Massage Therapy Test Bank PDF

TEST BANK Massage Therapy 7/E Susan Salvo Chapter 01: History of Massage: Prehistoric Times to the Modern Era and Professional Societies, Organizations, and Associations. MULTIPLE CHOICE 1. Which method is defined as manipulation of soft tissue using pressure and traction for clinical, the...

TEST BANK Massage Therapy 7/E Susan Salvo Chapter 01: History of Massage: Prehistoric Times to the Modern Era and Professional Societies, Organizations, and Associations. MULTIPLE CHOICE 1. Which method is defined as manipulation of soft tissue using pressure and traction for clinical, therapeutic, and palliative purposes? a. Acupuncture b. Ayurveda c. Polarity therapy d. Massage therapy ANS: D Massage therapy the manipulation of soft tissue using compression and decompression/traction for clinical, therapeutic, and palliative purposes or for wellness and self-care purposes. 2. Which origin for the word massage is Greek? a. Mashesh b. Masso c. Masser d. Makeh ANS: B The origin of the word massage is unclear, but can be traced to numerous sources: the Hebrew mashesh, the Greek masso and massin, the Latin massa, the Arabic mass’h, the Sanskrit makeh, and the French masser. 3. When was the earliest the term massage was used by most European-based cultures? a. 1600s b. 1700s c. 1800s d. 1900s ANS: C By the early 1800s, the term massage was used by most European-based cultures. Historically, massage was referred to by its techniques such as friction or rubbing. 4. The first written records of massage date back to 3000 BCE in which country? a. India b. China c. Egypt d. Greece ANS: B Written records regarding the practice of massage go back to 3000 BCE in China. Acupuncture was not mentioned in Chinese writings until 90 BCE. 5. Which work is commonly referred to as the classic scripture of traditional Chinese medicine?  a. Tao Te Ching b. Nei Ching c. Ayur-Veda d. Corpus Hippocraticum ANS: B At the time of Hwang Ti, various ideas and beliefs were compiled under the name of the Yellow Emperor (died in 2599 BCE) which became the classic scripture of traditional Chinese medicine known as the Nei Chang. The Nei Chang was written about 2760 BCE, and this work contains detailed descriptions of massage procedures as well as herbal medicines. 6. What is the original massage technique in China and the precursor to manual and energetic therapies? a. Polarity b. Shiatsu c. Acupuncture d. Amma ANS: D Amma is regarded as the original massage technique and precursor to all other Chinese therapies, manual and energetic. 7. Which healing method is based on Hindu tradition? a. Ayurveda b. Shiatsu c. Amma d. Polarity ANS: A Knowledge of amma massage traveled to the subcontinent of India from China, and massage became part of Hindu tradition. Massage is described in India’s first great medical texts, the Ayurveda books of wisdom (about 1800 BCE) and recommend massage as an indispensable healing procedure. 8. Which method is Japanese but based on Chinese medicine concepts, and uses pressure applied from the practitioner’s thumbs, elbows, and other parts of the body? a. Ayurveda b. Shiatsu c. Massage d. Amma ANS: B Shiatsu is a Japanese method based on the same traditional Chinese medicine concepts as acupuncture —energy flows in the body through streams called channels or meridians. Acupuncturists use needles at specific points to balance the flow of energy; shiatsu practitioners use their fingers, thumbs, forearms, elbows, and even their knees and feet. 9. Who is generally recognized as the father of modern Western medicine? a. Galen b. Celsus c. Rhazes  d. Hippocrates ANS: D Hippocrates was known to be a fine physician, founder of a medical school, author of numerous books, and advocated the use of massage or “rubbing.” These works are collectively known as the Corpus Hippocraticum, and summarized much of what was known about disease and medicine in the ancient world. Hippocrates is generally recognized as the father of modern Western medicine, and he believed that physicians should avoid causing harm to patients. 10. Who wrote the Canon of Medicine, the most famous book in the history of medicine in both the East and the West? a. Rhazes b. Celsus c. Avicenna d. Hippocrates ANS: C A text entitled or Canon of Medicine was written by one of the greatest Persian physicians of his era, Avicenna (980-1037). He was also known as Ibn Sina. The Canon of Medicine is the most famous book in the history of medicine in both the East and the West. 11. Which individual discussed the effects of massage and used friction on joints in the 1500s? a. Paré b. Harvey c. Galen d. Mezger ANS: A Ambroise Paré (1515-1590) was a famous French surgeon who was among the earliest individuals in this era to discuss the effects of massage. He used friction to treat dislocated joints and other orthopedic conditions. 12. Who was the first known scientist to demonstrate that blood circulation due to muscular contraction of the heart? a. Paré b. Galen c. Harvey d. Mezger ANS: C English scientist William Harvey (1578–1657) discovered the circulation of blood in 1628, and his writings did much to promote the acceptance of massage as a treatment measure. Harvey observed the hearts of living animals and determined that active phase of the heart muscular contraction (systole) pumped blood through arteries and veins. 13. Who developed the Swedish Movement Cure, which included the use of massage? a. Johann Mezger b. Pehr H. Ling c. George Henry Taylor  d. John Harvey Kellogg ANS: B Pehr Henrik Ling (1776 to 1839) developed his own system of massage and exercises or gymnastics, the latter of which consisted of four types—educational, military, medical, and esthetic. This system was called the Swedish Remedial Massage and Exercise, the Swedish Movement Cure, or simply the Ling system. 14. Which term describes a component of the Ling System? a. Shiatsu b. Ayurveda c. Thai massage d. Swedish massage ANS: D The term Swedish massage was used to describe the massage component of Ling’s system. For this reason, Ling is regarded as the father of Swedish massage. 15. Which individual is credited with having introduced French terms still in use to describe massage techniques? a. Johann Mezger b. William Harvey c. Pehr H. Ling d. Charles Taylor ANS: A French was the international language in the nineteenth century. The Dutch physician Johann Mezger (1838 to 909) is credited with having introduced the French terminology still used to describe massage techniques (e.g., effleurage, pétrissage, tapotement) which is still used in massage legislation, medical insurance billing codes, and massage curricula. 16. Who is the founder of modern nursing, which included massage as part of care? a. Tiffany Field b. Florence Nightingale c. Charles Fayette Taylor d. John Harvey Kellogg ANS: B Florence Nightingale (1829 to 1910) of England, founder of modern nursing, took care of wounded soldiers during the Crimean War (1853 to 1856). She developed a standard of care for patients, and massage was an integral part of care. When nurse training was developed, massage was included in the curriculum and massage was provided to patients as part of their comfort measures. 17. French physician Lucas-Championniere used massage and exercise to treat soldiers injured during which event? a. World War I b. World War II c. Civil War d. Viet Nam War ANS: A  World War I provided countless opportunities for the use of massage and exercise to rehabilitate injured soldiers. French physician Just Lucas-Championniere (1843 to 1913) advocated for the use of massage and passive movements to treat soft tissue injuries and fractures. 18. In what year did George Henry Taylor and Charles Fayette Taylor introduce the Swedish Movement system in the United States? a. 1796 b. 1856 c. 1911 d. 1958 ANS: B Drs. George Henry Taylor (1829 to 1899) and Charles Fayette Taylor (1827 to 1899) sailed to Sweden to study the Ling system and returned to the United States to open the Remedial Hygienic Institute of New York City in 1856. The institute was an orthopedic clinic specializing in Ling’s system of massage and exercise. “Water cures” and nutrition were incorporated into their treatment regimen. 19. Who wrote the first American textbook on the Swedish Movement System in 1860? a. Hartvig Nissen b. Andrew Weil c. George Taylor d. Douglas Graham ANS: C George Taylor wrote the first American textbook on the Swedish Movement System titled An Exposition of the Swedish Movement Cure (1860). 20. Who opened the Swedish Health Institute of Washington, DC, considered the first massage school in the United States? a. John Harvey Kellogg b. Douglas Graham c. Just Lucas-Championniere d. Hartvig Nissen ANS: D In 1883, Hartvig Nissen (1857 to 1924) opened the Swedish Health Institute of Washington, DC. This is considered the first massage school in the United States. 21. Who helped popularize massage therapy in the United States during the modern era by writing numerous books and publishing articles in his magazine, Good Health? a. John Harvey Kellogg b. Douglas Graham c. Just Lucas-Championniere d. Hartvig Nissen ANS: A John Harvey Kellogg (1852 to1943) of Battle Creek, Michigan, promoted massage to the general public. He wrote numerous articles and books on massage and published a magazine called Good Health. 22. Which massage organization took the first step toward professionalism by the establishing a massage curriculum and accreditation of massage schools? a. American Association of Masseurs and Masseuses b. Chartered Society of Physiotherapy c. Esalen Massage and Bodywork Association d. Society of Trained Masseuses ANS: D In 1894 the Commissioners of the British Medical Journal published a report titled “The Scandals of Massage” to expose these practices. This prompted nine British nurses and midwives to form a council of trained masseuses. The following year (1895), the council established the Society of Trained Masseuses. The founders of the Society acted to legitimize massage, which had become tarnished by its association with prostitution. The Society established a massage practice model, which regulated massage through a published massage curriculum and accreditation of massage schools, which included regular inspections and use of only qualified massage instructors. Members of the Society were required to pass examinations and were subject to routine surveillance. 23. What was the original name of the American Massage Therapy Association? a. Society of Trained Masseuses b. Esalen Massage and Bodywork Association c. American Association of Masseurs and Masseuses d. Chartered Society of Massage and Medical Gymnastics ANS: C In 1943, postgraduates from the College of Swedish Massage in Chicago created the American Association of Masseurs and Masseuses, renamed the American Massage and Therapy Association in 1958, then finally the American Massage Therapy Association in 1983. 24. When did the American Association of Masseurs and Masseuses become the American Massage and Therapy Association founded? a. 1943 b. 1958 c. 1965 d. 1987 ANS: B In 1943, postgraduates from the College of Swedish Massage in Chicago created the American Association of Masseurs and Masseuses, renamed the American Massage and Therapy Association in 1958, then finally the American Massage Therapy Association in 1983. 25. When was the Associated Bodywork and Massage Professionals founded? a. 1926 b. 1943 c. 1965 d. 1987 ANS: D  Associated Bodywork and Massage Professionals was founded in 1987. 26. Which center was a think tank for human potential movement and the first exposure to massage for many people? a. Remedial Hygienic Institute b. Esalen Institute c. Swedish Institute d. Touch Research Institute ANS: B In 1962, Michael Murphy and Richard Pierce founded the Esalen Institute, a retreat center and think tank for human potential movement. For many people, Esalen was their first exposure to massage and where many came to learn massage. 27. What organization was established to advance massage by supporting research? a. Associated Bodywork and Massage Professionals b. National Certification Board for Therapeutic Massage and Bodywork c. Federation of State Massage Therapy Boards d. Massage Therapy Foundation ANS: D In 1990, the American Massage Therapy Foundation was established by the AMTA to advance the massage profession through supporting scientific research and evidence-informed practice. In 2004, the foundation became an independent organization and changed its name to the Massage Therapy Foundation (MTF). 28. What organization offered a national certification exam in 1992 that was later adopted by most states as a licensure requirement? a. Federation of State Massage Therapy Boards b. National Certification Board of Therapeutic Massage and Bodywork c. Associated Bodywork and Massage Professionals d. American Massage Therapy Association ANS: B In 1992, the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) was founded after significant encouragement from the AMTA and other industry leaders. The objective was to create a national certification to facilitate massage licensing reciprocity throughout the United States. A national certification examination was launched, and many states adopted it as part of their licensing requirements. 29. What type of credential did the National Certification Board of Therapeutic Massage and Bodywork begin offering in 2013? a. Master’s certification b. Research licensure c. Board certification d. National licensure ANS: C In 2013, NCBTMB began providing board certification, which is currently the highest voluntary credential in the massage profession. Offering the exam as part of state licensure was retired in 2014. 30. Which center is the first in the world to focus on the effects of massage and its application in the treatment of diseases? a. Remedial Hygienic Institute b. Esalen Institute c. Swedish Institute d. Touch Research Institute ANS: D The Touch Research Institute (TRI) at the University of Miami’s School of Medicine was established in 1992 under the directorship of Dr. Tiffany Field. The Institute is the first in the world to focus on effects of massage and touch and its applications in the treatment of diseases. Their research efforts continue today and have shown massage and touch have numerous beneficial effects on health and wellbeing. 31. Which organization developed and released the Massage and Bodywork Licensing Examination in 2008? a. Federation of State Massage Therapy Boards b. National Certification Board of Therapeutic Massage and Bodywork c. American Massage Therapy Association d. Associated Bodywork and Massage Professionals ANS: A In 2005, the Federation of State Massage Therapy Boards (FSMTB) was formed after the ABMP convened a meeting of massage regulators and educators. One of the initial goals of the Federation was to create a valid and reliable licensing examination, and this came to fruition in 2008 with the publication of the Massage and Bodywork Licensing Examination (MBLEx). In 2014 the MBLEx became the only licensing examination in the United States. 32. Which approach does the National Center for Complementary and Integrative Health blend with mainstream medicine? a. Pharmacology b. Endurance training c. Yoga d. Booster vaccinations ANS: C In 2014, Congress changed the name National Center for Complementary and Alternative Medicine (NCCAM) to National Center for Complementary and Integrative Health (NCCIH), stating the use of “alternative medicine” was rare. The new center within the NIH blends medical and healthcare practices and products with mainstream medicine. NCCIH has two subgroups—products such as herbal supplements and probiotics; and practices such as massage, acupuncture, chiropractic, and yoga. 33. How is human trafficking best described? a. Immigrant movement b. Modern-day slavery c. Modern-day pioneering d. Rehabilitative coercion ANS: B  Human trafficking is a form of modern-day slavery in which traffickers use force, fraud, or coercion to obtain some type of labor or commercial sex act). Human trafficking is the third-largest source of revenue for organized crime, just behind drugs and guns/firearms trafficking. 34. Which illegal activity uses massage as a cover for its operations? a. Arms dealing b. Dog fighting c. Drug running d. Sex trafficking ANS: D While great strides have been made in the massage industry towards professionalism, human trafficking using massage as a cover is still prevalent today. According to a report published by the Federation of State Massage Therapy Boards, an estimated 9,000 illicit massage businesses are currently active, and this type of commercial-front massage business is one of the top venues for sex trafficking. 35. Which issue may legal massage practitioners have to deal with because of human trafficking? a. Paying higher costs for supplies b. Being threatened c. Needing additional continuing education d. Researching businesses ANS: B Several issues can arise for legal massage practitioners from human sex trafficking. Practitioners can be threatened, harassed, intimidated, and even assaulted. This may result in additional operational costs for practitioners to increase security. Personal and business establishment reputations may be compromised. It also erodes public trust as the integrity of massage educational institutions, testing authorities, and state licensing boards is questioned, especially if they have allowed unqualified individuals to enter the massage profession. 36. Which complementary therapy has the highest physician referral rate? a. Craniosacral therapy b. Aromatherapy c. Massage therapy d. Hypnotherapy ANS: C Massage is one of the complementary therapies with the highest physician referral rates, and massage is rated among physicians as the complementary therapy most likely to be beneficial and least likely to be harmful. Chapter 02: The Therapeutic Relationship: Ethics, Cultural Competencies, and Boundaries Salvo: Massage Therapy, 7th Edition MULTIPLE CHOICE 1. A good therapeutic relationship is one of the best predictors of which therapy-related factor? a. Client compliance b. Positive outcomes c. Legal actions d. Arbitration counsel ANS: B Several themes emerged from an investigation by Smith et al (2009a) into why clients receive and continue to receive massage. The most commonly reported reason was a positive outcome, such as pain relief, which was often immediate. 2. Which term means adherence to a set of values and obligations; formally agreed-upon codes of conduct; and reasonable expectations of clients, colleagues, and co-workers? a. Therapeutic relationships b. Professionalism c. Conflicts of interest d. Reciprocity ANS: B Professionalism is the adherence to a set of values and obligations, formally agreed-upon codes of conduct, and reasonable expectations of clients, colleagues, and co-workers. Key values of professionalism include acting in the client’s best interest and putting that interest before your own, maintaining standards expected of other members of the profession, and staying current with changes and discoveries in the field. 3. Which term means moral principles that govern behavior? a. Autonomy b. Laws c. Empathy d. Ethics ANS: D Ethics are moral principles governing behavior. Ethics involve judgments about what is right and wrong. 4. Which aspect of ethics involves respecting the rights of competent individuals to make their own decisions? a. Autonomy b. Veracity c. Beneficence d. Fidelity ANS: A  Professionals have an obligation to uphold autonomy, which is respecting the rights of competent individuals to make their own decisions. 5. Which aspect of ethics obligates professionals to act in ways that benefit the wellbeing of others? a. Autonomy b. Non-malfeasance c. Beneficence d. Fidelity ANS: C Beneficence obligates professionals to act in ways that benefit the wellbeing of others. 6. Which aspect of ethics requires that professionals remain loyal and dedicated to their clients, and that professionals keep their promises and honor commitments? a. Autonomy b. Justice c. Beneficence d. Fidelity ANS: D The principle of fidelity requires that professionals remain loyal and dedicated to their clients, and that professionals keep their promises and honor commitments. Fidelity includes promises and commitments made to individual clients and also to the public by practicing within the standards of care. 7. Which principle involves protecting information from unauthorized access or release, loss, theft, and from its modification? a. Fidelity b. Authenticity c. Justice d. Confidentiality ANS: D Confidentiality refers to the obligation of professionals or professional organizations to safeguard entrusted information. This includes protecting information from unauthorized access, release, loss, theft, or modification. 8. Under which circumstance can massage practitioners legally breach confidentiality? a. Records are requested by a client’s spouse b. Records are subpoenaed by a court order c. Transferring records from one massage practitioner to another d. Complying with verbal request for records by a client’s physician ANS: B If clients are involved in court proceedings and requests are made for client records, the practitioner may be legally required to release the record as the client/practitioner relationship may not be privileged under state law. The ability to disclose the receipt of a subpoena, and the fact that there is an investigation, can vary. Read all of the paperwork attached to the subpoena and contact the issuer or your attorney before disclosing any information to anyone other than the issuer of the subpoena.  9. Which legality requires professionals to report concerns of neglect or abuse to appropriate state agencies? a. Consumer protection b. Mandatory reporting c. Malpractice regulation d. Civil rights act ANS: B If practitioners suspect abuse or neglect of children, elderly, or incapacitated adults, they may be legally required to file a report and provide information to appropriate agencies. This legal requirement is called mandatory reporting. 10. What term means failure by a caregiver to provide necessary food, shelter, healthcare, or supervision for whom they are caring? a. Abuse b. Neglect c. Sympathy d. Misperception ANS: B Neglect is failure by a caregiver to provide necessary food, shelter, healthcare, or supervision to the person for whom they are caring. 11. What term means an action by a person in a position of trust or power that causes harm to another person? a. Abuse b. Neglect c. Insensitivity d. Misperception ANS: A Abuse is any action by a person in a position of trust or power that causes harm to another person. 12. Which concept allows practitioners to apply their professional knowledge and expertise to help clients achieve their treatment goals? a. Dual relationship b. Healing touch c. Therapeutic relationship d. Subjective rapport ANS: C The therapeutic relationship is the relationship between a practitioner and a client that allows practitioners to apply their professional knowledge and expertise to help clients achieve their treatment goals. This relationship protects a client’s dignity and provides a framework for ethical principles to be applied. 13. Which concept is the ability to accept another person’s beliefs despite own personal feelings? a. Trust b. Respect  c. Authenticity d. Sympathy ANS: B Respect is the ability to accept another person’s beliefs despite your own personal feelings, and the choice to treat them with value and consideration. Respect can be given to yourself, to others, and to situations regardless of conflicting beliefs. 14. Which term does Rogers use to describe the acceptance of another person regardless of what they say or do? a. Therapeutic accordance b. Healing therapeutic space c. Countertransference reversal d. Unconditional positive regard ANS: D When practitioners respect their clients, they accept them unconditionally as unique human beings, validating their humanity with their actions. This validation has the potential to be deeply healing for clients. Psychologist Carl Rogers called this unconditional positive regard, the acceptance of another person regardless of what they say or do. When we accept the whole person unconditionally, we validate and respect their humanity and accept them physically, mentally, spiritually, and emotionally. 15. Which example demonstrates respect on the part of the massage practitioner? a. Self-disclosure of personal information to clients b. Counseling distressed clients c. Giving clients the massage they requested d. Draping clients improperly ANS: C Massage practitioners who are respectful take into account the client’s preferences, expectations, predispositions, social and cultural values, and religious or spiritual beliefs when developing the plan of care, without inserting their own agenda. For example, when clients request relaxation massage, avoid turning the session it into a clinical massage, as this action would be disrespectful and invalidate the client’s preferences. 16. Which concept is the desire to understand what another person is experiencing without mistaking it for own experience? a. Empathy b. Tolerance c. Sympathy d. Ambivalence ANS: A Empathy is the desire to understand what another person is experiencing without mistaking it for your own experience. Empathy is educated compassion or intellectual understanding of another person’s perspective and emotions. 17. Which nonverbal expression demonstrates empathy? a. Avoiding eye contact b. Avoiding mirroring the look on the client’s face  c. Determining what emotional affect the client has d. Keeping arms crossed ANS: C Riess and Kraft-Todd identified seven essential nonverbal empathetic behaviors, and created the acronym E-M-P-A-T-H-Y. to help professionals remember them (E – is for meaningful eye contact; M - muscles of facial expression; mimic that of the client’s to some degree; P – posture; use an open posture, which includes facing clients at eye level, head erect or slightly side-tilted, shoulders back, and hands apart; A - affect; try to determine clients’ affect or what they are feeling, such as happiness, fear, apprehension, or sadness; T - tone of voice; mimic the clients voice tone initially, and then modulate own to convey warmth, concern, and curiosity; H - hearing the whole person; listen intently and curiously while suspending judgment until you understand the other person’s perspective; and Y - your response; responding calmly when communicating with clients will ultimately improve rapport. 18. Which concept means confidence in and reliance upon others to act in accordance with accepted social, ethical, or legal norms? a. Trust b. Respect c. Validity d. Congruence ANS: A Trust is confidence in and reliance upon others, whether individuals or organizations, to act in accordance with accepted social, ethical, or legal norms. 19. Which statement describes cultural competency? a. Ability of practitioners to speak languages of more than one culture b. Behaviors, attitudes, and policies that enable practitioners to work effectively in cross-cultural situations c. Behaviors, attitudes, and policies that enable practitioners to determine which culture is best d. Ability of practitioners to be tolerant of cross-cultural situations ANS: B Cultural competency is a set of behaviors, attitudes, and policies enabling professionals to interact effectively with others in cross-cultural situations. 20. Which aspect of cultural competency involves self-exploration and examination of one’s own cultural and professional background and biases toward other cultures? a. Desire b. Knowledge c. Encounter d. Awareness ANS: D Cultural awareness is conducting a self-exploration and examination of one’s own cultural and professional background and biases toward other cultures, including the existence of xenophobia (prejudice of people from other countries), racism (prejudice of people from different races), and other forms of cultural phobias and “-isms.” 21. Which statement demonstrates cultural competency and intercultural communication competence? a. Believing that most members of an ethic group tend to behave in the same way b. Thinking that people new to a country are comfortable once they learn societal norms c. Staying silent about disliking working on clients who cannot speak English d. Realizing that every client is unique with personal beliefs and characteristics ANS: D Cultural competency and intercultural communication competence acknowledge that individuals are unique; this allows clients to hold their own beliefs, characteristics, and cultural practices. 22. Which aspect of cultural competency involves directly interacting and engaging with individuals from culturally diverse backgrounds? a. Skills b. Knowledge c. Encounters d. Awareness ANS: C Practitioners are encouraged to engage in face-to-face interactions with people from culturally diverse backgrounds to potentially modify existing beliefs about cultural groups and prevent possible stereotyping. Cultural encounters provide the impetus to continue the journey toward cultural competence. 23. Which factor is a distinguishing cultural trait among LGBTQ+ community members? a. Age b. Gender identity c. Political views d. Intelligence ANS: B The distinguishing cultural trait among LGBTQ+ community members is sexual orientation and/or gender identity. 24. Which term means people who identify as other than strictly male or female? a. Transgender b. Nonbinary c. Queer d. Bisexual ANS: B Nonbinary refers to people who do not identify with the binary genders of male or female. Non-binary people may identify as being both a man and a woman, somewhere in between, or as falling completely outside these categories. 25. Which practice demonstrates LGBTQ+ inclusivity? a. Discussing with clients why so many people are changing their genders b. Talking with clients about legislation involving transgender people c. Asking clients about preferred pronouns  d. Using clients’ first names ANS: C Creating a LGBTQ+ inclusive practice involves asking clients about their preferred pronouns; having gender-neutral bathrooms; using gender-neutral draping, language, and scents; and learning about gender reassignment procedures. 26. The therapeutic relationship is a professional one that exists to meet the needs of whom? a. Client b. Therapist c. Client’s family d. Massage regulatory board ANS: A The therapeutic relationship is a professional relationship that exists to meet the needs of clients while providing them with safe, effective, and competent care. 27. Which term means the spaces between the practitioner’s power and the client’s vulnerability? a. Professional boundaries b. Power differential c. Ethical practice d. Interpersonal skills ANS: A Professional boundaries are the spaces between the practitioner’s power and the client’s vulnerability. 28. What is the term for the imbalance of authority between practitioners and clients in the therapeutic relationship? a. Emotional boundaries b. Cultural competency c. Power differential d. Boundary distribution ANS: C Power comes from the practitioner’s position, knowledge, and access to client information. In contrast, clients know (or should know) little about their practitioners. This imbalance of power is called the power differential, the inherently greater power and influence that helping professionals (i.e., practitioners) have compared to the people they help (i.e., clients). 29. Which strategy maintains professional boundaries? a. Develop and follow a treatment plan b. Have more than one source of income c. Put client needs ahead of self-care needs d. Meet personal needs within the therapeutic relationship ANS: A  Strategies for maintaining professional boundaries are: (1) have clearly defined roles and responsibilities, including who can participate in the relationship; (2) establish clear boundaries between yourself and others; (3) develop and follow a treatment plan; (4) recognize that different cultures and ethnic groups may have varying rules for interactions and that these rules must be factored into professional decisions and actions; (5) meet personal needs outside of the practitioner/client relationship; (6) develop self-awareness; and (7) create and follow a self-care plan. 30. What term describes a practitioner revealing thoughts, feelings, and personal history to clients? a. Self-disclosure b. Confidentiality c. Empathy d. Cultural competency ANS: A Revealing thoughts, feelings, and personal history to clients is called self-disclosure. 31. Which example demonstrates a physical boundary? a. Starting and finishing a massage session on time b. Sharing personal religious and political views with clients c. Obtaining consent before working on the gluteal region d. Intentionally evoking an emotional response from the client ANS: C Physical boundaries represent circumstances under which practitioners physically touch and massage their clients; this includes the who, what, when, where, why, and how of physical contact. Obtaining consent before working on the gluteal region is an example of a physical boundary in the therapeutic relationship. 32. Which type of boundary helps an individual identify own feelings and keep them separate from the feelings of others? a. Physical b. Biological c. Emotional d. Financial ANS: C Emotional boundaries involve the capacity to be aware of, to control, and to express one’s emotions. They also involve identifying which emotions are yours, which ones are not yours, and keeping these feelings separate. 33. Which response is appropriate for the massage practitioner if a client has an emotional release during the session? a. End the client’s treatment immediately b. Charge the client an additional fee c. Assume the role of psychotherapist for the client d. Bring the focus back to the client’s body ANS: D  A massage practitioner’s scope of practice does not allow for the intentional eliciting or processing of emotions. When clients share their emotional concerns with their massage practitioner, the practitioner should act to bring the focus back to the client’s body using questions such as, “Where do you feel that in your body?” or “Can you tell me what you notice in your body as you say that?” 34. Which term describes the client projecting feelings and behaviors they have for someone onto an entirely different person such as the massage practitioner? a. Empathy b. Transference c. Countertransference d. Fidelity ANS: B Transference occurs when a client transfers or projects feelings and behaviors they have for someone onto an entirely different person. In the professional relationship, transference occurs when the practitioner assumes a different role in the client’s life, more than just someone providing massage services. 35. Which term describes the projection of feelings and behaviors the massage practitioner has for someone onto the client? a. Sympathy b. Transference c. Countertransference d. Fidelity ANS: C Countertransference is similar to transference, except the direction is reversed—transferring from practitioner to client. Countertransference may occur from the practitioner’s unmet personal needs, unresolved emotions, or internal conflicts brought into the relationship unknowingly. 36. Which example is a sign of countertransference? a. Becoming angry when the client cancels an appointment b. Shortening the session time if the client is late c. Giving the client the office email address d. Calling the client as a reminder for a massage session ANS: A Signs of countertransference can include becoming angry or depressed when a client cancels an appointment. 37. What type of boundary encompasses beliefs, thoughts, and ideas while also safeguarding self-esteem? a. Physical b. Intellectual c. Time d. Location ANS: B  Intellectual boundaries encompass beliefs, thoughts, and ideas, as well as safeguarding self-esteem. 38. Which example demonstrates a time boundary? a. Starting and finishing a massage session promptly b. Sharing religious and political views with clients c. Obtaining consent before working on the gluteal region d. Intentionally evoking an emotional response from the client ANS: A Time boundaries include: (1) being ready when clients arrive, having clean linens on the table; (2) beginning and ending the session on time; and (3) focusing on the client during the session while avoiding distracting activities such as talking or texting on mobile devices or conversing with other people in the waiting room. 39. Which example demonstrates a financial boundary? a. Posting your fee schedule and accepted forms of payment b. Sharing personal religious and political views with clients c. Obtaining consent before working on the gluteal region d. Intentionally evoking an emotional response from the client ANS: A Financial boundaries involve issues of money and include fee schedules, payment arrangements and procedures, and policies of non-payment. 40. Which example shows a common scenario involving a financial conflict of interest for massage practitioners? a. Selling products to clients b. Using more than one therapeutic modality c. Being an independent contractor d. Using a cell phone for business calls ANS: A One of the most common financial conflicts of interest for massage practitioners is selling products to clients. In these situations, practitioners may be faced with choosing between the client’s best interest and practitioner’s financial interests when profits are received from the sales. 41. Which type of boundary is necessary for emails, texting, and social media? a. Intellectual b. Financial c. Digital d. Emotional ANS: C Digital media, including social media and electronic communications, introduce a new boundary for practitioners, and this may create dual relationships and issues with confidentiality and privacy. 42. Which term is defined as any situation where multiple roles exist between a practitioner and a client?  a. Dual relationships b. Transference c. Countertransference d. Power differentials ANS: A Dual relationships are any situation where multiple roles exist between practitioners and clients. Examples of dual relationships are when clients are also friends, family members, or business associates. 43. What is the most common social dual relationship between practitioners and their clients? a. Friend b. Family member c. Business associate d. Codependent ANS: A The most common social dual relationship is friendships. 44. What characteristic differentiates friendships from professional relationships? a. Choice b. Mutuality c. Trust d. Reciprocity ANS: D Friendships usually involve choice, mutuality (both parties voluntarily enter the relationship), trust, delight or pleasure (both parties enjoy the relationship), and reciprocity. Professional relationships involve choice, mutuality, trust, and pleasure, but not reciprocity. 45. According to the NCBTMB’s standards of practice, at least how much time should lapse between discontinuing the client–practitioner relationship and initiating a mutual romantic or sexual relationship with a client? a. 6 weeks b. 6 months c. 18 months d. 24 months ANS: B The NCBTMB Standards of Practice (Standard VI.A) require discontinuation of the client–practitioner relationship for at least 6 months before initiating a romantic or sexual relationship with that client. 46. Which action is part of an approach for solving a severe or extreme problem? a. Blaming the person who started the problem b. Imposing a preferred solution to a conflict c. Agreeing to whatever another person wants d. Thinking about consequences of various actions ANS: D  An 8-step approach for solving severe or extreme problems includes identifying the problem; identifying issues around the problem; reviewing ethical guidelines; reviewing laws and regulations; obtaining consultation; considering several actions; thinking about possible consequences of various actions; and deciding on the best course of action. 47. Which step of an approach for solving a severe or extreme problem involves seeking advice from mentors, teachers, peers, or other trusted professionals? a. Identify the problem b. Obtain consultation c. Identify potential issues involved d. Consider possible courses of action ANS: B Prejudices, biases, privilege, personal unmet needs or emotions can impair objectivity. Therefore, it is prudent to seek counsel from mentors, teachers, peers, or other trusted professionals. 48. Which term can be defined as sexual interaction between someone in an authoritative role and a subordinate? a. Interest b. Activity c. Misconduct d. Assault ANS: C Sexual misconduct is a range of sexual behaviors, consensual and nonconsensual, between someone in an authoritative role and someone in a subordinate role—these are relationships with power differentials. 49. Which term means sexual or sexually suggestive unwanted behaviors perceived as offensive, threatening or embarrassing? a. Harassment b. Exacerbation c. Activity d. Risk ANS: A Sexual harassment denies an individual dignity and respect; its behaviors range from unwelcome verbal, written, or physical conduct that denigrates an individual or an individual’s relatives, friends, or associates; derogatory comments, innuendos, insults, slurs, nicknames, negative stereotyping, and other similar conduct; and placement, dissemination, or circulation of written or graphic material (hard copy or electronic forms). 50. Which example demonstrates a way a massage practitioner can decrease the risk of sexual misconduct? a. Avoiding terms of endearment, such as “honey” or “sweetie” b. Dressing for work as though going on a date to increase tips c. Wearing tight or revealing clothing to perform the session d. Using the words “release” or “happy ending” in advertisements ANS: A  Avoiding terms of endearment, such as “honey” or “sweetie” is one way to reduce the risk of sexual misconduct. 51. Which procedure is an appropriate way of dealing with a client’s erection that is most likely due to a reflex response? a. Ask questions to distract the client b. Apply pressure to the client’s abdomen c. Tell the client that erections are unimpressive d. Turn down the thermostat to lower the client’s body temperature ANS: A If you believe the erection is a reflex response (which may not be easy to determine), simply ignore it. You can ask questions to distract the client from thoughts or feelings or sensations leading up to the erection. Or you can alter the speed and/or depth of the massage techniques or ask them to roll over into the prone position and continue the massage. 52. Which activity is an indication the client is sexualizing the massage? a. Snoring or drooling during part of the session b. Requesting additional draping, such as a blanket c. Wearing undergarments under the drape d. Moving the pelvis repetitively ANS: D If the client has an erection followed by inappropriate behavior, the client is likely sexualizing the massage. Behaviors range from subtle to overt, and may include: noises such as moaning; repetitive movements of the pelvis; touching their pelvis or penis; or removing part of, or the entire drape. The client may also touch you, even in a seemingly casual or accidental way. 53. Which action by the massage practitioner is appropriate when terminating a massage while in session? a. Answering any of the client’s questions while in the room b. Leaving the massage room without notifying the client c. Removing hands from the client and stepping toward the door d. Waiting in the massage room for the client to get dressed ANS: C Removing hands from the client and stepping toward the door is an appropriate way to terminate a massage while in session if the client is behaving inappropriately. 54. Which action is required of massage practitioners who know first hand about sexual misconduct by another therapist? a. Letting the therapist know the exact nature of the allegations b. Informing the therapist’s supervisor of the allegation c. Filing a report with the state licensing board d. Keeping information confidential until contacted by the authorities ANS: C In many states, there is a “duty to report” sexual misconduct and harassment by practitioners. If there is firsthand knowledge (i.e., we witnessed it ourselves or it was disclosed by the offending practitioner), practitioners may be required to file a report with the state licensing boards. Chapter 03: Tools of the Trade: Tables, Accessories, Linens, Lubricants, Aromatherapy, Essential Oils, and the Massage Environment Salvo: Massage Therapy, 7th Edition MULTIPLE CHOICE 1. Which feature is an advantage of portable massage tables? a. Thickness of padding on b. Relative ease of transport c. Strength of frame material d. Available accessories to use ANS: B An advantage of portable massage tables is that they can be moved with relative ease, increasing the number of locations where massage practitioners can work. 2. Which reason is an advantage of purchasing massage equipment from reputable, well-established manufacturers? a. Customer service is consistent among all massage manufacturers b. Massage table and massage chair warranties a less than one year c. Most manufacturers avoid offering a trial period for purchases d. Their equipment tends to hold its value and bring a higher resale price ANS: D Reputable, well-established companies have quality, well-made products that have withstood the test of time. These companies often provide excellent customer service before and after the purchase, and may offer a trial period with all or part of the purchase price refunded once the product is returned if the customer is not satisfied. In addition, massage tables and chairs sold by reputable companies often hold their value and bring a higher resale price. 3. What is the national standard for weight ratings for massage tables and chairs? a. 500 pounds b. Depends on whether client is male or female c. The massage practitioner’s best judgment d. None ANS: D Currently, there is no national standard for determining weight ratings for massage tables and chairs. Consumers must rely on weight ratings supplied by the company. The more reputable the company, the more trustworthy their published weight ratings are. 4. How wide are most massage tables? a. 25-27 inches b. 28-30 inches c. 30-31 inches d. 33-34 inches ANS: C Most massage tables have a width between 28 and 33 inches, with most tables being 30-31 inches wide. 5. Which term means the ability of table foam pads to return to their original height after being compressed? a. Loft b. Density c. Memory d. Durability ANS: C High-grade density pads generally have better memory, or ability of the foam pads to return to their original height after being compressed. 6. Which fabric is most often used on high-quality massage tables? a. Cordura b. Polyvinyl c. Gore-Tex d. Polyurethane ANS: D Most good-quality massage tables and products use polyurethane fabrics and do not contain polyvinyl chlorides (PVCs), which makes them environmentally friendly. 7. Which type of product should be avoided for cleaning the massage table because it may degrade the fabric? a. Vinegar-based b. Citrus oil–based c. Nonabrasive d. Nonalcohol ANS: B Many massage table manufactures recommend a 4:1 diluted solution of green Windex, 409, Fantastik, or other nonabrasive, nonalcohol cleaning products. Vinegar may also be used. Avoid citrus oil–based cleaners because they can damage the fabric. 8. When should chlorine bleach be used on the massage table? a. At the beginning of a three-month calendar period b. When table linens are thrown away and replaced with new ones c. When the table needs to be disinfected d. Before the start of each workday and before each massage therapy session ANS: C Chlorine bleach is used for disinfecting, but not routine cleaning. 9. Which massage table accessory allows a client’s neck to remain relatively straight while the client lies prone? a. Face rest b. Arm shelf c. Cervical pillow d. Covered bolster ANS: A  A face rest, or face cradle, allows clients to keep their heads and necks aligned while lying prone. 10. Which massage table accessory is used while the client is lying supine? a. Face rest b. Arm shelf c. Knee bolster d. Ankle bolster ANS: C A bolster placed behind the knees while the client is supine often reduces lower back strain by decreasing excessive lordosis. 11. A knee bolster increases client comfort by decreasing which condition? a. Lower back strain b. Abdominal distention c. Cervical extension d. Pectoral strain ANS: A A bolster placed behind the knees while the client is supine often reduces lower back strain by decreasing excessive lordosis. 12. Which fabric is the most popular for massage therapy linens? a. Rayon b. Cotton c. Jersey d. Polyester ANS: B Popular sheet fabrics are cotton, cotton blends, and flannel. Avoid thin, clingy, or see-through fabrics such as jersey knit because these types of fabrics reveal details of the client’s body. 13. What type of material should be avoided as a drape the client is positioned over because it can leave compression marks on the skin? a. Flannel b. Cotton c. Polyester d. Terrycloth ANS: D Towels are made with terrycloth and are designed to absorb water easily, making them ideal for spa treatments. Do not place a towel on the massage table then position the client over it, as the pressure of the client’s body will cause the towel to leave compression marks on the skin. 14. How often are sheets and accessory covers used before needing to be laundered? a. Once b. Twice c. For a week d. Until they smell rancid  ANS: A Sheets and accessory covers are used once for each client, then need to be laundered. 15. What is the primary purpose of using massage lubricants? a. Reduce friction b. Hydrate the skin c. Test for skin allergies d. Increase client relaxation ANS: A The primary purpose of a massage lubricant is to reduce friction between the practitioner’s hands and the client’s skin. Types of massage lubricant are crèmes, lotions, butters, oils, and gels. 16. Which type of product should be used if the massage therapist is unsure which is the safest for the client? a. Coconut oil b. Shea butter c. Scented d. Hypoallergenic ANS: D Hypoallergenic products are less likely to cause allergic reactions. They are used when the client has allergies to ingredients in nonhypoallergenic lubricants, has sensitive or hyper-reactive skin, or skin conditions such as eczema (atopic dermatitis) or psoriasis. If you are unsure what product to use, choose an unscented, hypoallergenic lubricant. 17. From what are oils and gels usually derived? a. Fruits, nuts, and seeds b. Petroleum-based products c. Nuts, seeds, and vegetables d. Extracts of medicinal herbs ANS: C Oils and gels are derived from nuts, seeds, and vegetables. Sesame, grape, coconut, and hemp seed oils tend to be well-tolerated. 18. From what are butters derived? a. Fruit, nuts, or seeds b. Petroleum-based products c. Vegetables, nuts, and seeds d. Extracts of medicinal herbs ANS: A Butters are derived from fruit, nuts, or seeds. The most common butters used in massage lubricants are cocoa butter and shea butter. 19. Which butters are the most common ones used in massage lubricants? a. Carrot and avocado b. Coconut and almond c. Cocoa and shea d. Shea and peanut  ANS: C The most common butters used in massage lubricants are cocoa butter and shea butter. 20. Which massage lubricant should be avoided if the client has a latex allergy? a. Olive oil b. Shea butter c. Coconut oil d. Almond butter ANS: B If the client is allergic to latex, he or she may also have an allergic reaction to shea butter because of cross-reactivity. Avoid shea butter as a massage lubricant or lubricant ingredient in these cases. 21. Which substance should be avoided because it can clog pores and may be carcinogenic? a. Aloe vera b. Cornstarch c. Mineral oil d. Cocoa butter ANS: C Mineral oil is thought to clog pores and may be a carcinogen (cancer causing agent). 22. Which type of product is thought to mimic the hormone estrogen, which may play a role in breast cancer development? a. Parabens b. Eucalyptus c. Mineral oils d. Alcohol ANS: A Parabens are thought to mimic the hormone estrogen when they are absorbed into the skin; estrogens may play a role in breast cancer development. In response to these concerns, many massage lubricant manufacturers are removing mineral oils and parabens from all or part of their product lines. 23. Which term means the transfer of harmful microorganisms from one source to another? a. Infection control b. Cross-contamination c. Universal precautions d. Single-usage ANS: B Cross-contamination occurs when microorganisms such as bacteria are transferred from one source to another. 24. Which method is the most effective way to prevent cross-contamination of a thin massage lubricant? a. An open jar used for multiple clients b. A container with a pump mechanism c. An open jar that sits in a massage holster  d. A container on the floor near the client ANS: B When dispensing thin lubricants such as lotions, gels, or oils, either use a container with a pump mechanism or a squeezable bottle or tube. 25. How long can massage lubricant remain blended and unrancid after being purchased if it is stored in a cool, dark place out of direct sunlight? a. 1 month b. 6 months c. 18 months d. 36 months ANS: C Store your massage lubricants in a cool, dark location away from direct sunlight. Under these conditions, most lubricants remain blended and unrancid for approximately 18 months. 26. Which scent does the National Sleep Foundation recommend to promote calmness and relaxation? a. Lavender b. Geranium c. Eucalyptus d. Patchouli ANS: A If scents are used, the National Sleep Foundation recommends lavender, vanilla, valerian, jasmine, or any scent the client enjoys to promote calmness and relaxation. 27. How many drops of essential oil should be added to one ounce of oil-based lubricant for a full-body massage? a. 2 to 5 b. 5 to 10 c. 15 to 20 d. 20 to 30 ANS: C Add 15 to 20 drops of essential oil to 1 oz of oil-based lubricant for a full-body massage. This gives a 2.5% to 3% dilution. For massaging a localized area (e.g., muscle spasm in the shoulder), a slightly stronger dilution can be used. Add 12 to 15 drops of essential oil to 1/2 oz of carrier oil or lubricant for this purpose. 28. Which temperature range is the most comfortable range for a massage room? a. 57° to 60° F b. 65° to 70° F c. 68° to 76° F d. 80° to 86° F ANS: C Ideal room temperatures for massage practitioners are between 68° and 76° F (Occupational Safety and Health Administration [OSHA], 2003). The higher end of this temperature range is recommended for clients. 29. Which colors are most likely to create a cozy feeling in the massage space? a. Taupe, gray, and beige b. Blue, violet, and green c. Green, taupe, and red d. Red, yellow, and orange ANS: D Rich shades of red, orange, and yellow can create a warm cozy feeling. 30. Which practice best promotes a safe and accessible treatment facility? a. Using circular-style door handles b. Providing slick and smooth flooring c. Posting a fire escape route inside a closet located near a building exit d. Checking and tightening loose knobs on massage tables before each business day ANS: D Maintain all equipment in safe working condition. This includes checking and tightening your massage table hinges, knobs, and locks before each business day. Chapter 04: Career Longevity: Wellness, Wellbeing, and Self-Care Salvo: Massage Therapy, 7th Edition MULTIPLE CHOICE 1. Studies about career longevity in nursing, education, and athletic training can be correlated to massage therapy because all these professions have what in common? a. Being health related b. A physical component c. Comparable pay rates d. Same amount of schooling ANS: B Although investigations into factors contributing to career longevity in massage have not been conducted, studies have been carried out in nursing, education, and athletic training. The information from these studies can be applied to the massage profession because of several commonalities – care of others and physicality in the performance of professional activities. 2. Which approach do professionals use to help prevent burnout? a. Being minimally active b. Keeping concerns to self c. Spending time with family d. Avoiding spiritual interests ANS: C Many professionals persisted in their careers and prevented burnout by utilizing self-care strategies such as exercising, talking with peers and supervisors, spending time with family, and practicing spirituality. 3. Which concept includes activities, choices, and lifestyles oriented toward optimal health and wellbeing? a. Wellness b. Perfection c. Tranquility d. Independence ANS: A Wellness includes activities, choices, and lifestyles oriented toward optimal health and wellbeing to live more fully within a community. 4. Which concept is a foundation for an evidence-informed approach of career longevity, self-care, and burnout prevention? a. Eustress b. Depersonalization c. Wellness model d. Biopsychosocial model ANS: C  The wellness model is a foundation for an evidence-informed approach of career longevity, self-care, and burnout prevention and includes exercising (physical wellness), having a balance between personal life and work life, spending time with family, friends, and coworkers (social and occupational wellness), taking educational courses (intellectual wellness), reducing stress (emotional wellness), and practicing spirituality (spiritual wellness). 5. According to Bonnie Prudden, massage is classified as which type of occupation? a. Active b. Walking c. Standing d. Strenuous ANS: D Prudden classifies massage therapy as a strenuous occupation. 6. According to Bonnie Prudden, someone in a sitting occupation may develop trigger points where? a. Feet b. Chest c. Abdomen d. Forearms ANS: B Sitting occupations often put trigger points in the chest, neck, shoulders, and upper and lower back. 7. According to the American College of Sports Medicine, what is the minimum number of minutes of moderate-intensity cardiorespiratory exercise should adults achieve each week? a. 30 b. 60 c. 100 d. 150 ANS: D Cardiorespiratory exercises are activities involving prolonged body movements that increase heart and respiration rates. Recommendations for cardiorespiratory exercise are 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity physical activity, or an equivalent combination of moderate- and vigorous-intensity activity. 8. According to the American College of Sports Medicine, how often should adults participate in resistance exercises? a. Every day b. 2 or 3 days each week c. 1 day each week d. Every other week ANS: B  Resistance exercises involve contracting muscles against resistance and takes effort. Recommendations for resistance exercises are 2 or 3 nonconsecutive days a week on all major muscle groups. 9. Which type of exercise specifically helps reduce fall risk? a. Cardiorespiratory b. Resistance c. Neuromotor d. Flexibility ANS: C Neuromotor exercises can improve agility, balance, coordination, gait, proprioception (self-awareness of movements and body positions), and reduce fall risk and fear of falling. 10. What term means ingesting food and drink to help the body function properly? a. Health b. Nutrition c. Calories d. Wellness ANS: B Nutrition is ingesting food and drink to help the body function properly, to support tissue growth and repair, and to supply the energy needed for daily activities. 11. What term encompasses proteins, carbohydrates, fats, vitamins, minerals, and water? a. Nutrients b. Calories c. Enzymes d. Hormones ANS: A Nutrients are substances in food and drink that provide nutrition. Nutrients can be grouped into two categories—macronutrients and micronutrients, and six subcategories—proteins, carbohydrates, fats, vitamins, minerals, and water. 12. Which food category provides energy through calories and includes proteins, carbohydrates, and fats? a. Micronutrients b. Macronutrients c. Dietary cofactors d. Organic compounds ANS: B Macronutrients are proteins, carbohydrates, and fats. They are needed in relatively large amounts. Macronutrients are also called the calorie group because they provide nutrients through calories, which are units of energy received from nutrients. 13. Which type of nutrient is composed of chains of amino acids? a. Fats b. Proteins c. Minerals  d. Carbohydrates ANS: B Proteins are chains of amino acids. The body uses approximately 24 amino acids. 14. Which nutrient aids the body’s growth and energy needs, helps build and repair tissues, and helps form antibodies to fight infection? a. Fats b. Proteins c. Minerals d. Carbohydrates ANS: B Proteins assist the body’s growth and energy needs, help build and repair tissues, and help form antibodies which fight infection. 15. Which type of protein contains all eight essential amino acids? a. Complete b. Saturated c. Incomplete d. Unsaturated ANS: A Foods that contain all 8 essential amino acids are complete proteins, and foods that lack one or more essential amino acid are incomplete proteins. 16. Which foods are considered good sources of protein? a. Meat, fish, poultry, eggs, milk, beans, and nuts b. Breads, cereals, potatoes, beans, peas, and honey c. Nuts, seeds, oils, butter, cream, and avocados d. Fresh fruits, nuts, sugar, syrup, corn, and honey ANS: A Good sources of complete proteins are meat, fish, poultry, eggs, milk, cheese, beans, peas, and nuts. 17. Which type of nutrient provides the body with energy? a. Fibers b. Vitamins c. Minerals d. Carbohydrates ANS: D Carbohydrates are sugars that turn into glucose (blood sugar) and are used by the body as energy. 18. Which foods are sources of carbohydrates? a. Meat, fish, poultry, eggs, milk, beans, and nuts b. Honey, whole grain breads, apples, peas, and beans c. Nuts, seeds, oils, butter, cream, and avocados d. Cheese, beans, peas, butter, cream, and nuts  ANS: B Sources of simple carbohydrates are fresh fruits, honey, and table sugar. Sources of complex carbohydrates are whole grains breads, fiber-rich fruits (apples, blueberries, raspberries, oranges), and fiber-rich vegetables (corn, acorn squash, peas, beans). 19. Which type of nutrients are sources of energy and help the body absorb certain vitamins? a. Fats b. Proteins c. Minerals d. Carbohydrates ANS: A Fats and oils are found in animal and plant foods, are sources of energy, and help the body absorb certain vitamins and minerals. 20. Which type of nutrient is classified as either unsaturated or saturated? a. Fats b. Proteins c. Minerals d. Carbohydrates ANS: A Fats can be either unsaturated (liquid at room temperature) or saturated (solid at room temperature). 21. Which term refers to a type of fat that is liquid at room temperature? a. Complete b. Saturated c. Incomplete d. Unsaturated ANS: D Fats can be either unsaturated (liquid at room temperature) or saturated (solid at room temperature). 22. Which term refers to fats with no nutritional value and are harmful to health? a. Unsaturated b. Saturated c. Organic d. Trans ANS: D Transfats are a type of fat with no nutritional value and are harmful to health. They can be found in processed foods such as baked goods, snack foods, fried foods, shortening, margarine, and certain vegetable oils. 23. Which foods are sources of healthy fats? a. Meat, fish, poultry, eggs, milk, beans, and nuts b. Breads, cereals, potatoes, beans, peas, and honey c. Nuts, seeds, olive oil, fatty fish, and avocados d. Fresh fruits, nuts, sugar, syrup, corn, and honey  ANS: C Good sources of healthy fats are nuts, seeds, olive oil, avocados, eggs, and fatty fish, such as sardines, tuna, salmon, trout, mackerel, and herring. 24. Which vitamin is water-soluble? a. A b. C c. D d. E ANS: B Water-soluble vitamins dissolve in water, are readily absorbed into tissues, are not stored in the body, and are quickly excreted in urine. Water-soluble vitamins must be consumed regularly. Examples of water-soluble vitamins are B-complex group and vitamin C. 25. Which vitamin is fat-soluble? a. B1 b. B12 c. C d. E ANS: D Fat-soluble vitamins dissolve in fat, are absorbed slowly, and are stored in the liver and in fat cells for future use. Examples of fat-soluble vitamins are A, D, E, and K. 26. Which food is the best source of Vitamin A? a. Yogurt b. Spinach c. Strawberries d. Citrus fruits ANS: B The best sources of vitamin A are liver, spinach, sweet potatoes, pumpkin, collard greens, and milk. 27. Which food is the best source of Vitamin C? a. Limes b. Cheese c. Seafood d. Potatoes ANS: A The best sources of vitamin C are citrus fruits (oranges, limes), strawberries, broccoli, and sweet red peppers. 28. Which food is the best source of Vitamin E? a. Yogurt b. Potatoes c. Strawberries d. Almonds ANS: D  The best sources of vitamin E are almonds, peanuts, sunflower seeds, spinach, avocado, oils (wheat germ, safflower), and carrot juice. 29. Which vitamin acts as an antioxidant and helps the body resist infection? a. A b. C c. D d. K ANS: B Vitamin C acts as an antioxidant, helps the body resist infection, promotes adrenal function, aids in collagen production, and can reduce high blood pressure and cholesterol. 30. Which vitamin promotes bone development as well as calcium absorption and metabolism? a. A b. C c. D d. K ANS: C Vitamin D promotes bone development, helps absorb and metabolize calcium, and aids immune function. 31. Which vitamin aid in blood clotting? a. A b. C c. D d. K ANS: D Vitamin K aids in blood clotting and maintains bone health. 32. Which nutrients are chemical elements found in the earth’s crust that are vital in regulating many body functions? a. Fats b. Proteins c. Minerals d. Carbohydrates ANS: C Minerals are chemical elements found in the earth’s crust that are vital in regulating many body functions. Minerals act as coenzymes (iron), support organs (potassium), build bone (calcium), relax muscles (magnesium), and aid healthy growth and development (zinc). 33. Which mineral supports the development and maintenance of strong bones and teeth? a. Iron b. Sodium c. Calcium d. Potassium ANS: C  Calcium supports the development and maintenance of strong bones and teeth and promotes heart, nerve, and muscle function. Calcium requires other nutrients to function, such as vitamin D. 34. Which mineral is part of hemoglobin in red blood cells, thereby helping deliver oxygen to the tissues? a. Iron b. Sodium c. Calcium d. Potassium ANS: A Iron attaches to the hemoglobin in red blood cells, thereby supporting the delivery of oxygen to the tissues. 35. Which nutrient helps regulate body temperature, flushes out waste products, and prevents constipation? a. Fats b. Water c. Protein d. Minerals ANS: B Drinking water helps regulate body temperature; lessens the burden on the kidneys and liver by flushing out waste products; helps dissolve minerals and other nutrients, making them more accessible to the body; helps prevent or reduce constipation; and moistens mucosal membranes such as those found in the mouth. 36. Food labels provide nutritional information based on a daily intake of how many calories? a. 1,000 b. 1,500 c. 2,000 d. 2,500 ANS: C Food labels are panels on packaged foods made in the United States and imported from other countries. They contain nutritional facts such as serving size, calories per serving, macro- and micronutrients, and a list of ingredients. The label also includes the daily values based on a 2000-calorie diet. 37. How much of the Healthy Eating Plate do fruits and vegetables occupy? a. One eighth b. One fourth c. One third d. One half ANS: D The Healthy Eating Plate was developed by the Harvard School of Public Health and helps people make food choices and plan portion sizes at mealtimes. It divides a meal plate into portions of fruits and vegetables (half of the plate), whole grains (one-fourth of the plate), and healthy proteins (one-fourth of the plate). 38. Which factor contributes to learning and memory, weight control, mood, health, and safety? a. Adequate sleep b. Insufficient sleep c. Adequate water intake d. Insufficient mineral intake ANS: A Adequate sleep is important for learning and memory, weight control, mood, health, and safety. Sleep deprivation contributes to slips/falls and errors in judgments, including medical mistakes and road accidents. Sufficient sleep is a key to the body’s ability to recuperate from the mental, emotional, and physical work of massage (CDC, 2017; Harvard Medical School, Division of Sleep Medicine; n.d.). 39. Which term means the ability to balance work and leisure time, manage workplace stress, and build good relationships with co-workers and colleagues. a. Occupational wellness b. Compassion c. Balance d. Emotional wellness ANS: A Occupational wellness is the ability to balance work and leisure time, manage workplace stress, and build good relationships with co-workers and colleagues. 40. Which statement defines burnout? a. Physical exhaustion from overstressing muscles during weight bearing exercise b. Emotional exhaustion, depersonalization, and diminished sense of personal accomplishment c. Emotional strain from working with those who are suffering from the consequences of traumatic events d. Mental exhaustion from interactions with people and from educational demands ANS: B Burnout is a state of emotional exhaustion, depersonalization, and diminished sense of personal accomplishment. It results from chronic workplace stress that has not been successfully managed. 41. Approximately how many massage therapists have experienced work-related pain and musculoskeletal symptoms? a. 25% b. 35% c. 50% d. 70% ANS: D Approximately 70% of massage practitioners experience work-related pain and musculoskeletal symptoms. Common pain locations were fingers and thumbs, wrists, elbows, and shoulders, followed by the neck and lower back (Albert et al., 2008; Greene & Goggins, 2006; Jang et al., 2006). 42. Which strategy is effective in improving occupational wellness for massage practitioners? a. Increasing repetitive movements performed with the wrist and fingers b. Having an area of one foot of open space around all sides of the table c. Using a table height that allows generation of sufficient downward force d. Stowing bolsters in overhead cabinets to eliminate tripping hazards ANS: C To improve occupational wellness, massage practitioners should evaluate and possibly modify these factors: Have an area of 3 feet (1 meter) of open space around all sides of the table to allow practitioners to stand or sit comfortably in relaxed, efficient, and aligned posture while administering techniques; stow bolsters in easy-to-access locations between knee and waist height, so they can be lifted without bending or reaching; perform massage on traditional wood, carpet with cushioned backing, or foam-backed vinyl flooring, if possible. Antifatigue mats can be placed around the table. use a correct table height to allow practitioners to generate sufficient downward force. 43. Which approach can help alleviate or prevent burnout in massage therapists? a. Refraining from physical exercise because it is stressful b. Avoiding taking continuing education because it is stressful c. Spending as much time alone as possible d. Being part of a positive work community ANS: D Positive interactions with co-workers and talking with peers and supervisors promote career longevity. Therefore, it is vital massage practitioners build and maintain a positive and supportive work community and participate in team-building activities to reduce feelings of isolation. 44. Which wellness domain involves acquisition, development, and creative application of critical thinking? a. Emotional b. Intellectual c. Spiritual d. Social ANS: B Intellectual wellness is the continuous acquisition, development, and creative application of critical thinking in the quest for a more satisfying existence. It involves recognizing one’s own creative abilities and finding ways to expand knowledge and skills. Intellectual wellness allows you to expand your ability to analyze, critique, understand, evaluate, problem solve, predict, and comprehend. 45. Which term means a response of the body due to an environmental, societal, situational, or chemical factor? a. Stress b. Nutrition c. Wellness d. Psychology ANS: A  Stress is the response of the body to demands placed on it by the stressors. A stressor is something that triggers the stress response and include environmental factors (crowding, deadlines, excessive noise, or destructive weather), societal factors (verbal aggression or conflict from family, friends, supervisors, co-workers or customers), situational factors (starting or losing a job, relocating, marriage, or divorce), or chemical factors (stimulants such as caffeine, irritants such as inflammation, and hormone/neurotransmitter imbalances such as thyroid-stimulating hormones and serotonin). 46. Which term means a positive form of stress? a. Social wellness b. Guided imagery c. Eustress d. Distress ANS: C Eustress is perceived as positive and within our ability to meet the demands of the situation—it keeps us focused on a goal, improves performance, and gives us personal satisfaction. 47. Which stress reduction method combines mindfulness meditation with an activity? a. Guided imagery b. Mindfulness-based c. Expressive writing d. Self-affirmations ANS: B Mindfulness-Based Stress Reduction (MBSR) combines mindfulness mediation with an activity. To practice MBSR, focus your attention to present moments and observe bodily sensations and the emotions felt while participating in the chosen activity. 48. Which stress reduction method involves positive statements spoken or read to promote confidence in oneself? a. Guided imagery b. Expressive writing c. Self-affirmations d. Mindfulness-based ANS: C Self-affirmations are positive statements spoken or read to affirm one’s worthiness and value and can be used to facilitate change in the individual using them. Self-affirmations can be used to promote self-confidence and the belief in your own abilities. 49. Which statement describes the social wellness domain? a. Interacting with others through good communication skills and maintaining meaningful relationships b. Choosing a satisfying career and contributing to society through volunteer efforts c. Searching for meaning and purpose of human existence with or without religious affiliation d. Maintaining health through proper nutrition and regular physical activity ANS: A  Social wellness is the positive interaction with others and involves good use of communication skills, developing and maintaining meaningful relationships, valuing diversity and treating others with respect, and creating a social support system. The social support system includes family, friends, teachers, classmates, and others. Social wellness also involves participating in community events such as celebrations and festivals. 50. Which statement describes the spiritual wellness domain? a. Maintaining health through proper nutrition and regular physical activity b. Searching for meaning and purpose of human existence with or without religious affiliation c. Choosing a satisfying career and contributing to society through volunteer efforts d. Interacting with others through good communication skills and maintaining meaningful relationships ANS: B Spiritual wellness is searching for meaning and purpose of human existence with or without religious affiliation. Spirituality is the life lived inside oneself, versus the life lived outside through occupations and social networks. Chapter 05: Evidence-Informed Practice and Research Literacy Salvo: Massage Therapy, 7th Edition MULTIPLE CHOICE 1. Which type of complementary care is one of the most common used by the general public? a. Massage therapy b. Aromatherapy c. Yoga d. Meditation ANS: A Massage, chiropractic, and osteopathic care are among the most common complementary practices utilized by the general public. 2. Which term means making treatment decisions by integrating relevant research, the client’s preferences and values, and the practitioner’s professional expertise? a. Dynamic functioning b. Behavior modification c. Evidence-informed practice d. Integrative–holistic practice ANS: C Evidence-informed practice is a problem-solving approach used when making treatment decisions that integrates relevant evidence, the client’s preferences and values, and the practitioner’s professional expertise to achieve desired patient/client goals. 3. Which activity involves the ability to locate, read, understand, and evaluate investigative studies? a. Digital competency b. Massage competency c. Research literacy d. Computer literacy ANS: C Research literacy is cognitive and social understanding of the basic purpose, process, and value of research. Research literacy involves a skill set that includes the ability to locate, read, understand, and evaluate research literature. 4. Which factor is a barrier to evidence-informed practice? a. Knowledge of statistical information b. Lack of information literacy skills c. Requirements by administration to incorporate information d. Preference for computerized sources over information from colleagues ANS: B  Barriers to evidence-informed practice include lack of information literacy skills; lack of research skills; limited or poor access to quality information; lack of time (speed of access); negative staff attitudes and resistance; lack of administrative support; preference for colleagues as information sources over printed or computerized sources; reading barrier (health literacy); language barrier (English language learners); lack of statistical knowledge. 5. Which term means information that supports an idea or conclusion? a. Data b. Placebo c. Variable d. Evidence ANS: D Evidence is information that supports an idea or conclusion. Evidence is used to support or refute arguments, and helps us to make professional decisions by knowing which methods are effective and what is not and how those methods should be applied to achieve documented results (e.g., length of session, frequency of sessions). 6. Which term means systematic inquiry using prescribed methods to validate or refine existing knowledge or to develop new knowledge? a. Abstract b. Research c. Hypothesis d. Evidence ANS: B Research is systematic inquiry using prescribed methods to validate or refine existing knowledge or to develop new knowledge. Research is the backbone of the healthcare profession and can validate, provide efficacy, and innovate treatment protocols. 7. Which type of research emphasizes objective measurements that is analyzed mathematically? a. Systematic b. Predictive c. Qualitative d. Quantitative ANS: D Quantitative research methods are largely objective and results may be replicated. Data is analyzed mathematically, often using statistical analysis and results are expressed in numbers, graphs, or tables. 8. Which term means recorded factual material that is used to validate research findings? a. Data b. Placebo c. Variable d. Evidence ANS: A Data refers to recorded factual material that is used to validate research findings. 9. Which type of research is subjective and narrative-based?  a. Systematic b. Predictive c. Qualitative d. Quantitative ANS: C Qualitative methods are largely subjective and narrative-based. Data is often collected by observations or interviews with open-ended questions to gather information about individual or collective experiences, or common themes. Data is analyzed by summarizing, interpreting, and categorizing commonalities to better understand concepts and their context, and to gain insights on topics not well understood. 10. Which process is used to conduct investigations and pursue knowledge within a field? a. Peer review b. Scientific method c. Secondary sourcing d. Therapeutic outcome ANS: B The research process is used to conduct investigations and pursue knowledge within a field. The terms research process and scientific method are often used interchangeably. In general, the research process includes (1) formulating a research question, (2) reviewing the literature, (3) selecting the best method to answer the research question, (4) conduction the experiment or investigation, (5) collecting the data, (6) analyzing the data, (7) presenting the research results or findings. 11. Which statement describes the concept of reliability in research? a. Alternative treatment was compared to the treatment of interest b. Test result is close to the actual value of what was measured c. Same test result is likely to occur if the experiment is repeated d. Degree to which a test measured what it was supposed to measure ANS: C Reliability means consistency and indicates that if the experiment or test was repeated by the same or different investigators, the results would be the same. 12. Which statement describes the concept of validity in research? a. Test result is close to the actual value of what was measured b. Alternative treatment was compared to the treatment of interest c. Same test result is likely to occur if the experiment is repeated d. Degree to which a test measured what it was supposed to measure ANS: D Validity means accuracy and indicates that the experiment measured what it was supposed to measure. 13. Which term means a personal tendency toward a preference or outcome? a. Bias b. Sample c. Variable d. Blinded  ANS: A Bias is a researcher’s preference for one outcome over other outcomes. In research, bias may occur when the investigator(s) select or encourage one outcome or answer over others. 14. During which process are research participants advised of the risks and benefits of the experiment? a. Data collection b. Results analysis c. Health history d. Informed consent ANS: D Risks and benefits are disclosed to participants during the informed consent process. 15. Which part of research is the presumed outcome of an experiment? a. Results b. Sample c. Hypothesis d. Conclusion ANS: C A hypothesis is the presumed outcome and what is expected to occur given a certain set of circumstances. Hypotheses are largely derived from the literature review. 16. Which part of research is anything that can be changed in an experiment? a. Sample b. Variable c. Result d. Analysis ANS: B A variable is anything that can vary or change in an experiment and this change can be measured. Two main variables are independent and dependent. 17. Which factor is the condition manipulated or controlled during an experiment? a. Dependent variable b. Independent variable c. Qualitative data d. Quantitative data ANS: B The independent variable is the condition manipulated or controlled and is the presumed “cause” of the effect. The independent variable is stable, unaffected, and independent of other variables in the experiment. An example of an independent variable is massage. 18. Which factor is the presumed effect from the procedure used in research? a. Dependent variable b. Independent variable c. Qualitative data d. Quantitative data ANS: A  The dependent variable is the variable that is dependent on other variables and is the variable that is expected to change as a result of the independent variable. The dependent variable is the presumed effect. 19. Which step occurs after the research question has been formulated? a. Participant recruitment b. Variable determination c. Method determination d. Literature review ANS: D A literature review represents existing scholarly works with the aim of discussing all published information about a specific topic or research question. These are often found in the professional literature and academic journals. 20. Which term means the steps taken to conduct the research experiment? a. Data b. Conclusions c. Methods d. Hypothesis ANS: C Methods are the steps taken to conduct the experiment. The researchers may choose to use questionnaires, surveys, polls, interviews, observations, archival records, or other instruments. Methods include details about the participant selection, if a control group was used, if group selection was randomized. 21. Which research term means a group of individuals used to represent the entire population? a. Data b. Sample c. Variable d. Hypothesis ANS: B Experiments are usually conducted on a small group of individuals called a sample. A sample is a subset of a population that is used to represent the entire population as whole. Research makes inferences about the population studied from the sample from which it was drawn. 22. Which term means characteristics disqualifying participants from being in an experiment? a. Qualitative data b. Exclusion criteria c. Independent variables d. Dependent variables ANS: B Exclusion criteria are characteristics disqualifying participants from inclusion in the experiment. 23. Which term means a group of people that receives something other than the treatment studied during an experiment? a. Sham  b. Independent c. Treatment d. Control ANS: D The control group does not receive the intervention under investigation or receives comparison or alternative treatment. The comparison treatment can be a sham treatment or an alternative treatment. 24. Which statement describes delimitations in an investigative study? a. Boundaries the researcher sets b. Potential weaknesses or problems c. Things the researcher accepts as true d. Variables outside of the study ANS: A Delimitations are boundaries the researcher sets for the study that are under their control. Examples of delimitations include the research question, choice of variables, and the population chosen for the study. 25. Which group evaluates and approves a study before it begins, monitors the study throughout the data collection, investigates any incidents that occur during the study, and evaluates the final report? a. Community Action Board b. Institutional Review Board c. Human Rights Commission d. Commission for Liberty and Justice ANS: B After the methods are determined and before participant recruitment begins, the study must be approved by a committee such as an Institutional Review Board (IRB). This process protects participants from undue harm caused by involvement in study, as well as monitors the study throughout data collection, investigates incidents occurring during the study, and evaluates the final report. 26. When do research scientists analyze data? a. During the design of the research study b. After it has been collected c. Before it has been collected d. During the determination of the hypothesis ANS: B Once data are collected, the researcher analyzes the data, aligns it with the research question, and then draws conclusions. 27. Which term means the outcome of an experiment? a. Results b. Criteria c. Variables d. Hypothesis ANS: A  Results are the study’s outcome. Research results are also called findings. Results apply only to what was found after data analysis. 28. Which method is in the weakest level of the hierarchy of evidence? a. Longitudinal studies b. Descriptive studies c. Case reports d. Expert opinions ANS: D Level 5 is the weakest level of evidence and includes expert opinions, the opinions of respected authorities, or reports of expert committees. Expert opinions are from people who have acquired vast amounts of information and offer experienced views on specified topics, but they may become biased about what works and what does not. 29. What do descriptive studies illustrate? a. Outcomes in relation to a suspected risk b. Phenomenon or characteristics of a population c. A personal experience d. Opinions of respected authorities ANS: B Descriptive studies describe the phenomenon or characteristics of a population (e.g., demographics, educational levels, socioeconomic factors). 30. Which term means a description of how dependent variables were measured in a study? a. Abstract b. Hypothesis c. Operational definitions d. Conceptual definitions ANS: C Operational definitions describe how dependent variables were measured. For example, if blood pressure is a dependent variable, the study must describe how blood pressure was measured, including what device used and where on the participant’s body measurements were taken. 31. What does the D in the IMRaD format stand for? a. Data format b. Dependent variable c. Distribution d. Discussion ANS: D In general, research papers have four main sections and follow the “IMRaD” format. The IMRaD stands Introduction, Method, Results, and Discussion. 32. Which term describes a system used to rank research based on strength of evidence? a. Research literacy b. Quantitative research c. Hierarchy of evidence  d. Evidence-based practice ANS: C Although all research evidence is valuable, some studies are given more “weight” when informing a treatment plan. Hence, a ranking system is needed to evaluate their strength. The ranking system, called a hierarchy of evidence, is often denoted by a pyramid, with the strongest evidence is near the peak and the weakest evidence near the wide base. 33. Which type of research is a critical analysis of many studies? a. Anecdote b. Cohort study c. Case report d. Systematic review ANS: D A systematic review (SR) is a critical analysis of many studies. It is in level 1 of the hierarchy of evidence. 34. Which type of research follows a group of participants across a period of time? a. Anecdote b. Cohort study c. Case report d. Metanalysis ANS: B A cohort study is a longitudinal study, which follows a group of participants across a period of time. A cohort is a group of individuals who share a common characteristic such as birth, occupation, geographic area, or condition such as they consumed tobacco products or received a certain vaccine. The comparison cohort does not share the characteristic studied and the study looks for differences between groups. 35. Which approach is a description of personal experience? a. Metanalysis b. Cohort study c. Case report d. Anecdote ANS: D An anecdote is a description of a personal experience. Without controls and comparisons, we do not know to what extent the intervention contributed to the participants’ outcomes, if at all. 36. Which result occurs from a combination of formal education, knowledge accumulation, past treatment decisions, and past patient care outcomes? a. Research methodology b. Professional expertise c. Research literacy d. Clinical preferences ANS: B  A practitioner’s professional expertise is a combination of formal education, knowledge accumulation, previous treatment decisions, and past outcomes. Development of expertise occurs when theoretical and practical knowledge are “tested” and “refined” in actual professional situations, which leads to improved judgment and improved quality of client care. 37. Which description fits a massage professional whose behavior is rule-governed and inflexible? a. Novice b. Competent c. Proficient d. Expert ANS: A Novices, or beginners, are new students who have no experience in situations they are expected to perform. Novices usually lack confidence, and their professional behaviors are rule-governed and relatively inflexible. 38. Which description fits a massage professional who perceives situations as wholes rather than chopped up parts? a. Novice b. Competent c. Proficient d. Expert ANS: C Proficient practitioners perceive situations as wholes rather than chopped up parts. Because of this perspective, they can better predict what might happen in given situations and what needs to change to alter outcomes. 39. Which aspect of evidence informed practice impacts client adherence and compliance? a. Including client preferences b. Researching client conditions