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