COTA Review

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.

An individual with complete C7 quadriplegia demonstrates fair plus (3+) strength in the wrist extensors. Which of the following interventions would the COTA introduce to MOST effectively increase strength in the wrist extenors? a. A craft activity using increasingly heavy hand tools. b. Mildly resistive activities that are halted as soon as the individual begins to fatigue. c. Electric stimulation to the wrist extensors d. Moderate resistance during AROM to the wrist.

a. A craft activity using increasingly heavy hand tools. Progressive resistive exercise is the most effective method for increasing strength in a muscle with fair plus strength. Mildly resistive activities that are stopped as soon as the individual begins to experience fatigue (answer B), are appropriate for maintaining or improving strength in individuals in which fatigue should be avoided ( MS, ALS, and Gillain-Barre syndrome). Electric stimulation (answer C) is appropriate for increasing strength in very weak muscles. When performing resistive active range of motion with this individual, the COTA would use maximal resistance. In addition, a craft activity that can be performed against increasing resistance for prolonged periods of time, would be more effective than resisted active range of motion (answer D), which is usually only preformed once or twice a day.

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 excesive fidgeting and reatlessness, 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.

3. 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 COTA instructs a client with chronic neck pain to use paychosocial 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 45 y/o client with COPD has the long-term goal of being able to shop independently for groceries. The client has achieved the short-term goal of going to a convenience store and purchasing three items. Which statement is the BEST revised short-term goal for this client? a. Client will purchase 10 items at the supermarket with supervision. b. Client will cook a one-dish mean with items purchased at the supermarket. c. Client will identify food items needed for developing a shopping list. d. Instruct client in energy conservation techniques that apply to grocery shopping.

a. Client will purchase 10 items at the supermarket with supervision. Short-term goals must relate to the long-term goal being addressed. Because the long-term goal being addressed is independence in grocery shopping, the short-term goal must relate to grocery shopping. "Goals need to be written to show that the patient will accomplish, not what the therapist will do" (p. 94). Answer D is an appropriate treatment intervention, but is written in a way that describes what the OT, not the client, will do. Answers B and C describe activities related to the task of shopping, but not the shopping itself.

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 lables 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 usind 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 to indicated the individual has cognitive deficits, therfore a cognitive evaluation (answer b) would not be indicated.

An individual with Guillian-Barre syndrome demonstrates poor to fair strength throughout the upper extremities. Which is the most appropriate approach for the COTA to use in the EARLY stages? a. Gentle non-resistive activities b. Progressive resistive exercise c. Fine motor activities d. Active range of motion against moderate resistance

a. Gentle non-resistive activities The initial phase of treatment for the individual with Guillian-Barre syndrome includes PROM and splinting, and positioning to protect weak muscles and prevent contactures. This should be followed by gentle, non resistive activities and ADL, as tolerated. Resistive activities and activities (answers B and D) should be implemented after strength begins to improve. Activities within later treatment sessions should alternate between gross and fine motor (unlike answer C), and resistive and nonresistive types, to avoid fatigue.

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 conservatioon techniques and daily aerobic activitites tnto 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 mobiliy 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 hih 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.

A COTA is working on laundry skills with and adult with cognitive disabilities. Initially, the OT practitioner recommeneded that the group home staff work with the individual for 2 months on how to recognize when clothing is dirty and needs to be laundered. After 2 months, however, the individual continues to wear soiled garments. The OT practitioner determines that the individual is unable to recongnize or judge when clothing is dirty. What is the NEXT step that should be taken to maximize the individual's independence in doing laundry? a. Instruct the individual to wear clothes for 2 days and then launder those items. b. Assess the individual's ability to recognize dirty clothing. c. Recommend that the individual take clothes for dry cleaning rather than wash them at home. d. Recommend to the staff that they do the individual's laundry from now on.

a. Instruct the individual to wear clothes for 2 days and then launder those items. Teaching the individual to recognize and judge when clothing needs to be laundered has been unsuccessful, indicating that the individual may not have the capacity to learn this skill. If the OT practitioner determines that the individual can usually wear clothes for 2 days before they need to be laundered, then providing a rigid schedule based on this average removes the need for judgement, and provides a schedule that will result in the individual wearing clean clothes most of the time, if not always. Assessment of the individual's clothing management capabilities (answer B), would have been performed before the implementation of the initial intervention. Taking the clothes to the dry cleaner (answer C), would be cost prohibitive and would still require judgment to determine when they needed to be cleaned. Turning the responsibility over to the staff (answer D), would not promote independence in clothing management.

Which of the following assessment methods would and OT practitioner MOST likely choose in order to learn about a family's falues 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 motoric 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.

A COTA is preparing for the discharge of a preadolescent child with limited strength and endurance. Which of the following home adaptations is MOST important to recommend? a. Mount lever handles on doors and faucets. b. Remove all throw rugs. c. Install nonskid pads on steps d. Mount a table top easel for written homework.

a. Mount lever handles on doors and faucets. For children with reduced strength and endurance, using less complex movements, and less force results in energy conservation. Lever handles require less energy than knob handles on doors, faucets, and appliances. Answers B and C are environmental adaptations recommended minimizing the danger of slipping and falling for children with incoordination or postural instability. Answer D is contraindicated, because work at a vertical surface against gravity requires more energy than movement in a horizontal plane.

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 question-aire 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.

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 positon 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. Answer B, horseshoe shaped bath collar would be indicated for a child with "severe motor limitations who is lying supine in shallow water." Whereas answer C, a bath hammock, might be considered as an alternative choice for this child because "bath hammocks fully hold the body and enable the parent to wash the child thoroughly" this type of equipment would not be as cost effective as the laundry basket. Answer D suggesting the child stand in the shower verses showering, does not address the parent or the child's immediate needs of using the bathtub. If the child lacks sitting balance it is likely they will also lack standing balance, thus indicating the need for durable medical equipment, such as a shower bench and/or grab bars.

Which of the following is the MOST important precaution to emphasize to parents when discharging a child with lower extremity paralysis as a result of myelomeningocele? a. Practice regular skin inspection. b. Avoid feeding the child chewy foods that may cause choking. c. Monitor apnea episodes. d. Avoid situations that can stimulate tactile defensiveness.

a. Practice regular skin inspection. Children with lower extremity paralysis resulting from myelomeningocele usually experience impaired lower extremity sensation, placing them at risk for developing decubitus ulcers or burns due to contact with hot water or objects. Generally, children with myelomeningocele do not have oral motor or eating problems (answer B) or apnea episodes (answer C), unless Arnold-Chiari deformity is present. Tactile defensive behaviors and other sensory integrative disorders (answer D) can be present in children with spina bifida and myelomeningocele, but the issue of skin breakdown is more important at this time.

2. 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 positon? 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 positon 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. The reality motivation approach is designed to maintain or improve awareness of time, situation, and place, and often uses activities related to holidays and other temporal concepts (answer B). The environmental adaptation approach (answer C) promotes independence, but has no relevance to remotivation. Interpersonal skills (answer D) are most effectively addressed through role-playing and discussion groups.

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.

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.

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 developement. d. advanced development.

a. a develpmental delay. Typically developing children (answer c) should be able to sit unsupported for several minutes by the age of 8 to 9 months; therfore, 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 thatn 8 months could indicated advanced developement (answer D).

An individual has demonstrated competence in heating canned soup. The COTA recommends modifying the treatment plan and upgrading the cooking activity to: a. baking brownies b. making an apple pie c. making toast d. making a fresh fruit salad

a. baking brownies A correctly sequenced progression of difficulty in meal preparation is access a prepared meal; prepare a cold meal; prepare a hot beverage, soup, or prepared dish; prepare a hot one dish meal; and prepare a hot multi-dish meal. Making a fresh fruit salad (answer D) is a less challenging activity, because no cooking is involved. Although both involve heating an item, preparing toast (answer C) is simpler than heating soup because opening a plastic bag is less complex task than opening a can. Baking brownies (answer A) is slightly more complex, because of the progression from stove top to oven, and the addition of several ingredients that need to be mixed. Therefore this would be an appropriate upgrade. Making an apple pie (answer B) requires a higher level of task performance and complexity than brownies, and would be an appropriate task after the individual demonstrates competence in the less complex task of baking brownies.

A client with a history of anger self-control issues has met the goals of independently identifying stressors in his home and work life, which tend to provoke his anger, and identifying his typical behaviors when dealing with anger provoking situations. The COTA's NEXT action should be to: a. begin instruction in anger management strategies, such as relaxation. b. change the focus of treatment to developing self-assertiveness skills. c. provide activities, such as hammering, that provide outlets for anger. d. recommend discontinuation of service to the OTR.

a. begin instruction in anger management strategies, such as relaxation. Beginning instruction in anger management techniques such as relaxation, conflict resolution and empathizing would be the next step in a plan to address anger management because the client has accomplished the first step of identifying key stressors leading to his anger and of defining his typical response to such stressors. Answer B, modifying treatment to focus on self-assertiveness, would not be an appropriate emphasis, and making such a change without collaboration with the OTE would not be appropriate. Answer C, providing activities as outlets for anger, may have the affect of "actually increasing anger" (p. 468). Though the client has made some progress towards goals, he has not achieved competence in anger management skills, therefore answer D, recommending discontinuation of services, is also incorrect.

A COTA is using leather stamping as part of a group activity but feels the need to increase the problem solving processes within the group. The BEST approach for encouraging problem solving in a craft media group is to: a. begin with activities that have obvious solutions and high probabilities of success, and then gradually increase the complexity. b. begin with activities that require gross motor responses and progress to activities that require fine motor responses. c. structure the number and kinds of choices available. d. gradually increase the time used in the activity by 15-minute increments.

a. begin with activities that have obvious solutions and high probabilities of success, and then gradually increase the complexity. This strategy is effective in developing problem-solving skills. Gross and fine motor activities (answer B) can heighten awareness of self and develop coordination. Increasing the time spent on the activity (answer D) helps development of attention span. Structuring the number and kinds of choices (answer C) is a method for developing decision-making skills.

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 snall part of the task but gradually increases participatio in all sequences in their correct order. Anasers B, C and D are ther methods that can be used, but forward and backward chaining are particularly successful instructional methods for individuals who are mentally retarded.

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.

An individual with Alzheimer's disease has difficulty following multiple-step instructions. Which method will the COTA instruct the caregiver to use when presenting instructions? a. give frequently repeated one- or two-step instructions. b. provide three-step instructions with gestures for demonstration c. write instructions down for the individual that are over three steps d. have individual verbally repeat instructions after the therapist gives them

a. give frequently repeated one- or two-step instructions. The best method to use with and individual with Alzheimer's disease is short instructions of one to two steps, keeping them to the point and repeating them frequently. Demonstration with multiple-step instructions (answer B) can be confusing because it provides too much stimulation. Multiple-step written instructions (answer C) are unlikely to be retained in the individual's short-term memory after reading, or remembered in sequence. Also, written instructions could be lost if the individual puts them down. Verbally repeating directions over and over (answer D) , or rehearsal does not enable a person with Alzheimer's disease to retain information in the memory, an her or she may not repeat the instructions properly.

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.

Task-specific training is being used to train an individual with severe cognitive limitations to put on a tee shirt. This training will be MOST effective if it takes place: a. in the individual's bedroom. b. in the OT department. c. at least twice a week. d. when the client is feeling cooperative.

a. in the individual's bedroom. Because individuals who require task-specific training are unable to generalize learning to other situations (including other garments and other environments), it is important to train the individual in the environment where the task will be preformed. This type of training should take place at least five times a week.

The COTA and physical therapist are attempting to order a wheelchair for a child with severe cerebral palsy who will most likely never ambulate. The child has no cognitive limitations and frequently expresses the desire to be independent in mobility, especially within the school setting. The COTA and physical therapist will MOST likely recommend that the family order a a. power wheelchair. b. standard wheelchair c. caster cart d. prone scooter

a. power wheelchair. A power wheelchair would be the most appropriate choice in this situation. Answer B, a standard wheelchair, may be something the family would like to purchase in addition to the power wheelchair. Standard wheelchairs tend to be less expensive, lightweight, and portable. They are also convenient when a power wheelchair is in for repairs. Answers C and D are not considered appropriate for the child with severe cerebral palsy, because adequate upper extremity function is required for use of the caster cart and scooter.

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 child diagnosed with ataxic CP exhibits tremors in the upper extremities. When she feeds herself, the tremors cause most of the food to fall off her spoon before it can reach her mouth. Which of the following adaptations should the COTA recommend? a. replace the spoon with a blunt-ended fork. b. build up the handle of the spoon. c. Give the child a swivel spoon. d. bend the spoon handle 45 degrees.

a. replace the spoon with a blunt-ended fork. For a child with incoordination and tremors, stabbing food with a blunt-ended fork is often more effective for feeding than using a spoon. The food will not fall off the fork, and the blunt tines will prevent any injury to the child. Building u the spoon handle (anser B) is more appropriate for a child with a weak grasp. A swivel spoon (answer C), and bending the handle 45 degrees (answer D), are more appropriate for a child with limited forearm and wrist motion.

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 meurologix 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 extermity 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, delebrate motor action is most effectively executed on a securely mounted device useing smiple movement patterns. Answers B, C and D involve devices that would respond to slight touch, and would therfore not beeffective 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 student has been working on learning to activate a switch for a communications device heeded in the fourth grade classroom. The switch is mounted on the wheelchair tray, but the student is having difficulty operating it because of excessive muscle tone. Despite practicing for extended periods of time, the student is not making any progress. The COTA decides to: a. work on coordinated reach in a side-lying position first and then transfer the skill to sitting position. b. passively stretch the student's upper extremity to increase range of motion. c. use a brightly colored switch to increase visibility. d. use systematic behavioral reinforcement through shaping.

a. work on coordinated reach in a side-lying position first and then transfer the skill to sitting position. The COTA should teach the skill with the child in the position in which they can most easily learn the skills and then teach how to transfer the skill to a more functional position. Answer B addresses a limitation in ROM; answer C is a strategy for dealing with a visual impairment; and answer D pertains to behavioral and cognitive issues, none of which were mentioned as concerns for this child.

An individual with a high level spinal cord injury is returning home. Which type of adaptive technology would the client MOST likely require to ensure safety in the home? a. An environmental control unit. b. A call system for emergency and nonemergency use c. A remote control power door opener d. An electric page turner

b. A call system for emergency and nonemergency use A call system (answer B) is necessary for a person with a high level spinal cord injury to allow the caretaker to leave the room, but remains available to answer calls for assistance with daily needs or an emergency. This is frequently the first opportunity that a person with a spinal cord injury would have to control some part of his or her life, giving some feeling of independence or choice. An ECU (answer A) does allow independence in operating appliances, lights, and so on through the use of switches or voice control, but would not be necessity for safety. A remote control power door opener that would allow a caretaker to enter would be useless if the individual is unable to call for assistance. An electric page turner (answer D) is useless without the ability to call for someone to position or replace reading material.

An early intervention COTA is working with a toddler whose significant physical disabilities have limited the child's ability to explore the environment. The BEST "low tech" assistive technology play aid to allow the child to experience cause and effect and some control over an aspect of his or her environment would be: a. a tape recorder for the child to listen to music. b. A switch-adapted battery-operated toy car the knocks down a black tower. c. storybook software for use on a computer. d. a powered wheelchair.

b. A switch-adapted battery-operated toy car the knocks down a black tower. A switch-adapted battery-operated car would be most age appropriate activity that would allow a young child to experience how his or her actions affect the environment. Listening to music on a tape recorder (answer A), unless the tape recorder was specially adapted for the child to turn on, would be a passive activity. Storybook computer software (answer C) would facilitate early learning and a powered wheelchair is a high technology application for facilitating mobility.

23. 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.

Of the following, which is the BEST activity a COTA could offer a preschooler to develop letter recognition skills? a. Using flashcards b. Forming letters out of clay c. Matching cut-out letters to a sample d. Coloring large letter outlines

b. Forming letters out of clay Preschoolers learn best using a multisensory approach. Making letters out of such materials as clay, bread dough, chocolate pudding, or sandpaper uses the child's tactile, kinesthetic, and (in some cases) gustatory senses, as well as vision. In this way, new learning is reinforced through a variety of sensory channels. Flash cards (answer B), matching to sample (answer C), and coloring (answer D), are methods that rely primarily on visual processing, and cognitive skills and are better suited for strengthening existing skills in older children.

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 decisiion 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 proces.

An individual attending an adult day program has expressed interest in obtaining employment. In groups, however, the individual grabs tools from others, frequently acts out of turn, and has difficulty accepting feedback. Participation in which one of the following interventions is MOST appropriate for addressing this individual's limitations and preparation for a work environment? a. Operating the photocopy machine in a clerical group b. Handing out trays and utensils in a food service group c. Placing books back on the shelves in a library group d. Balancing the books at the end of the day in a thrift store group

b. Handing out trays and utensils in a food service group This individual demonstrates limitations in the area of interpersonal skills. Handing out trays and utensils requires minimal interaction, and would provide and opportunity for this individual to practice interacting with others at a limited level. None of the other options provides the opportunity to develop interpersonal skills.

An OTR/COTA team is performing an assistive technology intervention with a client who has severe limitations of motor function resulting from CP. The FIRST function of the OTR/COTA team in this process is to: a. identify the most appropriate commercially available forms of assistive technology. b. identify the abilities, needs, and life goals of the client. c. select the appropriate method of accessing the technology. d. modify the assistive technology device to meet the needs of the client. b. . identify the abilities, needs, and life goals of the client.

b. Identifying the abilities, needs, and life goals of the client should occur before any other steps in the process in order to make a match between the client's abilities, environmental demands, and the appropriate technology to carryout desired daily occupations. Answers A, C. and D, are steps which would come later in the process.

27. 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.

A COTA working in the school system is adapting a chair for a student with extensor tone. Which of the following should the COTA recommend to the teacher in order to inhibit the child's extensor tone, while maintaining a functional seated positon in the classroom? a. Provide lateral trunk supports to the seat. b. Place a seatbelt at 45-degree angle at the hips. c. Insert a wedge-shaped seat that is higher in the front. d. Install a lapboard.

b. Place a seatbelt at 45-degree angle at the hips. A seat belt correctly placed at a 45 degree angle to the child's hips would inhibit extensor tone. Answer A is incorrect because trunk support from lateral trunk supports is for sideward movement only. Although a wedge-shaped seat insertion (answer C) increases hip flexion more than 90 degrees and inhibits extensor tone, it is not the best choice because it could have the undesirable side effect of tightening hamstrings over time. Answer D is incorrect because, although it may contribute to holding a child in a chair, it does not affect the angle of the hip joint, which is necessary for decreasing extensor tone when sitting.

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 vecause 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.

Which of the following is the MOST effective way for a COTA to structure the intervention environment for a patient who exhibits seductive or sexual acting out behavior? a. Provide a stimulating environment that offers options for engagement in real life activities. b. Provide a large area of personal space, where the person is protected from physical contact with others. c. Provide a quiet, relaxed environment, but not isolated from other people. d. Provide an environment where all possible distractions have been removed or reduced.

b. Provide a large area of personal space, where the person is protected from physical contact with others. Patients who exhibit sexual behaviors may be more likely to think about, and act on, their sexual impulses when they experience close physical contact with others. Answer A would be an appropriate intervention environment for individuals with delusional thinking. The environment described in answer C would be best for people experiencing hallucinations. An environment where all distractions are reduced as much as possible (answer D) is most relevant for individuals exhibiting manic behaviors.

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 (aqpplying 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 functinal in his or her task preformance. Reviewing the difference between glue and grout (answer A) would be a cognitive approach. Avoiding the use of white tiles (answer C) soulc 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 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. A was mitt (answer A), and a toothbrush with a built up handle (answer D), are good options for those with weak grasp. Spray deodorant (answer B), has a small button to push, which would be difficult to operate for someone with incoordination.

During a cooking evaluation, an individual with a history of traumatic brain injury exhibits moderate upper extremity incoordination. Which of the following recommendations would be MOST beneficial for this individual? a. Use built-up utensil handles. b. Use heavy utensils, pots, and pans. c. Use a high stool to work at counter height. d. Place the most commonly used items on shelves just above and below the counter.

b. Use heavy utensils, pots, and pans. Using heavy kitchen items (answer B) increases stability for individuals with incoordination. Other suggestions include using prepared foods, nonskid mats, easy open containers, serrated knives, and tongs. Built-up handles (answer A) are useful for individuals with limited grasp. A high stool (answer C) benefits those who fatigue easily. Placing the most commonly used items on shelves just above and below the counter (answer D) is a useful way to adapt the environment for individuals with limited reach.

A COTA who is beginning treatment for a child with athetoid CP is concerned about the chold's inability to control flexion and extension of the arm when reaching for a toy. The child flexes or extends to 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.

A second grade child has a diagnosis of muscular dystrophy. The child operates a manual wheelchair, but his mobility is slow because of muscle weakness. The COTA should consider discussing a powered wheelchair with the OTR when the: a. child starts junior high school and will be expected to switch classrooms several times daily. b. child's speed over long distances becomes less than that of a walking person. c. child's home can be made accessible for a power wheelchair. d. child becomes unable to propel a manual wheelchair.

b. child's speed over long distances becomes less than that of a walking person. A child should be considered for a power wheelchair when the current means of locomotion proves less efficient and slower than locomotion by walking. Because the child will be experiencing progressive muscle weakness, energy conservation is of primary importance. Answers A and C address valid environmental consideration to be made after determining the general need for a powered chair. Waiting until the child becomes unable to propel the wheelchair (answer D), would make the transition more difficult and prevent the child from getting around independently in the meantime.

Evaluation of a school-aged child diagnosed with moderate mental retardation should generall 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. Indifiduals 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 postioning and communication skills (answer a). Individuals with mild mental retardation ahve 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 determinied 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.

When treating individuals in the acute phase of cardiac rehabilitation, it is important for the COTA to FIRST select activities that: a. can be accomplished without causing fatigue b. decrease the effects of prolonged inactivity. c. promote strength, ROM, and endurance. d. can be carried out independently after discharge.

b. decrease the effects of prolonged inactivity. Some of the main objectives of inpatient cardiac rehabilitation include decreasing the effects of prolonged inactivity, such as thromboembolism, orthostatic hypertension, and muscle atrophy; safely providing a program of monitored activity performance to maximize function; reinforcing cardiac precautions; and providing instruction in energy conservation techniques. It is acceptable and expected to encounter fatigue in this population after activity (answer A), however, activities that produce cardiac symptoms should be avoided. Activities that promote endurance and strength are beneficial, but ROM (answer C) is not usually an area of concern. Most individuals do not need to relearn activities, other than applying energy conservation techniques, therefore, independent performance (answer D) is not a primary concern.

A COTA has been working on laundry skills with an adult with developmental disabilities who lives at home with her aging parents. Although the client is able to use the washer and dryer successfully with only verbal cues, her mother continues to do her laundry. The COTA should: a. explain to the mother that it is critical to allow the client to do her own laundryin order to achieve independence. b. discuss the meaning and value of the client's doing her own laundry with the mother and client. c. ask the father to intercede to stop the mother from doing the client's laundry for her. d. acknowledge that independence in laundry skills may not be an appropriate goal for the client.

b. discuss the meaning and value of the client's doing her own laundry with the mother and client. By discussing the intervention plan options with caregivers, the COTA can determine whether the goals and intervention are meaningful and relevant to the individuals involved. Unilaterally explaining the importance of independence to the mother (answer A), and asking the father to intercede (answer C), are actions that do not ascertain the value or significance of the goal, which, if not valued by the client and caregivers, is inappropriate. After speaking with the mother and client the COTA may determine later that independence in laundry skills is not an appropriate goal (answer D).

26. 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 (anser d) is not acknowledging the presence of information.

A COTA is working with a group of children in an early intervention program. All of the children in an early intervention program. All of the children in the group are able to sit independently on the floor except for one child with cerebral palsy. The child has told the COTA that he wishes to sit on the floor like his peers and not in his wheelchair. The COTA would MOST likely recommend that the child use a(n): a. hammock b. floor sitter c. adapted wheelchair insert d. prone stander

b. floor sitter "A floor sitter may enable the child with cerebral palsy to play on the floor near his or her typically developing peers"(p. 725). Occupational therapy practitioners can recommend and provide appropriate adapted equipment and positioning devices when working in an early intervention setting. A hammock (answer A) would not allow the child to feel as if he "fits in." The child verbalized the desire to sit on the floor like his peers, whereas the hammock may make the child feel even more different than when he sits in his wheelchair. Hammocks are typically utilized in therapy to provide sensorimotor/vestibular input, and would not be indicated in this situation unless no other viable options were available. Introducing an adapted wheelchair insert and prone stander (answers C and D), would be ignoring the child's desire to sit on the floor with his peers. Wheelchair inserts are often used for positioning a child in a wheelchair to permit increased trunk support and stability, thus allowing more independent use of the upper extremities. A prone stander would allow a child to assume a standing or weight bearing position, but would not assist with positioning the child while sitting on a mat.

When working with an individual who is severely depressed and demonstrates psychomotor retardation, it is MOST important to: a. encourage more rapid responses. b. provide extensive visual and auditory sensory stimulation. c. give simple directions and patiently wait for responses. d. provide activities involving large groups.

b. give simple directions and patiently wait for responses. Severe depression can result in slowing of cognitive and motor functions, known as psychomotor retardation. The OT practitioner must not rush the individual (answer A), but should give her or him time to process information and respond. Too much stimulation (answers B and D) may cause the individual to withdraw even further.

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 assciated 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 therapis 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. bitemporal 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 dise 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 cateract (answer c) would cause a visual impairment with detail on bothd sides of a page. Bitemporal hemianopia (hemianopia is also referrred to as hemianopsia) also known as "tunnel vision," occurs withn the individual's peripheral vision is lost (answer a). The individual would still be able to cross midline with cataracts or bitemporal 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 infuluencing functional independence outcomes. Visuospatial ability should be taken into account when establishing treatment goals as well as during discharge planning.

A COTA is leading a discussion with a group of individuals who are diagnosed with major depression. The MOST helpful approach for the COTA to take is to: a. be upbeat, positive, and cheerful when encouraging the individuals to discuss their feelings. b. offer even-tempered acceptance, reflecting back what is heard without agreeing that the situation is hopeless. c. remain silent and still while the individuals are describing their feelings. d. allow the individuals to structure and lead the group discussion.

b. offer even-tempered acceptance, reflecting back what is heard without agreeing that the situation is hopeless. Answer B is the most helpful approach. In contrast, a cheerful approach (answer A) can be perceived as denying the importance of the person's feelings. Silence (answer C) may also be perceived as unaccepting. Answer D is incorrect because the COTA needs to provide the structure because initiating and maintaining discussions is often difficult for depressed individuals.

A COTA is treating a restaurant worker with carpal tunnel syndrome. The MOST important instruction for the COTA to give the client is to avoid or modify activities that encourage: a. increased wrist extension, such as carrying dishes. b. prolonged wrist flexion, such as scrubbing pots and pans. c. tasks that increase ulnar deviation, such as whipping tables. d. increased radial deviation, such as screwing and unscrewing and filling sugar, salt & pepper containers.

b. prolonged wrist flexion, such as scrubbing pots and pans. Flexion at the wrist, especially while grasping or pinching (as in scrubbing pots), should be avoided or modified with a soft splint. Answer A, wrist extension, answer C, ulnar deviation, and answer D, radial deviation, do not tend to cause inflammation to the area surrounding the median nerve by repetitive compression or a static hold to the area of the wrist.

A client is having difficulty getting around her home as a result of low vision. The MOST appropriate strategy the COTA can be recommend to improve accessibility would be to: a. instruct the client to sit while preforming ADL. b. provide strong color contrast at key areas to identify steps, pathways, etc. c. recommended the client arrange to get assistance from another person when moving within her home d. recommend training in white cane use, for identifying obstacles in the home.

b. provide strong color contrast at key areas to identify steps, pathways, etc. Using contrast is a key environmental adaptation strategy for people with visual impairments. The more contrast, the easier it is to locate objects, steps, entrances, and pathways, thereby improving accessibility by maximizing remaining vision. Instructing the client to sit during ADL (answer A), or recommending human assistance (answer C), would not directly address accessibility. Answer D, recommending training in white cane use, is a method of improving mobility for a person who is blind.

A COTA is working with an elderly woman with a diagnosis of depression and dementia during the clean-up portion of a cooking activity. The patient begins to dry the plates and utensils she has already dried. The COTA should: a. tell the client that the same dishes and utensils are being redried. b. put the dried dishes away and begin to hand her wet dishes. c. ask the client to stop the activity because it seems too difficult. d. ask the client to describe what she is doing.

b. put the dried dishes away and begin to hand her wet dishes. Compensating for mistakes helps to increase the sense of self-worth and integrity of individuals with dementia. This approach is preferable to drawing attention to errors, especially in situations in which safety is not an issue. Answers A, C, and D all draw attention to the individual's errors.

An individual with lower extremity paralysis uses a standard manual wheelchair and is ready to be discharged to home. During the home evaluation, the COTA notes that the entrance to the bathroom is 32 inches wide and the toilet is 15 inches high. Which of the following recommendations will BEST facilitate use of the bathroom for this individual? a. widen the doorway b. raise the toilet c. widen the doorway and raise the toilet d. widen the doorway and lower the toilet

b. raise the toilet Minimum doorway width that allows a standard wheelchair to pass through easily is 32 inches. A standard toilet is 15 inches, which is 3 inches lower than the standard wheelchair seat. Raising the toilet to 18 inches would make transfers easier for this individual.

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 COTA has nothing to apologize for, and is unlikely to uncover any reasonable explanation for a misunderstanding (answer D). In addition, the practitioner should not complain of hurt feelings to a client (answer A). Delving into exploration of the individual's past (answer C) is not a recommended approach for occupational therapy.

A COTA is working with and individual who has identified alcohol abuse as a contributing factor to the depression that he has been experiencing. At discharge, the MOST appropriate type of group to recommend to this individual is a(n): a. advocacy group b. self-help group c. support group d. psychotherapy group

b. self-help group Self-help groups are supportive and educational, and focus on personal growth around a single major life disrupting problem. Support groups (answer C) focus on assisting members who are in crisis, until the crisis is past. Advocacy groups (answer A) focus on changing others or changing the system, rather than changing one's self. Psychotherapy groups (answer D) focus on understanding the influence of past experiences on present conflicts.

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 Neurodevelopmental 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. Placeing a weighted cudd on the extremity (answer A) would haved 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 peice 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 toothette

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 toothette is typically indicated in the child with oral hypersnsitiity 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.

Prior to discharging a client from the hospital, OTR requests that the COTA instruct a patient in some quick and easy to learn stress management techniques. Which of the following should the COTA review FIRST? a. Autogenic training b. Meditation c. Deep breathing and verbalization d. Work simplification and energy conservation

c. Deep breathing and verbalization Deep (diaphragmatic) breathing involves slowly inhaling and exhaling to reduce tension in the shoulders, trunk, and abdomen... deep breathing is relatively easy to learn, requires no equipment and can be done anywhere (p. 462). In addition to this, the act of verbalization, simply talking with friends regarding one's stress, can reduce stress levels. "Friends can offer different perspectives, new suggestions, and support, all of which are helpful in extricating a person from feeling stuck with a problem situation" (p 463) Answers A and B, autogenic training and meditation, are useful stress management techniques, but both require a considerable amount of time and practice in order to successfully implement. Answer D, work simplification and energy conservation, typically impact endurance and the performance of an actual task.

A very confused nursing home resident is frequently found in the rooms of other residents in the middle of the night. Which of the following environmental adaptations would MOST effectively prevent wandering? a. Apply wrist restraints after the client has fallen asleep. b. Keep hallways clear of obstructions to prevent injury. c. Disguise the bedroom door with wallpaper so it blends in with the surroundings. d. Suggest the night shift staff provide closer supervision.

c. Disguise the bedroom door with wallpaper so it blends in with the surroundings. Decorating the door handle is also a good way to prevent the confused individual from recognizing the door. The 1987 Omnibus Budget Reconciliation Act mandated reduction in the use of chemical and physical restraints (answer A) with rursing home residents. Keeping hallways clear of obstructions (answer B) results in a safer environment for wanderers, but does not prevent wandering. Modifying the environment is preferable to increasing demands on nursing staff (answer D).

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 ALS and mild dysphagia becomes extremely fatigued at breakfast, lunch and dinner. Which is the FIRST intervention the COTA should consider recommending? a. Speak to the physician about tube feedings. b. Sit in a semi-reclined position during meals. c. Eat six small meals a day. d. Substitute pureed food for liquids.

c. Eat six small meals a day. An individual with ALS who becomes fatigued eating three full meals a day should attempt eating six smaller meals a day before resorting to tube feedings or pureed diets (answers A and D). Eating regular food is usually more enjoyable and is therefore likely to enhance the quality of life. An upright position is optimal when feeding individuals with dysphagia. A semi-reclined position ( answer B) can make swallowing more difficult or dangerous.

A COTA is working with a child with a developmental disability who frequently bites his siblings and parents. Which of the following would the COTA MOST likely recommend? a. Encourage the parents to use verbal feedback, and explain to the child that biting is inappropriate. b. Tell the parent to enforce time-out periods for each biting incident. c. Encourage the child to wear a necklace with chewable objects attached. d. Tell the parents that the child will eventually stop biting when one of his siblings bites him back.

c. Encourage the child to wear a necklace with chewable objects attached. "Excessive biting of inedible objects is a problem often encountered in children with developmental disabilities...a chewy can be extremely helpful for children who bite excessively...the chewy can be warn as a necklace, attached to a belt, or even put in a pocket." (p. 227) Answers A, B and D will most likely be ineffective when working with a young child with a developmental disability. Implementing answers A and B (verbal feedback and time-out periods) is unlikely to extinguish the behavior, while answer D(waiting until the child eventually gets bitten back) would be considered and ineffective and inappropriate solution to the problem.

A child who has difficulty with visual perception of "position in space" will soon be discharged from an outpatient OT program. Of the following, which would be the BEST activity to recommend to the child's classroom teacher and parents? a. Identifying letters on a distracting page b. Finding geometric shapes scattered in a box c. Following directions about objects located in front, in back, and to the side d. Making judgements about moving through space

c. Following directions about objects located in front, in back, and to the side Answer C is correct because a deficit in "position in space " refers to difficulty in perceiving the relationship of an object to the self. Answer A, identifying letters on a distracting page, is not correct because it refers to a problem of recognizing size and shape (form) constancy. Answer D, making judgements about moving through space, is incorrect because it refers to a problem in perceiving spatial relationships.

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 schdule of activities. d. Leave doors open and avoid being alone with the individual.

c. Give him a tour of the OT department and a schdule 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 alighnment of the pelvis and trunk in the wheelchair. Answer A, a reclining wheelchair, would shift the child's weight posteriorly but would not prevent lateral shifting of the trunk. An arm trough (answer B) would probably contribute to lateral shifting, although bilateral arm troughs or a lapboard could help maintain a more centered trunk position. Lateral pelvic supports (answer D) would stabilize the pelvis and prevent it from shifting sideways, but would be too low to prevent the trunk from moving laterally.

24. 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 than by an authority figure (answer D).

A client with severe depression and suicidal ideation stops the COTA as she is about to leave the inpatient unity at the end of the day and asks her to accept her favorite necklace as a gift of thanks. Which of the following responses is MOST important? a. Explain the "Code of Ethics" prevents her from accepting gifts. b. Accept the gift so as not to imply rejection. c. Report the incident to the client's physician. d. Ask the client about her reasons for wanting to give her a gift.

c. Report the incident to the client's physician. When an individual with depression and suicidal ideation gives away personal possessions, it may indicate she is considering suicide. The most important response is to notify the physician, although answers A, B, and D may be appropriate.

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 perhension (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 extremmely 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.

A COTA planning a community living program for clients who are to be discharged after an average of 25 to 30 years of hospitalization. One of the goals of this program is to train this clients to effectively manage their money. Which of the following activities should be used FIRST? a. Provide each client with $25 to spend during a group trip to the local shopping center b. Provide samples of coins and paper money c. Use a board game to introduce the concept of receiving and spending money. d. Establish a hospital-based community store where the clients can buy clothing.

c. Use a board game to introduce the concept of receiving and spending money. This activity provides an opportunity for the individuals to experience the value and purpose of money. Although it is important to introduce the actual value of coins and paper money, it is essential to combine this with concrete applications that a board game can supply. Answers A, B and D are examples of graded activities to be used after the initial introduction of money concepts.

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 breathingwhen 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 cuase 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 psychococial goals by (1) allowing the individual to experience success using a messy process, and (2) requireing 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 empasized with tht addition of the grout. Waiting for the grout to dry requires an iddividual 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. askk additional questions(other than those listed) to gain forther 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 useing 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 eliminationm 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 shoping list (answers A and D) do not necessarily require sequencing of tasks. Planning a meal (answer B) invilves a great deal of organizaiontal 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. contructional d. game

c. contructional 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 depelopment 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.

The BEST way to instruct an individual with hemiparesis to button a shirt is to: a. button all the buttons before putting the shirt on. b. get the shirt all the way on, then line up the buttons and holes, and begin buttoning from the top. c. get the shirt all the way on, then line up the buttons and holes, and begin buttoning from the bottom. d. use a buttonhook with a built-up handle.

c. get the shirt all the way on, then line up the buttons and holes, and begin buttoning from the bottom. It is easier to see the buttons and buttonholes at the bottom of the shirt (answer C) than at the top (answer B). Therefore, beginning to button from the bottom is more likely to result in success for the individual with motor or visual-perceptual deficits. Buttoning first (answer A) may result in ripping off the buttons as the shirt is pulled over head. A button hook with a built up handle (answer D) would be more helpful for an individual with finger weakness or incoordination.

An individual with ALS swims three times a week to maximize strength and endurance. Initially able to swim for only 10 minutes, the individual is now able to swim 20 minutes without becoming fatigued. The NEXT step is to: a. continue the program of swimming 20 minutes, three times a week. b. decrease swimming frequency to two times a week c. increase swimming time to 25 minutes or to tolerance. d. provide adaptive equipment that will enable the individual to swim using less energy.

c. increase swimming time to 25 minutes or to tolerance. This individual's goal is to maximize strength and endurance. Although ALS is a progressive degenerative disease, improvements in strength and endurance are possible if the individual was not previously functioning at maximum capacity. This individual's performance indicates potential for further improvement. The program should therefore be upgraded, not downgraded (answer B). Methods for improving endurance include increasing the frequency, intensity, or duration of the activity. The correct answer (answer C) increases the duration of the activity while recognizing the importance of avoiding fatigue. Answer A continues the program at a maintenance level. Using adaptive equipment (answer D), such as a flotation belt, is and energy saving strategy that would be appropriate if the individual were experiencing fatigue during swimming.

c. provide a screen to reduce peripheral visual stimuli Although all the answers given describe techniques that could assist the student, the use of a screen is most appropriate in a mainstream classroom, because the other methods or adaptations (answers A, B, and D) could have an negative impact on the other children's ability to learn.

c. marking the end of each step with high contrast tape. Difficulty in seeing contrast and color are two forms of decreased visual acuity that cannot be addressed by corrective lenses. Two effective environmental adaptations to these deficits are increasing background contrast and illumination. Using tape or paint to make the edge of each step contrast sharply with the rest of the step is an inexpensive way to adapt the environment. Installing a stair glide or handrails (answers A and B) are more costly adaptations that do not address the problems of decreased visual acuity. Instructing the patient to take only one step at a time (answer D) may cause the individual to be unnecessarily slow, and does not address the problems of decreased visual acuity.

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.

The mother of a physically disabled 3 y/o has a goal that her child will be independently walking around the house. This is an unrealistic goal for the child but one that would be helpful to the mother who is finding her child difficult to lift. The BEST way to assist in the development of family centered intervention for this child would be to: a. support and work on the parents goal as is. b. suggest an alternative, realistic OT goal of improving siting balance for playing. c. propose a modified goal that still meets the parent's needs. d. empower the child to set her own goals.

c. propose a modified goal that still meets the parent's needs. "In family-centered intervention the occupational therapist addresses the needs of the entire family rather that only concentrating on specific deficits in the child"(p722). Proposing a modified goal of functional mobility with an adaptive mobility device, would best address both parent's need for decreased carrying, and the child's need to improve functional mobility within the environment. Agreeing to work on an unrealistic and possibility unachievable goal (answer A) would not meet the child's needs for developmentally appropriate intervention. Answer B, offering an alternative goal, would not be responsive to the problems identified by the family. Answer D is incorrect because this child is too young to establish her own goals, though this may encouraged at later stages of therapy.

Direct OT services are being discontinued for a student with attention deficit disorder, but consultation will be provided to help the child adjust to the new classroom. Which recommendation can the COTA make to help the teacher adapt the environment to promote optimal learning without affecting other students? a. use dim lighting and reduce glare by turning down lights b. remove all posters and visual aids to reduce visual distractions c. provide a screen to reduce peripheral visual stimuli d. restructure classroom activities into a series of short-term tasks

c. provide a screen to reduce peripheral visual stimuli Although all the answers given describe techniques that could assist the student, the use of a screen is most appropriate in a mainstream classroom, because the other methods or adaptations (answers A, B, and D) could have an negative impact on the other children's ability to learn.

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 wer present during the interview. It is a summary, and should hot nclude extensive discriptions (answer A) or interpretations of the interview (answer d). A treatment plan (answer b) should be developed collaboratively with the OTR.

A 12 y/o student will be discharged after receiving treatment for anxiety disorder. Which would be the most appropriate recommendation for an extracurricular school activity? a. a competitive gymnastics team b. debating club c. school newspaper d. basketball team

c. school newspaper Anxiety disorder is characterized by extreme self-consciousness and anxiety about competence. Public exposure and pressure for on-the-spot performance heighten the anxiety. By becoming involved in the school newspaper preparation, the student will have an opportunity to develop a sense of competence without the pressure of a face-to-face audience or judged competition, as represented by activities described in answers A, B, and D.

An 8 y/o boy with conduct disorder is disruptive, uncooperative, and occasionally combative during therapy. From a behavioral point of view, the MOST appropriate strategy to use to address the child's conduct would be to: a. allow the child to express his anger without restraint for a short period to vent his frustration. b. ignore the behavior and continue with therapy with or without the child's cooperation. c. set clear expectations for behavior and enforce consequences, such as a time-out, if the child looses control. d. ask the client to describe what she is doing.

c. set clear expectations for behavior and enforce consequences, such as a time-out, if the child looses control. A behavioral frame of reference can be useful in helping children with maladaptive behavior to learn to modify their behaviors and to lean new more adaptive behaviors through the principle of reinforcement. To use this effectively, the child must clearly understand the expectations for behavior (or rules), and that there will be consistent consequences for behaviors that break the rules. Answers A and B, allowing the child to express his anger and ignoring the behaviors, would not help the child to learn new behaviors and could cause an increased loss of control. A child who is out of control and responding to impulses is not able to respond to an insight-based approach such as reasoning.

An individual who uses a wheelchair is being discarged 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.

A client with paranoia prefers to stay away from the group, working alone at another table. The BEST action for the COTA to take is to a. encourage the client to join the group. b. tell the client he is required to sit with the group. c. tell the client it is okay to work where he is until he feels comfortable in joining the group. d. stay with the client until he is ready to join the group.

c. tell the client it is okay to work where he is until he feels comfortable in joining the group. The paranoid client frequently isolates themselves form the rest of the group as a self-protective measure. Such a client should be allowed to do this until her or she feels comfortable in joining the group. Although it is a good idea to encourage this client to join the group (answer A), the COTA should not insist (answer B). The paranoid client may attempt to take control of an uncomfortable group situation by demanding that the COTA stay with him, away from the group (answer D). In this instance it is important to be supportive of the patient's need, but to remain with the group.

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. sthickness of the cords she will be using. c. textrure 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 particulary 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.

25. 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 mya 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 backgroud music to increase competing sensory input. b. work against a patterned backgroud 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 cntaindicated 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 househould objects. This behaviour MOST likely indicates: a. apraxia b. stereognosis c. visual agnosia d. alexia

c. visual agnosia Visual agnosia is the inabiliyt 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 cocontraction, 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 develp 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 hlep 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.

28. When evaluating sensation of an individual with hemiplegia, the COTA should FIRST: a. apply the stimuli distally to proximally. b. test the involved area then 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.

The COTA is working with a child who has insufficient thumb opposition. This position makes it difficult for the child to write efficiently. The COTA recommends that the child practice opposition by: a. placing a universal cuff on the child's hand. b. using the pointer finger only when working on a keyboard. c. using a weighted writing utensil holder. d. pulling tiny objects out of clay.

d. By pulling tiny objects such as coins or pegs out of clay or putty, the child can work on increasing his ability to oppose his thumb to his digits. Answer A, a universal cuff, would most likely be used by a child who lacks grasp or digit strength. Answer B, using the pointer finger only when working on a keyboard, would not facilitate opposition between the thumb, unless use of the thumb with the space bar was encouraged. Answer C, using a weighted writing, utensil, would be indicated for a child with decreased proprioception.

A COTA is working with an individual who is unable to complete the multiple steps that are necessary to brush his teeth. In response to this, the practitioner modifies the activity by having the client perform the task one step at a time while gradually adding more steps with each success. The COTA is attempting to employ which of the following? a. Repetition b. Cueing c. Rehearsal d. chaining

d. Chaining Chaining is frequently used when teaching a multiple step task because it is easier to teach one step at a time than it I to teach a complete activity. Repetition and rehearsal (answers A and C) involve repeating the whole activity until the activity is learned. Cueing (answer B) uses an external source to remind a person of the next step or part of that step.

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 COTA is leading a craft media group with adolescents diagnosed with schizophrenia. Which of the following is the BEST method to use to facilitate problem solving? a. Begin with activities that have obvious solutions and a high probability of success, and then gradually increase the level of complexity. b. Begin with activities that require gross motor responses, and then gradually progress t fine motor responses. c. Select activities that require interaction with others, and then provide opportunities to discuss and analyze how the group went.

d. Gradually increase the time used in the activity by 15 minute increments. a. Begin with activities that have obvious solutions and a high probability of success, and then gradually increase the level of complexity. Beginning with activities that have obvious solutions, that are usually successful, and gradually increase in complexity, is an effective method for developing problem-solving skills. Sensorimotor activities (answer B) in a group can facilitate self-awareness. Increasing the activity time (answer D) facilitates attention span improvement. Activities that require interactions with others (answer C) are useful for developing social conduct and interpersonal skills.

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 client with schizophrenia begins to experience hallucinations while participating in a life skills group led by a COTA. Which environmental strategy would be BEST to minimize the hallucinations? a. Leave the person in the same environment b. Isolate the person completely from other people c. Move the person to a more stimulating environment d. Move the person to a quieter less stimulating environment

d. Move the person to a quieter less stimulating environment. " Many of those who hallucinate do so when they are under stress, especially in environments that are too stimulating for them" (p.251). Moving a person to a calmer, and less distracting environment, can help to decrease hallucinations if this type of stress is the precipitating factor. Answer A, leaving the person in the same environment would not help. Answer B, completely isolating the person from thers, is not recommended because interpersonal contact can have the effect of reinforcing reality and reducing hallucinations. Answer B, moving the person to a more stimulating environment could have the effect of increasing hallucinations.

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.

A first-grade child with a diagnosis of attention deficit disorder, hyperactivity type, is receiving OT to increase his attention span. Keeping this in mind, the COTA introduces a construction activity. When blocks were placed in front of the child, the child swept many of them onto the floor and started throwing the remaining ones around the room. How can the COTA MOST effectively restructure the activity to facilitate a successful experience for this child? a. Use soft foam blocks. b. Provide blocks of one color only. c. Use interlocking blocks. d. Present only a few blocks at a time.

d. Present only a few blocks at a time. Similar to other children with this diagnosis, this child most likely has poor impulse control and experiences great difficulty completing a task. By presenting a few block at a time (answer D), the COTA can help the child focus on a few relevant stimuli and make it possible to complete a short-term task successfully. This experience will then help the child increase attention span. Soft foam blocks (answer A) are less likely to cause injury if thrown, but their use is not likely to help increase hi attention span. Providing blocks of only one color (answer B) may reduce visual stimulation somewhat, and using interlocking blocks (answer C) may make manipulation of the pieces easier, but the overwhelming stimulus caused by presenting all the blocks at once would make these strategies irrelevant.

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 nost appropriate choice because the COTA is encouraging the child to partake in pretend play. "Playfulness, like play, encompasses intrinsic motivaion, 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 provideto 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 encourace problem solving when obstacles arise. c. The individual witll 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.

The MOST appropriate device a COTA can recommend to a child's parents to promote the development of upper lip control while feeding is a: a. straw b. "spork" c. deep spoon d. shallow spoon d. shallow spoon.

d. The use of a shallow spoon encourages the development of upper lip control because it makes it easier for the lip to remove all of the food on the spoon. It would be more difficult for the child to get food out of a deep spoon (answer C). Straws (answer A) can be used to develop sucking. A "spork" (answer B) is a device that combines the qualities of a fork and a spoon and is useful if the child can only manage one utensil.

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 househould 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 slelves 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 proglems 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 condider task analysis and teaching approach first.

An individual with left upper extremity flaccidity is observed sitting in a wheelchair with his left arm dangling over the side. The FIRST positioning device the COTA should introduce to the client is a(n): a. lap tray. b. wheelchair armrest. c. arm sling. d. arm trough.

d. arm trough. An arm trough would provide a stable surface that would keep the individual's arm in a safe and appropriate position. In addition, an arm trough approximates the humeral head into the glenoid fossa at a natural angle. If the individual has edema in his hand, a foam wedge may be placed in the trough to elevate the hand. A lap tray (answer A) would provide support, but is more restrictive than an arm trough, which should be attempted first. The fact that the individuals arm was seen dangling by the side of the wheelchair indicates that the wheelchair armrest alone (answer B) is inadequate. Answer C, an arm sling, would provide support for his arm, but would immobilize it in adduction and internal rotation. Current literature supports the use of slings only when necessary, such as during ambulation when a flaccid upper extremity may sublux or cause loss of balance.

29. 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.

An individual with join changes that limit finger flexion would be MOST comfortable using utensils with: a. regular handles b. weighted handles c. a universal cuff attachment d. built-up handles

d. built-up handles Built- up handles without using extra weight, allow a comfortable grasp that regular utensils do not provide. A weighted handle (answer B) would cause more rapid fatigue and strain to the joints. An arthritic person most likely has adequate grasp and release with a built-up handle, making it easier to use than a universal cuff (answer C).

In screenning 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 partents. 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 (anwser 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 behaviour 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 stiluli. Memory (answer a) is the ability to recal knowledge and poast events. Problems with spatial operations (answer b) are generally observed when individuals attempt to fit objects into specific spaces. Gerneralization of learning (anwser 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 tht 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 deomonstrated 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 emonstrate a deficit in strength (answer c).

While participating in activities to improve strength, an individual with multiple sclerosis who was recently admitted to the hospital complains of fatigue. Which of the following actions is the MOST appropriate for the COTA to take? a. Instruct the individual to work through the fatigue to complete the session. b. Instruct the individual to work through the fatigue for another 5 to 10 minutes. c. Discontinue strengthening activities. d. Give the individual a rest break.

d. give the individual a rest break. Fatigue may cause additional structural damage in the acute stage of MS so should be avoided. Rest breaks need to be scheduled to avoid fatigue. Strengthening activities (answer C) do not need to be discontinued, but should be designed to benefit the patient without causing undue fatigue.

A young man with a history of depression constantly makes negatie statements about himself. The goal set for him in the task group is to increase self-esteem. After several sessions, he is showing more self-confidence and asks the COTA for her phone number because "you're so nice to me." The MOST appropriate response is for the COTA to: a. give him her phone number and tell him to call when he is feeling depressed. b. ignore the request, but remind him he is doing a great job. c. tell him she has a boyfriend d. in private, explain the nature of the client-therapist relationship.

d. in private, explain the nature of the client-therapist relationship. It is inappropriate for the COTA. While self-disclosing some information to clients can be a therapeutic tool, there is some information that would be misinterpreted or inappropriate (answer A). Ignoring the clients request (answer B) constitutes avoidance on the COTA's part and is unprofessional. Though a difficult situation, the COTA looses an opportunity to provide valuable feedback to her client. Whether the COTA has a boyfriend or not (answer C), she should not use this as an excuse for not giving out her number. It is an easy way out but unprofessional.

A COTA is applying PNF techniques for weight shifting during an activity that requires an individual to use their right hand to remove groceries from a bag on the floor to the right. The MOST benefit would be gained from this activity by then placing the groceries: a. on the counter directly in front. b. on the counter to the left side. c. in the upper cabinet to the right side. d. in the upper cabinet to the left side.

d. in the upper cabinet to the left side. This pattern of movement promotes the greatest degree of weight shift to the affected side. Putting groceries on the counter directly in front of the person (answer A), or in the upper cabinet to the right side (answer C), would not cause enough weight to be shifted to the affected side, and would even shift weight away from that side. When placing groceries on the counter to the left side (answer B), minimal weight shift occurs.

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 cana result in difficulties with swallowing. Depending on the particular problems of the individual, providing adaptive devices(answer A) may or may not be helpful, but none the less would not be the first step given without assessment of need. Observing for swallowing after each bite (answer B), and instructing caregivers as to proper setup (answer C) would also be important steps, but these would occur later in the intervention process.

In a work-hardening program a COTA is teaching a warehouse worker with low back pain how to lift objects from the floor and place them on a shelf. Before doing this, the COTA would first review: a. energy conservation techniques. b. work simplification strategies. c. home maintenance activities. d. proper body mechanics.

d. proper body mechanics. Answer D, proper body mechanics is encourage through didactic instruction and new learning, and remains part of the work-hardening program until discharge, The COTA should educate the individual regarding unwanted stress to the lumbar spine with lifting tasks, Answers A and B, energy conservation and work simplification, can be part of tha work-hardening program, but tend to be indicated in cases where the individual demonstrates decreased endurance and fatigue with daily activities. Answer C, home maintenance activities, are typically introduced during inpatient or outpatient/home health OT interventions, not within the work hardening setting.

An individual complains of perspiration, which is causing his resting hand splint to be uncomfortable. The BEST action for the COTA to take is to: a. recommend putting talcum powder in the splint. b. line the splint with moleskin. c. fabricate a new resting hand spline with perforated material. d. provide a stockeinette sleeve for the individual to wear inside the splint.

d. provide a stockeinette sleeve for the individual to wear inside the splint. A stockinette liner worn inside the splint will keep perspiration from irritating the skin by absorbing it through the liner. Stockinette also keeps the body part from direct contact with the plastic surface of the splint. Stockinette is inexpensive and can be washed easily with soap and water. Answer A, putting talcum powder in a splint, assists with odor control as a result of prolonged splin wear, but does not typically address the perspiration issue. In addition, it also requires frequent cleaning due to the accumulation of powder within the splint. While moleskin as a liner (answer B), may be uncomfortable, it does nt clean well, hence it usually is removed because of the tendency to become soiled and odorous. Answer C, perforated material, will assist with ventilation, but the patient will typically continue to perspire, thus indicating the need to utilize alternative or additional methods to keep the splint dry.

A woman experienced repeated sexual abuse by her father as a child. She how describes her ather's abusive action as beight cause dy 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. Makind 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. screeen 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 rughs 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 adaptatons made for individuals with congnitive deficits, rather than motor deficits.

An unmarried patient with a spinal cord injury is on a rehab unit and constantly flirts with a COTA. The most appropriate action the COTA to take should be: a. firmly reject the patients advances. b. acknowledge the patients advances and mildly flirt back in order to protect the patient's self-esteem. c. request the supervising OTR discuss the effects of SCI and sexual functioning with the patient. d. set personal boundaries appropriate to the therapist-client relationship.

d. set personal boundaries appropriate to the therapist-client relationship. It is important to acknowledge the individual's need for sexual expression, while supporting the sense of self, and identifying acceptable relationships and behaviors. Setting boundaries while accepting the individual is the most appropriate therapeutic response. Out right rejection (answer AO may cause an individual to believe he or she is sexually undesirable or unlovable. Flirting back (answer B) may imply that a sexual relationship between COTA and the patient is acceptable. Although the individual may need to know how SCI affects sexual functioning (answer C), the behavior that requires a response is not about a lack of knowledge, but rather about how to appropriately express sexual interest and the need for reinforcement of a sexual identity.

A child is unable to bring her hand to her mouth because of weakness in supination. The MOST helpful utensil for the child would be a: a. spoon with an elongated handle b. "spork" c. spoon with a built up handle d. swivel spoon

d. swivel spoon A swivel spoon allows the head of the spoon to rotate as the child moves the handle into varying positions, thus compensating for poor supination. A child who is unable to reach her mouth due to limitations in shoulder or elbow flexion would benefit from a spoon with an elongated handle (answer A). A child who is unable to hold a spoon due to difficulty of grasp would benefit from a spoon with a built up handle (answer C). A "spork" is useful for someone who needs to use one utensil as both a fork and a spoon.

The spouse of a patient with a progressive disease has come into the OT department to learn how to help the spouse perform functional activities at home. The COTA should FIRST instruct the family member regarding: a. methods for motivating the patient to perform ADLs. b. techniques on how to analyze activities to solve problems. c. methods used to provide cues to the patient. d. techniques on how to perform activities safely.

d. techniques on how to perform activities safely. Instructing caregivers in methods that will promote safe performance of functional activities, such as locking the wheelchair brakes before standing up, and using proper body mechanics, is the first focus for caregiver training. Answers A, B, and C are also useful areas of caregiver instruction, however, safety is the first priority.

Report the incident to the client's physician. When an individual with depression and suicidal ideation gives away personal possessions, it may indicate she is considering suicide. The most important response is to notify the physician, although answers A, B, and D may be appropriate.

e. Drawing lines and shapes using shaving cream, sand, or finger paints The best activity to encourage prewriting would be drawing lines in different sensory media. Answer A, moving through an obstacle course with emphasis on making turns, would be a useful activity to focus on right-left-discrimination. Answer B, having the child create his or her own books, is useful for increasing orientation to printed language. Answer C, rolling clay into a ball, is recommended for improving the ability to regulate pressure during hand activity.

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.