NBCOT Registered Occupational Therapists (OTR) Quiz: Preparatory Selection
20 questions · exam conditions
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Preparatory SelectionQuestion 1 of 20

A client is referred to occupational therapy with subacute de Quervain's tenosynovitis. The OTR plans to use iontophoresis with dexamethasone to reduce inflammation. During the initial evaluation, the client's sensory screening reveals impaired sharp/dull and temperature discrimination over the radial styloid process, consistent with mild irritation of the superficial radial nerve.

Given these findings, what is the MOST appropriate action for the OTR to take?

Proceed with iontophoresis, but decrease the current amplitude to 2.0 mA.
Use phonophoresis with hydrocortisone cream as a safer alternative.
Apply a cold pack over the area for 15 minutes to reduce nerve irritation first.
Withhold electrical and thermal modalities and instead fabricate an orthosis.
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NBCOT Registered Occupational Therapists (OTR) Quiz

NBCOT Registered Occupational Therapists (OTR) Quiz: Preparatory Selection

Practice Preparatory Selection in NBCOT Registered Occupational Therapists (OTR) 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 Preparatory Selection, giving you a quick way to practice the rules, question types, and explanations that matter most for NBCOT Registered Occupational Therapists (OTR).

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 client is referred to occupational therapy with subacute de Quervain's tenosynovitis. The OTR plans to use iontophoresis with dexamethasone to reduce inflammation. During the initial evaluation, the client's sensory screening reveals impaired sharp/dull and temperature discrimination over the radial styloid process, consistent with mild irritation of the superficial radial nerve.

Given these findings, what is the MOST appropriate action for the OTR to take?

  1. Proceed with iontophoresis, but decrease the current amplitude to 2.0 mA.
  2. Use phonophoresis with hydrocortisone cream as a safer alternative.
  3. Apply a cold pack over the area for 15 minutes to reduce nerve irritation first.
  4. Withhold electrical and thermal modalities and instead fabricate an orthosis. (correct answer)
Explanation: The client's impaired sensation is a significant contraindication for both iontophoresis and other thermal modalities. The inability to feel pain, heat, or excessive stimulation puts the client at high risk for a skin burn or electrochemical injury. Reducing the current (A) does not eliminate this risk. Phonophoresis (B) often has a thermal component, which is also contraindicated with impaired sensation. Applying a cold pack (C) is also risky for the same reason. The safest and most appropriate action is to avoid modalities that require intact sensation for safety and to select an alternative intervention, such as a forearm-based thumb spica orthosis, to rest the inflamed tendons.

Question 2

A client with chronic lumbar muscle guarding and stiffness is being considered for a deep heating modality to prepare for core stabilization exercises. The OTR is deciding between continuous ultrasound and shortwave diathermy. During the medical history review, the client reports having a spinal cord stimulator implanted two years ago to manage neuropathic leg pain.

Based on this information, which of the following is the MOST appropriate clinical decision?

  1. Use shortwave diathermy with an inductive drum applicator, as it covers a larger surface area.
  2. Use continuous ultrasound at 1 MHz, as it can penetrate to the deep lumbar muscles.
  3. Proceed with either modality, as the stimulator is for the legs, not the low back.
  4. Withhold both modalities and use a moist heat pack instead. (correct answer)
Explanation: The presence of an implanted electrical device, such as a spinal cord stimulator, is an absolute contraindication for shortwave diathermy (A) due to the risk of interference from the strong electromagnetic field. It is also a contraindication for therapeutic ultrasound (B) applied over the area of the implanted leads or device. Even though the stimulator targets the legs, the device and leads are implanted in the spinal region, making both modalities unsafe. Therefore, the only appropriate decision is to withhold these deep heating modalities and choose a safe alternative like a superficial moist heat pack (D).

Question 3

An OTR is preparing to use a myofascial release technique on a client with chronic cervical pain and upper trapezius tightness. During the chart review, the OTR notes the client is taking warfarin (an anticoagulant) and has a diagnosis of severe osteoporosis.

Given the client's medical history, which preparatory intervention is the MOST appropriate choice?

  1. Moist heat pack application followed by gentle, pain-free active range of motion. (correct answer)
  2. Instrument-assisted soft tissue mobilization (IASTM) to the upper trapezius and cervical paraspinals.
  3. Direct myofascial release using sustained, deep pressure over the identified trigger points.
  4. Grade IV joint mobilizations to the lower cervical spine to improve mobility.
Explanation: When treating clients with multiple medical conditions, you must always select the safest intervention that addresses their needs while minimizing risk. This question tests your ability to prioritize safety considerations when contraindications are present. The client's warfarin therapy and severe osteoporosis create significant safety concerns. Warfarin increases bleeding risk, making aggressive soft tissue techniques dangerous. Severe osteoporosis means bones are fragile and prone to fracture with excessive force. Therefore, the most appropriate intervention is A) moist heat pack application followed by gentle, pain-free active range of motion. Heat promotes muscle relaxation and blood flow, while gentle active movements allow the client to control the force and stay within pain-free ranges, minimizing injury risk. B) IASTM is contraindicated because the scraping instruments can cause tissue trauma and bleeding in someone on anticoagulants. C) Direct myofascial release with sustained, deep pressure poses dual risks: the sustained pressure could cause bruising or bleeding due to warfarin, and deep pressure near the cervical spine area could be dangerous given the osteoporosis. D) Grade IV joint mobilizations involve high-velocity, end-range techniques that could easily fracture osteoporotic bones, making this extremely unsafe. Study tip: When you see anticoagulant medications or severe osteoporosis in a case study, immediately eliminate any intervention involving deep pressure, instruments, or high-force techniques. Always choose the gentlest option that still addresses the therapeutic goal. Safety trumps aggressive treatment every time on the NBCOT.

Question 4

A client presents to an outpatient clinic 24 hours after a Grade II ankle sprain, with significant pitting edema, pain, and ecchymosis. X-rays were negative for fracture. The client wants to return to their job, which involves standing for long periods, as soon as possible.

What is the MOST critical preparatory intervention to implement during this acute inflammatory phase?

  1. Instruction in a program of compression wrapping and consistent limb elevation. (correct answer)
  2. Initiation of retrograde massage to manually move fluid out of the interstitial space.
  3. Application of a continuous ultrasound to the lateral ankle ligaments to promote healing.
  4. Application of a moist heat pack to increase blood flow and reduce stiffness.
Explanation: When you encounter questions about acute injury management, think systematically about the inflammatory phase and which interventions support versus hinder the body's natural healing response. In acute inflammation (first 24-72 hours), your primary goals are controlling edema, minimizing secondary tissue damage, and promoting optimal conditions for healing. The RICE principle (Rest, Ice, Compression, Elevation) remains the gold standard because it works with, not against, the inflammatory process. Option A is correct because compression wrapping prevents further fluid accumulation in tissues while elevation uses gravity to promote venous and lymphatic return. This combination directly addresses the pitting edema described and creates optimal conditions for the inflammatory phase to progress normally. These interventions are safe, evidence-based, and can be implemented immediately. Option B is wrong because retrograde massage during acute inflammation can increase bleeding, worsen tissue damage, and potentially dislodge clots that are forming to control hemorrhage. Manual techniques should wait until the inflammatory phase subsides. Option C is incorrect because continuous ultrasound generates significant heat, which would increase blood flow and worsen edema during the acute phase. Thermal modalities are contraindicated in fresh injuries. Option D is wrong for the same thermal reasoning - moist heat increases circulation and metabolic demands when tissues need to limit further fluid accumulation and bleeding. Remember: During acute inflammation, your interventions should calm the system down, not ramp it up. Heat and aggressive manual techniques come later in the healing timeline, typically after 48-72 hours when inflammation begins to resolve.

Question 5

An OTR is treating a 9-year-old child with tactile defensiveness. As a preparatory activity, the therapist plans to use the Fluidotherapy machine to provide controlled, desensitizing input before working on fine motor tasks. During the intake, the parent notes that the child has a severe allergy to corn and all corn products.

Based on this new information, what is the therapist's best course of action?

  1. Select an alternative desensitization activity, such as a bin of dry rice or beans. (correct answer)
  2. Have the child wear a thin cotton glove during the Fluidotherapy session.
  3. Proceed with the Fluidotherapy but set it to a lower temperature to reduce risk.
  4. Proceed with the Fluidotherapy as planned, as the medium is not ingested.
Explanation: When treating children with sensitivities or allergies, safety must always be your top priority, even when the exposure route seems unlikely. This question tests your understanding of contraindications and clinical decision-making in pediatric practice. Fluidotherapy machines use cellulose particles derived from corn husks as the treatment medium. Even though the child won't be eating these particles, corn allergies can be severe and may trigger reactions through skin contact or inhalation of airborne particles. The severity of the allergy ("severe allergy to corn and all corn products") makes any exposure unacceptable, regardless of the route. Choice A is correct because it completely eliminates the allergen exposure while still providing appropriate desensitization input. Dry rice or beans can offer similar tactile experiences for gradual desensitization without safety risks. Choice B is wrong because thin cotton gloves won't prevent all particle contact or inhalation, and some particles could still reach exposed skin areas like wrists or arms. Choice C is incorrect because temperature adjustment doesn't address the fundamental problem of corn allergen exposure. Lower temperature doesn't reduce allergic reaction risk. Choice D represents dangerous thinking. While ingestion isn't occurring, severe allergies can trigger reactions through skin contact, inhalation, or even minimal exposure. The phrase "severe allergy" should immediately signal complete avoidance. Remember: When you encounter any mention of allergies in NBCOT questions, always choose the option that completely avoids the allergen. Never rationalize exposure through alternative methods or reasoning—patient safety always trumps treatment convenience.

Question 6

A client with chronic rheumatoid arthritis reports severe morning stiffness and pain in the joints of both hands, which limits their ability to perform morning self-care routines. The client has no open wounds or significant edema.

To prepare the client for an ADL session focused on dressing, which preparatory modality would be the BEST choice to decrease joint stiffness?

  1. Ice massage over the metacarpophalangeal (MCP) joints.
  2. A paraffin wax dip. (correct answer)
  3. Pulsed ultrasound to the wrist.
  4. Transcutaneous electrical nerve stimulation (TENS).
Explanation: A paraffin wax dip provides circumferential heat to the small joints of the hands, which is highly effective in reducing pain and stiffness associated with arthritis. This makes it an ideal preparatory method before functional activities. Ice massage (A) is used for acute inflammation and would likely increase stiffness. Pulsed ultrasound (C) is primarily for promoting tissue healing, not for generalized joint stiffness. TENS (D) is used for pain modulation but does not directly address stiffness.

Question 7

An OTR in an outpatient clinic is treating a client diagnosed with subacute lateral epicondylitis. The client complains of pain over the lateral epicondyle that increases with gripping activities. The goal is to prepare the client for progressive strengthening exercises.

What is the MOST appropriate preparatory technique to apply before initiating stretching of the wrist extensors?

  1. Cryotherapy over the common extensor tendon.
  2. A moist hot pack over the forearm. (correct answer)
  3. Iontophoresis with saline.
  4. Continuous ultrasound at 3 MHz.
Explanation: Applying a moist hot pack (superficial heat) is the most appropriate choice to increase tissue extensibility and blood flow, and to decrease pain before stretching the wrist extensors in a subacute condition. Cryotherapy (A) is typically used after activity to control inflammation, not before stretching as it decreases tissue extensibility. Iontophoresis (C) is a method to deliver medication, and saline is not a therapeutic agent for this condition. Continuous ultrasound (D) could be an option, but a moist hot pack is generally preferred for its larger treatment area and relaxation effects before stretching in this context.

Question 8

A client is 3 days post-CVA and presents with flaccid paralysis of the right upper extremity and trace (1/5) contraction of the anterior deltoid. The OTR is concerned about the risk of glenohumeral subluxation. The client is medically stable.

Which preparatory intervention is MOST appropriate to implement to stimulate muscle activity and help prevent further subluxation?

  1. Transcutaneous electrical nerve stimulation (TENS) to the shoulder.
  2. Neuromuscular electrical stimulation (NMES) to the supraspinatus and posterior deltoid. (correct answer)
  3. Application of a hot pack to reduce muscle tone.
  4. Manual retrograde massage to the upper extremity.
Explanation: NMES is used for muscle re-education and strengthening. Applying it to the supraspinatus and posterior deltoid can help approximate the humeral head in the glenoid fossa, providing dynamic support and reducing subluxation in a flaccid limb. TENS (A) is for pain management, not muscle contraction. A hot pack (C) is irrelevant for flaccidity. Retrograde massage (D) is for edema, which is not the primary concern.

Question 9

A client is scheduled for therapy to address a dense scar on the volar surface of their forearm resulting from a burn injury 6 months ago. The scar is limiting wrist and finger extension, impacting the client's ability to use a computer keyboard at work.

Which preparatory modality is the BEST choice to increase tissue extensibility of the scar before the OTR performs scar mobilization and stretching?

  1. Fluidotherapy for 15 minutes.
  2. Continuous ultrasound at 1 MHz. (correct answer)
  3. Ice massage directly over the scar tissue.
  4. High-voltage pulsed current stimulation.
Explanation: Continuous ultrasound is a deep heating modality. Using a frequency of 1 MHz targets deeper tissues, such as a dense scar on the forearm. The thermal effects increase collagen extensibility, making it an excellent preparatory method before mobilization and stretching. Fluidotherapy (A) provides superficial heat and is less effective for dense, deep scar tissue. Ice massage (C) would decrease tissue extensibility. High-voltage pulsed current (D) is typically used for wound healing or edema control, not for increasing scar extensibility.

Question 10

A factory worker is diagnosed with carpal tunnel syndrome and reports numbness and tingling in the median nerve distribution, especially after repetitive gripping tasks. The client has positive Tinel's and Phalen's signs. There is no significant muscle atrophy.

Which preparatory modality is MOST appropriate to apply to the volar wrist to reduce inflammation before initiating nerve gliding exercises?

  1. A moist hot pack.
  2. Paraffin bath.
  3. Cryotherapy (cold pack). (correct answer)
  4. Interferential current (IFC).
Explanation: Carpal tunnel syndrome involves inflammation of the flexor tendons and compression of the median nerve. Cryotherapy is indicated to cause vasoconstriction, which can help reduce inflammation and nerve irritation, thus decreasing the client's symptoms before therapeutic exercise. Heat modalities like hot packs (A) and paraffin (B) can increase blood flow and may exacerbate inflammatory symptoms. IFC (D) is typically used for pain over a larger area and is less specific for reducing localized inflammation than cryotherapy.

Question 11

A client in an acute care hospital has a stage II pressure ulcer on their sacrum. The wound bed is clean with evidence of granulation tissue. The OTR's goal is to facilitate wound healing to prepare the client for a sitting tolerance program.

Which physical agent modality would be an appropriate adjunct preparatory intervention to promote tissue healing for this type of wound?

  1. Continuous thermal ultrasound over the wound bed.
  2. Non-thermal (pulsed) ultrasound around the wound periphery. (correct answer)
  3. Application of a moist hot pack directly on the wound.
  4. Cryotherapy to reduce inflammation.
Explanation: Non-thermal (pulsed) ultrasound is used to facilitate healing in all phases of wound repair by stimulating cellular activity (e.g., mast cell degranulation, fibroblast activity). It should be applied to the periwound area, not directly over the wound. Continuous thermal ultrasound (A) and moist hot packs (C) are contraindicated over open wounds and can impede healing. Cryotherapy (D) is used for acute inflammation, which is not the primary characteristic of a clean, granulating stage II ulcer.

Question 12

An OTR is treating a client with chronic low back pain who has a goal of being able to stand for 20 minutes to cook a simple meal. The client reports a pain level of 7/10 with standing. The client has a cardiac pacemaker.

Which preparatory technique is MOST appropriate for pain modulation to allow the client to participate in the cooking activity, given the client's medical history?

  1. Transcutaneous electrical nerve stimulation (TENS) over the lumbar paraspinals.
  2. A moist hot pack applied to the low back. (correct answer)
  3. Interferential current (IFC) therapy.
  4. Myofascial release of the lumbar fascia.
Explanation: A moist hot pack is a safe and effective way to reduce pain and muscle guarding in the low back. It is a superficial thermal agent that promotes relaxation. TENS (A) and IFC (C) are contraindicated because the client has a cardiac pacemaker. Myofascial release (D) is a manual therapy technique, but a hot pack is often used first to prepare the tissues and is a very common, effective method for this type of pain.

Question 13

A child with athetoid cerebral palsy exhibits fluctuating muscle tone and writhing movements in the upper extremities. The OTR wants to prepare the child for a fine motor task involving placing pegs in a pegboard.

Which preparatory technique is the BEST choice to promote proximal stability before this activity?

  1. Fast brushing of the child's arms and hands.
  2. Applying compression and weight-bearing through the upper extremities. (correct answer)
  3. Using slow, rhythmic vestibular input (rocking).
  4. Stretching the wrist and finger flexors.
Explanation: Applying compression through the joints (proprioceptive input) and facilitating weight-bearing are effective techniques for increasing proximal stability and co-contraction around the shoulder and elbow joints. This provides a stable base for distal movements required in fine motor tasks. Fast brushing (A) is a tactile facilitatory technique but does not promote stability. Slow rocking (C) is generally calming and inhibitory. Stretching (D) addresses ROM but not the underlying issue of fluctuating tone and instability.

Question 14

A client with a C6 spinal cord injury has developed 2+ pitting edema in their dependent hands. The client's goal is to be able to don and doff a universal cuff for feeding. The edema is limiting finger flexion.

Which preparatory technique should the OTR use at the beginning of the session to manage the edema?

  1. Application of a contrast bath.
  2. Manual edema mobilization followed by elevation. (correct answer)
  3. Aggressive squeezing of a therapy putty.
  4. Wrapping the hand with an elastic bandage from distal to proximal.
Explanation: Manual edema mobilization (MEM) is a specialized massage technique designed to stimulate the lymphatic system and move low-protein edema fluid. It should be followed by elevation to assist gravity in fluid return. This is the most direct and effective treatment for pitting edema. A contrast bath (A) can be used for edema, but MEM is more targeted. Squeezing putty (C) requires active muscle contraction which may be limited, and is a therapeutic exercise, not a preparatory technique for edema. Wrapping (D) is a component of a comprehensive edema management program (compression), but MEM is the active preparatory technique used first to move the fluid.

Question 15

An OTR is treating a client who has a Boutonnière deformity of the PIP joint of the index finger due to chronic synovitis from rheumatoid arthritis. The client is unable to actively extend the PIP joint. The OTR is fabricating a splint and wants to prepare the joint for a better resting position.

Which preparatory technique should the OTR use to improve passive PIP extension before molding the splint?

  1. Gentle, sustained passive stretching into extension with a hot pack. (correct answer)
  2. Resisted DIP flexion exercises.
  3. Application of a cold pack to reduce joint inflammation.
  4. NMES to the extensor digitorum communis.
Explanation: Applying a hot pack will increase the extensibility of the soft tissues around the joint. Following this with a gentle, sustained stretch is the most effective way to passively improve the joint's extension before fabricating a splint to hold it in a corrected position. Resisted DIP flexion (B) would not help with PIP extension. A cold pack (C) would decrease tissue extensibility. NMES (D) to the EDC would extend the MCP joint but is unlikely to correct a fixed deformity at the PIP joint caused by central slip disruption.

Question 16

A client is referred to OT with a diagnosis of De Quervain's tenosynovitis. The client has pain localized over the radial styloid and a positive Finkelstein's test. The OTR plans to provide education on activity modification and joint protection.

Which preparatory physical agent modality is MOST appropriate to use to decrease pain and inflammation in the first dorsal compartment?

  1. Pulsed ultrasound at 3 MHz over the radial styloid. (correct answer)
  2. Warm water whirlpool for the hand and wrist.
  3. Moist heat pack over the forearm.
  4. Fluidotherapy with active wrist ROM.
Explanation: Pulsed ultrasound at a 3 MHz frequency is ideal for treating superficial tissues, such as the tendons in the first dorsal compartment at the radial styloid. The non-thermal (pulsed) setting helps to facilitate tissue healing and reduce inflammation without exacerbating it. All the other options (B, C, D) involve heat, which could increase inflammation in this acute/subacute tenosynovitis.

Question 17

A client is 7 days post-flexor tendon repair in Zone II of the middle finger and is being treated using an early active motion protocol with a dorsal block orthosis. The OTR notes significant pitting edema throughout the entire digit, which is limiting the prescribed tendon-gliding exercises.

Which preparatory modality is the MOST appropriate and safe choice to manage edema in this acute post-operative phase?

  1. Pulsed, non-thermal ultrasound (20% duty cycle, 3 MHz) applied to the digit. (correct answer)
  2. Contrast baths, alternating between warm and cold water immersion.
  3. Moist heat pack application to the forearm and hand to increase circulation.
  4. High-voltage pulsed current (HVPC) with the active electrode over the flexor sheath.
Explanation: When treating acute post-operative conditions like flexor tendon repairs, your primary concerns are promoting healing while avoiding anything that could disrupt the surgical site or increase inflammation. In Zone II flexor tendon repairs, edema management is crucial for maintaining range of motion, but you must choose modalities that won't interfere with tissue healing. Pulsed, non-thermal ultrasound (Answer A) is the ideal choice because it provides therapeutic benefits without thermal effects that could increase inflammation. The 20% duty cycle ensures minimal heat generation while the 3 MHz frequency is appropriate for superficial tissues like tendons and skin. Research shows pulsed ultrasound can reduce edema and promote tissue healing through non-thermal mechanisms like acoustic streaming and cavitation. Answer B (contrast baths) is contraindicated in acute post-operative phases because the temperature extremes and increased circulation could promote bleeding and excessive inflammation at the surgical site. Answer C (moist heat) would increase circulation and potentially cause vasodilation, leading to more edema rather than reducing it, plus risk disrupting early healing. Answer D (HVPC over the flexor sheath) places electrical stimulation directly over the surgical repair site, which could interfere with healing tissues and is contraindicated in acute post-operative conditions. Study tip: For NBCOT questions about acute post-operative care, always prioritize modalities that support healing without adding thermal stress or direct stimulation to surgical sites. Non-thermal ultrasound is often the safest choice for early intervention in tendon repairs.

Question 18

An OTR is treating a client who is 4 weeks post-distal radius fracture. The cast has been removed, and the client exhibits moderate edema, decreased wrist ROM, and significant pain with movement. The client's primary goal is to return to gardening.

Which preparatory method is MOST appropriate to use at the beginning of the therapy session to address the client's symptoms and prepare for therapeutic activity?

  1. A paraffin bath to decrease joint stiffness.
  2. A contrast bath to decrease edema and pain. (correct answer)
  3. Neuromuscular electrical stimulation (NMES) to increase muscle strength.
  4. Aggressive passive range of motion to restore joint mobility.
Explanation: A contrast bath, alternating between warm and cold water, creates a pumping action that is effective in reducing edema while also managing pain. In this subacute phase, moderate edema is a primary concern that limits ROM and causes pain. A paraffin bath (A) is contraindicated due to the presence of moderate edema. NMES (C) is premature as pain and edema should be addressed first to allow for active movement. Aggressive PROM (D) could exacerbate pain and inflammation in this stage of healing.

Question 19

A client is 2 weeks post-rotator cuff repair surgery and is referred to OT. The arm is in a sling, and the surgeon's protocol specifies passive range of motion only. The client has pain and significant stiffness.

What is the MOST appropriate preparatory intervention to use before initiating gentle, passive range of motion exercises?

  1. Pendulum exercises (Codman's).
  2. Application of a cold pack to the shoulder. (correct answer)
  3. NMES to the rotator cuff muscles.
  4. Continuous ultrasound to the surgical site.
Explanation: In the acute post-operative phase (2 weeks), inflammation and pain are primary concerns. A cold pack (cryotherapy) is the most appropriate modality to decrease pain and control inflammation before performing PROM. Pendulum exercises (A) are a form of active-assisted or active ROM and would likely violate a PROM-only protocol. NMES (C) involves muscle contraction and is contraindicated. Ultrasound (D) is generally contraindicated over the acute surgical area.

Question 20

An OTR in a skilled nursing facility is working with an older adult client who has shoulder pain and weakness (3/5) in the deltoid following a fall. The client has a history of deep vein thrombosis (DVT) and is on anticoagulant medication. The goal is to prepare the client for self-feeding using the affected arm.

Given the client's medical history and presentation, which preparatory technique is CONTRAINDICATED?

  1. Moist hot pack to the shoulder.
  2. Deep tissue massage to the deltoid. (correct answer)
  3. Cryotherapy over the anterior shoulder.
  4. Gentle active-assisted range of motion.
Explanation: Deep tissue massage is contraindicated for clients who are on anticoagulant medication. The pressure can cause bruising and bleeding under the skin. A history of DVT is also a precaution for massage, especially in the extremities. The other options are safe and appropriate preparatory techniques for this client. A moist hot pack (A) can help with pain, cryotherapy (C) can manage inflammation, and gentle AAROM (D) is a standard approach to begin restoring motion.