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A client taking warfarin (Coumadin) presents for deep tissue massage. Which of the following is the most appropriate clinical consideration?
A. Avoid massage for 48 hours after medication is taken
B. Use lighter pressure to reduce the risk of bruising
C. Increase pressure to reduce circulatory congestion
D. Perform vigorous tapotement to improve blood flow
Answer: B
Rationale: Warfarin is an Anticoagulants increase bleeding risk, so massage therapists must adjust techniques (e.g., avoiding deep or percussive pressure) to minimize bruising or hematoma.
A client has taken ibuprofen prior to their session. How should this influence your treatment plan?
A. No change is necessary as NSAIDs enhance muscle relaxation
B. Decrease pressure as NSAIDs increase muscle sensitivity
C. Be cautious, as pain relief may mask tissue sensitivity or injury
D. Cancel treatment due to risk of clotting abnormalities
Answer: C
Rationale: NSAIDs reduce inflammation and pain, potentially masking symptoms that would otherwise guide safe treatment boundaries.
Clients taking long-term corticosteroids (e.g., prednisone) may experience:
A. Increased bone density and muscle hypertrophy
B. Thin, fragile skin and decreased tissue integrity
C. Reduced risk of infection and improved healing
D. Enhanced proprioception and flexibility
Answer: B
Rationale: Corticosteroids can lead to skin thinning, bruising, and reduced connective tissue strength, requiring gentler massage.
Which of the following is a contraindication for massage in a diabetic patient taking insulin?
A. Injection site is in an area to be massaged
B. Client reports high blood sugar before session
C. The insulin dose was reduced the previous day
D. The client is asymptomatic and requests deeper work
Answer: A
Rationale: Avoid massaging over recent insulin injection sites to prevent altering absorption and blood sugar levels.
Clients on beta-blockers (e.g., atenolol) may show which of the following altered responses during massage?
A. Elevated heart rate and blood pressure
B. Reduced awareness of pain due to CNS depression
C. Blunted heart rate response, making exertion harder to assess
D. Flushed skin and increased sweating
Answer: C
Rationale: Beta-blockers suppress sympathetic activity, reducing heart rate response even during exertion, which may mask signs of distress.
Which statement best describes how muscle relaxants (e.g., cyclobenzaprine) impact massage therapy?
A. They cause muscle rigidity requiring deeper pressure
B. They increase alertness, improving proprioceptive feedback
C. They reduce muscle tone, but may also impair feedback about pressure
D. They prevent bruising by improving microcirculation
Answer: C
Rationale: Muscle relaxants dull nervous system feedback, increasing the risk of overpressure or injury if the client cannot perceive pain accurately.
A client taking antihypertensives (e.g., lisinopril) reports dizziness after getting off the table. What is the most appropriate response?
A. Suggest walking briskly to stabilize blood flow
B. Assume itโs unrelated to medication
C. Help them up slowly and monitor for orthostatic hypotension
D. Lay them flat with legs elevated indefinitely
Answer: C
Rationale: Antihypertensive medications can cause orthostatic hypotension; therapists should assist clients slowly and observe carefully.
A client has applied capsaicin cream to their back prior to treatment. How should the massage therapist proceed?
A. Perform normal massage; the cream enhances results
B. Apply ice to counteract the heat before beginning
C. Avoid massaging the area to prevent increased absorption
D. Wipe the area clean and proceed with deeper work
Answer: C
Rationale: Topical medications like capsaicin can be absorbed more deeply if massage increases circulation or frictionโposing a risk of irritation or systemic effects.
A client taking statins (e.g., simvastatin) for cholesterol complains of muscle soreness. What should concern you?
A. Statins do not affect muscles
B. This may indicate a serious side effect like myopathy
C. Deep tissue massage will reduce symptoms
D. The soreness is unrelated unless bruising is present
Answer: B
Rationale: Statins can cause muscle breakdown (myopathy or rhabdomyolysis); massage therapists should refer if unexplained muscle pain occurs.
Clients on SSRIs (e.g., sertraline) may experience which massage-relevant side effect?
A. Tachycardia and excessive sweating
B. Hypertension and alertness
C. Emotional blunting and delayed feedback to pain
D. Enhanced relaxation and mobility
Answer: C
Rationale: SSRIs (an Antidepressant) may dull emotional response or pain perception, affecting how clients experience pressure and requiring careful communication.
A 62-year-old male with uncontrolled hypertension reports recent onset of headaches, blurred vision, and tinnitus. As a massage therapist, what is your most appropriate action?
A. Perform gentle effleurage and petrissage to reduce stress
B. Refer him immediately to a physician
C. Continue treatment as usual, but avoid neck work
D. Apply ischemic compression to trigger points behind the ears
โ
Answer: B
Rationale: These are signs of a hypertensive crisis, which is a medical emergency. Massage is contraindicated until the condition is managed.
๐ Reference: Salvo, p. 117โ118
Which cardiovascular condition most likely presents with fatigue, shortness of breath, peripheral edema, and jugular vein distention?
A. Myocardial infarction
B. Deep vein thrombosis
C. Right-sided heart failure
D. Atherosclerosis
โ
Answer: C
Rationale: Right-sided heart failure leads to systemic congestion, including jugular vein distention and peripheral edema.
๐ Reference: Salvo, p. 125โ126
A client reports a history of deep vein thrombosis (DVT) in the left calf three months ago and is now asymptomatic. What is the best course of action for a massage therapist?
A. Apply deep pressure on the left calf to remove remaining adhesions
B. Proceed with massage normally as the clot has resolved
C. Avoid deep massage to the area and get physician clearance first
D. Use tapotement to stimulate circulation in the affected leg
โ
Answer: C
Rationale: Even after resolution, the area may be at risk for recurrence or embolism. Physician clearance is recommended.
๐ Reference: Salvo, p. 130โ131
Which of the following best describes atherosclerosis and why it is a concern for massage therapists?
A. Local infection of arteries; risk of spreading
B. Hardening of arteries; risk of tissue tearing
C. Accumulation of plaque in arteries; risk of embolism
D. Hypertrophy of the heart muscle; risk of chest pain
โ
Answer: C
Rationale: Plaque buildup increases embolism risk; deep or vigorous massage may dislodge plaque.
๐ Reference: Salvo, p. 115โ116
A massage client is taking warfarin for atrial fibrillation. What is the most appropriate consideration during treatment?
A. Perform lymphatic drainage
B. Avoid all massage due to drug interaction
C. Use gentle techniques and avoid deep pressure
D. Apply heat to increase circulation
โ
Answer: C
Rationale: Warfarin is a blood thinner. Deep pressure may cause bruising or hematoma.
๐ Reference: Salvo, p. 119โ120
. Which cardiovascular pathology would contraindicate abdominal massage due to risk of dislodging a thrombus?
A. Abdominal aortic aneurysm
B. Myocardial infarction
C. Varicose veins
D. Hypertension
โ
Answer: A
Rationale: Abdominal aortic aneurysm can rupture under pressure; avoid abdominal work.
๐ Reference: Salvo, p. 129
A 58-year-old client with a history of coronary artery disease is recovering from a stent procedure. Which sign during massage would warrant immediate cessation of treatment?
A. Mild dizziness
B. Numbness in toes
C. Cold sweat and chest discomfort
D. Warmth in the hands
โ
Answer: C
Rationale: These are signs of angina or cardiac distress and may indicate another cardiac event.
๐ Reference: Salvo, p. 123โ124
Which scenario best illustrates a massage precaution for a client with varicose veins?
A. Deep gliding strokes toward the heart
B. Cross-fiber friction over the vein
C. Gentle massage around the area, avoiding direct pressure
D. Tapotement over the vein to increase venous return
โ
Answer: C
Rationale: Varicose veins are fragile and prone to damage. Avoid direct pressure.
๐ Reference: Salvo, p. 132โ133
What is a key clinical distinction between angina pectoris and myocardial infarction?
A. MI pain resolves with rest; angina doesnโt
B. Angina pain resolves with rest or nitroglycerin; MI pain does not
C. Angina is caused by embolism; MI by inflammation
D. MI affects the lungs; angina affects only the heart
โ
Answer: B
Rationale: Angina is transient ischemia; MI is prolonged ischemia leading to tissue death.
๐ Reference: Salvo, p. 122โ124
A client with peripheral artery disease (PAD) complains of cramping in the legs during walking. Which term best describes this symptom, and how should the therapist respond?
A. Orthopnea โ advise breathing exercises
B. Claudication โ encourage medical follow-up and modify leg massage
C. Edema โ apply elevation and compression
D. Hyperemia โ apply cold therapy to relieve congestion
โ
Answer: B
Rationale: Claudication is classic PAD symptom; itโs a red flag for vascular compromise. Massage should be gentle and cautious.
๐ Reference: Salvo, p. 128โ129
A 6-year-old with a history of ventricular septal defect (VSD) is referred for massage by their pediatrician. What is the most important consideration for the therapist?
A. Avoid massage altogether due to the clientโs age
B. Focus treatment on stimulating the sympathetic nervous system
C. Confirm medical clearance and monitor for signs of fatigue
D. Perform deep chest compressions to improve breathing
โ
Answer: C
Rationale: VSD increases cardiac workload. Children with congenital heart defects can fatigue easily and require medical clearance.
๐ Salvo, p. 121
Which congenital heart defect causes mixing of oxygenated and deoxygenated blood and may present with cyanosis?
A. Patent foramen ovale
B. Coarctation of the aorta
C. Tetralogy of Fallot
D. Mitral valve prolapse
โ
Answer: C
Rationale: Tetralogy of Fallot includes right ventricular outflow obstruction and a VSD, causing cyanotic โblue babyโ syndrome.
๐ Salvo, p. 121
In a client with chronic venous insufficiency, which visual observation should prompt the therapist to avoid massage over the area?
A. Mild hair loss on the leg
B. Brownish skin discoloration with weeping sores near the ankles
C. Red stretch marks over the thigh
D. Pale, cool skin on the dorsum of the foot
โ
Answer: B
Rationale: Venous stasis ulcers indicate fragile tissues and are a local contraindication for massage.
๐ Salvo, p. 132โ133
What is the primary mechanism behind the development of varicose veins?
A. Arterial vasoconstriction
B. Valve incompetency in superficial veins
C. Lymphatic congestion
D. Platelet aggregation in capillaries
โ
Answer: B
Rationale: Faulty valves allow backflow and pooling in superficial veins, causing varicosities.
๐ Salvo, p. 132
A client recovering from a recent ischemic stroke has residual weakness on the right side and takes anticoagulants. What modification is most critical in massage planning?
A. Avoid supine positioning
B. Use deep tissue work on unaffected side only
C. Apply gentle massage with caution to prevent bruising
D. Avoid all massage until neurologist clears
โ
Answer: C
Rationale: Clients on anticoagulants bruise easily. Deep pressure must be avoided, but gentle massage can aid circulation.
๐ Salvo, p. 135โ136
Which stroke warning sign observed during a massage session would require you to immediately activate EMS?
A. The client reports shoulder discomfort after treatment
B. The client feels fatigued and wants to cut the session short
C. The client shows sudden slurred speech and facial drooping
D. The client reports mild numbness in fingers of one hand
โ
Answer: C
Rationale: These are hallmark signs of an acute stroke. Call emergency services immediately.
๐ Salvo, p. 135
A client with a repaired atrial septal defect (ASD) presents for massage. What is the most likely long-term issue the therapist should consider during assessment?
A. Spasticity in the limbs
B. Low blood pressure during treatment
C. Decreased exercise tolerance and fatigue
D. Hyperesthesia in the chest region
โ
Answer: C
Rationale: Even post-repair, ASD clients may have reduced cardiopulmonary capacity.
๐ Salvo, p. 121โ122
A massage therapist notices bilateral lower leg edema in a long-time client. The client mentions recent fatigue and a โheavyโ chest. What is the appropriate course of action?
A. Suggest the client elevate their legs during massage
B. Refer to a doctor for possible heart failure evaluation
C. Apply deep massage to improve venous return
D. Use tapotement on the chest to relieve pressure
โ
Answer: B
Rationale: These symptoms could indicate congestive heart failure. Medical referral is essential.
๐ Salvo, p. 126
In a client with post-stroke hemiplegia, what massage approach is most appropriate for the affected limb?
A. Trigger point therapy with ischemic compression
B. Light effleurage and passive movement
C. Cross-fiber friction to reduce spasticity
D. Tapotement to improve muscle tone
โ
Answer: B
Rationale: Gentle techniques and passive ROM are best for clients with neurological deficits post-stroke.
Which sign in a client with venous insufficiency suggests massage therapy may worsen the condition if not modified properly?
A. Spider veins on the thigh
B. Warmth in the soles of the feet
C. Restlessness in the legs at night
D. Pitting edema and tissue fragility near the ankle
โ
Answer: D
Rationale: Pitting edema and fragile skin are signs of advanced venous disease; avoid direct pressure.