Recognizing Adverse Effects - National Physical Therapy Examination NPTE

1. What is the key adverse sign of lymphedema bandaging applied too tightly?

   Increased distal edema with pain or paresthesia. These signs suggest impaired lymphatic drainage due to excessive pressure, exacerbating swelling and discomfort.

2. Identify the most common adverse effect that indicates excessive intensity with TENS or NMES.

   Skin irritation or burning sensation under electrodes. This occurs from excessive current density causing chemical irritation or burns at the electrode-skin interface.

3. What is the primary complication risk sign of overexertion in a patient with cardiac disease during PT?

   Angina or angina-equivalent symptoms. These symptoms signal myocardial oxygen demand exceeding supply, risking infarction if exertion persists.

4. Identify the immediate first action when autonomic dysreflexia is suspected during treatment.

   Stop activity and sit the patient upright. This action promotes venous pooling to rapidly reduce blood pressure while allowing identification of the triggering stimulus.

5. What is the key adverse sign of improper crutch fitting that indicates risk of brachial plexus injury?

   Numbness/tingling in hands with axillary pressure. This indicates compression of neurovascular structures in the axilla, potentially causing neuropraxia if uncorrected.

6. What is the most concerning sign of DVT that requires stopping treatment and urgent referral?

   New unilateral calf/thigh swelling with pain and warmth. These symptoms reflect venous inflammation and obstruction, posing a high risk for embolization if activity continues.

7. Which patient report most suggests tourniquet effect or ischemia from an overly tight compression wrap?

   New numbness/tingling with coldness or color change distal. These symptoms indicate vascular compromise distal to the wrap, risking tissue necrosis if compression persists.

8. Identify the adverse neurologic sign that suggests spinal cord compromise during cervical treatment.

   New bilateral limb symptoms or gait disturbance. These indicate possible myelopathy from cord compression, necessitating immediate cessation to avoid permanent damage.

9. Identify the most dangerous early sign of heat illness during exercise in a hot environment.

   CNS changes (confusion, ataxia) with overheating. These symptoms signal impending heat stroke from impaired thermoregulation, requiring immediate cooling to prevent organ failure.

10. What is the key adverse sign of exercise-induced hypoglycemia in a patient with diabetes?

    Shakiness, sweating, confusion, and irritability. These neuroglycopenic symptoms arise from glucose levels dropping below 70 mg/dL during increased metabolic demand.

11. Which symptom most suggests an acute stroke during therapy and requires emergency activation?

    Sudden unilateral weakness or facial droop with speech deficit. These FAST criteria (face, arm, speech, time) indicate ischemic or hemorrhagic event requiring rapid medical intervention.

12. What skin finding indicates a developing pressure injury that requires immediate offloading?

    Nonblanchable erythema over a bony prominence. This stage 1 pressure injury sign reflects tissue ischemia from prolonged pressure, progressing to ulceration without relief.

13. What adverse sign indicates an abnormal response to cryotherapy requiring discontinuation?

    Wheals/hives or intense burning suggesting cold urticaria. This allergic reaction to cold exposure can lead to anaphylaxis if application continues.

14. Which response best indicates orthostatic hypotension when moving from supine to standing?

    Lightheadedness with BP drop and possible tachycardia. These signs indicate inadequate compensatory mechanisms for postural change, risking syncope or falls.

15. Identify the adverse sign of overaggressive stretching in a post-op tendon repair patient.

    Sudden sharp pain with loss of function suggesting repair failure. This suggests rupture or dehiscence of the surgical site, compromising healing and function.

16. Which patient complaint during ultrasound most suggests periosteal heating and requires immediate adjustment?

    Deep, sharp pain localized over bone. This pain arises from acoustic energy absorption by bone, causing overheating that could lead to tissue damage.

17. Which symptom during aquatic therapy most suggests respiratory compromise requiring immediate exit?

    New severe shortness of breath or inability to speak full sentences. These indicate water aspiration or submersion risk, compounded by buoyancy reducing perceived effort.

18. What adverse event is most associated with hot packs or paraffin in patients with impaired sensation?

    Thermal burn. Impaired sensation prevents detection of excessive heat, leading to undetected tissue damage from prolonged exposure.

19. What is the most concerning sign of exertional rhabdomyolysis after unusually intense exercise?

    Dark "tea-colored" urine with severe muscle pain/weakness. These indicate muscle breakdown releasing myoglobin, risking acute kidney injury if not addressed urgently.

20. Identify the classic symptom cluster that indicates exercise-induced myocardial ischemia during therapy.

    Chest pressure with radiation, diaphoresis, nausea, dyspnea. This cluster reflects coronary artery insufficiency, necessitating immediate cessation to prevent cardiac damage.

21. Which new symptom during exercise most suggests pulmonary embolism rather than simple deconditioning?

    Sudden dyspnea with pleuritic chest pain and tachycardia. These acute symptoms indicate possible embolus obstructing pulmonary arteries, distinguishing from gradual fatigue in deconditioning.

22. What vital sign change most strongly indicates autonomic dysreflexia during therapy in SCI above $T_6$?

    Sudden severe hypertension (often with reflex bradycardia). This vital sign shift results from unopposed sympathetic response below the spinal cord injury level, triggered by noxious stimuli like bladder distension.

23. What finding during exercise indicates inadequate oxygenation and requires reducing intensity or stopping?

    Oxygen saturation $< 90\%$ or a rapid downward trend. This threshold signals hypoxemia, potentially leading to tissue damage if exercise continues without intervention.

24. What new symptom during cervical traction is a red flag for vertebrobasilar insufficiency?

    Dizziness with diplopia, dysarthria, dysphagia, or drop attacks. These '5 Ds' symptoms suggest compromised vertebral artery blood flow, risking brainstem ischemia.

25. Which finding during gait training most indicates a high fall risk requiring immediate guarding change?

    Repeated loss of balance with inability to self-correct. This reflects inadequate balance reactions, increasing injury risk without enhanced support or modification.

Study these flashcards