National Physical Therapy Examination (NPTE) Quiz: Safe Modality Application
20 questions · exam conditions
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Safe Modality ApplicationQuestion 1 of 20

A 62-year-old patient with hemiparesis following a left CVA is being treated with functional electrical stimulation (FES) to improve dorsiflexion during the swing phase of gait. The therapist observes that during stimulation, the patient's foot everts strongly with minimal dorsiflexion.

This observation MOST likely indicates that the active electrode is positioned too far in which direction?

Laterally, over the motor point of the peroneal longus and brevis muscles.
Proximally, over the tibialis anterior muscle belly near the tibial tuberosity.
Medially, over the motor point of the tibialis posterior muscle.
Distally, over the tibialis anterior tendon near the medial cuneiform.
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National Physical Therapy Examination (NPTE) Quiz

National Physical Therapy Examination (NPTE) Quiz: Safe Modality Application

Practice Safe Modality Application 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 Safe Modality Application, 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 62-year-old patient with hemiparesis following a left CVA is being treated with functional electrical stimulation (FES) to improve dorsiflexion during the swing phase of gait. The therapist observes that during stimulation, the patient's foot everts strongly with minimal dorsiflexion.

This observation MOST likely indicates that the active electrode is positioned too far in which direction?

  1. Laterally, over the motor point of the peroneal longus and brevis muscles. (correct answer)
  2. Proximally, over the tibialis anterior muscle belly near the tibial tuberosity.
  3. Medially, over the motor point of the tibialis posterior muscle.
  4. Distally, over the tibialis anterior tendon near the medial cuneiform.
Explanation: When you encounter functional electrical stimulation (FES) questions on the NPTE, focus on understanding the relationship between electrode placement and muscle activation patterns. The key is matching the observed movement dysfunction to the most likely anatomical cause. In this scenario, strong eversion with minimal dorsiflexion during FES indicates the stimulation is primarily activating the peroneal muscles rather than the intended dorsiflexors. The peroneal longus and brevis are the primary evertors of the foot, and their motor points lie laterally over the fibular head and upper lateral leg. When the active electrode is positioned too far laterally, it captures these peroneal muscles instead of the tibialis anterior, producing the observed eversion pattern with inadequate dorsiflexion. Choice A correctly identifies this lateral misplacement over the peroneal muscle motor points. Choice B (proximally over tibialis anterior near the tibial tuberosity) would still primarily stimulate the tibialis anterior, likely producing good dorsiflexion rather than eversion. Choice C (medially over tibialis posterior) doesn't make anatomical sense since the tibialis posterior lies deep in the posterior compartment and wouldn't be easily stimulated from a medial surface electrode placement. Choice D (distally over the tibialis anterior tendon) would produce weak or no response due to stimulating tendon rather than muscle belly, but wouldn't cause eversion. For NPTE success, memorize the primary actions and anatomical locations of key lower extremity muscles, especially the tibialis anterior (dorsiflexion/inversion) versus the peroneals (eversion/plantarflexion). FES questions often test whether you can troubleshoot electrode placement based on unwanted movement patterns.

Question 2

A physical therapist is treating a patient with pes anserine bursitis. The patient's medical history is significant for a total knee arthroplasty with cemented components performed one year ago. The therapist plans to use continuous ultrasound at 1 MHz, 1.2 W/cm² to the affected area. Which of the following is the MOST appropriate action?

  1. Proceed with the planned intervention, as ultrasound is safe to use over cemented joint replacements.
  2. Change the intervention to pulsed ultrasound at a 20% duty cycle to minimize thermal effects on the cement. (correct answer)
  3. Apply the ultrasound but ensure the transducer is moved more rapidly than usual to dissipate heat effectively.
  4. Refuse to use ultrasound as it is absolutely contraindicated over areas with any form of joint replacement hardware.
Explanation: The correct answer is B. Continuous (thermal) ultrasound is a precaution over cemented joint prostheses because the cement can become heated, potentially loosening the implant. The safest approach is to use non-thermal (pulsed) ultrasound, which can still provide mechanical effects for tissue healing without the risk of significant heating. While keeping the sound head moving (C) is always important, it may not be sufficient to prevent heat accumulation in the cement with continuous ultrasound. Proceeding with continuous ultrasound (A) ignores a significant precaution. Ultrasound is not absolutely contraindicated (D), but precautions must be taken, especially with cemented components.

Question 3

A physical therapist is using neuromuscular electrical stimulation (NMES) for quadriceps re-education on a patient 3 days post-anterior cruciate ligament reconstruction. The therapist notes a 3+ pitting edema and significant joint effusion around the knee. Despite using appropriate parameters, the patient is unable to achieve a strong, visible contraction. What is the MOST likely reason for the poor response?

  1. The patient has developed a peripheral nerve injury as a complication of the surgery.
  2. The NMES intensity is insufficient to overcome the impedance of the subcutaneous adipose tissue.
  3. The significant effusion is causing reflex inhibition of the quadriceps muscle. (correct answer)
  4. The patient's pain medication is interfering with the transmission of the electrical stimulus.
Explanation: The correct answer is C. Significant joint effusion is known to cause arthrogenic muscle inhibition, a neurological response where the muscle's ability to contract is diminished. This reflex inhibition makes it very difficult for both voluntary and electrically stimulated contractions to occur. While a nerve injury (A) is possible, it is less common and would likely present with other sensory or motor deficits. Increased impedance from adipose tissue (B) can be a factor, but the acute onset of effusion is a more powerful inhibitor. Pain medication (D) does not typically block the peripheral neuromuscular junction in a way that would prevent an NMES-induced contraction.

Question 4

A patient with stage 2 primary lymphedema of the right lower extremity is being treated with intermittent pneumatic compression (IPC). The patient has a comorbid diagnosis of stable, medically managed congestive heart failure (CHF). Which parameter adjustment is MOST critical for ensuring patient safety?

  1. Setting the inflation pressure below the patient's diastolic blood pressure.
  2. Ensuring the treatment duration does not exceed 30 minutes per session.
  3. Monitoring heart rate and blood pressure before, during, and after the treatment. (correct answer)
  4. Using a sequential chamber pump rather than a non-sequential pump.
Explanation: The correct answer is C. The primary safety concern when using IPC on a patient with CHF is the potential for fluid overload on a compromised circulatory system. Pushing a large volume of lymphatic fluid and venous return back into central circulation can exacerbate CHF. Therefore, the most critical safety measure is to closely monitor the patient's cardiovascular response (vitals) to ensure they are tolerating the fluid shift. While setting pressure below diastolic (A) is a standard guideline for IPC, it does not specifically address the CHF risk. Limiting duration (B) and using a sequential pump (D) are components of effective treatment but are secondary to monitoring the systemic effects in this high-risk patient.

Question 5

An elderly patient with type 2 diabetes and associated peripheral neuropathy is prescribed moist hot packs for chronic low back pain. The patient has decreased sensation to light touch and pinprick in the lower back region. Which is the MOST important safety instruction for the physical therapist to provide to the assistant applying the hot pack?

  1. Use a minimum of 6-8 layers of toweling between the pack and the patient's skin.
  2. Check the patient's skin for excessive redness or mottling after 5 minutes of application. (correct answer)
  3. Provide the patient with a bell and instruct them to ring it for any reason, avoiding reliance on verbal reports of heat.
  4. Set a timer for 15 minutes and do not allow the treatment to extend beyond this time.
Explanation: The correct answer is B. In a patient with impaired sensation, subjective reports of heat are unreliable. Therefore, objective monitoring becomes the most critical safety measure. The highest risk of a burn is within the first 5-10 minutes as the pack temperature equilibrates. Visually inspecting the skin after 5 minutes allows the therapist or assistant to identify signs of excessive heat (hyperemia, mottling) before a burn occurs and adjust the layers accordingly. While using 6-8 layers (A), providing a bell (C), and limiting time (D) are all good safety practices, the direct, objective skin check is the most crucial step to prevent thermal injury in this specific high-risk patient.

Question 6

A patient is being treated with interferential current (IFC) for shoulder pain, using a quadripolar electrode setup centered over the deltoid. The patient has a history of transient ischemic attacks (TIAs). During the treatment, the therapist notices that the superior medial electrode is positioned over the anterolateral neck. What is the therapist's MOST immediate and appropriate response?

  1. Decrease the intensity of the current to reduce the risk of an adverse reaction.
  2. Pause the treatment, reposition the electrode to be centered over the shoulder musculature, and then resume. (correct answer)
  3. Continue the treatment but monitor the patient's blood pressure and ask about dizziness.
  4. Switch to a premodulated current using only two electrodes placed directly on the deltoid.
Explanation: The correct answer is B. The anterolateral neck contains the carotid sinus. Electrical stimulation over this area is contraindicated as it can cause a reflex drop in blood pressure (vasovagal response) or other cardiac arrhythmias. Given the patient's history of TIAs, this is particularly dangerous. The most immediate and appropriate action is to stop the stimulation and correct the unsafe electrode placement. Decreasing the intensity (A) or simply monitoring (C) does not remove the immediate risk. While switching to premodulated current (D) might be a reasonable alternative for future sessions, the immediate priority is to correct the current unsafe setup.

Question 7

A patient who had a stroke is using surface EMG biofeedback to improve activation of the tibialis anterior during swing phase of gait. Initially, the therapist sets a high sensitivity (low microvolt threshold) to detect any muscle activity. The patient is now able to consistently activate the muscle and meet the threshold, but exhibits a hip-hiking gait deviation. What is the MOST appropriate progression of the biofeedback intervention?

  1. Increase the sensitivity of the unit to reward the patient for any attempted muscle firing.
  2. Decrease the sensitivity (increase the microvolt threshold) and instruct the patient to achieve the signal without hip hiking. (correct answer)
  3. Move the electrode to the gastrocnemius to focus on inhibiting plantar flexion during swing.
  4. Add a second biofeedback unit to the hip abductors to facilitate a stronger contraction.
Explanation: The correct answer is B. The patient has learned to activate the target muscle but is doing so with a compensatory movement (hip hiking). The next step in motor learning is to refine the movement pattern. By decreasing the sensitivity (i.e., raising the microvolt threshold), the therapist makes the task more difficult, requiring a stronger, more isolated contraction of the tibialis anterior. This should be paired with verbal and tactile cues to inhibit the unwanted hip hiking, thus promoting a more normal movement pattern. Increasing sensitivity (A) is a regression. Moving the electrode to the antagonist (C) is a different treatment strategy (inhibitory biofeedback) and doesn't address the quality of the current agonist contraction. Adding a second unit (D) increases the complexity unnecessarily and doesn't address the primary compensation issue.

Question 8

A physical therapist is applying low-frequency, non-thermal pulsed ultrasound to promote healing of a stage 3 pressure ulcer over the sacrum. The wound is covered with a transparent film dressing. Which application method is MOST appropriate and safe?

  1. Apply ultrasound gel directly to the transparent film dressing and treat through the dressing. (correct answer)
  2. Remove the dressing, fill the wound with sterile saline, and use the saline as a coupling medium.
  3. Remove the dressing, apply a hydrogel sheet into the wound bed, and apply ultrasound through the hydrogel sheet.
  4. Apply the ultrasound around the periphery of the wound (periwound) but not directly over the wound bed.
Explanation: The correct answer is A. It is acceptable and often preferable to apply ultrasound over a wound through an occlusive transparent film dressing. The dressing maintains a sterile environment, and the ultrasound waves can be effectively transmitted through the dressing with the use of a standard coupling gel on top. Removing the dressing (B, C) increases the risk of contamination. While filling the wound with saline (B) or hydrogel (C) can work as a medium, it is less practical and safe than leaving the dressing in place. Treating only the periwound (D) is an alternative technique but does not provide the direct mechanical stimulation to the wound bed that is desired for healing promotion.

Question 9

A physical therapist plans to use high-voltage pulsed current (HVPC) for edema reduction in a patient with an acutely swollen ankle following a Grade II sprain. The wound is closed and there are no signs of infection. To achieve the desired effect of repelling negatively charged proteins, which setup is MOST appropriate?

  1. Place the cathode (negative electrode) over the edematous area with the anode (positive electrode) placed proximally. (correct answer)
  2. Place the anode (positive electrode) over the edematous area with the cathode (negative electrode) placed proximally.
  3. Use a bipolar setup with two electrodes of equal size placed on either side of the swollen joint.
  4. Alternate the polarity of the active electrode every 5 minutes to prevent skin accommodation to the current.
Explanation: The correct answer is A. The theory behind using HVPC for acute edema is based on the principle of galvanotaxis, specifically repelling the negatively charged serum proteins (like albumin) that accumulate in the interstitial fluid after injury. To repel these negative charges away from the area, the active electrode placed over the edema must also be negative (the cathode). The dispersive electrode (anode) is placed more proximally to complete the circuit and draw the fluid away. Placing the anode over the edema (B) would attract, not repel, the proteins. A bipolar setup (C) is typically used for muscle stimulation, not edema control. Alternating polarity (D) would negate the desired directional repulsion of proteins.

Question 10

A patient with rheumatoid arthritis affecting the hands is scheduled for a paraffin bath treatment to decrease stiffness and pain. During the pre-treatment skin inspection, the therapist notes a small, open skin lesion on the patient's proximal interphalangeal joint of the index finger. Which of the following is the MOST appropriate action?

  1. Proceed with the treatment after covering the lesion with a non-permeable dressing.
  2. Proceed with the treatment, as the high temperature of the paraffin will sterilize the lesion.
  3. Do not proceed with the paraffin treatment, as open wounds are a contraindication. (correct answer)
  4. Lower the temperature of the paraffin bath to reduce the risk of irritating the open lesion.
Explanation: The correct answer is C. The presence of an open wound or skin infection in the treatment area is an absolute contraindication for a paraffin bath. The heat can increase inflammation and circulation to the area, potentially worsening the condition or spreading infection. Furthermore, dipping an open wound into a communal wax bath poses a significant cross-contamination risk. Covering the lesion (A) may not be sufficient to prevent leakage or heat transfer. The temperature of paraffin is not high enough to sterilize (B). Lowering the temperature (D) does not mitigate the contraindication of treating an open wound.

Question 11

A patient receiving iontophoresis with acetic acid for calcific tendonitis reports a significant burning sensation under the active (negative) electrode. The therapist observes marked erythema but no blistering. Which factor is MOST likely contributing to this adverse response?

  1. The current density is too high due to poor electrode contact or small electrode size. (correct answer)
  2. The patient is having a systemic allergic reaction to the acetic acid solution.
  3. The treatment duration is too short to allow for skin accommodation.
  4. The acetic acid solution has been excessively diluted, reducing its conductivity.
Explanation: The correct answer is B. A strong burning sensation and erythema under an electrode during iontophoresis are classic signs of an electrochemical burn, which is caused by excessive current density. Current density is the amount of current per unit area of the electrode (mA/cm²). This can happen if the electrode is too small for the current being used, or if it is peeling off, which reduces the effective contact area and concentrates the current in one spot. A systemic allergic reaction (A) would likely present with more widespread symptoms (e.g., hives, difficulty breathing). A short duration (C) would be less likely to cause a burn than a long one. Diluting the solution (D) would increase resistance and make it harder to pass current, not cause a burn.

Question 12

A patient with a T4 level spinal cord injury is being treated with neuromuscular electrical stimulation (NMES) to the shoulder abductors to improve glenohumeral joint stability. During the session, the patient reports a sudden, pounding headache. The therapist notes the patient's face is flushed and they have goosebumps above the level of the injury. What is the therapist's MOST critical immediate action?

  1. Stop the NMES, lay the patient flat, and elevate their legs to treat for shock.
  2. Continue the session, as a headache can be a common side effect of strong muscular contractions.
  3. Decrease the NMES intensity and have the patient perform diaphragmatic breathing to lower blood pressure.
  4. Stop the NMES, sit the patient fully upright, and check for noxious stimuli below the injury level. (correct answer)
Explanation: The correct answer is B. The patient's symptoms (pounding headache, flushing, goosebumps above injury level) are classic signs of autonomic dysreflexia (AD), a medical emergency common in patients with SCI at T6 or above. AD is triggered by a noxious stimulus below the level of injury. The first and most critical actions are to sit the patient upright to help lower their dangerously high blood pressure via orthostatic hypotension, and then to identify and remove the noxious stimulus (which could be the NMES itself, a kinked catheter, tight clothing, etc.). Laying the patient flat (A) is contraindicated as it will increase blood pressure further. Decreasing intensity (C) or continuing (D) is unsafe and fails to address the emergent nature of AD.

Question 13

A patient is 6 weeks post-Colles' fracture and is beginning active range of motion exercises in a Fluidotherapy unit to manage pain, stiffness, and tactile hypersensitivity. The patient finds the standard treatment temperature of 118°F (47.8°C) and moderate particle agitation to be intolerable. Which parameter adjustment is MOST appropriate for this patient?

  1. Increase the air speed to maximum to provide a greater sensory distraction from the pain.
  2. Pre-medicate the patient with a topical anesthetic cream before each Fluidotherapy session.
  3. Switch to a paraffin bath, as the moist heat will be better tolerated than the dry heat.
  4. Decrease the temperature to the lower end of the therapeutic range (e.g., 102°F or 39°C) and reduce air speed. (correct answer)
Explanation: The correct answer is B. Fluidotherapy parameters are adjustable to patient tolerance. For a patient with hypersensitivity, both the thermal and mechanical stimuli can be overwhelming. The most appropriate adjustment is to lower both the temperature and the particle agitation (air speed) to a level that the patient can tolerate. This allows the patient to experience the benefits of the modality (desensitization, pain relief, active motion) without an adverse response. Increasing the air speed (A) would worsen the mechanical hypersensitivity. Switching to paraffin (C) is an option, but adjusting the current modality is the first logical step. Pre-medication (D) is a medical decision and may not be necessary if the modality can be adjusted appropriately.

Question 14

When applying continuous thermal ultrasound to the biceps tendon, the physical therapist notes the treatment area has minimal soft tissue covering the humerus. Which procedural modification is MOST important for preventing a periosteal burn?

  1. Using a higher frequency (3 MHz) to ensure the energy is absorbed more superficially.
  2. Applying a thick layer of coupling gel to increase the distance between the transducer and the bone.
  3. Reducing the treatment time from 8 minutes to 4 minutes while maintaining the intensity.
  4. Keeping the transducer head in constant, rapid motion throughout the treatment. (correct answer)
Explanation: The correct answer is B. Ultrasound energy can be reflected at interfaces between different tissue types, with the highest reflection occurring at the soft tissue-bone interface. This reflected energy can create standing waves and concentrate heat at the periosteum, causing deep, intense pain and a potential burn. The single most effective way to prevent this is to keep the transducer moving constantly. This distributes the energy over a larger area and prevents any single point from overheating. While using 3 MHz (A) is appropriate for a superficial target, it doesn't prevent periosteal heating if the head is held still. Reducing time (C) or using more gel (D) are less effective strategies than ensuring proper application technique with constant motion.

Question 15

A patient with chronic pain has been taking a prescribed long-acting opioid for several months. The physical therapist decides to use low-frequency (acupuncture-like) TENS. The patient reports minimal pain relief from the TENS, even at a strong, tolerable intensity. What is the MOST likely pharmacological reason for this limited effectiveness?

  1. The patient has developed a cutaneous sensitivity to the electrode gel, blocking current.
  2. The electrical stimulation from the TENS unit is metabolizing the opioid medication too quickly.
  3. The opioid medication potentiates the gate control mechanism, making TENS redundant.
  4. The patient's chronic opioid use has led to a cross-tolerance with the endogenous opioid system. (correct answer)
Explanation: The correct answer is B. Low-frequency (acupuncture-like) TENS is believed to work primarily by stimulating the release of endogenous opioids (endorphins, enkephalins) which then act on opioid receptors in the central nervous system to produce analgesia. Patients on long-term exogenous opioid therapy often develop a tolerance, meaning their opioid receptors become less responsive. This tolerance can extend to the body's own endogenous opioids, a phenomenon known as cross-tolerance. As a result, the pain relief provided by opioid-mediated TENS is significantly diminished. The other options are less plausible; skin sensitivity (A) would cause irritation, not ineffectiveness; opioids do not make the gate control mechanism redundant (C); and TENS does not affect drug metabolism (D).

Question 16

A physical therapist is performing a trial of mechanical cervical traction on a patient with C6 radiculopathy. During the first 2 minutes of a 12 lb static pull, the patient reports a sudden onset of dizziness, nausea, and blurred vision. Which of the following is the MOST appropriate immediate action?

  1. Decrease the traction force to 8 lbs and ask if the symptoms subside.
  2. Release the traction tension completely, reassess the patient, and perform a vertebral artery test. (correct answer)
  3. Switch from static to intermittent traction to create a pumping effect and improve circulation.
  4. Reassure the patient that these are transient autonomic responses and continue for 2 more minutes.
Explanation: The correct answer is B. The patient's symptoms (dizziness, nausea, visual disturbances) are red flags for potential vertebral artery insufficiency, a serious adverse event during cervical traction. The immediate priority is to remove the stressor by releasing the traction completely. A subsequent assessment, including a vertebral artery test once safe, is necessary to determine the cause. Decreasing the force (A) or continuing (D) is unsafe as it prolongs a potentially dangerous situation. Switching to intermittent traction (C) does not address the underlying cause and is also unsafe.

Question 17

A patient with lateral epicondylalgia is receiving iontophoresis with dexamethasone sodium phosphate. The therapist sets the current at 3.0 mA. After 5 minutes, the patient reports mild itching and the therapist observes several small, pink papules under the negative-polarity active electrode. What is the therapist's BEST course of action?

  1. Immediately terminate the treatment and apply a cold pack to the area to manage a likely allergic reaction.
  2. Decrease the current intensity to 1.5-2.0 mA and continue to carefully monitor the skin's response. (correct answer)
  3. Reverse the polarity of the electrodes to decrease the alkaline reaction occurring under the cathode.
  4. Continue the treatment at 3.0 mA as this is a normal skin response and indicates effective drug delivery.
Explanation: The correct answer is B. Mild skin irritation, including itching and pink papules, can occur during iontophoresis due to the electrochemical effects of the current. The most appropriate initial action is to reduce the current intensity to improve patient tolerance while still delivering a therapeutic dose. Terminating treatment (A) is an overreaction for a mild, common response. Reversing polarity (C) is incorrect because dexamethasone is negatively charged and requires a negative current (from the cathode) to be repelled into the tissue. Continuing without modification (D) ignores the patient's report and the potential for the irritation to worsen into a more significant skin burn.

Question 18

A patient with a posterolateral lumbar disc herniation is receiving mechanical lumbar traction. The patient is positioned prone. After 5 minutes of a 10-minute intermittent traction session, the patient reports that their radiating leg pain has decreased, but they are now experiencing a new, centralized, intense pain in the lumbar spine. What is the therapist's BEST response?

  1. Stop the treatment immediately and reassess the patient's neurological status. (correct answer)
  2. Continue the treatment, as centralization of symptoms is the desired therapeutic outcome.
  3. Decrease the traction force by 25% and see if the central pain subsides.
  4. Change the patient's position to supine with hips and knees flexed to reduce lumbar extension.
Explanation: The correct answer is B. While centralization of distal symptoms is generally a positive sign, the concurrent onset of new, severe central pain is a red flag. This could indicate that the disc herniation is worsening or that the pressure on the nerve root has shifted to directly compressing the cauda equina or spinal cord, which is a medical emergency. Any report of a significant increase in pain or new, severe symptoms during traction warrants immediate cessation and reassessment. Continuing the treatment (A) is unsafe. While decreasing force (C) or changing position (D) might be options after reassessment, the first priority is to stop the intervention that is causing the adverse response.

Question 19

A patient is referred for management of chronic low back pain using transcutaneous electrical nerve stimulation (TENS). The patient's medical history reveals a diagnosis of colon cancer 7 years ago, treated with surgical resection and chemotherapy, with no recurrence. The patient is currently considered cancer-free. Which of the following is the MOST appropriate application of TENS?

  1. TENS is contraindicated due to the patient's history of cancer, and an alternative modality should be selected.
  2. TENS can be applied to the lumbar region as the contraindication applies only to active, metastatic malignancy. (correct answer)
  3. TENS can be applied, but only with low-frequency, motor-level stimulation to avoid stimulating dormant cells.
  4. TENS can be applied only after receiving written clearance from the patient's oncologist specifically for this modality.
Explanation: The correct answer is B. The primary contraindication regarding TENS and cancer is over an area of active, current malignancy or metastasis. A history of cancer, especially when the patient is in remission and the treatment area is not the site of the original tumor, is generally considered a precaution, not an absolute contraindication. Therefore, applying TENS to the lumbar region is appropriate. Choice A is overly cautious and misinterprets the contraindication. There is no evidence to support restricting TENS to a specific frequency based on cancer history (C). While communication with other providers is good practice, requiring specific written clearance (D) is not standard protocol for a remote history of cancer and may create unnecessary delays in care.

Question 20

A physical therapist is treating a patient with a chronic venous stasis ulcer using intermittent pneumatic compression (IPC). The patient's ankle-brachial index (ABI) was measured at 0.7. Which of the following statements BEST guides the safe application of IPC for this patient?

  1. IPC is contraindicated because the patient has evidence of arterial insufficiency.
  2. The inflation pressure should be set to a high level (60-80 mmHg) to overcome the venous hypertension.
  3. The inflation pressure should be reduced and not exceed 40-50 mmHg to avoid compromising arterial flow. (correct answer)
  4. A normal pressure setting can be used as the ABI is above the absolute contraindication level of 0.5.
Explanation: The correct answer is C. An ABI of 0.7 indicates mild to moderate peripheral arterial disease. While IPC is used for venous insufficiency, the external pressure can potentially compromise already-reduced arterial flow. Therefore, IPC is not absolutely contraindicated (A), but the pressure must be modified. Standard pressures used for lymphedema or severe venous insufficiency (B) would be unsafe. The pressure should be kept at a lower, modified level to avoid exceeding the patient's arterial capillary pressure and causing ischemia. Using a normal pressure setting (D) just because the ABI is above 0.5 ignores the significant precaution required for an ABI between 0.5 and 0.8.