AOTA questions week 3 & 4

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

A. An assisted stand pivot is used to move a client from one surface to another.

An OTR® is working with a client who fractured the distal radius 6 weeks ago. Within what time frame can controlled AROM be initiated if the fracture is healing secondarily? A. 0-3 weeks postinjury B. 3-6 weeks postinjury C. 6-9 weeks postinjury D. 9-12 weeks postinjury

B. Initiation of controlled AROM can begin between 3 and 6 weeks postinjury if the fixation of the fracture is adequate.

The caregiver of a client with middle-stage dementia requests assistance from the OTR®. The caregiver wants to ease the client's morning personal care routine. What is the BEST recommendation related to the bathroom environment that the OTR® can provide to the caregiver? A. Paint the bathroom a bright yellow. B. Use labels for hot and cold on the faucets in the bathroom. C. Use low levels of light to reduce eyestrain. D. Keep all bathroom items clearly visible to the client.

B. Labeling physical structures with symbols, such as arrows for direction, is helpful to people with dementia.

An OTR® receives a referral for a client who is preparing for hip replacement surgery. The client's caregiver attends the session. How would the OTR® BEST incorporate the caregiver into the session? A. Ask the caregiver to detail his or her schedule and ability to supervise the client upon release. B. Ask the caregiver to take notes on the session and provide brief feedback when complete. C. Ask the caregiver to practice adaptive activities alongside the client. D. Ask the caregiver to read a manual regarding hip replacement surgery.

C. Caregivers should be encouraged to practice adapted activities so that they fully understand the impact of prescribed hip precautions.

A 5-year-old client has been referred for fabrication of an orthosis after a flexor tendon repair. Which protocol would be MOST appropriate for this client? A. Early active motion B. Duran protocol C. Kleinert protocol D. Immobilization orthosis for 3-4 weeks

D. Children who cannot understand or follow a prescribed protocol for motion are best treated initially with an immobilization orthosis to strengthen the repair before movement to reduce the chance of rupture.

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

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.

Which of the following exercise programs is MOST appropriate for a client with rheumatoid arthritis (RA) during an acute flare-up that involves significant pain and swelling? A. Daily PROM of the joints through full comfortable ROM B. Daily AROM of the joints through full comfortable ROM C. Isotonic progressive resistive exercises of the joints as tolerated 3 times a week D. No exercise program

A. Exercise to maintain ROM and strength is important for clients with RA. Although as a general principle AROM is preferred, during a flare-up PROM is indicated if pain makes it difficult for the client to do AROM.

An OTR® is evaluating an electrician who sustained an electrical burn in the right palmar area 2 days ago. The client has a subdermal burn in the middle of the palm with a full-thickness burn extended into the middle and index fingers. After completing the initial goniometric measurements of the right wrist and fingers, what other assessment is MOST IMPORTANT for the OTR® to perform before developing an intervention plan? A. Gross sensory screening B. Edema measurement C. Grip and pinch strength D. Manual muscle testing

A. For a client with an electrical burn, it is especially important to complete gross sensory screening of the involved limb to identify the extent of peripheral sensory nerve involvement. Similarly, for full-thickness and subdermal burns, it is likely that the peripheral sensory nerves are involved.

handwriting curriculum with the kindergarten teacher. The OTR® is working with a small group of students to remediate their pencil grips. Which grip would require remediation? A. The pencil rests on the distal phalanx of the radial side of the little finger, and the pads of all five fingers control the movement; the thumb is opposed to the ring finger and the wrist is flexed. B. The pencil rests against the radial side of the middle finger, and the pads of the fingers control the movement; the thumb is not opposed to the index finger and rests on the distal interphalangeal joint. C. The pencil rests against the radial side of the ring finger, and the pads of the fingers control the movement; the thumb is not opposed to the index finger and rests on the distal interphalangeal joint. D. The pencil rests against the distal phalanx of the radial side of the ring finger, and the pads of the fingers control the movement; the thumb is opposed to the index finger.

A. This grip is not functional and should be remediated.

An OTR® is observing a client's driving performance in a contained environment; the client is performing tasks and responding to demands involving car controls and car handling or maneuvers. Which testing approach is the OTR® using? A. Closed route B. Simulator testing C. Instrumented vehicle D. Naturalistic driving

A. A closed route is a contained environment that allows a client to perform tasks and respond to car handling or maneuvers.

A client with a transfemoral amputation who is being fitted for a prosthesis is reporting severe pain when placing weight on the end of the residual limb. The OTR® examines the limb but does not see any reddened or open areas. What is this pain MOST likely the result of? A. A neuroma B. Phantom sensation C. Phantom limb D. A sebaceous cyst

A. A neuroma is a ball of nerve tissue that occurs when axons attempt to grow back in the distal limb. They can be painful when pressed but are not necessarily visible.

During an assessment, an OTR asks the client to pinch a pinch gauge and notices increased flexion of the thumb interphalangeal joint. What term is used to describe this type of pinch? A. Froment's sign B. Wartenberg's sign C. Jeanne's sign D. Ulnar claw

A. Froment's sign occurs when the flexor pollicis longus compensates for a weak or paralyzed adductor pollicis and flexor pollicis brevis. When a client attempts to pinch, the interphalangeal joint of the thumb flexes more than usual.

A 76-year-old client will be using a wheelchair after discharge from an acute rehabilitation facility. The client has achieved independence in wheelchair mobility on level surfaces but still requires minimal assistance for transfer. The client is planning to move into a daughter's home, which was not the client's previous residence. The OTR® is planning for an onsite home evaluation with the client and the client's daughter. Before the home evaluation, what will be the MOST appropriate action for the OTR® to take? A. Interview the client and daughter to obtain an appropriate profile and determine role expectations that the client will assume on discharge. B. Discuss with the client functional mobility limitations and the level of assistance required for toilet transfer as part of fall prevention education. C. Interview the daughter regarding detailed measurements and the physical layout of the home and acceptance of the necessary home modifications. D. Provide the client and daughter with information regarding the Americans With Disabilities Act's (Pub. L. 101-336) accessibility guidelines for buildings and facilities.

A. Gathering information on role expectation helps to determine the performance assessments to be completed during the home evaluation (e.g., if the client is expected to do laundry, then accessibility to the laundry room will be assessed during the home assessment).

An OTR® who works with adult clients with mental illness attends an introductory workshop on guided imagery. The OTR wants to begin applying the skills obtained from the workshop with clients. For which type of disorder is guided imagery an appropriate intervention technique? A. Generalized stress disorder B. Chronic schizophrenia C. Bipolar disorder with psychosis D. Schizoaffective disorder

A. Guided imagery is a type of mindfulness technique that encourages relaxation. It is an evidence-based strategy that has been found to be effective with people with stress-related disorders. The technique allows clients to practice skills in a situation with less pressure than might be encountered in a real situation, which gives them the ability to approach the real-life situation with less anticipatory stress and strategies to cope with stress as it arises.

During an initial evaluation, the OTR® brings a 7-year-old child with autism to the sensory gym to observe the child's play skills. The OTR® demonstrates a variety of play equipment and tells the child, "I want to see you play in the gym. What would you like to do?" The child is unable to figure out which equipment to use and how to use it. The OTR® suspects that the client may have difficulties in what aspect of play? A. Ideational praxis B. Motor organizational praxis C. Symbolic play D. Exploratory play

A. Ideational praxis is the ability to conceptualize and identify a motor goal and ways to achieve this goal. Problems in this area may lead to difficulties in generating independent play.

A client with a chronic median nerve compression at the carpal tunnel has severely diminished functional pinch. In what position should the thumb be splinted to facilitate functional pinch? A. The thumb should be splinted in opposition and palmar abduction to facilitate thumb-to-tip prehension. B. The thumb should not be included in a carpal tunnel orthotic to allow for functional prehension. C. The thumb should be splinted in opposition and radial abduction to facilitate thumb-to-tip prehension. D. The thumb should be splinted in extension to limit shortening of the extensor pollicus longus.

A. Opposition and palmar abduction represent the functional position of the thumb that best allows pinch.

An OTR is working with a client who has undergone a carpal tunnel release. The client describes postoperative pain on either side of the carpal tunnel that makes it difficult to grasp objects. What is the term for this type of pain? A. Pillar pain B. Chronic pain C. Phantom pain D. Complex regional pain

A. Pillar pain is pain on either side of the carpal tunnel release surgery site. The source of the pain is unknown and may be ligamentous or muscular in origin.

State laws vary with regard to use of physical agent modalities (PAMs) by OTR®s. When explaining how PAMs fit within the scope of occupational therapy practice in their state, which description of PAMs should OTRs use, provided in the Occupational Therapy Practice Framework: Domain and Process? A. Preparatory methods used as part of a treatment session in preparation for purposeful or occupation-based activity B. Occupation-based interventions that are systematically applied to modify specific client factors that may be limiting occupational performance C. Activities that support performance skills and patterns D. Preparatory tasks that target specific client factors or performance skills

A. Preparatory methods are described in the Framework as "modalities, devices, and techniques to prepare the client for occupational performance" (AOTA, 2014, p. S29). They may be used as part of a treatment session or concurrently with occupations and activities that support occupational performance.

An OTR® receives a referral for a child who has difficulty with handwriting. The OTR® wants to determine whether the child has difficulty with the integrated process of handwriting rather than specific components that support the production of handwriting. Which of assessment methods would be appropriate to use for this purpose? A. Print Tool B. Developmental Test of Visual Motor Integration C. Canadian Occupational Performance Measure D. Child Occupational Self-Assessment

A. The Print Tool is a commercially available and standardized way of measuring a child's ability to produce handwriting.

A dental hygienist is referred to occupational therapy for establishment of a work conditioning program after carpal tunnel release 1 month ago. The client is anxious to return to work but fearful of reinjury. Which intervention is MOST appropriate for the OTR® to include in the client's work conditioning program? A. Instructing the client in median nerve gliding exercises B. Instructing the client in ulnar nerve gliding exercises C. Guiding the client in progressive resistive exercises using therapy putty D. Writing simulated client progress notes

A. The median nerve travels through the carpal tunnel. Active exercises of wrist, thumb, and fingers are encouraged 24-48 hours postoperatively. Median nerve glides can be incorporated into a work routine between dental clients to decrease the risk for reinjury

The OTR® is working on a task-oriented gardening activity with a small group of adolescents in an inpatient mental health setting. One of the participants becomes self-absorbed and distractible and has bursts of energy that are affecting the other members of the group. What is the OTR®'s MOST appropriate response? A. "How are we doing with our pot transfer? We need to get this done today." B. "Can I speak to you privately about your behavior during the group work?" C. "You seem to be distracting the other members of the group." D. "Please stop whatever it is you are doing."

A. When a client starts shows symptoms of a manic episode, particularly emotional and cognitive symptoms, it is best to help the client engage in goal-directed action.

An OTR® is using Fidler's task-oriented group as a context for treatment to help participants explore healthy ways to deal with conflict. Which of the following activities would be BEST for this group? A. An activity that is challenging and likely to cause tension among members B. An activity that is highly structured so participants know exactly what is expected of them C. A parallel group activity that enables participants to work alongside one another D. An activity that facilitates participants' success and thus improves their self-esteem

A. A task-oriented group presents opportunities for participants to practice situations they may encounter in daily life. A group environment in which conflicts are likely to occur can help participants practice resolving conflict in appropriate ways.

An OTR® has just fabricated a dynamic splint for an inpatient who had an MCP joint arthroplasty 4 days ago. The patient is being discharged to home and will have home-health follow-up in several days. What information is MOST IMPORTANT for the OTR® include in the patient's discharge instructions? A. Call the inpatient OTR® with questions about the splint position or fit. B. Contact the home health OT with any questions about the splint. C. Remove the splint for short intervals and elevate the hand if swelling occurs. D. Contact the home health or inpatient OT if there is an increase in redness around the incision.

A. Any patient provided with a splint should be given thorough written instructions, which include the contact name and number of the practitioner who fabricated the splint.

A client recently began having difficulty walking and decided to borrow a wheelchair from a family member. However, the client complains that it is difficult to get into and out of the chair because the client's hips are wider than the seat. The client decides to purchase a chair and asks the OTR® for a recommendation on seat width. What should the OTR explain is the MAIN objective for proper wheelchair seat width? A. To distribute weight over the widest possible surface while keeping the width of the chair as narrow as possible B. To support the client's body in the wheelchair while maintaining the thighs in a position that is parallel to the floor C. To maintain proper posture and balance and to provide support and alignment for the upper extremities D. To provide for maximal function and support of the back while still allowing for change in body positioning

A. Distributing weight over the widest possible surface prevents too much pressure on any specific area. However, the narrower the width, the easier it is for the client to maneuver through the environment. Trying to find a balance between these two areas is key to good wheelchair selection.

A client's family purchased an ultra lightweight wheelchair (K0005) for the client. It has the correct seat height, seat width, and seat depth, but the client has difficulty propelling it. The OTR® asks the client to demonstrate moving the chair forward. What two potential problems would the OTR® FIRST focus on? A. Location of the axle in relation to the client's center of gravity, seat-back height B. Height of seat back, position of leg rests C. Position of leg rests, location of axle in relation to the client's center of gravity D. Distance of axle from the floor; location of the axle in relation to the client's center of gravity

A. If the axle is behind the client's center of gravity, the client may not be able to grasp enough of the pushrim during propulsion, making movement less efficient; if the seat back is too high, it can prevent the shoulder extension necessary to contact the pushrim

A client who has rheumatoid arthritis (RA) has difficulty with ADL tasks and has been referred to occupational therapy. Which statement reflects a principle of joint protection? A. The client should use an alternate grip on a walker, to provide more stability during ambulation. B. The client should lift items on the kitchen countertop instead of sliding them. C. The client should use a handheld purse instead of a backpack, to reduce stress on joints. D. The client should modify daily tasks, such as replacing elastic shoelaces with regular laces, to reduce stress on joints.

A. Rather than using a tight grip, the client with RA would benefit from modifying the walker (e.g., attaching arm troughs or larger handles) to reduce the grip pressure needed during ambulation and protect the small joints of the hands.

Retired NBCOT® Question A student in the first grade has illegible handwriting. Results of a standardized assessment indicate the student scored 0.5 standard deviations from the mean on a gross motor subtest and 2.0 standard deviations from the mean on a fine motor subtest. What do these results indicate? A. Activities to improve handwriting should be included as part of the intervention. B. Ninety-eight percent of the student's peers would score better on the fine motor test. C. Fine and gross motor skills are within an acceptable range from the norm. D. Fine motor and gross motor skills are moderately delayed compared to the norm.

A. Standard deviations less than 1.5 suggest a need for occupational therapy services; in this case, the gross motor standard deviation does not suggest a delay, whereas the fine motor standard deviation should be addressed through an intervention plan that addresses the student's handwriting

A client with Parkinson's disease is experiencing bradykinesia and reports decreased ability to move from sitting to standing. What strategy should the OTR® recommend? A. Consistent use of a short self-cue, such as "rise," each time the client needs to stand B. Use of a standard walker for transferring between surfaces in the household C. Strengthening of bilateral lower extremities in collaboration with another discipline D. Education on the need for a caregiver to be available for functional mobility

A. Teaching self-cueing is useful in helping clients initiate movement to minimize the effects of bradykinesia

A client with stroke is taught to dress the weaker side first when donning a button-down shirt. The client then initiates putting the weaker lower extremity into the pant leg. What learning has occurred for the client? A. Generalization B. Transfer C. Automaticity D. Acquisition

A. The client demonstrates generalization, which is the ability to take a strategy used with one task and apply that strategy to a new task.

A client who had a CVA is now being discharged from a hospital setting to home. The client continues to show signs of right-sided weakness and decreased balance. What referral for occupational therapy services is MOST appropriate for the OTR® to make? A. At home with a home health OTR® B. In an outpatient center C. In the acute-care hospital D. In a subacute rehabilitation hospital

A. The client is being discharged to home; therefore, continuing occupational therapy services in that setting is most appropriate.

Retired NBCOT Question: An OTR® is providing early intervention services to a 24-month-old child who has a pervasive developmental disorder. The parents' goal is for the child to be able to participate in age-appropriate activities with peers. Which of the following contexts is BEST for promoting progress toward this goal? A. Organized play group in a community playground B. Backyard of the child's home with siblings C. Group session in the occupational therapy clinic with other children D. Tumbling group for preschoolers in a community gymnasium

A. The environment is important for supporting a child's play actions; the child perceives the interactions within various environments, then learns to act on those interactions. A play group that is organized will allow the child to be in a natural play environment while learning to adapt to or accommodate peers in interactions.

Which statement BEST describes supplemental transportation programs? A. Transportation services for older adults and people with disabilities who cannot use existing transportation options B. Commercial transportation providers who have specialized training in serving older adults C. Paratransit services funded by taxpayer money that serve specific regions D. Transportation services staffed by paid drivers who operate a fleet of limousines

A. The term supplemental transportation program describes a wide array of volunteer, nonprofit, or community-based transportation options serving older adults and people with disabilities who either are unable to use existing transportation services or desire more flexible travel options.

An OTR® is educating a client about what to expect in the process of wound healing after surgery. What are the expected phases of wound healing in the order they occur? A. Inflammation, proliferation, and remodeling B. Coagulation, tension, and scar formation C. Proliferation, inflammation, and remodeling D. Tension, coagulation, and scar formation

A. Wound healing occurs in phases that generally follow the process of inflammation, proliferation, and remodeling.

An OTR® is working with a client who has difficulties with visual skills as a result of damage to the central nervous system (CNS). Which visual skill is related to CNS damage? A. Visual memory B. Stereopsis C. Figure-ground D. Kinesthesia

B. Stereopsis, or binocular depth perception, is a visual skill that would be affected by CNS damage.

A client receiving special education instructional support arrives at the occupational therapy clinic for an evaluation as part of the student's transition planning needs. As part of the evaluation process, what must the OTR® FIRST determine? A. The client's interests and roles B. The client's performance skills C. The client's career opportunities D. The client's community interests

B. The OTR® should first assess the client's performance skills to develop a transition plan to promote movement from school to postschool activities.

An OTR® is evaluating a new client and notes that the client has a bluish tinge to the skin and lips. The client also presents with significant edema. Which medical condition is this client MOST likely to have? A. Emphysema B. Chronic bronchitis C. Cystic fibrosis D. Cirrhosis of the liver

B. A client with chronic bronchitis has poor oxygenation, resulting in a bluish tinge to skin and lips, along with edema.

An OTR® consultant is hired to perform a job demand analysis for the assembly-line workers in a meat-processing factory. What areas will the OTR® MOST likely be measuring and reporting on? A. The ordering, assembly line, and documentation processes B. Height of the table, cutter and tool design, and vibration frequency of the automated tools C. Administrative hierarchy, lines of command, and ratio of supervisors to workers at the factory D. Job description, lifting requirement for the tasks, and the training process.

B. A job demand analysis is an objective evaluation of each task of a job, taking into consideration the physical environment in which the job occurs. The workstation's dimension and layout, equipment, tools, and any other factors that can affect workers will be documented. The ergonomic risk factors are also considered in a job demand analysis.

An OTR® is working with a client with severe kyphosis secondary to osteoporosis. What is the primary cause of kyphosis in osteoporosis? A. Pathological deterioration of the vertebrae of the cervical spine B. Pathological deterioration of the vertebrae of the thoracic spine C. Pathological deterioration of the vertebrae of the lumbar spine D. Pathological deterioration of the neck of the femur

B. A kyphosis is an abnormal rounding of the upper back. In the case of osteoporosis, it is caused by compression fractures of the vertebrae weakened by the osteoporotic condition.

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. During the multidisciplinary team meeting, the referring physician asks the OTR® to justify why OTR®s are suited to assess this client's fitness to drive. How would the OTR® BEST respond? A. Driving is an ADL included in the scope of practice of occupational therapy and therefore within the OTR®'s domain to assess. B. OTR®s need to extrapolate beyond the walls of the clinic to consider how clients will function in the community; making such an extrapolation, assessing driving fitness is no different from considering whether a client is fit to live alone. C. Occupational therapists use clinical reasoning to make determinations regarding a client's IADLs, including driving. D. OTR®s are trained to use clinical tests to assess domains of function. Because driving entails motor, sensory, cognitive, and visual functioning, occupational therapists may make fitness-to-drive decisions on the basis of functional performance of clients.

B. A: Driving assessment is within the OTR®'s scope of practice, it is an IADL, not an ADL. C: The OTR® should be using clinical reasoning, critical thinking, and best evidence to problem solve whether a client is fit to drive, not just clinical reasoning. D: A comprehensive evaluation, not just assessment of functional performance components, is necessary.

Which class of psychopharmaceutical drugs is mood elevating but may increase suicidal tendencies in young adults and carries a small risk of causing hypomania or mania? A. Adrenergic receptor drugs B. Antidepressants C. Anticholinergics D. Antipsychotics

B. Antidepressants have a variety of mechanisms, but all are mood elevating and carry potential for risk of suicide. Mania and hypomania are risks with all antidepressants.

An OTR® suspects that an OTR colleague is falsifying treatment session documentation in order to comply with documentation deadlines. If true, this constitutes a breach of the ethical principles of Veracity and Justice. What is the BEST next step for the OTR take? A. Report the person to the state regulatory board. B. Approach the person directly to refute the claim. C. Report the person to the rehab manager. D. Contact the human resources department.

B. Approaching the person directly is most appropriate; it is the most respectful approach, and the OTR may be incorrect about the OTR's behavior.

A client with poor visual acuity (20/200 bilateral) has had several near collisions and is working with an OTR® to improve driving performance. What are the BEST compensatory strategies the OTR® can recommend to decrease the impact of the driver's impaired visual acuity on road performance? A. The client should use bifocal lenses. B. The client should drive on roadways with reduced speed limits and should not drive at night. C. The client should drive with a "co-pilot" who can read road signs out loud. D. Train the client in the use of alternative transportation and start the driving retirement process.

B. Careful route choice and avoidance of night driving constitute the most comprehensive compensatory strategy.

A 10-year-old child sustained a Zone 2 flexor digitorum profundus tendon laceration and underwent primary repair. Which flexor tendon repair protocol represents best practice standards? A. Active mobilization approach B. Immobilization approach C. Passive mobilization approach D. Controlled early active mobilization approach

B. Children younger than age 12 are usually placed on an immobilization protocol because of their low maturity level and low ability to comply with the exercises and precautions of other protocols.

A client had surgery 6 weeks ago. The surgeon used a plate to fix a metacarpal shaft fracture. The client is experiencing moderate edema that makes it difficult to make a fist. Grasping containers and manipulating clothing fasteners are the most difficult tasks. What is the BEST approach for the OTR® to take to address the client's edema? A. Pneumatic pump and cold packs B. Cold packs and compression glove C. Deep retrograde massage and elevation D. A bulky dressing for the arm

B. Cold packs cause vasoconstriction, so they are appropriate to use for edema reduction. Compression will facilitate small molecule absorption by the venous system. A combination of the two is the best strategy to reduce edema.

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

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).

The topic of the February 7, 2013, newsletter MLN Matters, published by the Medicare Learning Network under the Centers for Medicare and Medicaid Services, was related to changes in the criteria for mobility assistive equipment and mobility-related ADLs (MRADLs), which OTR®s working with positioning, seating, and wheelchairs need to know for reimbursement. Which of the following is NOT an MRADL specifically cited by Medicare? A. Feeding B. Cooking C. Bathing D. Grooming

B. Cooking is not specifically cited by Medicare; Medicare regulations state that beneficiaries must have significant limitations in tasks such as "toileting, feeding, dressing, grooming, or bathing."

Which of the following tasks would be MOST appropriate to use during the functional training phase for a client learning to use a unilateral myoelectric terminal device (TD)? A. Grasping and releasing different-sized blocks B. Using scissors to cut paper C. Typing on a computer keyboard D. Brushing teeth

B. During the functional training phase, a client is learning to incorporate the TD as a functional assist. Bilateral activities that require one dominant extremity (the hand) and one functional assist (the TD) are the best tasks for practice. Using scissors to cut paper requires the TD to be the functional assist (holding the paper).

An OTR® is working with a client who has just had a total hip replacement using an anterolateral approach. Which type of equipment is MOST important for maintaining appropriate hip precautions? A. A reacher B. An abductor wedge C. A sock aid D. A tub bench

B. Hip precautions for an anterolateral approach are no external rotation, no adduction (crossing legs or feet), and no hip extension. An abductor wedge will prevent external rotation and adduction of the hips.

An OTR® is adapting the environment to reduce the incidence of repetitive strain injuries among office workers. To maximize the effectiveness of the ergonomic program, what would the OTR® be MOST likely to include? A. Visual reinforcement with signs posted around the office and workstations B. Empowerment of the workers and creation of a positive group-safety culture C. A series of lectures and videos showing bad versus good workstation ergonomics D. Education of supervisors in how to identify noncompliant workers

B. Motivation is a big factor for change to occur. Creating a sense of teamwork allows for mutual support to accomplish goals together.

An OTR® in a home health setting is working with a client in the kitchen and hears a heated argument between the client's spouse and one of the client's children in the next room. The client begins to cry, indicating that the arguing is causing stress. What action would be MOST reasonable for the OTR® to take? A. Confront the people in the next room B. Call the medical social worker and report the incident C. Drive the client to a shelter D. Try to resolve the conflict

B. Referral to an expert in dealing with these matters, such as a medical social worker, is the best course of action; direct intervention is outside the OTR®'s scope of practice.

According to the Model of Human Occupation (MOHO), occupational therapy intervention will best benefit adult clients with mental illness through which of the following approaches? A. Understanding the interaction between the client's perceived level of task mastery and the demands of the environment B. Understanding the client's dimensions of occupational participation and performance C. Understanding how the environment can be adapted, modified, and restored to enable effective performance D. Understanding how the client uses sensory information in the environment

B. The "dimensions of doing" is part of MOHO.

What is the most important safety recommendation for clients with middle-stage Alzheimer's disease (AD)? A. Do not allow this client to complete ADLs independently because the client might not dress appropriately for the weather. B. Do not leave this client alone because the client might get lost, even in a familiar environment. C. Provide this client with activity to engage the client throughout the day to minimize behavioral disturbances. D. Provide this client with redirection to minimize behavioral outbursts and prevent self-injurious behaviors.

B. The most important safety issue would be leaving a client with AD alone, because the client might become lost or confused, even in familiar environments.

An order came in for a hand splint for a new client. A newly graduated OTR® evaluated the client for the splint. The new OTR® had not made a splint on a client before and requested an experienced OTR® hand therapist's assistance. In doing so, the OTR® abided by the ethical principle that involves taking "responsibility for maintaining high standards and continuing competence?" Which principle is that? A. Nonmaleficence B. Procedural Justice C. Prudence D. Veracity

B. This principle relates to taking continuing education and being competent in one's job.

Which psychiatric condition is MOST frequently seen as interfering with the occupational engagement of a client with cardiac disease? A. Panic attack B. Major depression C. Personality disorder D. Hypochondriasis

B. depression have poorer outcomes and increased morbidity and mortality.

An OTR® is reviewing a chart on an infant who was referred to the developmental follow-up clinic. The OTR® notes that the mother transmitted syphilis to the baby during birth. Which impairments might be seen in the child? A. Poor bladder control B. Poor tolerance of passive range of motion C. Poor balance D. Poor feeding and vomiting

B. Congenital syphilis may result in osteochondritis at the joints, other bone anomalies, dental anomalies, and visual and auditory deficits. PROM may be painful.

A team of OTR®s begins to recognize the need for a program to promote work participation for the young adults with mental illness they serve. Which statement MOST accurately reflects the evidence about developing such a program? A. Prevocational training sufficiently prepares clients with mental illness for work. B. Supported employment programs with a "place-and-train" perspective are more effective than other vocational approaches. C. Transitional employment placement through a clubhouse model is a time-honored method for increasing job placement. D. Sheltered workshops are useful programs for advancing work participation.

B. Current rehabilitation focus is on the place-and-train supportive employment approach, and evidence supports its use.

An OTR® is working with a client who has been placed on bedrest because of a deep vein thrombosis. After anticoagulation therapy has been initiated, what is the accepted waiting period to resume occupational therapy interventions involving ambulation? A. 12 hours B. 2-3 days C. 5-7 days D. 8-10 days

B. Recent literature has indicated that ambulation may be permitted on the 2nd or 3rd day after anticoagulation therapy has been initiated.

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 With Disabilities Act D. Healthy American Students

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.

An OTR® is treating a client who burned the bilateral lower extremities 10 days ago. The client refuses to participate in ADLs because of pain. The client rates the level of pain as 4 of 10 when resting in bed and 7 of 10 when standing. What is the BEST action for the OTR® to take? A. Report the client's pain levels to the medical doctor and request stronger pain medication. B. Apply an elastic bandage wrap for vascular support before getting the client out of bed. C. Allow the client to perform ADLs while lying in bed, and focus on bed mobility skill. D. Explain to the client that nonparticipation may lead to an early discharge from therapy.

B. With lower-extremity burns, providing vascular support before standing decreases blood pooling in the lower extremity and therefore decreases pain in standing and ambulation. The client should learn an alternative strategy to manage pain early on in the intervention.

What is included when using a top-down approach to reduce risks in jobs? A. Work hardening program to increase endurance B. Maintaining neutral spine alignment in lifting C. Involving managers in work simplification D. Individual workstation ergonomic assessment

C. A top-down approach includes systemwide changes and management support of the change process.

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

C. Maintaining head and neck alignment reduces the risk of strain to the neck

An OTR® receives a referral for a client who is preparing for hip replacement surgery. The client's caregiver attends the session. How would the OTR® BEST incorporate the caregiver into the session? A. Ask the caregiver to detail his or her schedule and ability to supervise the client upon release. B. Ask the caregiver to take notes on the session and provide brief feedback when complete. C. Ask the caregiver to practice adaptive activities alongside the client. D. Ask the caregiver to read a manual regarding hip replacement surgery.

C. Caregivers should be encouraged to practice adapted activities so that they fully understand the impact of prescribed hip precautions.

At what stage of Alzheimer's disease (AD) will procedural memory impairments FIRST be noticed? A. Mild cognitive impairment B. Early stage C. Middle stage D. Late stage

C. During the middle stage, all memory worsens, including procedural memory.

A client with an acute mild brachial plexus stretch injury affecting the left side reports limited forward shoulder flexion because of pain; limited cervical mobility; forward head and rounded shoulder posture; and decreased sensation in the thumb, index, and radial side of the long finger. The client has full range of motion in internal and external rotation of the shoulder. The occupational profile reveals that the client is an accountant who enjoys surfing and tennis on the weekends. What instruction should the OTR® provide on the first visit? A. Rotator cuff strengthening exercises for humeral head stability to reduce impingement pain noted with forward flexion B. Forward flexion active-assisted exercises to reduce capsular tightness C. Postural correction exercises, modification of the workstation to promote appropriate posture, and reduction of overhead activities D. Recommendation to maintain normal work activities but avoid tennis and surfing until further notice

C. Nonoperative treatment of a brachial plexus stretch injury includes education on how to minimize further irritation to the brachial plexus, including postural education and education regarding avoidance of provocative positions (e.g., overhead activities).

What is the PRIMARY benefit of using the SETT (Student, Environment, Task, Tools) Framework to guide assistive technology (AT) evaluation and service delivery in a school-based setting? A. Helps to reduce the incidence of learned helplessness and low self-esteem among students who have communication deficits B. Meets specific standardized assessment requirements as outlined in the Individuals With Disabilities Education Improvement Act of 2004 C. Promotes educational team collaboration regarding students' AT needs throughout the school day D. Provides a method for prioritizing students' occupational therapy intervention activities based on hierarchy of scores

C. The SETT allows for collaboration and communication among educational team members to support good decision making to determine the AT needs of a student.

An OTR® believes that changing clients' negative beliefs ultimately reduces negative emotional statements and leads to a change in behavior. What is this OTR's main theoretical perspective? A. Cognitive disabilities B. Developmental C. Cognitive D. Sensorimotor

C. The cognitive perspective deals with clients' emotional response to experiences and assists them in reframing their behavioral response.

An OTR® is working with transplant recipients who have recently been discharged from a major hospital. Which type of client would be MOST likely to develop an infection posttranplantation and require greater infection control measures? A. A client with a kidney transplant B. A client with a heart transplant C. A client with a lung transplant D. A client with a liver transplant

C. A client with a lung transplant is the most susceptible to infection because the transplanted organ is exposed to bacteria and germs on inhalation.

An OTR® is working with a client who is about to undergo a second lower-extremity amputation. The client did not use a wheelchair with the first amputation but wants to purchase one now for occasional mobility if lower-limb prostheses are not available. What is necessary for wheelchair safety for a client with bilateral lower-extremity amputations? A. Reclining back rest B. Elevating leg rests C. Rear antitippers D. Wedge cushion

C. Because a person who has undergone a bilateral lower-extremity amputation has a different weight distribution when seated, the wheelchair is more likely to tip backward with less weight in the front. Antitippers prevent this.

A client with multiple sclerosis (MS) states that fatigue is negatively affecting work performance. What is the BEST action for the OTR® to take next? A. Perform a worksite evaluation to make personalized recommendations for energy conservation and environmental modification. B. Collaborate with the client to problem-solve work demands, such as breaking tasks down, increasing rest breaks, and performing more challenging tasks earlier in the day. C. Instruct the client to fill out a diary card that identifies common work tasks, rate each task for how much energy it requires, and then determine appropriate interventions. D. Advise the client to improve sleeping patterns and further assess cognition for difficulty with executive functioning.

C. Further evaluation is needed to determine appropriate interventions; this approach goes beyond typical energy conservation education and involves the OTR® working with the client to identify the specific work tasks that cause fatigue. Work tasks must be identified before determining work demands.

Which test assesses a client's ability to visually select features that differentiate objects? A. Depth perception B. Contrast sensitivity C. Selective attention D. Peripheral field

C. Selective attention, also called focal attention, enables a client to visually select features that differentiate objects. It is the ability to disregard irrelevant information or stimuli and attend to what is relevant.

Retired NBCOT® Question An OTR® is preparing to assess a student who is 17 years old and has moderate symptoms associated with Asperger's syndrome. The purpose of the assessment is to determine the student's strengths and needs for a work-study experience as part of a transition services program. What type of assessment would be MOST BENEFICIAL to administer when gathering information to achieve this goal? A. Self-administered occupational performance checklists B. Self-perception questionnaire related to occupational performance C. Social interactions and social adjustment inventory D. Functional capacities and work readiness evaluation

C. Social skills such as getting along with others and functioning socially in a group situation have been found to be significant predictors of employment for individuals with mental illness. This would be the most beneficial information to gather in this assessment.

While completing an FCE on a client referred to a work hardening program, the OTR® suspects the client, who experienced a muscle sprain to the shoulder, is magnifying symptoms. The client has repeatedly made comments to the therapist about experiencing pain during all activities and being unable to return to work because of constant severe pain. The client is 4 months postinjury. Which type of symptom magnification is the client MOST LIKELY exhibiting? A. The "refugee" B. The "identified patient" C. The "game player" D. The "symptom misinterpreter"

C. The game player (traditionally known as a malingerer) uses symptoms for positive gain and consciously attempts to convince others of the reality of the symptoms.

Retired NBCOT® Question An inpatient who has Stage III lung cancer undergoes surgery for removal of axillary lymph nodes of the dominant upper extremity, followed by palliative chemotherapy. The patient is referred to occupational therapy for ROM, edema management, and preparation for hospice care at home. What is the PRIMARY purpose of initiating an exercise program for this patient? A. To increase overall endurance for daily tasks B. To promote normal venous and lymphatic return C. To improve mobility for preferred activities D. To facilitate passive ROM through a full arc of motion

C. The goal of therapy is to restore a patient's participation in meaningful goal-directed activities that are preferred by the patient, and engaging in an exercise program that will improve mobility may facilitate improved engagement.

A client with a unilateral transradial amputation is undergoing pre-positioning training for a myoelectric arm. Which of the following is the MOST appropriate goal? A. Within three sessions, the client will independently don the prosthesis and obtain good electrical contacts with the electrode sites 100% of the time. B. Within three sessions, the client will be able to open and close the myoelectric terminal device 100% of the time. C. Within 1 week, the client will be able to accurately identify how to arrange the wrist of the myoelectric terminal device to be able to optimally grasp different objects. D. Within 1 month, the client will be able to use the myoelectric terminal device as a functional assist and stabilizer in 100% of daily activities.

C. The pre-positioning phase focuses on teaching the client with an amputation to position the terminal device for optimal grasp.

A client with rheumatoid arthritis (RA) is beginning to experience ulnar drift. The client enjoys cooking but is finding it increasingly difficult to use a knife to chop food. Which is the BEST intervention for this problem? A. Instruct the client to use a knife with a built-up handle. B. Instruct the client to raise the kitchen counters to place the food to be chopped closer to the shoulder. C. Instruct the client to use a knife with a bent handle. D. Instruct the client to have the spouse do all the food chopping.

C. Using a knife facilitates a position of deformity (increased ulnar deviation). One important principle of joint protection is to prevent positions of joint deformity. An ergonomic knife with a bent handle will place the wrist and hand in neutral, reducing stress, but still allow the client to perform the occupational task.

Which occupation might a child with arthrogryposis multiplex congenital likely have difficulty with? A. Being fed. B. Socializing with friends C. Listening to a teacher's instructions. D. Donning a shirt.

D. Children with arthrogryposis multiplex congenital have incomplete contractures or fibrous ankylosis of all or many of their joints, which would make donning a shirt, the only occupation that involves the use of the extremities, difficult without adaptive equipment or modified techniques.

An OTR®; has recently had a conflict with a physical therapist who works at the same treatment facility. During a team meeting that includes the client, the OTR says that the physical therapist is using outdated approaches that are ineffective. One of the other team members feels that the OTR has violated an ethical principle and wants to discuss the matter with the OTR after the meeting concludes. Which principle will the team member discuss with the OTR in relation to the OTR's comment? A. Beneficence B. Autonomy C. Justice D. Fidelity

D. The principle of fidelity requires that an OTR treat other professionals with respect, discretion, and integrity. By allowing the interpersonal conflict to affect comments during a team meeting, the OTR has not been respectful of the physical therapist's practice choices and has not used appropriate conflict resolution strategies. Principle 6I of the Occupational Therapy Code of Ethics (2015) states that occupational therapy practitioners "shall respect the practices, competencies, roles, and responsibilities of their own and other professions to promote a collaborative environment reflective of interprofessional teams."

An OTR® receives a referral to complete a functional capacity evaluation (FCE) on a client 2 months after a Stage 2 quadriceps strain. The client is employed as a police officer and sustained the injury during an altercation with a suspect. To identify the client's essential job functions, which sources would be BEST for the OTR® to use? A. The U.S. Department of Labor's Dictionary of Occupational Titles, O*Net, job classifications, and client interview B. Employer-provided job description, client and supervisor interview, and completion of a vocational evaluation C. The National Institute of Occupational Safety and Health (NIOSH) guidelines, job description, and client interview D. The U.S. Department of Labor's Dictionary of Occupational Titles job classifications and job description

D. A comprehensive FCE should assess all the physical demands of work as defined by the Dictionary of Occupational Titles (DOT). The DOT serves as a source document for job demands and aptitudes for all job classifications. OTR®s should refer to DOT and the employer-provided job description to identify essential job functions.

An OTR® supervises a COTA® who works with a group of adults who are continuing their recovery from alcohol and drug addiction by living in a halfway house. The OTR® suggests that the COTA® become familiar with a particular group intervention in working with these clients. What type of intervention would the OTR® MOST likely suggest? A. An occupational deprivation group B. ProjectMAINSTREAM C. A heavy work activity group D. A 12-step self-help group

D. Most substance abuse programs include one or more self-help groups that use a classic 12-step process. Most substance abusers seek help through self-help groups. Occupational therapists working with this population are likely to become involved in facilitating or supporting these groups.

A client with a learning disability is interested in exploring work opportunities after high school graduation. The client has difficulty sequencing more than three-step directions and lacks attention to detail. Which option would be considered a component of the student's transitional program plan? A. Completion of a transition-related evaluation by a vocational rehabilitation counselor to identify the student's strengths, weaknesses, and interests B. Completion of a job site analysis with physical demands to determine the feasibility of the client's performing specific tasks C. Provision of written directions to complete a three-step task and use of samples to promote problem solving D. Situational observation, interview, and activity analysis to determine a match between the client's abilities and expected performance

D. An effective transition-related evaluation primarily uses situational observation, interview, and activity analysis to determine a match between the client's abilities and expected occupational performance.

Which assessments would be considered the BEST format for an upper-extremity functional capacity evaluation (FCE) for an outpatient occupational therapy department currently developing a return-to-work program? A. Assessment of manual material handling, ADL assessment, ROM, manual muscle testing, sensory assessment, volumeter testing, Visual Analog Scale, and postevaluation questionnaire B. Subjective interview, sustained grasp assessment, Purdue peg board, work simulation testing, and computerized resistance testing C. Initial intake, pain assessment, musculoskeletal evaluation, Crawford Small Parts Dexterity Test, assessments using Valpar work samples D. Initial intake interview, subjective pain assessment, ADL assessment, musculoskeletal evaluation, physical demand testing, material handling skills, and postevaluation questionnaire

D. FCE should be individually tailored for each client. Physical demands should gradually increase in resistance and complexity. Evaluation should start with the most physically demanding components, and the evaluator should be aware of test specificity to determine test appropriateness.

An OTR® is working with a client with Stage III amyotrophic lateral sclerosis. Which strategy is BEST to help this client maintain the current level of participation in daily activities? A. Pain management B. Decubitus ulcer prevention C. Strengthening activities D. Caregiver assistance with ADLs

D. Having the caregiver assist the client with ADLs is the best strategy at ALS Stage III, which is characterized by an increased level of fatigue.

An OTR® is working with a child who has a sensory processing disorder. The therapist would like to assess the child's motor planning using a standardized assessment tool. Which tool would be appropriate for the therapist to use? A. Sensory Integration and Praxis Test (SIPT) B. Sensory integration clinical observations C. Sensory Profile D. Bruininks-Oseretsky Test of Motor Performance (BOT-2)

D. The BOT-2 can be used to assess aspects of fine and gross motor functioning that may be difficult as a result of dyspraxia.

The Beverly Foundation, a nonprofit group that promotes new ideas and options for older adult transportation, evaluates transportation programs using the Five As of Senior-Friendly Transportation. Which characteristic of a transportation system is categorized in the Acceptability category? A. Availability of transportation on evenings or weekends B. Affordability of the cost of travel C. Accessibility of the vehicles used for travel D. Cleanliness of the vehicles used for transportation

D. The Beverly Foundation categorizes cleanliness of vehicles, friendliness of vehicle operators, and safety of transit waiting areas as components of Acceptability.

An OTR® is working in a clubhouse with a group of clients who have mental health issues. Which leadership style would be MOST effective? A. Director B. Authority figure C. Facilitator D. Advisor

D. The clubhouse model puts the locus of control on the members. When designing groups, the members formulate the goals, and the OTR® acts as an advisor.

When performing a manual muscle test (MMT) on a client, the OTR® should use standard principles to guide the evaluation of muscle strength. Which statement accurately reflects those principles? A. The OTR can safely perform MMT on a client in acute pain. B. The OTR should apply the same amount of resistance for all muscles tested. C. The OTR should stabilize distally from the joint and apply resistance proximally to the joint. D. The OTR should apply resistance applied gradually and increase it as the client responds.

D. To appropriately measure muscle strength, the OTR should apply pressure in a gradual manner, giving the client time to respond to the resistance.

Whom would an OTR® working in an outpatient return-to-work program NOT consider a primary referral source for an FCE? A. Physician B. Case manager C. Attorney D. Career counselor

D. A career counselor is defined as an individual who counsels individuals or provides group educational and vocational guidance services. A career counselor would not be considered a primary referral source.

An inpatient who has a C6 spinal cord injury has met all occupational therapy goals and is preparing for discharge to live at home with caregiver assistance. What type of device should the OTR® recommend the patient use to maximize independence during self-care activities at home? A. Electronic aid to daily living B. Power wheelchair with head control C. Wheelchair-mounted mobile arm supports D. Custom-fitted tenodesis splint

D. A patient with a C6 spinal cord injury can use a tenodesis splint because he or she will have partial wrist extension.

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

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.

An OTR® wants to develop interventions for homeless adults with mental illness to improve independent living skills. Which of the following roles is MOST appropriate for the OTR®? A. Employment retraining B. Job searching C. Housing procurement D. Room and self-care management

D. Evidence has indicated that basic life skills training in areas such as room and self-care management, food and nutrition management, money management, and safe community participation leads to increased skill and knowledge in managing these areas.

A client is being treated for an extensor tendon repair in Zone VI of the middle finger proximal to the juncturae tendinum. Which orthosis would be MOST appropriate? A. Hand based, including only the middle finger B. Forearm based, including only the middle finger C. Hand based, including the middle, ring, and index fingers D. Forearm based, including the middle, ring, and index fingers

D. It is important to consider adjacent digits when applying an orthosis. In this example, the injury falls proximal to the juncturae tendinum, which can apply force to the repaired site if the adjacent digits were to flex, thus compromising the repair.

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

D. Keeping the client close while lifting is associated with decreased lumbar stress and is easily addressed in prevention

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

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.

An OTR®; is completing an intervention to address a client's decreased postural stability when performing tasks in standing. The client has hemiparesis after a stroke. The OTR wants to elicit a postural response at the trunk when completing an intervention activity. Where should the OTR place task objects FIRST to elicit a trunk response? A. Above the client's head B. Within arm's reach C. On a moveable surface D. Beyond arm's reach

D. Tasks that are beyond arm's reach will facilitate a weight shift and challenge the client's postural abilities.

An OTR® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The OTR suggests that the client use breathing techniques and relaxation breaks during the work day to minimize the client's response to stressful events at work. What frame of reference does this intervention suggest? A. Cognitive-behavioral B. Psychodynamic C. Cognitive disability D. Behavioral

D. The behavioral frame of reference relies on the idea that behavior is learned and that it can be unlearned. Introducing relaxation activities and breathing into this client's routine may allow the client to experience more time in a positive state of mind, thus reducing anxiety.

Retired NBCOT question: A client has central vision loss secondary to macular degeneration. The OTR® plans to teach the client eccentric viewing techniques to compensate for the client's visual loss. What should the OTR® teach the client as the FIRST step of this process? A. Head positioning for optimal viewing B. Methods for using a magnification device C. Scanning exercises across the full field of vision D. Strategies for increasing blind spot awareness

D. The first step in eccentric viewing techniques is increasing the client's awareness of the central scotoma, or blind spot.

An OTR is working with a client who has been in a motor vehicle accident. The client has sustained flexor tendon injuries to the index and middle fingers and also presents with a median nerve injury. Which flexor tendon zone corresponds to this client's injuries? A. Zone I B. Zone II C. Zone III D. Zones IV and V

D. Zone IV consists of the transverse carpal ligament, and the median nerve runs under this ligament; Zone V is distal to this ligament and thus contains the median nerve branch.

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

D. Reprimand is a formal expression of disapproval of conduct communicated privately by letter from the AOTA Ethics Commission.

What would be considered the first line of treatment in the acute setting for the medical management of a cardiovascular accident (CVA)? A. Anticoagulants B. Thrombolytic agents C. Antiplatelet treatments D. Nonsteroidal anti-inflammatory drugs

B Thrombolytic agents are the first line of treatment in the acute management of CVA to dissolve the clot that is blocking the flow of blood through its vessel.

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. What battery of assessments is MOST APPROPRIATE for the OTR® to use in assessing this client's fitness-to-drive skills? A. Rules-of-the-road recognition; Motor-Free Visual Perception Test, Third Edition; finger-to-nose test B. Trail Making Test, Part B; Useful Field of View; and Mini-Mental State Examination C. ROM, manual muscle strength, and family interview D. Color discrimination, contrast sensitivity, and depth perception

B These clinical tests selected to screen for the client's driving ability are consistent with the client's diagnosis of mild cognitive impairment.