National Physical Therapy Examination (NPTE) Quiz: Recognizing Adverse Effects
19 questions · exam conditions
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Recognizing Adverse EffectsQuestion 1 of 19

A 65-year-old female with a history of severe aortic stenosis is participating in a low-intensity strengthening program. She is performing seated knee extension with a 2-pound ankle weight. After 8 repetitions, she reports feeling lightheaded and dizzy. The therapist immediately checks her vitals and notes that her systolic blood pressure has dropped from a resting value of 120 mmHg to 95 mmHg.

This hypotensive response is MOST likely due to which physiological mechanism related to her condition?

An exaggerated parasympathetic response to low-intensity exercise.
Peripheral vasodilation from exercise without a compensatory increase in cardiac output.
A Valsalva maneuver performed inadvertently during the exercise.
Dehydration from inadequate fluid intake prior to the therapy session.
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National Physical Therapy Examination (NPTE) Quiz

National Physical Therapy Examination (NPTE) Quiz: Recognizing Adverse Effects

Practice Recognizing Adverse Effects in National Physical Therapy Examination (NPTE) with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Recognizing Adverse Effects, giving you a quick way to practice the rules, question types, and explanations that matter most for National Physical Therapy Examination (NPTE).

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

A 65-year-old female with a history of severe aortic stenosis is participating in a low-intensity strengthening program. She is performing seated knee extension with a 2-pound ankle weight. After 8 repetitions, she reports feeling lightheaded and dizzy. The therapist immediately checks her vitals and notes that her systolic blood pressure has dropped from a resting value of 120 mmHg to 95 mmHg.

This hypotensive response is MOST likely due to which physiological mechanism related to her condition?

  1. An exaggerated parasympathetic response to low-intensity exercise.
  2. Peripheral vasodilation from exercise without a compensatory increase in cardiac output. (correct answer)
  3. A Valsalva maneuver performed inadvertently during the exercise.
  4. Dehydration from inadequate fluid intake prior to the therapy session.
Explanation: In severe aortic stenosis, the aortic valve opening is narrowed, creating a fixed obstruction to blood flow out of the left ventricle. This severely limits the heart's ability to increase cardiac output in response to demand. During exercise, peripheral blood vessels in the working muscles dilate to increase blood flow. In a healthy individual, cardiac output would increase to maintain blood pressure. In this patient, the fixed obstruction prevents this compensatory increase, leading to a drop in systemic blood pressure (exertional hypotension), causing dizziness and lightheadedness. This is a critical adverse sign in this population. While a Valsalva maneuver (C) can cause transient drops in BP, the primary pathology here is the most likely cause.

Question 2

A 68-year-old male with a 10-year history of compensated congestive heart failure (NYHA Class II) and moderate knee osteoarthritis is participating in an aquatic therapy program. He is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor. During his fourth session, after 15 minutes of deep-water walking, he mentions to the therapist that he has developed a persistent, non-productive cough.

Which of the following is the MOST likely explanation for the patient's new symptom and the MOST appropriate immediate action?

  1. The patient is experiencing an exacerbation of his CHF due to increased central venous pressure from immersion; the session should be terminated and his physician contacted. (correct answer)
  2. The patient may be having an allergic reaction to the pool chemicals; he should be removed from the pool and monitored for any dermatological signs.
  3. The cough is a known, benign side effect of his ACE inhibitor medication, exacerbated by exertion; the patient can continue with reduced intensity.
  4. The patient has likely aspirated a small amount of water; he should be instructed in pursed-lip breathing and the session can continue with caution.
Explanation: The hydrostatic pressure of water immersion increases venous return and central blood volume, which can overwhelm a compromised left ventricle in a patient with CHF, leading to pulmonary congestion. A new, non-productive cough is a classic early sign of this decompensation. This is a significant adverse event requiring immediate termination of the session and physician notification. While a cough is a side effect of ACE inhibitors (B), its acute onset during immersion points to a cardiac cause. An allergic reaction (C) is less likely to present solely as a cough without other signs. Aspiration (D) is possible but less probable than hemodynamic decompensation in this specific patient population.

Question 3

A 44-year-old female is receiving intermittent mechanical cervical traction for a C6 radiculopathy. Treatment parameters are 15 pounds, 30 seconds on / 10 seconds off, for 12 minutes. During the 'on' cycle, her radiating arm pain completely centralizes to her neck. Immediately upon completion of the session, she reports that all of her neck and arm pain is gone, but she now feels a new, diffuse numbness in both hands, describing it as 'feeling like I'm wearing thin gloves.'

What is the MOST likely cause of this patient's post-treatment presentation?

  1. Successful decompression of the C6 nerve root resulting in resolution of symptoms.
  2. A temporary conduction block of multiple nerve roots due to excessive traction force. (correct answer)
  3. A transient sympathetic nervous system response to the traction stimulus.
  4. Development of an upper cervical spine instability previously undetected.
Explanation: The complete and sudden abolition of pain coupled with the onset of new, non-dermatomal, bilateral paresthesia ('glove' distribution) is a significant red flag. This pattern suggests a traction-induced ischemia causing a temporary conduction block (neurapraxia) affecting multiple nerve roots, rather than a successful therapeutic outcome. A successful decompression (A) would not typically produce new, diffuse numbness. A sympathetic response (C) is less likely to manifest as bilateral sensory loss. While instability (D) is a concern, the specific sensory change is more indicative of a nerve conduction issue.

Question 4

A 72-year-old patient with severe chronic obstructive pulmonary disease (COPD), with a known tendency for CO2 retention, is participating in pulmonary rehabilitation. The therapist implements inspiratory muscle training using a threshold device set at 30% of the patient's maximal inspiratory pressure (MIP). After five minutes of training, the patient becomes drowsy and confused, and their breathing becomes more shallow.

These new signs are MOST indicative of which adverse physiological event?

  1. Exercise-induced bronchospasm.
  2. Acute respiratory muscle fatigue.
  3. Worsening hypercapnia. (correct answer)
  4. Hypoglycemia from increased work of breathing.
Explanation: For patients who are chronic CO2 retainers, a sudden increase in the work of breathing (even with inspiratory muscle training) can lead to rapid respiratory muscle fatigue. This fatigue decreases effective ventilation, causing a sharp rise in arterial CO2 levels (hypercapnia). The classic neurological signs of severe hypercapnia include drowsiness, confusion, headache, and eventual coma. Bronchospasm (A) would present with wheezing and increased dyspnea. While muscle fatigue (B) is the root cause, hypercapnia is the specific physiological event causing the neurological signs. Hypoglycemia (D) would present with different symptoms like shakiness, sweating, and anxiety.

Question 5

A patient with post-mastectomy lymphedema and a history of stable, medically managed congestive heart failure (CHF) is receiving manual lymphatic drainage (MLD). Twenty minutes into the session, which includes treatment of the trunk and the affected upper extremity, the patient reports feeling short of breath and notes that their jugular veins appear more prominent.

What is the MOST appropriate interpretation of these findings and the subsequent action?

  1. The patient is having an anxiety response to the treatment; the therapist should use relaxation techniques before continuing.
  2. The MLD has successfully moved lymphatic fluid, which is now being processed; the session can continue as planned.
  3. The treatment has overloaded the cardiovascular system, causing acute decompensation of the CHF; the session must be stopped immediately. (correct answer)
  4. The patient is experiencing orthostatic hypotension from lying supine; the therapist should assist the patient to a sitting position.
Explanation: MLD works by moving a significant volume of interstitial fluid back into the circulatory system. In a patient with compensated CHF, this rapid increase in intravascular volume can overwhelm the heart's pumping capacity, leading to acute fluid overload and cardiac decompensation. The patient's symptoms of dyspnea and jugular venous distention (JVD) are classic signs of this adverse event. This is a medical emergency requiring immediate cessation of treatment. The other options misinterpret the severity and etiology of these cardinal signs of heart failure.

Question 6

A physical therapist is treating a patient for right posterior canal BPPV using the Epley maneuver. During the maneuver, as the patient is moved from long-sitting to the head-hanging right position, they experience the expected torsional upbeating nystagmus and vertigo. However, after 30 seconds, the nystagmus changes to a persistent, purely vertical downbeating nystagmus, and the patient reports feeling nauseous and 'unwell' in a way that is different from their typical vertigo.

The change in the type of nystagmus is MOST indicative of what type of problem?

  1. A successful canalith repositioning maneuver.
  2. Conversion of posterior canal BPPV to anterior canal BPPV.
  3. An underlying central nervous system pathology. (correct answer)
  4. Patient fatigue and a vasovagal response to the maneuver.
Explanation: While torsional nystagmus is characteristic of posterior canal BPPV, the development of a persistent, purely vertical (especially downbeating) nystagmus that does not fatigue is a red flag for a central nervous system disorder (e.g., cerebellar or brainstem lesion). This finding is atypical for any form of BPPV, including canal conversion (B), which would present with a different nystagmus pattern (e.g., torsional downbeating). A successful maneuver (A) results in the cessation of nystagmus. A vasovagal response (D) does not cause direction-changing nystagmus.

Question 7

A 16-year-old athlete sustained a severe quadriceps contusion (charley horse) one week ago. The therapist initiates aggressive soft tissue massage and passive stretching into knee flexion to regain motion. The patient reports a significant increase in pain during the session. Over the next two days, the patient's knee flexion range of motion decreases, and the thigh muscle feels progressively harder to palpation.

This clinical evolution is MOST consistent with the development of which complication?

  1. Complex regional pain syndrome (CRPS).
  2. A deep vein thrombosis (DVT).
  3. Myositis ossificans. (correct answer)
  4. Delayed onset muscle soreness (DOMS).
Explanation: Myositis ossificans is the formation of heterotopic bone in muscle tissue following trauma. A key risk factor for its development is overly aggressive physical therapy (massage, stretching) too soon after a severe contusion or hematoma. The classic signs are increasing pain, loss of motion, and a palpable hardening of the muscle, which matches the patient's presentation perfectly. CRPS (A) would involve more autonomic signs and diffuse pain. DVT (B) would present with calf swelling and tenderness. DOMS (D) would improve with time and gentle activity, not worsen with progressive hardening.

Question 8

A 45-year-old patient with a T10 spinal cord injury (ASIA A) is undergoing pelvic floor muscle retraining using surface EMG biofeedback for neurogenic bowel management. During a maximal effort contraction of the abdominal and pelvic floor muscles, the patient suddenly develops a pounding headache, profuse sweating above the level of the lesion, and flushing of the face. The blood pressure monitor reads 170/110 mmHg.

Which of the following describes the adverse event the patient is experiencing?

  1. Autonomic dysreflexia. (correct answer)
  2. Orthostatic hypotension.
  3. Vertebrobasilar insufficiency.
  4. Malignant hyperthermia.
Explanation: Autonomic dysreflexia is a medical emergency that can occur in individuals with spinal cord injuries at T6 or above. It is triggered by a noxious stimulus below the level of the lesion (in this case, likely intense muscle contraction or visceral stimulation). The classic triad of symptoms is a sudden spike in blood pressure, a pounding headache, and sweating/flushing above the lesion level. The intervention must be stopped immediately, and the patient should be placed in an upright position to help lower blood pressure. The other options are inconsistent with the symptom cluster; for example, orthostatic hypotension (B) involves a drop in blood pressure.

Question 9

A patient with foot drop secondary to a stroke is using a functional electrical stimulation (FES) device on the common peroneal nerve to assist with dorsiflexion during gait. The patient has been using the device successfully for 3 weeks. During a follow-up visit, the therapist notices a new, localized swelling and erythema over the proximal fibular head, and the patient reports a deep, aching pain in that area that is worse with weight-bearing.

Given that the FES unit parameters have not been changed, what is the MOST concerning potential adverse effect?

  1. An allergic contact dermatitis from the electrode gel.
  2. A stress fracture of the fibular head. (correct answer)
  3. Chronic inflammation of the common peroneal nerve.
  4. A deep tissue infection originating from a skin abrasion under the electrode.
Explanation: FES creates strong, repetitive, and sometimes non-physiological muscle contractions. The peroneal muscles, which are forcefully contracted by the FES, attach to the fibular head. Over time, this repetitive, forceful pulling on the bone, combined with impaired sensation and potentially osteoporotic bone post-stroke, can lead to a stress fracture. The signs of localized bone tenderness, swelling, and pain with weight-bearing are classic for a stress fracture. Dermatitis (A) would present with superficial itching and redness. Neuritis (C) would involve more neuropathic pain. An infection (D) would likely have more systemic signs or visible skin breakdown.

Question 10

A 58-year-old male is in Phase II cardiac rehabilitation 4 weeks after an uncomplicated myocardial infarction. His exercise prescription is for treadmill walking at 70% of his heart rate max. Midway through the session, the ECG telemetry shows three premature ventricular contractions (PVCs) in a row. The patient denies any symptoms.

What is the MOST appropriate immediate action for the physical therapist?

  1. Stop the exercise session immediately and activate emergency medical services.
  2. Reduce the intensity of the exercise and continue to monitor the ECG rhythm closely.
  3. Allow the patient to finish the interval, as asymptomatic PVCs are common.
  4. Have the patient stop exercising, assess their vital signs, and notify the supervising medical staff. (correct answer)
Explanation: Three or more consecutive PVCs is the definition of ventricular tachycardia (V-tach), which is a potentially life-threatening arrhythmia. This is an absolute indication to terminate an exercise session, regardless of whether the patient is symptomatic. The appropriate action is to immediately stop the exercise, assess the patient's stability (vitals), and inform the medical team (e.g., nurse or physician supervising the program) for further direction. Activating EMS (A) may be the next step if the patient becomes unstable or the arrhythmia persists, but notification of on-site staff is the first step. Reducing intensity (B) or continuing (C) is unsafe.

Question 11

A physical therapist is using dexamethasone with iontophoresis to treat plantar fasciitis. The negative electrode (containing the dexamethasone) is placed over the site of maximal tenderness on the heel. The parameters are 4.0 mA for 10 minutes (40 mA-min). The patient has normal sensation. After the treatment, the therapist removes the electrode and observes a 2 cm circular area of bright red, raised, and blistered skin under the electrode site.

This adverse skin reaction is MOST likely the result of which phenomenon?

  1. An anaphylactic reaction to the dexamethasone.
  2. A galvanic chemical burn from excessive alkaline reaction. (correct answer)
  3. Transient hyperemia, which is a normal response to iontophoresis.
  4. A thermal burn due to high resistance from a dry electrode.
Explanation: During iontophoresis, direct current causes electrochemical reactions under the electrodes. Sodium hydroxide (lye), a strong alkaline substance, can form under the negative electrode (cathode). If the current density is too high or the buffering of the electrode is inadequate, this can cause a severe chemical burn, characterized by redness, blistering, and tissue damage. An anaphylactic reaction (A) would be systemic. Transient hyperemia (C) is mild redness that resolves quickly and does not involve blistering. A thermal burn (D) is less common with iontophoresis than a chemical burn, which is the classic adverse event at the cathode.

Question 12

A 4-year-old child with spastic diplegic cerebral palsy is undergoing serial casting to reduce bilateral ankle plantar flexion contractures. After the second set of casts has been on for three days, the child becomes unusually irritable, refuses to bear weight, and has a low-grade fever. The mother also reports a foul odor coming from the distal end of the left cast.

These signs and symptoms are MOST indicative of what complication related to the intervention?

  1. A normal behavioral response to the discomfort and frustration of casting.
  2. Development of a pressure ulcer and potential infection beneath the cast. (correct answer)
  3. Excessive peroneal nerve compression causing neuropathic pain.
  4. Compartment syndrome in the lower leg due to swelling within the cast.
Explanation: The combination of focal signs (foul odor, refusal to bear weight on one side) and systemic signs (irritability, fever) strongly suggests a localized pressure injury under the cast that has become infected. A foul odor is a cardinal sign of tissue necrosis or infection. While irritability (A) can occur, the other signs point to a serious pathology. Nerve compression (C) would cause sensory or motor changes but not typically fever or a foul smell. Compartment syndrome (D) is an acute event with severe pain, pallor, and pulselessness, which is a different clinical picture.

Question 13

A 55-year-old male, who is a weekend athlete, undergoes a fitness evaluation. He has no prior cardiac history but has risk factors of hypertension and a sedentary lifestyle. He performs a high-intensity interval training (HIIT) protocol on a stationary bike. During a high-intensity interval, he reports a feeling of 'heartburn' and mild shortness of breath. His heart rate is 90% of his age-predicted maximum. The symptoms subside during the subsequent recovery interval.

The patient's reported symptoms are MOST concerning for which underlying condition being unmasked by the exercise?

  1. Gastroesophageal reflux disease (GERD).
  2. Exercise-induced bronchospasm.
  3. Undiagnosed coronary artery disease. (correct answer)
  4. Musculoskeletal strain of the intercostal muscles.
Explanation: Angina, or chest pain due to myocardial ischemia, can present atypically as 'heartburn,' epigastric pain, or jaw pain, especially when induced by exertion and relieved by rest. This is known as an anginal equivalent. Given the patient's age, risk factors, and the exertional nature of the symptoms that resolve with rest, the highest suspicion should be for underlying coronary artery disease. While GERD (A) can be exacerbated by exercise, its correlation with high-intensity intervals and resolution with recovery makes ischemia the primary concern. Bronchospasm (B) would involve more wheezing, and musculoskeletal pain (D) would likely be reproducible with palpation.

Question 14

A 30-year-old construction worker is receiving treatment for low back pain. The therapist applies continuous-duty shortwave diathermy (SWD) to the lumbar paraspinal muscles. The patient has a new tattoo covering the entire low back, which he got 3 weeks ago. Midway through the 15-minute treatment, the patient reports an intense, deep burning sensation specifically under the tattooed area.

What is the MOST likely cause of this adverse reaction?

  1. The metallic pigments in the tattoo ink are concentrating the electromagnetic energy. (correct answer)
  2. The SWD is causing a delayed allergic reaction to the tattoo ink.
  3. The patient's sweat is accumulating under the towel, creating a hot spot.
  4. The SWD field is interfering with cutaneous nerve endings in the recently traumatized skin.
Explanation: Some tattoo inks, particularly older or darker ones, contain metallic pigments (e.g., iron oxides). These metallic particles are conductive and can selectively absorb and concentrate the electromagnetic energy produced by the SWD unit. This creates a localized hot spot and can lead to a deep tissue burn. This is a specific contraindication for applying SWD over tattoos. An allergic reaction (B) would not be caused by SWD. While sweat (C) can create hot spots, the pain is specifically localized to the tattooed area, making the ink the most likely culprit. Nerve interference (D) would not typically cause a burning sensation.

Question 15

A patient with Parkinson's disease is performing lower extremity strengthening exercises. He is taking Levodopa-Carbidopa, and his last dose was 4 hours ago. During a set of sit-to-stands, he experiences a sudden increase in rigidity and tremor, making it impossible for him to continue the exercise. He also reports feeling anxious.

This sudden worsening of motor symptoms during therapy is BEST described as what type of adverse phenomenon?

  1. An on-off phenomenon, where the patient has abruptly switched to an 'off' state. (correct answer)
  2. Exercise-induced dyskinesia from excessive dopaminergic stimulation.
  3. A paradoxical reaction to the Levodopa-Carbidopa medication.
  4. Central fatigue of the basal ganglia pathways due to excessive exercise demands.
Explanation: The 'on-off' phenomenon in Parkinson's disease describes sudden, unpredictable fluctuations between periods of good mobility ('on' state) and periods of severe stiffness and tremor ('off' state). These fluctuations are related to the waning effect of Levodopa as plasma concentrations drop between doses. The timing (4 hours post-dose) and the abrupt onset of classic parkinsonian symptoms are characteristic of an 'off' period. Dyskinesia (B) involves involuntary writhing movements and is associated with peak medication dose ('on' state). Central fatigue (D) is a more gradual process, and a paradoxical reaction (C) is less common and would present differently.

Question 16

A 70-year-old patient with osteoporosis is performing weight-bearing exercises to improve bone density. The therapist progresses the patient to hopping in place. The patient performs 10 hops and then reports a sudden, severe pain in their groin and is unable to bear weight on their left leg.

Which of the following adverse events is the MOST likely cause of the patient's acute symptoms?

  1. A stress reaction of the pubic ramus.
  2. An acute tear of the hip adductor longus muscle.
  3. A femoral neck fracture. (correct answer)
  4. An exacerbation of underlying hip osteoarthritis.
Explanation: In an elderly patient with osteoporosis, the femoral neck is extremely vulnerable to fracture from compressive and torsional forces. High-impact activities like hopping, even in place, can exceed the bone's failure threshold. The classic presentation of a femoral neck fracture is acute, severe groin pain and an inability to bear weight. This is a medical emergency. While a muscle tear (B) or stress reaction (A) is possible, the suddenness, severity, and inability to bear weight in this specific population make a complete fracture the most probable and critical diagnosis. An osteoarthritis flare (D) would not typically have such an acute onset with mechanical failure.

Question 17

A physical therapist is performing a Grade III posterior-to-anterior mobilization on the T4 vertebra of a patient with mid-thoracic pain. The patient has a history of long-term corticosteroid use for rheumatoid arthritis. During the third oscillation, the patient reports a sudden, sharp, and localized pain at the spinous process being mobilized, distinctly different from their presenting complaint.

What is the MOST probable adverse event that has occurred?

  1. Vertebral fracture at the targeted segment. (correct answer)
  2. Exacerbation of an underlying costotransverse joint sprain.
  3. Protective muscle spasm of the multifidus.
  4. Rupture of an interspinous ligament.
Explanation: Long-term corticosteroid use is a significant risk factor for osteoporosis. A sudden, sharp, localized pain during a mobilization technique, especially a Grade III PA pressure, should raise immediate suspicion of a iatrogenic fracture (e.g., spinous process or compression fracture). This is the most severe and likely adverse event given the patient's history. A costotransverse sprain (B) or ligament rupture (D) would be possible but less likely to present with such sharp, localized pain directly under the mobilizing contact. A muscle spasm (C) would typically feel broader and less sharp.

Question 18

A patient is 10 days post-quadriceps tendon repair and has a large hematoma over the anterior thigh. The physical therapist decides to use continuous 1 MHz ultrasound at 1.2 W/cm² over the periphery of the resolving hematoma to facilitate tissue healing. After 4 minutes of treatment, the patient reports a sudden increase in pain and the therapist observes an increase in swelling over the treatment area.

What is the MOST likely adverse effect occurring from the ultrasound application?

  1. A chemical burn under the transducer head due to insufficient coupling agent.
  2. Re-bleeding of the damaged tissue due to the thermal and mechanical effects of ultrasound. (correct answer)
  3. A periosteal burn from applying ultrasound too close to the femur.
  4. Overstimulation of cutaneous nerve endings causing a referred pain phenomenon.
Explanation: Applying continuous (thermal) ultrasound over a hematoma, especially in the acute or subacute phase, is contraindicated. The thermal effects can increase local blood flow and the mechanical effects (micromassage) can disrupt fragile, newly-formed clots, leading to re-bleeding into the tissue. This would manifest as a sudden increase in pain and swelling. A chemical burn (A) or periosteal burn (C) would present as sharp, localized burning pain but would not typically cause a rapid increase in diffuse swelling. Referred pain (D) would not be accompanied by new objective swelling.

Question 19

A patient with chronic pelvic pain is using surface EMG biofeedback for down-training of the pelvic floor muscles. The patient has a history of trauma and post-traumatic stress disorder (PTSD). During a session where the patient is focusing on relaxing the pelvic floor while visualizing a stressful past event (a component of a graded exposure protocol), they suddenly become quiet, their gaze becomes fixed, and they are unresponsive to the therapist's questions for about 30 seconds. The biofeedback unit shows a flat, non-physiologic signal.

This patient is MOST likely experiencing which adverse psychological event?

  1. A catatonic state induced by overexertion.
  2. A dissociative episode triggered by the psychological stressor. (correct answer)
  3. A simple partial seizure localized to the temporal lobe.
  4. A syncopal event due to a sudden drop in blood pressure.
Explanation: Dissociation is a mental process where a person disconnects from their thoughts, feelings, memories, or sense of identity. It is a common coping mechanism in individuals with a history of trauma and PTSD. The combination of a psychological trigger (visualizing trauma) and the clinical presentation (unresponsiveness, fixed gaze, quietness) is classic for a dissociative episode. The flat EMG signal is likely due to the patient ceasing all muscle activity, including subconscious guarding, during the episode. Catatonia (A) is a more profound state, a seizure (C) may have motor components, and syncope (D) would involve loss of postural tone.