COTA EXam Prep: purple book

A client is participating in an assertiveness training group within a work setting. The expected outcome of this intervention is that the client will MOST likely improve he ability to: a. engage in relevant conversations with coworkers. b. use appropriate facial expressions when disagreeing with coworkers. c. express disagreement with coworkers in a productive manner. d. use courteous behavior when disagreeing with coworkers.

(c) express disagreement with coworkers in a productive manner. Assertiveness is the ability to express feelings in an appropriate and productive manner. Answers A, B, and D are examples of additional social interaction skills, however, they do not address an assertiveness component. Answers A and B are examples of actions taken when engaging in conversation, and answer D is an example of proper social conduct.

A teenager with fine motor incoordination reports difficulty with self-care. Which of the following options would this individual find MOST beneficial? a. Wash mitt b. Spray deodorant c. Toothpaste with a flip-open cap d. Toothbrush with a built-up handle

b. Toothpaste with a flip-open cap. An individual with fine motor incoordination would be able to manage a toothpaste cap that flips open much more easily than a cap that must be removed completely from the tube. Also, toothpaste tubes with flip-open caps are larger in diameter, which makes them easier to manage.

The OT treatment approach that will MOST likely meet the overall needs experienced by individuals with substance abuse problems is to: a. Assist with skill development in the areas of leisure, self-expression and ADLs b. Educate the family members about making safety modifications to the kitchen area c. Encourage AA involvement, address personal appearance, and issues of loss d. Make aftercare arrangements for vocational counseling and AA; provide time management education for self-care activities

a. . Assist with skill development in the areas of leisure, self-expression and ADLs In general, the areas of focus with OT intervention for individuals identified with substance abuse problems are alternative leisure time use, improved expression of feeling, and the acquiring of social and occupational roles. The approach described in answer B addresses the cognitive disability frame of reference approach, Answers C and D my address specific needs of the patient, but the overall needs of this population.

A child is observed grabbing toys from others, becoming easily frustrated, and is unable to sit still. This behavior MOST likely indicates: a. ADHD b. mood disorder, manic episode. c. conduct disorder. d. anxiety disorder.

a. ADHD This behavior exemplifies the excessive fidgeting and restlessness, inattention, and impulsiveness characteristic of ADHD. Although some of the symptoms of overactivity and impulsiveness are part of a mood disorder of the manic type (answer b), there are also usually symptoms of grandiosity and inflated self-esteem. A child with a conduct disorder (answer c) would exhibit interference with the basic rights of other children or societal rules. A child with anxiety disorder (answer d) would show signs of uneasiness, apprehension, or dread associated with anticipation or danger.

In assessing the dressing skills of a 5 y/o child, the COTA observes that the child is able to put on a jacket, zip the zipper, and tie a knot in the draw string, but needs verbal cueing to tie the bow. The COTA would MOST likely determine that the child's dressing skills are: a. Age appropriate b. Delayed c. Advanced d. Limited

a. Age appropriate The child being observed is preforming dressing activity which is age appropriate for a 5 y/o child. A typical child at this age can dress unsupervised and is able to tie and untie knots, but generally does not know how to tie a bow independently.

A COTA instructs a client with chronic neck pain to use psychosocial pain management techniques. Which of the following strategies should the COTA implement to assist in the management of this individual's chronic pain? a. Biofeedback, distraction, and relaxation techniques b. Specific skill training c. Strength and endurance building techniques d. Cognitive retraining techniques

a. Biofeedback, distraction, and relaxation techniques Biofeedback, distraction, and relaxation techniques are all examples of psychosocial measures that can be introduced to manage pain. Answer B and C, specific skill training and endurance building, are not directly related to pain management techniques and are often associated with cognitive or motor limitations. Answer D, cognitive retraining techniques, are also not directly related to pain management techniques.

A supermarket employee with obsessive compulsive disorder takes and hour to stock 24 soup cans on the shelf. He reports that once he has place all the cans on the shelf, he removes them all and starts over because "all the labels were not lined up exactly in the same direction." Which of the following methods would MOST effectively evaluate this individual's work performance? a. Functional assessment of work-related skills, such as carrying and opening cartons and shelving items b. Cognitive assessment used in the Allen's Cognitive Levels evaluation c. Verbal interview focusing on the requirements of the individual's job d. Task evaluation using a "clean" medium like a puzzle

a. Functional assessment of work-related skills, such as carrying and opening cartons and shelving items Observation of the individual performing actual job responsibilities with provide more objective and measurable information about the individual's strengths and weaknesses in the area of job performance than a verbal interview (answer c) or task evaluation (answer d). Although a "dirty" medium may be contraindicated when initially working with and individual with OCD for the washing type, it would not be and issue for this individual because his OCD is of the checking type. There is nothing indicated to the individual has cognitive deficits, therefore a cognitive evaluation (answer b) would not be indicated.

An individual with an IV drug abuse problem has developed AIDS. The OT evaluation revealed that the individual's major problems are with daily tasks, self-esteem, physical deconditioning, and anxiety. Which of the following approaches would be MOST beneficial to the client? a. Have the patient practice stress reduction using meditation, yoga, and energy conservation techniques. b. Have the patient participate in aerobic activities to combat deconditioning. c. Provide video lectures on AIDS to educate the client about the disease process. d. incorporate energy conservation techniques and daily aerobic activities into the client's ADLs.

a. Have the patient practice stress reduction using meditation, yoga, and energy conservation techniques. Individuals with AIDS should implement a form of exercise to provide mobility and reduce stress, without draining his or her physical resources, in addition to using energy conservation techniques during ADL. It would not be appropriate for and individual to participate in an aerobics program (answers B and C), because of the high energy demands. Vido lectures (answers C) would provide information about AIDS would not necessarily address physical deconditioning and self-esteem issues.

An individual with a history of depression and social isolation is hospitalized with the third time due to suicidal ideation. Completion of an interest checklist indicates interests in crafts, cooking, and participation in social activities. In planning treatment for a short hospitalization, which of the following activities would be MOST appropriate for this individual? a. Identify social opportunities using a local phone book. b. Scan craft catalogue to identify possible leisure interests. c. Implement writing in a personal log on a daily basis. d. Look through a recipe book to develop cooking as a leisure activity

a. Identify social opportunities using a local phone book. With the interest checklist already completed, the COTA can help the individual identify one or two choices that promote socialization in the community. The COTA can coach the individual on pertinent questions to ask (e.g., hours, cost, directions) and help the individual make these calls prior to discharge. While craft and cooking books (answers B and D) are useful materials to help improve new or existing skills, cooking and craft activities are fairly isolating in nature. A personal log (answer C) is a good way to encourage self-expression, but would not be helpful in developing outlets for socialization.

Which of the following assessment methods would and OT practitioner MOST likely choose in order to learn about a family's values and priorities? a. Interview b. Skilled observation c. Inventory d. Standardized test

a. Interview Interviews provide "an opportunity for the parents to identify their values and priorities about the skills being evaluated by the therapist." Open-ended questions are the best for eliciting information regarding the family's feelings about the intervention. Answers b, c, and d are structured observation methods, through which information on specific skills or functional levels is collected.

A COTA is working with an individual with amyotrophic lateral sclerosis who is no longer able to ambulate for kitchen or home management activities. Which of the following intervention BEST addresses the goals of independence in meal preparation for this individual? a. Meal preparation techniques using a wheelchair b. Training in the use of adapted cooking equipment c. Simple cooking activities while standing at the counter for gradually increasing amounts of time d. Beginning with cold meals and progressing to hot meals

a. Meal preparation techniques using a wheelchair As the disease progresses, individuals with ALS lose the strength required for ambulation and, therefore, begin to use wheelchairs. The development of meal preparation skills using a wheelchair, such as transportation of items, addressing work heights, using adaptive equipment (Gradually increasing standing tolerance (answer C) is not appropriate for this individual because motor function will continue to deteriorate. Developing competence in preparing cold meals before advancing to hot meals (answer D) is more appropriate for individuals with cognitive or perceptual deficits.

An individual who attends a day program for adults with developmental disabilities has difficulty participating in group activities because of extreme anxiety related to being around others. The BEST way to determine whether the individual is experiencing anxiety during group sessions would be to: a. observe the individual's body language during group sessions. b. ask the individual to complete a questionaire rating her anxiety level after each session. c. have group members provide feedback to the individual and COTA about her anxiety level. d. allow the individual to select two other clients she feels she'd be comfortable with in a small group.

a. Observe the individual's body language during group sessions. By observing an individual's body language for behaviors such as fidgeting, nail biting, toe tapping, etc., the COTA can determine whether and individual is experiencing anxiety during the group activity. Completion of a questionnaire (answer b)and feedback from group members (answer c) may not be practical or reliable alternatives for an individual with cognitive deficits. Answer D is an adaptive strategy, not a method for assessing anxiety.

A COTA is running a discharge planning group in which individuals discuss their personal feelings and concerns about returning to the community. Which of the following would be the BEST method to facilitate this process? a. Patients write fears and concerns on index cards and then the COTA collects and reads the cards to the group for discussion. b. Patients write fears ad concerns on index cards and then take turns reading their cards to the group. c. Patients each take a turn verbalizing their fears and concerns to the group. d. The psychologist speaks to the group about discharge fears in general.

a. Patients write fears and concerns on index cards and then the COTA collects and reads the cards to the group for discussion. This method allows for anonymity by having each patient write down their concerns without including their names. Thereby eliminating any fear of embarrassment.

An individual who is being discharged after participating in an inpatient pulmonary rehabilitation program for chronic obstructive pulmonary disease, is given a list of tips from the COTA to use in the home to promote function. Which of the following items with the COTA MOST likely recommend? a. Perform pursed-lip breathing when doing activities. b. Use long handled sponge while in the shower. c. Take hot showers to reduce congestion. d. Avoid air conditioned rooms during warm months.

a. Perform pursed-lip breathing when doing activities. Pursed-lip breathing is a technique that narrows the passage of air during expiration. This technique helps individuals with COPD keep the airway open and improves breathing efficiency. The overall effect is improved endurance and tolerance for activities. Taking hot showers and avoiding air condition during warm weather (answers C and D) are incorrect in that both activities are contraindicated for individuals with COPD. Using a long-handled bath sponge (answer B) may be helpful, but is not the most likely tip to be on a home program for and individual with COPD.

The COTA is working with the family of a 3 y/o child who lacks sitting balance in the bathtub. The family is requesting an alternative to a shower bench, because the child seems to enjoy submersing herself in the warm bathtub water, and their insurance does not cover durable medical equipment costs. Which of the following would the COTA MOST likely recommend? a. Place a foam-lined plastic laundry basket in the tub. b. Place a horseshoe-shaped inflatable bath collar around the child's neck while bathing. c. Utilize a bath hammock in the tub while bathing. d. Suggest that the child shower in a standing position instead of bathing in a tub.

a. Place a foam-lined plastic laundry basket in the tub. Answer A, a laundry basket with a foam-lined bottom, would be the most appropriate item for the COTA to recommend because this piece of equipment addresses both cost and positioning concerns. The laundry basket will also permit the child to continue to immerse herself in the tub, an activity that was stated as enjoyable to the child.

An individual with memory and attention deficits exhibits poor table manners and is working to address this in an ADL group. Which method is MOST appropriate for this individual? a. Role plays that include practicing good table manners. b. Reward the individual with dessert when he uses good manners. c. Instruct group members to remind him when he forgets his good manners. d. Reinforce use of good manners with praise and rewards.

a. Role plays that include practicing good table manners. A cognitive approach is best for individuals with memory and/or attention deficits, for those who must learn to do situational problem solving or when skills learned need to be generalized to other situations.

In administering an assessment of finger-tip pinch strength, the OT practitioner would instruct the individual being tested to place his or her fingers in which position? a. Thumb against the tip of the index finger b. Thumb against the side of the index finger c. Thumb against the tips of the index and middle fingers d. Thumb against the tips of all the fingers at once

a. Thumb against the tip of the index finger The correct position for tip pinch is the thumb against the tip of the index finger. The thumb against the side of the index finger describes the position for lateral inch. The thumb against the tip of the index and middle fingers describes the test position for three jaw chuck, or palmar pinch. The thumb against the tips of all the fingers is not a standard test position.

Which of the following is MOST important when using a remotivation approach with a group of elderly individuals? a. Use pictures, music, and discussion to encourage discussion of memories. b. Discuss an upcoming holiday and base an activity on that holiday. c. Adapt the environment to maximize independent functioning. d. Focus on group activities designed to enhance interpersonal skills.

a. Use pictures, music, and discussion to encourage discussion of memories. Remotivation approaches are use to encourage the expression of thoughts and feelings related to intact long-term memories. The topic should be linked to the groups past experiences and should be easy to understand.

During a stress management group, an individual recently diagnosed with multiple sclerosis complains that his teenage children are resistive to helping with chores that were previously his responsibility (e.g., mowing the lawn and taking out the trash). Which of the following stress management techniques would the COTA MOST likely recommend to address this client's concerns? a. Using effecting communication skills b. Applying time management techniques c. Deep breathing d. Laughter

a. Using effecting communication skills Clarifying expectations, honestly defining needs, and providing tactful and constructive feedback are communication skills that promote understanding. Successful communication with the patient's children will most likely help them deal with their fears and concerns, increase their understanding of their fathers condition, and elicit greater cooperation. Although time management techniques, deep breathing and laughter (answers B, C and D) are all useful and valid stress reduction techniques, they do not address the issue at hand, which is communication between the gather and his children.

A COTA observes that a 10-month old child is able to sit alone by propping himself forward on his arms, but consistently loses his balance when reaching for a toy. His behavior most likely indicates: a. a developmental delay. b. unintegrated primitive reflexes. c. normal development. d. advanced development.

a. a developmental delay. Typically developing children (answer c) should be able to sit unsupported for several minutes by the age of 8 to 9 months; therefore, this child demonstrates delayed development (answer A) The ability to sit while propped forward on his arms indicates primitive reflexes have been integrated (answer b). Sitting unsupported earlier than 8 months could indicated advanced development (answer D).

When teaching children with moderate mental retardation to feed, groom, and dress themselves, the COTA is MOST likely to use which technique? a. chaining b. Practice and repetition c. Demonstration d. Role modeling

a. chaining Chain ing with the child who demonstrates a cognitive disability shows the entire process of a task with all sequences. Initially , the child performs only the beginning or end of a task. Thus, the child concentrates on only a small part of the task but gradually increases participation in all sequences in their correct order. Answers B, C and D are the methods that can be used, but forward and backward chaining are particularly successful instructional methods for individuals who are mentally retarded.

The goal for an elderly person with Parkinson's disease is to dress herself independently. The BEST adaptation to compensate for this person's physical deficits would be: a. Velcro closures on front opening clothing. b. large buttons on front opening clothing. c. larger clothing slipped on over the head with no fasteners. d. stretchy fabric clothing with tie closures in the back. a. Velcro closures on front opening clothing.

a.Velcro closures on front opening clothing. Requires the least amount of dexterity, which becomes increasingly difficult with Parkinson's disease.

A COTA is organizing a group picnic outing to a park. The most important precaution for the COTA to implement for those group members taking neuroleptic medications is to: a. encourage the use of PABA-free sunblock and hats. b. encourage members to move slowly when changing positions from sitting to standing. c. encourage members to use and antiperspirant and wear light colored clothing. d. take along low-calorie snacks such as carrot and celery sticks.

a. encourage the use of PABA-free sunblock and hats. Individuals taking neuroleptic medications are prone to photosensitivity and need protection from the sun. A PABA-free sunblock is recommended because it reduces the chance of an allergic reaction from the sun. The precautions described in answer B are helpful to the individual experiencing postural hypotension, which can be a side effect of neuroleptic medication, but is not an issue for a picnic outing. Answers C and D are not linked to the side effects of neuroleptic medications.

The parent of an infant with hypertonia reports that dressing the child is extremely difficult. When teaching this parent how to put shoes and socks on the child, the COTA should recommend FIRST flexing the child's: a. hips b. knees c. ankles d. toes

a. hips Flexing the hips breaks up the extensor pattern and, combined with knee flexion, reduces tone in the lower extremities, thus facilitating dressing. Flexing more distal joints first (answers B, C and D), is ineffective in reducing tone and may lead to excessive stress to the joints involved.

A COTA is working with a group of patients who have orientation deficits resulting from head injuries. Using an adaptive or compensatory approach, the MOST appropriate intervention would be to: a. provide verbal cues, eternal aids such as calendars and family pictures, and opportunities to practice using the external aids. b. reduce the number of distractions by moving to a quiet room. c. present information in short units, with time between each segment. d. connect new information to previously learned knowledge and skills.

a. provide verbal cues, eternal aids such as calendars and family pictures, and opportunities to practice using the external aids. Answer A is most appropriate. Answer B, reducing distractions, and answer C presenting information in short units, would be adaptive strategies to promote attention and information processing. Answer D, connecting new information to previously held knowledge and skills, is a technique to aid retrieval of information and improve memory.

A COTA is working with and individual who was admitted to an inpatient psychiatric program for major depression. This individual is also diagnosed with stage 4 AIDS. The BEST general focus of treatment at this point would be to: a. restore and maintain performance of self-chosen occupations that support performance of valued occupational roles. b. increase physical endurance and maintain desired self-care tasks. c. facilitate resolution of current and anticipated losses through the grieving process. d. restore and maintain functional performance of the individual's primary work role.

a. restore and maintain performance of self-chosen occupations that support performance of valued occupational roles. The individual's depression is likely to be in reaction to the AIDS disease and major loss of functioning at stage 4. Stage 4 of AIDS generally means severe physical and neurological changes. Because the change of function can be broad, answer A is the most comprehensive approach. Answers B and C are too restrictive to be a "major focus." Answer D, restoration of work, is typically unrealistic at stage 4 of AIDS.

A sixth grader with a diagnosis of athetoid cerebral palsy needs an adapted computer for communication. Her upper extremity control is poor because of fluctuating muscle tone. The COTA suggests that the BEST way for her to operate her computer is to use a: a. single pressure switch, firmly mounted within easy reach b. lightweight keyboard placed at midline c. low-resistance mouse and pad d. mercury switch headband set to respond to minimal movement

a. single pressure switch, firmly mounted within easy reach A child with fluctuating muscle tone lacks stability and demonstrates extraneous movement, therefore, deliberate motor action is most effectively executed on a securely mounted device using simple movement patterns. Answers B, C and D involve devices that would respond to slight touch, and would therefore not be effective for a person with extraneous movement and difficulty grading motor action.

A COTA is working with a patient recovering from a hand injury who complains of pain when any sensation is felt on the affected hand. In planning a program of desensitization training for the patient, the MOST appropriate sequence for grading the sensory stimuli that will be applied to the patient's hand is from: a. soft to hard to rough. b. tap to rub to touch. c. light to medium to heavy. d. rough to hard to soft.

a. soft to hard to rough. The desensitization process involves applying a sequence of graded texture and force stimuli to the skin to reduce tactile hypersensitivity. Texture begins with soft, progresses to hard, and moves to rough stimuli. Answer B is incorrect because the force of the stimuli begins at the level of touch, progresses to rub, and moves to tapping as tolerance for sensation increases. Light, medium and heavy (answer C) do not specify what the texture and force of the stimuli would be during training. Answer D is incorrect because a person with hypersensitivity would be unable to tolerate stimuli beginning with a rough texture.

An OT practitioner is making a home visit to an elderly client who lives alone. The client exhibits sever hand weakness. When addressing safety in the home, the MOST important area to assess is the individual's ability to: a. work locks and latches on doors and windows. b. use built-up utensils while eating. c. use energy conservation techniques. d. manipulate fasteners on clothing.

a. work locks and latches on doors and windows. The ability to manipulate the locks and latches is a safety concern because the individual may be unable to open them to let family members into the home or close them to keep intruders from entering. Built-up handles (answer b), energy conservation techniques (answer c), and adaptations to clothing fasteners (answer d) are not safety issues.

A person with functional limitations in shoulder abduction and external rotation is performing self-care activities. Which of the following is MOST essential for the COTA assess? a. buttoning a shirt b. combing the hair c. tucking in a shirt in the back d. tying a shoe

b. An individual normally abducts and externally rotates the shoulder to comb his or her hair; therefore, the individual is more likely to have difficulty in this area than any of the others. Shoulder abduction is not required for buttoning a shirt (answer a) or tying a shoe (answer d). Tucking in a shirt in the back (answer c) requires shoulder abduction and internal rotation. Tying shoelaces (answer d) is less dependent on shoulder motion than on hip and spine flexibility.

After a 30 year hospitalization, an individual with mental illness has been discharged to a community group home. She is used to being told what to do and where to go. Which of the following would be the BEST approach to take for this individual's first meal preparation group? a. Have the individual plan the menu for the following group session. b. Give the individual one task to do such as making drinks. c. Ask the individual what she would like to do. d. Suggest that the individual just observe the group.

b. Give the individual one task to do such as making drinks. Having the individual start with one of the components of the activity addresses decision-making and problem-solving skills without overwhelming her. Planning a menu (answer A) requires a hight level of decision making and is too challenging. Asking the individual what she would like to do (answer C) is too open-ended, and would be too overwhelming. Limiting the individual to an observer role (answer D) would alienate her from the group process.

A COTA needs to report the results of an ADL evaluation to the supervising OTR. The OTR, who is on her way to the cafeteria for lunch, states she has to leave immediately after lunch to go to another facility. Which is the BEST method for the COTA to use to communicate the evaluation results to the OTR? a. With a phone call b. In a written report c. During discussion at lunch in the cafeteria d. During discussion in the OT office

b. In a written report The OTR can read the written report at her leisure. Confidential information about an individual must be respected by OT practitioners and should not be discussed in public places(answer c). A phone call (answer A) and a discussion in the OT office (answer D) would both require time the OTR does not have available.

A school child demonstrates aggressive and disruptive behavior in school as a result of a low sensory threshold. Which of the following suggestions would be MOST useful to discuss with the teacher regarding an upcoming class bus trip to the zoo? a. Review the bus rules with the child and apply consequences consistently. b. Let the child sit at the front of the bus and use a tape player with earphones. c. Give the child the responsibility of monitoring classmates as "bus patrol" d. Let the child set the criteria for a successful trip, and provide a reward if the criteria are met.

b. Let the child sit at the front of the bus and use a tape player with earphones. A child who is seated in the front of the buss will experience less jostling by peers, resulting in less tactile and visual stimulation. Also, the earphones will reduce auditory overload. The method described in answer B addresses the underlying problem of the child's low tolerance for sensory stimulation. Answers a, c and d are behavioral management techniques that do not take the child's hypersensitivity into account.

Which of the following interventions is MOST appropriate for an individual who has recently been diagnosed with rheumatoid arthritis and is in the acute stage of the disease? a. Strengthening with resistive exercises b. Positioning, adaptive equipment, and patient education c. Discharge planning d. Preparing the patient for surgical intervention

b. Positioning, adaptive equipment, and patient education Positioning and adaptive equipment are necessary to maintain the integrity of the musculoskeletal system and to prevent deformity. Patient education about the disease and ways of dealing with its effects can also be started at this stage. Resistive exercises (answer a) are not appropriate if there is joint swelling and inflammation, and are always used cautiously with individuals with RA because of the potential for tissue damage. Discharge planning would be more relevant at a later time (answer C). Surgical intervention (answer d) would not be needed in the early stages of rheumatoid arthritis. It may be offered later as a corrective measure for long-standing deformities.

An individual consistently confuses white glue with white grout during a tile activity. Which of the following actions would the COTA implement to remain consistent with and activity adaptation approach? a. Review the difference between glue and grout with the individual. b. Replace the white glue with blue glue. c. Avoid the use of white tiles. d. Complete the last step for the activity (applying grout) for the individual until they have learned how to apply grout successfully.

b. Replace the white glue with blue glue. Activity adaptations enable and individual to become more functional in his or her task performance. Reviewing the difference between glue and grout (answer A) would be a cognitive approach. Avoiding the use of white tiles (answer C) could be a solution if the problem were figure ground related. Completing the last step of the activity for the individual (answer D) reflects a forward chaining approach.

A COTA who is beginning treatment for a child with athetoid CP is concerned about the child's inability to control flexion and extension of the arm when reaching for a toy. The child flexes or extends too much, which makes placement of the hand very difficult. The MOST appropriate goal for this type of problem in hand function would be to improve the: a. ability to isolate movement. b. ability to grade movement. c. ability to control how fast movement occurs. d. bilateral integration of arm movements.

b. ability to grade movement. The grading of movement goal (answer b) best addresses the difficulty with control of the midrange of a movement pattern (common in children with athetosis). Answer A is incorrect, because this goal would be appropriate for a child who cannot break up a flexion or extension pattern during a movement. Answer C is not correct, because this goal is appropriate for a child who has difficulty with an arm or hand movement being too fast or too slow (graded movement are also too fast). Answer D is also incorrect, because this goal is appropriate for a child who has difficulty bringing both arms to midline and using them effectively together.

Evaluation of a school-aged child diagnosed with moderate mental retardation should general focus on: a. positioning and communication skills. b. communication, self-care, and social skills. c. ADLs and IADLs. d. feeding and personal hygiene.

b. communication, self-care, and social skills. Children with moderate mental retardation are likely to require some support of ADLs and IADLs, and can usually communicate either verbally or nonverbally. They are likely to have deficits in the areas of academic performance, communication, self-care, and socials skills. Individuals with profound mental retardation are dependent on others of nearly all their needs, and often have neuromuscular, orthopedic, or behavioral deficits. Evaluation of these individuals should focus on positioning and communication skills (answer a). Individuals with mild mental retardation have the potential for independence in ADLs and IADLs(answer c), may achieve academic performance at the third to seventh grade level, and may eventually obtain employment Individuals with severe mental retardation may be able to learn habitual activities, such as feeding and personal hygiene (answer d). Functional potential is often determined by physical limitations. They may learn to communicate verbally or nonverbally, and will require significant support to engage in most tasks.

The COTA reviews various functional activities that are being incorporated into her client's hand rehabilitation program. The COTA explains to the client that functional activities may include; a. AROM and self ROM techniques. b. crafts, games, and self-care tasks. c. cone stacking, pegs, and pulleys. d. mild, moderate, and resistive theraband exercises.

b. crafts, games, and self-care tasks. Crafts, games and self-care tasks can best be described as functional activities that should be a component of hand rehabilitation. Answers A, C, and D are all considered to be adjunct activities that may be implemented as a precursor to functional activities.

A COTA is preparing a work conditioning program for a patient who has decreased endurance. The COTA's FIRST step in developing a work conditioning program for this patient would be: a. implementing, adapting, or modifying work activities. b. creating nonspecific job-simulated work tasks. c. implementing job-specific work tasks. d. creating a simulated work environment.

b. creating nonspecific job-simulated work tasks. Nonspecific job-simulated work tasks such as carrying, pushing, and pulling are appropriate examples of work conditioning. Answer C, job specific work tasks, are representative of a work-hardening goal. Answers A and D are examples of intervention (work hardening), that are implemented after the client achieves success in the area of work conditioning.

A method that an OT practitioner can use to document total finger flexion without recording the measurement in degrees would be to measure the: a. passive flexion at each joint and total the numbers. b. distance from the fingertip to the distal palmar crease with the hand in a fist. c. active flexion at each joint and total the measurements. d. distance between the tip of the thumb and the tip of the fourth finger.

b. distance from the fingertip to the distal palmar crease with the hand in a fist. The distance from the fingertip to the distal palmar crease with the hand fisted may be measured in either inches or centimeters. This measures how close the fingertip comes to the palm. A person who has full flexion would have a measurement of zero. Answers a and c are incorrect as actively or passively measuring the flexion at each joint and totaling them are measurements taken with a goniometer and recorded in degrees. Answer d, measuring the distance between the tip of the thumb and fourth phalanx, is incorrect because it is a measurement of opposition.

An individual alternately exhibits laughing and crying throughout a treatment session. This behavior should be documented as: a. mania. b. emotional lability. c. paranoia. d. denial.

b. emotional lability. Emotional liability is the rapid shifting of moods. Emotional lability may be one of the symptoms observed in individuals experiencing mania (answer a). Paranoia (answer c) describes enduring beliefs about being harmed. Denial (answer d) is not acknowledging the presence of information.

A COTA who works in an outpatient facility recommends that clients with Parkinson's disease be treated in a therapeutic group. The COTA is MOST likely to select group treatment for these clients because: a. it is more effective in preventing motor problems associated with Parkinson's disease. b. it provides social interaction and support, as well as activity. c. it is an effective way to present therapeutic exercise activities. d. it requires less therapist time because the therapies can leave once the group has started.

b. it provides social interaction and support, as well as activity. Parkinson's disease frequently causes social isolation because of decreased mobility and communication, therefore group treatment is particularly valuable for these clients. Answer A is incorrect because group treatment is not necessarily better for addressing motor problems. Presenting exercise activities (answer C) can be effective in groups, but it would not be the primary reason to select a therapeutic group for clients with Parkinson's. Answer D is incorrect because the therapist is responsible for leading a therapeutic group and would not leave until the group session has concluded.

An individual who had a stroke is copying a picture of a clock. The drawing appears as a lopsided circle with a flat side on the left. The numbers one through eight are written in numerical order around the right side of the clock. The hands are correctly drawn on the clock to represent three o'clock. The individual's performance appears to demonstrate: a. right hemianopsia. b. left unilateral neglect. c. cataracts in the left eye. d. bi-temporal hemianopia.

b. left unilateral neglect. This is the inability to respond or orient to perceptions from the left side of the body. Evidenced as left unilateral neglect (answer b), this deficit is also apparent in the draw-a-man test, flower-copying test, house test, and completing a human figure or face puzzle. Unilateral neglect is contralateral to the side of a brain lesion, therefore, left unilateral neglect would result from right-sided brain damage. Left neglect occurs most commonly in right hemisphere lesions. A cataract (answer c) would cause a visual impairment with detail on both sides of a page. Bi-temporal hemianopia (hemianopia is also referred to as hemianopsia) also known as "tunnel vision," occurs within the individual's peripheral vision is lost (answer a). The individual would still be able to cross midline with cataracts or bi-temporal hemianopsia (answer d). A right neglect would not see the right side, and this type of patient would draw all the figures on the left side of the page. Visuospatial deficits are an important factor influencing functional independence outcomes. Visuospatial ability should be taken into account when establishing treatment goals as well as during discharge planning.

An individual diagnosed with borderline personality disorder tells a COTA that she is the only one she can trust. The next day she accuses the COTA of lying to her. The best way for the COTA to respond is to: a. tell the individual her feelings have been hurt. b. remain matter of fact and consistent in approach. c. ask the individual how she has felt when lied to in the past. d. apologize and try to determine how the misunderstanding occurred.

b. remain matter of fact and consistent in approach. Individuals with borderline personality disorder demonstrate inconsistent behavior, have difficulty maintaining stable relationships, and have poor self image. Practitioners usually need to work hard to remain consistent and trustworthy to those individuals. It is important in this case that the OT practitioner recognizes this behavior as part of the pathology and not take it personally. Because the accusation is a result of pathology.

The treatment goal that BEST addresses the psychosocial skill of self-expression is: a. the client will identify and pursue activities that are pleasurable to the self. b. the client will use facial expressions and gestures that are consistent with stated emotions during assertive, passive, and aggressive role-play situations. c. the client will recognize his or her own behavior and possible negative and positive consequences. d. the client will identify his or her own assets and limitation after an art or movement group.

b. the client will use facial expressions and gestures that are consistent with stated emotions during assertive, passive, and aggressive role-play situations. Self-expression is the use of a variety of styles and skills to express thoughts, feelings and needs. Being able to vary one's expression during role playing of three different styles of expressing feelings is and example of this. Identifying pleasurable activities (answer A) will help to develop interests. Recognition of one's behaviors and consequences (answer C) relates to self-control. Identifying one's own assets and limitations (answer d) is related to self concept.

A patient with a short below-elbow amputation is lacking sensation in the residual limb. The MOST appropriate intervention would be for the COTA to teach the patient: a. Techniques for tapping, rubbing, and application of textures to the residual limb. b. to routinely inspect the skin closely for signs fo skin breakdown. c. to perform deep massage on the residual limb. d. the necessary procedures of proper skin hygiene.

b. to routinely inspect the skin closely for signs fo skin breakdown. Teaching a patient with a residual limb to compensate for the lack of sensation with visual inspection, is essential to prevent injury from skin breakdown. Answer A is incorrect because tapping, rubbing, and application of textures is used when a residual limb is hypersensitive. Answer C, deep massage, is a technique use to loosen and prevent scar adhesions. Answer D, teaching procedures of skin hygiene is important, but would not, by itself, prevent skin breakdown, which is the primary concern when the residual limb lacks sensation.

A patient who had a CVA has difficulty using his left upper extremity for reaching activities because of fluctuating muscle tone. According to the Neurodevelopment Treatment approach, one of the MOST effective ways to teach a person to normalize high muscle tone in affected extremities prior to functional activities is by: a. placing a weighted cuff on the extremity. b. weight bearing through the upper extremity in sitting or standing. c. using the unaffected arm for all reaching activities. d. "forced use" of the affected extremity.

b. weight bearing through the upper extremity in sitting or standing. Weight bearing is the most effective way of normalizing tone, according to the NDT approach for adult hemiplegia. Placing a weighted cuff on the extremity (answer A) would have the effect of increasing muscle tone, making it more difficult. Answer C, using only the unaffected upper extremity, would accomplish the reaching task, but would not normalize muscle tone in the affected upper extremity. Answer D, "forced use" is a treatment concept used to encourage functional motor return in hemiplegic upper extremities, but is not a method designed to normalize muscle tone, nor is it a specific technique of the NDT approach.

Which individual would benefit the MOST from using a wrist-driven flexor hinge splint during a prehension activity? a. A client with a C1 injury b. A client with a C3 injury c. A client with a C6 injury d. A client with a T1

c. A client with a C6 injury An individual with C6 quadriplegia has some use of the abductor pollicis longus, extensor digitorum communis, and extensor carpi ulnaris. The extensor tone of the muscles in conjunction with the splint will operate the power for prehension force. Individuals with C1 or C3 injuries (answers A and B) have higher level lesions and lack the wrist extension strength needed to operate the wrist-driven flexor hinge splint. An individual with a T1 injury (answer D) is able to grasp and manipulate utensils without difficulty or need for assistance.

The COTA is observing a 3 y/o child during tooth brushing. The child demonstrates good bilateral upper extremity/hand strength, but decreased dexterity. Which piece of equipment would the COTA MOST likely encourage the child to use during brushing? a. A small soft bristle toothbrush. b. A velcro strap attached to a toothbrush. c. An electric toothbrush d. A soft sponge-tipped toothed

c. An electric toothbrush According to Case-Smith, "for the child who independently brushes, an electric toothbrush enables more thorough cleaning. This is a good solution for children with limited dexterity, although for children with weakness, and electric toothbrush may be too heavy to manage." Answer A, using a soft bristle brush, would most likely assist a child with tongue thrust, while answer B, attaching a velcro strap to the toothbrush, would assist a child who has decreased grip strength in the hand. Answer D, encouraging the child to use a soft sponge-tipped toothed is typically indicated in the child with oral hypersensitivity or defensiveness.

A fifth-grade child with significantly low muscle tone caused by Duchenne's muscular dystrophy is losing trunk control when sitting. Which of the following frames of reference should the COTA consider when planning the treatment program? a. Neurodevelopmental treatment b. Sensory integration c. Biomechanical d. Visual perceptual

c. Biomechanical According to Colangelo, "The biomechanical frame of reference is applied when a person cannot maintain posture through appropriate automatic muscle activity because of neuromuscular or musculoskeletal dysfunction." This child's physical status has changed with decreasing postural control. Adaptive support devices need to be considered and a biomechanical frame of reference provides this approach. Answer A is not correct because the neurodevelopmental treatment frame of reference is concerned with improving posture and movement, and supportive equipment is prescribed for that purpose. Answer B is not correct because the sensory integration frame of reference is concerned with sensory input in relation to posture and movement in children with sensory integration disorders, whereas Duchenne's disease is a neuromuscular disorder. Answer D is not correct because the visual perceptual frame of reference is concerned with guiding and compensating for visual perceptual problems, not postural delays.

An individual with a history of depression and low self-esteem has just begun to participate in a home management group. This individual had previously identified cooking as a leisure interest that he is good at. Which of the following approaches will MOST effectively promote individual growth and self-confidence? a. Praise the cooking skills of the individual in front of the group. b. Have the individual plan and demonstrate a cooking activity to the entire group. c. During a meal preparation activity, have the individual demonstrate a step that he is familiar with to two or three group members. d. Incorporate cooking activities only after the individual expresses a desire to participate in them.

c. During a meal preparation activity, have the individual demonstrate a step that he is familiar with to two or three group members. This is a good beginning toward increasing and individual's self-esteem. At this early stage, responsibility for planning an entire activity (answer B) is too challenging, but would be effective when self-esteem and confidence improve. While praise (answer A) may promote a positive self-image, praise alone is not enough. Waiting for the individual to initiate participation (answer D) may not provide the necessary encouragement and opportunities for growth that this individual needs.

An individual with an anxiety disorder feels so overwhelmed he cannot get himself from his room to OT group each morning. Which of the following strategies will be MOST helpful? a. Reduce distractions and keep the lights low b. Provide a stimulating environment with real life opportunities. c. Give him a tour of the OT department and a schedule of activities. d. Leave doors open and avoid being alone with the individual.

c. Give him a tour of the OT department and a schedule of activities. Becoming familiar with an environment in advance and knowing what to expect can help reduce anxiety. Reducing distractions and keeping light low (answer A), may be useful environmental adaptations for individuals with mania or hyperactivity. Providing a stimulating environment and real life activities (answer B), is recommended for individuals experiencing delusions. OT practitioners should leave doors open and avoid being alone (answer D) with individuals who are hostile or violent.

A child with quadriplegia complains of frequently slumping to the side when sitting in a wheelchair. The COTA would MOST likely recommend which of the following o enable the child to maintain optimal wheelchair positioning? a. A reclining wheelchair b. An arm trough c. Lateral trunk supports d. Lateral pelvic supports

c. Lateral trunk supports Lateral trunk supports (answer C) would help maintain correct alignment of the pelvis and trunk in the wheelchair.

A COTA is scheduled to interview an individual with a head injury about her home environment, and family and child care responsibilities. Knowing the individual has an attention span of 10 to 15 minutes, which of the following should the COTA do FIRST? a. Schedule a 30-minute treatment session. b. Obtain as much information as possible from the chart. c. Interview the individual using appropriate verbal and nonverbal communication. d. Perform the interview in an environment where distractions can be minimized.

c. Obtain as much information as possible from the chart. By reviewing the individual's medical records before the interview, the COTA can determine what information has already been obtained. This will enable the COTA to make the vest use of the available time, and to avoid asking the individual to answer the same question twice. Whit such a limited attention span, it would probably be more efficient to schedule two 15-minute sessions rather that one 30-minute session (answer a). Answers c and d are both essential to god interview technique, but would occur at the time of the actual interview, after collecting stats form the chart.

A COTA is positioning a child with low muscle tone and postural instability into a prone stander to develop head righting. The child rapidly shows fatigue and associated reactions. How can the COTA BEST adjust the stander to decrease these reactions while continuing to address the goal of head righting? a. Place the child in prone on the floor. b. Position the stander at 45 degrees from the floor. c. Position the stander 75 to 90 degrees from the floor. d. Position the child upright in a prone or supine stander.

c. Position the stander 75 to 90 degrees from the floor. Answer C is correct because adjusting the stander nearest to vertical (the least effect of gravity on the head or posture) the child will be able to tolerate working on head righting. Answer A is not correct because while working on the floor in prone, the head and neck are doing the most work against gravity. Answer D is not correct because the head and neck work the least against gravity in the standing or upright position.

A child with behavioral problems has difficulty with peer interactions. Which of the following aspects of the treatment plan is MOST important? a. Provide activities in an authoritarian environment. b. Allow the child the opportunity to develop basic social skills on his own. c. Provide enjoyable activities in safe and accepting environment. d. Strictly enforce rules for group play.

c. Provide enjoyable activities in safe and accepting environment. Children who learn to enjoy activities alone will be more likely to cooperate with peers in a group activity. It is unlikely that the child will initiate and develop social interaction in an environment that inhibits independence (answer A). Children with peer interaction problems need to be taught some basic social skills (unlike answer B) in order to increase successful peer interaction. Children will more likely learn and accept rules and limits established by their group then by an authority figure (answer D).

An individual demonstrates the ability to pick up a penny from a flat surface. this represents which of the following prehension patterns? a. lateral b. palmar c. tip d. three-jaw chuck

c. Tip Tip prehension is accomplished by flexing the IP joint of the thumb, and the PIP and DIP joints of the finger, and bringing the tips of the thumb and finger together. This type of prehension is used to pick up objects such as a pin, nail, or coin. Lateral prehension (answer A) is formed by positioning the pad of the thumb against the radial side of the finger. This prehension pattern is used for holding a pen, utensil or key. Palmar prehension (answer b), also known as three-jaw chuck (answer d), is formed by positioning the thumb in opposition to the tips of the index and middle fingers, forming a pad-to-pad opposition. This form of prehension is commonly used to lift objects from a flat surface and to tie a shoelace.

A COTA is fabricating a resting pan splint for a client with extremely fragile skin. Which or the following areas will the COTA have to inspect most carefully for signs of skin breakdown? a. Metacarpal heads, pisiform and trapezium b. Volar PIP joints, medial fifth digit, and thumb MP joint c. Ulnar styloid, distal head of radius, and thumb CMC joint d. Thumb PIP joint, pisiform, and hamate

c. Ulnar styloid, distal head of radius, and thumb CMC joint The ulnar styloid, distal head of the radius, and thumb CMC joints are the most common sites for pressure because of their overt bony prominences. Answers a, b and d are also areas that could potentially be susceptible to skin breakdown, but are not primary sites of pressure when fabricating a resting pan splint.

An individual with chronic obstructive pulmonary disease and low endurance is taught to modify his bathing techniques to carryover after discharge. The COTA should recommend which of the following as the BEST bathing method? a. Tub bathing with hot water b. Standing for a quick shower c. Using a bath chair and a hand-held shower with tepid water d. Tub bathing using lukewarm water

c. Using a bath chair and a hand-held shower with tepid water The best bathing method for a person with COPD considers the energy demands of the task as well as the effect of water temperature, in light of the person's functional status. A person with COPD has difficulty breathing when the environment is hot or humid, or when there is a high degree of steam. Answer A is incorrect because of the energy demand of transferring into a tub, and the use of hot water may cause difficulty breathing. Answer B, standing for a quick shower, is also incorrect because even if brief, standing would be more energy demanding than sitting, and an overhead shower can increase humidity. A lukewarm tub bath (answer D) would provide lower humidity by using the coolest water temperature, but the need to transfer in and out of the tub may make the task very energy demanding.

The COTA needs to identify an activity that will address psychosocial goals by (1) allowing the individual to experience success using a messy process, and (2) requiring the individual to delay gratification. The activity process that is BEST for providing this experience is: a. working in a group with three other individuals. b. selecting the design pattern for a tile trivet. c. applying grout to a tile trivet and waiting for it to dry. d. encouraging the individual to clean off the table at the end of the group session.

c. applying grout to a tile trivet and waiting for it to dry. Applying group to a tile trivet and waiting for it to dry (answer c) provided a variety of opportunities for therapeutic gains. The process of grouting a tile trivet involves covering the individual's tile design with grout mixture, which is a messy step. The individual then sees that the tile pattern is emphasized with that addition of the grout. Waiting for the grout to dry requires an individual to delay gratification. Answer a, working in a group of three, would address social and interpersonal interaction skills, but not the goals related to experiencing success and delaying gratification. Answer c, selecting the design pattern, and answer d, encouraging clean up, would also address other goals.

When conducting a structured interview, it is MOST important for the OT practitioner to: a. rephrase the interview questions in his or her own words. b. ask questions that he or she thinks are pertinent to this patient. c. ask the question as they are stated on the interview sheet. d. ask additional questions(other than those listed) to gain further insight into the patient.

c. ask the questions as they are stated on the interview sheet. A structured interview requires following the procedure, order, and wording of the questions to be asked, Answers a, b, and d are appropriate for semistructured interviews .

A 3 y/o child demonstrates the ability to use the toilet independently except for wiping and readjusting clothing afterward. This behavior indicates the child is performing at which of the following levels? a. significantly below age level b. slightly below age level c. at age level d. above age level

c. at age level At 3 y/o age a child is expected to know when her or she has t use the toilet and be able to get on and off the toilet. 3 y/o children may need assistance to cleanse themselves effectively and to manage fasteners or difficult clothing. Complete independence in using the toilet (answer d) is usually achieved by the age of 4 to 5 y/o. By the age of 2 (answer b), most children have daytime control over elimination with occasional accidents, so thy still need to be reminded to go to the toilet. One y/o infants (answer a) indicate discomfort when wet or soiled.

A COTA is planning a meal preparation activity for an adult client with attentional and organizational deficits secondary to alcohol abuse. The treatment goals address the client's difficulties in properly sequencing tasks. The most appropriate activity to use FIRST is: a. setting the table b. planning an entire meal c. baking cookies using a recipe d. preparing a shopping list

c. baking cookies using a recipe This is a well delineated meal preparation activity that provides structure with a specific sequence of tasks. Setting a table or preparing a shopping list (answers A and D) do not necessarily require sequencing of tasks. Planning a meal (answer B) involves a great deal of organizational ability, and would not be an appropriate choice for an initial activity to address goals relating to sequencing tasks.

A long-term goal for a client following a hip arthroplasty is independence in lower extremity dressing. The MOST relevant short-term goal for the COTA to work on would be that the: a. client will increase standing tolerance to 10 minutes b. client will increase hip flexion to 90 degrees. c. client will demonstrate appropriate hip precautions d. client will apply energy-conservation techniques during dressing activities.

c. client will demonstrate appropriate hip precautions The ability to stand for 10 minutes (answer A) or to increase hip flexion to 90 degrees (answer B) is not necessary for independence in dressing. Use of appropriate hip precautions (answer C), however, is mandatory. Energy-conservation techniques (answer D) are appropriate for individuals who demonstrate very low endurance levels, which is not an issue for most individuals following hip replacement surgery.

A child has considerable difficulty with problem solving when playing with Lego blocks and becomes frustrated and gives up easily. This MOST likely indicates a problem in which area of play? a. sensorimotor b. imaginary c. constructional d. game

c. constructional Constructional play involves building and creating things. It is in this area of play that children develop a sense of mastery and problem-solving skills. Sensorimotor play (answer a) generally develops a child's body awareness and sensory experience. Imaginary play (answer b) involves manipulating people and objects in fantasy as prelude to dealing with reality. Game play (answer d) requires the ability to learn and apply rules in play.

A school-aged child with multiple handicaps is beginning to develop some controlled movement in the upper extremities. It would be most appropriate to introduce switch operated assistive technology when the child: a. develops tolerance of an upright sitting posture. b. can reach and point with accuracy. c. demonstrates any reliable, controlled movement. d. develops isolated finger control.

c. demonstrates any reliable, controlled movement. As long as the child can produce any reliable, controlled movement, switches can be adapted to meet positioning and mobility needs. Accurate reach and pointing (answer B) or isolated finger control (answer D) are not necessary to use single pressure switches. An upright sitting position (answer A) would not be required if the child needed to be positioned in a reclining or side lying position.

A COTA is planning a collage activity task group for several clients with depression. The PRIMARY purpose of using an OT task group with these clients is to: a. Provide opportunities to evaluate areas of function. b. focus the group on a topic that is common to all of the members and can be discussed by the members c. encourage here-and- now explorations of member behaviors and issues, while promoting learning through doing. d. encouraging the members to develop sequentially organized social interaction skills with the other members

c. encourage here-and- now explorations of member behaviors and issues, while promoting learning through doing. The purpose of task groups, as developed by Fidler, is to focus on the here and now; involve learning through doing activity and processing; and involve the development of daily living and work skills. Answer A describes an evaluative group and answer B describes a topical discussion group, rather than a task group. Answer D describes the purpose of developmental group levels proposed by Mosey.

An individual is able to complete full range of shoulder flexion while in a side-lying position during an evaluation. How-ever, against gravity, the client is not quite able to achieve 50% of the range for shoulder flexion. This muscle should be graded as: a. good (4) b. fair (3) c. fair minus (3-) d. poor plus (2+)

c. fair minus (3-) The definition of fair minus (3-) is the grade given when an individual moves a part through incomplete range of motion (<50%) against gravity, or through complete range of motion with gravity eliminated against slight resistance. A grade of good (4), answer a, indicated ability to move through full range of motion against gravity and to take moderate resistance. A fair grade (3), answer b, would be the ability to move through the full range of motion against gravity but not take any additional resistance. A grade of poor plus (2+), answer d, would move through full range of motion with gravity eliminated and take minimal resistance before suddenly relaxing.

Infants and preschool children with musculoskeletal disorders require ongoing examination of their upper extremity strength, coordination, and functional abilities. The OT practitioner will obtain the majority of assessment information during infancy and preschool through: a. assessments related to the specific diagnosis that determine hand function. b. dynamometer and pinch meter function. c. observation of play and hand function. d. functional independence measures.

c. observation of play and hand function. The observation of play and hand function is the most appropriate way to obtain assessment information during infancy and preschool ages. "Much of the assessment, during infancy and preschool, centers around observation of play and hand function". Answers a, b, and d are all appropriate choices after the child is old enough for formal assessment.

When reporting data collected to the OTR, it is MOST important for the COTA to: a. observe everything the patient said and did during the interview and provide extensive notes for the OTR to read. b. provide the OTR with a comprehensive treatment plan based on the results of the evaluation. c. provide a summary of observations of the patient's behavior, including what the patient said and did during the interview. d. provide an interpretation of how the patient behaved during the interview.

c. provide a summary of observations of the patient's behavior, including what the patient said and did during the interview. An observation summary should present a concise and accurate picture of what happened so that the OTR can understand almost as well as if they were present during the interview. It is a summary, and should not include extensive descriptions (answer A) or interpretations of the interview (answer d). A treatment plan (answer b) should be developed collaboratively with the OTR.

An individual who uses a wheelchair is being discharged from a rehabilitation facility to home. In determining accessibility of the interior home environment, the area the COTA should be MOST concerned with is: a. location of telephones and appliances. b. arrangement of furniture in bedrooms. c. steps, width of doorways, and threshold heights. d. presence of clutter in the environment.

c. steps, width of doorways, and threshold heights. The first area of evaluation would be the steps, width of doorways, and presence and height of door thresholds to determine whether the wheelchair user will be able to enter or exit interior spaces in the wheelchair or whether structural modification are required. Answers A, B, and D reflect areas that will also need to be evaluated, however, they are not as critical to initial interior access.

An older adult with diabetes is working on a macramé project as a way of increasing standing tolerance. The MOST relevant safety factor for the COTA to take into consideration is the: a. length of the cords she will start with. b. thickness of the cords she will be using. c. texture of the cords she will be using. d. type of surface she will be standing on.

c. textrure of the cords she will be using. Coarse materials like jute may shred and give splinters or injure the skin on hands and fingers. This is particularly important for individuals with diabetes who frequently have poor sensation and circulation in their extremities. Skin damage must be avoided because healing is compromised. The length of the cord (answer a) would be significant for an individual with limited range of motion. The thickness of the cord (answer b) would be significant for an individual with limited hand function. The type of surface the individual stands on (answer d) would be important to an individual with back pain.

During the interview with the parents of a 3-year-old child with mild CP, the OT practitioner learns that the child is regularly fed by his grandmother and does not have any independent feeding skills. The FIRST issue the OT practitioner needs to explore further is: a. the degree of abnormal muscle tone in the UEs. b. the possibility of developmental delay. c. the cultural context and family interaction patterns. d. the need for adapted equipment.

c. the cultural context and family interaction patterns. Cultural expectations may determine behavior standards and the expression of family roles. Continued feeding for a young child with a handicap may be the expression of nurturing and caring. Such an expression may be viewed as more important that the promotion of independence and self-reliance. Answers a, b and d may be valid issues as well, but should be addressed after the OT practitioner has familiarized himself or herself with the cultural and familial context of the feeding process.

A COTA is working with a child whose poor visual attention is affecting his ability to perform school work. An adaptation of the sensory environment that would BEST improve attention during a visual task is to have the child: a. work with lively background music to increase competing sensory input. b. work against a patterned background to increase competing visual input. c. use headphones during work to reduce competing sensory input. d. use dim lighting to reduce the visual input.

c. use headphones during work to reduce competing sensory input. Reducing competing sensory input is helpful in increasing competing input (answers A and B), or reducing the amount of visual input (answer D), may reduce the ability to attend to visual stimuli.

In carrying out inpatient treatment groups for individuals with schizophrenia the COTA should routinely: a. use projective media, such as clay, to facilitate expression of feelings. b. allow an individual group member to work in an isolated area away from the group. c. use simple and highly structured activities. d. discuss the individuals' delusions with them.

c. use simple and highly structured activities. Projective media, isolation and discussing delusions are all contraindicated for people with schizophrenia. Projective activities (answer A) are most useful for encouraging expression of feelings. It may be appropriate to separate individuals (answer B) who are violent or unable to tolerate the presence of others nearby, but this would not be part of the regular group routine. Discussing delusions (answer D) is undesirable because it is likely to reinforce them.

A COTA is working with and individual who is unable to name or demonstrate the use of common household objects. This behavior MOST likely indicates: a. apraxia b. stereognosis c. visual agnosia d. alexia

c. visual agnosia Visual agnosia is the inability to recognize common objects and demonstrate their use in an activity. Apraxia (answer a) is the inability to perform purposeful movement on command. A person with alexia (answer d) is unable to understand written language. Stereognosis (answer b) is the ability to identify an object by manipulating it with the fingers without seeing it.

The treatment goal for a 4-yr-old child with hypotonia is to improve grasp. Which of the following activities would be BEST for preparing the child's hand for grasp activities? a. dropping blocks into a pail b. placing pegs on a pegboard c. weight-bearing on hands d. holding and eating a cookie

c. weight-bearing on hands Weight-bearing on hands (answer c) is the only activity that will facilitate hand function in the preparation phase. Weight bearing on the hands gives deep pressure to the surface of the hand. It facilitates wrist and arm extension, as well as shoulder co-contraction, to prepare the arm for reach, and stabilization of the hand for grasping. Answers a, b, and c provide different types of grasp activities that could be used as therapy.

An individual with a C6 spinal cord injury is unable to button his shirt. The COTA would be MOST likely to select with type of adaptive equipment to assist this client with buttoning? a. A buttonhook with and extra-long, flexible handle b. A buttonhook with a knob handle c. A buttonhook on a 0.5 inch diameter, 5 inch long wooden handle d. A buttonhook attached to a cuff that fits around the palm.

d. A buttonhook attached to a cuff that fits around the palm. Individuals with C6 quadriplegia may have a tenodesis grasp or no grasp available to them. Therefore, a buttonhook that fits into the palm, or a buttonhook with a built-up handle, are the only appropriate choices. A buttonhook with a knob handle (answer B) or on a 5-inch dowel (answer C) is appropriate for an individual with a functional grasp, but limited dexterity. A buttonhook with an extra-long, flexible handle benefits an individual with limited range of motion.

A child with athetoid CP is working in OT to develop self-feeding skills. The COTA observes that when the child attempts to pick up food, it slides off the plate. Which adaptation does the COTA provide to solve this problem? a. A swivel spoon b. A nonslip mat c. A mobile arm support d. A scoop dish

d. A scoop dish A scoop dish is a plate with a high rim that provides a surface against which to push the food. The child would have less difficulty with controlling movement of food because the sides of the scoop dish would provide a shape that aids scooping of food onto the spoon. A swivel spoon (answer A) helps primarily when supination is limited. A non slip mat (answer B) helps stabilize the plate itself, and a mobile arm support (answer C) positions the arm to help weak shoulder and elbow muscles to position the hand.

Which of the following would a COTA MOST likely introduce to a group of 10 y/o children with paraplegia? a. "Simon Says" b. Imaginative/role playing group with dolls and stuffed animals c. "Duck, duck, goose" and "Hot Potato" d. A tabletop air hockey competition

d. A tabletop air hockey competition Tabletop air hockey is the best choice because the rules of this type of game coincide with the developmental abilities of the child. This game would also be easily played at a wheelchair level. According to Case-Smith, "in middle childhood (6 to 10 y/o) children play in cooperative groups and value interaction with their peers...In these peer groups, children learn to cooperate, but also to compete. They are now interested in achievement through play." Answers A and C ("Simon Says" and "Duck, duck, goose") are activities that would be most appropriate for preschool or kindergarten age children, while answer B, role playing with toys, is more appropriate for children ages 3-4 y/o.

When evaluating sensation of an individual with hemiplegia, the COTA should FIRST: a. apply the stimuli distally to proximally. b. test the involved area than the uninvolved area. c. present test stimuli in an organized pattern to improve reliability during retesting. d. apply the stimuli to the uninvolved area proximally to distally in a random pattern.

d. Apply the stimuli to the uninvolved area proximally to distally in a random pattern. The general guidelines for sensation testing are that the person's vision should be occluded, the stimuli should be randomly applied intermingles with false stimuli, a practice trial should be performed before the test, and the unaffected side or area should be tested before the affected side or area. Also, the amount of time a person has to respond should be established.

A 9-year-old child with sensory integration problems has not developed a preferred hand for printing or writing. Which intervention option would MOST likely result in eventual development of a preferred hand to use in writing activities? a. Develop right-handed skills because most children are right-handed b. Wait a few more years until the child decided which hand is preferred, c. Let the child's teacher decide on a preferred hand d. Consider and treat underlying sensory integration problems as a possible cause.

d. Consider and treat underlying sensory integration problems as a possible cause. Often children's sensory integration problems interfere with the development of hand dominance. The cause could be deficits in motor planning, decreased ability to cross the body midline, poor sensory perception in the arms and hands, delayed integration of reflex patterns and so forth. Answers A, B and C are incorrect because they do not address possible underlying causes for poorly established hand dominance.

A COTA is planning a craft activity for an adolescent who has been hospitalized following a suicide attempt. An interest checklist indicates experience with fiber arts. Which of the following activities would be considered MOST appropriate for this individual? a. Leather wallet with single cordovan lacing b. Macrame choker c. Ceramic beads d. Decoupage wooden key fob

d. Decoupage wooden key fob A wooden key fob with a decoupage finish is the safest craft choice because it is free of sharp, toxic and cordlike materials. A ceramic object (answer C) could be broken into sharp pieces that an individual could use to harm him or herself. Craft projects that contain rope or cord like materials that could be used in hanging (answers A and C) should also be avoided. Although macramé is related to the fiber arts and may be of interest to this individual, it would not be considered a safe choice because of the cords involved.

A COTA is conducting and ongoing assertiveness training group. Which of the following strategies would be most helpful in the development of group cohesion? a. Define assertiveness, passivity, and aggression for the group members. b. Allow and encourage all group members to release their aggressive feelings physically and verbally toward inanimate objects. c. Demonstrate commonly used assertiveness techniques to the group members. d. Encourage group members to share similar experiences and reactions with each other.

d. Encourage group members to share similar experiences and reactions with each other. Answer D is a strategy designed to develop cohesiveness among members. Many people have reported that recognizing one's similarities with other people is a very valuable experience. Answers A and C are designed to impart information. Answers A and C are designed to impart information. Answer B is an example of catharsis, which may not be helpful to all members. Moreover, the OT practitioner must be aware of, and understand, the precautions necessary for the use of catharsis.

A young child exhibits tactile defensiveness with all dressing tasks. Which of the following would the COTA recommend as the MOST effective handling method for this child? a. Tickle him prior to dressing and undressing. b. Play loud music while undressing him. c. Lightly stroke the child's arms and legs while dressing him. d. Hold him firmly when picking him up and dressing him.

d. Hold him firmly when picking him up and dressing him. Holding the child firmly inhibits responses to light touch, which are usually uncomfortable for children with tactile defensiveness. Tickling (answer A), and light stroking (answer C), are also uncomfortable or intolerable for a child with tactile defensiveness. A strong stimulus such as loud music causes further discomfort during a time when the child is extremely vulnerable to the sensation of light touch(i.e. when clothing is being removed)

A COTA is planning a program for an individual who needs to increase shoulder strength, range of motion, and endurance. Which of the following activities is MOST suitable for periodic upgrading? a. Blowing up and tying balloons of various sizes. b. Playing a game of balloon darts c. Painting faces on balloons d. Playing balloon volleyball

d. Playing balloon volleyball An activity such as balloon volleyball may be graded for improving strength my adding resistance to the arm in the form of weights. Endurance may be improved by adding more repetitions of the movement. Raising the height of the net can increase the ROM required. Blowing up and tying balloons (answer a), and painting faces on balloons (answer b) are primarily fine motor activities. An individual who throws darts at balloons (answer c) would be able to increase the resistance needed for shoulder strengthening by adding weight to the arms or using balloons with thicker rubber. However, this activity is less suitable to increase the number of repetitions, because the repeated loud noise associated with bursting the balloons would be annoying.

The COTA is selecting activities for an 8 y/o child with Duchenne's muscular dystrophy. Which of the following developmental issues is MOST important to consider when identifying activities for this child? a. Establishment of basic trust b. Freedom to use his initiative c. Development of self-identity d. Reinforcement of competence

d. Reinforcement of competence According to Erikson, an 8 y/o child is usually at the stage of industry verses inferiority, during which he or she develops a sense of competency. For a client who is expected to lose moor function gradually, a treatment plan that will provide an ongoing sense of competence (possibly in other areas) is especially relevant. Answers A, B and C describe other developmental issues identified by Erikson that are typically achieved at other ages: basic trust (answer A) in infancy; initiative (answer B) during the toddler years; and self-identity (answer C) during adolescence.

The COTA is attempting to increase playfulness with a 7 y/o girl with sensory integrative dysfunction. The child experiences difficulties with motor tasks and often complains that no one likes her. After establishing rapport with the child, the COTA would MOST likely introduce which of the following? a. Playing a game of "Go Fish" b. Playing a game of checkers c. Jumping rope d. Role playing a tea party with "Barbie" dolls

d. Role playing a tea party with "Barbie" dolls Answer D, role playing with dolls, is the most appropriate choice because the COTA is encouraging the child to partake in pretend play. "Playfulness, like play, encompasses intrinsic motivation, internal control, and freedom to suspend reality." Role playing is focused primarily on the activity at hand rather than the end product, such as Answer A (playing a game of Go Fish) and answer B (playing a game of checkers). Answer C, jumping rope, might frustrate the child secondary to her difficulty with motor tasks. The end goal of an occupational therapy treatment would be to increase the child's play skills in the hopes that the child will begin to interact more comfortably within the home.

An individual with mental retardation lives in a group home and is expected to participate in laundry activities. The individual is usually successful with routine performance of daily tasks, is able to recognize whether clothing is clean or dirty, demonstrates sequencing skills, and is independent in most self-care activities. What advice should the COTA provide to the group home staff to enable the individual to perform laundry activities at the HIGHEST level of independence possible? a. The staff will probably need to instruct the individual t place dirty items in the hamper and remove sheets from the bed. b. The staff should encourage problem solving when obstacles arise. c. The individual will be independent in use of a washer and dryer, but the staff may need to demonstrate the use of new products d. The staff may only need to monitor water temperature and the amount of soap being used

d. The staff may only need to monitor water temperature and the amount of soap being used This individual is functioning within the level 4 range of Allen's Cognitive Levels. Because this individual can recognize whether items are clean or dirty, cueing to place dirty items in the hamper (answer A) is not necessary. Independent use of the washer and dryer (answer C) and problem solving (answer B) are more appropriate for individuals functioning at level 5, in which the individual demonstrates flexibility in response to change.

A sales executive is participating in a time-management program. Which of the following would be the expected outcome for the client? a. To control anxiety when arriving late for a meeting b. To take responsibility when late with reports c. To cope with feelings of inadequacy when missing a deadline d. To arrive at work on time consistently

d. To arrive at work on time consistently Time management mandates the importance to "recognize one's values and priorities, structure a daily routine, schedule one's time, and organize tasks efficiently." Answers A, B, and C are ways of coping with being late, not strategies for the time management goal of being on time.

A COTA is instructing a person with arthritis how to maintain range of motion while performing household activities. Which of the following activities would the COTA MOST likely recommend to accomplish this? a. Use short strokes with the vacuum cleaner. b. Keep elbow flexed when ironing c. Keep lightweight objects on low shelves d. Use a dust mitt to keep fingers fully extended

d. Use a dust mitt to keep fingers fully extended Using dust mitts prevents prolonged finger flexion and allows the fingers to remain straight while dusting. Pushing the vacuum (answer A) forward by straightening the elbow completely, then pulling it back close to the body utilizes long strokes and promotes good elbow and shoulder range of motion. When ironing (answer B), trying to get the elbow into full extension helps to maintain elbow range of motion. Keeping lightweight objects (answer C) on hight shelves encourage reaching, which helps maintain shoulder range of motion.

In planning a therapeutic dressing intervention for a first-grade child who is mentally retarded, the COTA's FIRST consideration should be the need for: a. adaptive equipment. b. adaptive clothing. c. proper positioning. d. adapted teaching techniques.

d. adapted teaching techniques. Answer D is correct because a child with this type of disability characteristically has learning problems that require teaching methods such as "chaining" or behavior modification. Answers a, b, and c are of secondary importance, because physical coordination may be impaired, or there may be other physical limitations, such as abnormal muscle tone or significant problems with balance could also be present. These additional problems may require adaptive equipment, clothing or techniques. However, all aspects of dressing depend on the child's ability to learn procedures of dressing: therefore, it is necessary to consider task analysis and teaching approach first.

When assessing the sense of proprioception at an individual's joint, movement within the range would BEST be performed: A. until pain is elicited. B. until the stretch reflex is elicited. C. at the end ranges of the joint. d. at the midrange of the joint.

d. at the midrange of the joint. Proprioception (or position sense) is demonstrated when an OT practitioner passively positions the joint being tested and the individual is able to imitate the position with the opposite extremity. The joint should not be moved through range to an extent that would elicit a stretch or pain response (answers a and b) which would be at the end ranges of the joint. Movement should be at a rate of approximately 10 degrees per second to prevent the stretch reflex from being elicited. The end points of the range (answer c) are used as the starting positions from which proprioception testing is initiated, because it is in these positions that the stretch or pain response would occur.

In screening a child who has been referred to OT, the PRIMARY goal of the OT practitioner is to: a. obtain necessary information for an occupational therapy consultation with teachers or parents. b. test a wide variety of developmental behaviors c. establish and information base for the occupational therapy treatment plan. d. determine the need for further evaluation.

d. determine the need for further evaluation. The purpose of screening is to determine whether further assessments are needed and if so which tests would be appropriate for the child a screening test is not designed for planning programs (answer c) or consultation (answer a) and they do not test any skills (answer b) in a comprehensive way.

An individual with the goal of increasing attention span is frequently observed watching the person next to her instead of performing her assigned task, This behavior MOST likely indicates a problem with: a. memory. b. spatial operations. c. generalization of learning. d. distractibility.

d. distractibility Distractibility involves losing ones focus because of other stimuli. Memory (answer a) is the ability to recall knowledge and past events. Problems with spatial operations (answer b) are generally observed when individuals attempt to fit objects into specific spaces. Generalization of learning (answer c) may be observed by asking the client to use existing knowledge in a new situation.

The COTA is observing dressing skills in an individual with COPD. While putting on his shirt, the individual becomes short of breath and stops to rest before finishing with that shirt and going on to his trousers. This behavior MOST likely indicates a deficit in: a. postural control b. muscle tone c. strength d. endurance

d. endurance A deficit in endurance is demonstrated by the individual's inability to sustain cardiac pulmonary, and musculoskeletal exertion for the duration of the activity. Answer a a deficit in postural control, would be correct if the client had been unable to maintain his balance while putting on the shirt. A deficit in muscle tone (answer b) would have been evident if the client had demonstrated spasticity while putting on the shirt. Inability to push his arm through the resistance of the shirt sleeve would demonstrate a deficit in strength (answer c).

A resident of a long-term care facility is receiving OT because of difficulties with eating. The FIRST step of intervention the COTA performs with this resident at mealtime is to: a. provide skid-proof placemats, plate-guard, and utensils with built-up handles. b. observe for swallowing after each bite of food. c. instruct the caregivers about a special eating setup for the resident. d. position the person in an upright posture, making sure head if flexed slightly and in midline.

d. position the person in an upright posture, making sure head if flexed slightly and in midline. Making sure the resident is correctly positioned is the first step in addressing eating problems. Improper posture can result in difficulties with swallowing.

A woman experienced repeated sexual abuse by her father as a child. She how describes her fathers abusive actions as being caused by his stress of being fired from a job because of new management. The defense mechanism she is MOST likely to be using is: a. identification. b. projection. c. denial. d. rationalization.

d. rationalization. Making excuses for, or justifying, the behavior of others that is generally considered to be unacceptable, is called rationalization. Identification (answer a) occurs when one takes on the characteristics of another person. Projection (answer b) is the blaming of other people for performing the behaviors. Denial (answer c) is refusing to acknowledge that the behavior occurred.

A COTA is treating a client with Parkinson's disease whose primary functional problems are caused by a shuffling gait. The MOST relevant environmental recommendation the COTA could make to address a potential safety hazard in the home is to: a. increase illumination in hallways. b. screen out distracting stimuli in the environment. c. place door locks higher or lower than eye level. d. remove scatter rugs throughout the house.

d. remove scatter rugs throughout the house. The greatest safety hazard would be from the presence of scatter roughs in the house, which could cause the client with a shuffling gait to trip and fall. Individuals with Parkinson's disease are at high risk for falls. Answer A, increasing illumination in hallways, would be more important if the client has low vision. Answer B, screening out distracting stimuli and answer C, placing door locks higher or lower than eye level, are safety adaptations made for individuals with cognitive deficits, rather than motor deficits.

The mother of a 3-month-old infant recently returned to her job as a bookkeeper on a part-time basis. She reports that she has difficulty concentrating at work because she keeps thinking about the baby, and that when she's at home, she is distracted because she feels she should be at work. This PRIMARILY indicates a problem in the area of: a. parenting skills. b. attention span. c. assertiveness. d. role performance.

e. role performance. Role performance is "identifying, maintaining, and balancing functions one assumes or acquires in society (worker, student, parent, friend, religious participant). This individual is having difficulty balancing in the roles of worker and mother, and is feeling stressed and conflicted. This stress may result in difficulty maintaining attention (answer b). Evaluation by an OT could include assessment of parenting and assertiveness skills (answers a and c) to determine if these are areas of need, and , if so, interventions could be designed to address these areas to support successful role performance.