NBCOT
General Rehab: When advising a patient with a higher level SCI how to provide pressure relief seated in their wheelchair for the first time, which is NOT the safest recommendation? A. Lean forward so their chest is resting on their thighs. B. Tilt the back of the chair as far back as possible. C. Lean to the right, then to the left. D. Get back in bed and perform bed mobility to the left and right.
A
Management & Evidence: Recommended counter top heights should be no higher than what according to the American National Standards Institute: A. 31 in B. 35 in C. 33 in D. 29 in
A
Neurological: A person experiencing contralateral hemiplegia, homonymous hemianopsia, and aphasia would most likely have a CVA affecting the A. Anterior cerebral artery B. Middle cerebral artery C. Posterior cerebral artery D. Basilar artery
A
Neurological: At what level does a spinal cord lesion have to occur in order for the patient to not be able to use tenodesis? A. C5 B. C6 C. C4 D. C7 E. C8
A
Neurological: If a patient has a stroke in the left hemisphere, which of the following will be a deficit? A. Receptive aphasia, expressive aphasia, or both B. Lack of insight and unawareness of deficits C. Left visual field cut D. Left hemiplegia
A
Orthopedic: Range of motion to the hand of a tetraplegia patient is performed in a specific way to facilitate tenodesis grasp. Which is correct? A. Passive opening of the fingers when the wrist is flexed and closing of the fingers when the wrist is extended. B. Passive closing of the fingers when the wrist is flexed and opening of the fingers when the wrist is extended. C. Passive closing of the fingers when the wrist is flexed AND closing of the fingers then the wrist is extended
A
Orthopedic: What is NOT a sternal precaution for patients following heart surgery? A. No pushing, pulling, lifting more than 4 lbs for 6 weeks following surgery B. No pulling or pushing up with arms when transferring C. No shoulder elevation above 90 degrees D. No driving for 4 weeks post-operative
A
Orthopedic: Which of the following is a hip precaution for the first 8 weeks after a hip replacement? A. Do not cross legs or ankles B. Do not bend knee C. Do not lay on back D. Do not lay on stomache
A
Pediatric: Marissa is a typically developing child who is able to demonstrate true sucking while feeding. How old is Marissa? A. 4 months B. 6 months C. 12 months D. 8 months
A
Pediatrics: You are evaluating a 24-month-old child who has just been referred to OT. She uses alternating steps to walk while holding an adult's hand, can open a book and turns a bottle over to dump out an object. She can pick up 2 cubes with 1 hand but cannot stack 2-3 blocks. She creeps up a couple of steps but cannot walk up steps without support. When presented with a string and beads she doesn't pick either up or attempt to slide beads on. When presented with a marker and a piece of paper she makes a few large scribbles on the paper. Based on this information, what developmental age range would you place this child at? A. 12-14 months B. 12-24 months C. 9-11 months D. 15-18 months
A
Psychology: A middle-aged woman comes into the hospital with auditory and visual hallucinations, delusions, disorganized speech and grossly disorganized behavior. She has a history of schizophrenia. What is known about these particular presenting behaviors? A. They are positive symptoms which can be reduced with medications B. They are positive symptoms which can not be reduced with medications C. They are negative symptoms which can be reduced with medications D. They are negative symptoms which can not be reduced with medications
A
Management & Evidence: A person who suffered a TBI exhibits eye opening to pain, no motor response, and no verbal response. What is their Glascow Coma Scale? A. 4 B. 0 C. 6 D. 2
A A pt who exhibits.... Eye opening to pain = 2 points on the coma scale No motor response = 1 point No verbal response = 1 point Total = 4 points A score of 8 or less is indicative of a server brain injury
General Rehab: A client is hypertonic in their right UE distal to the elbow secondary to a CVA. The OTR facilitates the client in to a right side-lying position for therapeutic exercise. What is the primary benefit of facilitating this position? A. To reduce tonicity B. To increase comfort for the client C. To practice safe bed mobility D. To allow for set-up of an electric stimulation unit
A By side-lying on the affected side, the client is weight bearing through the hypertonic limb which has been shown to be effective in reducing tone. While answers A,C, and D may all be reasons why a client would be in a side-lying position they are not the primary reasons in this scenario.
General Rehab: Caution MUST be taken when considering the use of electrical stimulation with which of the following patients? A. A patient with cancer. B. A patient with severe arthritis. C. A patient taking medication for high blood pressure. D. A patient with a broken bone.
A E-Stim should not be applied directly over or in proximity to active cancer. There are no warnings or contraindications for e-stim related to arthritis or broken bone. A pt with uncontrolled high blood pressure should not receive e-stim, but those on medication to regulate hypertension are safe to receive this treatment.
Neurological: You are treating Mr. Thomas in outpatient rehab following a stroke, who displays right hemiplegia, asymmetrical jaw movement during secondary to left-sided facial weakness, and medial strabismus/ esotropia of left eye. What cranial nerves are affected and what area of the brain was affected by the stroke? A. CN V, CN VI, pons B. CN III, Posterior Cerebral Artery C. CN V, CNVIII, medulla D. CN II, Anterior Cerebral Artery
A Facial nerve palsy Abducens nerve palsy
Orthopedic: An OTR is evaluating and patient and notices that the patient's PIP joint is hyperextended and the DIP joint is flexed. What best describes this condition? A. Swan neck deformity B. Subluxation deformity C. Boutonniere deformity D. Mallet deformity
A Swan neck - PIP hyperextended and DIP flexion Boutonniere- PIP flexion and DIP hyperextended Mallet- DIP flexed/drooping
Management & Evidence: When working with patients with mental health diagnoses it is important to take the individual's personal desires into accordance when making therapy goals. Which OT assessment is not in accordance with the Model of Human Occupation frame of reference? A. Allen Cognitive Level Screen (ACLS) B. Self-Assessment of Occupational Functioning (SAOF) C. Interest Checklist (IC) D. Role Checklist (RC)
A The ACLS is an assessment that looks at cognitive disability and predicts how individuals will function in the community, as well as predict unsafe behaviors associated with specific cognitive levels. The SAOF, IC, and RC are self-report assessment that allow for personal reflection.
Management & Evidence: When treating patients in an inpatient rehabilitation setting which of the following is the most common assessment used to address daily functioning? A. FIM B. Barthel Index C. Katz index D. Klein-Bell activities of daily living scale
A The FIM is a basic measure of the need of assistance for a pt it is also used in the Inpatient Rehab Facility-Pt Assessment Instrument (IRF-PAI) which is used to determine length for insurance companies.
General Rehab: Which of the following is an appropriate assessment to administer to a teenager (13-18 years old)? A. Beery VMI (Visual Motor Integration) B. PDMS-II (Peabody) C. SIPT (Sensory Integration & Praxis Test) D. Battelle Developmental Inventory, 2nd edition
A VMI = ages 2 y 0 m - 18 y 11 m Peabody = 1 m - 71 m ( 5 y 11 m) SIPT = 4 y - 8 y Battelle = Birth - 8 y
An OTR® completes a work tolerance screening with a worker at a manufacturing plant. What should be included in the documentation? A. Weight limits for various job tasks B. Worker's reported desire to remain in the job C. Worker's ability to perform ADLs D. Financial issues the worker experiences
A Work tolerance screenings identify limitations in the worker's ability to meet the activity demands of essential job functions, such as weights, distances, forces, angles, repetitions, and tools.
Neurological: You are working with a patient that you suspect has metamorphopsia . What would be an effective way to screen for this visual disorder? Select all that apply: A. Present the patient with several objects. Ask the patient to estimate each objects size and weight by observation alone. B. Present the patient with a puzzle of shapes with differing sizes. Ask the patient to put the correctly sized shape into its corresponding cut-out shape. C. Give the patient a photo of him or herself and ask the patient to identify the person shown. D. Show the patient photographs of detailed scenes E. Determine whether the patient has difficulty matching the correctly sized shape to its corresponding cut-out space.
A, B, & E Metamorphopsia involves a visual disortion of the physical properties of onjects so that objects appear bigger, smaller, or lighter than they really are
General Rehab: All of these are indications for physical agent modalities except: A. Before traction and soft tissue mobilization B. To increase circulation C. Prior to active exercise, passive stretching, and joint mobilization D. After acute inflammation to increase tissue healing
B
General Rehab: To facilitate increasing independence in lower body dressing in a patient with a TL-spine precautions and wearing a TLSO, which intervention is contraindicated? A. Provide the patient with a reacher. B. Instruct the patient to raise the head of the bed 50 degrees so they can reach their feet prior to donning the TLSO. C. Teach effective bed mobility techniques to assist in rolling. D. Use leg straps to help pull legs into a circle sit.
B
General Rehab: When evaluating a client for a wheelchair you determine they are appropriate for a regular/adult wheelchair. The dimensions of the chair will be _____ inches wide by ______ inches deep by ______ inches high, and the correct hip angle is ____, knee angle is ______ and ankle angle is ______. A. 18 x 18 x 20 and 90, 80, 90 B. 18 x 16 x 20 and 90, 90, 90 C. 18 x 20 x 16 and 90, 90, 90 D. 18 x 16 x 20 and 80, 80, 120
B
General Rehab: Which is not a contraindication for superficial thermal agents? A. Deep-vein thrombosis B. Chronic inflammation C. Impaired cognitive status
B
General Rehab: Your patient has just come to your inpatient rehab unit s/p right distal femur fracture. The doctor has ordered the patient to be PWB (partial weight bearing). What percent body weight can the patient place on the operated limb? A. 10-15% B. 30% C. 75-100% D. 50%
B
Management & Evidence: An OTR or COTA is educating a client with chronic obstructive pulmonary disease how to incorporate pursed lip breathing with self care tasks. The MOST EFFECTIVE breathing technique to incorporate during a dressing task to decrease symptoms of dyspnea is: A. Promote the client to breathe in when lifting legs into pants B. Encourage the client to breathe out when pulling a shirt overhead C. Reinforce a daily self-care routine be performed in sitting D. Emphasize the use of a pulse oximeter during lower body dressing
B
Neurological: A person who recently suffered a TBI is aggressive, agitated due to a heightened response and is confused. What Ranchos level is the patient at? A. VI B. IV C. II
B
Neurological: A person with left hemisphere stroke that left him with right side weakness and speech problems. His speech was fluent but lacked content and included paraphasias. His comprehension is intact but his ability to name objects was mildly impaired. The patient shows inability to repeat words or sentences. The communication impairment that he is diagnosed with is: A. Wernick's aphasia B. Conduction aphasia C. Sensory trans cortical aphasia D. Motor trans cortical aphasia E. Broca's aphasia
B
Neurological: An adult patient with a history of right hemisphere CVA would most likely demonstrate which of the following characteristics? A. Slow and labored movements B. Standing up from a wheelchair without locking the brakes C. Information that seemed confabulated D. All of the above
B
Neurological: Which of the following signs and symptoms are the best common factors occurring in Alzheimer's disease? A. Disorganized thinking, delusions, hallucinations, and social withdrawal with an onset early in life B. Progressive mental deterioration consisting of memory loss, confusion, and disorientation C. An inability to read at a level that correlates with the person's overall intelligence D. The inability to plan, to maintain goal orientation, and to make decisions
B
Neurological: You are seeing a patient who shows aggressive behavior and keeps removing his restraints and pulling at his catheter. Pt. lacks short term recall and seems to be acting out based on past events. Pt is unable to complete self-feeding and dressing without maximum assistance. What Rancho level is your pt. functioning at? A. III- localized response B. IV-confused/agitated C. VII- automatic/appropriate D. I - no response
B
Orthopedic: An OT practitioner is fabricating a static splint that will assist with the maintenance of a functional hand and finger position while keeping the soft tissures of the hand in midrange position. Which splint would the OT MOST likely select to address these needs? A. Bivalve cast B. Resting pan splint C. Dynamic extension splint D. Wrist cock-up splint
B
Orthopedic: An OTR is developing an exercise program for a client with Reflex sympathetic dystrophy/Complex regional pain syndrome in her right hand. The client is demonstrating pain, swelling, and stiffness. Which initial exercise plan would be BEST? A. Manually manipulate the wrist and hand to increase ROM B. Gentle active exercise and frequent massage C. Protective sensory reeducation D. Relaxation training
B
Orthopedic: What are the back precautions for someone who has had a lumber fusion? A. No bending, no twisting, log roll to get out of bed. B. No bending, no twisting, log roll to get out of bed, do not carry more than 5 lbs., up 3x a day for a max of 15 min C. No bending, no twisting, no carrying more than 5 lbs. D. No bending, no twisting, no carrying more than 5 lbs, log roll to get out of bed.
B
Orthopedic: Which of the following does NOT describe a proper tip for good body mechanics when sitting? A. Your feet should be flat on the floor. B. Your knees are positioned higher than your hips. C. Work is placed directly in front of you. D. Arms rested on armrests.
B
Pediatric: A child has been referred to you with arthrogryposis multiplex congenita. Which of the following areas would be least important to evaluate and treat? A. ROM B. Trunk Stability C. PROM D. Hand Functions
B
Pediatric: An infant has been referred to you from the doctor with a prescription that says: "DX Cerebral Palsy: OT Evaluate and Treat". What occupation is most important to start with? A. ROM B. Feeding C. Play D. Self Care
B
Pediatrics: A child with tactile defensiveness can probably best tolerate: A. Light touch B. Actively self-applied stimuli C. Stimuli applied when unable to see the source of touch D. Hair brushing
B
Pediatrics: Sensory Integration is... A. Something that begins after age 7 B. The process of turning sensation into perception C. Primarily controlled by the cardiovascular system D. Something that is an "all-or-nothing" response
B
Psychology: After concern is raised among family members, police pick up and bring in a 45 year old man and admit him to the ER. He presents with rapid speech, racing thoughts and impulsive behavior (Last week, he quit his job after 20 years of service). He reports that prior to this episode he felt depressed for about 2 weeks and isn't sure why he went from feeling so down to feeling very out of control. What is his diagnosis? A. Bipolar II B. Bipolar I C. Cyclothymic Disorder
B
Psychology: When working in a long term care facility, you need to evaluate the long term memory of a resident; which of the following methods best evaluates memory of personally experienced events? A. Have the individual state the place, date, and time. B. Ask the individual how he spent New Year's. C. Show the person a series of objects and ask him to recall the objects within 60 seconds D. Ask the client to remember to bring a specific item to the next therapy session.
B
Psychology: Which is NOT true of both Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)? A. Fighting/hostile behavior is common with people who have ODD or CD B. All of the above are true C. Results in a high degree of impairment and antisocial behavior D. Referred to a disruptive disorders E. Behavior causes significant impairment in social, academic, &/or occupational functioning
B
Neurological: You are treating a patient 2 weeks s/p left sided CVA for R sided hemiparesis with Therapeutic electrical stimulation (TES). All of the following are claimed to be benefits from using TES EXCEPT: A. Increased ROM B. Sensory re-education C. Reduction of spasticity D. Improvement of muscle strength
B According to research, the primary benefits of TES do not include anything about resolving sensory deficits that may be secondary to a CVA
Management & Evidence: According to the evidence, which of the following intervention plans is likely to be most effective in preventing falls in older adults? A. Maximize ADL function and improve leisure participation to decrease depression B. A program to assess self-efficacy, physical activity, fear of falling, strength, balance, and environmental risks C. Perform a home evaluation to address environmental hazards D. Designing a home exercise program to improve balance
B All intervention are appropriate, but evidence has shown that interventions addressing multiple risk factors present in the order adult at risk for falls are most effective in the prevention of falls.
General Rehab: When transferring a patient an OT can best protect themselves from injury by doing which of the following? A. Stepping back from the individual B. Keeping the knees bent C. Keeping the back in a flexed position D. Maintaining a narrow base of support
B Allows for anatomical position for a transfer.
Neurological: Which area of cognition can be described as an impaired association with neurological dysfunction including the lack of knowledge about own physical/cognitive-perceptual impairments and/or their functional implications as well as the inability to anticipate difficulties, recognize error, or monitor performance within the context of an activity? A. Attention B. Self awareness C. Motor planning D. Problem solving
B Attention involves several components, for instance the ability to detect/react, the ability to sustain attention for a period of time, the ability to exhibit selective attention or shift attention, and keep track of stimuli during ongoing activity. Motor planning is the ability to execute learned and purposeful activity. Problem solving involves planning and concept. Screening adult neurologic populations.
General Rehab: During the initial ADL evaluation the patient is provided a toothbrush and asked to brush their teeth. The patient begins to brush their hair with the toothbrush. Which behavior is this most likely indicative of? A. Motor apraxia B. Ideational apraxia C. Simultanognosia D. Astereognosis
B Conceptual deficit seen as an inability to use real objects appropriately
Neurological: You are assessing a traumatic brain injury patient and note that the patient has a right eyelid droop. This indicates that the patient has received injury to which cranial nerve? A. Cranial nerve II B. Cranial nerve III C. Cranial nerve VI D. Cranial nerve VII
B Cranial nerve III (oculomotor) controls eyelid movement. A and D are distracters because you could be fooled that the optic (II) or facial (VII) nerves affect eyelid droop.
Management & Evidence: Prior to discharging a patient with a mental illness back into the community it is important to assess how independent an individual will be with IADLs or ADLS and how much assistance they will need. Which assessment does not evaluate how independent an individual will be within their home following discharge? A. Kitchen Task Assessment (KTA) B. Feasibility Evaluation Checklist (FEC) C. Kohlman Evaluation of Living Skills (KELS) D. Executive Function Performance Test (EFPT)
B Feasibility Evaluation Checklist (FEC). The FEC (in the most general sense) measures how acceptable an individual will be as an employee. The KTA, EFPT and KELS all evaluate ADL performance, evaluating cooking, self-care or telephone use in individuals with mental illnesses.
An OTR® is working with a client with chronic obstructive pulmonary disease on therapeutic exercise and how to measure exercise tolerance. The client is performing seated bilateral shoulder flexion with 3-lb weights and rates this activity as "very, very easy." How would the OTR® appropriately grade this activity? A. Change the muscle groups used by switching to shoulder abduction. B. Advise the client to perform the task in a standing position. C. Switch the client to a resistance band. D. Increase the number of repetitions and have the client perform the exercises while standing.
B If the client states that the current exercise is too easy, the OTR would appropriately upgrade the task. Performing these exercises in a standing position uses trunk and leg muscles, thereby increasing the physical demands.
Neurological: When screening for impairments of cranial nerve 5, Trigeminal Nerve, all would be appropriate screens except: A. Detect light touch, sharp touch and hot and cold touch to the patient's forehead, cheek, jaw and chin. B. Place your index and middle finger over the patient's Adam's apple or laryngeal muscles to see if the larynx rises and falls normally as the patient swallows. C. Touch the patient's cornea with a cotton swab to check for a corneal reflex or blink. D. Ask the patient to move his or her jaw from side to side looking for asymmetry of jaw movement.
B Impairments of the laryngeal muscles, or the presence of dysphagia is associated with impairments of the cranial nerve root of cranial nerve 11, Accessory Nerve.
General Rehab: In what age-range are symptoms of multiple sclerosis most likely to emerge? A. 11-19 B. 20-40 C. 50-75 D. 75 and up
B Individual may begin to notice symptoms such as incoordination or paresthesia of limbs, trunk, or face, as well as an overall fatique
Orthopedic: Immediate precautions following a total hip replacement procedure include which of the following? A. No lifting, no bending, no twisting B. No hip flexion beyond 90, no hip rotation, no crossing legs, no adduction and no bending or bringing foot close to hands C. No hip flexion beyond 70, no hip rotation, no crossing legs D. No hip flexion beyond 120, no twisting, no adduction
B No hip flexion beyond 90 No hip rotation No crossing legs No adduction No bending or bringing foot close to hands
Neurological: OT's often times evaluate muscle spasticity. What does muscle spasticity NOT include: A. Changes in response to stretch B. Increase ability to produce appropriate force for a specific task C. Inability to rapidly turn off muscles D. Changes in the intrinsic properties of muscle fibers
B Spasticity includes: Changes in response to stretch, DECREASED ability to produce appropriate force for a specific task, increased latency of activation, inability to rapidly turn off muscles, loss of reciprocal inhibition between spastic muscles and their antagonists, changes in the intrinsic properties of muscle fibers, and inability to generate enough antagonist power to overcome spastic muscles.
Pediatric: An 8-year-old girl is referred secondary to poor handwriting and the OT notices general low muscle tone during evaluation. This is particularly noticeable in the hands due to the decreased prominence and visibility of the knuckles. What activities would be most appropriate to focus on as you begin therapy with this child with a goal of improved handwriting? A. Handwriting tasks at a table/desk B. Finding marbles in therapy putty C. Finding the right pencil grip D. Handwriting on a slanted or vertical surface
B Without the necessary hand strength, the child may not be able to develop the appropriate grip, intrinsic movements, or endurance for handwriting at the first or second-grade level. Practicing handwriting without improving the underlying skills may lead to future bad habits and porr skills.
Management & Evidence: What commonly used theory relating to stroke rehabilitation attempts to retrain normal movement responses to the effected arm? A. Constraint Induced Movement Therapy (CIMT) B. Brunnstrom Movement Therapy Approach C. Brunnstrom Movement Therapy Approach D. Rood and Proprioceptive Neuromuscular Facilitation Techniques
B/C The goal of NDT is a retrain normal movement responses on the patient's hemiplegia side
General Rehab: When evaluating a patient with low ulnar nerve palsy, which is NOT a symptom that would be present? A. Limited extension at IP joints B. Fromont's sign C. Inability to assume intrinsic minus position D. Inability to oppose thumb and 5th digit
C
General Rehab: When working with a patient with motor control dysfunction an occupational therapist can observe the patient during an assessment of basic activities of daily living and instrumental activities of daily living. The therapist must observe how problems in motor control affect motor performance. What other area(s) of patient's performance should the therapist be concerned with? A. Sensation B. Perception C. All of the above D. Medical status E. Cognition
C
General Rehab: Which frequency of ultrasound would most likely be used over areas of the hand? A. 1MHz B. 2MHz C. 3MHz D. 4MHz
C
General Rehab: Which of the following methods is the BEST way to evaluate for a hook grasp? A. Direct the individual to hold a sewing needle while it is being threaded. B. Observe the individual lift a tall glass filled with water C. Have the individual hold a heavy handbag by the handles D. Hand the individual a key to place in a lock.
C
General Rehab: Which one of the following is not a benefit of using Nintendo Wii in burn rehabilitation as an adjunct traditional therapy? A. Increasing motivation B. Recovering from motor deficits C. Fatigue and soreness D. Distraction from pain
C
Neurological: A 90-year-old woman suffered a right CVA and will be receiving therapy in a SNF. Upon evaluation the OT determines that left shoulder is subluxed. The most appropriate approach for treating the subluxed shoulder is: A. Wear a shoulder sling 24 hrs a day to avoid movement in the left shoulder B. Rest the left arm across the patient's lap while in bed and seated in a wheelchair C. Position the arm to avoid traction of the left shoulder muscles while in bed and seated in a wheelchair D. Rest let arm in should extension and adduction
C
Neurological: A patient who has had a CVA presents with the following: loss of sensation and apraxia in LE, has a flat affect, is impulsive, and has difficulty with divergent thinking. What artery of the cortical branch was occluded? A. Middle B. Posterior C. Anterior
C
Neurological: A patient with a lesion in the cerebellum may present with all of the following symptoms except? A. Ataxic movement B. Balance/equilibrium problems C. Apraxia D. Decreased coordination (gross and fine)
C
Neurological: In patients with complete SCI's, which is NOT an appropriate technique to prevent orthostatic hypotension? A. TED hose. B. Abdominal binder. C. Monitor their blood pressure to make sure their systolic BP is above 100. D. Wrapping legs with Ace wraps
C
Neurological: Which of the following are you least likely to observe following a CVA occurring in the middle cerebral artery? A. Sensory deficits B. Language deficits C. Ataxia D. Contralateral hemiplegia
C
Orthopedic: An OT is conducting a Manual Muscle Testing with a patient during an evaluation. The patient can hold the test position against slight pressure in an antigravity position. What is the patient's manual muscle testing score? A. Fair (3/5) B. Fair - (3-/5) C. Fair + (3+/5) D. Good - (4-/5)
C
Orthopedic: Patient with rotator cuff injury had a repair surgery. At what week should the patient start isotonic exercises with Theraband and free weights for strengthening? A. Week 4 B. Week 6 C. Week 8 D. Week 12
C
Orthopedic: Which provocative test would not be used when evaluating De Quervain's tenosynovitis? A. Look for pain with resisted thumb extension or abduction B. Thickening/swelling over first dorsal compartment C. Cozen's test D. Finkelstein's test
C
Orthopedic: While working in the acute care, a pt is referred to you status post CABG (coronary artery bypass graft) via sternotomy. The pt should adhere to the following sternal precautions except... A. Avoid pushing or pulling. B. Avoid lifting over 10 pounds C. Avoid over head activities D. Avoid bending at the hip past 90 degrees
C
Orthopedic: You are treating a patient, Mr. Wonderful, with Carpal Tunnel Syndrome of his right hand. You are taking a conservative treatment approach and plan to have him perform median nerve glides as part of his home exercise program. How would you advise him to perform a median nerve glide exercise? A. None of the exercises listed above are the correct way of performing a median nerve glide. B. Instruct him to perform the following AROM of his right upper extremity in a slow and controlled manner (shoulder extension, abduction, internal rotation; elbow extension; forearm pronation and wrist flexion). Instruct him to hold this position for approximately 10 seconds and repeat 3 times per day. C. Instruct him to begin by making a closed fist with his right hand and bring that fist up, thumb side, close to his face. Next, instruct him to open his hand and extend his elbow and wrist slowly (with a supinated forearm), as if pretending to be playing with a yo-yo. Instruct him to return to the starting position and repeat 10 more times. D. Instruct him to move the fingers of his right hand through the following 5 positions: straight digits, hook fist, composite fist, tabletop, and straight fist. Instruct him to return to starting position and repeat 10 more times.
C
Pediatric: A child has been referred to you from the school system who has observed behavioral difficulties and they believe he may have autism. All of the following evaluations would be relevant except _______ : A. Observation B. Sensory Profile C. MVPT-II D. Bayley Scales of Infant Development-II
C
Pediatrics: An OT designs an evaluation group for adolescents in an eating disorder unit. The activity most useful to assess the clients' task and social skills is: A. Discussions of reasons for admission into unit B. Watching a teen soap opera and discussing problem scenarios. C. Completion of group collage reflecting personal interests D. Cooking a three-course meal to be eaten family-style
C
Pediatrics: How does a typical child with a Brachial Plexus injury present when entering an OT clinic for an evaluation? A. Shoulder internally rotated and depressed with a straight elbow, and the wrist rotated outward B. Shoulder hiking and internal rotation, flexed elbow, and flexed wrist C. Shoulder external rotation, extended elbow, extended wrist D. Shoulder in neutral, elbow flexion, wrist in neutral
C
General Rehab: A patient with a recent hip fracture wants to have grab bars installed in her bathtub to prevent future falls. The occupational therapist recommends the grab bars to be installed: A. 24 inches from the floor B. 33-36 inches from the floor of the bathtub C. 33-36 inches from the floor outside of the bathtub D. At the patient's waist level
C According to ADA recommendations, grab bars should be 33 to 36 inches above the bathroom floor (Grab bars at bathtubs, 2002), not from the bottom of the bathtub
Pediatrics: When initially working with a child with gravitational insecurity, what is not an appropriate intervention? A. Tilt board or trampoline in sitting B. Swinging low to the ground C. Moving backwards in space D. Therapeutic listening
C All of these are appropriate interventions when beginning treatment, except for moving backwards in space - children with gravitational insecurity tend to be frightened of moving backwards and this should not be done until later in treatment after you have gained the trust of the child and he/she has made some gains.
Psychology: You are doing an initial intake with a psychiatric patient who is having a hard time making eye contact, sitting still and is shifting her weight frequently. Based on her history, you note that this is uncharacteristic. She keeps moving her hands in and out of her pockets and then up to her face and the back down. Her speech is fast and pressured. The patient recently had her medications increased and complains that she is more anxious than usual. What could the patient be experiencing? A. Echopraxia B. Hyperactivity C. Akathisia D. Psychomotor agitation
C Echopraxia- is the meaningless imitation of another persons movements so this does not apply. Psychomotor agitation-This would have been a good answer if it were not mentioned in the question that the patient recently had her medications changed. This is excessive motor and cognitive activity that is usually nonproductive and stems from inner restlessness Akathisia- This is the best answer-it is the state of restlessness characterized by the urgent need for movement, usually a side effect of medication. Hyperactivity-Another good option-if the medication change had not been noted as well as the note that this behavior was uncharacteristic. Hyperactivity is described as restless, sometimes destructive activity typically resulting from brain pathology.
Pediatric: Per parental report or therapist observation, a 5-year-old boy fidgets so much that daily routines are interrupted, spins or twirls frequently, and rocks in his chair while performing fine motor tasks. During evaluation, he wants to try all suspended equipment in the room. This most likely points to: A. Low threshold vestibular processing B. High threshold tactile processing C. High threshold vestibular processing D. Low threshold auditory processing
C High threshold vestibular processing, child needs a higher/greater amount of input to register the sensation, therefore seeks out greater input or constant input.
General Rehab: Which patient would be the MOST likely to succeed using a cognitive behavioral approach? A. A patient who does not seem to be motivated extrinsically B. A patient who is both intrinsically and extrinsically motivated. C. A patient with intact processing skills. D. A patient who does not feel socially pressured to change their behavior.
C People change by changing the way they think. The occupational therapist can teach clients to apply logic to produce adaptive change in persons with intact processing skills (i.e. persons with substance use, eating disorders, OCD, or personality disorders). Patients become aware of beliefs and attitudes that result in problem emotions and behaviors.
General Rehab: During an evaluation you test the patient's strength and ROM. The patient's right side is weaker than the left within normal limits. The patient's right upper extremity does not flex above shoulder height. You also observe the patient sitting on the edge of bed and reaching for an item on the floor. Based on the observations and using your clinical reasoning skills, what ADL can you suspect that your patient can do? A. Shower B. Toileting C. LB dressing D. Functional mobility
C Pt needs to be able to reach to the floor without losing balance
Neurological: An OT is providing intervention for a client who had a stroke involving Broca's region in the left hemisphere. This client would have difficulty with: A. A rapid speech pattern B. Both expressive and receptive language C. Expression D. Receptive language
C Pt with Broca's aphasia have slowed labored speech with some apraxia also noted, but they have good receptive language skills unless it is too rapid or lengthy.
How would the OTR® BEST establish service competency? A. Review the COTA®'s documentation of multiple patients whose feeding impairments warranted adaptive equipment, then discuss the outcomes with the COTA®. B. Observe the COTA® educate clients on how to use adaptive feeding equipment to ensure the COTA® instructs clients in the same manner as would the OTR®. C. Compare outcomes by rating the same client's performance with the adaptive feeding equipment at the same level of independence. D. Collect information from various sources, including other therapists, the COTA®'s documentation, and feedback from clients, to determine competency.
C Service competency is defined as "the process of teaching, training, and evaluating in which the OTR® determines that the COTA® performs tasks in the same way that the OTR® would and achieves the same outcomes" (Youngstrom, 2009, p. 943). In this example, both the COTA® and OTR® observe the same client performing a task and rate that performance in a similar manner. Comparing outcomes helps to ensure clients receive care of equal quality.
Pediatrics: The primary role of an Occupational Therapist in sensory integration is... A. Helping the child learn specific skills B. Helping the child develop one strong sense that will overpower their other senses C. Helping the child learn to reorganize their brain D. Helping the child learn to accept that they are different
C Specific skill attainment won't aid in integrating one's skills. You want the child's senses to be in balance. A sensory integration disorder most certainly doesn't ostracize a child from their peers.
An OTR® is working with a client with Down syndrome to develop cooking skills. The client successfully makes a peanut butter and jelly sandwich. Which therapeutic activity would be BEST for the next treatment session? A. A turkey-and-cheese sandwich B. A microwavable dinner C. A grilled cheese sandwich D. A stir-fry vegetable dish over brown rice
C The activity analysis skill here is grading; the OTR® recognizes the success of a multistep cold meal and appropriately upgrades the task to require more complex steps.
General Rehab: Passive stretching to increase ROM should not involve: A. Hold the stretch for 15-30 seconds B. Holding the stretch a few degrees beyond the point of discomfort C. Quick, vigorous movements D. Relief of discomfort immediately after release of stretch
C To increase (and not just maintain) ROM, the limb must be stretched to the point of maximal stretch, which is just a few degrees beyond the point of mild discomfort. This can be assessed by patients verbal or facial indications. The discomfort should not linger after release of stretch (if it does, you may have injured the tissue). The most effective stretch is slow and controlled movement which allows for tissues to adjust gradually. The stretch should be held for 15-30 seconds. Quick movements are counterproductive and should be avoided, as connective tissue will resist the movement as a protective mechanism.
General Rehab: When positioning a patient with hemiplegia in bed, which of the following would NOT be considered one of the recommended bed positioning techniques if lying them on the affected side? A. Uninvolved LE with knee flexed and supported by pillows B. Involved LE with knee flexed C. Involved UE retracted and internally rotated with elbow extended, forearm supinated, wrist neutral and hand open. D. Trunk aligned with head and neck in neutral
C When lying on the affected side the involved UE should be PROTRACTED and externally rotated
Neurological: While doing a chart review of a newly admitted client at a SNF, you see that this person has been admitted for complications following a right CVA of the MCA. What dysfunctions would you typically expect NOT to see based on this diagnosis? Check all that apply: A. Left unilateral neglect B. Depression C. Bilateral motor apraxia D. Lack of judgment E. Aphasia F. Visuospatial impairment G. Anosognosia
C & E
General Rehab: A 62 year old widow, who lives alone, is preparing to be discharged from a SNF after 4 weeks of therapy following a hip replacement. The most important equipment the OT should recommend would be: A. Wheeled walker B. Bedside commode C. Weighted hairbrush D. Long handled reacher
D
General Rehab: An individual had a coronary artery bypass graft 5 days ago, his cardiologist approved his activities at a MET level of 2-3. What would be an appropriate activity for this individual? A. Vacuuming. B. Showering standing. C. Grooming at the edge of bed. D. Grooming while standing at the sink.
D
General Rehab: Handling techniques used in the NDT approach are utilized to obtain all of the following except A. Normalization of movement patterns B. Increasing range of motion C. Facilitation and inhibition of muscle groups D. Increasing associated reactions
D
General Rehab: Which is not precaution for patient in several weeks after having implanted pacemaker? A. Not pull or push B. Not raise the affected arm over your shoulder C. Not to lift more than 5lb D. Not bend hip more than 90 degree
D
General Rehab: Which of the following hemoglobin levels indicate a safe reading to get a patient up out of bed, in an acute setting? A. 3.0 L B. 5.0 L C. 8.0 L D. 12.0 L
D
General Rehab: Which of the following is not a warning sign of Deep Vein Thrombosis? A. Skin that look pale or blue and is cold to touch B. Shortness of breath or chest pain C. Swollen or red areas that could be warm to touch in the groin, heel or calf D. Shooting pain running up and down the body
D
Management & Evidence: Working in a SNF setting, you notice a patient is fatigued and seems more weak then usual. After weighing the patient, you determine that they have lost 9 lbs in the past week. What course of action should you take? A. Notify nursing and patients physician B. Consult the dietitian C. Discontinue the exercise and activities portion of intervention and focus on discussion/observation. D. All of the above
D
Neurological: A person who is not able to see in the left lower quadrant of each eye is suffering from: A. Right homonymous hemianopsia B. Left homonymous hemianopsia C. Pie in the sky syndrome D. Pie on the floor syndrome
D
Neurological: A recent CVA patient exhibits no active range of motion in her left upper extremities and presents with some cognitive deficits. The best intervention approach to facilitate muscle activation includes: A. Ultrasound B. E-Stim C. Ice pack D. Vibration
D
Neurological: Mr. Smith is a 76 y/o who was admitted to the hospital and presented with the following symptoms during the evaluation: paralysis of the L UE, hemiparesis of L LE, decreased light touch sensation on L side, and kept his head turned to the R side even when asked to look to the left. His speech was slurred when answering questions, and he was distracted easily by noises from outside his room. Based off these symptoms, which cerebral artery was occluded and led to Mr. Smith's CVA? A. Left Middle Cerebral Artery B. Left Anterior Cerebral Artery C. Right Anterior Cerebral Artery D. Right Middle Cerebral Artery
D
Neurological: There are several complications that can occur after a stroke including all of the following EXCEPT: A. Apraxia B. Depression C. Shoulder pain/subluxation D. Anxiety
D
Orthopedic: A patient presents to your outpatient facility several weeks after a recent 2nd digit compression fracture. Surgery was completed and several pins were placed in the finger to provide stability. The digit is noticeably swollen and lacks both passive and active range of motion. Upon evaluation you find that his grip and pinch strength are much lower than those in his none affected hand and that he is unable to make a full fist. What would be your first priority with this patient? A. Providing resistive strengthening exercises to increase grip strength B. Providing manual therapy to stretch the shortened muscle fibers and increase ROM C. Providing ultrasound to the affected digit to decrease pain D. Providing the patient with a compression garment and strategies to reduce edema at home
D
Orthopedic: All of the following are good suggestions to provide a patient who is returning home after hip surgery, except: A. Sit in a high stool when working at the kitchen counter. B. Remove all throw rugs. C. Use a rolling basket or utility cart when doing laundry. D. Place the most used kitchen items on bottom shelves and cabinets under the counter.
D
Orthopedic: Which of the following would be the LEAST important to stress to a patient following back precautions? A. Do not bend B. Do not lift more than 5 pounds C. Do not twist trunk D. Do not dress without supervision
D
Pediatrics: A 4 year old patient presents with bruises and parents complain of their clumsiness. The patient is difficult to understand because his speech is inarticulate and jumbled. You observe the child running around the room and jumping from item to item without an apparent plan or goal for play. You suspect the child has dyspraxia. What standardized test would be the most comprehensive for assessing the child's praxis skills. A. BOT-2 B. Peabody C. Sensory Profile D. SIPT
D
Neurological: You are working with a patient who sustained a Traumatic Brain Injury. You have been practicing self-care tasks for several sessions and the patient has shown carry-over for relearned familiar tasks. On some occasions they can tell you where they are and they inconsistently recognize who you are. They are able to follow simple directions but require moderate assistance for problem solving during tasks and maximum assistance for new learning. They are unable to identify their own impairments, but have begun to verbalize expressions appropriately in familiar, structured situations. Based on the above information, at which Rancho Level of Cognitive Functioning would you consider this patient to be functioning? A. Level IV B. Level V C. Level VII D. Level VI
D Confused Appropriate
Neurological: Which of the following methods is INCORRECT when working with a TBI patient with a Rancho Level IV? A. Work in a quiet environment with minimal distracters B. Maintain a predictable daily structure and routine C. Be calm and confident in your approach with the patient D. Maintain the activity despite agitation from patient
D During this stage of recovery, we want to decrease the pt's agitation by attempting to normalize the environrment and providing consistency and predicability that counters their confusion. If a pt becomes agitated or restless during an activity, change the activity or move to another environment.
Orthopedic: Which of the following actions does not violate precautions during the first six weeks following lumbar spine surgery? A. Checking the car's blind spot while driving. B. Lifting a 2-year-old child out of the swing at the playground. C. Reaching down to tie one's shoes. D. Sitting with your hips above your knees and feet planted on the floor.
D No twisting No lifting greater than 10 lbs No bending
A patient in the early stages of amyotrophic lateral sclerosis (ALS) presents with weakness in the thenar eminence. During which ADL task would the evaluating OTR® MOST LIKELY observe the effect on function? A. Transferring from the bed to the bedside commode B. Taking a sip from a glass of water C. Reaching overhead to don a T-shirt D. Squeezing toothpaste onto a toothbrush
D Typical early signs of ALS are distal, with weakness of the small muscles of the hand being the most typical initial symptom. The muscles that make up the thenar eminence are responsible for opposition of the thumb. Squeezing toothpaste and holding a toothbrush require grasp-and-pinch patterns that involve thumb opposition.
Orthopedic: A patient with left-sided hemiplegic stroke has a non-functional right hand with a mildly increased muscle tone in the flexor muscle groups. The patient has been using a hand splint to prevent joint deformities. The hand splint should maintain the hand in a position of: A. Slight extension of the wrist, MCPs and IPs joints B. Slight flexion of the wrist, MCPs and IPs joints C. Slight extension of the wrist, MCPs and flexion of IPs D. Slight flexion of the wrist, IPs and flexion of MCPs E. Slight extension of the wrist, IPs, and flexion of MCPs
E
Orthopedic: For an individual with RA, treatment should include: A. Adaptive equipment B. Joint protection education C. Low impact exercises D. Community resources E. All of the above
E
Psychology: When treating a patient with a mood disorder who is severely depressed or hypermanic, which treatment strategy is recommended? A. Unstructured group activities B. Complex activities that take multiple days to complete C. Simple repetitive activities D. Concrete, tangible, and short-term activities E. A & C F. B & D
F
