✓NBCOT Questions #14: 731-830 (7/18/19)

DK- An OTR® is working with a client in the active phase of C8 spinal cord injury. What is the BEST method of preventing heterotopic ossification in the client? A. Low-load prolonged stretch B. Maintenance of joint ROM C. High-low limited stretch D. Application of leg wraps

The right answer is B Heterotopic ossification refers to the growth of bone in abnormal anatomic locations and is best prevented with joint ROM and medication routine. A, C: Stretching alone is generally not adequate to increase full joint ROM. D: Leg wraps do not address ROM and are more appropriate for preventing orthostatic hypotension.

A client with T1 spinal cord injury exhibits headache, sweating, congestion, hypertension, and bradycardia. What is the client MOST likely experiencing? A. Spasticity B. Autonomic dysreflexia C. Orthostatic hypotension D. Hypertonia

The right answer is B This combination of symptoms describes autonomic dysreflexia. The symptoms would prompt an OTR® to sit the client upright and remove any noxious stimulus. A, D: Spasticity and hypertonia describe muscle conditions. C: Orthostatic hypotension is characterized by a drop in blood pressure.

X- An OTR® is working with a client population with severe intellectual disabilities. What risk factor MOST predisposes this client population to pneumonia? A. History of smoking B. Antibiotic overuse C. Aspiration of food D. Chest surgery

Among people with severe intellectual disabilities, the most frequent cause of pneumonia is aspiration of food or liquids. A, B, D: Smoking, antibiotic use, and chest surgery are all risk factors for pneumonia in the the general population.

A client with multiple sclerosis (MS) presents with balance deficits and impaired lower-body ADL resulting from increased spasticity in the bilateral lower extremities. The OTR® wants to promote safety during bathing tasks, particularly the parts of the task that require standing. What might the OTR® FIRST suggest? A. That the client maintain at least 90° of hip flexion on a shower chair B. That the client use a long-handled bath sponge to reach the lower legs and feet C. That the caregiver be instructed in stretches to the lower extremities D. That the client place one foot at a time on a small stool while washing

The right answer is A A addresses both the balance deficits and the spasticity that interfere with lower-body ADLs. By sitting down to wash, the client reduces the risk of falls, and flexed hips may lessen spasticity in the lower extremities. B: Using a long-handled bath sponge is a compensatory strategy that does not help decrease the pain and discomfort associated with spasticity. C: Stretching helps decrease spasticity, but this option also reduces independence. D: This option is an environmental modification that may promote hip flexion but does not address the balance impairments and may further compromise the client's balance.

A worker participating in back-neck rehabilitation is receiving education on proper standing workstations. The worker is required to move 10-lb discs onto a dowel. Which design element should be considered for the client's workstation? A. Workstation height should allow some elbow extension during the task. B. The workstation should enable the worker to sit or stand during the task. C. The workstation should enable the worker to reach overhead during the task. D. Workstation tools should be placed beyond arm's reach during the task.

The right answer is A A standing workstation is ideal for tasks requiring downward force; heavier tasks should be done with some elbow extension to minimize forces applied to the elbow musculature. B: Sitting is not recommended during heavy lifting tasks. C: Repetitive heavy lifting overhead is not recommended. D: Tools used during tasks should be kept within arm's reach for ease of access.

X- A generalist OTR® is working with a teenager with developmental disabilities who hopes to acquire a driver's license. Which intervention MOST appropriately addresses this client's community mobility needs? A. Training to improve the client's comprehension of travel rules tested in the licensing process B. Practice in driving skills in the OTR®'s vehicle in the school parking lot C. Practice in handwriting skills to improve the client's communication about driving skills D. Use of cognitive-behavioral therapy to address the client's beliefs about the ability to drive

The right answer is A AOTA's (2010) "Statement on Driving and Community Mobility" states that occupational therapy intervention for people with developmental disabilities may include evaluation, education, and training in preparation for obtaining a driver's license. B: On-road driving practice would require specialist training as a driver rehabilitation specialist. C: Practice in handwriting skills is unrelated to community mobility skills. D: No indication is provided that the client's beliefs about ability to drive need to be addressed.

X- An older adult client with age-related macular degeneration presents for evaluation and demonstrates difficulty reading and signing consent forms. What visual function should the OTR® evaluate first? A. Visual acuity B. Tolerance to glare C. Visual field D. Visual scanning

The right answer is A Age-related macular degeneration causes loss of central visual acuity, resulting in difficulty discriminating small visual details required for reading and writing. B, C, D: Tolerance to glare and visual field and visual scanning are not characteristic of age-related macular degeneration.

Performing a functional transfer with a client with CVA, the OTR® blocks the client's affected knee and instructs the client to reach for the desired surface and move toward the stronger side. What transfer technique does this BEST describe? A. Assisted stand pivot B. Bent pivot transfer C. Maximum assist transfer D. Dependent lift transfer

The right answer is A An assisted stand pivot is used to move a client from one surface to another. B: This transfer involves equal weight bearing between both lower extremities and knees bent. C: Because the client is standing and performing the primary movements required for transfer, the client is not likely requiring maximum assistance from the OTR®. D: In a dependent transfer, the OTR® (or device) is completing the entirety of the work.

X- Retired NBCOT® Question An OTR® is completing a wheelchair assessment for an adult client who has progressive cerebellar degeneration and requires the use of a power wheelchair for mobility. What type of control switch would be MOST BENEFICIAL for enabling this client to independently operate the wheelchair? A. Sip and puff B. Joystick C. Chin-activated toggle D. Proximity-sensing microswitch

The right answer is A Cerebellar degeneration results in loss of balance and coordination. A sip-and-puff control switch would allow control of the power wheelchair without the client needing to use coordination. B, C, D: All of these control switches require some degree of fine motor and upper-extremity coordination to operate. Cerebellar degeneration will result in further decline of coordination, and these would be unusable switches for the client.

An entry-level OTR® working in an outpatient rehabilitation clinic is evaluating a client who was recently hospitalized for dehydration and subsequently diagnosed with mild cognitive impairment. The client lives alone in an independent living facility. Before admission, the client was independent in ADLs and light homemaking and active in community and social activities, including driving independently. The client reports no crash record and no violations or citations but avoids night driving, highway driving, and driving in rush-hour traffic or heavy rain. By what means would the OTR® MOST APPROPRIATELY gather background information on the client's fitness to drive? A. Contact the Department of Motor Vehicles to verify the client's driving history, do a chart review, and gather collateral information. B. Do a chart review, and ask for a copy of the client's driver's license. C. Do a chart review, and interview a close relative about the client's driving skills and avoidance behaviors. D. Interview the client about the client's driving experiences and skills.

The right answer is A Collateral and background information from all these sources are necessary to form a comprehensive picture of the client's fitness-to-drive background. B, C, D: These data sources will not provide comprehensive background information on fitness to drive.

When fitting a client to a wheelchair, why is it important to ensure that the wheelchair has appropriate seat depth? A. To distribute body weight along the entire sitting surface B. To maintain the thighs in a position parallel to the floor C. To keep the depth of the chair as small as possible D. To provide support and alignment for the upper extremities

The right answer is A Distributing body weight along the sitting surface (along the entire length of the thigh to just behind the knee) helps to prevent pressure sores on the buttocks and the lower back and to attain optimal muscle tone normalization to assist in prevention of pressure sores throughout the body. B: Wheelchair seat height, rather than depth, determines thigh position in relation to the floor. C: If the seat depth is less than 1 to 2 inches away from the bent knee, the client can be at greater risk for pressure sores. D: Support and alignment for the upper extremities is an objective for armrest height, not seat depth.

Retired NBCOT® Question An OTR® working in an acute care hospital has completed the initial self-care evaluation with a patient who has had a recent TBI and is functioning at Level VI (Confused-Appropriate) on the Rancho Los Amigos scale. During grooming and hygiene tasks the patient is able to stand at the sink with stand-by assistance, is easily distracted and consistently requires verbal and tactile prompts. The OTR® observed that the patient put toothpaste on a washcloth when preparing to brush teeth and attempted to brush hair with a toothbrush. Additionally, the OTR® noted that the patient has minimal spontaneous functional movement of the left upper extremity and uses synergistic movements when asked to grasp and hold objects. What information about the patient is MOST IMPORTANT to document in the evaluation? A. Factors affecting performance B. Level of family interaction with the patient C. Projected time frame for recovery D. Scores from a standardized perceptual assessment

The right answer is A Documenting factors that affect performance is essential in the initial evaluation because it serves to support the need for occupational therapy services and establishes the areas to be addressed in the intervention plan. B, C, D: Each of these pieces of information may be included in documenting an initial evaluation; however, they are not the most important in establishing the need for occupational therapy services or supporting the intervention plan.

An OTR® is leading a group for clients who are depressed and unable to initiate activity or make choices about what to do. Which leadership style would be MOST effective with this group? A. Directive B. Facilitative C. Advisory D. Co-leadership

The right answer is A For participants who are unable to make choices or direct their behavior, the group leader must structure the group to limit the number of choices. A directive leadership style best ensures participants' success in engaging in the group activities. B, C, D: Facilitative, advisory, and co-leadership styles all require participants to select the activity and share leadership responsibilities. Participants unable to initiate activities or make choices for themselves would not respond well to these styles of group leadership.

An OTR® is working with a child on tooth brushing. The OTR® lets the child brush the teeth for a minute. The child fails to brush the majority of the teeth. Next, the OTR® uses the toothbrush to brush all of the child's teeth. What strategy is the OTR® using with this child? A. Forward chaining B. Modifying C. Grading D. Backward chaining

The right answer is A Forward chaining involves the therapist encouraging the child to complete the first step of the task, and then the therapist completes the rest of the task. B: Modifying might include the use of other materials to complete the task . C: Grading is a way to modify a task and is consistent with adapting a task, or part of a task, to present the next "just-right" challenge. D: Backward chaining is consistent with the therapist's performing the majority of the task and having the child completing the last part of the task.

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The OTR writes the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." Which phrase represents the MOST measurable formulation of the client (or C) element of this goal? A. "The client will complete all steps of cooking a meal." B. "The client will understand how to cook a meal." C. "The client will know how to cook a meal." D. "The client will do all parts of cooking a meal."

The right answer is A Goals should describe what a client will be able to do after successful occupational therapy intervention. Accordingly, goals should be written using measurable action verbs such as demonstrate, perform, and complete. B, C: Understand and know are not measurable action verbs. D: Do is a vague action verb that is not easily measured.

X- In a predischarge consultation with a hip fracture client, the client's spouse reports planning to take the client home in a small four-door car and being unsure as to whether the client can get into the car while adhering to hip precautions. Which solution is the BEST solution for the OTR® to recommend? A. Recommend that the client sit in the rear seat of the car for transportation home. B. Recommend that the client take a cab for transportation home. C. Recommend that the client stay at the facility until proper arrangements are made. D. Recommend that the client's spouse rent a car that can accommodate precautions.

The right answer is A If transferring to the front seat is a problem, transferring to the back is an alternative. B, C, D: These recommendations are unnecessary and costly.

A corporate client has hired an OTR® as an injury prevention consultant. How might the OTR's role BEST be described? A. Educating managers and other employees in ways to control and reduce workplace musculoskeletal injuries and in designing an ergonomic team B. Evaluating employees and treating those with upper-extremity musculoskeletal injuries C. Educating employees to be self-sufficient in ADL management after injury D. Prescribing therapeutic exercise and orthotics for injured employees

The right answer is A In a consultant role, the OTR provides services to the corporate client as whole, not to individual employees of the company. B, C, D: The OTR playing a consultant role does not provide treatment to individual employees.

X- An OTR® is working with an adult male client with an incomplete spinal cord injury. The client has expressed some concern regarding his ability to sexually perform with his partner. Which statement regarding the client's sexual function is MOST accurate? A. The client's sexual drive and need for emotional intimacy has not been altered. B. The client's ability to have an erection and to ejaculate has not been altered. C. The client's sexual function is not affected by his altered body image. D. The client's sexual function is not appropriate for the OTR® to discuss.

The right answer is A Physical and emotional needs are not altered by spinal cord injury. Explanations of Incorrect Answers B: Erections and ejaculations are often affected by spinal cord injury. C: Body image can play a role in sexual function D: Awareness and acceptance of a client's sexuality and the potential need for intervention to address this area of occupational performance is important for health care professionals to incorporate into a comprehensive treatment plan in collaboration with the client and family (as appropriate).

X- Retired NBCOT® Question A client is recovering from an acute flare-up of rheumatoid arthritis. An initial screening indicates significant joint laxity in both hands. What type of assessment would be CONTRAINDICATED for the OTR® to use during this stage of the client's disease process? A. Manual muscle testing B. Standardized test of hand function C. Goniometric ROM measurements D. Comprehensive sensory testing

The right answer is A Resistance applied during manual muscle testing may be harmful to inflamed tissue and joints and is contraindicated in an acute phase of arthritis. B: Standardized test of hand function is not contraindicated during an acute phase of arthritis though the practitioner should use caution when stressing painful or vulnerable joints. C: Goniometric ROM measurements are used to assess active ROM and are not contraindicated in the acute phase of arthritis though the measurements may be difficult when joint deformity is present. D: Comprehensive sensory testing is not contraindicated in the acute phase of arthritis and should be considered when nerves have been compressed or damaged because of swelling.

Orthostatic hypotension is a common complication of spinal cord injury (SCI). What should the OTR® do for the client when it occurs? A. Sit the client up. B. Lean the client back. C. Call the nurse. D. Nothing; the client is not at risk

The right answer is B Orthostatic hypotension occurs when the person's blood pressure drops on assuming an upright posture. Leaning the client back or helping the client lie down will help restore the blood pressure back to normal. A, D: Orthostatic hypotension occurs when the person's blood pressure drops on assuming an upright posture. Sitting the client up or doing nothing can lead to a further drop in blood pressure. C: Although a nurse or physician should be alerted, the OTR® must first lean the client back to restore blood pressure.

Retired NBCOT® Question What MUST be addressed as part of the intervention plan for children who meet eligibility for services under the mandates of the Individualized Family Service Plan (IFSP) component of the Individuals With Disabilities Education Act (IDEA, Part C)? A. Needs of both the child and the family B. Rationale for providing one-on-one sessions C. Activities for achieving curriculum-based goals D. Reasonable accommodations beneficial to the child

The right answer is A The IFSP must contain what services (including frequency, intensity, and method of delivery) are needed to meet the needs of the infant or child and family. B, C, D: It is not required to include rationale for one-on-one sessions, specific activities that will be used, or reasonable accommodations as part of the written IFSP, although information about the child's natural environments where intervention services will be provided must be included. The criteria and procedures to meet the outcomes expected also must be included in the written plan.

An OTR®; is conducting a cooking group for people with schizophrenia. During the group, one of the clients tells the OTR, "I've seen some people from the government watching me this week." Where and how should the OTR document this information in a SOAP note? A. The OTR should document the client's statement in the S section of the note. B. The OTR should include the client's statement as data from the treatment session in the O section of the note. C. The OTR should include the client's statement as part of the treatment session evaluation in the A section of the note. D. The OTR should use the client's statement as the basis of future treatment planning in the P section of the note.

The right answer is A The S, or subjective, section of a SOAP note gives the client's perspective on his or her condition, treatment, or experience. B: The O, or objective, section records measurable data obtained during the treatment session. C: The A, or assessment, section contains an interpretation of subjective and objective information from a treatment session. D: The P, or plan, section outlines the frequency and duration of continued treatment for the client.

For a client with C5 spinal cord injury (SCI) in the acute phase of rehabilitation, what is the BEST position to place the client's forearms in? A. Pronation B. Supination C. Flexion D. Extension

The right answer is A The forearm should be pronated because clients with C5 SCI are prone to contractures in their supinators because of their inability to pronate actively. B: Placing the forearm in supination encourages the supination contracture as there is no resistance applied C: Placing the forearm in flexion threatens additional contractures of the forearm flexors D: While placing the forearm in extension is indicated, it does not address the potential supinator contraction

DK- Retired NBCOT® Question An OTR® is providing consultative services to develop a new occupational therapy department as part of a comprehensive rehabilitation program for a rural regional medical center. When reviewing the impact of the macroenvironment on the organization, what MUST the OTR® consider? A. Local and national legislative acts and regulatory policies that affect service delivery models B. Internal resource availability, and service delivery goals of the organization C. Corporate culture, supply availability, and organizational staffing policies that relate to quality care D. Organization's vision statement, governance, and internal auditing processes and procedures

The right answer is A The macroenvironment includes the external environment including policy, funding, and political services that impact provision of services. B: These factors would be part of the micro level because they are internal to the organization itself and not related to the broad external environment factors. C: These factors would be part of the mezzo level of factors influencing delivery of services because these factors are the environment external to the organization itself. D: The organization itself is considered the micro level of factors influencing delivery of services.

Retired NBCOT® Question An inpatient had a total hip replacement 2 days ago. The OTR® observes that the patient uses proper hip precautions during bed mobility and when moving from the bed to a bedside chair. What should be the focus of the NEXT intervention session with this patient? A. Methods for transferring on and off a toilet with a raised toilet seat B. Grooming and hygiene while standing at the bathroom sink C. Bathing in a bathtub equipped with a removable shower chair D. Learning to use a long-handled reacher to complete lower body dressing

The right answer is A This goal progresses the patient's functional mobility by progressing the next most appropriate transfer, which is a commode chair transfer. B: The patient's standing tolerance at this stage of post-op status may be limited for standing at the bathroom sink to complete grooming and hygiene. C: A patient should be confident with commode chair transfers prior to progressing to tub bench transfers because the tub bench transfer is more difficult and requires greater strength and mobility. D: Lower body dressing will be appropriate as the patient gains strength and begins to incorporate the hip precautions into daily activity.

An OTR® is working with a 3-year-old child with autism and oral defensiveness to improve feeding skills. Which activity is BEST to begin desensitization of this child's oral defensiveness? A. Make the child hold a vibrating toy and put it close to the face B. Provide deep pressure on distal parts of the body and slow linear rocking C. Ask the child to touch the lips with a piece of cracker D. Provide only preferred foods during feeding sessions

The right answer is A Tools can be used to provide oral stimulation to desensitize oral hypersensitivity. B: Deep pressure on distal parts of the body and slow linear rocking are preparatory activities that can be used for GENERAL TACTILE DESENSITIZATION. C, D: Touching the lips with a piece of cracker and providing preferred foods will not help with desensitization.

DK- An OTR® is working with a 10-month-old infant who has osteogenesis imperfecta (OI) and the infant's family. To reduce the child's occupational dysfunction, in what areas should the family receive training and education? A. The family should receive training and education in pain management and how to cope with exacerbations. B. The family should receive training and education in handling and positioning to prevent possible fractures. C. The family should receive training and education in energy conservation and the use of adaptive equipment to prevent fatigue. D. The family should receive training and education in donning and doffing the child's thoracic lumbar sacral orthosis to promote breath support.

The right answer is B Children with OI, or "brittle bones," are at risk for fractures after minor and accidental traumas. Parent education on handling and positioning can help to reduce the likelihood of fractures. A: Children with OI may not experience pain unless they currently have a fracture. C: Children with OI do not typically experience fatigue, unless they have a comorbid condition D: Children with OI do not typically need a thoracic lumbar sacral orthosis.

A sales associate for a pharmaceutical company developed bilateral carpal tunnel syndrome 3 months ago. During an occupational interview, the OTR® finds out that the associate has recently switched from a sedentary office job to a job that requires frequent traveling. On average, the sales associate visits five to seven medical offices per day, using a rolling briefcase that weighs about 15 pounds. The sales associate uses a laptop computer in different environments, often including countertops at medical offices. The associate also uses the laptop at home several hours per day on the kitchen counter. What work-related factor would the OTR® MOST likely describe as the main contributor to the sales associate's carpal tunnel syndrome? A. Inappropriate height for the laptop computer on different countertops B. Lifting the rolling briefcase in and out of the car C. Lifting the laptop computer in and out of the briefcase D. Excessive and sustained gripping on the steering wheel of the car

The right answer is A Working with a laptop computer at different countertop heights creates static environments for awkward joint posture, especially in relation to static loading of the wrist, and contributes to the carpal tunnel syndrome. B, C: Lifting the rolling briefcase or the laptop computer is not considered repetitive motion because it is not repeated frequently. D: Excessive sustained gripping may lead to other cumulative traumatic disorder but is not usually considered a risk factor for carpal tunnel syndrome.

According to AOTA and the Occupational Therapy Practice Framework: Domain and Process, which clinical occupational engagement treatment session would be considered to include an inappropriate use of physical agent modalities? A. Application of a hot pack to the hand followed by an activity that involves making a cord bracelet B. Use of fluidotherapy for the upper extremity followed by passive stretch C. Use of a transcutaneous electrical nerve stimulation unit for the back during homemaking activities D. Use of a cold pack to the elbow after a game of checkers

The right answer is B A treatment session consisting of fluidotherapy followed by passive stretch does not include occupational engagement as part of the session. A, C, D: The use of each modality is combined with some form of occupational engagement.

An OTR® has received a referral for a pre-hip replacement consultation. Which task should be completed INITIALLY? A. A baseline physical evaluation to determine whether preexisting limitations are present B. An occupational profile to determine occupational history and performance C. An introduction to and training with assistive devices to be used after surgery D. A general education session on proper transfer techniques to be used after surgery

The right answer is B An occupational profile, as well as an explanation of the role of occupational therapy, should be performed before any physical examination or training. A, C, D: Before any physical assessment or intervention, the role of occupational therapy should be explained and an occupational profile completed.

Which task might a person with early-stage dementia have difficulty performing, in light of typical psychosocial and cognitive abilities present during this stage? A. Completing the morning ADL routine consistently B. Balancing a checkbook C. Maintaining social interaction with family D. Cooking a simple meal

The right answer is B Balancing a checkbook is a higher level cognitive task that will most likely be difficult for a client with early-stage dementia. Typically, people with early-stage dementia have the most difficulty with IADLs that require executive function, such as money management and driving. Other IADLs and ADLs become impaired as the disease progresses. A: A morning ADL routine will be maintained by people with dementia until the MIDDLE stages. C: Social interactions will begin to deteriorate during the mild stage, due to memory loss. Marked loss of social interaction will occur during the middle stage, when the client has also lost sense of time. LATE-stage dementia is characterized by minimal interaction and verbalization. D: The ability to PLAN for and cook for others will begin to decline in the EARLY stage, but the ability to cook a simple meal will be MAINTAINED into the MIDDLE stage of dementia.

A client with bilateral transtibial amputation is being fitted for a wheelchair. Which of the following adaptations is MOST important? A. Swing-away elevating footrests B. Rear antitipping devices C. Padded swing-away arm rests D. Wheel-lock extensions

The right answer is B Because of the change in their center of gravity, clients with bilateral amputations are more likely to tip over backward during weight shifts. Rear antitipping devices are necessary for safety. A: Clients with lower limb amputations cannot use footrests and require residual limb supports. C: Padded swing-away armrests may increase comfort but are not necessary for safety. Clients with bilateral amputations are more likely to tip over backward during weight shifts, so rear antitipping devices are necessary for safety. D: Wheel-lock extensions will improve the ease of locking the brakes but are not necessary. Clients with bilateral amputations are more likely to tip over backward during weight shifts, so rear antitipping devices are necessary for safety.

A client with recent hip replacement surgery is concerned about how to shampoo hair while not able to use the shower at home. What recommendation from the OTR® will most appropriately address the client's concern? A. The client may shampoo the hair while standing in the shower, covering the hip with a plastic bag. B. The client may shampoo the hair while sitting on a stool or standing at the kitchen sink. C. The client may shampoo the hair while in a wheelchair at the bathroom sink. D. The client may shampoo the hair while standing at the bathroom sink.

The right answer is B Bending forward at the kitchen sink does not require as much hip flexion as bending forward at a typical bathroom sink; many clients are able to wash hair at the kitchen sink without compromising hip precautions. A: Showers should not be considered in the early stages of wound healing. C, D: These approaches require more hip flexion than allowed by standard hip precautions.

When conducting an on-road assessment, which elements should the driver rehabilitation specialist consider? A. The client's performance in his or her own vehicle on a predetermined road course B. Client-centered principles and the client's context as referenced in the Occupational Therapy Practice Framework C. Parking lot, residential, suburban, urban, city, rural, and highway contexts D. The client's ability to engage in conversation or adjust controls (e.g., air conditioning) while driving

The right answer is B Conducting an assessment according to client-centered principles and the client's context is consistent with the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; AOTA, 2008). A: A test vehicle, insured by the provider of services, should be used. C: Not all clients will need to drive in all aspects of traffic. D: Conversations need to be kept to a minimum during the on-road assessment.

An OTR® working in an acute care hospital has completed the initial self-care evaluation with a patient who has had a recent TBI and is functioning at Level VI (Confused-Appropriate) on the Rancho Los Amigos scale. During grooming and hygiene tasks the patient is able to stand at the sink with stand-by assistance, is easily distracted and consistently requires verbal and tactile prompts. The OTR® observed that the patient put toothpaste on a washcloth when preparing to brush teeth and attempted to brush hair with a toothbrush. Additionally, the OTR® noted that the patient has minimal spontaneous functional movement of the left upper extremity and uses synergistic movements when asked to grasp and hold objects. Which neurobehavioral deficit is the patient exhibiting during grooming tasks? A. Constructional disorder B. Ideational apraxia C. Stereopsis D. Visual agnosia

The right answer is B Ideational apraxia involves a patient using an object improperly or using the wrong tool with the action that is required, such as putting toothpaste on the washcloth or brushing the hair with a toothbrush. A: Constructional disorder occurs when a patient has a deficit in organizing and assembling parts into a whole. C: Stereopsis occurs when a patient is unable to perceive depth in relation to self or other objects. D: Visual agnosia occurs when a patient cannot verbally identify objects from visual input.

DK-X A 2-year-old client was referred to an outpatient burn clinic for management of developing scar tightness in the left hand and wrist. The client's mother is the primary caregiver and has expressed severe guilt about the child's being burned in a kitchen fire 6 months ago. The mother is feeling very overwhelmed with the postburn management program and has been having difficulty looking at the client's hand during therapy. What should be the INITIAL program for the mother to carry out at home? A. Compression glove worn 24 hours per day with 20 minutes of deep scar massage every 2 hours during waking hours B. Compression glove worn 24 hours per day with silicone gel pads inserted at all the web spaces and regular play time with play dough and toy building blocks C. Coban™ self-adherent wrap on each individual finger during the day, deep scar massage 3 times per day, and antideformity hand splint at night D. Coban™ self-adherent wrapping of each individual finger and elasticated tubular bandage 24 hours per day, regular PROM of left fingers and wrist

The right answer is B It is important that the mother accept the child after the accident, and having therapeutic playtime can help with mother-child bonding. To not further overwhelm the mother, the initial scar management program should be simple and yet efficient. The use of silicone gel pad inserts at the web spaces can soften the scar and maintain the web spaces. A, C, D: Although Coban™ self-adherent wrap might be suitable for the initial phase of compression therapy, it does not provide adequate pressure to manage active tight scars 6 months postburn. Deep scar massage, antideformity hand splint, and PROM are all appropriate scar management interventions. However, it might provoke further guilt feelings in the mother. Use of play activity that requires active use of the hand is the best choice.

An older adult client complains that objects appear distorted—for example, straight lines look wavy. The client has difficulty reading and makes frequent mistakes when reading but is able to navigate busy and crowded environments using peripheral vision. Which visual deficit would the OTR® suspect? A. Glaucoma B. Macular degeneration C. Cataract D. Diabetic retinopathy

The right answer is B Macular degeneration results in a gradual loss of ability to see objects clearly. Objects appear distorted in shape and straight lines look wavy or crooked, creating difficulty with reading. A: Clients with glaucoma experience loss of peripheral vision and often report difficulty with mobility. C: Clients with cataract most frequently report blurred or hazy vision and reduced intensity of colors. D: Clients with diabetic retinopathy see spots or floaters in the field of vision, have blurred vision, and have a dark or empty spot in the center of the visual field.

A client with multiple sclerosis (MS) presents with extensor tone in the bilateral lower extremities, which interferes with work tasks completed at a desk. The OTR® performs a worksite evaluation. What would the OTR® recommend to decrease spasticity? A. Trialing moist heat pads B. Positioning the hips into 90° or more of flexion. C. Taking frequent rest breaks to stretch D. Using a reclining chair to open the hips

The right answer is B Maintaining at least 90° of hip flexion will help reduce spasticity and can be achieved by adjusting the height of the chair or using a small stool for the feet. A: Hot temperatures are contraindicated for people with MS. C: Although stretching may help decrease spasticity, if the client states that the pain interferes with function, this approach may not be sufficient; moreover, frequent standing rest breaks may increase fatigue and draw attention. D: Using a reclining chair to open the hips would promote extensor tone, thereby increasing the client's difficulty with work tasks.

Retired NBCOT® Question An OTR® working in an acute care hospital has completed the initial self-care evaluation with a patient who has had a recent TBI and is functioning at Level VI (Confused-Appropriate) on the Rancho Los Amigos scale. During grooming and hygiene tasks the patient is able to stand at the sink with stand-by assistance, is easily distracted and consistently requires verbal and tactile prompts. The OTR® observed that the patient put toothpaste on a washcloth when preparing to brush teeth and attempted to brush hair with a toothbrush. Additionally, the OTR® noted that the patient has minimal spontaneous functional movement of the left upper extremity and uses synergistic movements when asked to grasp and hold objects. What additional information is MOST IMPORTANT to obtain as part of the initial evaluation in order to select intervention activities? A. Contexts for preferred leisure and social activities B. Performance skills displayed during activities of daily living C. Types of architectural barriers within the patient's home D. Upper-extremity strength based on a manual muscle test

The right answer is B Once occupational performance analysis has been initiated, identifying performance skills of the client during activities of daily living would be beneficial information to gather. A: Contextual information may be beneficial to further understand the client's occupational needs but is not the most important information to obtain. C: Home assessments are not a first priority when seeing patients in the acute care environment and are generally deferred until the inpatient rehabilitation setting. D: Manual muscle testing is not indicated given the information that was gathered in the initial self-care evaluation, and in this situation assessment of muscle tone over muscle strength is indicated.

An OTR® is assessing bed mobility with a client with Guillain-Barré syndrome (GBS) 2 weeks into the plateau phase. The patient reports dizziness on performing supine to sit at the edge of the bed and begins to lie back down. What step is MOST appropriate for the OTR® to take? A. Encourage the patient to remain upright and allow for the dizziness to subside by performing simple ROM exercises to promote circulation. B. Assist the patient back to bed safely, lower the head of the bed, and monitor vitals, comparing the current blood pressure with the resting blood pressure. C. Assist the patient back to bed slowly, elevate the lower extremities, and immediately search for the nurse to assess the patient. D. Educate the patient on the importance of sitting upright and out of bed to help regulate the nervous system and prevent secondary complications.

The right answer is B People with GBS are at risk for autonomic nervous system dysfunction such as postural hypotension or experiencing a significant drop in systolic blood pressure on moving from a horizontal to an upright position. Common among people who endure a prolonged time in bed, the change in position causes blood to rush to the lower extremities, resulting in feelings of lightheadedness or dizziness. The best option is to slowly and carefully assist the patient back to supine, monitor blood pressure, position the patient in Trendelenberg (lower the head of the bed and raise the lower extremities), recheck blood pressure, and then alert nursing, leaving the call bell in reach. A: The patient is already attempting to lie down to reduce the dizziness. Trying to prevent this will only increase the patient's anxiety and may result in an unsafe situation. C: It would be inappropriate to leave the room while the patient is experiencing postural hypotension, especially without having first monitored the patient's blood pressure to have information to report to nursing. D: Educating the patient on the importance of sitting upright and out of bed to help regulate the nervous system and prevent secondary complications is a valid intervention component, but it is not the most appropriate choice at this time.

Which characteristic of a general education classroom would promote access to the general education curriculum of a student diagnosed with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome)? A. Large classroom size B. Predictable transitions C. Teacher's gender D. Low level of structure

The right answer is B Preparing students with autism spectrum disorder for transitions (e.g., from math activities to reading activities) is a fundamental strategy in managing the classroom environment to facilitate their engagement. Because all students benefit, preparation for transitions is considered best practice in an inclusive classroom setting. A, C, D: Class size, teacher's gender, and level of structure would not necessarily promote access to the general education curriculum for a student with autism spectrum disorder. Although smaller size might make a classroom more effective, preparation for transitions would have a much greater impact.

A client with traumatic brain injury is demonstrating agitation. What strategy would minimize the client's frustration and confusion? A. Provide tactile stimulation by tapping the client's upper extremity B. Tell the client orientation information about his or her location and what will occur in session C. Ask the client to state why he or she is in the hospital D. Have the client complete a fine motor task as a distraction

The right answer is B Providing passive orientation information and preparing the client for what to expect in the session will provide the client with a sense of familiarity, decreasing confusion and agitation. A: Tactile stimulation produces increased awareness of the affected upper extremity and may increase the client's agitation as he or she tries to process the stimulation. C, D: Challenging the client's cognitive abilities or motor skills may lead to greater confusion and frustration, thereby increasing the client's agitation.

DK- An OTR® is working with an 8-year-old child with mild autism to improve the child's diet repertoire and toleration of food from restaurants. The child has begun to like meat slices and white bread in the clinic. Which activity BEST uses an Ecology of Human Performance approach to intervention? A. Desensitizing the child by introducing wheat bread B. Bringing the child to a sandwich shop and ordering a turkey sandwich C. Identifying other food habits that may interfere with improving the child's diet repertoire D. Watching a video of the child in school eating meat slices

The right answer is B The Ecology of Human Performance Model states that a child's true performance occurs in natural environments. Bringing the child to a sandwich shop is a way to test transfer of a learned skill. A, C, D: These choices do not use an Ecology of Human Performance approach.

DK- What is the primary focus of the Joint Commission? A. Researching new methods of intervention B. Improving health care services C. Relicensing OTR®s and COTA®s D. Identifying an organization's strengths and weaknesses

The right answer is B The Joint Commission's focus is more on improving health care services by facilitating effective and safe services. A, C, D: These responses are not the primary focus of the Joint Commission accrediting body. Its focus is on improving health care services by facilitating effective and safe services.

DK- In 2005, Congress passed a federal transportation bill, SAFETEA-LU, which included funding for a program that encouraged children (including those with disabilities) to bike and walk to school, acted to reduce air-polluting traffic near schools, and encouraged healthy lifestyles from a young age. What was the name of this initiative? A. WalkFit to School B. Safe Routes to Schools C. Children w/ Disabilities Act D. Healthy American Students

The right answer is B The Safe Routes to School program was funded from 2005 to 2012 as part of the SAFETEA-LU legislation (Pub. L. 109-59) and provided 100% federal funding to facilitate states' initiatives to create safe environments surrounding schools and encourage children to bike and walk to school as part of developing a healthy lifestyle. In 2012 these initiatives were combined with others as part of the federal Transportation Alternatives Program. A, C: D: These are not names of federal legislative efforts to encourage children to walk and bike to school.

Which group activity would be the MOST appropriate to engage clients in an expressive activity using the psychodynamic approach? A. Baking chocolate chip cookies B. Constructing a magazine collage C. Hiking in the woods D. Attending a dance performance

The right answer is B The psychodynamic approach makes use of projective media such as clay, magazine collages, painting, and poetry. A: Making chocolate chip cookies using a recipe is a structured activity that does not allow for expression of the individual's personality. C: Hiking is not an expressive activity. D: Attending a dance performance as a passive spectator does not allow for self-expression.

DK- STUDY A client will initiate dressing at the appropriate time of the day but will not attend to the day, temperature, or season. The client is able to don clothing slowly but has difficulty with fasteners or fails to see errors in the back (i.e., not tucking in the shirt). At what stage of the Allen Cognitive Level Screen is this client? A. 4.4 B. 4.0 C. 3.6 D. 3.2

The right answer is B The question describes typical dressing behaviors of clients at Mode 4.0; a client would attend to visible sensory cues and ignore what is not in plain sight (e.g., not tucking in the back of the shirt). A: Clients at Mode 4.4 will be able to locate clothing and initiate dressing at a customary time of the day and dress in sequence. Clients may wear the same clothing over and over again because they like it and have worn it before. C: At Mode 3.6, clients must be trained to initiate dressing at the customary time of day. D: At Mode 3.2, clients will need cues to sequence through a dressing routine.

An OTR® is working with a child who was identified as having sensory integrative dysfunction. What is the typical duration of Ayres Sensory Integration treatment? A. Typically 1 to 2 times per week for 1 year B. Typically 1 to 2 times per week for 2 year C. Typically 3 to 4 times per week for 1 year D. Typically 3 to 4 times per week for 2 year

The right answer is B Treatments typically last between 45 and 60 minutes 1-2 times per week and continue for about 2 years. A: The duration of treatment is too short; it typically continues for 2 years. C, D: The frequency of treatment is too high; sessions typically take place once or twice per week.

A client with Parkinson's disease has experienced a significant decrease in participation in activities in the home. The OTR® finds that this decrease in activity is related to the client's postural instability and the caregiver's fear that the client will fall. Which intervention is BEST to restore this client's participation in home activities? A. Refer the client to another profession to address mobility B. Instruct the caregiver in ways to assist the client's participation in activities C. Train the client in energy conservation techniques to improve posture D. Assist the client in finding new activities to be involved with at home

The right answer is B Use of specific cueing methods and clear verbal and visual instructions may facilitate improved motor movements for activity participation. A: A referral to another discipline such as physical therapy may be beneficial to address postural instability; however, occupational therapy should first address increasing the client's participation in activities. C: Fatigue may be causing the client's postural instability, but the first area to address to improve postural stability in clients with Parkinson's disease is to improve movement through cueing. D: The client has lost participation in roles and activities that were previously important. Those activities should be resumed with modifications before the client takes on new activities.

An OTR® is working with a 5-year-old with autism on developing a toileting routine. Which intervention strategy is most appropriate? A. Teaching energy conservation techniques to incorporate into the routine B. Using a picture checklist that depicts the routine C. Encouraging the child to invite a peer to model the routine D. Incorporating adaptive equipment and orthotics into the routine

The right answer is B Visual supports, such as picture checklists, have been found to be effective intervention strategies for children with autism. A: Children with autism do not typically experience any complications, such as fatigue or shortness of breath, which would suggest the need for energy conservation technique. C: Although it may be appropriate for a child with autism to watch a peer model other routines, watching a child model this routine would compromise his or her privacy. D: Children with autism, unless they have a comorbid condition, do not usually need adaptive equipment or orthotics to complete toileting.

A client in the burn unit sustained deep partial-thickness burns to the bilateral dorsal hands 1 week ago. What is the BEST position for splinting to prevent deformity? A. Volar hand splint with wrist in neutral, metacarpals (MPs) in slight hyperextension, and interphalangeals (IPs) in full extension B. Volar hand splint with wrist in 30° extension, MPs in 70° flexion, and IPs in full extension C. Dorsal hand splint with wrist in neutral, MPs in 90° flexion, and IPs in 50°-70° flexion D. Dorsal hand splint with wrist in 30° flexion and MPs and IPs in full extension

The right answer is B When a burn occurs on the dorsal surface of the hand, it has potential to form a claw-hand deformity. The intrinsic-plus position is thus the best splinting position to prevent contracture. A: It is not anatomically appropriate to immobilize a hand with MP hyperextension C, D: When the dorsal surface of the hand is burned, a dorsal splint should be avoided to decrease shear and friction on the skin's surface.

DK- X A client fell while skiing downhill and sustained a Type III fracture of the radial head. Which treatment would be MOST appropriate for this type of fracture? A. Long arm cast for 6 weeks B. Therapy alone C. Fragment excision with a long arm cast for 3-4 weeks D. Fragment excision with a long arm splint for 3-4 weeks

The right answer is C A Type III fracture of the radial head requires removal of the fragmented bone and a cast for 3-4 weeks to ensure proper healing and support. A: A long arm cast for 6 weeks would not be appropriate because that time frame would lead to greater stiffness. B: Therapy alone would not be sufficient for a Type III injury. D: A splint would not stabilize the fracture sufficiently for a Type III injury.

What is the first course of action the AOTA Ethics Commission takes when it receives an ethics complaint? A. It conducts a full investigation. B. It imposes a sanction or discipline. C. It starts a preliminary assessment. D. It writes an educative letter.

The right answer is C A preliminary assessment would be conducted before a full investigation, educative letter, or imposition of a sanction or discipline. A, B, D: These actions occur at later stages of the complaint process, if at all.

An OTR® consultant to a retail store corporation's ergonomics team notices an increase in back pain complaints for workers in the stockroom. The OTR® should present which activity as the next step for intervention? A. Report all workers who have complained of back pain to management. B. Implement a modified duty program for all workers in the stockroom. C. Provide an in-service to educate workers on ergonomics. D. Begin an exercise training program to improve workers' health.

The right answer is C An in-service would provide secondary injury prevention for workers reporting mild symptoms related to work tasks. A: Successful implementation of an injury prevention program requires management support and worker participation in a cooperative partnership. B: Modified duty programs are developed for individual workers on the basis of medical treatment recommendations. D: The effectiveness of exercise programs in preventing injuries has not been established.

During an intervention session in which a client with unilateral neglect reads single letters across several lines, the OTR® uses a vertical line on the left side of the page to cue the client to read the correct line. Which intervention technique is the OTR using? A. Patching B. Attention C. Anchoring D. Prisms

The right answer is C Anchoring, a cue on the impaired side to indicate starting position, brings attention back to the neglected side. Vertical anchoring lines are generally used on the left side. A: Patching increases eye movements to the contralateral side, decreasing neglect. B: Attention training increases attention and general alertness to reduce unilateral neglect. D: Prisms shift the visual field toward the intact side, enabling the client to see things on the involved side.

Which of the following is considered an area of occupation, as described in the Occupational Therapy Practice Framework? A. Space demands B. Hearing functions C. Rest and sleep D. Habits

The right answer is C C: Rest and sleep fall under the areas of occupation in the Occupational Therapy Practice Framework: Domain and process (AOTA, 2008). A: Space demands are a type of activity demand in the Occupational Therapy Practice Framework: Domain and process (AOTA, 2008). B: Hearing functions are a client factor in the Occupational Therapy Practice Framework: Domain and process (AOTA, 2008). D: Habits are a type of performance pattern in the Occupational Therapy Practice Framework: Domain and Process (AOTA, 2008). A, B, C:

The extremities of a client with brain injury in an acute care unit are in a position of spastic extension, adduction, and internal rotation. The client is displaying symptoms of which condition? A. Decorticate rigidity B. Torticollis C. Decerebrate rigidity D. Athetosis

The right answer is C Decerebrate rigidity involves the client's lower and upper extremities in a position of spastic extension, adduction, and internal rotation. A: Decorticate rigidity involves upper extremities in spastic flexed position with internal rotation and adduction and the lower extremities in spastic extended position with internal rotation and adduction. B: Torticollis is a dystonic posture of the neck. D: Athetosis involves slow movements of the face, tongue, or limbs.

X- During a therapy evaluation of a client who sustained a radial head fracture, the OTR® notes that elbow range of motion (ROM) is 60° of extension and 80° degrees of flexion; wrist ROM is 30° of extension and 25° of flexion. Which statement about this client is TRUE? A. This client will need additional education in pain management because pain is the most common complication after elbow injury. B. This client will regain elbow ROM before wrist ROM, because wrist stiffness is the most common complication after elbow injury. C. This client will regain wrist ROM before elbow ROM, because elbow stiffness is the most common complication after elbow injury. D. This client will require only one visit for home exercise program (HEP) instructions, and the OTR can then discharge the client from therapy.

The right answer is C Elbow stiffness is the most common complication of elbow trauma. A: Although pain is a primary consideration for all clients, it should subside as healing progresses. B: It is important to include wrist ROM and strengthening when addressing elbow injuries, but wrist ROM should return to normal before elbow ROM. D: Even if the OTR is recommending a HEP for a client, the OTR should suggest return visits to measure carryover of HEP training and adjust the HEP, as needed, until the client has returned to independence.

X- STUDY Using the Allen Cognitive Level Screen-5 for screening, followed by use of the Allen Diagnostic Module and the Routine Task Inventory for confirmation of screening results, an OTR® identifies Level 4 as the current level of functioning of a client in an adult day treatment center. What is the MOST appropriate scenario for activity completion for this client? A. The task includes mostly familiar steps but also one step requiring new learning. B. The project and tasks involved are relatively unstructured. The client is given opportunities to find and revise errors. C. A model of the completed project is provided for the client to imitate. Simple instructions are provided. D. The project is designed to encourage relatively independent planning and organizing to complete tasks.

The right answer is C Level 4 activities typically require a model as a guide to task completion, simple directions, and unshared tools. Unstructured tasks, problem solving, planning, and even independent completion of unfamiliar steps without guidance are likely too challenging for a person at Level 4. A: This choice is appropriate for Level 5 of the Allen Cognitive Level Screen. A client at Level 5 has new learning occurring, and inductive reasoning enables new ways of performing activities. B: This choice is appropriate for Level 3 of the Allen Cognitive Level Screen. A client at Level 3 can engage in repetitive, unstructured actions. D: This choice is appropriate for Level 6 of the Allen Cognitive Level Screen. A client at Level 6 can think of hypothetical situations and do mental trial and error.

Since getting new workstations, clerical workers at a law office are noticing increased neck stiffness and fatigue, and an OTR® is preparing a 1-week educational program for them. Which strategy would be MOST likely to reduce neck stiffness and fatigue? A. Require workers to stand and march in place for 5 min once every hour during the day B. Provide neck stretching and strengthening exercises to improve flexibility C. Move computer monitors into alignment with keyboards so workers face the monitor straight on D. Position workers with forearms resting on the edge of the desk while typing for support

The right answer is C Maintaining head and neck alignment reduces the risk of strain to the neck. A: Standing during prolonged sitting tasks allows for a change in position but is not the most direct strategy to prevent neck injury. B: The evidence neither supports nor refutes the effectiveness of routine exercise programs in preventing injuries. D: Positioning arms in this way contributes to contact stress injury.

An OTR® is working with a client who has had a cerebrovascular accident (CVA). One of the client's goals is independence in baking activities. Which modality intervention is BEST used to decrease shoulder subluxation of the nonpainful hemiparetic arm during this task? A. Ultrasound B. Fluidotherapy C. Neuromuscular electrical stimulation (NMES) D. Conventional transcutaneous nerve stimulation (TENS)

The right answer is C NMES can be used during an activity to decrease shoulder subluxation post CVA. A, B: Ultrasound and fluidotherapy cannot be used during an activity and do not increase functional control of muscles. D: TENS can be used during an activity but is typically used for pain and edema control.

An OTR® is working with a client experiencing a cumulative trauma disorder of the right upper extremity. To document client improvement as a result of therapy, which occupation-based statement would the OTR® be MOST likely to write? A. Client's pain-free AROM of right elbow is now 15° to 110°. B. Client can perform 30 repetitions of elbow flexion-extension using a 1-lb weight. C. Client can brush teeth using the involved upper extremity without pain. D. No progress was noted this week.

The right answer is C Occupation-based practice requires documentation of improvement in occupations such as ADLs. A, B: Statements about AROM and exercise document progress from a biomechanical frame of reference. D: This statement does not document improvement as a result of therapy.

A therapy group of clients with rheumatoid arthritis is meeting once a week. These clients may benefit from a group education approach to teach which technique? A. Exercises to increase stability of the hands and digits B. Medication management to ensure proper use of prescribed medications C. Joint protection strategies to help prevent further joint stress or injury D. Night splinting in a position of antideformity

The right answer is C Studies have shown a decrease in reported pain and disability after participation in a group program in which joint protection strategies have been taught. A, B, D: Exercises, medication management, and night splinting are more appropriate as individual rather than group interventions.

DK- An OTR® is conducting an evaluation with a child on the pediatric intensive care unit. While observing the child's heart monitor, the OTR® notes that the child may be experiencing tachydysrhythmia and alerts the nurse immediately. What are the implications of tachydysrhythmia? A. The child's heartbeat is less than 60 beats per minute. B. The child has an atrioventricular block. C. The child's heart beat is between 200 and 300 beats per minute. D. The child has a pacemaker.

The right answer is C Tachydysrhythmia is fairly common in children with cardiac conditions. In extreme cases and when complications are present, it can lead to congestive heart failure. It is characterized by fast heart rate of 200-300 beats per minute. A, B, D: These options are related to BRADYDYSRHYTHMIA

X- When working with a client with chronic pain, the OTR® needs to set a tone that will facilitate a therapeutic relationship with the client. Which statement sets an open and appropriate tone when working with a client who has chronic pain? A. "Your pain is all in your head. All you have to do is ignore it." B. "I have pain when I wake up in the morning. I have arthritis. It usually takes a while before it gets any better. Maybe you should try to exercise in the morning to get things moving, like I do." C. "I realize that you are in pain. Let's try this activity and see what happens. If you need to stop, let me know, but I would like to see you push yourself." D. "I think we should slowly increase the time you are spending at work-related tasks so that you can get back to work as soon as possible."

The right answer is C The OTR needs to acknowledge that the client with chronic pain has pain; the OTR also needs to communicate the importance of the client's participating to the best of his or her ability. A: It is never appropriate to suggest that a client with chronic pain does not have pain. B: By focusing the conversation on him- or herself, the OTR is minimizing the impact of pain on the client's functioning. D: Although it might be appropriate to address work tasks with this client, the OTR's response does not acknowledge the client's pain or other psychosocial concerns.

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The OTR writes the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." What conclusion can you draw about the assist level (or A) needed for this client? A. The OTR intends for the client to complete the occupation with moderate assistance. B. The OTR intends for the client to complete the occupation independently. C. The OTR has not clearly communicated the assist level. D. The OTR intends for the client to complete the occupation with minimal assistance.

The right answer is C The assist level must include information about the physical and verbal assistance the client requires to complete the occupation. As written, this goal does not include such information. A, B, D: The goal does not include specific information about physical or verbal assistance.

An OTR® has received a referral to evaluate a client with dementia who lives alone in the community. When the OTR® arrives at the client's home, the OTR® notices that the client is well groomed but appears to have forgotten that the OTR® had called earlier in the day to set up the appointment. Which area of occupation would be a priority to assess during the initial occupational therapy assessment? A. Bathing and showering B. Sleep C. Emergency system access D. Personal device care

The right answer is C The client has early-stage dementia as evidenced by short-term memory deficits but maintains the ability to complete routine ADLs. Other ADLs are likely intact, but IADLs, in particular those that require higher level executive function, would be affected at this stage. In addition, the client lives alone so understanding the client's safety in the community would be important. A, B, D: Bathing or showering and personal device care are both ADLs and not likely to be impaired at this stage. Sleep, although an IADL and possibly affected, would not be priority at this time.

DK- An OTR® reviews recommended guidelines on the use of weighted vests to help provide sustained touch pressure and promote organization in a child with autism. Which statement describes a correct use of a weighted vest? A. The child must be between 4 and 7 years old. B. The vest is worn for 45 minutes to 1 hour at a time. C. The vest's weight should be no more than 10% of the child's body weight. D. Weight should be distributed over the trunk and upper extremities.

The right answer is C The evidence-based recommendation is that the vest weigh no more than 10% of the child's body weight. A, B, D: These choices have no basis in the available evidence.

DK- STUDY An OTR®; is developing a professional development plan. The OTR has identified personal needs for growth after completing a self-assessment. What step should the OTR take NEXT in developing the professional development plan? A. Review progress toward current professional development goals and objectives. B. Determine available resources for meeting goals and objectives. C. Determine what learning needs to occur. D. Set new goals for professional development.

The right answer is C The steps in developing a professional development plan are to (1) reflect on current performance to date and determine learning needs on the basis of the self-assessment results; (2) review progress toward previous professional development goals; (3) ascertain what resources exist to meet identified professional development goals; (4) modify previous professional development goals and set new ones; (5) take action to meet professional development goals; and (6) document completed professional development activities. Thus, after identifying personal needs for growth by means of a self-assessment, the next step an OTR would take would be to determine what learning needs to occur. A: Step 2 in creating a professional development plan is to review progress toward current professional development goals. Progress toward current professional development goals and objectives cannot be assessed before learning needs have been identified. B: Step 3 in creating a professional development plan is to ascertain what resources exist to meet identified professional development goals. Learning needs must be determined before appropriate learning resources can be identified. D: Step 4 in creating a professional development plan is to modify previous professional development goals and set new ones. Goal setting cannot occur before professional learning needs have been determined.

X- Which method would be MOST effective to gather data on the needs of a homeless population in a large urban area? A. Face-to-face interviews with people who work with the homeless population B. A written survey distributed to people who are homeless C. Interviews with key informants who are homeless D. Telephone interviews with caseworkers at homeless shelters

The right answer is C The use of key informants enables one to gather information directly from the population being assessed. A, D: Interviewing people who work with the homeless population would provide secondhand information from the worker's perspective, not from the perspective of those who are homeless. B: Some homeless people are unable to read and write, and survey distribution and collection are time consuming and may be expensive.

X- A physician has referred a client to an outpatient setting for an occupational therapy evaluation and intervention. The client has late effects from a stroke that occurred approximately 10 years ago. The OTR® conducts the evaluation and begins to formulate the client's goals. Which short-term objective would be MOST appropriate for improving independence in homemaking? A. Client will demonstrate one-handed homemaking techniques to the therapist in 5 days. B. Therapist will teach client five one-handed homemaking techniques for meal preparation. C. By 2 weeks, client will be independent in cutting vegetables using adaptive equipment. D. Using an adaptive cutting board, client will peel and cut up five vegetables.

The right answer is C This answer includes all the components necessary for a measurable goal (client, measurement, what client will achieve, condition required to achieve the goal, and how long it will take the client to achieve the goal). A: This goal is missing the measurement aspect of the objective. B: This item would be part of the intervention plan rather than a goal. D: This goal is missing the assistance level and the estimated time it will take for client to achieve the goal.

A client with rheumatoid arthritis in the dominant hand complains of pain while stirring food on the stove. The OTR® uses fading techniques to instruct the client on how to resume cooking with less pain. Which approach BEST describes fading? A. Advise the client to use the nondominant hand in all activities that aggravate the arthritis. B. Outline the steps of the task that cause pain and problem solve solutions with the client. C. Instruct the client in joint protection techniques and reduce the number of cues over time. D. Adapt the activity with lightweight built-up handles to decrease grasp.

The right answer is C This approach begins by providing meaningful education on joint protection—such as stirring with the forearm in a neutral position and without the thumb pinching—and then reduces the number of cues as the client performs the tasks repeatedly. Fading approaches to treatment involve reducing or eliminating support as a client's skills improve or develop. The result is improved independence and decreased pain in the activity, in this case cooking. A: This approach changes the physical demands but may be difficult for coordination. B: Outlining the steps of the task to define expectations, describes coaching. D: This option describes activity modification by changing the tools and using adaptive equipment.

X- An OTR® has determined that a visually impaired client can no longer drive. What should the therapist include in the occupational therapy intervention to help this client be independent in the use of community mobility? A. Familiarize the client with the procedures for using paratransit. B. Obtain a bus schedule and start training the client to use the bus for fixed-route travel. C. Select, test, adopt, and train the client and the client's family or support system in the use of the most appropriate transportation options. D. Educate the client on the need for driving cessation and the importance of maintaining independence in the community mobility.

The right answer is C This is a comprehensive approach to follow after determining a client cannot drive. A, B: The client may not want to use these methods of transportation. D: This option may be part of the intervention process, but it is not adequate for independence in community mobility.

DK- An OTR® is establishing an intervention plan for a client who sustained a work-related musculoskeletal injury to the low back. The client has been out of work for 6 months and presents with generalized deconditioning. What would be the MOST appropriate duration for this client's treatment program? A. A minimum of 8 hours of treatment per day for 1 month. B. A minimum of 8 hours of treatment per day for 1.5 months. C. A minimum of 5 hours of treatment per day for as long as 3 months. D. A minimum of 5 hours of treatment per day for as long as 1 month.

The right answer is C Total body deconditioning may require from 1 month to as long as 3 months of reconditioning the worker to preinjury status. A, B, D: The focus of the question is on duration of treatment, not frequency of treatment, and the focus of return-to-work programs is to predict outcome. The Commission on the Accreditation of Rehabilitation Facilities standards do not prescribe a frequency specific to the duration of treatment needed to predict outcomes. Some programs may release clients from the program once they are able to tolerate 5 hours of activity; however, this duration may not be appropriate for all clients.

An OTR® assesses a client using the Allen Disability Framework. The client scores an Allen Cognitive Level (ACL) of 4.0. Given this score, what discharge arrangement would the OTR likely recommend for this client? A. This client could be discharged home alone with weekly checks for novel safety issues and health maintenance needs and reminders. B. This client could be discharged home with family for support in all areas of IADLs and personal care including bathing, dressing, and hygiene. C. This client should remain in the psychiatric facility under close 24-hour supervision for safety and personal care needs. D. This client could be discharged to a supported living arrangement with the expectation that the client can independently complete the morning self-care routine.

The right answer is D A client with an ACL of 4.0 should be in a supported living arrangement but would be expected to complete habitual routines independently (e.g., morning self-care). A: This response indicates a person functioning at an ACL of 4.2. B, D: These responses indicate a person with an ACL of less than 4.0, because a person at such a level will require close supervision and support for all needs.

An OTR® is working with a client diagnosed with fibromyalgia who is experiencing disturbed sleep patterns. Which cognitive areas of functioning are disturbed sleep patterns MOST likely to interfere with? A. Arousal and orientation B. Sequencing and categorization C. Initiation of movement and language D. Attention span and short-term memory

The right answer is D Nonrestorative sleep, fatigue, and pain interfere with the client's ability to pay attention and remember day-to-day events. A, B, C: Arousal and orientation, sequencing and categorization, and initiation of movement and language are cognitive deficits and are most likely to be the result of traumatic brain injury or cerebrovascular accident, not fibromyalgia.

An OTR® is working in a school with a high incidence of violence in a district with increasing numbers of students diagnosed with oppositional defiant disorder. The superintendent announces the formation of a task force to study the problem. Which response to this announcement would be BEST? A. Document the progress the OTR® has made with students with oppositional defiant disorder to justify continuing work with these students B. Increase the frequency of visits to the students on the OTR®'s caseload with this diagnosis because the task force will scrutinize intervention with these students C. Research intervention strategies to make sure that the intervention the OTR® has been providing to these students is considered best practice D. Contact the superintendent and request to be appointed to a seat on the task force to study violence and the incidence of oppositional defiant disorder

The right answer is D AOTA's societal statement on youth violence has clearly articulated the role occupational therapy should play in this area. Prevention is within the scope of occupational therapy practice, and practitioners should welcome any opportunity to participate. A: Documentation should always be kept up to date. B: Frequency of visits to clients should be determined case by case on the basis of the client's needs, not a potential threat of scrutiny. C: Researching intervention strategies to ensure that one is engaging in best practice should not be done retroactively but rather as a proactive, ongoing process.

X- An OTR® is running a group in an innovative preventive program for parolees. The goal of the program is to assist parolees with establishing or restoring occupational balance and productive occupations. The current group has been meeting regularly for 6 months. The members have good insight, and they understand the goals of the program. What leadership style should the OTR use in this setting? A. Directive B. Facilitative C. Cooperative D. Advisory

The right answer is D An advisory style would be most appropriate because the group knows its goals and has been established for a while. The OTR can help the group by providing additional knowledge and resources for further action. A: Given this group's characteristics, the directive leadership style would not be appropriate. A directive style is best with clients who have low cognition, low motivation, and low insight. B, C: Given this group's characteristics, the facilitative and cooperative leadership styles would not be appropriate. These leadership styles are best with groups that are in development and with clients with moderate motivation and cognition.

X- A client with multiple sclerosis (MS) reports decreased ability to pay attention to daily work-related tasks, including keeping track of documents and phone calls. Which strategy is the MOST appropriate for this client? A. Change the work environment to work at home B. Modify the workload to decrease fatigue levels C. Improve lighting in the work environment D. Complete one task at a time and avoid multitasking

The right answer is D Attention to task is a cognitive skill that benefits from a cognitive compensatory approach in clients with MS. Avoiding multitasking helps the client pay attention to one task a time, improving focus on each task. A: Changing the work environment to work at home would not address the client's ability to track documents and phone calls. B: Fatigue may affect cognition; however, modifying the workload is not the most appropriate intervention to address decreased attention to tasks. C: Lighting would not influence the client's ability to attend to tasks.

DK- An OTR® is working with a child who has sensory integrative dysfunction related to motor planning. According to Ayres Sensory Integration, what type of sensory input would be most supportive in developing this child's motor planning skills? A. Proprioceptive, visual, and auditory B. Vestibular, tactile, and olfactory C. Visual, auditory, and olfactory D. Tactile, vestibular, and proprioceptive

The right answer is D Children with motor planning problems benefit from vestibular and proprioceptive input. They might also have difficulties with tactile perception. A, B, C: These combinations of sensory input would not be the most effective for a child who has sensory integrative dysfunction related to motor planning, because they do not combine vestibular and proprioceptive input. Auditory and olfactory input are not considered to be among the most salient according to Ayres Sensory Integration.

Which tool should the OTR® use to assess peripheral visual fields? A. Interview B. Amsler grid(Central Visual) C. Snellen chart (Acuity) D. Confrontation testing

The right answer is D Confrontation testing provides a gross assessment of how much peripheral vision the client has. A: Although interview might be helpful in identifying the client's problems, it is not adequate to assess peripheral visual fields. B: The Amsler grid is used to assess central visual fields. C: The Snellen chart is used to assess visual acuity.

An OTR is evaluating a client for an injury to the right middle finger. On assessment, the OTR notices that the client is unable to extend the distal interphalangeal (DIP) joint but can move it into extension passively (mallet finger). What treatment plan would the OTR recommend for this injury? A. Electrical stimulation and ultrasound to facilitate extensor tendon gliding B. A hand strengthening program C. Resting of the joint D. A static orthosis holding the DIP joint in slight hyperextension

The right answer is D D: An orthosis holding the DIP joint in slight hyperextension places the tendon on slack for optimum healing of the extensor tendon injury. A: Electrical stimulation and ultrasound are not used on tendon injuries until 6-8 weeks postinjury. B: Gripping activities can damage the tendon further initially. C: The joint does need to rest, but the slight hyperextension position is essential to place the tendon on slack for healing.

Which occupation-based intervention activity is MOST appropriate to develop the bilateral hand skills of a 3-year-old child with autism? A. Holding a cup while pouring water from a large pitcher B. Donning a dress and buttoning the five 2-inch buttons on the dress C. Writing the child's own name while stabilizing the paper D. Holding the handle of a small bucket while filling it with water from a faucet

The right answer is D Of the options, holding the handle of a small bucket while filling it with water from a faucet is the most appropriate play-based activity for the child's age. A: Holding a cup while pouring water is a bilateral skill activity, but holding a large pitcher and cup at the same time will be a difficult task for a 3-year-old. B: Buttoning a dress is a bilateral hand activity, but buttoning clothes is not a developmental expectation for a 3-year-old. C: Writing one's own name is not expected of a 3-year-old child.

An OTR® is a member of an interdisciplinary work hardening program. When completing documentation according to best practice guidelines, which type of documentation should the OTR® NOT use? A. Progress notes that include pain reports, psychosocial complaints, modalities received, job analysis, and plans for next session B. Daily notes that reflect a detailed description of circuit training, including duration, number of repetitions, or both C. Progress notes that reflect the client's attendance, number of sessions, and response to the program D. Progress notes that reflect daily gradations of activities and exercises arranged in a therapeutic hierarchy

The right answer is D Daily gradations may not be clinically indicated for all clients. In the case of cumulative trauma disorders, clients may need to have tissue tolerance established by focusing on one specific job demand. A, B, C: These responses are reflective of documentation content that should be included in work hardening programs. A: Progress notes may also include pain behaviors, progress to date, meetings held, classes attended, cancellations of appointments, and client's attempts to problem solve and descriptions of any modifications. B: Daily circuit and schedule sheets are recommended for all clients to foster client responsibility for and independence with the program. C: Progress notes should complement initial and discharge summaries and keep the treatment team abreast of progress or problems.

DK- A client sustained partial-thickness and deep-thickness burns over a total body surface area of 60%, including the bilateral arms and legs. In the acute phase postburn, on what should the OTR® focus? A. Fluid retention B. Scar management C. Sensory reeducation D. Deformity prevention

The right answer is D During the acute phase of the burn, it is important to position the client to prevent the development of deformity and contracture. A: Fluid retention is one of the primary goals for the nurses and physician. B: A scar will not yet be developed in the acute phase. Scar management will be addressed in a later phase of the rehabilitation process. C: If there is any sensory impairment, reeducation will occur at a later phase of the rehabilitation.

X- A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. To minimize the risk of graft rejection in the initial phase (7 days postinjury), in what should the client be instructed? A. Daily active pronation and supination exercises at least 5 times per day B. Desensitization using ice to gently rub the burned areas from distal to proximal C. Retrograde massage followed by elastic bandage wrapping from distal to proximal D. Immobilization using the elbow extension splint and avoiding forearm movement

The right answer is D During the initial phase post-skin graft operation, it is important to maintain immobilization for 2-7 days or per the physician's specific instruction. A, B, C: Risk of graft rejection as a result of shear friction, movement, and excessive pressure should be avoided.

An occupational therapy student asks the professor for additional time on a final exam because of an attention deficit disorder and claims to have been too busy to get the required accommodations letter from the university's office for students with special needs. The professor waives the requirement and grants the additional time. On the basis of the principles of the Occupational Therapy Code of Ethics (2015), how can the professor's behavior BEST be characterized? A. The professor behaved benevolently while protecting Principle 6, Fidelity. B. The professor supported the student's right to privacy while ensuring that no harm was imposed on other students. C. The professor behaved both empathically and prudently. D. The professor behaved altruistically but violated Principle 4, Justice.

The right answer is D In behaving benevolently toward the student, the professor may not have weighed the fairness of the waiver to other students by giving the student an unfair advantage. Additionally, NBCOT® does not recognize a disability unless the student's university recognizes it. The professor should prepare the student to take the NBCOT and future course exams by denying any accommodations until they are properly designated by the university. A: The professor may have violated Principle 6, Fidelity, by not adhering to the school's guidelines for accommodating students with disabilities. Subprinciple 6K state that practitioners shall "abide by policies, procedures, and protocols when serving or acting on behalf of a professional organization or employer to fully and accurately represent the organization's official and authorized positions." B: Obtaining accommodations for a disability does not threaten one's right to privacy. Other students may have been indirectly harmed by the preferential treatment provided to this student. C: Although the professor may have behaved empathically toward the student, more careful scrutiny of the situation might have identified the threat to justice and fairness for other students. Prudence likely was not a main focus of the decision.

The occupational profile of a client recently diagnosed with bilateral osteoarthritis of the first carpometacarpal joints of the thumbs reveals that the client is retired and enjoys reading, playing cards with friends, and painting. The client has insurance coverage for only three occupational therapy sessions. What client education topics should the OTR® focus on FIRST? A. Hand strengthening exercises the client can perform independently B. Orthoses that may be fabricated to support and protect affected joints C. Thermal modalities to reduce pain and stiffness D. Joint protection principles

The right answer is D Joint protection principles are ideally taught early in the disease process to decrease joint stress and damage. A: Exercise programs that use active range of motion have been found to be more effective than strengthening; thus, hand strengthening exercises would not be the first focus for this client. B, C: Although orthotics and thermal modalities may be effective interventions, practitioners must work within time constraints. Joint protection principles would be addressed first because they cover the scope of the client's valued occupations.

An OTR® has been asked to provide an inservice for a facility's nursing assistants to prevent back pain or on-the-job injury. What principle BEST reflects safe patient lifting? A. Keep feet together to maintain a high center of gravity for transfer B. When lifting, do as much as possible in the transverse plane C. Use a stoop lift, when possible, to assist clients in transfer D. Maintain the clients body as close as possible while transferring

The right answer is D Keeping the client close while lifting is associated with decreased lumbar stress and is easily addressed in prevention A: A high center of gravity decreases stability and increases susceptibility of lower back B: Proper lifting is to be performed in the sagittal plane; the transverse plane would encourage "twisting" while lifting, increasing lower back susceptibility. C: A stoop lift is indicated for lifting very light loads (20 pounds and below)

Retired NBCOT® Question A 4-year-old child with bilateral congenital limb deficiencies at the transhumeral level was recently fitted with new prostheses. Which activity should be introduced FIRST as part of the prosthetic program with the child? A. Self-feeding using standard eating utensils B. Coloring pictures in an oversized coloring book C. Stacking 1-inch (2.54-cm) wooden blocks D. Pushing an 18-inch- (45-cm-) diameter exercise ball

The right answer is D Once an individual is fit with a prosthetic, use training should begin so the client can understand how to operate and control the prosthetic. The client is able to implement practice with pre-positioning the limb to more effectively approach an object, such as pushing a ball. A, B: Functional training occurs after the client has gained concepts of control and use of the prosthetic as through pre-positioning and prehension control. C: Prehension training occurs after the client is successful with pre-positioning the prosthetic in preparation for grasp or interaction with an object.

DK- X While an OTR® is working with a client on the grooming task of brushing teeth, the client mentions having to take antibiotics before going to the dentist for any dental work. What condition is MOST likely a part of the client's medical history? A. Chronic obstructive pulmonary disease B. Lung cancer C. Hip replacement D. Endocarditis

The right answer is D People with a history of endocarditis generally take antibiotics before any dental procedures to prevent an infection from migrating to the heart. A, B: Although people with chronic obstructive pulmonary disease or lung cancer are prone to respiratory infections, they do not need to take antibiotics before dental work. C: People with a hip replacement may be at risk for infection at the operative site, but not from dental work.

Retired NBCOT® Question An OTR® attended a continuing education workshop on the topic of proprioceptive neuromuscular facilitation. The OTR® plans to use this approach with an outpatient orthopedic population. What INITIAL action should the OTR® take prior to implementing this approach with clients? A. Ask the workshop instructor for permission to use copyrighted protocols. B. Develop a department budget for the required equipment and supplies. C. Discuss the use of the intervention with referring physicians. D. Review the evidence in peer-reviewed literature related to the approach.

The right answer is D Practitioners must be aware of the need to stay up to date in practice, and peer-reviewed literature is an acceptable source of scholarly information to examine the evidence. A: Obtaining copyright permission is important when using material from another person; however, the practitioner should first seek scholarly based peer-reviewed literature to assess the quality of the evidence. B: The quality of the evidence as an effective intervention must be assessed before the method is implemented with equipment and supplies. C: Communicating opportunities of evidence-based practice is an important step in implementing evidence into everyday practice; however, the quality of the evidence should be assessed first so the team can make informed decisions.

Retired NBCOT® Question An OTR® is presenting an inservice to case managers about the benefits of occupational therapy for patients who have respiratory disorders. What should be the PRIMARY focus of this presentation? A. Differences between occupational therapy and respiratory therapy B. Specific occupational therapy protocols for patients who have respiratory disorders C. Revenue-generating potential of occupational therapy services D. Impact of occupational therapy services on patients' abilities to function at home

The right answer is D Presenting intervention outcomes is important in establishing program justification such as expanding occupational therapy services to include patients who have respiratory disorders. A: Differences between the disciplines may be included in the inservice; however, this area should not be the primary focus of the presentation because case managers will find information on effectiveness of services more beneficial. B: Although specific occupational therapy protocols may be beneficial in establishing the outcomes of occupational therapy services for patients with respiratory disorders, the case managers will find information on effectiveness of services more beneficial. C: Revenue generated from expanding services is an important consideration in justifying programs; however, case managers will find information on the effectiveness of services related to improving patient outcomes more beneficial.

When the AOTA Ethics Commission determines that unethical conduct has occurred, it typically issues a disciplinary action. Which disciplinary action does NOT require public report of conclusions and sanctions? A. Suspension of AOTA membership B. Censure C. Revocation of AOTA membership D. Reprimand

The right answer is D Reprimand is a formal expression of disapproval of conduct communicated privately by letter from the AOTA Ethics Commission. A, B, C: Censure and suspension and revocation of membership all require a report of conclusions and sanctions in an official AOTA publication.

An OTR® is working with a client in an inpatient psychiatric facility and decides to use the Allen Cognitive Level Screen to assess cognitive functioning. Which goals would be appropriate on the basis of the Cognitive Disabilities Model? A. The client will demonstrate appropriate coping skills in identified stressful situations with 100% success. B. The client will independently apply relaxation techniques and report relief from stress at 0/10 after using the technique. C. The client will apply grounding techniques with 100% accuracy as a preventative measure to reduce over-stimulation. D. The client will be discharged home from the inpatient psychiatric unit with daily checks from caregiver to address novel safety needs in the home environment.

The right answer is D The Cognitive Disabilities Model assesses the client's current cognitive functioning to maximize supports in the environment that will facilitate maximal occupational performance. This goal suggests that after discharge, the client will be placed in an environment that will successfully manage the client's current cognitive ability through appropriate environmental supports. A: This goal is based on a cognitive-behavioral approach, not the Cognitive Disabilities Model. B: This goal is based on the behavioral approach, not the Cognitive Disabilities Model. C: This goal is based on a sensorimotor approach, not the Cognitive Disabilities Model.

An OTR® conducts a screening with a second-grade student who was referred to occupational therapy for handwriting legibility. In which way would the OTR® assess legibility during the screening? A. Calculate the number of letters or words written per minute. B. Ask the student to generate a short composition and determine whether it matches grade expectations. C. Observe the child's posture and note the child's grasp on the writing utensil. D. Document the total number of readable words divided by the total number of words written.

The right answer is D The OTR® would use the word legibility formula, which would allow the OTR® to calculate the number of written words relative to the number of legible words. The OTR® would likely also address the other legibility factors, such as alignment, spacing, sizing, and slant. A, B, C: All of these options could be part of a comprehensive handwriting evaluation, but only D specifically targets legibility.

Retired NBCOT® Question In preparation for an upcoming orchestral performance, an adolescent student has been practicing playing a string musical instrument 5 to 6 hours per day. The student reports hand pain that is causing illegible handwriting and an inability to complete written classwork in a timely manner. What INITIAL action should the OTR® take in this situation? A. Advise the student to take a break from music practice until the pain subsides. B. Arrange for the student to use a computer for written assignments for school. C. Collaborate with the music teacher to determine an appropriate rest/practice schedule. D. Schedule a time to observe the student during a rehearsal set-up and practice.

The right answer is D The primary goal of intervention for upper-extremity overuse with musicians is to identify and reduce muscle tensions when playing the instrument. Observing the student during a rehearsal and practice would allow the practitioner to gather this information. A: It may be necessary for the student to decrease practice time or discontinue playing altogether, although this does not have to be the initial action until the practitioner observes the student playing the instrument. B: The increase in practice time is what has caused the hand pain to occur, and changing from writing to computer use will not address the source of the problem. C: Collaborating on accommodations to the practice schedule may be a necessary intervention approach once the practitioner has observed the student playing the instrument.

An OTR® is evaluating a client with Parkinson's disease who lives at home but has begun to have mobility challenges. Which intervention is BEST to facilitate lifestyle changes to improve safety? A. Issue a long-handled reacher and teach the client how to use it B. Advise the client to continue to carry items during functional mobility C. Issue a rolling walker and educate the client how to use it D. Introduce use of a rhythmic beat to facilitate mobility

The right answer is D The use of rhythm has been shown to support mobility in people with Parkinson's disease. This approach can minimize the impact of the immobilization that may occur from this disease. A: A long-handled reacher may be difficult for a client with Parkinson's disease to use because of tremors and rigidity. B: Carrying items during mobility may decrease postural stability responses. C: A rolling walker may not be effective because the motoric freezing and festinating gait characteristic of this condition cause people to take smaller steps to adjust for postural instability.

A client is injured while lifting a 50-lb box at his manufacturing job and files an injury report the next day. He is diagnosed with lower lumbar pain. He sees an OTR® at an outpatient therapy setting 3 days after the injury. Which of the following is the MOST likely source of reimbursement for occupational therapy services related to work injuries? A. Private insurance B. Individual medical plan C. Long-term disability D. Workers' compensation

The right answer is D Workers' compensation is the most likely source of reimbursement for acute work injuries. A, B: Injuries that occur on the job are not covered by medical plans, and workers should not pay privately for medical bills to avoid filing a workers' compensation claim. C: Not enough time has elapsed for the worker to be covered by long-term disability.

An OTR® receives a referral to evaluate a client with Alzheimer's disease. The client is difficult to redirect while performing the assessment. What would be the BEST approach for the OTR® to use to gather appropriate information to complete the assessment and guide intervention planning? A. Decide that it is not the appropriate time to complete the assessment; plan to return later in the day. B. Talk to the physician about the client's inability to maintain attention to the assessment. C. Explain to the family members that they should contact the OTR® when the client is able to participate more fully in the assessment. D. Observe the client's behavior and reactions to environmental stimuli to gather information for the assessment.

he right answer is D Observation can yield rich information about a person with dementia. It is one of the primary modes of assessment recommended for people with dementia. A, C: Delaying the assessment as a result of behaviors is not appropriate because they are a hallmark feature of AD. B: Contacting the physician to discuss behaviors that have been observed during contact with the client might be acceptable, but doing only this does not address the referral.