NBCOT Missed Questions
An 18-year-old client is admitted to an inpatient psychiatric hospital. The psychiatrist describes an uninterrupted 18-month period of illness that includes visual and auditory hallucinations. What type of issues would the OTR® expect to see when the client attempts to do a task? A. Aggressive outbursts of behaviors when frustrated with a project B. Overassertive, controlling behaviors during group activities C. Difficulty engaging in problem solving D. Panic over task choices
A. Aggressive outbursts of behaviors when frustrated with a project B, C, and D are more so for Bipolar I (Depression + Manic episodes)
An OTR® is working with a 56-year-old client who has recently undergone a bilateral hip replacement. What musculature is the MOST IMPORTANT to focus on in the client's strength training?
Gluteal muscles Emphasis in rehabilitation should be on maintaining motion and increasing strength of surrounding musculature. Gluteal muscles are inclusive of this group.
performance patterns
Habits Routines Roles Rituals
when is moist heat contra-indicated?
Heat is contraindicated during the acute, inflammatory phase of healing and for acute edema.
Ideational praxis
Ideational praxis involves knowing which objects are used and how to use them to complete tasks. the patient puts on eyeglasses upside down, attempts to stir before coffee is poured in a cup, and uses a spoon to cut meat.
Which outpatient treatment intervention is contraindicated for decreasing the arm edema and stiffness associated with complex regional pain syndrome of the upper extremity? Instruction in the use of contrast baths several times a day Instruction in performing gentle, pain-free AROM movements several times a day Provision of an arm sling to wear during the day Provision of a compression garment to wear during the day
Provision of an arm sling to wear during the day - that will make em MORE stuff and swollen - Taking contrast baths and using a compression garment are beneficial for edema control of the arm in a client with complex regional pain syndrome. - Gentle, pain-free AROM encourages circulation, decreases stiffness, and may assist in interrupting the pain cycle.
What is tardive dyskinesia?
Tardive dyskinesia involves facial movements and writhing motions of the tongue and fingers as a result of antipsychotic medication. rhythmic tongue movements, grimacing, and lip smacking
when to use deep heat?
contractures scarring pain muscle spasms (PMSing C*nt$!!!) NOT for generalized stiffness.
Developmental coordination disorder (DCD) deficits
difficulty with fine and gross motor skills and often require accommodations and modification for written language.
Performance Skills
motor skills, process skills, social interaction skills Ex: Communication and interaction skills
Situational assessment
used to assess a client's ability to perform the exact same tasks in an environment identical to that of the actual target vocation.
client factors
values, beliefs, spirituality, body functions, body structures Ex: Neuromusculoskeletal function
Modified Ashworth Scale (MAS)
0 = NORMAL 1 = Slight increase in muscle tone with a catch and release OR minimal resistance at end of ROM 1+ = Slight increase in muscle tone with catch followed by minimal resistance through rest of ROM 2 = More marked increase in tone through most of ROM 3 = Considerable increase in tone, passive movement difficult 4 = Affected part rigid Can do at many joints (elbow, wrist, fingers, thumb, hamstrings, quads, gastroc, soleus) NO SPINE
An OTR® is developing an intervention plan for a client with postacute myocardial infarction on the cardiac care unit. What metabolic equivalent of task (MET) should the client's early activity intervention not exceed? A. 1-2 METs B. 3-4 METs C. 5-6 METs D. 7-8 METs
A. 1-2 METs
An OTR® is using Fidler's task-oriented group as a context for treatment to help participants explore healthy ways to deal with conflict. Which of the following activities would be BEST for this group? A. An activity that is challenging and likely to cause tension among members B. An activity that is highly structured so participants know exactly what is expected of them C. A parallel group activity that enables participants to work alongside one another D. An activity that facilitates participants' success and thus improves their self-esteem
A. An activity that is challenging and likely to cause tension among members A task-oriented group presents opportunities for participants to practice situations they may encounter in daily life. A group environment in which conflicts are likely to occur can help participants practice resolving conflict in appropriate ways. D: Although an activity can build in success and still cause conflict, ensuring success is not essential in a group aimed at improving healthy ways to resolve conflict.
With which type of client would it be best practice to allow the proximal interphalangeal (PIP) joints to develop a contracture to facilitate functional grasp? A. Client with a C6 spinal cord injury B. Client with rheumatoid arthritis C. Client with cerebrovascular accident (CVA) D. Client with cerebral palsy (CP)
A. Client with a C6 spinal cord injury Ranging the hand (wrist extension combined with finger flexion and wrist flexion combined with finger extension) of a client with a spinal cord injury preserves a functional tenodesis grasp while encouraging PIP flexion contractures.
A client is referred to a return-to-work program 3 months postlaceration with subsequent flexor tendon repair to the index finger. The client sustained the injury while working as a sous chef. Which option would provide the OTR® with the MOST comprehensive summary of the physical demands of the client's job? A. Dictionary of Occupational Titles (DOT) and O*Net B. Occupational Safety and Health Administration (OSHA) and National Institute of Occupational Safety and Health (NIOSH) C. Employer-provided job description and Occupational Safety and Health Administration (OSHA) D. U.S. Department of Labor and job demand analysis
A. Dictionary of Occupational Titles (DOT) and O*Net DOT is a standardized classification system used to define physical demands of work and occupations within the United States. It is the primary source for generic occupational descriptions worldwide. O*Net is an online searchable database for information about occupations. Both DOT and O*Net are consulted when obtaining occupational information.
What strategy might an OTR® appropriately recommend to caregivers of a client with Alzheimer's disease to assist with fall prevention? A. Engage the client in daily, structured activity. B. Provide visual reminders in the home environment. C. Install grab bars in the bathroom. D. Engage the client in an exercise program.
A. Engage the client in daily, structured activity.
A client with a recent diagnosis of dementia is receiving occupational therapy. The caregivers are most distressed about significant behavioral changes that have occurred since the client was diagnosed. The client has become increasingly impulsive and difficult to redirect. What type of dementia does this client MOST LIKELY have? A. Frontotemporal dementia B. Alzheimer's dementia C. Vascular dementia D. Dementia with Lewy bodies
A. Frontotemporal dementia The distinguishing feature of frontotemporal dementia is behavioral changes with an increase in disinhibited behavior, decreased social tact, lack of empathy, and lack of interest. B, C, D: None of these dementia categories has behavioral changes as a significant symptom
A client with Down syndrome is preparing for transition from high school to work and is seeking a work placement. The client needs to identify vocational interests and abilities for general job tasks. To which service should the OTR® refer the client? A. Job coaching B. Functional capacity evaluation C. Job site evaluation D. Prework screening
A. Job coaching Job coaching provides vocational evaluation to identify a client's vocational interests and abilities along with physical and mental tolerances for general job activities.
A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. When all the wounds are closed and the graft is stable, what is the BEST intervention to prevent hypertrophic scar development? A. Jobst pressure sleeve with inserts B. Elastic bandage wrapping from distal to proximal C. Scar massage 3-5 times per day D. Frequent PROM and AROM
A. Jobst pressure sleeve with inserts When most of the wounds are closed, a Jobst pressure garment is the best choice to prevent hypertrophic scarring. Adding inserts increases the effectiveness of compression therapy. B: Elastic bandaging provides light compression and can initially be used when the wounds are not closed. C, D: Scar massage and ROM activities are an important part of burn rehabilitation but are not interventions for preventing hypertrophic scars.
The parent of a 7-year-old child with attention deficit hyperactivity disorder informs the OTR® that the child recently started taking dexmethylfenidate (Focalin). Which side effect of this drug must the OTR® watch for? A. Moodiness and agitation B. Euphoria C. Blurred vision D. Mydriasis and hyperthermia
A. Moodiness and agitation
A client with advanced amyotrophic lateral sclerosis (ALS) is new to a computerized communication device. On what would the OTR® treating this patient focus? A. Positioning, to ensure proximal support on a lap tray B. ROM exercises, to enable the patient to adequately reach the device C. Trunk strengthening, to enable upright sitting during use of the device D. Adapting the device with larger buttons and controls, to enable independent use
A. Positioning, to ensure proximal support on a lap tray The simplest and first approach would be to ensure positioning so that the client can see the device and having the neck and shoulder (proximal muscles) stabilized to allow the most distal control. The placement of the device is also important, with a lap tray to secure the device in bed or on the wheelchair.
For a client with C5 spinal cord injury (SCI) in the acute phase of rehabilitation, what is the BEST position to place the client's forearms in? A. Pronation B. Supination C. Flexion D. Extension
A. Pronation - pronation PROMOTES fx post C5 SCI The forearm should be pronated because clients with C5 SCI are prone to contractures in their supinators because of their inability to pronate actively. -picture holding the basketball picture, the hand is already in supination as this is the most comfortable --> resist that and place in pronation to avoid contracture
When evaluating a client in a skilled nursing facility, the OTR® notes that the client's skin has a yellowish cast, the fingernail beds are bluish in color, and the client has noticeable edema in both lower extremities. What condition would MOST likely cause these symptoms? A. Right-sided congestive heart failure B. Left-sided congestive heart failure C. Aortic stenosis D. Aortic insufficiency
A. Right-sided congestive heart failure When the right side of the heart fails, blood flows back into the venous system. Symptoms of right-sided heart failure include cyanotic nail beds, jaundice, and lower-extremity edema. When the left side of the heart fails, blood flows back into the lungs, causing difficulty breathing, anxiety, and cerebral hypoxia. Aortic stenosis and aortic insufficiency have symptoms similar to those of left-sided heart failure.
An OTR® is completing a wheelchair assessment for an adult client who has progressive cerebellar degeneration and requires the use of a power wheelchair for mobility. What type of control switch would be MOST BENEFICIAL for enabling this client to independently operate the wheelchair? A. Sip and puff B. Joystick C. Chin-activated toggle D. Proximity-sensing microswitch
A. Sip n Puff - Cerebellar degeneration results in loss of balance and coordination. A sip-and-puff control switch would allow control of the power wheelchair without the client needing to use coordination.
Of what is the place-and-train approach an example? A. Supported employment B. Transitional employment C. Job matching D. The clubhouse model
A. Supported employment The place-and-train approach first places the client in a supported employment situation and then trains the client to do the job.
An OTR® is working with a student with a learning disability to improve independence getting to and from community college. Which action represents a scaffolding approach to this intervention? A. The OTR® helps the student study the bus map to identify the appropriate route and then encourages to the student to look at the schedule to determine the times. B. The OTR® accompanies the student to and from the school on the bus and points out landmarks to serve as visual reminders of the route. C. The OTR® outlines what will be expected of the student regarding bus times, schedule, cost, and appropriate behavior on public transportation. D. The OTR® encourages the student to take the bus with a friend to ensure the student does not get lost.
A. The OTR® helps the student study the bus map to identify the appropriate route and then encourages to the student to look at the schedule to determine the times. The OTR® assists the student with one of the more difficult tasks, identifying the appropriate bus route to and from school. The OTR® then allows the student to independently proceed with the public transportation planning. Scaffolding involves the OTR® working with the client on components of the activity that prove too difficult, but the client ultimately finishes the activity independently, thereby improving motivation. C = coaching approach (outlining expectations)
An OTR is selecting a wheelchair for a patient in an acute rehabilitation center who has transhumeral amputation of both arms and a distal transtibial amputation of one leg. The patient plans to alternate between using a manual wheelchair and ambulating with a prosthesis. Which wheelchair feature would be MOST BENEFICIAL for meeting the patient's daily needs? A.Low seat-to-floor height B.Off-set rear axle position C.High back height
A.Low seat-to-floor height
what type of leadership is best for adolescents with operant defiant disorder?
Adolescents, particularly those diagnosed with oppositional defiant disorder, need boundaries, and an authoritative leadership style is critical to successfully managing this group.
Allen cognitive level 4 (Goal-Directed Actions)
At Level 4, the client would be able to complete quick tasks and model single-step completion. Routine tasks would be independent for a client. Ex: During a task-oriented group the OTR® observes that the client has difficulty understanding the concept of completing the multiple steps involved with developing a monthly personal budget plan.
Allen cognitive level 5 (Exploratory Actions) and level 6 (Planned Actions)
At Level 5, clients are able to improve actions through trial and error and are able to complete several steps at a time, whereas the client in this scenario is having difficulty completing multiple-step tasks. At Level 6, a client would handle unlimited steps in an activity including diagrams and written directions and would be independent with personal budget planning.
An OTR® is working with a client diagnosed with fibromyalgia who is experiencing disturbed sleep patterns. Which cognitive areas of functioning are disturbed sleep patterns MOST likely to interfere with?
Attention span and STM Nonrestorative sleep, fatigue, and pain interfere with the client's ability to pay attention and remember day-to-day events
Which psychiatric condition is MOST frequently seen as interfering with the occupational engagement of a client with cardiac disease? A. Panic attack B. Major depression C. Personality disorder D. Hypochondriasis
B. Major depression
An OTR® works at a skilled nursing facility that provides wheelchairs for clients who need them. As a result, the facility has a room full of wheelchairs of various sizes. The OTR is often expected to find the wheelchair that best fits each new client, which requires determining whether the seat depth is appropriate for that client. Where should the front edge of the wheelchair seat be in relation to the client's hamstrings? A. 5 to 6 inches proximal to the posterior side of the bent knee B. 1-2 inches proximal to the posterior side of the bent knee C. At the knee crease on the posterior side of the bent knee D. 1-2 inches distal to the posterior side of the bent knee
B. 1-2 inches proximal to the posterior side of the bent knee
A client who has schizophrenia is attending an adult mental health day treatment program. During a task-oriented group the OTR® observes that the client has difficulty understanding the concept of completing the multiple steps involved with developing a monthly personal budget plan. Which Allen Cognitive Level BEST describes this client's level of function based on this observation? A. 3 (Manual Actions) B. 4 (Goal-Directed Actions) C. 5 (Exploratory Actions) D. 6 (Planned Actions)
B. 4 (Goal-Directed Actions) At Level 4, the client would be able to complete quick tasks and model single-step completion. Routine tasks would be independent for a client.
An OTR, who works in an acute care setting, encourages a patient who recently had surgery, to use an incentive spirometer. What is the PRIMARY purpose for post-operative incentive spirometry? A.It offers an alternative to pharmaceutical pain control methods. B.It expels anesthesia from the lungs and improves lung function. C.It prevents thromboembolic conditions such as deep vein thrombosis.
B. A post-op incentive spirometer expels anesthesia from the lungs and improves lung function.
In reading a client's medical chart, the OTR® notes that the client has a history of postprandial orthostatic hypotension. What activity precautions should the OTR give the client? A. Limit standing to 30 minutes while completing an occupation, such as cooking. B. Avoid a positional change from lying down to standing within 30 minutes of eating a meal. C. Take several minutes in the morning to move from lying down to sitting and then standing after being in bed all night. D. Avoid leaning the head too far forward, for example, bending over to tie shoes while sitting
B. Avoid a positional change from lying down to standing within 30 minutes of eating a meal. Postprandial orthostatic hypotension occurs when a person goes from supine to standing shortly after eating a meal. It generally affects older adults, people with hypertension, and people with Parkinson's disease.
An OTR® is evaluating a new client and notes that the client has a bluish tinge to the skin and lips. The client also presents with significant edema. Which medical condition is this client MOST likely to have? A. Emphysema B. Chronic bronchitis C. Cystic fibrosis D. Cirrhosis of the liver
B. Chronic bronchitis A client with chronic bronchitis has poor oxygenation, resulting in a bluish tinge to skin and lips, along with edema A client with emphysema is most likely to have pinkish skin. A client with cystic fibrosis may have yellowing of the skin. A client with cirrhosis of the liver will tend to have an orange tint to the skin
According to the Occupational Therapy Practice Framework, which of the following elements is part of the domain of occupational therapy? A. Occupational profile B. Habits, routines C. Intervention plan D. Outcomes
B. Habits, routines DOMAINS: - occupations - client factors - performance skills - performance patterns - contexts and environments PROCESS: eval, intervention, targeted outcomes.
A summer picnic has been planned for clients in a day treatment program for people with mental illness. Before leaving, what medication-related precaution should the OTR® review with the clients? A. Effects of combining alcohol with psychotropic medications B. Need to protect oneself from direct sun when taking psychotropic medications C. Increased likelihood of ataxia after consuming typical picnic foods for people using monoamine oxidase (MAO) inhibitors D. Need to take medications before leaving for the picnic to avoid losing them
B. Need to protect oneself from direct sun when taking psychotropic medications Photosensitivity is a side effect of many psychotropic medications. Avoiding direct exposure to sun is essential. C: Although it is true that typical picnic food may include items that people on MAO inhibitors cannot eat, ataxia is not listed as a result of this drug-food interaction (it would actually lead to a sudden ^ in BP)
A client was recently diagnosed with multiple sclerosis and has been referred to occupational therapy for evaluation. When assessing the client's occupational performance, which information should the OTR® consider? A. ADL assessments completed on the first visit B. Observations of the client's performance over a period of time C. Results of specific measures, such as the manual muscle test D. Observation of the client's routine early in the morning
B. Observations of the client's performance over a period of time Observing the client over a period of time allows the OTR® to identify variability in endurance and fatigue a client with MS may experience.
A client who has cardiac disease is participating in outpatient occupational therapy and is able to complete activities in the 1-3 metabolic equivalent (MET) range. Dyspnea and angina limit physical activity above 5 METs. Which activity is safe to include as part of the initial intervention for this client? A. Completing self-care tasks including dressing, bathing, grooming, and hygiene for 5-minute intervals each with 1-2 minutes rest between activities B. Participating in very light stationary biking for 5 minutes with a short rest of 1 minute and then standing to pack moderate weight items into boxes for 5 minutes C. Pedaling a stationary bicycle for several 5-minute intervals followed by a 1- to 2-minute rest between interval and continuing with 5-minute intervals until fatigued D. Walking on a treadmill at 10 miles per hour (16 km per hour) for 5 minutes followed by a 1- to 2-minute rest, then walking on treadmill at 5 miles per hour (8 km per hour
B. Participating in very light stationary biking for 5 minutes with a short rest of 1 minute and then standing to pack moderate weight items into boxes for 5 minutes
An OTR® is conducting a cooking activity in an outpatient occupational therapy group in a community mental health setting. One of the group members is an adult with obsessive-compulsive disorder (OCD). During meal preparation, the client washes hands repetitively and excessively each time the client touches a food item, which delays the group's progress in the activity. What should the therapist do to help the client more efficiently perform the task? A. Assign the client to a role that does not involve touching food. B. Remind the client of triggers for compulsive behavior and recommend use of latex gloves for the activity. C. Encourage the client to use utensils to avoid touching the food. D. Assign the client the role of teaching and managing hygienic cooking behaviors.
B. Remind the client of triggers for compulsive behavior and recommend use of latex gloves for the activity. Cognitive-behavioral therapy approaches to OCD include helping the client overcome the tendency toward compulsive behavior by identifying the triggers to a compulsive episode, planning a strategy for overriding the compulsion, and continuing to do the activity or task. A, C: Avoidance, either by not coming to group or not touching the food, is not a preferred approach because it does not help the client address and eventually manage the compulsion.
An OTR, who works in medical oncology, plans to have an inpatient walk to the bathroom and complete all steps for showering. Prior to the session, the OTR reviewed the medical record and noted that the international normalized ratio (INR) value for the patient is greater than 5.0. What action should the OTR take based on this INR value? A.Have the patient walk to the sink for a sponge bath. B.Cancel the intervention session planned for the day. C.Proceed with the showering activity as planned.
B.Cancel the intervention session planned for the day.
An inpatient is recovering from a second major depressive episode. The patient plans to resume family and homemaking responsibilities after discharge from the hospital. Which INITIAL action should the OTR take as part of the intervention for promoting progress toward this goal? A.Educate the patient and family about pacing typical daily tasks. B.Determine the patient and family priorities for role resumption. C.Recommend family share responsibilities based on typical home routines. D.Develop a program that promotes gradual integration into family routines.
B.Determine the patient and family priorities for role resumption.
An OTR is preparing an intervention plan for a student in second grade who has attention deficit hyperactivity disorder. The student has difficulties getting ready for school, often misplaces homework assignments, and forgets to bring assignments from home to school. The OTR plans to help the student learn strategies to use in preparation for going to school each day. Which activity would be MOST EFFECTIVE for supporting initial progress toward this objective? A.Ask the student's parents to assist the student in completing a school needs checklist each morning. B.Help the student develop an organizational checklist to use as part of a treasure hunt game. C.Have the student follow a step-by-step instruction sheet during a class art project.
B.Help the student develop an organizational checklist to use as part of a treasure hunt game. intrinsically motivating. It will teach the student the skill associated with developing a checklist that can then be transferred to developing a checklist to support the morning routine.
An OTR is planning intervention for an outpatient client who had a CMC thumb arthroplasty 1 week ago. What should the OTR include as part of the INITIAL intervention plan at this stage of recovery? A.Encourage active range of motion of the affected hand within tolerance of pain. B.Immobilize the wrist and thumb CMC and MCP joints while allowing AROM of the IP joint. C.Begin gentle passive range of motion at the wrist and thumb CMC.
B.Immobilize the wrist and thumb CMC and MCP joints while allowing AROM of the IP joint.
A patient in a rehabilitation facility has a C6 (ASIA A) spinal cord injury. The patient is learning techniques to maintain forward sitting balance while sitting on the edge of the bed. Which technique is MOST BENEFICIAL for the OTR teach the patient to support progress toward this goal? A.Position the elbows in slight flexion; use available shoulder movement while maintaining the wrist in neutral B.Lock the elbows in full extension; and use shoulder depression, protraction and external rotation, and full wrist extension C.Alternate between full elbow extension and flexion; use shoulder elevation, retraction and internal rotation
B.Lock the elbows in full extension; and use shoulder depression, protraction and external rotation, and full wrist extension
A client who works as a hair stylist has cubital tunnel syndrome. The OTR is providing the client with instructions about work modification techniques the client should use to minimize exacerbation of symptoms. What should the OTR include as part of these instructions? A.Wear a neoprene elbow sleeve on the affected arm as much as possible when cutting and styling hair. B.Maintain the affected elbow in 90° of flexion or greater when shampooing, cutting, and blow-drying hair. C.Use a small handheld vacuum instead of a push broom to remove hair from around the styling chair.
B.Maintain the affected elbow in 90° of flexion or greater when shampooing, cutting, and blow-drying hair. -avoids exacerbating positioning
An OTR is reviewing the lab values of a patient in an acute care hospital. Which medical condition is typically associated with upward trending troponin levels greater than 0.04 ng/mL? A.Pulmonary embolism B.Myocardial infarction C.Hyperglycemia
B.Myocardial infarction --> ^ troponin levels
Which symptoms of cranial nerve dysfunction are TYPICALLY associated with a diagnosis of multiple sclerosis? A.Trigeminal neuralgia and facial pain B.Optic neuritis and diplopia C.Tinnitus and hearing loss
B.Optic neuritis and diplopia also vision loss and dysphagia
An OTR leads a leisure skills group with young adults who have intellectual and developmental disabilities. The OTR plans to use scaffolding techniques as part of the group process. What is the PRIMARY purpose for using these techniques? A.To use directed discussions to ensure each participant engages in the group B.To control task elements that exceed the learners' current capabilities C.To provide support to the participants if an error occurs during the group task
B.To control task elements that exceed the learners' current capabilities
While assessing muscle tone in an inpatient who has multiple sclerosis, the OTR® moves the patient's upper extremity rapidly through its full range while the patient relaxes the limb. The OTR® notes a slight catch of the upper extremity in the midrange of motion. Which of the following occurred during the assessment of this movement? A. Hypertonicity B. Flaccidity C. Spasticity D. Weakness
C - Spasticity Spasticity is indicated when a sudden catch or resistance occurs within a quick movement throughout the range of motion for the extremity A: Hypertonicity is typically elicited during slow joint movements. B: Flaccidity indicates a lack of muscle tone with no resistance during passive movement. D: Weakness is assessed through active movement such as moving the extremity against gravity.
A client with dementia quits bathing routines before completing them and has difficulty measuring shampoo and lotion. The areas of the body that are usually washed are more distal (hands, arms). The client might attempt to wash the back, but not consistently. At what stage is this client, according to the Allen Cognitive Level Screen? A. 4.0 B. 3.8 C. 3.6 D. 3.4
C. 3.6 - At Level 3.6, the client will be able to wash most distal portions of the body and those that are easily seen but will not always follow the sequence thoroughly. The client may quit before completion and may have difficulty with measuring soaps, lotions, and deodorant. A, B: At Levels 4.0 and 3.8, the client will typically recognize the need for a bath and will bathe thoroughly as long as no major problems develop during the bathing process (i.e., lack of soap). D: At Level 3.4, the client will typically wash only areas easily seen and reached. The client may wash one area repetitively and may forget to rinse or dry off.
A client will initiate dressing at the appropriate time of the day but will not attend to the day, temperature, or season. The client is able to don clothing slowly but has difficulty with fasteners or fails to see errors in the back (i.e., not tucking in the shirt). At what stage of the Allen Cognitive Level Screen is this client? A. 4.4 B. 4.0 C. 3.6 D. 3.2
C. 4.0 - a client would attend to visible sensory cues and ignore what is not in plain sight (e.g., not tucking in the back of the shirt). Clients at Mode 4.4 will be able to locate clothing and initiate dressing at a customary time of the day and dress in sequence. Clients may wear the same clothing over and over again because they like it and have worn it before. C: At Mode 3.6, clients must be trained to initiate dressing at the customary time of day. D: At Mode 3.2, clients will need cues to sequence through a dressing routine.
Which statement BEST describes a task-oriented group in the "storming" phase of group development? A. Because two participants were able to work out their differences early on, the group is now running smoothly and handles problems efficiently. B. The group is meeting for the first time, and participants are asking the group leader for help because they don't understand the task at hand. C. A participant who has recently joined the group sets up a roadblock to everything another participant says. A third participant does not think that the task is reasonable and questions whether accomplishing it is even possible. D. The group leader is exhausted by all the questions about the details of the finished product. No one seems to want to work together, and the participants seem to expect the leader to solve this problem.
C. A participant who has recently joined the group sets up a roadblock to everything another participant says. A third participant does not think that the task is reasonable and questions whether accomplishing it is even possible. Storming - It is common for disagreements to occur during the storming phase. Setting up roadblocks and questioning the task at hand are normal during this stage. Storming is characterized by conflict and competition. A: This group is in the performing stage: Participants are able to problem solve through challenges. The disagreements that are the hallmark of the storming stage have been resolved. B: A group meeting for the first time is in the forming stage. Forming is characterized by dependence. D: Reliance on the group leader is common during the forming stage, in which the group has not yet taken ownership of the task and instead expects the leader to solve all issues. Norming is characterized by initiation of cohesion.
With the Allen Diagnostic Module, an OTR® measures a client at an Allen Cognitive Level (ACL) of 4.0. The OTR is working with the client in an adult day treatment center. When the OTR is designing intervention activities, what type of project is appropriate for this client? A. Any project with mostly familiar steps; no more than two steps of the task should require new learning. B. A project that is unstructured; the client should be given opportunities to find and revise errors. C. A project that is set up with a model final product; simple instructions should be provided, along with supervision. D. A project that encourages relatively independent planning and organizing to complete; none of the steps should require new learning.
C. A project that is set up with a model final product; simple instructions should be provided, along with supervision. ACL of 4.0 can perform only simple tasks and will have difficulty with problem solving. A model with clear instructions should be provided along with supervision for cues and guidance when needed.
An OTR® is fitting a client with a pelvic deformity and minimal dynamic sitting balance impairments to a new wheelchair. The client lives alone and must be able to independently get the wheelchair and all accessories into and out of a car for community mobility. What type of cushion would be MOST appropriate for a client with this issue? A. Gel filled B. Air filled C. Custom-contoured foam D. Alternating pressure system
C. Custom-contoured foam Custom-contoured foam is often necessary for clients who need accommodations for deformities of the pelvis or spine. It increases surface area coverage, reduces shearing, and increases postural control. B: Air-filled cushions are lightweight but do not support postural control the way custom-contoured foam cushions do.
An OTR® has received a referral to evaluate a client with dementia who lives alone in the community. When the OTR® arrives at the client's home, the OTR® notices that the client is well groomed but appears to have forgotten that the OTR® had called earlier in the day to set up the appointment. Which area of occupation would be a priority to assess during the initial occupational therapy assessment? A. Bathing and showering B. Sleep C. Emergency system access D. Personal device care
C. Emergency system access The client has early-stage dementia as evidenced by short-term memory deficits but maintains the ability to complete routine ADLs. Other ADLs are likely intact, but IADLs, in particular those that require higher level executive function, would be affected at this stage. In addition, the client lives alone so understanding the client's safety in the community would be important. ABD not impaired at this stage
An OTR® performs an evaluation on a client who has a new diagnosis of Parkinson's disease (PD), Stage 1. The client's goal is to maintain employment as an administrative assistant in a moderate-paced law firm. With which intervention would the OTR® BEST begin treatment? A. Instruct the client in adaptive equipment such as large-button telephones and distal wrist weights. B. Develop a home exercise program for the client to maximize balance and strength. C. Plan the client's work day so that the most difficult tasks align with the time when medications are at optimal effect. D. Advise the client to alert superiors and coworkers to the new diagnosis to gain support and help modify work tasks.
C. Plan the client's work day so that the most difficult tasks align with the time when medications are at optimal effect.
During an initial interview with a young adult who has Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome), the OTR® notices that the client lives alone and is isolated, does not go out much, does not value family relationships, and does not seem to have any friends. Additionally, the client is not gainfully employed and does not take care of the apartment. The client spends most of the day surfing the Web and watching TV. Using the Model of Human Occupation, which of the following assessments would be the MOST appropriate? A. A projective test such as House-Tree-Person B. Worker Role Interview C. Role Checklist D. Canadian Occupational Performance Measure
C. Role Checklist The Role Checklist gathers information on the client's former and current roles and the value the client places on these roles, consistent with the Model of Human Occupation. B: The Worker Role Inventory is associated with the Model of Human Occupation and would yield valuable information but is too narrowly focused on the worker role.
A client with morbid obesity and obstructive sleep apnea is collaborating with an OTR® on improved sleep routines and positioning. What sleep position is optimal for this client? A. Supine position with head of the bed elevated B. Supine position with only the client's head elevated C. Side-lying position with head of the bed elevated D. Side-lying position with only the client's head elevated
C. Side-lying position with head of the bed elevated The supine position is not preferred because the weight of the body makes breathing more difficult.
An OTR® has been working with a client recently diagnosed with complex regional pain syndrome of the upper extremity secondary to an improperly casted distal radius fracture. Which modality is BEST to reach the treatment goal of pain control for this client? A. Cold spray B. Neuromuscular electrical stimulation (NMES) C. Transcutaneous electrical nerve stimulation (TENS) D. Iontophoresis
C. Transcutaneous electrical nerve stimulation (TENS) - -- TENS unit will best aid the client in reaching the treatment goal of pain control. A: Cold spray is used to treat trigger points and increase passive stretch of a muscle tendon unit. B: NMES is best used to facilitate muscle contraction. D: Iontophoresis is used to control inflammatory conditions.
An OTR is providing ramp specifications for a client with a disability who uses a power wheelchair for mobility. What is the minimum gradient for the ramp that the OTR should recommend to this client? A.1:6 B.1:10 C.1:12
C.1:12
Which of the following symptoms are associated with a client who is experiencing an absence (petit mal) seizure? A.Sudden movement of a single body part with no change in vital signs B.Stiffening of extremities with rhythmic, bilateral jerking of limbs C.Abruptly stopping an activity with a blank stare and fluttering eyelids
C.Abruptly stopping an activity with a blank stare and fluttering eyelids
A 6-year-old child who has developmental delay is learning to self-dress. Over the past several months, the child has made significant progress and is now able to complete age-appropriate dressing tasks with the exception of independently tying shoe laces. The parent reports the child becomes extremely frustrated with this task and has behavioral outbursts when an adult provides assistance. Which technique should the OTR incorporate into the intervention to MOST EFFECTIVELY support the child's success with shoe-tying? A.Gesture prompting B.Forward chaining C.Backward chaining
C.Backward chaining Backward chaining technique is motivating to the child with a low frustration tolerance because it starts with having the child learn the final step of the task first, providing a rewarding experience.
A resident, who lives in a nursing home, has schizophrenia and tardive dyskinesia. The OTR is using the Abnormal Involuntary Movement scale (AIMS) to measure uncontrollable movements of the resident's face and upper body. At what frequency should the OTR administer the AIMS for this resident? A.After a change in the resident's medication regimen. B.Prior to each of the resident's medical appointments. C.During every intervention session with the resident.
C.During every intervention session with the resident.
An OTR is collaborating with a client and a building contractor to have wall-mounted grab bars installed in the client's bathroom. The client lives independently in a mobile home and is at-risk for falls due to cerebellar ataxia. The OTR determines the optimal placement of the grab bars to meet the needs of the client, however the contractor informs the OTR there are no available studs behind the wallboard in the recommended locations. Which alternative option would be MOST BENEFICIAL for the OTR to discuss with the contractor and the client? A.Install 1/2-inch (1.2cm) plywood over existing wallboard. B.Apply suction cup bathroom safety bars on the wallboard. C.Place blocks between the wall studs under the wallboard.
C.Place blocks between the wall studs under the wallboard. Having a contractor place blocks between the wall studs provides additional structural support to allow for grab bars to be securely installed.
Which of the following symptoms are associated with a client who is experiencing a simple focal (partial) seizure? A.Stiffening of extremities with rhythmic, bilateral jerking of limbs B.Abruptly stopping an activity with a blank stare and fluttering eyelids C.Sudden movement of a single body part with no change in vital signs
C.Sudden movement of a single body part with no change in vital signs
An OTR is working with a client in a home health setting who has a wound on the lateral aspect of the proximal forearm. The wound is 4 cm (1.57 inches) in diameter and is being treated by the wound care nurse with a hydrogel sheet dressing. The wound margins are pink and flat, and the wound is draining a low volume of serosanguinous exudate. What is the PRIMARY reason for using a hydrogel sheet dressing type for this client? A.To provide hydration to the wound while offering pain relief with a hydrogel sheet B.To create a moist healing environment while absorbing discharge from the wound C.To keep bacteria out of the wound while promoting autolytic debridement
C.To keep bacteria out of the wound while promoting autolytic debridement Hydrogel sheets help establish a clean, moist wound healing environment to promote autolytic debridement.
An OTR® is working with a client who has ventricular tachycardia. The client's vital signs include a heart rate greater than 100 beats per minute. What is the appropriate therapeutic response to this client's situation? A. Allow the client to rest 10 minutes, then begin an occupational task that focuses on upper-extremity movement. B. Work with the client in a supported sitting position with the client's legs elevated. C. Instruct the client in adapting performance of grooming and feeding tasks. D. Defer the client's participation in occupational therapy until later, because the client is medically unstable.
D. Defer the client's participation in occupational therapy until later, because the client is medically unstable. Ventricular tachycardia of more than 100 beats per minute can cause sudden cardiac death. Therapy should be deferred until the client is medically stable. If the client had stable angina then allowing a 10 min. rest would be okay
A new OTR® receives a referral to evaluate a very depressed client. The new OTR®'s supervisor recommends using motivational interviewing as the main source of information during assessment. Which statement is one of the four general principles of motivational interviewing that guides the interaction between a client and an OTR®? A. Test the client's sense of reality. B. Identify the problem. C. Identify the good and bad points of a behavior. D. Avoid argument and opposition to the client's resistance.
D. Avoid argument and opposition to the client's resistance. "roll with resistance" principle of motivational interviewing. Motivational interviewing also includes: express empathy, develop discrepancy, and support self-efficacy.
An OTR® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The OTR suggests that the client use breathing techniques and relaxation breaks during the work day to minimize the client's response to stressful events at work. What frame of reference does this intervention suggest? A Cognitive-behavioral B. Psychodynamic C. Cognitive disability D. Behavioral
D. Behavioral The behavioral frame of reference relies on the idea that behavior is learned and that it can be unlearned. Introducing relaxation activities and breathing into this client's routine may allow the client to experience more time in a positive state of mind, thus reducing anxiety.
A client with Huntington's disease presents with decreased motor planning. What is the most effective intervention for an OTR® to implement with this cognitive impairment? A. Provide alternative suggestions for safe mobility, including use of a wheelchair for community mobility. B. Provide the client with strategies to self-assess performance on tasks. C. Suggest that the client reduce participation in tasks that are difficult. D. Have the client imagine performing the task in a smooth, coordinated manner.
D. Have the client imagine performing the task in a smooth, coordinated manner. Mental imagery is an effective strategy to improve motor abilities for clients with decreased motor planning.
A client with a diagnosis of dementia has memory loss. The OTR® observes that the client has visual hallucinations. In addition, the client has decreased spontaneous motor movements and rigidity. What type of dementia does this client MOST LIKELY have? A. Frontotemporal dementia B. Alzheimer's disease C. Vascular dementia D. Dementia with Lewy bodies
D. Lewy Bodies Dementia - Distinguishing features of dementia with Lewy bodies are visual hallucinations and Parkinson-like motor symptoms.
A client with amyotrophic lateral sclerosis reports functional limitations when completing his daily routine. The OTR® has completed ADL and IADL assessments as part of the evaluation and is considering how the client's upper-extremity motor control is affecting his functional ability. Which assessment would be MOST effective for assessing this client's upper-extremity ability? A. Modified Ashworth Scale B. Trigger point evaluation C. FIM™ D. Purdue Pegboard test
D. Purdue Pegboard test The Purdue Pegboard test is a timed test of upper-extremity function and is useful in determining a client's functional limitations. The Modified Ashworth Scale is a measure of spasticity.
A 4-year-old child with bilateral congenital limb deficiencies at the transhumeral level was recently fitted with new prostheses. Which activity should be introduced FIRST as part of the prosthetic program with the child? A. Self-feeding using standard eating utensils B. Coloring pictures in an oversized coloring book C. Stacking 1-inch (2.54-cm) wooden blocks D. Pushing an 18-inch- (45-cm-) diameter exercise ball
D. Pushing an 18-inch- (45-cm-) diameter exercise ball Once an individual is fit with a prosthetic, use training should begin so the client can understand how to operate and control the prosthetic. The client is able to implement practice with pre-positioning the limb to more effectively approach an object, such as pushing a ball. A, B: Functional training occurs after the client has gained concepts of control and use of the prosthetic as through pre-positioning and prehension control. C: Prehension training occurs after the client is successful with pre-positioning the prosthetic in preparation for grasp or interaction with an object.
An OTR is working with a client who has been in a motor vehicle accident. The client has sustained flexor tendon injuries to the index and middle fingers and also presents with a median nerve injury. Which flexor tendon zone corresponds to this client's injuries? A. Zone I B. Zone II C. Zone III D. Zones IV and V
D. Zones IV and V - Zone IV consists of the transverse carpal ligament, and the median nerve runs under this ligament; Zone V is distal to this ligament and thus contains the median nerve branch. Zones 1, 2, and 3 dont contain the median nerve branch.
what causes most pulmonary embolisms?
DVT of lower extremities
common side effect of donepezil (Aricept)
Donepezil is a cholinergic-modulating drug that may improve memory and cognition and reduce negative mood, anxiety, and hallucinations; however, dizziness is a side effect.
How can you make bed mobility easier for clients with Parkinsons Disease?
Environmental modifications for improving bed mobility include using light bedding (e.g., changing from flannel to satin sheets), using a firm mattress, lowering the height of the bed, and using a bed rail for support.
feedforward praxis vs. executional praxis
Feedforward praxis enables a person to compare previous motor plans and sensory information to detect potential errors and correct the plan before attempting it again. Ex: modifying kick when ball didnt go into the goal A: Executional praxis is the ability to perform the motor action with precision.
Fitness-for-duty evaluation
Fitness-for-duty evaluation determines whether a worker can perform the essential functions of a specific job. The evaluation screens for conditions that may place the worker at risk for injury and takes place only after an employer has offered employment.
Job site evaluations
Job site evaluations assess the physical demands and layout of a specific job setting.
MOHO vs. Occupational Adaptation
MOHO = Understanding the client's dimensions of occupational participation and performance OA = Understanding the interaction between the client's perceived level of task mastery and the demands of the environment
An OTR® is seeing a client 1 day post laminectomy surgery for back pain. What would the treatment session MOST likely emphasize?
Normal spinal alignment needs to be maintained post surgery --> log rolling and sitting and standing postures Laminectomy: a surgical operation to remove the back of one or more vertebrae, usually to give access to the spinal cord or to relieve pressure on nerves.
The caregiver of a client with Alzheimer's disease questions the home health OTR® about a recent increase in the client's dosage of donepezil (Aricept) prescribed by the physician. The caregiver is particularly concerned about potential consequences of the increased dosage. What is the OTR®'s most appropriate suggestion for the caregiver?
Observe the client for signs of dizziness, which increases potential for falls. Donepezil is a cholinergic-modulating drug that may improve memory and cognition and reduce negative mood, anxiety, and hallucinations; however, dizziness is a side effect.
pacemaker precautions?
Pacemaker precautions include no shoulder flexion or abduction greater than 90° on the side on which the pacemaker was implanted for the first 4 weeks.
prework screening
Prework screening is done when a client has been offered a job.
RUMBA tool for goal writing
Relevant outcome (improve work tolerance) - Time to meet goal (2 weeks) Understandable Measurable Behavioral (i.e., the outcome can be observed), and Achievable in the time frame given.
An OTR® is working in a cardiac rehabilitation program. Of the four clients on the OTR's caseload, which client would require a longer warm-up and cool-down period during exercise and activity sessions? A. The client with congenital heart disease B. The client with a coronary artery bypass graft C. The client with a heart transplant D. The client with an automatic defibrillator
The client with a heart transplant Because a donor heart is denervated, the autonomic nervous system does not control the client's heart rate. The heart relies on circulating hormones, which take longer to increase and decrease the heart rate.
An OTR® is providing intervention in the home of a client who is recovering from Guillain-Barré syndrome. The client ambulates independently using a walker, but becomes unsteady when tired. What should the OTR® include as part of the intervention for supporting the client's safety at home? A. Talk with family members about providing contact-guard assistance whenever the client is engaged in daily tasks. B. Advise the client to complete self-care tasks while seated in a wheelchair in the home bathroom. C. Problem-solve with the client to identify and eliminate existing fall risks within the home. D. Teach the client diaphragmatic breathing techniques to use during functional ambulation at home.
The right answer is C Providing safety strategies for proper use of a walker within the home is the most effective intervention strategy because it allows the client to identify situations that could be modified for better safety. Not B bc that would decrease independence.
An OTR® is interviewing a new client who physically presents with a "barrel chest." This appearance is most often associated with what condition? A. Cystic fibrosis B. Asthma C. Collapsed lung D. Emphysema
The right answer is D Clients with emphysema have hyperinflated lungs, which partially expand the ribcage.
wound vac precautions
The wound VAC should not be turned off without the nurse's knowledge because it can only be turned off for 2 hours within a 24-hour period.
Which assessments should you administer in an acute care hospital for a client with an incomplete T1 spinal cord injury? - Canadian Occupational Performance Measure - Barthel Index of ADLs - FIM™ - Community Integration Measure - Kohlman Evaluation of Living Skills
YES - COPM, Barthel index of ADLs, FIM NO - Community Integration Measure and Kohlman Eval of Living Skills (The client has no difficulty performing cognitive tasks for living independently.)
Allen cognitive level 3 (Manual Actions)
clients are able to engage in simple tasks that have repetitive actions with limited choices, and a client at Level 3 would require assistance for personal budget planning.
Which of the following tasks would be MOST appropriate to use during the functional training phase for a client learning to use a unilateral myoelectric terminal device (TD)? A. Grasping and releasing different-sized blocks B. Using scissors to cut paper C. Typing on a computer keyboard D. Brushing teeth
cutting bc/ its a bilateral activity brushing teeth only requires one hand
The international normalized ratio (INR)
is a calculation based on results of a PT and is used to monitor individuals who are being treated with the blood-thinning medication (anticoagulant) warfarin (Coumadin®). >5 = bed rest 3.5-4.5/5 = VERY high clot risk 2.5-3.5 = getting bad 2-3 = standard therapeutic target range .8-1.2 = normal range
job site analysis
looks to define the actual demands of the job and involves the use of questionnaire, interviews, observations, and formal assessment completed in the real work environment. Many FCEs include a job demand analysis; does not have ergonomic evaluation
