsions should not be restrained or restricted

ANS: D The traditional treatment of a patient with a seizure includes placing the person in a safe location and position. You should not attempt to restrain or restrict the convulsions. PTS:

6. How should a seizing individual’s head be positioned after convulsions subside? A. To one side B. Upright C. Facing up D. None of the above

Test Bank

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ANS: A When the convulsions subside, turn the person’s head to one side in case vomiting ensues. You may assist in keeping the patient’s airway patent during the seizure, but do not attempt to open the mouth by placing an object between the teeth. PTS:

7. What should you do before attempting to assist an adult who appears to be choking? A. Place the person supine B. Ask the person if he or she is choking C. Phone for emergency services D. Place the person in a sitting position

ANS: B If an adult appears to be choking, first ask if he or she is choking. If the person can speak, cough, or breathe, do not attempt to provide further assistance but remain close by until it appears the person is no longer in distress. PTS:

8. Over which body part should your hands be clasped when performing the Heimlich maneuver? A. The sternum B. The upper back C. Below the umbilicus D. Below the diaphragm

ANS: D Hands should be clasped over the person’s abdomen slightly above the umbilicus but below the diaphragm. PTS:

9. What is included in the initial treatment for heat exhaustion? A. Place the person in a shady, well-ventilated room B. Loosen or remove the person’s outer clothing C. Monitor vital signs and contact emergency service personnel as necessary D. All of the above

ANS: D

Test Bank

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You may also sponge the person’s forehead and neck with a cold compress or ice bag. Cool wet towels or sheets can be used to cool the person, and water or a solution containing electrolytes may be given by mouth if the person is conscious. PTS:

10. Which of the following conditions is life threatening and requires prompt emergency care? A. Heat stroke B. Hyperglycemia C. Hypoglycemia D. Heat exhaustion

ANS: A Heat stroke is a life-threatening condition, and its signs and symptoms must be recognized quickly so that emergency first aid treatment can be initiated promptly. PTS:

11. What is the proper procedure if you suspect a victim has become unresponsive due to asphyxiation (drowning)? A. Call 911 and then begin CPR. B. Call 911 and wait for emergency service personnel to arrive. C. Initiate CPR for 2 minutes beT foEreScTaB lliAnN gK 91S1E . LLER.COM D. Initiate CPT for 10 minutes before calling 911.

ANS: C If a responder is alone and is trained and has immediate access to a phone, 911 should be called immediately unless it is known that the victim has become unresponsive due to suffocation (e.g., drowning). In this case, the responder should provide CPR with compressions followed by two breaths for 2 minutes before calling 911 or an emergency service. PTS:

12. If an AED is available, how many cycles of CPR should be performed before its application? A. 2 B. 5 C. 15 D. 25

ANS: B

Test Bank If an automated external defibrillator (AED) is available, apply it after five cycles of CPR (about 2 minutes), follow prompts from the AED, and continue with CPR. PTS:

13. Which of the following are considered severe reactions to an allergy? A. Itchy skin and sneezing B. Itchy and watery eyes C. Hives and skin redness D. Abdominal pain and difficulty swallowing

ANS: D Other severe reactions to an allergy include swelling of the face or mouth, difficulty speaking or breathing, nausea, vomiting, and dizziness. PTS:

14. Which of the following are symptoms of heat stroke? A. Dry skin, no diaphoresis B. Labored breathing C. Strong, rapid pulse D. All of the above

ANS: D Heat stroke is a life-threatening condition; therefore, its signs and symptoms should be recognized quickly. A highly elevated temperature (106–110 °F), flushed or gray skin color, contracting then dilating eyes, and convulsions are also signs and symptoms of heat exhaustion. PTS:

15. Which of the following are symptoms of heat exhaustion? A. Dry skin B. Slow, deep breathing C. Nausea and headache D. Convulsions

ANS: C Heat exhaustion is less serious than heat stroke. Other signs and symptoms include profuse diaphoresis, shallow and rapid breathing, weak pulse, and pale color. Convulsions are associated with heat stroke. PTS:

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Test Bank

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16. Which of the following are signs of hypoglycemia? A. Fruity breath odor B. Vomiting C. Excited, agitated behavior D. Deep, labored breathing

ANS: C All of the other choices are signs of hyperglycemia. Hypoglycemia may also cause hunger and pale, moist skin. If the person is conscious, provide some form of sugar (e.g., candy or orange juice). If the person is unconscious, glucose may need to be provided intravenously. PTS:

17. Which of the following are signs of hyperglycemia? A. Dry tongue B. Large amounts of glucose in urine C. Drowsy behavior D. All of the above

ANS: D Hyperglycemia also presents with thirst, vomiting, fruity breath odor, and flushed, dry skin. It should be considered a medical emergency that requires prompt action, including assistance from qualified personnel. The patient should not be given any form of sugar. An injection of insulin is usually needed. PTS:

18. What functions can be evaluated using the Tinetti Assessment? A. Upper body strength B. Balance and gait C. Upper and lower body endurance D. None of the above

ANS: B The Tinetti Assessment for balance and gait, the Berg Balance Test, the Timed Up and Go Test, the Timed One-Legged Standing Test, and Czuka’s Sit-Stand Test are all tools that can assist in testing a patient for risk of falls. PTS:

19. Which body part is often wrapped in a circular pattern with a “figure of eights”?

Test Bank A. B. C. D.

The forefoot and ankle The thigh The shoulder The head

ANS: A The forefoot should be wrapped in a circular pattern with a “figure of eights” around the ankle and back to a circular pattern above the ankle. The foot should be wrapped while in dorsiflexion and either eversion or inversion, dependent upon which ligament has been sprained. PTS:

20. To what depth should chest compressions be performed on an adult? A. 1 centimeter B. 2 centimeters C. 2 inches D. 3 inches ANS: C The adult victim’s chest should be compressed at a rate of 100 times per minute to a depth of 2 inches. PTS:

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Chapter 13: Americans with Disabilities Act and Environmental Assessments Test Bank MULTIPLE CHOICE 1. Which title of the Americans with Disabilities Act applies to employment? A. Title I B. Title II C. Title III D. Title IV ANS: A Employers may not discriminate against an individual with a disability in hiring or promoting if the person is otherwise qualified for the job. PTS:

2. Which title of the Americans with Disabilities Act applies to telecommunications? A. Title I B. Title II C. Title III D. Title IV ANS: D Companies or businesses offering telephone service to the general public must offer telephone relay services to individuals who use telecommunication devices for the deaf (TDDs) or similar devices. PTS:

3. Which title of the Americans with Disabilities Act applies to public accommodations? A. Title I B. Title II C. Title III D. Title IV ANS: C Public accommodations operated by private entities such as restaurants, hotels, retail stores, and theaters may not discriminate against individuals with disabilities. PTS:

4. For a wheelchair-accessible home, what is the minimum sidewalk width?

Test Bank A. B. C. D.

30 inches 32 inches 36 inches 40 inches

ANS: C Sidewalks should be at least 36 inches wide and provide a smooth, firm surface. PTS:

5. For a wheelchair-accessible home, what is the minimum door width? A. 30 inches B. 32 inches C. 36 inches D. 40 inches ANS: B Doors should be at least 32 inches wide; however, 36 inches is preferable. Pocket doors conserve space and make access easier for emergencies. PTS:

6. For a wheelchair-accessible home, what is the minimum hall width? A. 30 inches B. 32 inches C. 36 inches D. 40 inches ANS: B Hall width must be at least 32 inches; however, 40 inches is a more preferred width. PTS:

7. For a wheelchair-accessible home, what is the maximum distance door handles and windows should be from the floor? A. 30 inches B. 32 inches C. 36 inches D. 40 inches ANS: C Door handles and windows should be no more than 36 inches from the floor. Door handles should be of the lever type, and windows should be vertical sliding or crank-operated. PTS:

8. Which term defines a residence with a design such that some of its features can be altered to enable an individual to function as independently as possible?

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Test Bank A. B. C. D.

Accessible housing Adaptable housing Universal design housing Wheelchair-accessible housing

ANS: B Accessible housing refers to a residence built or modified to meet specific requirements for accessibility and that enables an individual to function at the optimal level of independence. Universal design housing is a residence designed to be used by all people at the greatest level of independence without the need for adaptation. PTS:

9. Which of the following, with respect to an individual, defines the term “disability”? A. A physical or mental impairment that substantially limits one or more major life activities B. A record of an impairment that substantially limits major life activities C. Being regarded as having an impairment that substantially limits major life activities D. All of the above ANS: D Communicating, working, walking, standing, lifting, bending, caring for oneself, breathing, learning, seeing, hearing, speaking, reading, thinking, sleeping, concentrating, eating, and performing manual tasks are considered major life activities. PTS:

10. Which term refers to an action necessary to provide a reasonable accommodation that would cause an employer or owner significant difficulty or expense? A. Undue burden B. Reasonable accommodation C. Undue accommodation D. Reasonable burden ANS: A Several factors are considered in determining whether a hardship would occur for the employer or owner, including the size of the business, number of employees, type of operation, nature and cost of the needed accommodation, and whether the accommodation would have an adverse effect or pose a risk to other employees. PTS:

11. How much of a deduction does the IRS allow per year for expenses associated with the removal of qualifying architectural and transportation barriers? A. $5,000 B. $10,000 C. $15,000 D. $20,000

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ANS: C In addition, small businesses are eligible to receive a tax credit of up to $5,000 for certain costs that are incurred to comply with the ADA. PTS:

12. Which of the following is not an adaptive feature for an individual with a hearing deficit? A. Text telephone B. Closed caption for television C. Computer or voice command technology D. Amplified handset ANS: C Voice command technology is an adaptive feature for an individual with a vision deficit. Visual signals for alarms, security systems, telephone ringers, and doorbells may also be helpful for a patient with hearing loss. PTS:

13. What is an example of a “major life activity” as defined by the ADA? A. Walking B. Hearing C. Working D. All of the above ANS: D Functions such as caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working are defined as major life activities. PTS:

14. For a wheelchair-accessible ramp, what is the maximum grade allowed? A. No more than 1 inch of rise for each foot of vertical rise B. No more than 2 inches of rise for each foot of vertical rise C. No more than 3 inches of rise for each foot of vertical rise D. No more than 4 inches of rise for each foot of vertical rise ANS: A The specifications for a wheelchair-accessible ramp are as follows: 36 to 48 inches wide; no more than 1 inch rise for each foot of vertical rise; firm, slip-resistant surface; ramps longer than 30 feet will need to change direction and may need a landing area. PTS:

15. What is the optimal turning radius for a wheelchair-accessible kitchen? A. 3 by 3 feet B. 4 by 4 feet

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Test Bank C. 5 by 5 feet D. 6 by 6 feet ANS: C A 5 by 5 foot area will provide optimal area for a wheelchair’s turning radius. U- or L-shaped kitchen floor plans are best. PTS:

16. How high should sinks be in a wheelchair-accessible kitchen? A. 16 to 18 inches from the floor B. 24 to 26 inches from the floor C. 32 to 34 inches from the floor D. 40 to 42 inches from the floor ANS: C Sinks should be 32 to 34 inches from the floor. They should also have an open front with insulated or shielded plumbing to allow the wheelchair to position as close as possible during use. Similar recommendations apply to a bathroom sink. PTS:

17. What is the recommended regular shower area in a wheelchair-accessible home? A. 32 by 32 inches B. 36 by 36 inches C. 40 by 40 inches D. 44 by 44 inches ANS: B A regular shower should be 36 by 36 inches with a fixed seat, hand-held shower head, and single-lever water control. PTS:

18. For a wheelchair-accessible bedroom, how high should the bed be from the floor? A. 10 to 14 inches B. 14 to 18 inches C. 18 to 22 inches D. 22 to 26 inches ANS: C The bed should be 18 to 22 inches from the floor and have a firm mattress. There should also be adequate space for a wheelchair transfer on at least one side. PTS:

19. What is the maximum recommended height for closet rods in a wheelchair-accessible home?

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Test Bank A. B. C. D.

36 inches 42 inches 48 inches 54 inches

ANS: C Rods should be adjustable or 48 inches maximum from the floor. Sliding entry doors are also recommended, and a “roll-in” closet is beneficial. PTS:

20. What garage height is needed for a wheelchair-accessible home if a raised-roof van is used? A. 8 feet minimum B. 10 feet minimum C. 12 feet minimum D. 14 feet minimum ANS: B A garage height of 10 feet minimum is required if a raised-roof van is used; 8 feet is required for a wheelchair lift. The garage should also have a direct entrance to the house. PTS:

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TEST BANK Pierson and Fairchild’s Principles and Techniques of Patient Care 6th Edition by Sheryl Fairchild, Roberta O'Shea.