NBCOT Practice test 1

An OTR® receives evaluation orders for a client who has recently experienced a traumatic brain injury. The client is swearing and anxiously looking for something. What Rancho Los Amigos level BEST corresponds with the client's behavior? A. VI B. IV C. V D. II

B. Because the client is confused and agitated, the behavior most closely resembles Level IV: confused & agitated. A: At Level VI, the client would, although confused, generally not be agitated. C: Although confusion and memory issues are profound at Level V, the client would generally not be behaving erratically. D: Level II implies low levels of activity and limited responses.

An OTR® will begin teaching dressing skills to a 4-year-old child with autism. To ensure success during the first attempt, which activity should the OTR® choose? A. Use a shirt with large buttons for easy manipulation B. Use the child's favorite shirt that fits really well C. Use an over-the-head shirt that is slightly large for the child D. Use a cotton shirt that does not have an itchy hem and collar

C. When beginning to teach dressing skills, the OTR® begins with basic, simple articles of clothing, such as loose-fitting pants and over-the-head, slightly large shirts, to allow for success.

An OTR® in an inpatient facility is working with an adolescent with major depression who repeatedly expresses feelings of worthlessness and poor self-concept. What therapeutic activities will BEST address this client's self-concept issues? A. Activities that establish normal daily routines B. Activities that engage the client socially C. Activities that do not require too many choices D. Activities that allow for self-expression

D. For clients who have self-concept symptoms, activities that allow for self-expression and self-exploration help combat feelings of worthlessness and guilt.

To prevent skin breakdown in a client with an incomplete spinal cord injury, which method is BEST for preventing pressure sores? A. Remove after-market cushioning from wheelchair. B. Apply moist heating pads to areas of discomfort. C. Encourage the client to remain still in bed. D. Teach the client to inspect the skin on a daily basis.

D. The client must learn to perform self-inspections regularly.

An OTR® is using the Ayres Sensory Integration Intervention program for a 6-year-old child with attention deficit hyperactivity disorder and sensory-seeking behaviors. Which principle should the OTR® keep in mind when selecting activities for this intervention program? A. The sensory environment is completely structured to allow for optimum integration of sensory information. B. Sensory experiences are limited to one sensory factor at a time to ensure mastery. C. Passive participation on the part of the child is encouraged. D. Appropriate activities are done individually and not in a small group.

D. The Ayres Sensory Integration Intervention program is applied individually rather than in groups. A: In the Ayres program, complete structuring of the sensory environment is not recommended. B: The Ayres program incorporates multiple sensory experiences to ensure mastery. C: The OTR® encourages the child's active participation in the Ayres program.

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

A. If transferring to the front seat is a problem, transferring to the back is the most economical alternative (the client backs up to the seat, sits, and slides back so that the leg that was operated on is extended and is supported by the seat). In some cases, the front seat can be removed completely or pulled forward to create more space.

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 provides vocational evaluation to identify a client's vocational interests and abilities along with physical and mental tolerances for general job activities.

A client in the early stage of Huntington's disease (HD) displays difficulty with initiation and completion of the morning grooming routine. What might be a good approach for the OTR® to use to assist the client to become more independent in this activity? A. Train the client in the use of checklists for completion of daily living tasks, including the morning grooming routine. B. Remove any barriers from the bathroom because they may impair the client's mobility and prevent the client from using the bathroom for grooming. C. Recommend that the client's caregiver offer as much physical assistance as possible to decrease frustration during the task. D. Suggest that the client move through the steps of the task as naturally as possible, not worrying about the quality of each step.

A. Checklists for completion are an effective strategy that OTR®s might use with clients with HD who are having difficulty initiating and completing multistep tasks.

An OTR® recently completed an evaluation with a client with T4 spinal cord injury (SCI). In development of a client-centered intervention plan, what INITIAL activity may the client need assistance with? A. Transfer training B. Eating training C. Cognitive training D. Dexterity training

A. Clients with T4 SCI will need assistance with transfers because of lower extremity paralysis.

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. Solution

A. Engagement in activity-based interventions, along with daily structure, has been documented to assist in fall prevention.

A construction worker was referred to occupational therapy as part of a work hardening program. During the interview, the OTR® discovers that the client is required to lift construction equipment weighing 20 lb on a frequent basis. At what level of work must the OTR create work simulation tasks? A. Medium B. Heavy C. Very heavy D. Light

A. Medium work requires exerting 20-50 lb of force occasionally, 10-25 lb of force frequently, or more than negligible weight to as much as 10 lb of force constantly to move objects. B: Heavy work requires exerting 50-100 lb of force occasionally, 25-50 lb of force frequently, or 10-20 lb of force constantly to move objects. C: Very heavy work requires exerting 100 lb of force occasionally, in excess of 50 lb of force frequently, or in excess of 20 lb of force constantly to move objects. D: Light work requires exerting as much as 20 lb of force occasionally, as much as 10 lb of force frequently, or a negligible amount of force constantly to move objects. The physical demands are in excess of those for sedentary work.

An OTR® is facilitating an activity for a group that includes an adolescent with major depression. Partway into the session, the adolescent complains of an inability to concentrate on the activity because the bright lights in the room have caused sore eyes. How should the OTR® respond? A. Offer the client a choice to discontinue the session and ask the nurse about medication changes and effects B. Immediately report the situation to the nurse and ask the client to rest for the day C. Ignore the client's response because it might be an effort to avoid work D. Speak to the client privately and inquire whether the client is telling the truth

A. OTR®s should be cognizant of the possible functional performance effects of medication. Offering a choice is an effective way of handling an adolescent.

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

A. Physical and emotional needs are not altered by spinal cord injury.

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

A. Resistance applied during manual muscle testing may be harmful to inflamed tissue and joints and is contraindicated in an acute phase of arthritis.

An adolescent hospitalized for suicidal ideation and depression is meeting with an OTR® for discharge planning. What aspect of the discharge plan is MOST urgent? A. Provide client education on the effects of prescription medication B. Review the contract for safety procedures the client will follow when thoughts of suicide commence C. Contact the client's school system to see if a suicide prevention program is in place D. Reinforce the need for follow-up occupational therapy treatments to monitor progress

B. A contract for safety is the client's written agreement that he or she will tell an appropriate person if he or she is having thoughts of suicide. Preventive measures are the MOST urgent and important part of the discharge plan for clients with suicidal tendencies.

An OTR® is working with a client with polyarticular juvenile rheumatoid arthritis (JRA). Which biomechanical technique would be MOST appropriate to include in the client's intervention plan during an exacerbation? A. A resistive exercise program B. An AROM program C. A taping program D. A pacing program

B. AROM exercises are most appropriate to include in the intervention plan for a child with JRA. Splinting, monitoring joint function, preventing deformation, teaching energy conservation techniques, and instruction in the use of adaptive equipment may also be components of the intervention. A: A resistive exercise program is contraindicated because it would compromise the involved joints. C: A taping program would not be recommended unless the child with JRA had a comorbid condition. D: A pacing program would not be recommended unless the child with JRA had a comorbid condition

An OTR® is seeing an adolescent client with major depression for the first time in an individual treatment session. The client has been withdrawn and has stayed in bed except for meals. What is the MOST important consideration in choosing an activity for this client? A. The activity should involve some degree of challenge. B. The activity should be completed easily. C. The activity should require multiple sessions to finish. D. The activity should require primarily observational learning.

B. Activities for clients with major depression should be able to be completed easily to provide a sense of success and competence.

An OTR® is instructing a client post-hip surgery on after-toileting cleansing while adhering to appropriate hip precautions. What method is the BEST to prevent further injury? A. Advise the client to wipe between the legs in a standing position over the commode. B. Instruct the client to wipe between the legs in a sitting position on an elevated toilet seat. C. Advise the client to wipe between the legs in a standing position with one foot placed on a step stool. D. Instruct the client to wipe from behind the legs in a sitting position on an elevated toilet seat.

B. All hip replacement clients should wipe between their legs either in a sitting position or from behind while standing.

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

B. An occupational profile, as well as an explanation of the role of occupational therapy, should be performed before any physical examination or training

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

B. Children with OI, or "brittle bones," are at risk for fractures after minor and accidental traumas. Parent education on handling and positioning can help to reduce the likelihood of fractures.

While reviewing the chart of a client with spinal cord injury, the OTR® notices that the client has experienced past episodes of autonomic dysreflexia in the hospital. What is the BEST recommendation the OTR® can make to the client? A. Suggest the client seek another OTR® because the OTR® is unfamiliar with the condition. B. Suggest the client carry an emergency card describing the condition for medical personnel and others. C. Suggest the client wear elastic stockings and abdominal binders to increase blood pressure. D. Suggest the client leave sessions early if experiencing symptoms.

B. Clients susceptible to autonomic dysreflexia are encouraged to carry an emergency card describing the condition and treatment. A: OTR®s must be aware of the symptoms of and treatment for autonomic dysreflexia because it can occur at any time postinjury. C: Increasing blood pressure is not indicated to prevent autonomic dysreflexia. D: The client should not be left alone if experiencing symptoms of autonomic dysreflexia.

An OTR® in an outpatient facility is working with a client with Guillain-Barré syndrome (GBS) who is in the recovery phase. During ADL and IADL tasks, on what is education primarily focused? A. Skin integrity techniques B. Energy conservation C. Adaptive techniques and equipment D. Caregiver training

B. People who recover from GBS typically report fatigue as the most common residual symptom. Managing daily life after discharge from the hospital will likely require significant education on energy conservation and fatigue management to ensure resumption of important roles, rituals, and routines.

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. A client with Stage 1 PD may present with a resting tremor, a typical first symptom; a resting tremor will make fine motor tasks more difficult. Most people with PD experience their worst symptoms just before the next medication dosage. Timing more difficult fine motor tasks with medication is the most nonintrusive intervention.

An OTR® is performing family training with a client with Stage VI amyotrophic lateral sclerosis (ALS) who is preparing for discharge home. Which points are MOST IMPORTANT for the OTR® to address? A. Adaptive equipment for ADLs and how to set up the client with ALS to perform as independently as possible B. Energy conservation for the client with ALS, as well as caregiver support resources to prevent burnout C. Positioning to prevent skin breakdown, a ROM home program, and safe bed mobility and transfers D. Therapeutic exercises for the client with ALS and how caregivers can use proper body mechanics

C. A client with end-stage ALS would likely be totally dependent for all ADL and mobility, thus requiring major caregiver assistance for bed mobility and transfers. An OTR® instructing family members in these techniques would educate them on body mechanics. Positioning and ROM at this stage are important to prevent discomfort, contractures, and skin breakdown.

An OTR® in an outpatient clinic is working on energy conservation strategies with a client with multiple sclerosis (MS). The client states that fatigue is negatively affecting work performance. What is the BEST action for the OTR to take next? A. Perform a worksite evaluation to make personalized recommendations for energy conservation and environmental modification. B. Conduct a job demands analysis and collaborate with the client to problem-solve to reduce fatigue related to specific job demands. C. Ask the client to complete a daily diary to identify common work tasks and rate each task for how much energy it requires. D. Advise the client to improve sleeping patterns and further assess cognition for difficulty with executive functioning.

C. More information is needed to determine appropriate interventions; this client-centered approach involves the OTR® working with the client to identify the specific work tasks that cause fatigue. Strategies to address fatigue can then be determined.

An OTR® is reviewing the chart of a client with Down syndrome. The chart indicates that the client has a history of patent ductus arteriosus (PDA). What are the risks associated with this condition? A. This condition can lead to increased blood pressure and rapid heart rate. B. This condition can lead to difficulties with feeding and shortness of breath. C. This condition can lead to pulmonary hypertension and heart failure. B. This condition can lead to vertigo and dehydration.

C. PDA is a heart defect that is common in premature children and people with Down syndrome. A defect of the ductus arteriosus results in a lack of constriction, causing too much blood to flow to the lungs, eventually resulting in congestive heart failure.

An OTR® working in an inpatient psychiatric wing of a state prison is leading a group of clients who have the potential to have emotional outbursts and to cause harm to themselves or others. Which group design element would have the highest priority? A. Cognitive and educational level of the participants B. Age and gender of the participants C. Location of the meeting room and exits D. Climate and temperature of the meeting room Solution

C. Part of fulfilling the ethical responsibility to maintain a safe and secure group environment is to meet in a physical space that allows escape from a dangerous situation. Knowing where the exits are located ensures that participants and the leader can escape if necessary

An OTR® is considering using an ergonomics rating scale with a worker participating in back training. Which factor is MOST important to consider in selecting an ergonomics rating scale? A. Whether the rating scale can detect subtle change in task performance B. Whether the rating scale provides information on fatigue tolerance C. The extent to which the rating scale is reliable and valid D. The worker's preference for body position when performing tasks

C. Rating scales (e.g., checklists) in work rehabilitation may not have established reliability and validity. The use of reliable and valid scales supports more accurate outcome comparison and ensures that factors intended to be measured are actually measured by the scale

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

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

The mother of a 7-year-old boy with mild autism reports that the child has begun to stand while urinating, imitating behaviors seen at school. His mother asks the OTR® to help her child aim accurately into the toilet bowl. Which method is BEST to teach this skill? A. Use a water gun to squirt water inside the toilet bowl to teach the concept of in and out B. Ask the child to sit, keep deflecting the urine stream inside the bowl, and slowly stand C. Place a small piece of toilet paper inside the bowl to serve as a target D. Use a piece of cardboard to elevate the rim of the bowl for a visual cue

C. Using a target such as a small piece of toilet paper can help increase a child's attention to accuracy when learning to urinate while standing.

An OTR® receives a referral to evaluate a client with dementia. What type of assessment would the OTR® likely use to evaluate this client? A. Nonstandardized assessment tool that assesses memory B. Standardized assessment tool that assesses executive function C. Observation of client and interview with caregivers D. Assessment tool that examines occupational performance and performance skills in detail

C. When assessing clients with dementia, observation and interview of caregivers are the primary method of assessment.

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

D. A career counselor is defined as an individual who counsels individuals or provides group educational and vocational guidance services. A career counselor would not be considered a primary referral source. A, B, C: Physicians, case managers, and attorneys are all considered primary referral sources for FCE.

An OTR® is working with a client who has recently undergone a coronary artery bypass graft and is relearning how to perform certain tasks secondary to sternal precautions. Which adaptation or modification would be the BEST to ensure independence with upper-body dressing? A. Allow for increased time and monitor vital signs because of cardiac risk. B. Instruct the client with verbal cues and reduce the number of cues as the client repeats the task. C. Advise the client on gentle overhead shoulder stretching to ease dressing. D. Educate the client on adaptive positioning to eliminate overhead movements.

D. A client with sternal precautions should avoid bilateral overhead or posterior movements to protect the incision site. This approach adapts the task by modifying the positions used.

During an occupational therapy evaluation, which approach would pose the biggest barrier to engaging in a client-centered process with an adult client who is able to converse? A. Paying attention to the meaning of nonverbal cues B. Being directive C. Being too empathetic with the client D. Asking too many closed-ended questions

D. Questions that have a simple yes-no or single-word answer do not capture the essence of an individual client as an occupational being. Although closed-ended questions might be helpful in filling out an assessment tool with single-word answers, they prevent the client from conveying his or her perspective, which is the core of client-centered practice. Closed-ended questions have their place with clients who have limited verbal ability, but they must be used with skill.

A COTA® working on an inpatient rehabilitation unit has had two patients fall in the past month. The supervising OTR® has concerns about the COTA®'s safety awareness during certain interventions. Which approach is the BEST for the OTR® to take to address these concerns? A. Speak with the rehabilitation manager about possible disciplinary action. B. Review the documentation of the two patients who fell and discuss their cases thoroughly with the COTA® to determine the causes of the falls. C. Ask the COTA® whether more thorough supervision is needed and then proceed to provide close supervision. D. Collaborate with the COTA® to determine potential causes of the falls and provide direct supervision with more deliberate feedback.

D. Supervision that is more frequent may be necessary when the OTR®, COTA®, or both determine that additional supervision is needed to ensure safe and effective delivery of occupational therapy services. In this case, safety is a major concern, and therefore additional supervision may be necessary.

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

D. The OTR® would use the word legibility formula, which would allow the OTR® to calculate the number of written words relative to the number of legible words. The OTR® would likely also address the other legibility factors, such as alignment, spacing, sizing, and slant.

An OTR® is working on bed mobility with a client in the active phase of C8 spinal cord injury. The client becomes dizzy and nauseous when brought to the sitting position. What is the BEST action for the OTR® to take? A. Apply antiembolism stockings and continue activity. B. Return to the lying position and loosen clothing. C. Transfer to wheelchair and elevate legs. D. Return to the lying position and elevate legs.

D. The client appears to be experiencing symptoms of orthostatic hypotension and should be reclined with legs elevated until symptoms subside A: Antiembolism stockings may help prevent orthostatic hypotension, but they are not the best choice when symptoms have begun. B: Clothing does not need to be loosened for clients experiencing hypotension and may partially prevent blood pressure from rising as needed. C: Because the client is already in bed, it would be most efficient to keep the client there.

An OTR® is collaborating with a team of early intervention specialists to develop an individualized family service plan (IFSP). Which of the following components is required? A. Steps to support the child's transition to preschool B. Projected dates of each individual service to be provided C. A detailed report and documentation of all sources of income for the family D. A statement of all expenses to be incurred from occupational therapy services

A. A description of the steps to support the child's transition to preschool is one of the required components of an IFSP under the Individuals With Disabilities Education Act.

A client with Stage 1 Parkinson's disease (PD) identifies grocery shopping as a valued occupation but lists fatigue as a barrier and states that occasional tremors can be embarrassing. What intervention approach would be meaningful as the OTR® prepares to accompany the client to the store for an occupation-based treatment session? A. Creating a list of needed items and making a route to navigate the store efficiently B. Providing the client with psychosocial support to focus on reducing the anxiety or shame associated with symptoms C. Having the client don wrist weights to reduce tremors while reaching for items to put in the shopping cart D. Instructing the client in the use of a rollator to take seated rest breaks or one of the store's power chairs to save energy

A. A is the simplest approach; organizing a grocery list and planning the most efficient route through the store to obtain the needed items is an energy conservation technique that maintains dignity.

An OTR® is working with a child who has a diagnosis of cerebral palsy. The child demonstrates an extreme startle response on hearing a loud noise coming from another treatment space. Which key marker of cerebral palsy is this behavior associated with? A. Retention of primitive reflexes B. Abnormal or variable tone C. Clonus D. Involuntary movements

A. An extreme startle may be associated with a retained Moro reflex.

An OTR® is planning intervention approaches for a client in the recovery stage of Guillain-Barré syndrome (GBS). According to the biomechanical frame of reference, which preparatory method is the BEST for addressing upper-body dressing? A. Instruct the client in hand-strengthening exercises using therapy putty to increase strength for manipulating fasteners on shirts. B. Measure the client for resting hand splints to wear at night to prevent contractures while ROM returns to bilateral hands. C. Teach the client how to use a dressing stick and button hook to don a formal shirt independently. D. Develop a home exercise program for the client for upper-body ROM and light strengthening and provide education on energy conservation and the importance of rest breaks.

A. A correctly addresses hand weakness and its effects on fine motor tasks of dressing. The biomechanical frame of reference is a common theory used in practice and focuses on restoring or remediating skills to enhance occupational performance. A hand-strengthening program would restore needed ROM and muscle power to adequately perform fine motor tasks.

A client with a new diagnosis of bipolar disorder is struggling with the medication routine. The OTR® decides to address it with a scaffolding approach to the task. How is this approach BEST described? A. The OTR® and the client work together to type a list of medications and their times and dosage. The OTR® instructs the client to post it by the medicine and check off each dose taken. B. The OTR® educates the client on the benefits of using an electronic pill-dispensing device that has been preprogrammed to dispense the medications at the proper time, and the OTR® sets it up. C. The OTR® and client collaborate on ways to remember to take medications; the client says that an alarm on the client's cell phone would work, and the OTR® sets it for the client at the appropriate times. D. The OTR® meets with the client at the start of each week to help the client set up a daily pill box for the week ahead and reviews compliance from the previous week.

A. Scaffolding occurs when the OTR® helps the client perform the parts of the task that are difficult, but the client completes the task. In this example, the OTR® helps the client create a detailed list of the medication routine, but the client posts it and checks it off every day.

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. The 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 and was last revised in 1991.O*Net is an online searchable database for information about occupations. Both DOT and O*Net are consulted when obtaining occupational information. B: OSHA is an agency of the U.S. Department of Labor. Its mission is to ensure safe and healthful working conditions. NIOSH, a division of the Centers for Disease Control and Prevention, is responsible for conducting research and making recommendations for the prevention of work-related illnesses and injuries. C: An employer-provided job description may not be the most inclusive or comprehensive source. D: The U.S. Department of Labor is the department of the U.S. government responsible for occupational safety, wage and hour standards, unemployment insurance benefits, reemployment services, and some economic statistics.

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® 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.

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

A. The OTR® should first assess the client's interests and roles to develop a transition plan to promote movement from school to postschool activities.

The mother of a 5-year-old child with attention deficit hyperactivity disorder is nervous about her child's ability to perform in kindergarten. What is the BEST recommendation the OTR® can give using the Person-Environment-Occupation (PEO) Model? A. Allow the child to adjust to the classroom setup for a few weeks and observe whether there are difficulties B. Further develop the child's attention and sitting span to prepare for the structure of kindergarten C. Ask the teacher to position the child closest to the front of the class for immediate monitoring D. Defer kindergarten until the child is able to sit for at least 30 minutes at a time

A. The PEO Model focuses on the transaction between the child (person), the classroom (environment), and school-related tasks (occupation). By allowing time to adjust, the parent will be able to assess the fit between kindergarten and the child's strengths.

A client with developmental coordination disorder is referred for evaluation by the transition services team at a high school. Which assessment is the MOST appropriate for the OTR® to complete first with the client? A. Self-Directed Search B. Cognitive Status Examination C. Box and Block Test D. Functional capacity evaluation

A. The Self-Directed Search measures a client's vocational interests.

An OTR® working with families of children with autism wants to ensure a family-centered intervention program. Which strategy BEST reflects use of this approach? A. Ensuring that all of the children's skill deficits are addressed B. Helping develop a weekend plan of activities with the families C. Educating families about their child's deficits and needs indicated in the evaluation D. Modifying families' lifestyle to ensure carryover of intervention at home

B. Of the options, only involving families in selecting activities reflects a family-centered approach to intervention.

An OTR® receives a referral for evaluation of a 6-year-old client with autism and sensory processing disorders who has extreme difficulties with sports activities in physical education class. The mother reports that the child has fair to good comprehension of verbal instructions but cannot seem to follow movement patterns related to sports activities. Medical reports indicate that the child is able to follow simple verbal directions and is generally able to perform during standardized testing. Which assessment is the BEST choice for assessing this child? A. Sensory Integration and Praxis Test B. DeGangi-Berk Test of Sensory Integration C. Sensory Profile D. Sensory Processing Measure

A. The Sensory Integration and Praxis Test offers the most comprehensive measure of sensory integrative functions appropriate for a child's age. B: The DeGangi-Berk Test of Sensory Integration is indicated for children aged 3-5 years. C, D: The Sensory Profile and Sensory Processing Measure are rating scales that offer a limited picture of possible praxis problems of the child.

An OTR® is preparing to perform bedside ADLs with a client with spinal cord injury. As the OTR assists the client into a sitting position, the client reports dizziness and nausea. What action is the MOST APPROPRIATE for the OTR to take? A. Assist the client in returning to a reclining position and elevate the client's feet. The OTR should alert the client's nurse and physician as soon as possible. B. Place the client upright, remove restrictive devices, and check the client's catheter. The OTR should alert the client's nurse and physician as soon as possible. C. Ensure the client is seated and quickly leave to alert the nurse or physician. D. Encourage the client to remain seated, with assistance, and wait for symptoms to pass. The OTR should alert the client's nurse and physician as soon as possible.

A. The client is experiencing orthostatic hypotension and should be returned to a supine position, with feet elevated over the heart. The OTR should alert the client's nurse and physician as soon as possible.

An OTR® is evaluating a construction worker who recently experienced radial wrist pain in the right dominant hand. The worker has been unable to perform the duties of the job and is working light duty. Which short-term goal would be BEST, using the RUMBA tool for goal writing? A. Client will improve work tolerance to use right hand and wrist to lift 5-lb bucket during work activities within 2 weeks. B. Client will receive ultrasound twice daily to right radial wrist area for 2 weeks. C. Client will increase score on the JebsenTaylor Hand Function Test within 2 weeks. D. Client will be able to type 2 minutes using right wrist cockup splint within 2 weeks.

A. The goal includes the relevant outcome (improve work tolerance) and time to meet goal (2 weeks) and is understandable, measurable, behavioral (i.e., the outcome can be observed), and achievable in the time frame given.

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

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

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

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

An OTR® is establishing reasonable accommodations for a client with a history of attention deficit disorder who is employed as a receptionist for a lawn care company. The client exhibits decreased attention span, concentration, and periodic physical restlessness. The essential job functions include answering phone calls, taking messages, sending out statements for services rendered, and setting up appointments. Which accommodation is MOST appropriate for the OTR® to recommend? A. A digital voice messaging system to save and review phone messages B. A redesign of the work space to minimize distractions C. A day planner to organize tasks D. A color-coded filing system to organize records

B. Essential job functions are defined as job duties fundamental to the position the individual holds or desires to hold, as opposed to functions that are marginal. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Redesigning the office space to limit distractions to promote the client's ability to attend to tasks would be the most appropriate choice. A: Before purchasing a digital voice messaging system, the OTR® should recommend minimizing distractions in the client's work environment. According to the Job Accommodation Network, most job accommodations cost less than $500. Accommodations may involve altering the job duties or work schedule, modifying the facility, purchasing adaptive equipment or assistive technology, or modifying or designing a new product. C, D: Using a day planner and a color-coded filing system are compensatory strategies to improve organizational skills.

An OTR® is performing caregiver training for a client with Stage 3 Parkinson's disease (PD) and family members because of the client's emerging need for increased assistance with ADLs and mobility. Which instruction would MOST appropriately help family members deal with a freezing episode? A. Educate the family to have the client silently count each step while walking. B. Recommend that the family use a rhythmic beat to each step as they walk with the client. C. Advise the family to place vertical strips on the floor where freezing episodes are likely to occur at home. D. Encourage the family to give the client tactile cues to promote weight shifting to resume walking.

B. External cueing and feedback from caregivers is an important strategy to improve safety and in this case reduce freezing episodes. The rhythmic nature of counting out loud or using a beat helps promote smoother movements that are more coordinated.

An OTR® is working with a client with chronic obstructive pulmonary disease on therapeutic exercise and how to measure exercise tolerance. The client is performing seated bilateral shoulder flexion with 3-lb weights and rates this activity as "very, very easy." How would the OTR® appropriately grade this activity? A. Change the muscle groups used by switching to shoulder abduction. B. Advise the client to perform the task in a standing position. C. Switch the client to a resistance band. D. Increase the number of repetitions and have the client perform the exercises while standing.

B. If the client states that the current exercise is too easy, the OTR would appropriately upgrade the task. Performing these exercises in a standing position uses trunk and leg muscles, thereby increasing the physical demands.

An OTR® is asked to help a 4-year-old child with autism with feeding skills. A main concern for the parents is their inability to eat at a restaurant because the child can only tolerate food served at home. They also would like the child to tolerate sitting at a restaurant for at least 10 minutes to eat. Which treatment goal should the OTR® prioritize? A. Tolerate holding a French fry for 5 minutes while seated at a restaurant B. Tolerate sitting at a restaurant for 5 minutes while eating preferred home food C. Tolerate sitting at a restaurant for 1 minute while eating a French fry D. Tolerate putting a French fry near the mouth for 5 minutes while seated at a restaurant

B. Increasing food intake is difficult if the child is unable to tolerate sitting for a long time. Increasing the amount of time seated at a restaurant with preferred food must be the priority. A, C, D: These choices focus on incorporating tolerating a new food before the more important goal of being able to sit longer periods of time at a restaurant. Increasing nutritional intake takes a longer time to address; therefore, the social aspect of eating can be prioritized.

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

B. Maintaining at least 90 of hip flexion will help reduce spasticity and can be achieved by adjusting the height of the chair or using a small stool for the feet.

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

B. People with GBS are at risk for autonomic nervous system dysfunction such as postural hypotension or experiencing a significant drop in systolic blood pressure on moving from a horizontal to an upright position. Common among people who endure a prolonged time in bed, the change in position causes blood to rush to the lower extremities, resulting in feelings of lightheadedness or dizziness. The best option is to slowly and carefully assist the patient back to supine, monitor blood pressure, position the patient in Trendelenberg (lower the head of the bed and raise the lower extremities), recheck blood pressure, and then alert nursing, leaving the call bell in reach.

An OTR® and speech-language pathologist are co-leading a group for people with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome). One of the group's outcome measures is to increase participants' social and pragmatic language skills. Which element of group design illustrates best practice for this type of group? A. The group must be heterogeneous. B. Participants should be encouraged to practice their new language skills in settings outside of the group context. C. The OTR® should lead this group as an occupational therapy group rather than engage in the group as a co-leader. D. Parallel group activities or tasks should be included to maximize social interaction.

B. People with autism spectrum disorder typically do not generalize skills well. A challenge in practice is to facilitate carryover of rehearsed skills from therapy sessions to other settings to ensure that participants can apply the skills in cross-contextual situations.

A child with a sensory processing disorder and Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome) is attending a regular classroom. Which reasonable accommodation would be BEST for this child under the Individuals With Disabilities Education Improvement Act? A. Place the student's desk at the back of the classroom B. Reduce the number of math problems to one per page C. Increase the number and variety of spontaneous activities in the school day D. Increase the number of other students at the student's lunch table

B. Presenting math problems one to a page reduces sensory overload by removing clutter on the page, allowing the student to attend to one math problem at a time and supporting the student in an inclusive setting by altering the task.

A client with history of Type 1 diabetes is employed as a computer programmer. The programmers sit with their desks next to and facing each other in an open floor plan. To minimize disruption and distraction, employees eat lunch and snacks in a break room that includes a full kitchen and several tables. In establishing reasonable accommodations for this employee, which suggestion is most likely to present an undue hardship for the employer? A. Alteration of the client's work schedule allowing for blood glucose monitoring and insulin injection B. Purchase of a small refrigerator to provide the client with ready access to insulin and snacks at the client's desk C. Alteration of lunch break to permit the client two 30-minute breaks instead of one 60-minute break D. Provision of improved lighting at the client's desk area and use of an antiglare magnifying computer screen

B. Provision of a separate refrigerator for the client's desk area may be considered an undue hardship because a refrigerator is already available in the break room, space near the client's desk is tight, and the office culture is to eat snacks in the break room. Undue hardship refers to any accommodation that would be unduly costly, extensive, substantial, or disruptive to or alter the nature of the operation of the business. Undue hardship is an exception to the ADA requirement that employers provide reasonable accommodations. The employee should store insulin and snacks in the refrigerator in the break room.

A 4-year-old child with attention deficit hyperactivity disorder is using a tire swing for vestibular input to feel more organized. After a few minutes, the child appears to have some autonomic reactions to the fast swinging. Which course of action for the OTR® is BEST? A. Immediately ask the child to stop and sit in a corner to relax B. Ask the child to slow down the swinging by pulling a trapeze bar for proprioceptive input C. Ask the child to slow down while doing slow, deep breathing D. Let the child continue because the vestibular stimulation ceases with autonomic activation

B. Research indicates that proprioceptive input inhibits vestibular stimulation.

An OTR® has just begun working on the cardiology unit of an acute care hospital and will be responsible for supervising the COTA® who has been on this unit for 5 years. What is the BEST type of supervision for this COTA®? A. Continuous B. Minimal C. Routine D. Close

B. The COTA® has been working on the unit for 5 years and likely sees very similar types of patients. Therefore, the COTA®'s knowledge and professionalism likely do not require frequent supervision.

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

B. The Ecology of Human Performance Model states that a child's true performance occurs in natural environments. Bringing the child to a sandwich shop is a way to test transfer of a learned skill.

A COTA® decides that a client has returned to the previous level of function and continued occupational therapy services are no longer needed. Which is the BEST way to discharge this client? A. The COTA® sets a last treatment day, provides a home exercise program, and reviews progress with the patient while completing the discharge note. B. The COTA® alerts the OTR®, and the OTR® reviews the documentation, discusses the patient's progress and response to intervention, and collaborates on a last treatment day. C. The COTA® notifies the OTR®, who meets with the patient to discuss potential discharge from therapy, and the OTR® proceeds with the discharge. D. The COTA® sets a last treatment day, provides a home exercise program and home safety packet, and reports final notes on functional levels to the OTR®

B. The OTR® judges a client's need to continue, modify, or stop occupational therapy services, based on information and documentation from the COTA® about the client's feedback and performance during the intervention process. This choice best depicts the roles of the COTA® and OTR® in the discharge planning process.

An OTR® is working with a client with hemiplegia on laundry tasks. Folding the laundry proves too difficult because of the weaker extremity, and the client becomes increasingly frustrated. How should the OTR BEST modify the activity? A. Stop the task and move on to the next planned activity. B. Instruct the client to sort the laundry by type of garment using both hands. C. Use appropriate therapeutic use of self to address the client's frustration. D. Allow the client to practice hanging up clothes in the closet.

B. The activity analysis skill here is grading; the OTR recognizes the difficulty of performing this bilateral upper-extremity activity and appropriately downgrades the task to reduce the demands.

An OTR® is in the process of completing a functional capacity evaluation (FCE) on a client employed as a cashier in a lumber yard. The client was referred to occupational therapy after sustaining a ruptured biceps while lifting a sheet of lumber. The OTR® suspects the client is exhibiting less than maximum effort during assessment. How would the OTR® BEST assess grip strength to determine whether client is exhibiting maximal effort? A. Have the client complete three trials on the second handle setting of the Jamar dynamometer. B. Have the client complete one trial on each of the five handle settings of the Jamar dynamometer. C. Have the client perform rapid exchange between the left and right hands for a total of 20 trials for each hand using the Jamar dynamometer. D. Have the client perform two trials on each of the five handle settings of the Jamar dynamometer and compare the results with normative data.

B. The five-level grip test is used to determine maximum and consistent effort by clients. The OTR® should expect the strongest grip on the second and third handle settings

A client who had a recent CVA would like to return to work on an assembly line at a manufacturing plant. An OTR® preparing to provide job coaching to this client should review which document FIRST? A. Functional capacity evaluation B. Job analysis for essential functions C. Performance reviews of worker D. ADL and IADL checklist results Solution

B. The job analysis identifies the physical, psychological, cognitive, and social functions of a specific position and is used to assess whether a worker with a disability or injury can perform the job task requirements.

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

B. The question describes typical dressing behaviors of clients at Mode 4.0; a client would attend to visible sensory cues and ignore what is not in plain sight (e.g., not tucking in the back of the shirt).

A client who has cardiac disease is participating in outpatient occupational therapy and is able to complete activities in the 1-4 metabolic equivalent (MET) range. Dyspnea and angina limit physical activity above 6 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 12 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 fold towels 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. This routine targets different muscle groups for the same time interval while offering opportunities to gradually increase the intensity of the tasks. A: Self-care tasks are within the MET range of 1.0-2.5, which the client is currently able to complete; therefore, this intervention would not provide sufficient challenge for the client. C, D: Working on one piece of exercise equipment, such as pedaling on a stationary bike or walking on a treadmill, provides only one form of aerobic exercise and limits the targeted muscle groups. In addition, these exercises could push the client over the 6-MET limit.

An OTR® is evaluating a child with Level 1 autism spectrum disorder without intellectual impairment. At 1:05 p.m., the child pulls out a smartphone and says, "It's 1:05. I have to check the weather." What response to this behavior would be MOST effective? A. Redirect the behavior to a more appropriate one B. Insist that the child put the cell phone away during the evaluation C. Find out more about the child's insistence on checking the weather D. Introduce the child to a new weather app for the smart phone

C. An evaluation includes identification of factors that affect participation in occupation, and this ritual is one such factor. It is good client-centered practice to obtain the client's perspective on what the weather at 1:05 means to this person and to gather enough information about it to determine whether this factor is a strength or a weakness. A, B: Interrupting a ritualistic behavior may provoke anxiety or a meltdown, which would render the remaining data the OTR® gathers unreliable. Keeping the client functioning at his or her optimal level by reducing and minimizing anxiety is essential to the evaluation process. D: Introducing the client to a new weather app is more appropriate in evaluating the ability to adapt to new learning.

An OTR® receives evaluation orders for a client who has recently experienced traumatic brain injury. The client displays severe memory impairment and can only respond to simple commands without being distracted. What Rancho Los Amigos level BEST corresponds with the client's behavior? A. VII B. III C. V D. II

C. Because the client is highly distractible and displays severe memory impairment but can respond to simple commands, the client most closely resembles Level V. A: A Level VII client has limited distractibility and is capable of carrying out a intelligible conversation despite minimal confusion. B: A Level III client inconsistently responds to stimuli and would not be capable of intelligibly responding to simple commands. D: A Level II client responds to stimuli only through physiological changes, gross body movement, or vocalization.

On the way to evaluate a student in the lunchroom, an OTR® working under a fee-for-service contract observes another client with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome) reacting negatively to a student who accidently brushed against the client in line. Which response would be BEST? A. Do nothing, because the OTR® is on the way to a session with another student B. Deliver negative consequences to the client for misbehaving C. Suggest that the client move to the end of the line to avoid being crowded D. Suggest that the client eat alone in a room to avoid being crowded

C. Being the last person in line will create the space the client needs to successfully wait in line for lunch. Additionally, the client will feel safer knowing that no unwanted sensory stimulation can come from behind.

A 6-year-old child with autism is trying to kick a ball through a goal 10 feet away. The child has made six attempts already. Although the child is able to kick the ball with correct movements, the child does not seem to be able to calibrate the amount of motor input to approximate the goal. When the child kicks the ball, it always lands beyond the goal. What skill seems to be impaired for this child? A. Executional praxis B. Upper-extremity coordination C. Feedforward praxis D. Eyehand coordination

C. 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.

An OTR® evaluates a client who has just entered the plateau phase of Guillain-Barré syndrome (GBS). When assessing ADLs, what would the OTR most likely expect to see? A. Bowel and bladder incontinence, which affects skin integrity and toileting routine B. Unilateral sensory impairments, which affect fine motor tasks such as oral care C. Edema and weakness in the lower extremities, which makes bathing and dressing difficult D. Shoulder weakness, which results in decreased independence in upper-body bathing and dressing

C. In the plateau phase, symptoms are at their most severe: Edema and weakness are common symptoms with GBS. Because symptoms are typically symmetrical and ascend from distal to proximal, bilateral symptoms would likely affect self-care of the lower body.

An OTR® is working in the neonatal intensive care unit with a 28-week-old infant and the infant's mother. The infant has bronchopulmonary dysplasia (BPD). Which occupation would be affected by this condition? A. Bathing B. Dressing C. Feeding D. Socializing

C. Infants with BPD may require the use of mechanical ventilation and other traumatic interventions to treat acute respiratory problems. In addition, they may experience excess mucus and airway thickening that may make feeding difficult.

Which of the following goals would be appropriate for a client with mild dementia? A. Client will improve money management skills to independent as evidenced by paying five of five bills on time in 30 days. B. Client will verbalize with 100% accuracy the names of at least four family members once cued when looking at family photos. C. Client will maintain good safety during independent light meal preparation while using visual cues for sequencing as needed. D. Client will improve bathing to independent while using adaptive equipment for safety.

C. The primary goals for clients with dementia are related to maintaining functional capacity.

A person with Level 1 autism spectrum disorder without intellectual impairment is having difficulty in the transition to a new adult foster care home, and an OTR® is contracted to make four home visits to assess the client and provide appropriate intervention. When the OTR arrives for the first visit and attempts to interview the client, the client angrily refuses to speak with the OTR. Which option is BEST in response? A. Stay long enough to convince the client to cooperate so that the placement can be successful B. Engage the client in a favorite game and convince the client to work together C. Leave the home, allowing the client to refuse occupational therapy services D. Tell the client that the OTR will stop hassling the client after four visits

C. Recipients of occupational therapy services have the right to refuse services. As noted in Principle 3 of the AOTA 2020 Occupational Therapy Code of Ethics, "Occupational therapy personnel have a duty to treat the client or service recipient according to their desires, within the bounds of accepted standards of care" (p. 3). Because the client's foster family is also a client, it would be acceptable to ask the client for permission to meet with the foster family to gather information and provide indirect recommendations.

A COTA® is working toward service competency for adaptive feeding equipment instruction. How would the OTR® BEST establish the COTA's service competency? A. The OTR reviews the COTA's documentation of multiple patients whose feeding impairments warranted adaptive equipment, then discusses the progress notes and related documentation with the COTA. B. The OTR observes the COTA educating clients on how to use adaptive feeding equipment to ensure that the COTA instructs clients following the plan of care. C. The COTA and OTR observe the same client using adaptive feeding equipment and, using established procedures and protocols, rate the client at the same level of performance. D. The OTR collects information from various sources, including other therapists, the COTA's documentation, and feedback from clients, to determine competency.

C. Service competency is defined as "the process of teaching, training, and evaluating in which the OTR determines that the COTA performs tasks in the same way that the OTR would and achieves the same outcomes" (AOTA, 2009, in Youngstrom & Gentile, 2019). In this example, both the COTA and the OTR observe the same client performing a task and rate that performance at the same level using the same outcome measure.

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

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

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 is indicated when a sudden catch or resistance occurs within a quick movement throughout the range of motion for the extremity (Hypertonicity is typically elicited during slow joint movements.)

An OTR® is preparing to discharge a client to home after hip replacement. The client reports having a high-step tub with a shower door and no money to buy additional equipment. Which recommendation is MOST appropriate for bathing? A. Recommend the client substitute a plastic lawn chair for a shower chair. B. Recommend the client place nonskid strips on the floor of the stall. C. Recommend the client sponge-bathe at the sink until the client is sufficiently healed to use the shower. D. Recommend the client stay at the facility until the client is sufficiently healed to use the shower.

C. Sponge-bathing at the sink is an alternative activity if hip precautions cannot otherwise be met.

An OTR® is working with a client with Down syndrome to develop cooking skills. The client successfully makes a peanut butter and jelly sandwich. Which therapeutic activity would be BEST for the next treatment session? A. A turkey-and-cheese sandwich B. A microwavable dinner C. A grilled cheese sandwich D. A stir-fry vegetable dish over brown rice

C. The activity analysis skill here is grading; the OTR® recognizes the success of a multistep cold meal and appropriately upgrades the task to require more complex steps.

An OTR® is working with a client with a T2 spinal cord injury. While performing ADLs, the client reports a pounding headache and is sweating profusely. What action is MOST APPROPRIATE for the OTR to take to help the client? A. Ensure the client is seated and quickly leave to alert the nurse or physician. B. Recline the client and elevate the legs until the symptoms diminish, alerting the client's nurse and physician as soon as possible. C. Place the client upright, remove restrictive devices, and check the client's catheter, alerting the client's nurse and physician as soon as possible. D. End the session early to allow the client some rest, and alert nursing staff.

C. The client is experiencing autonomic dysreflexia, a medical emergency. The OTR should place the client in an upright position, remove anything restrictive, and check the client's catheter for an obstruction. The OTR should alert the client's nurse and physician as soon as possible.

An OTR® is conducting a classroom observation as part of an evaluation for a 6-year-old child with attention deficit hyperactivity disorder. The therapist decides to approach this case using the Occupational Adaptation Model. Which target of observation is MOST consistent with the use of this model? A. The way the child modulates various stimuli in the classroom environment B. The teacher's teaching styles and whether they match the student's learning styles C. The demand that the classroom rules place on the child's ability to follow them D. The child's ability to navigate the physical classroom

C. The occupational environment includes classroom rules, which create a demand for mastery. The interaction between the child's ability to follow the rules (desire for mastery) and the occupational environment creates a press for mastery.

An OTR® receives a referral to complete a functional capacity evaluation (FCE) on a client who is employed full time as a machinist in the tool-and-die trade. The client completed a course of outpatient therapy after a wrist fracture to the dominant hand. Which assessment would be MOST clinically appropriate to determine a client's ability to return to full-duty employment? A. A hand evaluation B. A situational assessment C. A fitness-for-duty assessment D. A job demands analysis

D. A job demands analysis looks to define the actual demands of the job and involves the use of questionnaires, interviews, observations, and formal measurement completed in the actual work environment. Many FCEs include a job demands analysis. A: A hand evaluation is a comprehensive assessment of upper-extremity function that does not assess the actual material handling skills required for job performance. B: Situational assessment is used to assess a client's ability to perform the exact same tasks in an environment identical to that of the actual target vocation. C: Fitness-for-duty assessment 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. Haruko Ha, D., Page, J. J., & Wietlisbach, C. M. (2018). Work evaluation and work programs. In H. M. Pendleton & W. Schultz-Krohn (Eds.), Pedretti's occupational therapy: Practice skills for physical dysfunction (8th ed., pp. 336-373). Elsevier; pp. 342-343.

An OTR® is working with a child who has a diagnosis of cerebral palsy. The child's tone fluctuates from low to normal with little spasticity. What would the OTR® expect to see when the child reached for a toy that was positioned on the table next to the child? A. A limb that appeared flaccid B. A limb that appeared ataxic C. A limb that appeared choreoathetoid D. A limb that appeared athetoid

D. Athetosis is characterized by tone that fluctuates from low to normal with little spasticity. A: Flaccidity is characterized by marked low tone. B: Ataxia is characterized by generally normal tone but involves flexor patterns in the lower extremities. C: Choreoathetosis is characterized by constant fluctuations from low to high tone, without co-contractions.

An OTR® is evaluating a child with Down syndrome who is transitioning from early intervention to the school system. The OTR wants to collect relevant information regarding the child's developmental history. Which method is the BEST to obtain this information? A. Observation B. Consultation with another provider C. Standardized assessment D. Parent interview

D. Because parents have intimate knowledge of their children's development, parent interview is the best way to obtain specific information about a child's developmental history, including when the child achieved different developmental milestones.

A client with secondary progressive multiple sclerosis (MS) is recovering from a recent relapse and seeks occupational therapy to manage anxiety associated with the disease and its effect on occupational performance. What strategy might the OTR® suggest? A. Participation in a cognitive retraining group B. Implementation of a home exercise plan that incorporates deep breathing C. Relaxation, such as taking a hot bath and yoga D. Using coping strategies for self-identified difficult tasks or situations

D. Emotional stress may exacerbate symptoms in clients with MS, especially relapse-related anxiety. This strategy is client centered and will empower the client with MS to problem solve and handle difficult tasks.

An adolescent with Down syndrome is applying for a part-time job and completing an online job application. Which visual-perceptual skill would this adolescent need to use to locate the appropriate tab to click on to submit the application? A. Form constancy B. Depth perception C. Visualspatial orientation D. Figureground recognition

D. Figureground recognition allows a person to distinguish between the foreground and the background so as to focus on the essential information (or objects) and not be distracted by other information.

An OTR® receives a referral to evaluate an older adult client with moderate-stage dementia who resides in a long-term care facility. While the OTR® is conducting the assessment, it becomes apparent that the client is becoming agitated. The client tells the OTR® that she or he is going to make the client late to pick up the client's children from daycare. What is the BEST approach for the OTR® to take in this situation? A. Remind the client that the children are grown adults. B. Attempt to engage the client in an alternative activity. C. Leave the client alone and plan to return later in the day. D. Assure the client that the client will be able to get to the daycare on time.

D. It is important to use therapeutic use of self with clients who have dementia. By acknowledging the client's issue, the OTR® is able to establish rapport and demonstrate empathy. In addition, by living in the client's reality, the OTR® will be able to observe how the client responds to stimuli and how to approach the client in the future and plan interventions.

A client with multiple sclerosis (MS) has been referred to occupational therapy because of impaired sensation in the bilateral upper extremities. The OTR® wants to assess stereognosis. Which action would the OTR instruct the client to do after closing the eyes? A. Imitate with the right hand how the OTR has positioned the client's left hand. B. Use touch to determine whether an object is dull or sharp. C. Participate in the Semmes-Weinstein assessment. D. Identify an object in the hand by touch only.

D. People with MS may experience sensory deficits that affect perceptual skills. Stereognosis is "the use of both proprioceptive information and touch information to identify an item with the vision occluded" (Abrams & Ivy, 2018, p. 589).

An OTR® at an acute care hospital is evaluating a client in the onset stage of Guillain-Barré syndrome (GBS) who requires total assistance for most tasks. At this stage, what goals should the OTR focus on? A. Patient and caregiver education on the progressive nature of this disease B. ADL performance, especially adaptive equipment training and other compensatory strategies C. ROM and strengthening to prevent muscles from further weakening D. Positioning to prevent skin breakdown or contractures and to allow access to needed items Solution

D. The symptoms of GBS in the acute inflammatory stage—which include edema, muscle weakness or paralysis, sensory loss, bladder incontinence, and pain—increase a client's risk for skin breakdown, especially a client who is totally dependent for most tasks. Such clients are likely not able to reposition themselves or independently clean up incontinence issues. At this stage focusing on preventing secondary complications, such as skin breakdown and contractures, and decreasing anxiety, by having items such as a call bell, telephone, communication devices, and fresh water in easy reach, will be paramount.

An order came in for a hand splint for a new client. A newly graduated OTR® evaluated the client for the splint. The new OTR had not made a splint on a client before and requested an experienced OTR hand therapist's assistance. The newly graduated OTR decided to attend a splinting continuing education class to improve splint-making skills and increase the OTR's comfort level. By which ethical principle is the OTR abiding? A. Autonomy B. Justice C. Fidelity D. Beneficence

D. This principle relates to concern with the well-being and safety of clients. By becoming more proficient in splint making, the OTR® is demonstrating concern for the client's safety and well-being.

Under what circumstances is a COTA® allowed to administer the Kohlman Evaluation of Living Skills to a new patient in an inpatient acute psychiatric hospital? A. After an OTR® has directed the COTA® to initiate the evaluation process B. When the OTR® is unavailable to administer the assessment C. When the OTR® is in the room while the COTA® administers the assessment D. When the COTA® has demonstrated competence in administering the assessment to the OTR®

D. To administer an assessment, a COTA® must demonstrate to the supervising OTR® competence in administering the specific instrument. The supervising OTR® is responsible for ensuring that the COTA® is competent in each task he or she is directed to carry out.

A patient in the early stages of amyotrophic lateral sclerosis (ALS) presents with weakness in the thenar eminence. During which ADL task would the evaluating OTR® MOST LIKELY observe the effect on function? A. Transferring from the bed to the bedside commode B. Taking a sip from a glass of water C. Reaching overhead to don a T-shirt D. Squeezing toothpaste onto a toothbrush

D. Typical early signs of ALS are distal, with weakness of the small muscles of the hand being the most typical initial symptom. The muscles that make up the thenar eminence are responsible for opposition of the thumb. Squeezing toothpaste and holding a toothbrush require grasp-and-pinch patterns that involve thumb opposition.

A client presents with decreased awareness of cognitive deficits. What is the most effective strategy for an OTR® to implement to intervene with this cognitive impairment? A. An auditory signal that cues the client when he or she is not acting in a safe manner B. Reduction of the number of choices presented to the client at any given time C. Mental rehearsal of a task before participation to increase the likelihood that all steps will be completed D. Instruction in the use of a self-evaluation checklist (i.e., "Did I complete all the steps?")

D. Use of self-evaluation or self-reflection before or after a task are the most effective strategies for decreased awareness.

An OTR® at a private clinic is working with a 10-year-old client with attention deficit hyperactivity disorder and depression. At the start of the session, the child shows signs of being depressed and reports feelings of worthlessness because of academic difficulties. The client refuses to participate in the planned handwriting activity for the day. What is the MOST appropriate course of action for the OTR®? A. Ask the child to cheer up because many activities have been planned for the day B. Ask whether the child wants to discontinue the session C. Discontinue the session and report the signs of depression to the parent D. Offer the child a change in activities from planned handwriting to artwork

D. When a client is depressed and shows signs of self-concept issues, engaging in occupations that involve self-expression can help the client deal with his or her emotions

An OTR® receives evaluation orders for a client who has recently experienced traumatic brain injury. The client's chart lists a Glasgow Coma Scale (GCS) score of 7. What does this score imply? A. The client has experienced a severe head injury and will provide minimal feedback. B. The client has experienced a moderate head injury and may not be able to provide discernible feedback. C. The client has experienced a mild head injury and may be confused but able to follow simple commands. D. The client has experienced an extreme head injury and will provide minimal feedback.

Severe head injuries include GCS scores of 8 or less. B: Moderate head injuries include GCS scores of 9-12. C: Mild head injuries include GCS scores of 13-15. D: The GCS does not classify an "extreme" head injury.