Chapter 01: Patient Supervision and Observation During Treatment

MULTIPLE CHOICE

	1.	Who is responsible for carrying out prescribed selected interventions, patient supervision, data collection, and appropriate supervision of a patient during physical therapy?
a.	Physical therapist (PT)	
b.	Physical therapist assistant (PTA)	
c.	Nursing assistant	
d.	Medical doctor	

ANS:	B
The PTA is responsible for carrying out prescribed selected interventions, patient supervision, data collection skills, and appropriate problem-solving and clinical decision making.

REF:	P. 3

	2.	Which of the following is NOT a purpose of the clinical patient supervision process?
a.	To gather relevant information and data	
b.	To establish and enhance rapport, trust, and confidence	
c.	To prescribe interventions the patient requires	
d.	To assist in the management of the patient	

ANS:	C
PTAs do not prescribe interventions for the patient. The PTA observes, documents, and discusses patient observations with the PT.

REF:	P. 4

	3.	Select the open-ended question.
a.	What is your pain level today on a scale of 1-10?	
b.	When did the pain begin?	
c.	Tell me about the time that you injured knee.	
d.	When did you take your last pain medication?	

ANS:	C
The open-ended question leads the patient to say more than yes or no. Open-ended questions provide much richer details about the incident or experience.

REF:	P. 6

	4.	Which of the following statements is true regarding the working environment of PTAs?
a.	PTAs work in isolation with their patient assignments.	
b.	PTAs work with a team of experts in all areas of a patient’s care.	
c.	PTAs work only with the PT in providing therapy.	
d.	PTAs are the most important people on the rehabilitation team when providing therapy.	

ANS:	B
The PTA must be aware of the key members of the rehabilitation team. Occupational therapists, PTs, nurses, respiratory therapists, psychologists, and audiologists are only a few of the important members of the rehabilitation team. The PTA does not work in isolation.

REF:	P. 4

	5.	Which of the following statements would be used in a discussion with a patient?
a.	Your blood pressure is 150/90, which indicates hypertension and could lead to a cerebral vascular accident if you don’t take your medications.	
b.	Your blood pressure is higher than normal today, 150/90. Did you take your blood pressure medication this morning?	
c.	The doctor prescribed a beta-blocker for you a month ago. Has that been helping your blood pressure?	
d.	The combination of your calcium-channel blocker and beta-blocker do not seem to be controlling your blood pressure. Let’s call the doctor.	

ANS:	B
The PTA should learn to communicate openly, freely, and in a professional manner. The PTA must employ appropriate and professional medical terminology with professional people—but use familiar (lay) terms to describe the same condition to a patient or a family member. Avoiding the use of medical jargon (hypertension, beta-blocker, calcium-channel blocker) with patients is required by PTAs.

REF:	P. 4

	6.	How can a PTA demonstrate accountability in their practice?
a.	Maintain timely documentation about patient interventions.	
b.	Maintain good rapport with patients.	
c.	Continue their education past their initial degree.	
d.	Report all findings to the supervising PT so that modifications can be made in response to changes in patient status.	

ANS:	D
PTAs are responsible for reporting all findings to the supervising PT so that modifications can be made in accordance with changes in patient status.

REF:	P. 6

	7.	Which type of questioning would you use to find facts or obtain specific responses from a patient about an injury to a limb or joint?
a.	Open-ended questions	
b.	Closed-ended questions	
c.	A pause	
d.	Neutral phrase	

ANS:	B
Figure 1-1. Closed-ended questions are used to find out specific details, direct the discussion, or elicit specific responses from the patient.

REF:	P. 8

	8.	Which of the following is an example of prompting during a physical therapy session?
a.	“When you walk up the steps, which foot will you move first?”	
b.	“All right, now pick up your right foot and put it on the next step.”	
c.	Point to the step and touch the patient’s right leg.	
d.	Observe the behavior of the patient to see if they will lift up the correct foot while walking up the steps.	

ANS:	A
Prompting a patient to perform a task can be viewed as the presentation of a question. Prompting allows patients to decipher information, solve problems, and provide solutions to activities they must overcome during recovery. Cues are directions.

REF:	P. 9

	9.	Who holds the ultimate responsibility for the patient’s physical therapy?
a.	PTA	
b.	Medical doctor	
c.	Nurse	
d.	PT	

ANS:	D
To minimize the confusing array of treatment protocols, the PTA must effectively and efficiently communicate with the supervising PT to clarify differences in patient care, always remembering that the PT has the ultimate responsibility for the interventions provided.

REF:	P. 10

	10.	Which of the following actions should you take if you have a disagreement with the PT?
a.	Refuse to provide the treatment or intervention on the PT’s plan of care.	
b.	Change the treatment for the day and then report to the PT what was done at the end of the day.	
c.	Follow the plan of care no matter what changes are observed in the patient and document later.	
d.	Discuss your findings and rationale with the PT to learn and provide better care.	

ANS:	D
A full understanding of the rationale and purpose of PT interventions allows for improved delivery of care and safe and effective care. PTAs cannot change the plan of care by themselves.

REF:	P. 10

	11.	What type of behavior is the PTA using in the following example?

The PTA quickly agrees to the patient’s request to slow down and stop the treatment for the day instead of discussing the purpose and benefits of the treatment.
a.	Dominance	
b.	Submission	
c.	Hostility	
d.	Warmth	

ANS:	B
Figure 1-2. Submission is defined as being passive. People who show submissive behavior are willing to take a back seat and are quick to comply and reluctant to try to exert influence.

REF:	P. 8

	12.	What type of behavior is the PTA using in the following example?
The PT insists the patient continue treatment for the full time limit even when the tearful patient reports a fear of continuing exercise of a particular joint.
a.	Dominance	
b.	Submission	
c.	Hostility	
d.	Warmth	

ANS:	C
A dominant PTA would try to sway the patient to think or behave in a certain way. In this example, the PTA ignores the patient’s complaints and feelings and continues with the treatment.

REF:	P. 8

	13.	In the basic dimensional model, which behaviors would be seen in a warm but submissive person?
a.	Stubborn, argumentative	
b.	Sincere, open, candid, responsive	
c.	Talks little, doesn’t listen well	
d.	Appeases; compromise leads to lack of focus	

ANS:	D
Figure 1-3, B. The submissive-warm person demonstrates a lack of organization, appeasing behavior, and compromises.

REF:	P. 8

	14.	In the basic dimensional model, which behaviors would be seen in a dominant-hostile person?
a.	Stubborn and argumentative	
b.	Sincere, open, candid, responsive	
c.	Talks little and doesn’t listen well	
d.	Appeases; compromise leads to lack of focus	

ANS:	A
Figure 1-3, B. The dominant-hostile person would be stubborn and argumentative, taking fixed positions and sticking to them, talking a lot rather than listening, and being pushy and arrogant.

REF:	P. 8

	15.	In the basic dimensional model, which behaviors would be seen in a dominant-warm person?
a.	Stubborn and argumentative	
b.	Sincere, open, candid, responsive	
c.	Talks little and doesn’t listen well	
d.	Appeases; compromise leads to lack of focus	

ANS:	B
Figure 1-3, B. The dominant-warm person is sincere, open, and candid; listens; is open-minded and flexible.

REF:	P. 8

	16.	In the basic dimensional model, which behaviors would be seen in a submissive-hostile person?
a.	Talks a lot rather than listens and is belligerent.	
b.	Sincere, open, candid, responsive	
c.	Talks little and doesn’t listen well and avoids issues	
d.	Appeases; compromise leads to lack of focus	

ANS:	C
Figure 1-3, B. The submissive-hostile person talks little, doesn’t listen well, avoids or ignores issues, is uninvolved, quiet, and backs down easily.

REF:	P. 8

	17.	When can a PTA adjust or modify a program of treatment?
a.	When the PTA observes certain signs and symptoms in the patient.	
b.	After seeking input and direction from the supervising PT.	
c.	The PTA cannot ever change the plan of care.	
d.	None of the above.	

ANS:	B
The PTA, with direction and input from the supervising PT, can adjust or modify the program of treatment.

REF:	P. 9

	18.	The PTA’s clinical decision-making process should begin with
a.	taking orderly and specific steps to notify the supervising PT.	
b.	recognizing that a problem exists.	
c.	adjusting the program according to the patient’s needs.	
d.	asking the PT to assess the patient.	

ANS:	B
The clinical decision-making process used by the PTA involves recognizing that a problem exists, then taking orderly and specific steps to notify the supervising PT and adjusting the program accordingly.

REF:	P. 9

	19.	Which of the following behaviors exemplifies a well-adapted PTA?
a.	Constantly asks about the rationale for treatment	
b.	Establishes themselves as an eager learner	
c.	Is open to innovative ways of managing various pathologic conditions	
d.	All of the above	

ANS:	D
The well-adapted PTA views any apparent roadblocks as learning opportunities. The PTA is advised to take advantage of the broad knowledge and experience of many PTs, constantly inquire about the rationale and scientific basis for a particular program, and establish him- or herself as an eager learning participant who is open to innovative ways of managing various pathologic conditions.

REF:	P. 10

	20.	Why do PTAs and PTs use general scales of measurement?
a.	To standardize assessment and more accurately measure patient progress	
b.	To shorten the amount of time needed to document the patient’s condition	
c.	To demonstrate knowledge of medical terminology	
d.	None of the above	

ANS:	A
General scales are used to standardize assessment and more accurately measure patient progress.

REF:	P. 4