Non-Systems: Safety and Protection, Professional Responsibilities, Research
Non-Systems: Safety and Protection
The safety framework
Safety questions reward the least invasive, most standard action. Know standard precautions (hand hygiene, gloves, gown, mask, eye protection) for all patients; transmission-based precautions add contact (MRSA, C. difficile, scabies), droplet (influenza, pertussis, meningococcus), and airborne (TB, measles, varicella) measures. Sequence PPE: gown, mask, goggles, gloves; remove gloves first, then goggles, gown, mask, with hand hygiene after.
Concepts to name
- Body mechanics: wide base, load close, avoid twisting, use assistive devices and team lifts.
- Fall risk: orthostatic vitals, footwear, call light, bed height, clutter, sedatives.
- Patient identification: two identifiers before any intervention.
- Equipment: oxygen safety (no open flame, secure cylinders), electrical checks, wheelchair locks and brakes.
- Fire response: RACE (rescue, alarm, confine, extinguish/evacuate); PASS for extinguishers.
- Restraints: last resort, ordered, time-limited, monitored.
Traps
Candidates choose heroic or fast actions over safe ones, or skip hand hygiene before gloving. Isolation questions often test that contact precautions require gown and gloves on entry, while droplet precautions require a mask within 3-6 feet. Restraint questions test that you try alternatives first and never tie to side rails.
Worked rule
Before any transfer, ask: can the patient bear weight, is the equipment locked, and is help needed? If any answer is uncertain, get assistance. For a patient with C. difficile, use soap and water rather than alcohol rub because spores resist alcohol.
Professional Responsibilities
Scope and ethics
Professional practice questions test the line between what you may do, what you must delegate, and what you must report. Your state practice act and payer rules define scope; the APTA Code of Ethics supplies principles: autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity. Informed consent requires capacity, disclosure, understanding, and voluntariness; the therapist obtains consent for therapy, not for surgery.
Concepts to name
- Delegation: unlicensed assistive personnel may perform trained, routine tasks with supervision, but not evaluation, assessment, program design, or skilled interventions.
- Supervision levels: direct, indirect, and general, defined by state law and setting.
- Documentation: objective, timely, accurate, and never altered after the fact.
- Confidentiality: HIPAA minimum necessary; release only with authorization or legal requirement.
- Mandatory reporting: suspected abuse, neglect, or exploitation of vulnerable adults and children.
- Advocacy and conflict resolution: patient first, then chain of command.
Traps
Questions offer a task that seems routine but is actually skilled (for example, having the aide progress the exercise) or ask you to continue treatment despite an ethical breach. Also watch for boundary issues: accepting gifts, dual relationships, or treating a family member.
Worked rule
If a request is outside your scope or unsafe, do not perform it; state the concern, document it, and escalate. If you witness impaired practice or abuse, report through the appropriate channel even if it strains a relationship. When in doubt about delegation, ask whether the task requires clinical judgment - if yes, it stays with the licensed clinician.
Research
Appraisal essentials
Research questions test whether you can judge a study rather than memorize statistics. Start with design: randomized controlled trials best answer treatment questions; cohort studies follow exposure to outcome; case-control studies start with outcome and look back; cross-sectional studies measure one point in time. Systematic reviews and meta-analyses sit at the top of the evidence hierarchy when well conducted.
Concepts to name
- Validity (does it measure truth?) versus reliability (consistency).
- Bias: selection, attrition, detection, performance, publication.
- Blinding, allocation concealment, intention-to-treat analysis.
- p-value: probability of data given the null; not the probability the null is true.
- Confidence intervals: range of plausible effects; narrower means more precise.
- Diagnostic statistics: sensitivity, specificity, positive and negative predictive values, likelihood ratios.
- Clinical relevance: MCID and MDC.
Traps
Candidates treat p < 0.05 as proof of importance, ignore confidence intervals, or confuse sensitivity with PPV. PPV and NPV depend on prevalence - a highly sensitive test in a low-prevalence population still yields many false positives. Correlation is not causation; a cohort association may reflect confounding.
Worked rule
For a diagnostic test, ask two questions: how well does it rule out disease (sensitivity, NPV) and how well does it rule in disease (specificity, PPV)? A negative result on a highly sensitive test is useful for ruling out; a positive result on a highly specific test is useful for ruling in. Then check whether the study population resembles your patient.