Castleport Test Prep

Free NPTE-PTA Practice Test

60 original, unofficial NPTE-PTA practice questions, with explanations and sources—free, with no signup. Your score here is feedback on these 60 items, not a predicted NPTE score.

Section 1: Questions 1–15

Question 1 · Cardiovascular & pulmonary (data collection)

Before a session, a PTA measures an adult patient's resting blood pressure twice and gets 126/78 mm Hg both times. Using the American Heart Association categories, how should this reading be classified?

  • A. Normal
  • B. Stage 1 hypertension
  • C. Elevated
  • D. Stage 2 hypertension
Show answer and explanation

Answer: C

Why: The AHA categories are: normal, under 120 systolic and under 80 diastolic; elevated, 120–129 systolic with diastolic under 80; stage 1 hypertension, 130–139 systolic or 80–89 diastolic; stage 2, 140 or higher systolic or 90 or higher diastolic. A systolic of 126 with a diastolic of 78 is elevated.

  • A is wrong: normal requires a systolic under 120.
  • B is wrong: stage 1 starts at 130 systolic or 80 diastolic. Neither number reaches it.
  • D is wrong: stage 2 starts at 140 systolic or 90 diastolic.

Review next: Blood pressure categories and when an abnormal reading should stop a session.
Source: American Heart Association, Understanding Blood Pressure Readings (Blood pressure categories chart)

Question 2 · Musculoskeletal (interventions)

A patient is 2 weeks after an arthroscopic rotator cuff repair. The surgeon's protocol and the PT's plan call for sling use, pendulum exercises, and passive shoulder range of motion only. They also permit active elbow, wrist, and hand motion. Which activity is outside the plan at this stage?

  • A. Pendulum exercises
  • B. Active shoulder flexion with a 1-lb weight
  • C. Passive shoulder flexion performed by the PTA within the protocol's range limits
  • D. Active elbow, wrist, and hand motion
Show answer and explanation

Answer: B

Why: Early after a cuff repair, the repaired tendon is protected: the sling stays on and shoulder motion is passive. Active elevation, and especially adding a weight, makes the repaired muscle contract against load before the tendon has healed to bone. That is a later-phase activity the PT and surgeon progress to.

  • A is wrong: pendulums are a standard early, gravity-assisted motion when the protocol allows them.
  • C is wrong: passive motion within limits is exactly what the plan calls for.
  • D is wrong: active elbow, wrist, and hand motion is permitted by this patient's plan and helps prevent stiffness.

Review next: Phases of rotator cuff repair rehab and when active and resisted motion begin.
Source: Thigpen CA et al. ASSET consensus statement on rehabilitation after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2016 (Abstract: immobilization, protected passive motion, delayed strengthening)

Question 3 · Neuromuscular & nervous (interventions)

A patient with a recent right-hemisphere stroke sits leaning strongly to the left (the weak side). When the PTA tries to bring him upright, he pushes harder to the left with his right arm and leg. Which approach is most appropriate?

  • A. Use a visual reference for upright, such as a doorframe, and have him reach toward his stronger side to shift his own weight
  • B. Push him firmly back to midline and hold him there
  • C. Have him push down harder through his right hand on the mat
  • D. Avoid sitting activities until the pushing resolves on its own
Show answer and explanation

Answer: A

Why: This is pusher behavior (contraversive pushing). The patient's sense of upright is tilted, so he actively pushes toward the weak side and resists correction. Treatment that works with the problem uses visual feedback of vertical and has the patient move his own center of mass toward the stronger side.

  • B is wrong: forcing him upright triggers more pushing. He will resist.
  • C is wrong: pushing through the stronger arm is the behavior that tips him over.
  • D is wrong: avoiding upright practice delays recovery of sitting balance.

Review next: Pusher behavior versus ordinary loss of balance after stroke.
Source: Karnath HO, Broetz D. Understanding and treating 'pusher syndrome.' Phys Ther. 2003 (Abstract; treatment: visual control of upright)

Question 4 · Cardiovascular & pulmonary (interventions)

After abdominal surgery, a patient is using an incentive spirometer as part of the plan of care. Which instruction should the PTA give?

  • A. Seal your lips around the mouthpiece, breathe in slowly and as deeply as you can, then hold the breath for a few seconds
  • B. Blow out into the mouthpiece as hard as you can
  • C. Take several quick, short breaths in a row
  • D. Use it once at bedtime only
Show answer and explanation

Answer: A

Why: An incentive spirometer guides slow, deep, sustained inhalation to encourage lung expansion. The patient inhales slowly to raise the indicator, holds the breath for 3 to 5 seconds, and then breathes out slowly.

  • B is wrong: the device is driven by inhaling, not exhaling.
  • C is wrong: fast, shallow breaths don't open collapsed lung areas.
  • D is wrong: it's used many times a day, not once.

Review next: Airway clearance and lung expansion techniques after surgery.
Source: MedlinePlus (NLM), Using an incentive spirometer (How to use your incentive spirometer)

Question 5 · Musculoskeletal (data collection)

A patient reports numbness and tingling that wake her at night. Which distribution of symptoms is most consistent with carpal tunnel syndrome?

  • A. Little finger and the little-finger side of the ring finger
  • B. Back of the hand near the base of the thumb only
  • C. Thumb, index finger, middle finger, and the thumb side of the ring finger
  • D. The whole hand, including the little finger, in a glove pattern
Show answer and explanation

Answer: C

Why: Carpal tunnel syndrome compresses the median nerve at the wrist. Its sensory territory in the hand is the thumb, index, middle, and radial half of the ring finger, and symptoms are often worse at night.

  • A is wrong: that's the ulnar nerve distribution.
  • B is wrong: that's the superficial radial nerve area.
  • D is wrong: A glove pattern suggests a polyneuropathy, not a single nerve at the wrist.

Review next: Median, ulnar, and radial nerve territories in the hand.
Source: AAOS OrthoInfo, Carpal Tunnel Syndrome (Anatomy; Symptoms)

Question 6 · Equipment, devices & technologies

A PTA is fitting axillary crutches for a patient who is standing upright in his shoes. Which fit is correct?

  • A. The crutch tops press firmly into the armpits for stability
  • B. The handgrips are at shoulder height
  • C. The tops of the crutches sit about 1–2 inches below the armpits, and the handgrips are at hip level so the elbows are slightly bent
  • D. The elbows are fully straight when holding the handgrips
Show answer and explanation

Answer: C

Why: The crutch top stays a short distance below the armpit so weight goes through the hands, not the armpit, which protects the nerves there. With the handgrips level with the hips, the elbows stay slightly bent so the patient can push down to lift the body.

  • A is wrong: leaning on the crutch tops can compress the nerves and vessels in the armpit.
  • B is wrong: handgrips at shoulder height are too high; the recommended position is at the hip line.
  • D is wrong: fully straight elbows do not provide the slight bend recommended for correct crutch fitting.

Review next: Fitting canes, walkers, and crutches.
Source: AAOS OrthoInfo, How To Use Crutches, Canes, and Walkers (Crutches: proper fit)

Question 7 · Neuromuscular & nervous (data collection)

A PTA is collecting strength data for a patient with a spinal cord injury using the key muscles of the International Standards (ISNCSCI). Which muscle group is the key muscle for the C7 level?

  • A. Elbow flexors
  • B. Elbow extensors
  • C. Wrist extensors
  • D. Finger flexors
Show answer and explanation

Answer: B

Why: The ISNCSCI upper-limb key muscles are: C5 elbow flexors, C6 wrist extensors, C7 elbow extensors, C8 finger flexors (middle finger, distal joint), and T1 small finger abductors.

  • A is wrong: elbow flexors are the key muscle for C5.
  • C is wrong: wrist extensors are the key muscle for C6.
  • D is wrong: finger flexors are the key muscle for C8.

Review next: Key muscles and functional expectations by spinal cord level.
Source: ASIA/ISCOS, International Standards for Neurological Classification of SCI (ISNCSCI) worksheet, 2026 edition (Key muscles, upper limb)

Question 8 · Integumentary (data collection)

A patient has a burn on the forearm. The area is red, moist, and blistered, blanches when pressed, and is very painful to touch. Which burn depth does this describe?

  • A. Superficial (first-degree)
  • B. Deep partial-thickness
  • C. Full-thickness
  • D. Superficial partial-thickness
Show answer and explanation

Answer: D

Why: Superficial partial-thickness burns involve the epidermis and upper dermis. They blister, look red and moist, blanch with pressure, and are very painful because the nerve endings are intact.

  • A is wrong: superficial burns are red and painful but don't blister.
  • B is wrong: deeper burns look paler or mottled, blanch poorly, and are less painful.
  • C is wrong: full-thickness burns look white, brown, or leathery and are usually painless because the nerve endings are destroyed.

Review next: Burn depth and what each depth means for healing and scarring.
Source: Merck Manual Professional Version, Burns (Classification of burn depth)

Question 9 · Therapeutic modalities

The plan of care includes TENS for a patient's chronic neck pain. Where should the PTA avoid placing the electrodes?

  • A. Over the upper trapezius
  • B. Over the front of the neck, near the carotid sinus
  • C. Along the cervical paraspinal muscles at the back of the neck
  • D. Over the medial border of the scapula
Show answer and explanation

Answer: B

Why: Electrical stimulation over the anterior neck can stimulate the carotid sinus and the structures of the throat. Evidence-based contraindication guidance lists the anterior neck and carotid sinus as a site to avoid for TENS and other electrical stimulation.

  • A is wrong: the upper trapezius is a common, appropriate site for neck pain.
  • C is wrong: the posterior neck muscles are a typical TENS site.
  • D is wrong: this area carries no special contraindication.

Review next: Contraindications and precautions for electrical stimulation.
Source: Houghton PE, Nussbaum EL, Hoens AM. Electrophysical Agents: Contraindications and Precautions. Physiother Can. 2010 (Section 4-15: Anterior Neck, Carotid Sinus; Table 1)

Question 10 · Metabolic & endocrine (conditions)

A patient with type 1 diabetes arrives for an exercise session. His glucometer reads 310 mg/dL, his urine test shows moderate ketones, and he feels nauseated. What should the PTA do?

  • A. Hold the exercise session and promptly seek urgent medical assessment for possible ketoacidosis
  • B. Proceed with vigorous exercise to bring the glucose down
  • C. Proceed but shorten the session
  • D. Give him a sugary drink before starting
Show answer and explanation

Answer: A

Why: High glucose with ketones means insulin is insufficient. Exercise in that state can push glucose and ketones higher and raise the risk of ketoacidosis. Nausea adds to the concern. He needs urgent medical assessment for possible ketoacidosis; exercise waits until he has been medically assessed and cleared to resume.

  • B is wrong: with ketones present, exercise can make things worse, not better.
  • C is wrong: any exercise is inappropriate until the ketones are managed.
  • D is wrong: extra sugar raises glucose that's already too high.

Review next: Hypoglycemia versus hyperglycemia: when each one stops a session.
Source: Colberg SR et al. Physical Activity/Exercise and Diabetes: A Position Statement of the ADA. Diabetes Care. 2016 (Minimizing exercise-related adverse events: hyperglycemia; Table 1); CDC, Diabetic Ketoacidosis (Signs and symptoms; Test for ketones)

Question 11 · Professional responsibilities

In a crowded hospital elevator, a coworker asks a PTA about a patient's diagnosis and test results. What should the PTA do?

  • A. Answer quietly, since both of them work at the hospital
  • B. Say they'll talk in a private area, and then share only what the coworker needs for the patient's care
  • C. Refuse to ever discuss the patient with the coworker
  • D. Answer, then document the conversation in the chart
Show answer and explanation

Answer: B

Why: HIPAA expects reasonable safeguards against avoidable disclosures, such as discussing patients in elevators or other public areas, and limits staff access to what their role requires. Moving the conversation and sharing only what the coworker needs for the patient's care meets both. The minimum-necessary rule does not apply to provider-to-provider disclosures for treatment, but privacy safeguards and appropriate role-based access still apply.

  • A is wrong: others in the elevator can still hear, and there's no reason to discuss it there.
  • C is wrong: sharing information needed for treatment is allowed. It just has to happen appropriately.
  • D is wrong: documenting it doesn't fix an avoidable disclosure.

Review next: HIPAA basics: minimum necessary and incidental disclosures.
Source: U.S. HHS, Incidental Uses and Disclosures (HIPAA Privacy Rule guidance) (Reasonable safeguards; minimum necessary)

Question 12 · Musculoskeletal (conditions)

A 70-year-old man reports leg aching and heaviness after walking a few minutes. It eases when he sits or leans forward on a shopping cart. The plan addresses lumbar spinal stenosis. Which aerobic exercise will he most likely tolerate best?

  • A. Stationary cycling
  • B. Walking downhill on a treadmill
  • C. Prone press-ups
  • D. Walking upright on a level track without any rest
Show answer and explanation

Answer: A

Why: Lumbar spinal stenosis symptoms worsen in extension, which narrows the canal, and ease in flexion, which opens it. That is why leaning on a cart helps. Cycling keeps the spine slightly flexed, so it's usually the best-tolerated aerobic option.

  • B is wrong: downhill walking increases lumbar extension and usually worsens symptoms.
  • C is wrong: press-ups are an extension exercise.
  • D is wrong: upright walking reproduces his symptoms; the problem is the extended posture.

Review next: Flexion- versus extension-biased conditions of the lumbar spine.
Source: AAOS OrthoInfo, Lumbar Spinal Stenosis (Symptoms; Nonsurgical treatment)

Case 1 (Questions 13–15)

Setting: Acute care hospital
Patient: 71-year-old man
Current condition: Day 3 of admission for a COPD exacerbation
Medical history: COPD, hypertension
Other information: Physician order: oxygen 2 L/min by nasal cannula; target SpO2 88–92%. Nursing manages oxygen titration.
Physical therapy plan of care: Progressive ambulation with vital-sign and SpO2 monitoring, breathing strategies, activity education

Question 13 · Cardiovascular & pulmonary (data collection)

Partway down the hallway, his SpO2 drops from 90% to 85% and he is more short of breath. What should the PTA do?

  • A. Stop and have him sit and rest, monitor his SpO2 and breathing as he recovers, and report the drop to nursing and the supervising PT
  • B. Turn his oxygen up to 6 L/min and keep walking
  • C. Keep walking, since SpO2 often drops during exercise
  • D. Have him take several quick, deep breaths and continue
Show answer and explanation

Answer: A

Why: His SpO2 has fallen below the ordered target range with symptoms. The PTA stops the activity, lets him recover in a supported position, monitors, and reports. Oxygen is prescribed, and titration belongs to nursing under the physician order, so the PTA doesn't change the flow on their own.

  • B is wrong: oxygen is a prescribed drug. In COPD, giving more than needed can also cause carbon dioxide retention.
  • C is wrong: A drop below the ordered range with worse symptoms is a reason to stop.
  • D is wrong: fast breathing worsens air trapping in COPD.

Review next: Oxygen targets in COPD and the PTA's role with supplemental oxygen.
Source: O'Driscoll BR et al. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017 (Recommendations A3 (COPD target 88–92%) and T4 (who adjusts oxygen))

Question 14 · Cardiovascular & pulmonary (interventions)

While seated to recover, he is still breathing hard. Which position should the PTA suggest?

  • A. Lying flat on his back
  • B. Sitting and leaning forward, with his forearms resting on his thighs or on a table
  • C. Sitting upright with his arms raised overhead
  • D. Standing and bending forward to touch his toes
Show answer and explanation

Answer: B

Why: Leaning forward with the arms supported lets the chest expand and lets the accessory breathing muscles help, which reduces the work of breathing. People with COPD often find it the most comfortable way to recover their breath.

  • A is wrong: lying flat usually makes breathing harder for someone with COPD.
  • C is wrong: holding the arms up adds work for muscles that are already helping him breathe.
  • D is wrong: toe touching compresses the abdomen and is tiring.

Review next: Positions that ease shortness of breath.
Source: Cleveland Clinic, Tripod Position (How the tripod position helps)

Question 15 · Cardiovascular & pulmonary (interventions)

Before discharge, the PTA teaches him how to breathe when getting up from a chair at home. Which instruction fits?

  • A. Hold your breath while you push up to stand
  • B. Breathe in quickly as you stand up
  • C. Breathe in before you start, then breathe out slowly through pursed lips while you stand up
  • D. Stand up as fast as you can so it's over sooner
Show answer and explanation

Answer: C

Why: Breathing out during the hardest part of an activity avoids breath-holding and the Valsalva effect, and pursed-lip exhalation slows breathing and limits air trapping.

  • A is wrong: breath-holding strains and raises blood pressure.
  • B is wrong: inhaling during the effort is the opposite of the advice.
  • D is wrong: rushing increases breathlessness.

Review next: Energy conservation and paced breathing during daily activities.
Source: Cleveland Clinic, Pursed-Lip Breathing (When to use pursed-lip breathing)

Section 2: Questions 16–30

Question 16 · Musculoskeletal (conditions)

During range-of-motion data collection for a patient with adhesive capsulitis (frozen shoulder), which motion is usually the most limited?

  • A. Internal rotation
  • B. Horizontal adduction
  • C. Shoulder extension
  • D. External rotation
Show answer and explanation

Answer: D

Why: Adhesive capsulitis limits shoulder motion in several directions, but external rotation is characteristically lost the most. Both active and passive motion are limited.

  • A is wrong: internal rotation is often limited too, but usually less than external rotation.
  • B is wrong: horizontal adduction isn't the hallmark limitation.
  • C is wrong: extension is not the defining loss in a frozen shoulder.

Review next: Capsular patterns of the shoulder, hip, and knee.
Source: Ramirez J. Adhesive Capsulitis: Diagnosis and Management. Am Fam Physician. 2019 (Clinical presentation)

Question 17 · Neuromuscular & nervous (interventions)

A PTA is reviewing ways to maintain shoulder range of motion for a patient with hemiplegia after a stroke. Which should be avoided?

  • A. Supported positioning of the arm when sitting
  • B. Gentle range of motion that avoids pain
  • C. Overhead pulley exercises
  • D. Teaching staff not to pull on the arm during transfers
Show answer and explanation

Answer: C

Why: Stroke rehabilitation guidelines recommend against overhead pulleys for the hemiplegic shoulder because uncontrolled, forceful elevation is linked to shoulder pain. Gentle range of motion, positioning, and support are preferred.

  • A is wrong: supporting the arm is recommended to protect the shoulder.
  • B is wrong: gentle, pain-free range of motion is appropriate.
  • D is wrong: avoiding traction on the weak arm protects it.

Review next: Hemiplegic shoulder pain and subluxation.
Source: Canadian Stroke Best Practice Recommendations, Rehabilitation, Recovery and Community Participation, Part Two. 7th edition, 2025 (Sections 2.1 and 2.3: hemiplegic shoulder pain, pp. 24–25)

Question 18 · Cardiovascular & pulmonary (interventions)

A patient with peripheral artery disease has calf pain when walking (intermittent claudication). The plan includes a walking program. Which instruction matches current guidance?

  • A. Stop walking for the day at the first sign of leg pain
  • B. Walk until the leg pain reaches a moderate to strong level, rest until it goes away, then walk again, repeating for the session
  • C. Avoid walking and use only seated leg exercises
  • D. Walk through severe pain without resting
Show answer and explanation

Answer: B

Why: Structured exercise for claudication uses repeated bouts of walking to moderate-to-strong claudication pain, each followed by rest. Repeated walking-and-rest bouts can improve walking distance over weeks.

  • A is wrong: stopping the entire session at the first symptom omits the repeated walking-and-rest bouts in this program.
  • C is wrong: walking is the core of the program.
  • D is wrong: the program uses rest periods between bouts.

Review next: Claudication versus neurogenic (spinal stenosis) leg pain.
Source: Gornik HL et al. 2024 ACC/AHA Guideline for the Management of Lower Extremity Peripheral Artery Disease. Circulation. 2024 (Section 6: exercise therapy; Table 14)

Question 19 · Musculoskeletal (interventions)

A runner has mid-portion Achilles tendinopathy. Which intervention in the plan of care has the strongest research support?

  • A. Complete rest until the tendon is pain-free
  • B. Progressive calf loading, such as heel raises with slow lowering
  • C. A walking boot for 6 weeks
  • D. Ice and therapeutic ultrasound as the main treatment
Show answer and explanation

Answer: B

Why: Clinical practice guidelines for Achilles tendinopathy give their strongest recommendation to resistance exercise that loads the calf and tendon, typically eccentric or heavy, slow heel raises progressed over weeks.

  • A is wrong: tendons adapt to load. Rest alone doesn't restore their capacity.
  • C is wrong: immobilization isn't the main treatment for tendinopathy.
  • D is wrong: these have weaker support than progressive loading.

Review next: Tendinopathy versus acute tendon injury.
Source: Chimenti RL et al. Midportion Achilles Tendinopathy Revision 2024. JOSPT. 2024 (Interventions: exercise (tendon loading))

Question 20 · Neuromuscular & nervous (conditions)

A patient with a traumatic brain injury is at Rancho Los Amigos Level IV (confused, agitated). Which approach fits best?

  • A. Treat him in the busy main gym to improve his tolerance of distractions
  • B. Teach new multi-step tasks to challenge his memory
  • C. Argue with him until he agrees he's in the hospital
  • D. Treat him in a quiet room with a consistent routine, short and simple tasks, and calm redirection
Show answer and explanation

Answer: D

Why: At Level IV the patient is confused and easily overstimulated, and his behavior can escalate. A calm, structured, low-stimulation setting with brief familiar tasks reduces agitation and keeps everyone safe.

  • A is wrong: A busy setting adds stimulation that can increase agitation.
  • B is wrong: he can't yet process complex new learning.
  • C is wrong: arguing escalates agitation. Calm redirection works better.

Review next: Rancho Los Amigos levels and the approach at each one.
Source: Sunnybrook / Rancho Los Amigos, Levels of Cognitive Functioning: A Guide for Family and Friends (Level IV: Confused–Agitated)

Question 21 · Integumentary (conditions)

A patient has a shallow wound near the inside of the ankle (medial malleolus). The edges are irregular, there's moderate drainage, the lower leg is swollen, and the skin around it is brownish. Which type of ulcer is most likely?

  • A. Arterial ulcer
  • B. Neuropathic (diabetic) ulcer
  • C. Pressure injury
  • D. Venous ulcer
Show answer and explanation

Answer: D

Why: Venous ulcers typically sit in the gaiter area, often over the medial malleolus. They are shallow, irregular, and draining, with leg swelling and brownish (hemosiderin) skin staining. Compression is a core treatment when arterial perfusion has been assessed and the prescribed compression level is appropriate.

  • A is wrong: arterial ulcers usually sit on the toes or foot, look deep and dry with little drainage, and come with weak pulses and a cool foot.
  • B is wrong: neuropathic ulcers form on pressure points of the sole, often with surrounding callus.
  • C is wrong: pressure injuries form over bony areas under sustained pressure, such as the sacrum or heels.

Review next: Venous versus arterial versus neuropathic ulcers, and how arterial perfusion determines whether and how compression is prescribed.
Source: WOCN Society, Lower-Extremity Wounds Due to Venous Disease, Arterial Disease, or Diabetes Mellitus and/or Neuropathic Disease: Clinical Resource Guide (2021) (printed p. 6: location, wound characteristics and surrounding skin); WOCN compression algorithm (active-ulcer pathway: Refer to ABI)

Question 22 · Musculoskeletal (interventions)

The order for a patient after an ankle fracture reads toe-touch weight bearing (TTWB) on the right. How should the PTA teach this?

  • A. Put as much weight on the right foot as is comfortable
  • B. The right foot may touch the floor for balance, but it should not support body weight
  • C. Keep the right foot off the floor at all times
  • D. Put about half of body weight through the right foot
Show answer and explanation

Answer: B

Why: Toe-touch weight bearing lets the foot rest on the floor for balance. The body's weight is taken through the arms on the device and the other leg.

  • A is wrong: that describes weight bearing as tolerated.
  • C is wrong: that describes non-weight bearing.
  • D is wrong: that describes partial weight bearing, where only a set portion of body weight is allowed.

Review next: Weight-bearing statuses from non-weight bearing to full.
Source: Hull University Teaching Hospitals NHS Trust, Use of Elbow Crutches (updated 30 June 2025; Toe touch weight bearing)

Question 23 · Lymphatic (interventions)

Manual lymphatic drainage (MLD) for a patient's right-arm lymphedema is part of the plan of care. How does an MLD session usually begin?

  • A. By starting at the fingers and stroking firmly up the arm
  • B. By applying deep, firm massage to the swollen arm
  • C. By wrapping the arm before any manual work
  • D. By clearing the trunk and neck regions closest to the center of the body before working on the swollen arm
Show answer and explanation

Answer: D

Why: MLD starts centrally, clearing the trunk and nearby lymph node regions first and then working on the limb, guiding fluid toward the cleared regions. The International Society of Lymphology describes it as a specific light manual massage.

  • A is wrong: starting at the hand pushes fluid toward areas that haven't been cleared.
  • B is wrong: MLD uses light, skin-stretching pressure, not deep massage.
  • C is wrong: compression bandaging follows MLD in decongestive therapy.

Review next: The phases and components of complete decongestive therapy.
Source: Nonoperative Treatment of Lymphedema. Semin Plast Surg. 2018 (Manual Lymph Drainage: proximal-to-distal sequence and timing before bandaging); International Society of Lymphology, 2023 Consensus Document (printed p. 140: Complex Decongestive Therapy)

Question 24 · Equipment, devices & technologies

A patient with a transtibial amputation says her prosthetic socket feels loose by the end of the day, and her residual limb is moving inside it. Her skin is intact with no redness or pain, and her prosthetist has prescribed sock-ply adjustments for this socket. What is the usual first step within the plan of care?

  • A. Add prosthetic sock ply to improve the fit, and report the change
  • B. Remove all socks so the limb sits deeper
  • C. Tighten the suspension strap as hard as possible
  • D. Stop wearing the prosthesis until the next clinic visit
Show answer and explanation

Answer: A

Why: A residual limb's volume changes during the day and shrinks over the first months. Adding sock ply can restore contact with the socket, and persistent or large changes are reported so the prosthetist can adjust or replace the socket.

  • B is wrong: removing socks makes a loose socket looser.
  • C is wrong: overtightening doesn't fix the volume mismatch and can harm the skin.
  • D is wrong: In this prescribed sock-compatible system, adjust the sock ply and reassess fit. Stop use and contact the prosthetist if pain, skin changes, or looseness persist.

Review next: Residual limb care, shaping, and socket fit.
Source: Amputee Coalition, Beginning Your New Journey: Below Knee Amputation (Residual limb changes (p. 10); liners and socks (p. 17))

Question 25 · Safety & protection

An adult patient in the gym suddenly collapses. The PTA finds him unresponsive and only gasping. During a simultaneous breathing and pulse check lasting no more than 10 seconds, no pulse is definitely felt. What should the PTA do first?

  • A. Wait to see whether his breathing improves over the next few minutes
  • B. Check his pulse for a full minute before doing anything else
  • C. Shout for help, activate the emergency response, send someone for the AED, and begin chest compressions
  • D. Sit him up and give him water
Show answer and explanation

Answer: C

Why: Gasping is not normal breathing. An unresponsive adult who isn't breathing normally and has no pulse definitely felt within 10 seconds is treated as being in cardiac arrest: activate the emergency response, get the AED, and start high-quality compressions without delay.

  • A is wrong: gasping is a sign of cardiac arrest. Waiting loses critical minutes.
  • B is wrong: the pulse check takes no more than 10 seconds. A long check delays CPR.
  • D is wrong: an unresponsive person must not be given anything by mouth.

Review next: Basic life support steps for adults.
Source: American Heart Association, 2025 Adult Basic Life Support Algorithm for Health Care Professionals (Boxes 2, 3, and 6)

Question 26 · Musculoskeletal (interventions)

A patient has plantar heel pain that is worst with the first steps out of bed in the morning. Which home exercise from the plan of care best targets this?

  • A. Stretching the plantar fascia by pulling the toes back toward the shin before getting out of bed
  • B. Walking barefoot on hard floors to toughen the heel
  • C. Avoiding all calf stretching
  • D. Toe curls with the ankle kept pointed as far down as possible
Show answer and explanation

Answer: A

Why: The AAOS guide recommends plantar fascia-specific and calf stretching for pain relief. Doing the stretch before the first steps of the day targets the moment pain is usually worst.

  • B is wrong: walking barefoot on hard floors doesn't stretch the fascia or calf and tends to load the painful heel.
  • C is wrong: calf stretching is part of the recommended care.
  • D is wrong: keeping the ankle plantarflexed doesn't stretch the fascia or calf.

Review next: Heel pain interventions with the strongest support.
Source: AAOS OrthoInfo, Plantar Fasciitis and Bone Spurs (Nonsurgical Treatment: Stretching; Plantar fascia stretch)

Question 27 · Cardiovascular & pulmonary (interventions)

A patient with cystic fibrosis tires quickly from repeated, forceful coughing during airway clearance. Which technique in the plan should the PTA teach?

  • A. Huff coughing: take a medium breath, then breathe out forcefully through an open mouth, as if fogging a mirror
  • B. Hold the breath for 30 seconds before each cough
  • C. Cough as hard as possible ten times in a row
  • D. Breathe in and out quickly through the nose
Show answer and explanation

Answer: A

Why: A huff is a forced but steady exhalation with the mouth open. It moves mucus from smaller toward larger airways, and the Cystic Fibrosis Foundation notes it can work better and be less tiring than a full cough.

  • B is wrong: long breath-holds aren't part of the technique and are tiring.
  • C is wrong: repeated hard coughs are what's exhausting the patient.
  • D is wrong: rapid nasal breathing doesn't clear mucus.

Review next: Airway clearance techniques: huffing, active cycle of breathing, and postural drainage.
Source: Cystic Fibrosis Foundation, Coughing and Huffing (Huffing (huff coughing))

Case 2 (Questions 28–30)

Setting: Outpatient clinic
Patient: 67-year-old woman
Current condition: 3 weeks after a right total knee arthroplasty (TKA)
Physical therapy examination: Knee range 10°–95°; quadriceps lag on straight-leg raise
Physical therapy plan of care: Knee ROM, quadriceps strengthening including neuromuscular electrical stimulation (NMES), gait training

Question 28 · Musculoskeletal (interventions)

Along with her quad sets and straight-leg raises, which intervention in her plan has the strongest support for restoring quadriceps strength in the early months after TKA?

  • A. TENS for pain relief
  • B. Moist heat to the knee before exercise
  • C. Neuromuscular electrical stimulation (NMES) to the quadriceps
  • D. Therapeutic ultrasound over the incision
Show answer and explanation

Answer: C

Why: The TKA clinical practice guideline recommends NMES to augment quadriceps strengthening after surgery. It helps overcome the quadriceps activation failure that follows TKA.

  • A is wrong: TENS can help pain but doesn't build strength.
  • B is wrong: heat doesn't restore quadriceps strength.
  • D is wrong: ultrasound has no role in restoring strength here.

Review next: Quadriceps activation failure after knee surgery.
Source: Bove AM et al. Clinical Practice Guideline for Physical Therapist Management of Total Knee Arthroplasty: Revision 2026. Phys Ther. 2026 (Neuromuscular electrical stimulation recommendation and rationale)

Question 29 · Musculoskeletal (interventions)

She tells the PTA she rests every evening with a pillow under her knee because it's more comfortable. Her knee lacks 10° of extension. What should the PTA advise?

  • A. Keep the pillow, since comfort helps her recovery
  • B. Use two pillows to raise the leg higher
  • C. Wear a knee brace locked in 30° of flexion at night
  • D. Don't rest with a pillow under the knee; prop a towel roll under the ankle instead so the knee can straighten
Show answer and explanation

Answer: D

Why: Resting with the knee bent over a pillow encourages a flexion contracture, and full extension is needed for a normal gait. Supporting the ankle just above the heel lets gravity help straighten the knee.

  • A is wrong: comfort here comes at the cost of losing extension.
  • B is wrong: more pillows under the knee bend it further.
  • C is wrong: holding the knee bent makes the contracture worse.

Review next: Range-of-motion goals and positioning after TKA.
Source: Nova Scotia Health, After Knee Replacement Surgery: 1 to 12 Weeks (2024) (Sleep, printed p. 2 / PDF page 3); AAOS OrthoInfo, Total Knee Replacement Exercise Guide (Knee Straightening Exercises)

Question 30 · Cardiovascular & pulmonary (conditions)

At today's visit her right calf is newly swollen, warm, and tender, and the left calf is normal. What should the PTA do?

  • A. Massage the calf to reduce the swelling
  • B. Hold today's exercise and report the findings promptly so she can be medically evaluated
  • C. Proceed with exercise, since movement prevents clots
  • D. Apply a hot pack to the calf and reassess next week
Show answer and explanation

Answer: B

Why: One-sided calf swelling, warmth, and tenderness after joint replacement raise concern for deep vein thrombosis. The risk is a clot traveling to the lungs, so she needs prompt medical evaluation before exercise continues.

  • A is wrong: massaging a possible clot is unsafe.
  • C is wrong: movement helps prevent clots, but a suspected clot needs evaluation first.
  • D is wrong: heat and delay both miss a possible emergency.

Review next: Signs of DVT and pulmonary embolism.
Source: CDC, About Venous Thromboembolism (Blood Clots) (Signs and symptoms: DVT; Testing and diagnosis)

Section 3: Questions 31–45

Question 31 · Musculoskeletal (conditions)

A patient who had an anterior shoulder dislocation last month is returning to activity under a PT plan that includes early anterior-instability precautions. Which arm position should he avoid during exercise?

  • A. Arm out to the side with the hand rotated back, as in a throwing motion
  • B. Arm at the side with the elbow bent to 90°
  • C. Arm across the body at chest height
  • D. Arm resting in internal rotation in front of the body
Show answer and explanation

Answer: A

Why: Abduction combined with external rotation is the position that places the humeral head against the stretched anterior capsule, and it is the usual mechanism for anterior dislocation.

  • B is wrong: that arm-at-side position is less provocative for anterior instability than combined abduction and external rotation.
  • C is wrong: horizontal adduction is more relevant to posterior instability.
  • D is wrong: that resting position avoids the combined abduction and external rotation of the provocative position.

Review next: Anterior versus posterior instability and the positions to avoid for each.
Source: University Hospitals Plymouth NHS Trust, Anterior Shoulder Dislocation (December 2023 v2; Key points and Phase 2 exercises)

Question 32 · Neuromuscular & nervous (conditions)

A patient with Guillain-Barré syndrome is in the recovery phase and his strength is slowly returning. Which principle should guide his exercise?

  • A. Push to maximum effort every session to speed recovery
  • B. Avoid all exercise until strength fully returns
  • C. Exercise the weakest muscles to fatigue first
  • D. Keep exercise low to moderate in intensity with frequent rest, and stop before he becomes overly fatigued
Show answer and explanation

Answer: D

Why: Recovering nerves are vulnerable to overwork. Exercise is kept low to moderate and short, and the PTA watches for overwork signs such as weakness that is worse in the days after a session, fatigue lasting more than 12–24 hours, or new tingling.

  • A is wrong: overwork can worsen weakness in recovering nerves.
  • B is wrong: graded activity helps recovery and prevents deconditioning.
  • C is wrong: exhausting the weakest muscles is the opposite of what's needed.

Review next: Exercise dosing in neuromuscular disease.
Source: UW Medical Center Rehabilitation, Guillain-Barré Syndrome and Exercise (Exercise intensity; signs of overwork)

Question 33 · Neuromuscular & nervous (data collection)

As part of foot screening for a patient with diabetes, which test checks for loss of protective sensation?

  • A. Deep tendon reflex at the knee
  • B. The 10-g Semmes-Weinstein monofilament
  • C. Capillary refill time
  • D. Two-point discrimination at the fingertips
Show answer and explanation

Answer: B

Why: Diabetes foot care standards use the 10-g monofilament as part of the annual foot exam to identify loss of protective sensation, which raises the risk of ulcers.

  • A is wrong: reflexes don't test protective sensation.
  • C is wrong: capillary refill checks circulation, not sensation.
  • D is wrong: fingertip testing isn't the standard foot screen.

Review next: Diabetic foot screening and footwear education.
Source: Indian Health Service, Diabetes Standards of Care: Foot Care (Clinical Practice Recommendations: annual comprehensive examination and 10-g monofilament plus another neurologic assessment)

Question 34 · Neuromuscular & nervous (interventions)

A patient with unilateral vestibular hypofunction is doing gaze stabilization exercises in the plan of care. Which describes the exercise?

  • A. Close the eyes and turn the head as quickly as possible
  • B. Keep the head still and follow a moving target with the eyes
  • C. Keep the eyes on a target, such as a letter on a card, while turning the head side to side and keeping the letter in focus
  • D. Lie still in a dark room until the dizziness passes
Show answer and explanation

Answer: C

Why: Gaze stabilization (VOR x1) exercises have the patient move the head while keeping a target in focus. Repeating this drives adaptation of the vestibulo-ocular reflex, and it's a core part of the vestibular rehabilitation the guideline recommends.

  • A is wrong: the exercise needs a visual target to work.
  • B is wrong: that's a smooth pursuit task, not gaze stabilization.
  • D is wrong: avoiding movement slows compensation.

Review next: Gaze stabilization, habituation, and balance exercises.
Source: Hall CD et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline. J Neurol Phys Ther. 2022 (Action statements 4 and 6b; gaze-stabilization adaptation description, PDF p. 34)

Question 35 · Metabolic & endocrine (conditions)

A patient with type 1 diabetes injects rapid-acting insulin subcutaneously into his thigh just before stationary cycling and often becomes shaky partway through. During today’s episode, his blood glucose is 60 mg/dL (3.3 mmol/L). What best explains the problem?

  • A. Cycling slows insulin absorption from the thigh
  • B. The shakiness means his glucose is too high
  • C. The injection site has no effect on absorption
  • D. Exercising the injected thigh can speed up insulin absorption, increasing the risk of low blood glucose
Show answer and explanation

Answer: D

Why: Exercise increases blood flow to working muscle, so insulin injected into an exercising limb can be absorbed faster, adding to exercise's own glucose-lowering effect. Patient guidance commonly suggests a non-exercising site, such as the abdomen, before exercise. During an episode of low glucose, stop exercise and follow the hypoglycemia protocol; review recurrent episodes with the diabetes care team before changing the insulin plan.

  • A is wrong: exercise can speed absorption from an exercising limb; slower absorption would not explain the measured low glucose.
  • B is wrong: the measured glucose is low, and shakiness is a common symptom of hypoglycemia.
  • C is wrong: site and exercise both affect absorption.

Review next: Insulin timing, sites, and exercise.
Source: Alberta Health Services, Insulin Injection Guidelines (p. 1: exercise and injection site); CDC, Treatment of Low Blood Sugar (low glucose and prompt treatment; Prevention)

Question 36 · Gastrointestinal (conditions)

A patient is being seen for right shoulder pain. Today she mentions the pain flares after fatty meals and comes with nausea, and moving the shoulder doesn't change it. What should the PTA do?

  • A. Increase shoulder stretching to address the stiffness
  • B. Tell her to take an antacid and continue treatment
  • C. Report these findings to the supervising PT, since the pain may be referred from an internal organ
  • D. Apply heat to the shoulder and document the session as usual
Show answer and explanation

Answer: C

Why: Pain that isn't changed by shoulder movement, with a link to meals and nausea, suggests a visceral source. Gallbladder disease can refer pain to the right shoulder or shoulder blade. The PT needs to know so the patient can be re-examined and referred if needed.

  • A is wrong: the pain isn't behaving like a shoulder problem.
  • B is wrong: the PTA doesn't give medication advice or ignore a possible medical cause.
  • D is wrong: this misses a possible visceral cause.

Review next: Visceral pain referral patterns and when they matter.
Source: Healthdirect Australia, Gallstones (Symptoms); HSE, Gallstones: Symptoms (reviewed 4 December 2025; biliary colic and other symptoms)

Question 37 · System interactions

A patient receiving chemotherapy for breast cancer reports constant fatigue and asks whether she should stop exercising and rest as much as possible. Within the plan of care, what is the best response?

  • A. Agree that complete rest is best during chemotherapy
  • B. Explain that moderate exercise in her program can actually help reduce cancer-related fatigue
  • C. Increase to high-intensity intervals so she adapts faster
  • D. Stop therapy until chemotherapy ends
Show answer and explanation

Answer: B

Why: Exercise guidelines for cancer survivors report that moderate aerobic and resistance exercise reduces cancer-related fatigue. Rest alone tends to worsen deconditioning. The program is still adjusted for her symptoms and any medical precautions.

  • A is wrong: complete rest can worsen fatigue and fitness.
  • C is wrong: jumping intensity isn't part of the plan and can backfire.
  • D is wrong: stopping loses the benefit of exercise for fatigue.

Review next: Exercise during and after cancer treatment.
Source: Campbell KL et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019 (Fatigue)

Question 38 · Therapeutic modalities

A patient with lower-leg swelling is scheduled for intermittent pneumatic compression (IPC). Which finding is a contraindication?

  • A. Swelling that has been stable for months
  • B. Mild lymphedema after cancer treatment
  • C. Healed incision from surgery a year ago
  • D. New calf pain and swelling that could be a deep vein thrombosis
Show answer and explanation

Answer: D

Why: New calf pain and swelling raise concern for an acute DVT. Withhold IPC and notify the supervising PT for prompt medical evaluation before treatment. Follow the prescribed device’s contraindications; compression can be used in some medically managed DVT circumstances.

  • A is wrong: stable chronic edema is a common reason to use IPC.
  • B is wrong: lymphedema can be an indication.
  • C is wrong: A healed scar isn't a contraindication.

Review next: Indications and contraindications for compression.
Source: Lympha Press Optimal Plus, Indications and Contraindications (manufacturer instructions: known or suspected DVT); CDC, About Venous Thromboembolism (DVT signs, evaluation and treatment)

Question 39 · Musculoskeletal (conditions)

A patient had surgery that included removing lymph nodes from the armpit. During a wall push-up, the inside border of her shoulder blade lifts off her back. Which nerve is most likely affected?

  • A. Long thoracic nerve
  • B. Axillary nerve
  • C. Suprascapular nerve
  • D. Musculocutaneous nerve
Show answer and explanation

Answer: A

Why: The long thoracic nerve supplies the serratus anterior, which holds the scapula against the chest wall. Injury causes medial scapular winging, made obvious by pushing against a wall. It runs along the chest wall and can be injured during armpit surgery.

  • B is wrong: the axillary nerve supplies the deltoid and teres minor.
  • C is wrong: the suprascapular nerve supplies supraspinatus and infraspinatus.
  • D is wrong: the musculocutaneous nerve supplies elbow flexors.

Review next: Nerve injuries around the shoulder and how each shows up.
Source: Belmonte R et al. Long thoracic nerve injury in breast cancer patients treated with axillary lymph node dissection. Support Care Cancer. 2015 (Abstract: clinical winged scapula assessment and EMG-confirmed long thoracic injury)

Question 40 · Neuromuscular & nervous (data collection)

The plan of care calls for measuring a patient's elbow flexor spasticity. Which tool should the PTA use?

  • A. Manual muscle testing
  • B. Berg Balance Scale
  • C. Modified Ashworth Scale
  • D. Goniometry
Show answer and explanation

Answer: C

Why: The Modified Ashworth Scale grades resistance to passive movement. It is commonly used in spasticity assessment, but the score can also reflect non-neural resistance such as soft-tissue or joint stiffness.

  • A is wrong: MMT measures voluntary strength, not resistance to passive stretch.
  • B is wrong: the Berg measures balance.
  • D is wrong: goniometry measures range of motion, not tone.

Review next: Tone versus strength versus range of motion.
Source: Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987 (Abstract: elbow-flexor ratings); Shirley Ryan AbilityLab, Ashworth Scale / Modified Ashworth Scale (updated 20 October 2021; Considerations)

Question 41 · Musculoskeletal (data collection)

A patient has numbness of the thumb, weak wrist extension, and a reduced brachioradialis reflex on the same side. Which cervical nerve root is most likely involved?

  • A. C5
  • B. C7
  • C. C8
  • D. C6
Show answer and explanation

Answer: D

Why: The C6 root supplies sensation to the thumb and radial forearm, wrist extension strength, and the brachioradialis reflex.

  • A is wrong: C5 affects the lateral upper arm, shoulder abduction, and the biceps reflex.
  • B is wrong: C7 affects the middle finger, elbow extension, and the triceps reflex.
  • C is wrong: C8 affects the little finger and finger flexion.

Review next: Dermatomes, myotomes, and reflexes of the upper limb.
Source: Childress MA, Becker BA. Nonoperative Management of Cervical Radiculopathy. Am Fam Physician. 2016 (Table 2: Neurologic patterns of cervical nerve roots)

Question 42 · Neuromuscular & nervous (data collection)

A patient with a cerebellar stroke overshoots and wobbles as her finger approaches a target. Which test is the PTA using to collect data on this problem?

  • A. Finger-to-nose test
  • B. Romberg test
  • C. Babinski reflex
  • D. Modified Ashworth Scale
Show answer and explanation

Answer: A

Why: The finger-to-nose test checks coordination. Overshooting (dysmetria) and a tremor that worsens near the target (intention tremor) are classic cerebellar findings.

  • B is wrong: the Romberg compares standing balance with the eyes open and closed. A positive result can reflect impaired proprioception or vestibular function; it does not test the finger-to-target coordination described here.
  • C is wrong: the Babinski tests for an upper motor neuron lesion.
  • D is wrong: that rates spasticity, not coordination.

Review next: Cerebellar versus sensory versus motor causes of poor movement control.
Source: StatPearls, Cerebellar Dysfunction (History and Physical); StatPearls, Romberg Test (Indications; Technique)

Case 3 (Questions 43–45)

Setting: Inpatient rehabilitation facility
Patient: 62-year-old man
Current condition: 10 days after a left middle cerebral artery stroke
Physical therapy examination: Right hemiparesis; inferior subluxation of the right shoulder; right foot drop; expressive (Broca) aphasia with comprehension largely intact
Physical therapy plan of care: Transfer and gait training, right upper-extremity positioning and protection, orthotic training

Question 43 · Neuromuscular & nervous (interventions)

He understands most of what's said but struggles to get words out. How should the PTA communicate during transfer training?

  • A. Speak louder than usual
  • B. Finish his sentences for him so he doesn't get frustrated
  • C. Use short, simple sentences and yes/no questions, and give him time to respond
  • D. Give long, detailed explanations before each step
Show answer and explanation

Answer: C

Why: With expressive aphasia, comprehension is relatively spared but producing speech is hard. Short sentences, yes/no questions, gestures, and patience make communication easier without talking down to him.

  • A is wrong: his hearing isn't the problem.
  • B is wrong: finishing his sentences takes away his chance to communicate.
  • D is wrong: long instructions are harder to follow during a task.

Review next: Expressive versus receptive aphasia.
Source: ASHA, Aphasia (Tips for communicating with a person who has aphasia)

Question 44 · Neuromuscular & nervous (interventions)

He sits in his wheelchair between sessions. How should his right arm be positioned?

  • A. Supported on a lap tray or arm trough so the shoulder isn't pulled down
  • B. Hanging at his side so gravity stretches the muscles
  • C. Held overhead in a sling attached to an IV pole
  • D. Tucked under his thigh to keep it out of the way
Show answer and explanation

Answer: A

Why: A subluxed, weak shoulder needs support. A lap tray or arm trough keeps gravity from pulling the humerus down and out of the socket.

  • B is wrong: A dangling arm adds traction to the subluxed joint.
  • C is wrong: an improvised overhead sling attached to an IV pole is not an appropriate supported resting position.
  • D is wrong: this traps the arm under body weight and puts it at risk of compression or injury.

Review next: Positioning to protect the hemiplegic shoulder.
Source: American Stroke Association, Shoulder Pain (Slings; lap trays and arm troughs)

Question 45 · Equipment, devices & technologies

During gait training, his right toes catch on the floor during swing. Which device in the plan best addresses this?

  • A. An ankle-foot orthosis (AFO)
  • B. A knee immobilizer
  • C. A heel lift in the right shoe
  • D. A quad cane used alone
Show answer and explanation

Answer: A

Why: An AFO holds the ankle and foot so the toes clear the floor during swing. It's the standard device for foot drop after stroke.

  • B is wrong: A knee immobilizer stops the knee from bending and makes clearance harder.
  • C is wrong: A heel lift raises the heel and can worsen toe catching.
  • D is wrong: A cane helps balance but doesn't lift the foot.

Review next: Orthotic options after stroke.
Source: American Stroke Association, Foot Drop (Treatment: ankle-foot orthoses)

Section 4: Questions 46–60

Question 46 · Neuromuscular & nervous (conditions)

During an outpatient session for knee pain, a 66-year-old patient suddenly develops slurred speech, a right facial droop, and weakness in the right arm. She is awake and breathing. What should the PTA do?

  • A. Have her rest for 5 minutes, then recheck her arm strength
  • B. Ask a family member to drive her to urgent care
  • C. Wait for the supervising PT to see her before calling for help
  • D. Stop the session, call 9-1-1 right away, and note the time the symptoms started
Show answer and explanation

Answer: D

Why: Sudden one-sided face or arm weakness and trouble speaking are warning signs of stroke. The CDC says to call 9-1-1 right away and to write down when the symptoms started, because the time of onset helps the hospital choose treatment. The supervising PT is notified, but that never delays the emergency call.

  • A is wrong: waiting loses time that matters for stroke treatment.
  • B is wrong: the CDC advises calling an ambulance instead of driving, so treatment can start on the way.
  • C is wrong: notify the PT, but don't hold the emergency call for anyone.

Review next: Stroke warning signs and the emergency response.
Source: CDC, Signs and Symptoms of Stroke (Signs of stroke; Call 9-1-1 right away (updated May 19, 2026))

Question 47 · Neuromuscular & nervous (conditions)

A patient with myasthenia gravis takes pyridostigmine. Her weakness gets worse as the day goes on and with repeated effort. How should her therapy be scheduled?

  • A. Late in the afternoon, when she's had time to warm up
  • B. Long continuous sessions without breaks to build endurance
  • C. Right before her next dose is due, to train in her weakest state
  • D. When her medication is working well, usually earlier in the day, with rest breaks between activities
Show answer and explanation

Answer: D

Why: Myasthenia gravis causes fatigable weakness: it worsens with repeated use and later in the day, and improves with rest. Myasthenia guidance advises exercising when medication is most effective, often in the morning, in short sessions with planned rest.

  • A is wrong: her weakness is usually worse later in the day.
  • B is wrong: continuous work worsens fatigable weakness.
  • C is wrong: training when the drug effect is lowest is the least effective timing.

Review next: Fatigable weakness and exercise in neuromuscular disease.
Source: Myasthenia Gravis Foundation of America, Myasthenia Gravis: A Manual for the Health Care Provider (Chapter 7: Physical Therapy Issues; exercise timing and energy conservation)

Question 48 · Musculoskeletal (interventions)

A patient with patellofemoral pain is starting a home program. Which approach has the strongest research support?

  • A. Strengthening exercises for both the hip and the knee
  • B. Complete rest from all activity for 6 weeks
  • C. Stretching only, with no strengthening
  • D. A long-term knee brace as the only treatment
Show answer and explanation

Answer: A

Why: The patellofemoral pain guideline recommends exercise therapy, with combined hip and knee strengthening favored over knee exercise alone.

  • B is wrong: rest alone doesn't address the strength deficits.
  • C is wrong: strengthening is the core of the recommended program.
  • D is wrong: bracing isn't recommended as a stand-alone treatment.

Review next: Patellofemoral pain: loading and exercise selection.
Source: Willy RW et al. Patellofemoral Pain: Clinical Practice Guidelines. JOSPT. 2019 (Interventions: exercise therapy)

Question 49 · Genitourinary (conditions)

A patient on hemodialysis has an arteriovenous (AV) fistula in her left forearm. Where should the PTA take her blood pressure?

  • A. On her left arm, above the fistula
  • B. On her right arm
  • C. On her left forearm, directly over the fistula
  • D. On whichever arm is closer
Show answer and explanation

Answer: B

Why: A blood pressure cuff on the fistula arm can compress and damage the access. Kidney care guidance says no blood pressure cuff on that arm, no blood draws there unless the dialysis team approves, and nothing tight over the access.

  • A is wrong: any cuff on the fistula arm risks the access.
  • C is wrong: this puts pressure right on the access.
  • D is wrong: the fistula arm must always be avoided.

Review next: Dialysis precautions and exercise around dialysis days.
Source: National Kidney Foundation, Hemodialysis Access (Keeping your access working well)

Question 50 · Research & evidence-based practice

A PTA measures the same patient's knee flexion three times in a row with a goniometer and gets nearly identical results. Which property does this consistency illustrate?

  • A. Interrater reliability
  • B. Validity
  • C. Intrarater reliability
  • D. Sensitivity
Show answer and explanation

Answer: C

Why: Intrarater reliability is the consistency of one rater's repeated measurements. Interrater reliability compares different raters. Validity asks whether a tool measures what it's supposed to measure.

  • A is wrong: that compares measurements between different clinicians.
  • B is wrong: consistent results don't show that the measurement is correct.
  • D is wrong: sensitivity describes how well a test detects people who have a condition.

Review next: Reliability versus validity versus sensitivity and specificity.
Source: Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016 (Types of reliability)

Question 51 · Therapeutic modalities

The plan includes iontophoresis with dexamethasone sodium phosphate, which carries a negative charge. From which electrode is it delivered?

  • A. The positive electrode (anode)
  • B. Either electrode works the same
  • C. Neither, since iontophoresis uses alternating current
  • D. The negative electrode (cathode)
Show answer and explanation

Answer: D

Why: Iontophoresis uses the principle that like charges repel. A negatively charged drug is placed under the negative electrode so it's pushed into the tissue.

  • A is wrong: the anode repels positively charged drugs, not negative ones.
  • B is wrong: polarity determines which drugs are driven in.
  • C is wrong: iontophoresis uses direct current.

Review next: Iontophoresis principles. FSBPT emphasizes knowledge behind iontophoresis, including indications, contraindications, and precautions.
Source: FDA, iontophoresis device 510(k) summary K060236 (Device description; dexamethasone sodium phosphate used for cathodal iontophoresis)

Question 52 · Musculoskeletal (interventions)

A PTA is teaching a warehouse worker with low back pain how to lift a box from the floor. Which instruction is correct?

  • A. Keep your knees straight and bend at the waist
  • B. Hold the box at arm's length to see your path
  • C. Twist at the waist to place the box quickly
  • D. Keep the box close to your body, bend at the hips and knees, and turn by moving your feet rather than twisting
Show answer and explanation

Answer: D

Why: Holding a load close reduces the force on the low back, and turning with the feet avoids combining spinal flexion and rotation under load.

  • A is wrong: bending at the waist with straight legs loads the low back.
  • B is wrong: A load held far away multiplies the stress on the back.
  • C is wrong: twisting under load is a common injury mechanism.

Review next: Body mechanics and ergonomics education.
Source: NIOSH, Ergonomic Guidelines for Manual Material Handling (Pub. 2007-131) (Section 1: Employee Guidelines for Safer Lifting, pp. 19–20)

Question 53 · System interactions

A patient with fibromyalgia asks which treatment is most likely to help her symptoms. Which answer reflects the strongest evidence?

  • A. Complete rest until the pain resolves
  • B. High-intensity exercise from the first session
  • C. A graded exercise program, including aerobic and strengthening exercise
  • D. Avoiding activity on any day with pain
Show answer and explanation

Answer: C

Why: The EULAR fibromyalgia recommendations made exercise the only "strong for" recommendation among non-drug therapies. The program is graded to build tolerance while monitoring and adjusting for symptoms.

  • A is wrong: rest leads to deconditioning and doesn't treat fibromyalgia.
  • B is wrong: starting too hard tends to worsen symptoms.
  • D is wrong: that makes activity unpredictable and reduces conditioning.

Review next: Exercise dosing in persistent pain conditions.
Source: Macfarlane GJ et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017 (Accepted author manuscript; exercise recommendation); EULAR, Managing fibromyalgia (Aerobic and strengthening exercise)

Question 54 · Cardiovascular & pulmonary (conditions)

A patient with stable angina develops his usual exertional chest pressure while walking on a treadmill. His prescribed angina action plan includes sublingual nitroglycerin. What should the PTA do?

  • A. Slow the treadmill and continue at a lower speed
  • B. Finish the session, then report the chest pressure to the PT
  • C. Stop the exercise, have him sit and follow his prescribed nitroglycerin action plan; activate emergency services immediately if the pain worsens or differs from his usual angina, or if it is not better 5 minutes after the first dose
  • D. Have him lie flat and wait 20 minutes before deciding what to do
Show answer and explanation

Answer: C

Why: Chest pain during exercise means stopping. He follows his prescribed angina action plan. Call 9-1-1 immediately if the pain worsens, differs from his usual angina, or returns after improving; also call if it is not better 5 minutes after the first dose. Notify the supervising PT without delaying emergency help.

  • A is wrong: exercise stops with angina; it isn't just reduced.
  • B is wrong: waiting delays response to possible ischemia.
  • D is wrong: that delays nitroglycerin and help.

Review next: Stop-exercise signs and the emergency response for chest pain.
Source: MedlinePlus (NLM), Angina – when you have chest pain (Taking nitroglycerin; when to call 9-1-1); American Heart Association, Warning Signs of a Heart Attack (Do not delay—call 911 right away)

Question 55 · Cardiovascular & pulmonary (interventions)

Postural drainage with head-down positioning is planned for several patients. For which patient should the head-down position be avoided?

  • A. A patient with stable cystic fibrosis and thick sputum
  • B. A patient with severe uncontrolled hypertension
  • C. A patient with bronchiectasis and daily sputum
  • D. A patient recovering from lower-lobe pneumonia
Show answer and explanation

Answer: B

Why: Hospital postural-drainage guidance lists severe hypertension among conditions in which drainage should not be used. The PTA should avoid the planned head-down position and report the finding to the supervising PT.

  • A is wrong: this is a classic candidate for airway clearance.
  • C is wrong: bronchiectasis is an indication.
  • D is wrong: pneumonia alone does not establish the stated contraindication. Airway clearance is individualized; it is not routinely recommended for uncomplicated pneumonia.

Review next: Postural drainage positions and contraindications.
Source: University Hospitals Dorset NHS, Postural Drainage (Conditions in which drainage should not be used); AARC, Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients, 2013 (Routine treatment of uncomplicated pneumonia)

Question 56 · Equipment, devices & technologies

A PTA is checking the fit of a patient's wheelchair. Which finding shows the seat depth is correct?

  • A. There is about 2 inches (a few finger widths) between the front edge of the seat and the back of the knee
  • B. The front edge of the seat presses into the back of the knee
  • C. The seat ends at mid-thigh
  • D. There's a 6-inch gap behind the knee
Show answer and explanation

Answer: A

Why: Seat depth should support the thighs without pressing into the back of the knee. A gap of about 2 inches, checked as a few finger widths, does both.

  • B is wrong: that pressure can irritate nerves and vessels and push the user into a slouch.
  • C is wrong: A short seat concentrates pressure on the buttocks.
  • D is wrong: too short a seat reduces thigh support.

Review next: Wheelchair measurements: seat width, depth, height, and back height.
Source: WHO, Wheelchair Service Training Package: Trainer’s Manual—Basic Level (B.4 Physical assessment: seat depth, p.141; B.9 Fitting: check seat depth, p.180)

Question 57 · Musculoskeletal (interventions)

A patient with acute low back pain and no red flags asks whether he should stay in bed until the pain is gone. What should the PTA tell him?

  • A. Stay in bed for at least a week
  • B. Staying active and keeping up his daily activities as tolerated usually helps recovery more than bed rest
  • C. Avoid all bending for 3 months
  • D. Wear a back brace at all times
Show answer and explanation

Answer: B

Why: Low back pain guidelines advise against bed rest and recommend staying active, alongside the interventions in the plan of care.

  • A is wrong: prolonged bed rest slows recovery.
  • C is wrong: fear-based restriction isn't recommended.
  • D is wrong: A brace doesn't replace staying active and isn't routinely recommended.

Review next: Low back pain: staying active and recognizing red flags.
Source: MedlinePlus (NLM), Low back pain – acute (Treatment; activity); NICE NG59, Low back pain and sciatica in over 16s (Recommendations 1.2.1 and 1.2.3; updated July 2026)

Case 4 (Questions 58–60)

Setting: Home health
Patient: 82-year-old woman
Current condition: Fell at home 2 weeks ago; no fracture
Medical history: Hypertension, knee osteoarthritis
Other information: Lives with her adult son, who is her main caregiver. Oriented and conversational at prior visits.
Physical therapy plan of care: Balance training, gait training with a rolling walker, home safety education

Question 58 · System interactions

Today she is drowsy and confused about where she is, her temperature is 100.9°F, and she says she has been urinating frequently. What should the PTA do?

  • A. Proceed with balance training, since confusion is common at her age
  • B. Document the confusion and recheck at next week's visit
  • C. Ask her son to give her a fever reducer and continue
  • D. Hold the session, call 9-1-1 for the acute change, stay with her, and notify the supervising PT and her medical team without delaying emergency help
Show answer and explanation

Answer: D

Why: A sudden change in alertness and orientation with fever may reflect delirium or another serious illness and needs emergency medical evaluation. Infection is one possible cause; urinary frequency alone does not establish a urinary tract infection.

  • A is wrong: A sudden change from her baseline isn't normal aging.
  • B is wrong: A week's delay risks missing a treatable medical problem.
  • C is wrong: this masks the problem and doesn't get her evaluated.

Review next: Delirium versus dementia, and acute changes that need reporting.
Source: MedlinePlus (NLM), Confusion (When to Contact a Medical Professional; Home Care)

Question 59 · Safety & protection

On a later visit, the PTA notices several bruises on both upper arms that she can't explain. She seems fearful and quiet when her son is in the room. What should the PTA do?

  • A. Confront the son about the bruises
  • B. Wait to see whether new bruises appear
  • C. Follow the agency's abuse-reporting policy and the state's reporting law, and inform the supervising PT
  • D. Assume the bruises are from her fall and say nothing
Show answer and explanation

Answer: C

Why: Unexplained bruises and new fear of a caregiver are possible signs of elder abuse. The PTA documents objectively and reports the concern through the channels and within the time required by applicable state law, without waiting to prove abuse. Informing the supervising PT does not replace any direct report the law requires.

  • A is wrong: confronting the suspected abuser can put her at greater risk.
  • B is wrong: waiting leaves her exposed. Suspicion is enough to report.
  • D is wrong: the bruises are unexplained and accompanied by a behavior change. A previous fall does not rule out abuse.

Review next: Signs of abuse and mandatory reporting.
Source: US Department of Justice, Red Flags of Elder Abuse (Physical and emotional warning signs); US HHS, How do I report elder abuse? (Suspected abuse; state reporting duties)

Question 60 · Safety & protection

At a separate visit when she is alert and medically stable, which home-safety recommendation in her plan best reduces her fall risk?

  • A. Keep throw rugs to soften a fall
  • B. Remove loose throw rugs and add night-lights along the path from the bedroom to the bathroom
  • C. Keep lights off at night to help her sleep
  • D. Store everyday items on high shelves
Show answer and explanation

Answer: B

Why: Tripping hazards and poor lighting at night are common causes of falls at home. Removing rugs and lighting the bedroom-to-bathroom path are core recommendations in fall-prevention home checklists.

  • A is wrong: loose rugs are a tripping hazard.
  • C is wrong: darkness increases the risk of a fall on the way to the bathroom.
  • D is wrong: reaching overhead or using a step stool raises fall risk.

Review next: Home safety and fall-prevention screening.
Source: CDC STEADI, Check for Safety: A Home Fall Prevention Checklist for Older Adults (Floors; Bedrooms; Kitchen)

Answer key

1-C · 2-B · 3-A · 4-A · 5-C · 6-C · 7-B · 8-D · 9-B · 10-A · 11-B · 12-A · 13-A · 14-B · 15-C
16-D · 17-C · 18-B · 19-B · 20-D · 21-D · 22-B · 23-D · 24-A · 25-C · 26-A · 27-A · 28-C · 29-D · 30-B
31-A · 32-D · 33-B · 34-C · 35-D · 36-C · 37-B · 38-D · 39-A · 40-C · 41-D · 42-A · 43-C · 44-A · 45-A
46-D · 47-D · 48-A · 49-B · 50-C · 51-D · 52-D · 53-C · 54-C · 55-B · 56-A · 57-B · 58-D · 59-C · 60-B

Score yourself and review your misses

Count three things: correct, incorrect, and skipped. Your percentage is (correct ÷ 60) × 100. For example, 45 correct, 12 incorrect, and 3 skipped is 75% of this set. Count a lucky guess as a miss for review purposes, even if you scored it.

Then mark your misses in the table below. The real exam has 140 scored questions, and FSBPT's outline sets a range for each content area. Every area on this test falls inside its official range scaled down to 60 questions, so the mix of topics roughly matches the real thing.

Content area Questions on this test FSBPT range (of 140 scored)
Cardiovascular & pulmonary 10: Q1, 4, 13, 14, 15, 18, 27, 30, 54, 55 20–27
Musculoskeletal 15: Q2, 5, 12, 16, 19, 22, 26, 28, 29, 31, 39, 41, 48, 52, 57 31–40
Neuromuscular & nervous 13: Q3, 7, 17, 20, 32, 33, 34, 40, 42, 43, 44, 46, 47 27–35
Integumentary 2: Q8, 21 3–8
Metabolic & endocrine 2: Q10, 35 4–6
Gastrointestinal 1: Q36 0–4
Genitourinary 1: Q49 0–4
Lymphatic 1: Q23 2–6
System interactions 3: Q37, 53, 58 5–7
Equipment, devices & technologies 4: Q6, 24, 45, 56 8–10
Therapeutic modalities 3: Q9, 38, 51 5–7
Safety & protection 3: Q25, 59, 60 6–8
Professional responsibilities 1: Q11 2–4
Research & evidence-based practice 1: Q50 1–3

What to do with your result:

  • Two or more misses in musculoskeletal, neuromuscular, or cardiovascular & pulmonary: that system gets your next block of study time. Adding their published range endpoints gives 78 to 102 of the 140 scored questions.
  • A miss in a small area (one or two questions here): check whether you didn't know the fact or chose an action outside the PTA's role. Those two need different fixes: restudy the fact, or rework the question with the three steps below.
  • No area stands out: review the questions you guessed on or took longest to answer, and explain why each alternative is wrong.

With only one to three questions in most small areas, a miss there points to a topic to check, not a measure of your ability in that area.

A percentage on 60 practice questions doesn't convert to FSBPT's 200–800 scale. The NPTE is scored by equating each form, and the number of correct answers needed for 600 changes slightly from form to form.

Turn each miss into a review task

Write one line per missed or guessed question. The fix is the part people skip.

Question What I missed What I'll do next
13 I chose turning up the oxygen. I overlooked that oxygen is a prescribed order and nursing titrates it. Reread the PTA's role with supplemental oxygen, then redo Questions 13–15 without looking.

Retaking this same set later checks whether the reasoning stuck. A higher score on familiar questions isn't new evidence that you're ready.

Three checks for PTA clinical scenarios

The PTA outline tests the knowledge needed to carry out the PT's established plan of care. So when a question gives you a change in the patient, sort it this way:

  1. Is the patient unsafe right now? Stop the activity and take the emergency or safety action the situation requires. Do not delay urgent help while contacting the supervising PT (Questions 13, 25, 30, 46, 54, 58).
  2. Is it inside the plan? Carry it out and adjust only within the plan's limits (Questions 2, 22, 28).
  3. Does it need re-examination, a new goal, or a plan change? That's the PT's call. Report it rather than acting on it yourself (Question 36).

Several wrong answers in this set exceed the stated plan or delay the required response: independently changing an oxygen order, recommending a new medication, or confronting a suspected abuser.

APTA's direction and supervision policy supports the distinction between carrying out interventions and changing the plan of care. Supervision requirements vary by state.

How this test compares with the real NPTE-PTA

Timed option: 20 minutes per section, or 80 minutes for all 60. That matches the real exam's average available time of 80 seconds per question; it is a study pacing target, not an official per-question limit.

Feature Real NPTE-PTA This practice test
Questions 180 in 4 sections of 45 60 in 4 sections of 15
Scored 140; the other 40 are unscored pretest items you can't identify All 60 count toward your result
Case sets Shared-scenario sets of 2–5 questions at the end of each section One 3-question case at the end of each section
Time 4 hours of testing (4 hours 30 minutes with tutorial, break, and survey); one block of time, sections not separately timed Optional 20 minutes per section
Question types Stand-alone questions, some with a graphic or video, plus case sets Text only
Moving around You can move freely and mark questions within a section, but once you end a section you can't go back to it Go back to anything, any time
Lab values Normal reference ranges generally not provided Glucose readings appear in relevant clinical items
Scoring Scaled 200–800; 600 passes; the number correct needed for 600 varies slightly by form, generally within 1–2 questions; no penalty for wrong answers Raw count of correct answers

Sources: FSBPT's Understanding the NPTE, Test Day, and NPTE Content.

Answer every question on test day. There's no penalty for guessing.

Free and official practice, compared

Feature This page FSBPT sample questions FSBPT NPTE Demo Exam
Made by Castleport Test Prep (independent) FSBPT FSBPT
PTA content 60 original questions, 4 case sets 4 PTA sample questions with answers 12 PTA sample questions plus one PTA scenario with 3 questions; not scored, answers listed
Best for Content review by area, with explanations and sources A quick look at FSBPT's question style Learning the real test interface before test day
Cost Free, no signup Free Free

Links: FSBPT sample questions · NPTE Demo Exam · NPTE-PTA Test Content Outline (PDF)

A sensible order: use this page to review the topics behind your missed or guessed answers, FSBPT's sample questions for a look at official wording, and the Demo Exam to learn the interface.

Where these questions come from

These original, unofficial study questions were prepared by Castleport Test Prep from FSBPT's published content outline and checked against the clinical or professional sources linked under their answers. They are not actual, recalled, or leaked NPTE items. These source checks are not a licensed clinical review.

That matters. FSBPT warns candidates to be very cautious with "free" NPTE questions found online, because some have turned out to be stolen exam questions. Candidates agree before testing that FSBPT can invalidate a score earned with an unfair advantage, even if they didn't know the questions were compromised. If a site advertises "real exam questions," close the tab.

FAQ

Is the PTA exam the same as the PT exam? No. The PT exam has 225 questions over 5 hours and its own content outline. The PTA exam is built around carrying out the PT's plan of care and collecting data, so make sure your practice questions are written for the PTA level.

Can I retake this practice test? Yes. Wait a few days, keep the explanations collapsed, and check whether you now choose the right answer for the right reason, not from memory of this page.

Sources

Last verified November 4, 2026: exam format, scoring, section navigation, pretest items, lab-value policy, content outline ranges, the published Demo Exam description, FSBPT's sample questions, and FSBPT's guidance on free online questions. Each question's clinical or professional support was also checked; sources are linked under its answer.

Official FSBPT sources

Clinical and professional sources for the questions

Castleport Test Prep is an independent exam prep publisher. We are not affiliated with, endorsed by, or approved by the Federation of State Boards of Physical Therapy (FSBPT). NPTE and other exam and credential names identify the subject of this page; trademarks belong to their respective owners. The practice questions are original and unofficial, not actual or recalled NPTE items. Clinical content is for exam study, not patient care decisions, and this resource doesn't guarantee a passing score or licensure. Prepared by the Castleport Test Prep Editorial Team.