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(C) Train the client in the operation of the AT system and in strategies for its use. Training activities in the use of the assistive devices are the next critical step after setup of the system, and are essential because the complex nature of assistive technologies can require many hours of practice to master.

106. An OT practitioner, along with the assistive technology team, has made specific recommendations for electronic assistive technology for an adult with muscular dystrophy. After the devices are ordered, and modified as necessary, the NEXT step in the process of implementation is for the OT to: a. Evaluate how well the whole system works. b. Evaluate if the assistive technology devices match the needs of the client. c. Train the client in the operation of the assistive technology system and in strategies for its use. d. Determine if funding is available for the assistive technology recommended.

(B) the OTR must assume responsibility for all OT services delivered. An OTR is always responsible for services provided by the COTA under his or her supervision. The AOTA does not require that the patient have a referral for provision of services. However, it is important to note that state licensure laws and accrediting agencies may require a formal referral. See reference: Ryan (ed): Practice Issues in Occupational Therapy: Ryan, SE: Therapeutic Intervention process.

111. When there is not a referral for OT services, it is MOST important for the COTA involved in the provision of services to know that: A. The OTR is operating outside the scope of practice and regulating agencies should be notified. B. The OTR must assume responsibility for all OT services delivered C. A written letter of consent must be received from the patient or a significant other D. The COTA should seek a referral from the patient's family physician

(C) Flange the area around the ulnar styloid. Reddened areas indicate the splint is too tight in a particular spot. To reduce pressure, it is often helpful to flange splint edges.

113. After wearing a new splint for 20 minutes, an individual develops a reddened area along the ulnar styloid process. The MOST important first modification the OT practitioner should make to correct the splint is to: A. Line the splint with moleskin B. Line the splint with adhesive-backed foam C. Flange the area around the ulnar styloid D. Reheat and refabricate the entire splint

(A) Set the climate, provide structure, and offer support. Answer A reflects typical leadership involvement in OT groups.

135. The PRIMARY functions of an OTR leading a therapeutic group in the beginning stages of group development will be to: a. set the climate, provide structure, and offer support. b. leave members to set the climate, provide structure, and offer support to each other. c. aid group members in separation d. work individually with group members until each is ready to join group activity.

(C) has a standard format. Standardization of a test means that the test is administered in a prescribed manner and that scoring and interpretation of scores are also completed in a prescribed way. See reference: Case-Smith (ed): Richardson, PK: Use of standardized tests in pediatric practice.

148. In selecting a standardized test to use with a child, an OT practitioner can assume that the test: A. is valid. B. has normative data. C. has standard format. D. is reliable

(C) Acute care hospitalization. The emphases of acute care hospitalization are symptom, reduction, medications, and discharge planning.

151. The treatment environment in which an OTR would be MOST likely to emphasize discharge planning for addressing mental health problems would be a(n): a. club house b. community mental health center c. acute care hospitalization d. quarterway house

(C) Digging a garden with a shovel. Activities that include bilateral use of tonic muscles against resistance, such as digging a garden, playing volleyball, or playing tug of war, can help to normalize tone in this population. See reference: Bruce and Borg: Movement-centered frame of reference.

153. An adult with schizophrenia walks with a shuffling gait and hunched posture. Using a movement-centered frame of reference, which of the following activities would MOST effectively contribute to normalization of this individual's posture? A. Dancing with rapid alternating movements B. Playing the game twister C. Digging a garden with a shovel D. Rocking in a rocking chair

(B) Use moderately heated water. Hot water may contribute to fatigue in individuals with MS and should therefore be avoided. Moderate water temperature is recommended.

156. A young individual with MS is about to be discharged to home. The client is independent in bathtub transfers using a grab bar. The MOST important self-care recommendation the OT practitioner can make regarding bathing is to: A. Use cool water B. Use moderately heated water C. Take showers and avoid bathing D. Bathe at the sink with a basin

(C) to both sides of the client's body. Answer C is correct because the client must be able to transfer to both sides of the body. It is usually difficult or impossible to arrange the home environment so that the all transfers can be done from one side only. For instance, if the toilet at home is close to the wall, getting on and off the toilet will require transfer first to one side of the body and then to the opposite side. The family also needs to know the different kinds and amounts of support they must use on each side of the client's body. See reference: Trombly (ed): Retraining basic and instrumental activities of daily living.

157. A client with hemiplegia and her spouse are working on toilet transfer training activities with the OT practitioner. The BEST way for the OT practitioner to teach the couple to perform transfers will be: A. only the unaffected side of the client's body B. only to the affected side of the client's C. to both sides of the client's body D. only to the side of the body from which the client will be approaching the toilet

(C) "I'm just too tired." One of the main symptoms of severe depression is decreased energy: therefore, the response of "I'm too tired" indicates fatigue.

16.In an acute mental health facility, an individual refuses to participate in OT activities, and the therapist notes the refusal in the subjective section of documentation note. Which form of refusal would MOST likely reflect acute depression? A. "I had an argument with another group member and I'm too angry" B. "I don't want to participate because I don't know how to do the activity" C. "I'm just too tired" D. "I'm waiting for my visitors to come"

(A) The amount of self-control demands, time management demands, self-expression opportunities, and interest in the activity. Components that are primarily within the psychosocial areas and skills of occupational performance are most important to consider with psychosocial populations.

16.Which of the following of the following performance components are MOST important to consider when analyzing activities for use with adults with psychosocial problems? a. The amount of self-control demands, time management demands, self-expression opportunities, and interest in the activity b. Age appropriateness, prehension patterns required, and the presence of small pieces that could be mistakenly swallowed c. Tactile, kinesthetic, visual and olfactory properties d. Space requirements, equipment and supply needs, cost and safety considerations

(A) learn to type. See reference: Fisher, Murray, and Bundy (eds): Cermak, S: Somatodyspraxia.

161. An individual with poor writing skills needs to produce large amounts of legible material upon returning to work. The MOST appropriate method of compensation the OT could recommend would involve having the person: A. learn to type B. practice fine motor coordination exercises C. practice letter or shape formations D. strengthen the finger flexors and extensors

(B) A tub bench and toilet rails. A tub bench and toilet rails make bathroom transfers easier and safer and allows the person with a unilateral LE amputation to transfer independently.

165. In preparing a patient with a unilateral below-knee amputation for discharge from a rehabilitation facility, the MOST important adaptive equipment for the OT to recommend is: A. Lightweight cooking utensils B. A tub bench and toilet rails C. Long-handled dressing devices D. A reacher

(B) Objective. Measured results based on an individual's performance are included in the objective section.

166. "The patient arrived without her walker 3 out of 3 days this week." The MOST appropriate section of a SOAP note for the OT practitioner to place this statement is the: A. Subjective B. Objective C. Assessment D. Plan

(C) Removing the threshold altogether. Removing the threshold altogether would be the simplest and safest solution. Door thresholds may have a maximum height of a half inch and these must be leveled. The best solution would still be to remove the threshold altogether to provide the most accessible surface.

172. An OPT practitioner is providing accessibility consultation services to a local library. In the back of the library there is a reference room with a doorway that has a threshold of 1-inch height. Concerning the threshold and accessibility according to the ADA guidelines, the BEST recommendation would be: a. Keeping the threshold as is, place a sign near the door alerting people to the threshold. b. Providing a throw rug which covers the threshold. c. Removing the threshold altogether. d. Ramp the threshold.

(D) Suggesting furniture and accessories that promote better positioning at work. The best recommendation is for ergonomically correct furniture and accessories. Additional adaptations may include tool modification and the training of workers in appropriate positioning.

175. An OT practitioner is requested to evaluate and make recommendations to a job site that is in search of ergonomic adaptations. An example of this type of adaptation might be: A. Introducing relaxation seminars for employees to decrease stress while on the job B. Treating corporate clients for cumulative trauma disorders C. Initiating a smoking cessation program D. Suggesting furniture and accessories that promote better positioning at work

(D) Perform slow push-ups against the wall. Having the child perform push-ups against the wall is an activity which provides joint compression of the upper extremities with motor activity- a combination which will have a normalizing effect on the nervous system. See reference: Kramer and Hinojosa (eds): Kimball, JG: Sensory integration frame of reference: Theoretical base, function/dysfunction continua, and guide to evaluation

18.A therapist is discussing discharge plans with the parents of a 7-yearold child with sensory defensiveness problems. The OT practitioner is recommending additional activities for a "sensory diet" to provide proprioceptive input. The MOST appropriate activity for this child would be to: A. Walk barefoot on textured surfaces B. Rock over a large therapy ball C. Play in a large box full of Styrofoam pellets D. Perform slow push-ups against the wall

(D) Shallow spoon. The use of a shallow spoon encourages the development of upper lip control because it makes it easier for the lip to remove all of the food on the spoon. It would be more difficult for the child to get food on the spoon. See reference: Case-Smith (ed): Case-Smith, J, and Humphry, R: Feeding intervention

19.The MOST appropriate device to use for promoting development of upper lip control is a: A. Straw B. Spork C. Deep spoon D. Shallow spoon

(D) All individuals with open wounds. Treating blood and body substances of all individuals as though they are contaminated is the concept of universal precautions. There are several strategies to protect employees from potential exposure. Engineering controls modify the work environment to reduce risk of exposure; for example, using sharps containers, eyewash stations, and biohazard waste containers. Work practice controls are policies that require a procedure be performed a certain way so that potential for exposure is minimized. Examples of work practice controls include the technique for disposal of sharps using only one hand and frequent hand washing during and after patient contact. Personal protective equipment, another strategy is the use of appropriate gear to prevent contact with blood or identified bodily substances. Equipment may include goggles, masks, gowns, and gloves. Answers A, B, and C are all examples of individuals with open wounds, where exposure to blood is likely. Both the health-care provider and the patient could be placed at risk unless gloves are worn.

190. OT practitioner should PRIMARILY wear gloves when working with: a. individuals with open wounds who have been diagnosed with human immunodeficiency virus. b. individuals with third-degree burns. c. individuals with open wounds who have been diagnosed with hepatitis. d. all individuals with open wounds.

(C) Obtain a physician's plan of care identifying services to be provided. Within the home care setting, the therapist must have a physician's order, which identifies the services that are to be provided. See reference: Piersol and Ehrich (eds): Zahoransky, M: The system and its players.

191. A home health OT has received a referral from an individual with Medicare coverage. Which one of the following actions must occur before the therapist can initiate evaluation or treatment? A. Identify the deficits that impair functional abilities B. Establish short and long term goals C. Obtain a physician's plan of care identifying services to be provided D. Obtain the individual's history of the current illness

(A) Copying letters. A test of visual motor integration usually consists of design-copying tasks that can yield information on the child's ability to translate a visual image into a motor output. Visual motor integration is defined as "the ability to integrate the visual image of letters and shapes with the appropriate motor response necessary".

2. An OTR is MOST likely to administer a test of visual motor integration to a child referred to OT for difficulty with: A. Copying letters B. Remembering letters C. Recognizing letters D. Sequencing letters

(B) Learning proper body mechanics. Learning proper body mechanics (along with achieving a good fitness level) is one of the first steps to reducing the risk of reinjury in a work program. See reference: Neistadt and Crepeau (eds): Fenton, S, and Gagnon, P: Treatment of work and productive activities. Functional restoration, an industrial approach.

21.An OT practitioner is working with a client in a work program setting. What is the FIRST step to achieving the program objective of preventing reinjury within a work program? A. Performing a prework screening B. Learning proper body mechanics C. Participating in work hardening D. Engaging in vocational counselling

(C) Biomechanical FOR. The biomechanical approach is based on enhancing strength, ROM, and endurance. The biomechanical approach is typically used when impairment does not affect the interact CNS. This approach is primarily used for individuals who have had a traumatic injury or illness that has affected the musculoskeletal system.

22.A therapist is evaluating an individual with a peripheral nerve injury for strength, range of motion and endurance. The most appropriate frame of reference on which to base the evaluation is: a. rehabilitative FOR b. neurodevelopmental FOR c. biomechanical FOR d. psychoanalytic FOR

(A) provide each patient with an individual project and have him or her choose a tile color for the projects. The activity should begin with the most basic level of decision making. Each of the other choices provide increasingly more challenging decision making abilities. See reference: Early: Analyzing, adapting, and grading activities.

22.The goal of an arts and crafts group for chronically mentally ill individuals is to improve their decision-making abilities. The MOST appropriate approach to initiating a mosaic tile activity would be to: A. Provide each patient with an individual project and have him or her chooses a tile color for the project B. Have the patient choose from a variety of projects C. Have the patients decide on a design, size, shape and colors for a group mosaics projects D. Have the patients decide on a pattern and two tile colors to use in the his or her mosaic project

(C) At age level. At 3 years of age, a child is expected to know when he/she to use that toilet and be able to get on and off the toilet. Three-year-old children may need assistance to cleanse themselves effectively and to manage fasteners or difficult clothing.

25.A 3-year-old child is able to use the toilet independently except for wiping and readjusting clothing afterward. This behavior indicates the child is performing at which of the following levels? A. Significantly below age level. B. Slightly below age level C. At age level D. Above age level

(D) doll house and dress-up clothes. To encourage symbolic play, the child should be exposed to toys offering imaginative, open-ended play opportunities, encouraging formulation of ideas and feelings. See reference: Case-Smith (ed): Morrison, CD, Metzger, P: Play.

25.In a home program to promote beginning symbolic play for a child with developmental delay, the OT practitioner would MOST likely recommend playing with: A. Busy box, nesting toys, and blocks B. Board games C. Craft kits D. Doll house and dress up clothes

(B) A local wheelchair equipment vendor. Although any community resource may be helpful to a child and family with a severe physical disability. Answer B is correct because of the possible break down in this piece of equipment, which has already been purchased. The OT practitioner needs to consider this possibility and provide local support for a problem solution. See reference: Case-Smith (ed): Wright-Ott, C, and Egilson, S: Mobility.

27.An OT practitioner is planning discharge and follow-up via a consultant only basis for a child with paraplegic spina bifida who has just started using a powered wheelchair. The community resource that the OT recommends as MOST critical for this child is: A. The local social service agency B. A local wheelchair equipment vendor C. The family physician D. The early intervention program

(C) Anterograde amnesia. Anterograde amnesia is the inability to recall events after a trauma.

37.An individual with myocardial infarction (MI) was transferred from the acute care unit to a rehabilitation unit. During the initial interview, he displays good memory of information processed before the MI but poor recall of the period spent in the acute care facility. He is able to recall information since the transfer. The OT practitioner would be MOST likely to document these behaviors as: A. Orientation problems B. Long-term memory deficits C. Anterograde amnesia D. Retrograde amnesia

(A) using effective communication skills. Clarifying expectations, honestly defining needs, and providing tactful and constructive feedback are communication with the patient's children will most likely help them deal with their fears and concerns, increase their understand of their father's condition, and elicit greater cooperation. See reference: Neistadt and Crepeau (eds): Giles, GM, and Neistadt, ME, in Treatment for psychosocial components: stress management.

38.During a stress management group, and individual recently diagnosed with MS complains that his teenage children are resistive to helping with chores that were previously his responsibility, such as mowing the lawn and taking out the trash. The stress management technique that would MOST successfully address this concern is: A. Using effective communication skills B. Applying time management techniques C. Deep breathing D. Laughter

(B) Go out for lunch to a fast-food restaurant. A key principle in intervention for effective transition includes using natural environments and cues and increasing community-based instruction as the student gets older. See reference: Case-Smith (ed): Spencer, K: Transition services: From school to adult life.

39.An OT practitioner is developing transition activities for a group of 16 year old students diagnosed as trainable mentally retarded. Which of the following activities would be BEST for addressing goals related to transition? A. Role play ordering food in the classroom B. Go out for lunch to a fast-food restaurant C. Order take out lunch by phone D. Select lunch items from a picture menu in the classroom

(C) Skilled observation. Checklists are simple lists of factors or behaviors that a therapist thinks are important to observe as a support for referral or screening of a child. Although checklists may appear in a standard format, they are not well developed enough to include establishment or normative data and other attributes of tests, such as validity and reliability.

39.The OT practitioner plans to use a checklist she has designed for evaluating a child's eating performance skills. Which term BEST describes the type of evaluation the OT practitioner will be using? A. Norm referenced B. Criterion referenced C. Skilled observation D. Valid and reliable

(B) Moro reflex. The Moro reflex is characterized by abduction, extension, and external rotation of the arms. See reference/; Neistadt and Crepeau (eds): Kohlmeyer, K: Evaluation of performance components.

39.While observing a child for the first time, the OT practitioner notes that the child responds to a loud noise by abducting and extending the arms. The reflex observed in this child is documented by the OT as a: A. Rooting reflex B. Moro reflex C. Flexor withdrawal reflex D. Neck righting reaction

(B) Stressing bilateral activities incorporating the prosthesis. Two-handed activities for play, school, and self-care should be used to incorporate the prosthesis into the child's body image. See reference: Pedretti (ed): Rock, LM, and Atkins, DJ: Upper extremity amputations and prosthetics.

4. A young child has been wearing left upper extremity prosthesis for 3 weeks. When consulting with the child's preschool teacher, the OT practitioner recommends: A. Offering toys that the child can manipulate with one hand B. Stressing bilateral activities incorporating the prosthesis C. Teaching the child one-handed manipulation techniques D. Involving the child in activities that do not require manipulation, such as sing-alongs

(C) Provide a screen to reduce peripheral visual stimuli. Although all the answers describe techniques that could assist the student the use of a carrel is most appropriate in a mainstreamed classroom, because the other methods or adaptations. See reference: Case-Smith (ed): Schneck, CM: Visual perception.

46.Direct OT services are being discontinued for a student with attention deficit disorder, but consultation will be provided to help the child adjust to the new classroom. Which of the following recommendations is MOST appropriate? A. Use dim lighting and reduce glare by turning down the lights B. Remove all posters and visual aids to reduce visual distractions C. Provide a screen to reduce peripheral visual stimuli D. Restructure classroom activities into a series of short-term tasks

(B) perform the evaluation over several sessions. Upper extremity evaluation is lengthy and can be fatiguing, ad fatigue should be avoided with individuals with Guillain-Barre syndrome. In addition, results may be invalid if the individuals is fatigued and not performing at the highest level possible. See reference: Pedretti (ed): McCormack, GL, and Pedretti, LW, in motor unit dysfunction.

46.When administering an evaluation of upper extremity function to newly admitted patient with Guillain-Barre syndrome, it is MOST important to: A. Test proximal muscle strength first B. Perform the evaluation over several sessions C. Include sensory testing D. Evaluate range of motion

(A) Learn to type. Typing would allow the individual to communicate legibly in writing, while circumventing the individual's poor handwriting skills.

47.An individual with poor writing skills needs to produce large amounts of legible material upon returning to work. The MOST appropriate method of compensation the OT could recommend would involve having the person: A. Learn to type B. Practice fine motor coordination exercises C. Practice letter or shape formations D. Strengthen the finger flexors and extensors

(C) Demonstrates any reliable, controlled movement. As long as the child can produce any such movement, switches can be adapted to meet positioning and mobility needs. Accurate reach and pointing and mobility needs.

56.A school-age child with multiple handicaps is beginning to develop some controlled movement in the UE. It would be MOST appropriate to introduce switch-operated assistive technology when the child: A. Develops tolerance of an upright sitting posture B. Can reach and point with accuracy C. Demonstrates any reliable, controlled movement D. Develops isolated finger control

(B) detachable armrests. Armrests need to be removed to allow the individual to move sideways out of the chair. See reference: Pedretti (ed): Adler, C and Titon-Burton, M: Wheelchair assessment and transfers.

57.To practice transfers using a transfer board with a patient, the OT practitioner must have the patient use a wheelchair that has: A. Detachable footrests B. Detachable armrests C. Antitip bars D. Brake handle extensions

(B) 33 to 36 inches. This is the proper height for grab bars to allow for the UE to lift the body with enough clearance to transfer onto the toilet seat. See reference: Rothstein, Roy, and Wolf: American's with disabilities act and accessibility issues.

58.A family would like to place grab bars around the toilets in the house for easy access during transfers by the mother, who uses a wheelchair. At what height should they be placed? A. 28 to 32 inches B. 33 to 36 inches C. 38 to 41 inches D. 43 to 46 inches

(D) Doll house and dress-up clothes. To encourage symbolic play, the child should be exposed to toys offering imaginative, open-ended play opportunities, encouraging formulation of ideas and feelings.

73.In a home program to promote beginning symbolic play for a child with developmental delay, the OT practitioner would MOST likely recommend playing with: a. busy box, nesting toys, and blocks b. board games c. craft kits d. doll house and dress-up clothes

(B) Labels with white print on a black background. White print on a black background is easier to see for individuals with poor vision.

74.An OT practitioner is working with an older adult who has diabetes, poor vision, and peripheral neuropathies. The client also has difficulty discriminating between medications. The BEST adaptation for the OTR to provide is: A. Braille labels B. Labels with white print on a black background C. A pill organizer box D. Brightly colored oils with each type of medication a different color

(B) Use a guiding techniques: place food in the resident's hand and bring it to the mouth. Use of a guiding technique is particularly effective because the person receives sensory cues that something is approaching the face ahead of time. See reference: Larson: Stevens-Ratchford, Pedretti, and Crabtree (eds): Foti, D: Evaluation and interventions for the performance area of self-maintenance.

78.A resident in a long-term care facility is being treated by the OTR to regain self-feeding skills. The MOST effective strategy for beginning self-feeding with a resident who is tactilely defensive around the facial area is to: A. Have the therapist clear food pocketed in the resident's cheeks B. Use a guiding technique: place food in the resident's hand and bring it to the mouth C. Wipe food particles off a person's mouth and chin as he or she eats D. Allow resident to select whatever food or beverage he or she prefers

(C) Inferior to the anterior superior iliac spine. A seat belt placed across the lap inferior to the ASIS prevents the hips from being extended into a posterior pelvic tilt.

78.In order for an individual sitting in a wheelchair to achieve maximal pelvic stability, the seat belt should be positioned: a. inferior to the ischial tuberosity b. superior to the iliac crest c. inferior to the anterior superior iliac spine d. superior to the posterior superior iliac spine

(A) Provide verbal cues, external aids such as calendars and family pictures, and opportunities to practice using the external aids. Verbal cues, external aids, and opportunities to practice using the external aids would be most appropriate for clients with deficits in orientation. See reference: Unsworth (ed): Schwarzberg, S: Clinical reasoning with groups.

81.An OT practitioner is working with a group of patients who have orientation deficits resulting from head injuries. Using an adaptive or compensatory approach, the MOST appropriate intervention would be to: A. Provide verbal cues, external aids such as calendars and family pictures, and opportunities to practice using the external aids B. Reduce the number of distractions; move the group to a quiet room C. Present information in short units, spaced with time between each segment D. Connect new information to previously learned knowledge and skills

(B) activity adaptation. Modifying how directions are provided is one way to adapt activities. See reference: Early: Analyzing, adapting, and grading activities.

83.A child observed grabbing toys from others, becoming easily frustrated and is unable to sit still. This behavior MOST likely indicates: A. Activity analysis B. Activity adaptation C. Grading the activity D. Clinical reasoning

(A) Extend the operated leg forward, reach back for the armrests, and slowly sit, while attempting to not lean forward. By extending the operated leg forward, reaching back for the armrests, slowly sitting, and attempting to not lean forward, an effective and safe transfer can be accomplished.

86.An OT practitioner is instructing a client to perform stand-to-sit chair transfers after a total hip replacement. Before sitting down from a standing position, the OTR FIRST instructs the client to: a. extend the operated leg forward, reach back for the armrests, and slowly sit, while attempting to not lean forward b. extend the non-operated leg forward, while gradually flexing the operated side, reaching back for the armrests, and slowly sit, while attempting to not let lean forward c. flex the operated leg, then flex the non-operated leg, reach back for the armrest and slowly sit, while attempting to not lean forward d. never perform stand to sit transfers with a client with a new total hip replacement until 2 weeks after surgery

(B) Bingo. Luck is the key element in games of chance. Bingo is a game whose outcome depends on the calling out of random numbers.

88.An OT practitioner is planning a group session in which the group members will be encouraged to participate in a game of chance. Which of the following would MOST likely be considered a game of chance? a. collecting baseball cards b. bingo c. charades d. balloon volleyball

(D) Plan new motor works tasks. Dyspraxia refers to difficulty planning new motor tasks (answer D).

9. While observing a newly referred child in the playground, the OT practitioner suspects that the child has dyspraxia. The MOST relevant assessment to determine the child's level of performance will be one which determines the child's ability to: A. Print or write B. Read C. Calculate mathematics D. Plan new motor tasks

(C) Removing pants. Answer C is correct because, according to most developmental scales, children first learn to remove garments, especially socks.

97.A 3 year old child with a diagnosis of mental retardation is dependent in all areas of dressing. If the OT practitioner uses a developmental approach with this child, which skill should FIRST be addressed? a. Putting on garments with the front and back of clothing correctly placed b. Putting on a t-shirt c. Removing pants d. Buttoning and tying bows

(C) visual agnosia. Visual agnosia is the inability to recognize common objects and demonstrate their use in an activity. See reference: Trombly (ed): Quintana, L: Evaluation of perception and cognition.

98.An OT practitioner is evaluating a client who is unable to name or demonstrate the use of common household objects. the practitioner document this as: A. Apraxia B. Stereognosis C. Visual agnosia D. Alexia

(A) Further observation and evaluation of right-sided dysfunction is indicated. Answer A is correct because infants usually use a bilateral approach at this age. Although unilaterally occurs several months later, most children alternate hands in many activities until 6 year. This means that this infant should be observed for possible right-sided dysfunction.

1. A 4 month-old infant being seen for an OT assessment shows a strong preference for the left hand when reaching for a rattle at midline. Considering the development of dominance in normal children, the OT practitioner should conclude that: a. Further observation and evaluation of right sided is indicated b. Development of hand dominance is proceeding in a typical manner c. Hand dominance will not develop until age 1 year d. Unilaterally precedes bilaterality in typical development

(C) Assertiveness training. Broken record is a specific assertiveness skill concerned with repeating your position without losing control.

95.An OT practitioner is trying to demonstrate and then involve a group of individuals in practicing "broken record" behaviors which of the following intervention BEST encompasses the broken record technique? a. music therapy activities b. self-awareness activities c. assertiveness training d. psychodrama approaches

(D) Treat the patient as scheduled and charge for the 1 hour of direct time spent with the patient.

199. On the way to lunch, an OT practitioner is stopped by a patient's spouse and questioned for 15 minutes about the patient's progress. What is the MOST appropriate action for the OT practitioner to take when determining how the patient will be treated and charged for the scheduled one hour treatment session? a. charge the patient for an additional 15 minutes of treatment for the time spent with family member b. reduce the patient's therapy to 45 minutes and charge for 1 hour to treatment cover the time spent with the family member c. reduce patient's therapy to 45 minutes and charge patient for 45 minutes of treatment d. treat the patient as scheduled and charge for the 1 hour of direct time spent with the patient

(A) Fail the student. Students should be evaluated at the midpoint of each level-II fieldwork experience as well as at the conclusion. The purpose of the final evaluation is to provide the student with feedback regarding performance during fieldwork as well as to document that entry-level competence has been achieved. A student who does not demonstrate entry-level competence should not be passed.

199. Upon completion of a level-II fieldwork placement on a rehabilitation unit, student is functioning slightly below minimal entry-level competence. The supervising fieldwork educator should: a. fail the student. b. pass the student with the requirement that the student not practice in a rehabilitation setting. c. pass the student and recommend additional training or volunteer work in rehabilitation setting. d. pass the student.

(B) Compares performance with a normal standard. Norm referencing is a term applied to standardized or format tests that have been given to a large number of persons in a specific population called the normative sample. When a child is tested with a norm-referenced test, the scores are compared with those of the normative sample: this provides information on how a child performs compared with the average performance of the normative sample.

29.In using an assessment that is "norm referenced" for children, the OT practitioner assumes that the test: a. measures normal behavior of children b. compares performance with a normal standard c. is valid and reliable d. should be used with a normal population

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

29.The OT practitioner is evaluating a client who has position-in-space difficulties. When assessing the sense of proprioception at an individual's joint, movement within the range would BEST be performed: A. Until pain is elicited B. Until the stretch reflex is elicited C. At the end ranges of the joint D. At the midrange of the joint

(C) further decline. Because MS is a degenerative disease, it is likely that the individual receiving a wheelchair will eventually decline further in functional performance. See reference: Neistadt and Crepeau (eds): Pulaski, KH, in Adult neurological dysfunction.

29.When ordering a wheelchair for an individual with multiple sclerosis, the MOST important consideration is the adaptability of the wheelchair in anticipation of: A. Gradual gains in strength B. Growth of the individual C. Further decline D. Improved wheelchair mobility

(B) An interest checklist. An interest checklist is frequently used to initiate discussion of how a patient usually spends his leisure time and to identify areas of specific interest.

3. An OTR has asked a COTA to identify how a patient spends his leisure time, which leisure activities he especially enjoys, and which others he has participated in that he would be interested in renewing. The MOST appropriate tool for the COTA to use is: A. An evaluation of living skills B. An interest checklist C. An activity configuration D. A self-care evaluation

(C) Fair plus (3+). A person with strength of fair or fair minus would be unable to tolerate resistance. A person with strength of fair plus during a MMT can tolerate minimal resistance. A person whose strength is good minus can tolerate less than moderate resistance but more than minimal resistance.

38.During a functional assessment of a person's strength, the therapist observes that the individual can move the arm through the full range of motion to reach a high bathroom shelf, but can lift and place nothing heavier than a can of spray deodorant on the shelf, suggesting that the person can tolerate only minimal resistance against gravity during arm motion. The strength according to the manual muscle test (MMT) is: A. Fair minus (3-) B. Fair (3) C. Fair plus (3+) D. Good minus (4-)

(C) Visual agnosia. Visual agnosia is the ability to recognize common objects and demonstrate their use in an activity.

4. An OT practitioner is evaluating a client who is unable to name or demonstrate the use of common household objects. The practitioner documents this as: a. Apraxia b. Stereognosis c. Visual agnosia d. Alexia

(D) After the development of the goals and objectives. "Once short and long term goals have been agreed upon, an implementation plan must be made regarding how to provide services to meet these goals most effectively" (p.256). See reference: Case-Smith (ed): Richardson, PK, and Schulz-Krohn, w: Planning and implementing services.

10.Through the evaluation process, the therapist may consider many possibilities for intervention; however, the specific plan for implementation of intervention is MOST often developed at which point in the OT process? A. After observation or screening B. After the interview C. After the evaluation D. After the development of the goals and objectives

(C) Interpret the results based on data collected by the COTA. One the OTR has assigned performance of an evaluation to a COTA, or the OTR is responsible for analyzing and interpreting the responsible for analyzing and interpreting the results. See reference: Early: Data Collection and evaluation

107. A COTA frequently administers the ACLS Test and then discusses it with the supervising OTR. Which of the following MOST accurately describes the OTR‟s role during these discussions? A. Determine the COTA‟s service competency B. Collect data on the patient's performance C. Interpret the results based on data collected by the COTA D. Developed the treatment plan

(B) measure the distance from the finger-tip to the distal palmar crease with the hand in an fist. The distance from the fingertip to the distal palmar crease with the hand fisted may be measured in either inches or centimeters. This measures how close the fingertip comes to the palm. A person who has full flexion would have a measurement of 0. See reference: Hunter, Schneider, Mackin, and Bell (eds): Cambridge, C: Range of motion measurements of the hand.

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

(A) Have the patient use stress reduction using medication, yoga, and energy conservation techniques. Individuals with AIDS should implement a form of exercise to provide mobility and reduce stress without draining his/her physical resources, in addition to using energy conservation techniques during ADL. It would not be appropriate for an individual to participate in an aerobics program because of the high energy demands, and video lectures would provide information about AIDS but not provide information about AIDS but not provide support to reduce anxiety.

109. An individual with an IV drug use problem has developed AIDS. The OT evaluation revealed that the individual's major problems are with daily tasks, self-esteem, physical conditioning, and anxiety. Which of the following approaches would be MOST beneficial to the client? A. Have the patient use stress reduction using meditation, yoga, and energy conservation techniques B. Have the patient participate in aerobic activities to combat deconditioning C. Provide video lectures on AIDS to educate the client about the disease process D. Incorporate energy conservation techniques and daily aerobic activities into the client's ADL

(C) Safety razor with extended handle. The extended handle is the necessary component that allows this individual to overcome limited SH and elbow ROM in order to reach his face.

112. A 16-year-old boy with juvenile rheumatoid arthritis is ready to begin shaving but has difficulty as a result of limited range of motion in his shoulders and elbows. Which of the following is the BEST adaptation for him to use? A. Electric razor attached to universal cuff B. Safety razor with built-up handle C. Safety razor with extended handle D. Safety razor attached to universal cuff

(B) Tip the wheelchair backward and guide it down the ramp forwards. This is the recommended technique for going down a steep ramp. The individual sitting in the wheelchair can also help to control the wheels, if capable of doing so, by a grasping the hand rims.

112. Which of the following is the BEST instruction to impart to a caregiver regarding how to propel a wheelchair down a steep ramp? a. tip the wheelchair backward and guide it down the ramp backwards b. tip the wheelchair backward and guide it down the ramp forwards c. allow the patient to propel the wheelchair independently d. obtain the assistance of a second individual

(C) swimming in a cool water pool. Swimming is an excellent activity for promoting physical fitness, and the cool water pool (temperature under 84 degrees) will prevent the overheating that is contraindicated for individuals with MS. See reference: Pedretti (ed): Hiatpas, J, Hooks, ML, Atchinson, P, et al, in Degenerative disease of the central nervous system

114. An artist recently diagnosed with MS is interested in pursuing a leisure activity that will promote physical fitness. Because the individual's symptoms are limited to mild UE numbness and slight weakness in the dominant hand at this point, the BEST activity to recommend is: A. Volleyball B. Painting with the dominant hand C. Swimming in a cool water pool D. Jogging on a track or treadmill

(B) holding a class about job-seeking strategies. The purpose of applying remedial strategies is to enhance underlying abilities. Teaching and training methods are commonly used techniques. See reference: Early: Data collection and evaluation.

117. An OT practitioner is planning to use remedial strategies to prepare individuals treated in a psychosocial setting for job hunting. The activity MOST consistent with this approach is: A. Reviewing an interest checklist B. Holding a class about job-seeking strategies C. Modifying the work environment to reduce stress D. Using an expressive group magazine collage using pictures of different type of jobs

(D) Washing windows. Washing windows is a repetitive activity that involves resisted, eleyated upper extremity activity. Rests can be taken as needed. See reference: Dutton: Introduction to biomechanical frames of reference.

118. An individual diagnosed with Guillain-Barre syndrome exhibits good upper extremity strength. The activity that would be MOST appropriate for further strengthening is: A. Peeling potatoes B. Vacuuming C. Polishing furniture D. Washing windows

(B) Superior and inferior colliculi. The correct answer is B because the inferior and superior colliculi are the areas that integrate stimuli from the visual, auditory, vestibular, and somatosensory systems. They also respond to stimuli of a protopathic nature and play an important role in spatiotemporal orientation.

12.A child with a learning disability has difficulty integrating visual, auditory, vestibular, and somatosensory stimuli, and responds to stimuli primarily with defensiveness. The area of the central nervous system that serves as a center for these functions is the: A. Reticular formation B. Superior and inferior colliculi C. Cerebral cortex D. Cerebellum

(D) Carpol tunnel and chronic cervical tension are just some of the work-related occurences secondary to the arrival of visual display terminals and specialized technology that require repetition and unusual body positioning. See reference: Neistadt and Crepeau (eds): Fenton, S, and Gagnon, P: Treatment of work and productive activities. Functional restoration, an industrial approach.

12.A computer programmer arrives at an OT clinic complaining of pain while on the job. Which of the following are MOST likely to be considered work-related injuries specifically linked to the age of technology? A. Systemic diseases B. Edema and paresthesias C. Burns and electrocution D. Carpal tunnel and chronic cervical tension

(D) Picking up raisins with a pair of tweezers. While all answers describe methods to promote some aspect of handwriting skills, this activity is the only one that targets isolated finger use.

121. A first grader has difficulty with poor finger isolation. The MOST appropriate activity for the OT practitioner to recommend to the teacher is: A. Crayon drawing on sandpaper B. Copying shapes from the blackboard C. Rolling out Play Doh with a rolling pin D. Picking up raising with pair of tweezers

(D) Continues reinforcement of correct responses. Continuous reinforcement is provided every time the correct behavior occurs. Continuous reinforcement is helpful with learning of new behaviors.

123. An OT practitioner is training an adult worker with a developmental disability to put a pencil in a box before putting the score pad in the box for a game packaging task in a sheltered workshop assembly line. The employee has not done this task before. The type of reinforcement schedule that will BEST achieve the goal of learning this task sequence is: a. intermittent reinforcement with correct responses. b. reinforcement every 10 minutes. c. reinforcement for every fourth correct response. d. continuous reinforcement of correct response.

(D) Walking at 1 mph. The MET value for sitting at the edge of the bed is 1.3, and the MET value for walking is 1.2 mph is 2. Although it is unrealistic to expect the entry-level practitioner to memorize a MET table, several factors can help the therapist assess the demand of any given task. For example, UE activity work produces a greater cardiovascular response than LE work.

123. An individual has been referred to OT following open heart surgery and a period of prolonged bedrest. After the individual is able to tolerate sitting unsupported at the edge of the bed, the NEXT activity the OT practitioner should introduce is: a. peeling potatoes while seated b. wheelchair propulsion at 1.2 mph c. taking a shower d. walking at 1 mph

(C) Teach use of mirror feedback to make the person aware of his/her facial expression. Teaching the use of a mirror to make the person aware of his/her facial expression can help the person to understand how he/she appear to others. It can also help the person learn to smile and use more facial expressions, which can be accomplished with concentration.

123. An individual with Parkinson's disease exhibits a lack of facial expression, resulting in decreased communication. The BEST strategy to promote improved social interaction through facial expression is to: A. Teach caregivers to give patient time to reply and to ask questions so that short responses are required. B. Give a word chart or communication board to prevent frustration. C. Teach use of mirror feedback to make the person aware of his or her facial expression. D. Instruct in deep breathing, articulation, speech volume, breaking up sentences into segments.

(D) plan new motor tasks. Dyspraxia refers to difficulty planning new motor tasks. See reference: Case-Smith (ed): Rogers, SL, Gordon, CY, Schanzenbacher, KE, and Case-Smith, J: Common diagnosis in pediatric occupational therapy practice

123. While observing a newly referred child in the playground, the OT practitioner suspects that the child has dyspraxia. The MOST relevant assessment to determine the child's level of performance will be one which determines the child's ability to: A. Print or write B. Read C. Calculate mathematics D. Plan new motor tasks

(B) Have the resident dress in bed with garments which are stretchy and one size larger than usual; preview each step of the process with the resident. The resident who is resuming the activity has low endurance as well as cognitive deficits so would benefit from an adapted, structured approach. Dressing in bed will require less energy initially; the larger, stretchy garments will make dressing easier, and reviewing each step before it occurs will provide cognitive cues.

129. A resident of a long-term care facility is being seen by the OT practitioner in the mornings to help the resident reestablish dressing routines after a period of illness. The client is in a weakened condition and has mild cognitive deficits. The BEST way to structure the task is to: A. Have the resident select the clothing they prefer, then dress the client B. Have the resident dress in bed with garments which are stretchy and one size larger than usual; preview each step of the process with the resident C. Have the resident walk to retrieve clothing garments and encourage independent performance D. Place clothing within close reach of the resident, encourage the resident to proceed as you provide distant supervision

(D) (1) gather shirt up at the back of the neck; (2) pull gathered back fabric off over head; (3) remove shirt from unaffected arm; (4) remove shirt from affected arm. See reference: Pedretti (ed): Foti, D, Pedretti, LW, and Lillie, S: Activities of daily living.

129. An OT practitioner is instructing an individual with left hemiplegia how to remove a t-shirt. The correct sequence is: A. (1) remove shirt from unaffected arm; (2) remove shirt from affected arm; (3) gather shirt up at the back of the neck; and (4) pull gathered back fabric off over head B. (1) remove shirt from affected arm; (2) remove shirt from unaffected arm; (3) gather shirt up at the back of the neck; and (4) pull gathered back fabric off over head C. (1) gather shirt up at the back of the neck; (2) pull gathered back fabric off over head; (3) remove shirt from affected arm; and (4) remove short from unaffected arm D. (1) gather shirt up at the back of the neck; (2) pull gathered back fabric off over head; (3) remove shirt from unaffected arm; and (4) remove shirt from affected arm

(C) Handle the child slowly and gently. Answer C is correct because the child with hypertonicity will be most relaxed and easier to handle if tone is inhibited by the OT practitioner's slow and gentle handling of the body.

129. An OT practitioner is showing a parent how to bathe a child with hypertonic muscle tone. Which of the following approaches is MOST appropriate to use? a. Avoid the use of adaptive equipment. b. Avoid explanations of the procedure. c. Handle the child slowly and gently. d. Stand and lean over the tub to support and wash the child.

(C) Provide project samples for clients to duplicate. Individuals functioning at cognitive level 4 are able to copy demonstrated directions presented one step at a time. They find it easier to copy a sample than to follow directions or diagrams.

132. An OT practitioner working in a sheltered workshop with adult clients with developmental disabilities is preparing for a group of clients functioning at Allen's Cognitive Level 4. Which of the following is the BEST method for introducing an assembly activity? a. Provide repetitive, one-step activities. b. Demonstrate a three-step assembly process. c. Provide project samples for clients to duplicate. d. Provide written directions for the individuals to follow.

(D) Position the person in an upright posture, make sure head is flexed slightly and in midline. Making sure that the resident is correctly positioned is the first step in addressing eating problems. Improper posture can result in difficulties with swallowing.

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

(B) Functional-position resting splint. Bedridden individuals are often provided with splints to prevent the development of flexion contractures in the hand that can lead to problems with hygiene. A functional-position resting hand splint is most appropriate because it will prevent flexion contractures from developing and allow the caregiver access to his hand for cleaning.

145. An individual in the late stages of AIDS is bedridden, and flexion contractures have begun to develop in his right hand. Which of the following types of splints would be MOST appropriate for this individual? A. Dorsal wrist splint B. Functional position resting splint C. Volar wrist cock-up splint D. Dynamic finger extension splint

(B) Sip and puff switch. A sip and puff switch (answer B) is operated by breath control and is unaffected by random movements of the extremities.

146. A woman who had a CVA exhibits random movements in all four extremities. What is the MOST appropriate switch to use on the controls for her wheelchair? A. Infrared switch B. Slip and puff switch C. P switch D. Rocking lever switch

(B) Stringing beads for a necklace, following a pattern. This is the only activity of those listed that requires the individual to follow a sequence in order to achieve the desired outcome.

146. An OT practitioner is working on sequencing skills with a young patient who is s/p TBI. The MOST effective activity to promote development of these skills is: a. leather stamping using tools in a random design b. stringing beads for a necklace, following a pattern c. putting together a 20 piece puzzle d. playing Concentration

(B) Go out for lunch to fast-food restaurant. A key principle in intervention for effective transition includes using natural environments and cues and increasing community-based instruction as the student gets older. See reference: Case-Smith (ed): Spencer, K: Transition services: From school to adult life.

155. An OT practitioner is developing transition activities for a group of 16-year-old students diagnosed as trainable mentally retarded. Which of the following activities would be BEST for addressing goals related to transition? A. Role-play ordering food in the classroom B. Go out for lunch to a fast-food restaurant C. Order a take-out lunch by phone D. Select lunch items from a picture menu in the classroom

(C) Notify the OTR. Regardless of the source of the referral or the anticipated length of stay, the COTA must first notify the OTR of the referral, who is ultimately responsible for any action taken. Under the supervision of the OTR, that COTA may then initiate screening, chart review, or ADL evaluation (answer A, B, and D).

198. The FIRST step a COTA should take upon receiving a written referral for OT services for an acute care patient being discharged in 2 days is to: A. Initiate the ADL component of the evaluation B. Begin a chart review C. Notify the OTR D. Screen the patient

(D) Label each item with the individual's names. Cosmetics should never be shared. Federal regulations prohibit the sharing cosmetics if there is any likelihood would be high in a geropsychiatric population. See reference: Early: Safety techniques.

199. An OT practitioner has been running a "beauty group" with a group of chronically mentally ill older women. Which of the following is the MOST important action to take with the makeup at the end of the session? A. Put all supplies in a basket to be used next time B. Label any supplies use by individuals with communicable diseases with the individual's name and put the rest in a basket C. Label lipstick with the individual's names. Eye makeup and blush can be shared D. Label each item with the individual's names. Cosmetics should never be shared

(A) The time he spends at the computer. Because computer work requires very little active movement and the lower extremities; trunk, and neck are generally held in a static position, it is essential to assess how much time the child spends in this position. The OT practitioner needs to instruct the child to take regular breaks and maintain proper positioning while at the computer to avoid further strain. See reference: Ryan (ed): The Certified OT Assistant: Ryan SE, Ryan BJ, and Walker, JE: Computers.

2. A preteen with a diagnosis of spastic CP is enjoying computer-assisted learning while making significant progress in written communication, but he complains of general fatigue, body aches, and eye strain. Based on this information, which area would be MOST relevant for the OT practitioner to reassess? A. The time he spends at the computer B. The size of the computer screen C. The challenge level of the learning program D. His control of the keyboard

(D) Provide a therapy ball to sit on while the child is playing a game of checkers Answer D is the only one that contributes to the development of postural background movement. See reference: Case-Smith (ed): Nichols, DS: The development of postural control.

25.A child has poor sitting balance, which interferes with seated tabletop activities. Which of the following treatment recommendations is MOST appropriate for promoting the development of ongoing postural adjustments in sitting? A. Use a sturdy chair with lateral trunk supports while the child is doing homework B. Use a corner floor seat with built in desk surface while the child is self-feeding C. Provide a bolster for back support while the child is coloring D. Provide a therapy ball to sit on while the child is playing a game of checkers

(B) Add the 2 new clients and then divide the members into 2 groups. It is generally not costeffective to run groups less than 3 individuals, and it is not effective to have more than 8 in a group. Maintaining an appropriate group size enables the OT practitioner to adequately observe the interpersonal skills of the members. Using interviews or group with 3 or fewer members.

25.An OT practitioner has planned to assess group interpersonal skills in an activity-based group of seven individuals. Shortly before the group is to begin, the therapist is asked to add two newly admitted clients to the group. Which of the following actions would yield the MOST efficient and effective result? A. Ask one or two of the original seven members to wait until later and include the two new clients in the group. B. Add the two new clients and then divide the members into two groups. C. Interview the two new clients separately and continue with the original evaluation group of seven. D. Proceed with the group as planned, adding both new clients to the original seven.

(B) objective. Measured results based on an individual's performance are included in the objective section. See reference: Sabonis-Chafee and Hussey: Treatment planning and implementation.

26."The patient arrived without her walker 3 out 3 toys this week." The MOST appropriate section of a SOAP note for the OT practitioner to place this statement is the: A. Subjective B. Objective C. Assessment D. Plan

(B) Median nerve. The median nerve passes through the carpal tunnel at the wrist. Impingement in this region causes sensory changes in the thumb, index finger, long and half of the ring finger. Prolonged impingement in the carpal tunnel results in atrophy of the thenar eminence and weakness of the opponens pollicis.

26.An OT practitioner is treating a client who demonstrates pain, progressive weakness of the thumb, atrophy of the thenar muscles and numbness and tingling in the thumb, index, long, and half of the ring fingers. The client is not experiencing proximal upper extremity limitations so the practitioner will MOST likely suspect problems with which of the following? A. Ulnar nerve B. Median nerve C. Radial nerve D. Brachial plexus

(C) Moderate assistance. Moderate assistance is defined as having the ability to complete the task with supervision and cueing while requiring physical assistance for 20 to 50% of the task.

26.During a tub transfer training session, an individual requires cueing to lock his wheelchair brakes and requires assistance to lift his legs from the wheelchair into and out of the tub. He is able to scoot himself from the wheelchair to the tub bench with occasional loss of balance. How should the individual's performance be documented? A. Dependence B. Minimal assistance C. Moderate assistance D. Maximal assistance

(B) play and self-care activities. "When providing occupational therapy care for children with terminal illness, the underlying principle is to add quality to their remaining days. There are two performance areas that occupational therapists should address in children with terminal illness" (p.838). See reference: Case-Smith (ed): Barnstorff, MJ: The dying child.

27.When providing OT for children who have been diagnosed with a terminal illness, the PRIMARY focus for OT intervention would be: A. Educational activities B. Play and self-care activities C. Socialization activities D. Motor activities

(B) Flexion. Flexion at the wrist, especially while grasping or pinching, should be avoided. Repetitive flexion and extension movements also cause compression of the median nerve. See reference: Hunter, Schneider, Mackin, and Bell (eds): Baxter-Petrlia, P: Therapist's management of carpal tunnel syndrome.

3. The OT practitioner is treating a person with mild carpal tunnel syndrome. The MOST important instruction for the therapist to give the patient is to avoid: A. Extension B. Flexion C. Ulnar deviation D. Radial deviation

(D) Conduct a group discussion about responsibilities people have when living in a group home. A cognitive approach is most appropriate with individuals "who must learn to do situational problem solving... when the individual has deficits in attention span, memory, or other cognitive abilities... or when the skills being learned need to be generalized." Discussion that heightens awareness in an attempt to modify behavior is one example of a cognitive intervention. See reference: c=Christiansen (ed): Self-care strategies in intervention for psychosocial conditions.

32.An individual with a history of substance abuse lives in a group home. The residential manager has asked the OT practitioner to work with the individual to develop house cleaning skills. Which of the following interventions is most appropriate when a COGNITIVE approach is desired? A. Reward the individual with a snack bar token when chores have been successfully completed B. Praise the individual when chores have been successfully completed C. Post a schedule of each individuals ‟chore responsibilities in a highly visible location D. Conduct a group discussion about responsibilities people have when living in a group home

(B) Objective signs and duration of the seizure. In order to assess the efficacy of antileptic medication or during periods of gradual withdrawal, staff members are often asked to monitor the child for seizures activity. Type and duration of seizures should be documented carefully.

4. An OT student witnesses a seizure in young client with hydrocephalus. The MOST relevant information to document and report to the supervising therapist is: A. The child's positioning during the seizure. B. Objective signs and duration of the seizure. C. Responsiveness during the seizure. D. Facial expression during and after the seizure

(C) A heavy handbag held by handles. The hook grasp is strongly based on the use of two digits two to five. The thumb is not always required for the hook grasp and can remain inactive. A needle would be held with two-point pinch while being threaded. A glass would be held with a cylindrical grasp. Finally, a key being placed in a lock would be held by a lateral pinch.

44.An OT instructor is teaching a group of OT students about various hand grips and their relationship to specific muscles and nerves. A hook grasp, for example, would MOST likely be used to hold: A. A sewing needle while it is being threaded B. A tall glass half filled with water C. A heavy handbag held by the handle D. A key while it is being placed in a lock

(A) Constructional apraxia. An individual with constructional apraxia may have full sensory awareness of the affected side of the body but be unable to perform the construction of one or more objects onto each other to carry out a verbal command or put on clothing in the proper sequence or position.

44.During morning self-care activities, a client is able to place his dentures in his mouth but has difficulty applying denture cream to the appropriate place on the dentures and attempts to place the cap on the tube backwards then on the wrong end of the tube. This behavior would MOST accurately be reported as: A. Constructional apraxia B. Ideomotor apraxia C. Visual agnosia D. Unilateral neglect

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

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

(A) decreased joint stress and pain. It is very important to preserve joint integrity in individuals with arthritis by using adaptive equipment to avoid or reduce the wear and tear stresses on fragile joints. See reference: Pedretti (ed): Hittle, JM, Pedretti, LW, and Kasch, MC: Rheumatoid arthritis.

44.When providing adaptive equipment to an individual with arthritis, the OT practitioner would explain that the PRIMARY purpose of using this equipment is to: A. Decrease joint stress and pain B. Correct deformity C. Simplify work D. Decrease independence

(B) Raising the handle bars. The correct answer is B because raising the handle bars demands that the arms are raised, thus bringing the child to the upright posture. See reference: Kramer and Hinojosa (eds): Colangelo, CA: Biomechanical frame of reference.

45.A child with CP tends to flex forward while riding her adapted tricycle even though her LE are correctly positioned. The adaptation that would BEST enable her to maintain a more upright position is: A. Raising the seat height B. Raising the handlebars C. Lowering the seat height D. Lowering the handlebars

(D) Social skills training. Social skills training can be used to develop the ability to relate appropriately and effectively with others.

45.A college student has been referred to a day treatment program following hospitalization for an acute schizophrenic episode. The individual is uncomfortable in social settings; has difficulty sustaining conversation, is unable to make eye contact, and responds with bizarre comments when spoken to. Which of the following would be the MOST effective treatment approach? A. Vestibular stimulation and gross-motor exercises B. Modification of the environment C. Pleasurable activities that don't require conscious attention to movement D. Social skills training

(B) Reflex sympathetic dystrophy. This diagnosis is typically "a disabling reaction to pain that is generated by an abnormal sympathetic reflex." Signs include pain, edema, coolness of the hand, and blotchy skin. The level of trauma does not typically correlate to the amount of pain that the client is experiencing.

5. An OT practitioner is working with a client diagnosed with a mild sprain. The client cradles her hand and appears to be hypersensitive to light touch. The individual also presents with edema, pain, shiny skin, and excessive dryness of the extremity. Based on this, the OT assumes that the client is MOST likely suffering from: a. neuromas b. reflex sympathetic dystrophy c. carpal tunnel syndrome d. desensitization

(B) Learning proper body mechanics. Learning proper body mechanics (along with achieving a good fitness level) is one of the first steps to reducing the risk of reinjury in a work program.

68.An OT practitioner is working with a client in a work program setting. What is the FIRST step to achieving the program objective of preventing reinjury within a work program? a. performing a prework screening b. learning proper body mechanics c. participating in work hardening d. engaging in vocational counselling

(B) The child's writing, dressing, and self-feeding skills. Because the child was being treated for difficulties with fine motor skills, discharge criteria should focus on fine motor function. See reference: Case-Smith (ed): Case-Smith, J, Rogers, J, and Johnson, JH: School-based occupational therapy.

82.A school age child with fine motor difficulties is ready for discharge from outpatient OT services. Which of the following is the MOST important information to focus on? A. The child's interests and hobbies B. The child writing, dressing and self-feeding skills C. The child's academic achievement D. The availability of the child parents for follow up services

(A) Head pointer and slanted keyboard. The use of a head pointer on a slanted keyboard would be the best solution because it requires no hand use.

83.A client with CP has severe motor impairment resulting in insufficient arm and hand motion, and insufficient grasp or prehension to access a computer keyboard. The BEST low-technology solution for improving his ability to access keys would be a(n): A. Head pointer and slanted keyboard B. Typing splint C. Adapted mouse D. Built-up pencil to press the keys

(D) applesauce. Foods with even consistency, uniform texture, and increased density such as applesauce are the easiest to control and swallow. See reference: Case-Smith, J, and Humphry, R: Feeding intervention.

90.A child has difficulty controlling food in her mouth when swallowing. In helping the parents to plan snacks, the OT practitioner would be MOST likely to recommend: A. Chicken noodle soup B. Peanut butter C. Carrot sticks D. Applesauce

(C) Increases the management of texture by slowly increasing texture of food with a baby food grinder. This method offers a gradual increase in texture that encourages chewing

94.A child is on a pureed diet because of an inability to chew food. The MOST effective for the OTR to facilitate the child‟s ability to chew would be to: a. encourage the child to remove food from the spoon with his teeth b. stimulate the management of texture by using vegetable or beef soup c. increase the management of texture by slowly increasing texture of food with a baby food grinder d. stimulate biting and chewing by placing a raisin between a child‟s teeth

(B) avoid use of power tools and sharp instruments. Individuals experiencing extrapyramidal syndrome, which may cause muscular rigidity, tremors, and/or sudden muscle spasms, should avoid using power tools or sharp instruments. See reference: Early: Psychotropic medications and somatic treatments.

99.While in the hospital, a 48 year old roofing contractor experienced extrapyramidal syndrome after being placed on neuroleptic medications. The patient is to continue taking the medication after discharge from the hospital. It is MOST important to advise the patient to: A. Keep time in the sun as brief as possible B. Avoid use of power tools and sharp instruments C. Get up slowly from a standing, sitting or lying position D. Be aware of the dehydrating effects of caffeinated drinks and alcohol

(B) Perform desired activities in a simplified manner, to conserve energy. One method used to extend a person's occupational as Parkinson's disease progresses is to introduce task simplification. This allows conservation energy which can then be expended on desired activities. In a person with long-standing parkinson's disease, encouragement to "work through" fatigue. See reference: Neistadt and Crepeau (eds): Pulaski, KH: Adult nuerological dysfunction.

1. A person with a long history of Parkinson's disease is experiencing considerable fatigue during the day. The OT practitioner's MOST appropriate response to help the person maintain his other level of function is to teach the person how to: A. "work through" the fatigue B. Perform desired activities in a simplified manner, to conserve energy C. Perform additional exercises to increase energy level D. eliminate activities and reduce activity level as much as possible

(B) A pinch meter. A pinch meter is used to measure the strength of a three-jaw chuck grasp (palmar pinch), in addition to key (lateral) pinch and tip pinch. These tests are performed with 3 trials that are averaged together and then compared with a standardized norm.

14.An OT practitioner conducting a hard assessment would use which instrument to measure the strength of the three-jaw chuck: a. an aesthesiometer b. a pinch meter c. a dynamometer d. a volumeter

(A) SH flexion and protection. Answer A is correct because the infant changes from extensor influences on posture to development of flexion in the supine position. This requires the ability to flex and protract the SHs against gravity in order to reach forward and upward to grasp toys.

103. An OT practitioner positions an infant in the supine position and places attractive toys overhead to provide an opportunity to work against gravity. This position is MOST effective for developing which ability? A. Shoulder flexion and protraction B. Shoulder extension and retraction C. Development of head control D. Development of trunk control

(A) Clearly direct a caregiver in preferred head position, food portion size, and choice of food to eat. An individual with C3 quadriplegia lacks the strength necessary to use an MAS or any cuff device. See reference: Christiansen (ed): Garber, SL, Gregorio, TL, Pumphrey, N, and Lathem, P: Self-care strategies for persons with spinal cord injuries.

107. An OT practitioner is working on feeding with an individual with a C3 spinal cord injury. The strategy that will enable the HIGHEST level of independence is for the individual to: A. Clearly direct a caregiver in preferred head position, food portion size, and choice of food to eat B. Use a mobile arm support C. Use a wrist support with a utensil inserted into the cuff D. Use a universal cuff with a utensil inserted into the cuff

(A) The therapist has the child play "Sandwich" between heavy mats. The sandwich activities provides heavy touch pressure over the child's body, which can be inhibitory to a child experiencing sensory defensiveness. See reference: Kramer and Hinojosa (eds): Kimball, JG: Sensory integration frame of reference: theoretical base, function/dysfunction continua and guide to evaluation.

1. Results of an OT evaluation show that a young child has many tactile defensive behaviors. The MOST appropriate beginning activity for intervention would require that: A. The therapist has the child play "sandwich" between heavy mats B. The therapist applies a feather brush lightly to the child's arms and legs C. The child is blindfolded ad must guess where he or she is touched on the body D. The therapist has the child play the "duck, duck, goose" circle game

(C) Lower back. Touching the lower back requires shoulder abductor and internal rotation.

10.An OTR is performing a UE functional assessment on an elderly client with rheumatoid arthritis. The OTR is MOST likely to determine that the client has limited internal rotation if the client is unable to touch the: A. Back of the neck B. Top of the head C. Lower back D. Opposite shoulder

(C) Tip. Tip prehension is accomplished by flexing the IP joint of the thumb and the PIP and DIP joints of the finger and bringing the tips of the thumb and finger together. This type of prehension is used to pick up objects such as a pin, nail, or coin.

10.An individual demonstrates the ability to pick up a penny from a flat surface. This represents which of the following prehension patterns? a. Lateral b. Palmar c. Tip d. Three-jaw chuck

(D) Endurance. A deficit in endurance is demonstrated by the person's inability to sustain cardiac, pulmonary, and musculoskeletal exertion for the duration of the activity.

10.The OT practitioner is observing dressing skills in an individual with chronic obstructive pulmonary disease (COPD). While putting on his shirt, the individual becomes short of breath and stops to rest before finishing with the shirt and going on to his trousers. The OTR would recognize this as a deficit in: A. Postural control B. Muscle tone C. Strength D. Endurance

(B) A key guard. A key guard is a device that covers the keys and provides a guide for a finger or stick without punching extra keys.

107. An individual uses a mouthstick when working with a computer. Which of the following devices will prevent the mouthstick from accidentally striking other keys? A. A moisture guard B. A keyguard C. An auto-repeat defeat D. One-finger-access software

(D) Neutral. Answer D describes the test position for the Tinel's sign, which is with the wrists in neutral. "Tinel's sign is positive if there is tingling along the course of the nerve distally when percussed."

1. To assess an individual who is suspected of having carpal tunnel syndrome, the OTR tests for Tinel's sign by gently tapping the median nerve at the level of the carpal tunnel with the person's wrist positioned in: A. 10 degrees of ulnar deviation B. 10 degrees of radial deviation C. 20 degrees of flexion or 20 degrees of dorsiflexion D. Neutral

(A) incident report. Facilities use incident reports to document incidents such as this. See reference: Ryan (ed): Practice Issues in Occupational Therapy: Jones, RA: Service operations.

101. During a routine transfer, a patient's legs buckle, causing him and the OT practitioner to fall to the floor. The most appropriate way for the OT practitioner to document this accident is in a(n): A. Incident report B. Daily progress note C. Letter to the department head D. Verbal report to the department head

(B) Follow test manual directions. When administering a standardized test, directions from the test manual should be followed closely to ensure reliability of test results.

14.Which of the following instructions should the OT practitioner follow when administering standardized tests to young children? A. Test in a stimulating environment B. Follow test manual directions C. Always administer test in a single session D. Carry on a conversation with the child

(B) Boutonniere deformity. A boutonniere deformity is typically characterized by PIP joint flexion and DIP joint hyperextension.

1. While performing a hand reassessment, the OT practitioner notices a deformity developing on the dorsal aspect of the client's second digit. The client's PIP joint appears flexed, and the DIP appears to be hyperextended. The OTR can BEST describe this condition as a: A. Mallet deformity B. Boutonniere deformity C. Subluxation deformity D. Swan neck deformity

(C) Applying grout to a tile and waiting for it to dry. Activities provide a variety of opportunities for therapeutic gins. The process of grouting a tile trivet involves covering the individual's tile design with the grout mixture and is messy step. The individual then sees that the tile pattern is emphasized with the addition for the grout. Waiting for the grout to dry requires an individual to delay gratification. See reference: Neistadt and Crepeau (eds): Crepeau: Activity analysis, a way of thinking about occupational performance.

10.The therapist needs to identify an activity that will address psychosocial goals by (1) allowing the individual to experience success using a messy process and (2) requiring the individual to delay gratification. The activity process that is the BEST for providing this experience is: A. Working in a group of three other individuals B. Selecting the design pattern for a tile trivet C. Applying grout to a tile trivet and waiting for it to dry D. Encouraging the individual to clean off the table at the end of the group session

(C) Cumulative trauma disorders. Cumulative trauma disorders are viewed as a mechanism of injury for tendonitis, nerve compression syndromes, and myofascial pain because of the nature of repetitive strain and motion disorders. See reference: Pedretti (ed): Kasch, MC: Hand injuries.

100. An OT practitioner is working in an outpatient upper extremity and hand clinic. The practitioner's case load consists of clients who have tendinitis, nerve compression syndromes, and myofascial pain. The OT practitioner can assume that these diagnoses are MOST commonly associated with: A. Osteoarthritis conditions B. Peripheral vascular diseases C. Cumulative trauma disorders D. Neuroma-related conditions

(C) Program evaluation. Program evaluation is the compilation of the intervention results for a population of individuals. See reference: Neistadt and Crepeau (eds): Perinchief, JM: Management of occupational therapy services.

100. An OT wishes to assess the results of a life-skills training program provided to individuals at a shelter for abused women. Which of the following methods would be BEST for obtaining this information? A. Final evaluation of each client involved B. Client satisfaction survey C. Program evaluation D. Utilization review

(B) Working on a mock car engine.

100. An auto mechanic is currently in a work hardening program after being in a car accident that left him with numerous upper and lower extremity impairments. The ultimate goal for this individual is to return to full employment as an auto mechanic. Which of the following BEST represents a work hardening activity for this individual? a. lifting weights b. working on a mock car engine c. visiting the work site garage d. preparing a light lunch at mealtime

(D) Instruct her to perform only gentle AROM. Gentle AROM allows the individual to control the movement and avoid overstretching of inflamed joint issues.

100. During a home visit, a client with rheumatoid arthritis informs the OT practitioner that her joints have recently become very painful and inflamed. She reports she has been performing her activity program despite the pain and demonstrates a series of briskly executed active range of motion movements. The BEST response of the OT practitioner is to instruct the client to: A. Continue performing her program as she has been. B. Instruct her to perform gentle active range of motion with weight as tolerated. C. Eliminate all range of motion exercises for a week. D. Perform only gentle active range of motion.

(A) Begin with activities that have obvious solutions and a high probability of success and then gradually increase the level of complexity. Beginning with activities that have obvious solutions and are successful and gradually increase in complexity is an effective method for developing problem solving skills

100. Which of the following is the BEST method to use for encouraging problem solving during a craft media group? a. begin with activities that have obvious solutions and a high probability of success and then gradually increase the level of complexity b. begin with activities that require gross motor responses and then gradually progress to fine motor responses c. select activities that require interaction with others and then provide opportunities d. gradually increase the time used in the activity by 15-minute increments

(B) A mobile arm support. A C5 quadriplegic with fair shoulder flexors and abductors and at least poor minus biceps, upper trapezius, and external rotators will be able to operate a mobile arm support for self-feeding and facial hygiene activities. A wrist driven flexor hinge splint would be used for a lower level SCI (C6-C8) in which the individual has functional use of the shoulder and arm muscles and has fair plus or better wrist extension strength. The splint is indicated for individuals who lack prehension power. An electric feeder is indicated for individuals with higher level of involvement (C4) and who demonstrate poor plus or weaker shoulder strength. Built-up utensils may be indicated for individuals with C8 or T1 injuries because they may lack the strength to tightly grasp regular utensils.

101. An OT practitioner is planning a self-feeding session with an individual with a C5 spinal cord injury. Which piece of feeding equipment would be MOST appropriate for the OT practitioner to introduce to the client? a. a wrist driven flexor hinge splint b. a mobile arm support c. an electric self-feeder d. built-up utensils

(C) Eat 6 small meals a day.

101. An individual with ALS and mild dysphagia becomes extremely fatigued at breakfast, lunch, and dinner. Which is the FIRST intervention the OT practitioner should considering recommending? a. Speak with the physician about tube feedings b. Sit in a semi reclined position during meals c. Eat six small meals a day d. Substitute pursed foods for liquids

(C) I think baking would be a helpful activity to try. Baking something you like offers you several choices and decisions. These choices and decisions can help you more positive about making other decisions. You can choose a cake mix or cookie mix. Which would you like? Answer C limits options as well as provides the rationale for the choices.

101. The OT is working with an individual in a psychosocial partial hospitalization program who is having difficulty making decisions. The therapist has suggested a baking activity but the client as unsure if she wants to do this activity. The therapist's response that would BEST facilitate decision making is: A. "I think baking would be a helpful activity to try. Baking something you like offers you several choices and decisions. You wanted to bake cookies today, didn‟t you?" B. "I think baking would be a helpful activity to try. Baking something you like offers you several choices and decisions. Why do you want to bake?" C. "I think baking would be a helpful activity to try. Baking something you like offers you several choices and decisions. These choices and decision can help you feel more positive about making other decisions. You can choose a cake mix or a cookie mix. Which would you like?" D. "I think baking would be a helpful activity to try. Baking something you like offers you several choices and decisions. These choices and decision can help you feel more positive about making other decisions. You can choose a cake mix or a cookie mix. Do you want to bake cookies?"

(B) Below the MCP joints. The MCP joints are stabilized proximally, or below the MCP joints, to isolate the joint movement being measured and to eliminate any combined movements. See reference: Norkin and White.

101. While measuring the active range of motion of a patient's metacarpophalangeal (MCP) joints, it is MOST important for the OT practitioner to provide stabilization: A. Above the MCP joints B. Below the MCP joints C. At the wrist D. On top of the MCP joints

(B) 1 foot of ramp of every inch of rise in height. According to the ADA Accessibility Guidelines for Buildings and Facilities, the maximum slope for a ramp should be 1:12. A foot of ramp for every inch of rise in height would be the maximum amount of incline to allow for independent and safe navigation by an individual using a wheelchair.

102. A client's family wants to build a ramp to the primary entrance of the home. The OT practitioner advises the family that the ramp should be graded with a maximum slope of: A. 1 inch of ramp for every foot of rise in height. B. 1 foot of ramp for every inch of rise in height. C. 10 inches of ramp for every 2 inches in height. D. 1 foot of ramp for every foot of rise in height

(D) Alternative tasks that require standing with those that can be performed sitting.

102. An individual with MS reports extreme frustration because her house is so dirty. When she does attempt to clean it, she is too exhausted to do anything else afterward. She does not think she can afford to pay someone else to clean. Which of the following strategies is MOST appropriate for this individual? a. Convince the individual to hire a house cleaner b. Prescribe activities that will increase strength c. Use the largest joint available for the task d. Alternative tasks that require standing with those that can be performed sitting

(A) Identify options and the consequences of each option. Individuals are frequently resistive to changes that will affect familiar home environment, such as moving furniture or adding medically necessary equipment. For them to accept change, their feelings and cultural attitudes and beliefs must be recognized. Then the following steps can be implemented to encourage acceptance of change: (1) identify options and the consequences of each option; (2) allow time for reflection and consideration of options (answer B); (3) practice with a "demo" device (answer C); (4) reassess the decision; (5) if acceptable, order the equipment, order the equipment; and (6) if rejected, document the steps taken and the reasons for rejection (answer D).

102. An individual with emphysema reports recently "having an accident" when unable to make it to the bathroom in time. When the home health OT practitioner recommends a bedside commode, the idea is immediately rejected. Which of the following actions should the OT practitioner take FIRST? a. identify options and the consequences of each option b. decrease the effects of prolonged inactivity c. practice with a "demo" bedside commode d. allow time for the individual to think about the bedside commode

(C) Repeatedly squeeze with the hand against increasing amounts of resistance. The biomechanical approach is a treatment approach used when a person has a deficit in strength, endurance, or range of motion but has voluntary muscle control during performance of activities. The biomechanical approach focuses on decreasing the deficit area to improve the person's performance of daily activities. See reference: Trombly (ed): Zemke: Remediating biomechanical and physiological impairments of motor performance.

102. An individual with hand weakness has difficulty holding a fork. Using a biomechanical frame of reference, which of the following interventions would be MOST appropriate? A. Elicit functional grasp using reflex inhibiting postures B. Stimulate the hand flexors to promote a functional grasp C. Repeatedly squeeze with the hand against increasing amounts of resistance D. Build up utensils handles

(D) Pressure marks or redness from the splint should disappear after 20 minutes. Many types of splints may be made without the fingers flexed, or the thumb opposed and abducted: for example, an antispasticity ball splint or a dynamic splint for extension. Most splints are not worn at all times but are removed for activities such a wearing schedule when a splint is fitted or given to a patient. All splints that are made or given to a patient. All splints that are made or given to a patient are checked for correct fit by adjusting any areas that still have redness or pressure marks after the splint has been removed for 20 minutes. See reference: Trombly (ed): Linden, CA, and Trombly, CA: Orthoses: Kinds and purposes.

102. When an OT practitioner makes or issues splints, the PRIMARY criterion common to all splints is that the: A. Finger should be flexed in a functional position B. Thumb is opposed and abducted C. Splint should be worn at all times D. Pressure marks or redness from the splint should disappear after 20 minutes

(D) Provide wrist extension, MCP extension, and thumb extension.

103. An OT practitioner is fabricating a dynamic splint for a butcher who sustained a low level radial nerve injury while slicing lunchmeat at the deli where he works. The OTR explains to the client that a dorsal dynamic splint for this type of nerve injury should: a. provide wrist extension, MCP flexion and thumb flexion b. prevent wrist extension, MCP extension, and thumb extension c. prevent wrist extension, MCP flexion and thumb flexion d. provide wrist extension, MCP extension, and thumb extension

(C) developmental dyspraxia. The motor problem described as it occurs during the evaluation is characteristic of developmental dyspraxia. Children with dyspraxia often learn tasks such as jumping rope with great difficulty, effort, and considerable practice. However, when the task is altered, such as in this case by asking the child to skip backwards, the child is unable to adapt the task for a long while. See reference: Case-Smith (ed): Parham, LD, and Maillous, Z: Sensory integration.

103. An OTR performing a motor skills evaluation observes that a child is awkward at many gross motor tasks, particularly those which require relating the body to objects in space. Though able to skip rope in the regular forward pattern of movement, the child is unable to skip rope backwards, even after several attempts. This information would lead the therapist to be particularly observant for additional signs of: A. Delayed reflex integration B. Inadequate bilateral integration C. Developmental dyspraxia D. General incoordination

(B) Pinch meter. A pinch meter is used to measure the strength of a three-jaw-chuck grasp pattern (also known as palmar pinch), as well as key (lateral) pinch and tip pinch. For each of these tests, the individual three trials, which the tester averages together: the result is compared to a standardized norm. See reference: Trombly (ed): Trombly, CA: Evaluation of biomechanical and physiological aspects of motor performance.

103. The OT practitioner who is measuring the strength of a patient's three-jaw-chuck grasp pattern must know how to use a(n): A. Aesthesiometer B. Pinch meter C. Dynamometer D. Volumeter

(B) Decrease the effects of prolonged inactivity. Some of the main objectives of inpatient cardiac rehab include decreasing the effects of prolonged inactivity, such as thromboembolism, orthostatic hypotension, and muscle atrophy safely providing a program of monitored activity performance to maximize function; reinforcing cardiac precautions; and providing instruction in energy conservation techniques.

103. When planning intervention for individuals in the acute phase of cardiac rehabilitation, it is MOST important for the OT practitioner to select activities that: a. can be accomplished without causing fatigue b. decrease the effects of prolonged inactivity c. promote strength, range of motion and endurance d. can be carried out independently after discharge

(B) Perform desired activities in a simplified manner, to conserve energy. One method used to extend a person's occupational performance as Parkinson's disease progresses is to introduce task simplification. This allows conservation of energy which can then be expanded on desired activities. In a person with long-standing Parkinson's disease, encouragement to "work through" fatigue (answer A) and to perform additional exercises (answer B) would further deplete available energy.

104. A person with a long history of Parkinson's disease is experiencing considerable fatigue during the day. The OT practitioner's MOST appropriate response to help the person maintain his or her level of function is to teach the person how to: A. "work through" the fatigue B. Perform desired activities in a simplified manner, to conserve energy C. Perform additional exercises to increase energy level D. Eliminate activities and reduce activity level as much as possible

(A) collecting chart review information. After a certified OT has demonstrated service competency, it is appropriate for him or her to complete data collection through record reviews, interviews, general observations, and behavior checklists. See reference: AOTA: Occupational therapy roles.

104. A supervising OT asks an experienced COTA to complete a portion of an assessment. The portion that is MOST appropriate for the COTA to complete independently would be: A. Collecting chart review information B. Analyzing and interpreting assessment information C. Establishing the treatment goals D. Establishing the treatment plan

(D) Make sure the child's hips are secured against the back of the seat. The hips are one of the key points of control when positioning a child. Positioning the hips securely against the back of the seat with a seat belt or an abductor wedge (or both) in the correct angle serves to break up the extensor pattern and facilitate the positioning of the other body parts (answers A, B, and C), so that the child can participate in family games.

104. A young child has a diagnosis of spastic quadriplegia. The OT practitioner is teaching the child's parents how to effectively position the child sitting so that participation in family games will be facilitated. What is the MOST important point the practitioner can make? a. make sure the child's head is upright b. make sure the child's arms are on the armrests c. make sure the child's back is straight d. make sure the child's hips are secured against the back of the seat

(D) Airplane and burn hand splint. Airplane and burn hand splints are typically seen in the treatments of patients with burn injuries, especially when the wounds involve the crossing of a joint. The burn hand splint prevents ligamentous stress at the interphalangeal joints while aiding in the reduction of edema, and the airplane splint maintains the shoulder in 90 degrees of abduction in attempts to prevent contracture development at the axillary region. See reference: Neistadt and Crepeau (eds): Rivers, EA, and Jordan, CL: Skin system dysfunction: Burns.

104. An OT practitioner is educating a level-I OT student about the various types of splints primarily used in burn units. Which of the following BEST represents these splints? A. Resting splints and ankle foot orthotics B. Dynamic and posterior neck splints C. Below-the-knee amputation and burn wrist cock-up splints D. Airplane and burn hand splint

(B) Facilitating postural reactions.

104. While working with child who has a neuromuscular disorder, the OT practitioner places the child in a sitting position on therapeutic ball, starts moving the ball and asks the child to reach for a toy while sitting on the moving ball. The primary purpose of this activity is MOST likely: a. increasing upper extremity strength b. facilitating postural reactions c. decreasing tactile defensiveness d. improving visual perception

(C) To both sides of the client body.

105. A client with hemiplegia and her spouse are working on toilet transfer training activities with the OT practitioner. The BEST way for the OT practitioner to teach the couple to perform transfers will be: a. only to the unaffected side of the client's body b. only to the affected side to the client's body c. to both sides of the client body d. only to the side of the body from which the client will be approaching the toilet

(A) Coughing or choking. Coughing and choking are motor problems that are commonly noted in patients with dysphagia.

19.An OT practitioner is working with a client who demonstrates motor limitations when swallowing. Which of the following represents a motor problem commonly associated with dysphagia? A. Coughing or choking B. Disorientation or confusion C. Pain while swallowing D. Decreased smell and taste

(A) Store the most frequently used items on the shelves just above or below the counter. When an individual experiences difficulty reaching because of limited ROM, convenient placement of commonly used items will facilitate home management.

105. An OT practitioner is performing a kitchen evaluation with an individual with limited shoulder ROM the day before discharge. The individual demonstrates difficulty retrieving items from the higher shelves. Which of the following recommendations will BEST facilitate home management for this individual? A. Store the most frequently used items on the shelves just above or below the counter B. Use the largest joint available to move or lift items from the high shelves C. Perform shoulder range of motion exercises 10 times each, twice a day D. Continue reaching for items on high shelves because it will help improve range of motion

(A) Plaster cylindrical splint. A plaster cylindrical splint would encourage a static stretch of the PIP joint contracture. See preference: Pedretti (ed): Belkin, J, and English, CB: Orthotics.

105. An OT practitioner is treating a client who developed severe PIP joint contractures in the third digit, 2 months after a burn injury. Which of the following static splinting techniques would BEST address the needs of this individual? A. Plaster cylindrical splint B. Dynamic outrigger splint C. Blocking splint D. PIP-DIP splint

(B) Flexed at all joints. When weight bearing, the fingers should be flexed at all joints (the fisted position). This preserves the tenodesis function by protecting the finger flexors from overstretching. Another reason for this position is to prevent claw-hand deformity by protecting the intrinsic hand muscles from overstretching.

105. An OTR is working on sitting balance with an individual with C6 quadriplegia. The BEST position for the individual's hands to be in when using them for support is to have the fingers: a. extended and adducted b. flexed at all joints c. extended and abducted d. adducted and flexed only at the metacarpal phalangeal joints

(A) Carpeting woth low or looped pile. Carpeting with low pile would be the best choice for an elderly person who may be prone to falls because it provides the fewest tripping hazards and provides a sense of security during walking. See reference: Larson, Steven Ratchford, Pedretti, and Crabtree (eds): Christanson: MA: Environmental design, modification adaptation.

105. An elderly client, who has had several falls at home and ambulates with a cane, is preparing for discharge to the home of an adult child who is renovating some rooms for the parent. The OT has been asked to recommend flooring for the client's rooms. The BEST recommendation for the OT to make is: A. Carpeting with low or looped pile B. Wood floor C. Area rugs D. Carpeting with dep pile and padding

(D) Use active listening techniques. Active listening (answer D) is an effective listening response that enables the patient to know that his or her message has been communicated.

106. A young client who is diagnosed with depression tells an OT practitioner about feelings associated with being alone and afraid. A chart review reveals that the individual leads a very isolated lifestyle. The BEST way for the practitioner to respond is to: A. Reassure the client that they can be friends B. Tell the client, "I know how you feel." C. Encourage the client to socialize more often D. Use active listening techniques

(D) Strength. Exerting enough pressure to twist off the lid requires strength. He demonstrates adequate range of motion. See reference: AOTA: Uniform Terminology for OT, third edition.

106. An OT practitioner is assessing hand function in a man with arthritis by observing him as he makes a peanut butter sandwich. The individual is unable to remove the lid from a 28-ounce peanut butter jar but is able to stand at the counter, spread peanut butter on the bread with a knife, and replaces the lid when he has finished making the sandwich. These observations would MOST accurately reflect deficit in the performance component: A. Range of motion B. Coordination C. Endurance D. Strength

(A) Mount lever handles on doors and faucets. For children with reduced strength and endurance, using less complex movements and less force results in energy conservation. Lever handles require less energy the knob handles on doors, faucets, and appliances.

106. An OT practitioner is preparing for the discharge of a preadolescent child with limited strength and endurance. Which of the following home adaptations is MOST important to recommend? a. mount lever handle on doors and faucets b. remove all throw rugs c. install non-skid pads on steps d. mount a table top easel for written home work

(A) Thumb against the tip of the index finger. The correct position for tip pinch is the thumb against the tip of the index finger. The thumb against the side of the index finger describes the position for lateral pinch. The thumb against the tips of the index and middle fingers describes the test position for three-jaw chuck, or palmar pinch. The thumb against the tips of all the fingers is not a standard test position. See reference: Trombly (ed): Trombly, CA: Evaluation of biomechanical and physiological aspects of motor performance

106. In administering an assessment of fingertip pinch strength, the OT practitioner would instruct the individual being tested to place the finger in which position? A. Thumb against the tip of the index finger B. Thumb against the side of the index finger C. Thumb against the tips of the index and middle fingers D. Thumb against the tips of all the fingers

(A) A resting pan splint for a client after a TBI who has been unresponsive in the ICU for 3 weeks, yet grimaces with passive digit extension. This type of static splint appropriately positions the wrist and digits in a functional position in order to prevent the development of contractures while providing protection for the hand.

107. An OT practitioner is fabricating a static splint to prevent further injury, reduce pain, and encourage proper positioning. Which if the following would BEST address these goals? a. a resting pan splint for a client after a TBI who has been unresponsive in the intensive care unit for 3 weeks, yet grimaces with passive digit extension b. a dynamic extension splint for a client with radial nerve injury sustained after skiing accident c. an articular splint after surgical repair of PIP joint for a burn injury d. a spring coil splint for a client with a median nerve injury sustained in a boating accident

(C) Assertiveness training. Broken record is a specific assertiveness skill concerned with repeating your position without losing control. See reference: Posthume: Process and leadership.

134. An OT practitioner is planning to demonstrate and then involve a group of individuals in practicing "broken record" behaviors. Which of the following interventions BEST encompasses the broken record technique? A. Music therapy activities B. Self-awareness activities C. Assertiveness training D. Psychodrama approaches

(A) Use pictures, music, and discussion to encourage discussion of memories. Remotivation approaches are used to encourage the expression of thoughts and feelings related to intact long-term memories. The topic should be linked to the group's past experiences and be easy to understand.

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

(B) Corner chair with head support and padded abductor post. A corner chair provides hip, knee, and ankle flexion of 90 degrees, and the abductor post keeps the legs separated when or if extensor tone increases. The corner shape of the chair facilitates SH protraction or prevents SH retraction, which can prevent the child's hands from coming forward to assist with eating.

108. A child with CP demonstrates poor head control, high LE extensor tone, and high lower extremity tone, and high UE flexor tone. The BEST device for positioning this child for feeding is a: A. Prone stander with lateral trunk supports B. Corner chair with head support and padded abductor post C. Wedge that positions the hips in 15 degrees of flexion when the child is supine D. Bolster chair without back support

(D) Blowing cotton balls into a target. Children with ADHD have difficulty with sustained attention and effort. Answers A, B, and C require sustained visual vigilance and involve delayed gratification. By contrast, blowing cotton balls into a target is a short-term activity with immediate reward for successful completion. This activity is therefore the most appropriate one, responding to the child's dual needs.

108. A child with a diagnosis of ADHD also exhibits perceptual deficits. The activity that would be the MOST effective intervention for this child to train visual attention is: a. Playing a game if Memory in which images are matched by memory. b. Assembling a 200-piece puzzle. c. Finding Waldo against a complex visual background d. Blowing cotton balls into a target.

(A) Teach the child to dress in a side lying position. The side lying position eliminates the need for the child to maintain balance in order to dress the LEs.

108. A child with poor balance is unable to put on and remove lower extremity clothing. Which of the following approaches would BEST address this functional problem? a. teach the child to dress in a side lying position b. add loops to the waistbands of pants and skirts c. use Velcro fasteners in place of zippers d. teach the child to dress in standing position

(B) Dressing apraxia. To some extent, dressing apraxia is a result of impaired awareness of the affected side and the relation of body parts to the clothing, as well as difficulty with assembly of the clothing onto the body. See reference: Trombly (ed): Quintana, LA: Evaluation of perception and cognition

108. During a perceptual evaluation, an OT practitioner determines that an individual exhibits constructional apraxia, body scheme disturbances, and unilateral neglect. During the functional part of the evaluation, these deficits are MOST likely to contribute to self-care difficulties related to: A. Spatial relations B. Dressing apraxia C. Anosognosia D. Figure-ground discrimination

(C) Have the individual visualize the task first and then provide general statement suck as "Let's get ready." Answer C is correct because visualizing a task and its movement sequences helps the individual with motor apraxia by giving a visual model to refer to during the activity. Using general comments such as "Let's get ready" rather than specific step-by-step directions is more effective because individuals with motor apraxia have difficulty imitating or initiating motor tasks on command, though they understand the concept of the task. See reference: Gillen and Burkardt (eds): Rubio, KB: Treatment of neurobehavioral deficits.

109. An OT is planning intervention for an individual who recently experienced a left CVA resulting in right-sided hemiplegia and motor apraxia. To BEST facilitate the individual's attempts to perform morning ADL the OT should plan to: A. Provide the individual with detailed, step-by-step commands for each task throughout the ADL process B. Make the environment as simple and uncluttered as possible and use sharp contrast to make objects clearly stand out C. Have the individual visualize the task first and then provide general statements such as "Let‟s get ready." D. Teach the individual to move slowly through the environment and encourage touching of objects during the task

(C) Providing a program to enhance occupational performance in ADL, work, and leisure. The role of the OT on the LE management team is to address occupational performance in areas of function: ADL, such as self-care, functional mobility, community mobility; work or productive activities, such as home management and vocational activities; and leisure activities. The OT may address performance components such as endurance, pain management, and soft tissue integrity to achieve the overall aim of maximizing occupational performance.

109. An OTR is on the treatment team for patients with lower extremity amputations in a rehabilitation hospital. The PRIMARY role of the OT in the management of lower extremity amputation is: a. fabricating artificial limbs b. providing therapeutic exercise, wound care, pain management and gait training c. providing a program to enhance occupational performance in ADL, work, and leisure d. assessing the client's social environment and making recommendations

(D) Setting personal boundaries appropriate to the therapist-patient relationship. It is important to acknowledge the individual's need for sexual expression while supporting the sense of self and identifying acceptable relationship and behaviors. Setting boundaries while accepting the individual is the most appropriate therapeutic response.

109. An attractive unmarried patient with a spinal cord injury (CSI) is on a rehab unit and constantly flirts with the OT and PT staff. The staff should reach by: a. Firmly rejecting his advances. b. Flirting back in order to promote his self-esteem. c. Selecting one team member to discuss the effects of SCI on sexual functioning with the patient. d. Setting personal boundaries appropriate to the therapist-patient relationship.

(A) Gentle, nonresistive activities. The initial phase of treatment for the individual with GuillainBarre syndrome includes PROM and splinting, and positioning to protect weak muscles and prevent contractures. This should be followed by gentle, nonresistive activities and light ADL, as tolerated.

114. An individual with Guillain-Barre Syndrome demonstrates poor to fair strength throughout the upper extremities. Which is the most appropriate approach for the OT practitioner to use in the EARLY stages? A. Gentle, nonresistive activities B. Progressive resistive exercise C. Fine motor activities D. Active range of motion against moderate resistance

(C) Use the handout only as a resource while developing the presentation. The OT Code of Ethics states that "Occupational therapy personnel shall accurately represent the qualification views, contributions, and findings of colleagues" (p.1038). See reference: AOTA: Occupational therapy code of ethics.

109. While preparing for his first presentation at a professional conference, an OT realized he does not have the name of the author of an article containing critical information he planned on photocopying and distributing. Which of the following is the MOST appropriate action for the OT to take? A. Distribute the handout and apologize for not having the author's name B. Show the handout with and overhead projector and apologize for not having the author's name C. Use the handout only as a resource while developing the presentation D. Refrain from using the handout in any way

(C) Supervision. At this level, the child performs the task on his or her own but cannot be safely left alone, or the child may need verbal cueing or physical prompts for 1 to 24% of task. At the independent level. See reference: Case-Smith (ed): Sheperd, J: Selfcare and adaptations for independent living.

11.A preteen with a history of TBI is relearning to prepare simple foods but has been having difficulties with sequencing so the OT practitioner has provided the patient with a chart of steps to follow. The child has just learned to prepare his favourite sandwich without "losing his place" in the process but continues to need occasional verbal reminders to look at the chart and to ensure safety. At this point, the child's MOST recent level of independence would be documented as: A. Independent B. Independent with setup C. Supervision D. Minimal assist

(B) Let the child sit at the front of the bus and use tape player and earphones. A child who is seated in the front of the bus will experience less jdsdsdsd by peers, resulting in less tactile and visual stimulation. Also, the earphones will serve to reduce auditory overload. See reference: Case-Smith (ed): Cronin, AF: Psychosocial and emotional domains.

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

(C) 8 to 9 months of age. "By 8 to 9 months the infant sits erect and unsupported for several minutes."

11.An OT practitioner is informing a child‟s caregiver about when developmental milestones of childhood occupations typically occur. The therapist reports that infants sit without support for a few minutes by: a. 3 to 5 months of age b. 6 to 7 months of age c. 8 to 9 months of age d. 13 to 15 months of age

(C) Conduct disorder. Conduct disorders often involve aggression toward people or animals and property destruction.

11.An adolescent patient is attending a craft group for the first time. The OT practitioner is observing the patient closely for signs of aggressive and violent behavior. The individual has MOST likely been diagnosed with: A. Hyperactivity B. Attention deficit disorder C. Conduct disorder D. Oppositional defiant disorder

(B) Normal development. Proximal movement on a fixed distal limb component - that is, on hands and knees - is an example of the development of mobility superimposed on stability. This stage is essential in the development of coordinated antigravity movement. The development of this type of movement in the quadruped position occurs between the ages of 7 and 12 months. This pattern is typical of normal development and does not indicate answers A, C, or D.

11.While assessing the motor skills of an 8-month old child, the OT practitioner observes him assume a quadruped position and then begin to rock back and forth. This behavior MOST likely indicates: A. Perseverative tendencies B. Normal development C. Low muscle tone D. Limitation in movement repertoire

(B) Use a walker. Ambulatory aids may be used to substitute for lost motion, reduce weight bearing on the lower extremities, or widen the base of support to increase stability. An individual with a balance deficit requires a wider base of support, which is provided by walkers and quad canes.

110. A home health OT is working with an individual who is ambulatory but demonstrates poor balance. The individual has a walker, a standard cane and a wheelchair at home, but financial constraints have prevented any home modifications. Which of the following ambulatory methods would be MOST appropriate for use during meal preparation training? A. Use a standard cane B. Use a walker C. Use a wheelchair D. Hold on to counters and walls

(B) To routinely inspect the skin closely for signs of skin breakdown. Teaching the person with a residual limb to compensate for the lack of sensation with visual inspection is essential to prevent injury from skin breakdown.

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

(C) Precipitating conditions and events that elicit stress reactions. The conditions and events that elicit stress reactions are known as stressors (answer C). Stressors can be either short term or long term.

110. An OT practitioner who is leading a stress management group explains to the members that stressors can be MOST accurately described as the: a. process by which individuals adjust to daily stressful events within their environments b. body‟s reactions to threat, often described as "fight or flight" c. precipitating conditions and events that elicit stress reactions d. process of "fit" between the individual and his or her environment

(A) Postural hypotension. A frequent side effect of neuroleptic drugs is a decrease in blood pressure in response to sudden movements, specifically up and down movements, resulting in faintness or loss of consciousness. The parachute activity involves significant up-and=down body movements and therefore warrants the therapist's attention with this patient population. See reference: Early: Psychotropic medications and other biological treatments.

110. An OTR is preparing to do a parachute activity as part of a sensory integration program and several of the patients in the group are taking antipsychotic medications. The OTR should be alert for which possible side effect that could occur as a result of this activity? A. Postural hypotension B. Photosensitivity C. Excessive thirst D. Blurred vision

(B) Comfort the individual's behavior: "Are you aware that you frequent interruptions prevent others from having a chance to contribute?" In general, the group leader should try answers A, C or D before confronting the individual who is monopolizing the conversation. Answer B, confronting the behavior, is the approach that would most likely be taken after more conservative attempts have failed the practitioner.

110. While running a nutrition awareness group, an OY practitioner observes that one member tends to monopolize the discussion be frequently interrupting. Which intervention would be NEST to implement after other, more conservative approaches have been unsuccessful? a. Sit beside the person who is monopolizing and touch his or her hand or arm as a reminder not to interrupt others who are talking. b. Confront the individual's behavior: Are you aware that your frequent interruption prevents others from having a chance to contribute? c. Redirect the individual: Now let's hear what others have to say about this. d. Restructure the task: Select a group activity that requires sequential turn taking.

(D) Ice application, immobilization, and splinting ice, immobilization, and splinting are all interventions that are considered to be appropriate adjunct activities to be used during the acute stages of tennis elbow. See reference: Cailliet: Elbow pain.

111. A client that the OT practitioner is treating brings an order from his physician requesting treatment for epicondylitis. Which of the following adjunct activities should be used to treat the ACUTE symptoms of tennis elbow? A. PROM, weight bearing, and mobilization B. Resistive exercises, heat application, and work simulation C. Heat application, PROM, and strengthening D. Ice application, immobilization, and splinting

(C) Tell the client it is okay to work where he is until he feels comfortable in joining the group. The paranoid client frequently isolates himself/herself from the rest of the group as a selfprotective measure. Such a client should be allowed to do this until he/she feels comfortable in joining the group. Although it is a good idea to encourage the person to join the group.

111. A client with paranoia prefers to stay away from the group, working alone at another table. The BEST action for the OT practitioner to take is to: A. Encourage the client to join the group B. Tell the client he is required to sit with the group C. Tell the client it is okay to work where he is until he feels comfortable in joining the group D. Stay with the client until he is ready to join the group

(D) Weaving on a wide frame loom. Use of and attention to the entire loom area is essential for weaving on a frame loom. The shuttle must slide across the entire width of the loom, which involves crossing the midline.

111. An individual demonstrate a left visual field cut as a result of a CVA and demonstrates difficulty crossing the midline during many selfcare activities. Which of the following interventions would best represent a REMEDIAL approach to addressing this deficit area? a. Placing self-care supplies to the individual's right side b. Patient and family education regarding the effects of visual field loss c. Verbal and tactile cueing to look to the right side d. Weaving on wide frame loom

(A) Ease the patient onto the floor, cushioning his fall. Proper body mechanics must be used when transferring patients. No one should "attempt a transfer that seems unmanageable because of the discrepancy between the patient size and her own or because of the patient's level of dependency." Attempting to continue or reverse the transfer on an obese patient who has already begun to slip (answers B and C) is likely to result in injury to the OT practitioner and perhaps to the patient as well. Once the patient has started to slip, the OT practitioner should begin easing him to the floor immediately. Although calling for assistance is an appropriate action, the higher-priority action is to begin easing the patient to the floor to prevent injury to the individuals involved.

111. In the middle of a wheelchair to bed transfer, an obese patient begins to slip from the grasp of an average-size OT practitioner. The BEST action for the OT practitioner to take is to: a. ease the patient onto the floor, cushioning his fall. b. reverse the transfer getting the patient back in the wheelchair. c. continue the transfer, getting the patient to the bed. d. call next door for assistance.

(D) Low-impact aerobics 3 times a week for 1 hour. The avoidance of activities that promote hyperextension and resistance to the joints best addresses the neuromuscular aspect of preventing further damage to arthritic joints.

112. A physical education teacher is being treated for osteoarthritis of the upper and lower extremities. Which of the following neuromuscular activities would the therapist MOST LIKELY suggest to prevent further complications? a. Lifting weights three times a week for 1 hour b. Listening to relaxation tapes three times a week before bedtime. c. Vocational retraining d. Low-impact aerobics three times a week for 1 hour

(A) improving accessibility in building access, building interiors, and rest rooms. Title III of the ADA addresses accessibility of facilities used by the public and focuses on removal of structural barriers to allow access to the premises and use of the facilities, including, parking areas, walks, ramps, entrances, etc. See reference: Pedretti (ed): Smtih, P: Americans with Disabilities Act: Accommodating persons with disabilities.

112. An OTR is working as a consultant to a health care facility to assist the facility in achieving compliance with the Americans with Disability Act (ADA), Title III. The PRIMARY focus of the OT‟s efforts would be to make recommendations about: A. Improving accessibility in building access, building interiors, and rest rooms B. Modifying equipment, providing assistive aids, and training in adaptive methods so a disabled person can perform a particular job C. Providing education to persons who hire personnel concerning nondiscriminatory behaviors and procedures regarding persons with disabilities D. Assistive technology systems to facilitate job performance of disabled employees

(C) Fair minus (3-). The definition of fair minus (3-) is that the part moves through incomplete range of motion (<50%) against gravity or through complete range of motion with gravity eliminated against slight resistance. A grade of good (4), answer A, indicates strength on the manual muscle test and ability to move through full range of motion against gravity and to take moderate resistance. See reference: Trombly (ed): Trombly, CA Evaluation of biomechanical and physiological aspects of motor performance.

112. An adult with polymyositis and dermatomyositis, is able to complete full range of shoulder flexion while in a supine position during an evaluation with an OT practitioner. However, against gravity, the client is only able to achieve 50% of the range for shoulder flexion. The practitioner grades this muscle as: A. Good (4) B. Fair (3) C. Fair minus (3-) D. Poor plus (2+)

(C) Word prediction software. Word prediction software anticipates the word desired and increases the speed of input by decreasing the number of keystrokes required.

113. A child with athetoid cerebral palsy is learning to use augmentative communication and is frustrated because it takes so long to produce a sentence. Which of the following is the BEST solution for this problem? a. a larger monitor b. a voice output tool c. word prediction software d. masking inappropriate keys

(C) recommend activities to develop fine coordination that teachers can incorporate into classroom programming. Recommending classroom activities that will develop the performance component of fine coordination would be the best population-based intervention since it involves addressing the occupational performance needs of many students. See reference: AOTA: Guide to Occupational Therapy Practice.

113. AN OT practitioner working for the school system has identified a general need to enhance the fine coordination skills of the elementary school students to facilitate better writing skills. The BEST population-based interventions would be to: A. Screen students for writing problems and provide in-depth assessment of those identified B. Provide remedial activities for those students identified having fine coordination deficits C. Recommend activities develop fine coordination that teachers can incorporate into classroom programming D. Recommend additional OT staff to provide direct services for students

(C) Take the individual's vital signs at rest. First, vital signs should be taken at rest. The individual should them perform an activity while being monitored by the OT practitioner for any signs or symptoms. See reference: Introduction to biomechanical frame of reference.

113. An individual who recently experienced an MI is now medically stable and has been referred to OT. In order to determine the individual's current endurance level, the OT practitioner plans to monitor performance of self-activities. The FIRST step is to: A. Take the individual's vital signs after performance of self-care activities B. Observe the individual for signs and symptoms during self-care activities C. Take the individual's vital signs at rest D. Take vital signs 5 minutes after the individual has completed self-care activities

(D) Perform behavioral techniques and developmental positioning with parental observation and interaction. The NICU environment can often undermine the importance of the family. Therefore, implementing and integrating parental involvement with daily neonatal care becomes of primary importance for the carryover of learned techniques to best promote developmental acquisition. Answers B, C, and D are all family-centered strategies and are recommended for NICU intervention. However, D is clearly the optimal strategy for fostering parental observation skills, building positional and handling skills, and developing their ability to interpret and respond their infant's behaviors. Initial chart interview and updating with nursing staff (answer A) are essential assessment steps made prior to initial contact with the infant and family and is the least optimal intervention strategy to pursue with the family present

113. Upon arrival to an infant's therapy session in the neonatal intensive care unit (NICU), the OT finds the infant's parents present. Of The following, which is the OPTIMAL intervention to pursue? a. Review the chart to complete birth history information and speak to the infant's primary nurse. b. Introduce yourself as their child's OT, explain and excuse yourself from the situation secondary to limited availability for intervention. c. Issue written positioning and state regulation and readiness information for the parents to review. d. Perform behavioral techniques and developmental positioning with parental observation and interaction.

(C) Describe how using a shower chair improves safety. Informing the patient of various options is the first response. By describing the shower chair and how it make showering safer, the OT practitioner is conveying the concept that occupational performance is based on the interaction of performance contexts (physical environment) and performance components (balance) and that there are methods to ensure safety.

114. A 78 year-old individual who is ambulating in the home informs the OT practitioner that improving balance is a major concern. Although the patient took showers in the past, now his fear of falling limits him to sponge baths. The OT practitioner tells the individual that it is wise to avoid situations in which the risk of falling is high. Which of the following should the OT practitioner advise the individual to do NEXT? a. try the bathtub instead of the shower b. purchase a shower chair c. describe how using a shower chair improves safety d. stretchy fabric clothing with tie closures in the back

(A) Practice preparing a variety of foods, using different cooking methods and recipes. Recent findings in motor learning suggest that practicing variety of tasks in a nonsystematic but repetitive way (variable practice) can enhance learning retention and transfer of skills because the novelty introduced into the task engages more cognitive effort.

114. A client is being seen by OT to promote independence in meal preparation and clean-up activities. The method of structuring activity practice that would BEST promote retention of learning and transfer of skills is to: a. practice preparing a variety of foods, using different cooking methods and recipes. b. practice cooking one meal from beginning to end in the same kitchen setting several times. c. Practice making a sandwich until that is mastered, then practice preparing another part of a meal until the person has mastered that skill, etc. d. Practice performing each step of the food preparation process, such as cutting vegetables.

(B) Two A person in stage two of Brunnstrom's levels of recovery demonstrates weak, associated movements, usually in a flexor synergy; there may be little or no finger flexion. See reference: Pedretti (ed): Pedretti, LW: Movement theraphy: The Brunnstrom approach to treatment of hemiplegia.

122. According to Signe Brunnstrom, a person who demonstrates developing spasticity on the hemiplegic side of the body with weak, associated movements in synergy and little active finger flexion would be in which stage of recovery? A. One B. Two C. Three D. Four

(B) Perform the evaluation over several sessions. Upper extremity evaluation is lengthy and can be fatiguing, and fatigue should be avoided with individuals with Guillain-Barre syndrome. In addition, results may be invalid if the individual is fatigue and not performing at the highest level possible. See reference: Pedretti (ed): McCormack, GL, and Pedretti, LW, in Motor unit dysfunction

114. When administering an evaluation of upper extremity function to a newly admitted patient with Guillain-Barre syndrome, it is MOST important to: A. Test proximal muscle strength first B. Perform the evaluation over several sessions C. Include sensory testing D. Evaluate range of motion

(C) Dysphagia is the inability to swallow. See reference: Pedretti (ed): Nelson, KL: Dysphagia: Evaluation and treatment.

115. An OT practitioner is working with a client who demonstrates the inability to swallow when attempting to self-feed water ice. The OTR should interpret the inability to swallow as: A. Deglutition B. Dysmetria C. Dysphagia D. Dysarthria

(D) Encourage independent self-feeding and dressing skills with minimal use of adapted utensils and tools. Encouraging independent self-feeding and dressing skills with minimal use of adapted utensils and tools is the most significant ADL intervention. It is important to avoid an overreliance on adapted equipment so the client can experience full active ROM when engaged in ADL.

115. An OT practitioner is working with a medically stable client who sustained bilateral upper extremity partial thickness burns 3 days ago while frying chicken. Which of the following BEST represents a typical ADL intervention? a. Instruct the client to use all adapted equipment. b. Encourage independent compression garment, application. c. Perform bilateral upper extremity PROM exercises twice a day. d. Encourage independent self-feeding and dressing skills with minimal use of adapted utensils and tools

(B) Having the worker put only the last piece into the game package. Working backwards from the last (successful) step of a sequence known as "backward chaining."

115. An OT practitioner realizes that an adult worker with a developmental disability is having difficulty learning an assembly sequence. The practitioner decides to use backward chaining. Backward chaining can BEST be implemented by: A. Encouraging the individual to reverse the packaging sequence B. Having the worker put only the last piece into the game package C. Putting only the pencil or the pad into the game box D. Having the OT demonstrate and repeat the correct sequence before each of the worker's attempts

(C) Both OTRs and COTAs should have liability insurance. Liability insurance protects OT practitioners from financial damage should they be sued for negligence or misconduct. Most facilities maintain coverage for licensed professionals, but the level of coverage may not be sufficient to cover the amount sought for by the claimant. Therefore, OT practitioners may chose to insure themselves at a higher level. See reference: Ryan (ed): Practice Issues in Occupational Therapy: Jones, RA: Service operations.

115. An entry-level OT practitioner wants to know the extent of her liability when providing occupational therapy. Which of the following answers is MOST accurate? A. Only OTRs need to have liability insurance B. Only COTAs need to have liability insurance C. Both OTRs and COTAs should have liability insurance D. Neither OTR or the COTA need to have liability insurance

(A) Velcro closures on front-opening clothing. Velcro closures on front-opening clothing would require the least amount of dexterity, which becomes increasingly difficult with Parkinson's disease.

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

(C) The client is receiving nasal tube feedings. Nasal tube feedings (or nasal gavage) is process of feeding that is introduced through a tube that enters the nasal passage and leads to the stomach. See reference: Pedretti (ed): Nelson, KL: Dysphagia: Evaluation and treatment.

116. A client requests a drink of water after working on UE exercises during therapy. The OT practitioner reads in the patient's chart that "Mr. J is on a nonoral feeding program." The OTR interprets that: A. The client is on thin liquid only feedings. B. The client is on stage I foods only. C. The client is receiving nasal tube feedings. D. The client is eating pureed only foods

(A) Work on coordinated reach in sidelying position first and then transfer the skill to sitting position. The OT practitioner should teach the skill with the child in the position in which the child can most easily learn the skill and then teach the child to transfer the skill to a more functional position.

116. A student has been working on learning to activate a switch for a communications device needed in the fourth grade classroom. The switch is mounted on the wheelchair tray, but the student is having difficulty operating it because of excessive muscle tone. Despite practicing for extended periods of time, the student is not making any progress. The OTR decides to: a. work on coordinated reach in side lying position first and then transfer the skill to sitting position b. passively stretch the student's upper extremity to increase range of motion c. use a brightly colored switch to increase visibility d. use systematic behavioral reinforcement through shaping

(B) A switch-adapted battery-operated toy car that knocks down a block tower. A switchadapted battery-operated car would be most age appropriate activity that would allow a young child to experience how his/her actions affect the environment.

116. An early intervention OT practitioner is working with a toddler whose significant physical disabilities have limited the child's ability to explore the environment. The BEST "low-tech" assistive technology play aid to allow the child to experience cause and effect and some control over an aspect of his or her environment would be: A. A tape recorder for the child to listen to music. B. A switch-adapted battery-operated toy car that knock down a block tower C. Storybook software for use on a computer D. Powered wheelchair

(A) Complete independence with self-care and transfers. An individual with T4 paraplegia will have sufficient trunk balance and upper extremity strength and coordination to complete selfcare and transfers independently. See reference: Pedretti: (ed): Adler, C. Spinal cord injury.

116. In establishing long-term goals for an individual with T4 paraplegia in a rehabilitation setting, the OT practitioner would MOST likely predict that the patient will attain what level of independence with bathing, dressing, and transfers? A. Complete independence with self-care and transfers B. Independence with self-care and minimal assistance with transfers C. Minimal assistance with self-care and moderate assistance with transfers D. Dependence with both self-care and transfers

(C) Allow child to self-apply tactile stimuli to maximize child's tolerance. Tactile defensiveness is an overreaction or negative reaction to sensations of touch. Answer C is correct. "Generally, tactile stimuli that are actively self-applied by the child are tolerated much better than stimuli that are passively received, as when being touch by another person."

116. The BEST way for an OT practitioner to utilize sensory stimulation for the child with tactile defensiveness is to: a. apply light touch stimulation such as tickling on the abdomen for desensitization b. avoid all forms of tactile stimulation to accommodate child's preferences c. allow child to self-apply tactile stimuli to maximize child's tolerance d. avoid all deep pressure tactile stimuli to decrease defensiveness

(A) Are most easily performed if coordinated with consistent timing of medications. A patient with Parkinson's needs to learn to use the period of reduced symptoms and improved mobility resulting from medication use to best advantage for performing ADL. Medications taken regularly and consistently aid the establishment of routines for self-care.

117. A patient diagnosed with Parkinson's disease is being seen by an OT practitioner to develop a routine for performing self-care activities. The therapist is MOST likely to begin this process by instructing the patient that self-care activities: a. are more easily performed if coordinated with consistent timing of medications. b. should be performed before medications are taken. c. should be attempted only with the assistance of others. d. should be performed at intervals throughout the day until completed.

(B) Replace the white glue with blue glue. Activity adaptations enable the individual to become more functional in his/her task performance.

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

(A) Work simplification and energy conservation. In the first stage of the disease, mild limitations in function and endurance begin to develop. The individual becomes easily fatigued, so work simplification and energy conservation techniques are beneficial.

117. An individual in the early stages of amyotrophic lateral sclerosis (ALS) has been referred for OT in an outpatient setting. Which of the following interventions is MOST appropriate for this individual? A. Work simplification and energy conservation B. Progressive resistive exercises C. Splinting D. Active and passive range of motion exercises

(A) Using effective communication skills. Clarifying expectations, honesly defining needs, and providing tactful and constructive feedback are communications skills that promote understanding. Successful communication with the patient's children will most likely help them deal with their fears and concerns. Increase their understanding of their father's condition, and elicit greater cooperation. Although time management techniques, deep breathing, and laughter. See reference: Neistadt and Crepeau (eds): Giles, GM, and Neistadt, ME, in treatment for psychosocial components: stress management.

117. During a stress management group, an individual recently diagnosed with multiple sclerosis (MS) complains that his teenage children are resistive to helping with chores that were previously his responsibility, such as mowing the lawn and taking out the trash. The stress management technique that would MOST successfully address this concern is: A. Using effective communication skills B. Applying time management techniques C. Deep breathing D. Laughter

(B) Verbal and gestural cues. The next least intrusive level of cues consists of the combination of verbal and gestural cues.

118. A child has mastered brushing her teeth with the OT practitioner giving verbal and physical cues. What would be the NEXT step in the process of reducing the intrusiveness of cues? A. Verbal cues B. Verbal and gestural cues C. Physical cues D. Verbal and physical cues

(B) Obstacle courses. This child should be exposed to situations that require problem solving by challenging to the child to move his or her body in relaxation to objects in the environment. Although all of the answers involve motor planning in response to the environment to some degree, running obstacle courses clearly emphasizes the spatial element the most. Obstacles also consist of static items and therefore facilitate success in adjustment (motor planning) more easily than moving objects.

118. A third grade student receives direct OT services provided through the public school system. Which of the activities should the OT practitioner recommend to the gym teacher to BEST consolidate the child's skills in spatial organization and motor planning? a. relay races b. obstacle courses c. the balance beam d. freeze tag

(D) apply the stimuli to the uninvolved area proximally to distally in a random pattern. The general guidelines for sensation testing are that the person's vision should be occluded, the stimuli should be randomly applied with false stimuli intermingled, a practice trial should be performed before the test, and the unaffected side or areas should be tested before the affected side or area. Also, the amount of time a person has to respond should be established. See reference: Trombly (ed): Bentzel, K: Evaluation of sensation.

118. An OT practitioner is performing sensation testing on an individual with hemiplegia. The therapist should FIRST: A. Apply the stimuli distally to proximally B. Test the involved area then the uninvolved area C. Present test stimuli in an organized pattern to improve reliability during retesting D. Apply the stimuli to the uninvolved area proximally to distally in a random pattern

(D) Distractibility. Distractibility involves losing one's focus because of other stimuli.

20.An individual with the goal of increasing attention span is frequently observed watching the person next to her instead of performing her assigned task. This behavior MOST likely indicates: A. Memory deficits B. Spatial operations C. Generalization of learning D. Distractibility

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

118. The BEST method for handling a child who exhibits tactile defensiveness is to: a. tickle him during play times. b. play loud music when undressing him. c. lightly stroke his arms and legs during baths. d. hold him firmly when picking him up.

(B) Seating the patient upright on a firm surface with the chin slightly tucked. The best position for feeding an individual with a swallowing disorder is upright and symmetrical, with the chin slightly tucked. "Correct positioning normalizes tone, thereby facilitating quality motor control and function of the facial musculature, jaw and tongue movement, and the swallow process, all of which minimize the potential for aspiration."

119. A patient who is being discharged from a rehabilitation center to home has Parkinson‟s disease and is at risk for aspiration. When instructing the primary caregiver in proper positioning during feeding, the OT practitioner should recommend: a. feeding the patient in bed in a supine position b. seating the patient upright on firm surface with the chin slightly tucked c. positioning the patient in a semireclined position in reclining chair d. feeding the patient in bed in a side lying position

(C) Swimming in a cool water pool. Swimming is an excellent activity for promoting physical fitness, and the cool water pool (temperature under 84 degrees) will prevent the overheating that is contraindicated for individuals with MS. Joggling and volleyball. See reference: Pedretti (ed): Hietpas, J, Hooks, ML, Atchison, P, et al, in Degenerative diseases of the central nervous system.

119. An artist recently diagnosed with MS is interested in pursuing a leisure activity that will promote physical fitness. Because the individual's symptoms are limited to mild UE numbness and slight weakness in the dominant hand at this point, the BEST activity to recommend is: A. Volleyball B. Painting with the dominant hand C. Swimming in a cool water pool D. Jogging on a track or treadmill

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

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

(D) Lordosis. Lordosis, a concave posterior curvature of the spine, is a result of excessive anterior pelvic tilt.

119. In a work-hardening program, an OT practitioner is teaching a man with an excessive anterior pelvic tilt how to use proper body mechanics during lifting tasks. The MOST appropriate emphasis of the instruction should be correction of: A. Stenosis B. Scoliosis C. Kyphosis D. Lordosis

(C) Avoid resistive materials. For a child with acute juvenile rheumatoid arthritis, the OT practitioner should always use techniques for joint protection and energy conservation. Activities requiring the manipulation of highly resistive materials such as clay, leather, and copper sheets should be avoided; the pressure applied to the joints could exacerbate the condition. See reference: Case-Smith (ed): Rogers, SL, Gordon, CY, Schanzenbacher, KE, and Case-Smith, J: Common diagnosis in pediatric occupational therapy

119. When developing play activities for a child with acute juvenile rheumatoid arthritis, which of the following precautions should the OT practitioner follow? A. Avoid light touch B. Avoid rapid vestibular stimulation C. Avoid resistive materials D. Avoid elevated temperatures

(B) Medicold. Medicaid is a joint federal and state program. Because it is a joint program, benefits very widely from state to state. In each state, the Medicaid program must include Aid to Families with Dependent Children (AFDC) and Supplementary Security income (SSI). See reference: AOTA: The OT Manager: Thomas, VH: Evolving health care systems: Payment for OT services.

12.A mother of child who is medically indigent and does not have health insurance is concerned about payment for laboratory work and OT services in the hospital. The OT practitioner explains that federal and state programs exist that fund health care for the poor and medically indigent. This program is referred to as: A. Medicare B. Medicaid C. Worker's compensation D. Education for All Handicapped Children Act

(C) Stated instructions for administration and scoring. In standardized assessments, the instructions to the examiner are detailed and fixed so that procedures are followed consistently each time the test is administered. Following these instructions assures the highest level of reliability and validity possible.

12.Of the following, the MOST important aspect of administering a standardized test for an OT practitioner is the use of: a. subjective judgment to determine how best to administer the test b. previous experience as a way to gauge test results c. stated instructions for administration and scoring d. practice to learn the best way to administer and score the test

(C) Cruising. The described pattern is cruising. Cruising occurs at approximately 12 months of age and directly precedes walking.

12.While standing and holding onto furniture, a 3-year-old boy with delayed motor development shifts his weight onto one leg and steps to the side with the other. This movement pattern is best described as: A. Creeping B. Crawling C. Cruising D. Clawing

(D) "Family will demonstrate independence in current positioning and feeding techniques." Goals should be functional, measurable, and objective. In addition, short-term goals must relate to the long-term goal being addressed. See reference: AOTA" Effective documentations for OT.: Moorhead, P, and Kannenberg, K: Writing functional.

120. A long-term goal for an individual with progressive weakness is for the family to carry out his feeding program. They have achieved the short-term goal of understanding how the individual's disability affects his ability to feed himself. Which statement is the BEST example of a revised short-term goal? A. "Pt. will participate in feeding program." B. "Pt. will feed himself with moderate assistance." C. "Family will feed patient safely and independently 100% of the time." D. "Family will demonstrate independence in current positioning and feeding techniques."

(B) Awareness, minimal deficits, and learning potential. The client most likely to benefit from remedial activities would be one with minimal deficits, awareness of limitations, and learning potential.

120. A patient who sustained head trauma is receiving an OT program of repetitive pegboard, paper and pencil tasks, and computer activities to remediate attention and memory deficits. The type of client MOST likely to benefit from this type of cognitive remediation is one who has: A. Cognitive deficits which must be treated within a short treatment time frame B. Awareness, minimal deficits, and learning potential C. Difficulty transferring learned skills to new situations D. A history of cognitive deficits resulting from a head trauma years ago

(D) strength. Exerting enough pressure to twist off the lid requires strength. See reference: AOTA: Uniform Terminology for Occupational Therapy, third edition.

120. An OT practitioner is assessing hand function in a man with arthritis by observing him as he makes a peanut butter sandwich. The individual is unable to remove the lid from a 28-ounce peanut butter jar but is able to stand at the counter, spread peanut butter on the bread with a knife, and replace the lid when he has finished making the sandwich. These observations would MOST accurately reflect deficit in the performance component: A. Range of motion B. Coordination C. Endurance D. Strength

(A) The depth of the wound and location and patient's race and age can all influence scar information.

120. An OT practitioner is educating a middle-aged roofer who is recovering from full-thickness burn about hypertrophic scarring. The OTR should FIRST inform the client that: a. the depth of the wound and location and the patient's race and age can all influence scar formation b. full-thickness wounds typically heal without significant scar formation c. surgical intervention eliminates all risk of hypertrophic scarring d. hypertrophic scars involving the joints do not interfere with range of motion

(D) Instruction in how to perform the activities safely. Instructing caregivers in methods that promote safe performance of functional activities, such as locking wheelchair brakes before standing up, is the first focus for caregiver training. Answers A, B, and C are also useful areas of caregiver instruction, however, safety is the first priority.

120. The spouse of a patient with a progressive disease has come into the OT department to learn how to help the spouse perform functional activities at home. The FIRST focus of caregiver education for this person should be: a. methods for motivating the patient to perform ADLs. b. how to analyze activities to solve problems. c. instruction in how to provide cues to the patient. d. instruction in how to perform the activities safely.

(D) A sheltered workshop. Sheltered workshops are designed to help individuals master basic work skills. See reference: Neistadt and Crepeau (eds): Baloueff, O: Developmental delay and mental retardation.

121. Adults with mental retardation can be offered a variety of work alternatives. Which of the following MOST likely involves simple assembly or sorting and packaging tasks with supervision and subcontracted piecework? A. An adult activity center B. Supervised employment C. Job coaching D. A sheltered workshop

(D) Use dust mitt to keep fingers fully extended. Using dust mitts "keeps fingers straight and prevents the static contraction and potentially deforming forces of holding a dust cloth."

121. An OT practitioner is instructing a person with arthritis how to maintain range of motion while performing household activities. Which of the following activities MOST effectively accomplishes this? a. use short strokes with the vacuum cleaner b. keep elbow flexed when ironing c. keep lightweight objects on low shelves d. use dust mitt to keep fingers fully extended

(D) Provide a stockinet for the individual to wear inside the splint. A stockinet liner worn inside the splint keeps the perspiration from irritating the skin by absorbing the perspiration from irritating the sin by absorbing the perspiration and keeping the skin away from the damp plastic. A stockinet liner is inexpensive enough to have several, so the individual can always have a clean one available.

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

(D) Touch the senses included in the somatosensory system are touch, movement, pain, and temperature. The auditory, olfactory, visual gustatory, and vestibular systems are special systems that directly give input into the brain. The somatosensory system has receptors located throughout the body (muscles, tendons, ligaments, joints, skin, and so forth). In the brain stem. Receptors also exist in certain tracts of the spinal cord. See reference: Trombly (ed): Woodson, AM: Stroke

121. When evaluating the somatosensory system, the OTR would have to include testing procedures for? A. Taste B. Smell C. Vision D. Touch

(B) Have the child practice tying her shoes at home as well as in school. Children with mental retardation often have difficulty generalizing learning from one setting to another. For instance, they learn to tie their shoes in the OT clinic but are unable to perform the same skill at home or at school. The ability to generalize is essential in making the new skill functional in this child's daily life.

122. A child with a diagnosis of mental retardation is currently learning to independently tie her shoes. The facilitated generalization of this skill, the OT practitioner should: a. fit the child's shoes with Velcro closures b. have the child practice tying her shoes at home as well as in school c. use a backwards-chaining technique d. provide brightly colored shoelaces

(B) Pain as a result of disease or injury that persists for long segments of time that has not resolved itself in the anticipated time. Chronic pain, such as pain related to the low back, exists for long periods of time and is present for much of the individual's day.

122. An OT practitioner is interviewing a client who believes she is suffering from chronic low back pain. As part of the educational process, the OTR explains the differences between acute versus chronic pain to the client. Chronic pain is: A. Pain that is associated with an inflammation or irritation that lasts for a brief period of time. B. Pain as a result of disease or injury that persists for long segments of time and has not resolved itself in the anticipated time. C. Pain as a result of surgery that lasts for hours, days, or weeks. D. Pain that presents itself through motor behaviors such as limping.

(A) fail the student. Students should be evaluated at the midpoint of each level-II fieldwork experience as well as at the conclusion. The purpose of the final evaluation is to provide the student with feedback regarding performance during fieldwork as well as to document that entry-level competence should not be passed. See reference: Neistadt and Crepeau (eds): Interdisciplinary communication and supervision of personnel.

122. Upon completion of a level-II fieldwork placement on a rehabilitation unit, a student is functioning slightly below minimal entry-level competence. The supervising fieldwork educator should: A. Fail the student B. Pass the student with the requirement that the student not practice in a rehabilitation setting C. Pass the student and recommend additional training or volunteer work in a rehabilitation setting D. Pass the student

(D) Lock the brakes. Brakes should be locked first to stabilize the wheelchair.

122. Which of the following is the FIRST step an OT practitioner should take when initiating a safe wheelchair transfer? a. have the patient scoot forward to the front of the seat b. position foot plates in the up position c. swing away the leg rests d. lock the brakes

(D) Playing balloon volleyball. An activity such as balloon volleyball may be graded for improving strength by adding resistance to the arm in the form of weights. Endurance may be improved by adding more repetitions of the movement. Raising the height of the net can increase the range of motion required. See reference: PEdretti (ed): Pedretti LW, and Wade, IE: Therapeutic modalities.

123. An OT practitioner is planning a program for an individual who needs to increase shoulder strength, ROM, and endurance. Which of the following activities is MOST suitable for periodic upgrading? A. Blowing up and tying balloons of various sizes B. Playing a game of balloon darts C. Painting faces on balloons D. Playing balloon volleyball

(B) A resting pan splint. A resting pan splint is the most appropriate splint to fabricate for the maintenance of a functional hand position.

124. A PT practitioner receives a referral to fabricate a splint that will assist with the maintenance of a functional hand position while keeping the soft tissue of the hand in a midrange position. Which splint would the OTR MOST likely select to address these needs? a. A bivalve cast b. A resting pan splint c. A dynamic extension splint d. A wrist cock-up splint

(C) Making a checklist of steps in the process, then consulting the list while doing laundry in the actual setting. Making a checklist and having the person use the checklist during the activity would provide an external memory aid during practice of the functional activity. This would provide compensation for cognitive deficits during task training in the specific context where it will be performed.

124. A client with cognitive deficits exhibits little transfer of skills from one activity to the next. Which intervention would be BEST to assist this client in performing the steps of doing his laundry? A. Performing memory drills of the steps involved in doing in a laundry activity B. Placing serial pictures of a laundry activity in sequence C. Making a checklist of steps in the process, then consulting the list while doing laundry in the actual setting D. Reading a story about a person doing laundry with the client, then discussing the story

(A) Patients write fears and concerns on index cards. The OT practitioner collects and reads the cards to the group for discussion. This method allows for anonymity by having each patient write down their concerns without including their names, thereby eliminating any fear of embarrassment.

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

(A) Training to inspect for pressure sore on bony preminences and affected areas. Visual inspection of an area is important to prevent pressure sores, which may develop because there are no sensory cues o alert a person to the skin breakdown. It is recommended that an individual with absent sensation not trim his or her nails. See reference: Tromblt (ed): Bentzel, K: Remediating sensory impairment.

124. An adult with MS has decreased sensation of the buttocks and bilateral lower extremities. When educating and individual with absent sensation, the OT practitioner should include: A. Training to inspect for pressure sores on bony prominences and affected areas B. Instructions pertaining to careful trimming of fingernails and toenails C. Padding to areas of a splint that cause redness on the individual D. Hypersensitivity training

(A) apply the stimuli beginning at an area distal to the lesion progressing proximally. The general guidelines for sensation testing are that the person's vision should be occluded, the stimuli should be occluded, the stimuli should be randomly applied with false stimuli intermingled (opposite of answer C), a practice trial should be performed before the test, and the unaffected side or area should be tested before the affected side or area (opposite of answer B). Also, the tested individual should be given a specified amount of tine in which to respond; therefore, answer D is incorrect. See reference: Trombly (ed): Bentzel, K: Evaluation of sensation.

124. The OT practitioner is evaluating two-point discrimination in an individual with a median nerve injury. The MOST appropriate procedure is to: A. Apply the stimuli beginning at an area distal to the lesion progressing proximally B. Test the involved area first, then the uninvolved area C. Present test stimuli in an organized pattern to improve reliability during retesting D. Allow the individual unlimited time to respond

(A) Single pressure switch firmly mounted within easy reach. A child with fluctuating muscle tone lacks stability and demonstrates extraneous movement; therefore, deliberate motor action is most effectively executed on a securely mounted device using simple movement patterns.

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

(C) needs assessment. Need assessment is the necessary first step of gathering data about the population, treatment needs, and resources available. See reference: Cottrell (ed): Grossman, J, and Bortone, J: Program development.

125. An OT practitioner has been hired to develop a community based program for patients with chronic mental illness. The FIRST step in the process which the practitioner must complete is: A. Program planning B. Program implementation C. Needs assessment D. Program evaluation

(D) Just before discharge. Because the prognosis for patients with Guillain-Barre syndrome is usually good, equipment should be ordered just before discharge to accurately determine the individual's needs.

125. An individual with Guillain-Barre syndrome was recently admitted to a rehabilitation unit and is expected to remain for 3 to 4 weeks. When should the OT practitioner order adaptive equipment for this individual? a. After the patient and family have accepted the individual's disability b. As soon as the insurance provider approves it c. Within the first week of therapy d. Just before discharge

(D) Loose-fitting clothing. Individuals with paraplegia can dress independently. The process is somewhat easier when loose-fitting clothing and dressing loops are used.

125. The adaptation that provides the MOST benefit for an individual with paraplegia in the area of dressing is: A. A buttonhook zipper pull device B. A clip-on tie C. Adapted shoes D. Loose-fitting clothing

(C) Provide transfer tub bench and install grab bars. The best adaptation to achieve access to the tub would be providing the client with transfer tub bench, which is recommended for individuals who cannot step over the edge of the tub, and bathroom grab bars to provide stability during the move into the tub. See reference: Pedretti (ed): Smith, P: Americans with Disabilities Act: Accommodating persons with disabilities.

125. The goal for an elderly client with lower extremity weakness is to be independent with bathing, but this requires the tub to be more accessible to the client who uses a walker. Which environmental adaptation would be BEST to achieve this? A. Place the light switch outside the door so the bathroom is lit before entering B. Provide long-handled adaptive devices to facilitate lower extremity dressing C. Provide transfer tub bench and install grab bars D. Place nonskid decals in the tub and mats on the floor to prevent slipping on the wet floor

(B) Provision of foot support. Adequate foot support is probably the first concern of the practitioner for the child to feel secure on the toilet and to be positioned for bowel control.

126. A child with a physical disability and poor postural stability is developmentally ready for toileting. Which of the following elements of the treatment plan should be considered FIRST? A. Training in management of fasteners B. Provision of foot support C. Provision of a seatbelt D. Training in climbing onto the toilet

(A) Using the strongest joint, avoiding positions of deformity, and ensuring correct patterns of movement. The significance of using these principles for individuals with preexisting joint conditions and adverse musculoskeletal changes may help to restore function as well as prevent further impairments. See reference: Trombly (ed): Bear-Lehman, J: Orthopaedic conditions.

126. An OT practitioner is training an individual in the principles of joint protection. The principles that the OT would MOST likely include would be: A. Using the strongest joint, avoiding positions of deformity, and ensuring correct patterns of movement B. Massaging a joint before exercise C. Practicing vivid imagery and relaxation exercises during difficult functional activities D. Application of heat before treatment and application of cold after range of motion treatment

(A) Rots repetition of the task substeps with gradually fading cues. Functional skill training focuses on mastery of a specific task. It requires the client to repeatedly practice the substeps of a task with the number of cues given for each step gradually decreased or faded.

126. An OT practitioner is working with a client who has severe cognitive deficits. Using a functional skill training approach, the MOST appropriate method to teach the client to brush his or her teeth is based on: a. rote repetition of the task sub steps with gradually fading cues. b. practice of fine-motor activities that incorporate motions needed in tooth brushing c. teaching the caregiver how to set up the task and guide the client's performance. d. use of instructional cards which the client will learn to use to remind him of how to perform the task.

(C) Using a bath chair and a hand-held shower with tepid water. The best bathing method for a person with COPD considers the energy demands of the task as well as the effect of water temperature in light of the person's functional status. A person with COPD has difficulty breathing when the environment is hot or humid or when there is a high degree of steam.

126. An individual with chronic obstructive pulmonary disease (COPD) with low endurance is taught to modify his bathing techniques for carryover after discharge. The BEST bathing method would be: a. tub bathing method with hot water b. standing for a quick shower c. using a bath chair and hand-held shower with tepid water d. tub bathing using lukewarm water

(D) adapted teaching techniques. Answer D is correct because a child with this type of disability characteristically has learning problems that require such teaching methods as "chaining" or behavior modification. See reference: Case-Smith (ed): Shepherd, J: Self-care and adaptations for independent living.

126. In planning therapeutic dressing program for a first grade child who is mentally retarded, the therapist's FIRST consideration should be the need for: A. Adaptive equipment B. Adaptive clothing C. Proper positioning D. Adapted teaching techniques

(D) Present important principles in small units that are spaced at a slower than normal pace. According to learning principles for older adults, learning will be more effective if the information is presented in small units at a slower pace. See reference: Larson, Stevens-Ratchford, RG: OT services within the rehabilitation health care system.

127. An OT practitioner is teaching several older adults with COPD energy conservation techniques in home management skills. Following learning principles for older adults, the MOST effective way to present the information would be for the OT to: A. Present all the important principles to be covered together in a single presentation B. Keep the presentation loosely structured, rather than highly organized C. Attempt to persuade clients about the importance of those points on which the clients don't seem to agree D. Present important principles in small units that are spaced at a slower than normal pace

(C) Divide the laundry into several small loads for carrying. "Several small loads place less stress on the back than 1 or 2 larger ones."

127. An individual with a low back injury lives alone and must be able to do laundry independently. Which of the following recommendations will BEST protect the back from reinjury? A. Place the clean laundry basket on the floor next to a chair and sit for folding B. Stop the activity when pain becomes severe C. Divide the laundry into several small loads for carrying D. Carry the laundry in one or two large loads

(A) a cotton ball. When retesting it is important to use the method used initially in order to make an accurate comparison of status before and after treatment. In addition, evaluation results are more consistent when the individual who performed the initial evaluation performs subsequent reevaluations. See reference: Pedretti (ed): Pedretti, LW: Evaluation of sensation and treatment of sensory dysfunction.

127. As part of an initial evaluation of an individual with carpal tunnel syndrome, the OTR evaluates light touch sensation using a cotton ball. After wearing a wrist splint for 2 weeks the patient returns for a reevaluation, which the COTA performs. At this time, the MOST appropriate method for reevaluation of light touch is to use: A. A cotton ball B. An aesthesiometer C. Semmes-Weinstein monofilaments D. A pin or straightened paper clip

(B) Educate employees about ergonomic adaptations including correct typing techniques, posture, hand positioning, and equipment modification. Educating employees on correct positioning and equipment modification would be an effective way to introduce this population to a change in in task methods related to keyboarding which may prevent CTD.

127. Prevention of cumulative trauma disorders (CTD) in the primary focus of an OT practitioner who is working as an industry consultant. The MOST appropriate way to reduce risk of CTD in an industry where there is heavy keyboard use is to: a. teach employees to identify the symptoms of cumulative trauma disorder early. b. educate employees about ergonomic adaptations including correct typing techniques, posture, hand positioning, and equipment modification. c. provide inexpensive resting splints to employees to rest hands and wrists at night if symptoms appear. d. instruct employees in exercise routines to increase strength in weak upper extremities.

(A) A vacuum feeding cup. Individuals with impulsive behavior or poor judgment often attempt to drink too quickly. The rate of intake can be limited by using a drinking spout with a small opening, pinching a straw, or using a vacuum feeding cup with a control button.

127. Which of the following would be the BEST cup for the OT practitioner to recommend using when working with an individual who tend to drink too quickly? a. a vacuum feeding cup b. a "nosey cup" (cut out for the nose) c. a mug with two handles d. a cup with a large drinking spout

(B) Reposition the person in the wheelchair to allow optimal range of motion when a person in a wheelchair who uses an augmentative communication device suddenly begins making errors, it is necessary to FIRST check the position of the individual. Improper positioning could result in the wheelchair's interfering with access or with range of motion needed use the communication device. See reference: Angelo and Lane (eds): Taylor, SJ, and Kreutz, D: Powered and manual wheelchair mobility.

128. A nonspeaking person who uses a wheelchair is suddenly making many errors on the augmentative communication device but experienced no difficulty the previous day. Which of the following is the FIRST step the OT practitioner should take in responding to this problem? A. Refer the person to physician for evaluation B. Reposition the person in the wheelchair to allow optimal range of motion C. Reassess the person‟s communication abilities D. Replace the communication device

(D) Treat the patient as scheduled and charges for the 1 hour of direct time spent with the patient. This answer is correct in that this meeting was not part of the planned intervention and had occurred spontaneously and without measurable goals. Based on the Standards of Practice, if collaboration with the individual or family was included as a part of the intervention plan, the patient could be billed for the time. See reference: Kornblau and Starling: Legal Issues in ethical decision making.

128. On the way to lunch, an OT practitioner is stopped by a patient's spouse and questioned for 15 minutes about the patient's progress. What is the MOST appropriate action for the OT practitioner to take when determining how the patient will be treated and charged for the scheduled one-hour treatment session? A. Charge the patient for an additional 15 minutes of treatment for the time spent with family member B. Reduce the patient's therapy to 45 minutes and charge for 1 hour of treatment to cover the time spent with the family member C. Reduce the patient's therapy to 45 minutes and charge patient for 45 minutes of treatment D. Treat the patient as scheduled and charge for the 1 hour of direct time spent with the patient

(B) Provide the cold packs followed by purposeful activity. Purposeful activity should follow, not precede a cold pack.

128. The MOST appropriate treatment sequence for an OT practitioner to follow when providing a cold pack to an individual with edema of the hand is: A. Precede the cold packs with purposeful activity B. Provide the cold packs followed by purposeful activity C. Provide the cold packs as the main focus of intervention D. OT practitioners should never provide this type of intervention

(A) Neck flexion. Answer A is correct because this method decreases the abnormal extension pattern that is influencing the oral motor patterns. Jaw and tongue thrust are part of an overall extension pattern.

130. A child with athetoid CP demonstrates a jaw and tongue thrust when a food-filled spoon is placed in his mouth. To decrease this problem, the therapist is MOST likely to recommend a positioning strategy that includes increased: A. Neck flexion B. Shoulder retraction C. Hip extension D. Neck extension

(A) Encourage the use of PABA-free sunblock and hats. Individuals taking neuroleptic medications are prone to photosensitivity and need protection from the sun. A PABA-free sunblock is recommended because this reduces the chance of an allergic reaction to the sunblock.

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

(D) Give the individual a rest break. Fatigue may cause additional structural damage in the acute stage of MS and should be avoided. Rest breaks need to be scheduled to avoid fatigue.

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

(C) 10 degrees of head flexion from the midline then an individual's neck's is kept at 10 degrees of flexion post midline, this closes the passage to the lungs, but allows food to easily pass down the esophagus. See reference: Pedretti (ed): Nelson, KL: Dysphagia: Evaluation and treatment.

129. An OT practitioner is working with a patient who has mild difficulties swallowing. The OT instructs the patient that the BEST position for him to maintain during feeding activities is: A. 30 degrees of neck extension B. 10 degrees of head extension past the midline C. 10 degrees of head flexion from the midline D. 30 degrees of head flexion

(A) Provide gentle human touch to enable the infant to slowly respond to intervention. Although all answers are possible examples of applied calming techniques, the tactile system is the first to develop and the most sophisticated in the young NICU patient. Therefore, answer A is the most suitable for initial interaction contact.

129. To avoid overstimulation when handling a stable, 12 week premature infant in the NICU setting, an OT practitioner must FIRST: a. provide gentle human touch to enable the infant to slowly respond to intervention b. establish a calm state by utilizing the infant's musical mobile c. swaddle the infant in a blanket and cuddle to provide containment and warmth to assist with self-regulation d. establish a bond through visual orientation to the therapist's face

(B) child's speed over long distances becomes less than that of a walking person. This child should be considered for a power wheelchair when the current means of locomotion proves less efficient and slower than locomotion by walking. Because the child will be experiencing progressive muscle weakness, energy conservation is of primary importance. See reference: Case-Smith (ed): Wright-Ott, C, and Egilson, S: Mobility.

13.A Grade 2 child has a diagnosis of muscular dystrophy. The child operates a manual wheelchair, but his mobility is slow because of muscle weakness. The OT should consider a powered wheelchair when the: A. Child starts junior high school and will be expected to switch classrooms several times daily B. Child's speed over long distances becomes less than that of a walking person C. Child's home can be made accessible for a power wheelchair D. Child becomes unable to propel a manual wheelchair

(A) A brachial plexus injury. A brachial plexus injury is a lesion that is typically a result of a traumatic injury. The nerve roots innervating the upper extremity originate between C4 and T1.

13.An OT practitioner is working with a client who sustained a traumatic injury to the right upper extremity during a motorcycle accident. The client states that he does not understand why he has paralysis to the deltoid, brachialis, biceps, and brachioradialis muscles. In addition to this, the client's arm hangs limply with minimal functional movement noted in the hand. The OTR suggests that this injury MOST accurately describes: A. A brachial plexus injury B. A long thoracic nerve injury C. An axillary injury D. A Volkmann‟s contracture

(D) Dynamometer. This individual exhibits difficulty in the area of the strength. A dynamometer measures grip strength through gross hand grasp.

13.An individual who works as a nurse reports difficulty squeezing the bulb of the sphygmomanometer when taking blood pressures and difficulty opening pill bottles. Which of the following instruments would be MOST appropriate for assessing the individual? A. Goniometer B. Aesthesiometer C. Volumeter D. Dynamometer

(A) A cotton ball. When retesting it is important to use the method used initially in order to make an accurate comparison of status before and after treatment. In addition, evaluation results are more consistent when the individual who performed the initial evaluation performs subsequent reevaluations.

13.As part of an initial evaluation of an individual with carpal tunnel syndrome, the OTR evaluates light touch sensation using a cotton ball. After wearing a wrist splint for 2 weeks the patient returns for re-evaluation, which the COTA performs. At this time, the MOST appropriate method for re-evaluation of light touch is to use: a. a cotton ball b. an aesthesiometer c. Semmes-Weinstein monofilaments d. a pin or straightened paper clip

(B) "The child demonstrated tongue thrust". "Tongue thrust" is an objective, well defined term. The other answers are less objective. See reference: Early: Medical records and documentation.

13.The OT practitioner has just completed observation of a child eating lunch. Which of the following statements BEST describes the OBJECTUVE observations? A. "The child did not appear to like the food presented." B. "The child demonstrated tongue thrust." C. "The child was uncooperative and kept pushing the food out of her mouth." D. "The child was obviously not hungry at the time."

(B) Avoid internal t=rotation and abduction of involved hip. Following hip arthroplasty, positions such as flexion of the hip past a prescribed range (usually 60 to 90 degrees). Internal rotation and adduction can result in dislocation of the hip. Therefore, this answer priority, OT practitioner instruct patients in hip precautions and provide them with adaptive equipment so they can safely perform self-care, work, and leisure activities. See reference: Pedretti (ed): Morawski, D JP, and Bobrove, H: Hip fractures and total hip replacement.

130. An individual who is s/p total hip arthroplasty (posterolateral approach) is working on independence in lower extremity dressing. Which of the following instructions is MOST important to convey to this individual? A. Sit during dressing activities B. Avoid internal rotation and adduction of the involved hip C. Use a long-handled shoe horn and dressing stick D. Wear shoes with elastic laces

(B) Playing Velcro checkers to tolerance. Gentle, repetitive, resistive exercises help maintain strength and endurance in weakened muscles.

130. An individual with amyotrophic lateral sclerosis (ALS) has asked an OT practitioner how to maintain strength in a weak (fair plus) wrist extensors. Which is the MOST appropriate intervention for the OT practitioner to recommend? a. Cock-up wrist support b. Playing Velcro checkers to tolerance c. Active range of motion for wrist daily without resistance d. Wrist extension exercises several times a day against maximal resistance

{a (d)} (A) A craft activity using increasingly heavy hand tools. Progressive resistive exercise is the most effective method for increasing strength in a muscle with fair+ strength.

130. An individual with complete C7 quadriplegia demonstrates fair+ strength in the wrist extensors. Which of the following interventions will MOST effectively increase strength in the wrist extensors? a. a craft activity using increasingly heavy hand tools b. mildly resistive activities that are halted as soon as the individual begins to fatigue c. electric stimulation to the wrist extensors d. moderate resistance during active range of motion to the wrist

(C) Notify NBCOT of the situation and reassign the patient to a different therapist. According to the Coe of Ethics, therapists are responsible for maintaining relationships that "do not exploit the recipient of services sexually, physically, emotionally, financially, socially or in any other manner." The patient-therapist relationship is compromised when the therapist enters into a social or intimate relationship with a patient: Every therapist is responsible to report "any breaches of the Code of Ethics to the appropriate authority." Whether they are a supervisor or not. Because the issue is practice related, the NBCOT is the appropriate authority. It is then the responsibility of the NBCOT to determine if and what type of disciplinary action should be taken. See reference: AOTA: Occupational therapy code of ethics.

130. The supervisor of OT is off work and in a local establishment listening to a band with her friends. She observes one of the therapists she supervises at another table being intimate with a gentleman she is currently treating on an outpatient basis. Which of the following actions should the supervisor take in order to be consistent with the OT Code of Ethics? A. Indicate to the therapist that she may maintain the relationship as long as it does not impair the patient's treatment B. Notify the state licensure board and terminated the employee C. Notify NBCOT of the situation and reassign the patient to a different therapist D. Discipline the employee and refer the patient to anther outpatient center

(B) Weight bearing through the upper extremity in sitting or standing. Weight bearing is the most effective way of normalizing tone, according to the NOT treatment approach for adult hemiplegia. Placing a weighted cuff on the extremity. See reference: Pedretti (ed): Davis, JZ: Neurodevelopmental treatment of adult hemiplegia: The Bobath approach.

131. A patient who has had a CVA has difficulty using his left upper extremity for reaching activities because of fluctuating muscle tone. According to the Neurodevelopmental Treatment (NDT) approach, one of the MOST effective ways to teach a person to normalize high muscle tone in affected extremities prior to functional activities is by: A. Placing a weighted cuff on the extremity B. Weight bearing through the upper extremity is sitting or standing C. Using the unaffected arm for all reaching activities D. "forced use" of the affected extremity

(B) Pass around a scent box and ask each patient to smell the contents. Sensory integration theory holds that individuals can learn by receiving, processing, and responding to sensory stimulation. Starting a group for regressed individuals with sensory stimuli such as touch and smell helps to get the individuals' attention and arouse their interest. See reference: Early: Group concepts and techniques.

131. An OT practitioner is using a sensory integration approach with a group of regressed individuals with limited attention spans. Most group members can tolerate a group situation for nor more than a half-hour. Which of the following activities would be BEST for beginning the session? A. Go around the circle and ask each patient to introduce himself/herself B. Pass around a scent box and ask each patient to smell the contents C. Ask each patient to select a favorite poem and read it D. Discuss the lunch menu and heathy eating habits

(C) Take the bottom, supine position. This position requires the least amount of energy expenditure and should be recommended. In addition, the therapist may encourage experimentation with a variety of positions (answer D).

131. An individual with low endurance complains of becoming too fatigued during sexual activity to enjoy it. The BEST strategy for the therapist to recommend is for the individual to: a. time sex for the end of the day. b. take the top, prone position. c. take the bottom, supine position. d. experiment with a variety of positions.

(B) Flexion. Flexion at the wrist, especially while grasping or pinching, should be avoided. Repetitive flexion and extension movements also cause compression of the median nerve.

131. The OT practitioner is treating a person with mild carpal tunnel syndrome. The MOST important instruction for the therapist to give the patient is to avoid: A. Extension B. Flexion C. Ulnar deviation D. Radial deviation

(D) Drawing lines and shapes using shaving cream, sand, or finger paints. The best activity to encourage prewriting would be drawing lines in different sensory media.

131. Which of the following activities would be BEST to promote prewriting skills with a child in preschool or kindergarten? a. maneuvering through obstacles and focusing on making turns b. having the child create his or her own books in specific topics' c. rolling clay into a ball d. drawing lines and shapes using shaving cream, sand or finger paints

(B) A hook provides better prehensile function that a hook TD provides better prehensile function and allows greater visibility of objects would be the most important consideration for a person whose primary concern is functioning as a carpenter. See reference: Pedretti (ed): Rock, LM, and Atkins, DJ: Upper extremity amputations and prosthetics.

132. A therapist is working with a patient who has had an UE amputation to determine whether a hook terminal device (TD) or a functional prosthetic hand would be most appropriate for the patient. The patient's primary concern is his ability to return to work and function as a carpenter. The MOST important factor in the OT's recommendation would be that: A. A functional prosthetic hand has a better cosmetic appearance B. A hook provides better prehensile function and allows greater visibility of objects C. A hook weighs less than a hand D. A functional hand is covered by a rubber glove that stains easily

(C) Avoid having these individuals in close proximity to others to reduce opportunities for physical contact. Avoiding close proximity situations is the recommended environmental modification for sexual acting-out behaviors. See reference: Early: Safety techniques.

132. Staff members in a group home report to the OT practitioner that several of the men repeatedly try to touch female clients and staff and often make sexual gestures and comments. Which of the following environmental modifications would be MOST likely to reduce this behavior? A. Provide a relatively active and stimulating environment with opportunities for these individuals to engage in real-life activities B. Stand to the side of these individuals instead of face to face during interactions with them C. Avoid having these individuals in close proximity to others to reduce opportunities for physical contact D. Advise these individual in a calm nonjudgmental manner about the behavior you expect

(C) Extension during finger flexion and flexion during finger extension. The method used to maintain tenodesis in the hand of a person with quadriplegia is to keep the wrist extended during finger flexion and flexed during finger extension. This allows the finger flexor tendons to shorten so tenodesis action can occur.

132. The OTR is teaching a student how to perform range of motion exercises with a patient who has quadriplegia. In order to encourage the development of tenodesis, the OTR must be sure to position the patient's wrist in: a. the neutral position during finger flexion and extension b. flexion during finger flexion and extension c. extension during finger flexion and extension and flexion during finger extension d. flexion during finger flexion and extension during finger extension

(B) Obtain a raised toilet seat. The individual will most likely continue to require a raised toilet seat for several months in order to avoid flexing the hip past the designated range.

132. Which of the following is the MOST important adaptation to recommend to an individual returning home following a total hip replacement? A. Move items form high cabinets to lower locations B. Obtain a raised toilet seat C. Place high-contrast tape at the edge of each step D. Install a handheld shower head

(B) The patient's written consents to take the photographs and use them for publicity. See reference: Bailey: Final preparation before implementing the research plan.

133. A hospital's public relations department plans to take some pictures of the OT staff working with patients. Before proceeding, which of the following MUST be obtained? A. The correct spelling of the patients‟ names for the photograph caption B. The patients‟ written consents to take the photographs and use them for publicity C. The department head's written consent to take photographs and use them for hospital purposes D. The correct spelling of the patient's diagnoses and names for the photographs‟ captions

(B) Identify the abilities, needs, and life goals of the client. Identifying the abilities, needs, and life goals of the client occurs before any other steps in the process in order to make a match between the client's abilities, environmental demands, and the appropriate technology to carry out desired daily occupations.

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

(A) Group size of fewer than 5 members. Group size strongly influences how members relate to one another. In general, an ideal group size is 7 to 10 members for the most interaction among members. Groups with fewer than 5 members tend to increase the focus on the leader in their interactions. Group membership of similar goals improves cohesiveness more than interactions. Differing ages is not known to have an impact on interactions.

133. An OT practitioner is running a living skills group. Before the active involvement of the participants, the practitioner needs to review lecture materials for 30 minutes. The group composition that is MOST LIKELY to result in an increased focus on the group leader and decreased interaction among the group members is a: A. Group size of fewer than five members B. Group made up of members of differing ages C. Group size between 7 and 10 members D. Group with members who have similar goals and abilities

(D) Place dishes near the dishwasher, bend down on one or both knees, and load. Bending down on one or both knees increases balance while reducing the need to bend at the waist.

133. An OT practitioner is working with a client who complains of pain while completing kitchen cleaning tasks. Which of the following positions would be MOST effective in alleviating low back pain when the patient is loading the dishwasher? a. Place dishes next to dishwasher and load from a standing position. b. Wash dishes in the sink. c. Place dishes next to dishwasher and load from the front of the dishwasher. d. Place dishes near the dishwasher, bend down on one or both knees, and load.

(C) Toothbrush with built-up handle. An individual with C7-8 quadriplegia has the hand strength to hold a toothbrush with a built-up handle. An alternate method can be to position the toothbrush between the fingers. An individual with a C5 injury may require an MAS for brushing teeth. See reference: Christiansen (ed): Carber, SL, Gregorio, TL, Pumphrey, N, and Lathem, P. Self-care strategies for person with spinal cord injuries.

133. Which of the following devices will be required by an individual with C7-8 quadriplegia when performing oral hygiene activities? A. Mobile arm support with utensil holder B. Universal cuff C. Toothbrush with built-up handle D. Wrist support with utensil holder

(B) Edema. Contrast baths cause vasodilation and vasoconstriction, which facilitate a pumping out of the edema. Retrograde massage assists with the facilitation of blood and lymph movement. Pressure wraps (coban) are applied distal to proximal to address edema issues.

134. An OT practitioner requests that an OT student treat a client with a condition involving the upper extremity. The OTR suggests the use of contrasts baths, retrograde massage, and pressure wraps. The OT student can consider these interventions a PRIMARY technique to address: a. heterotopic ossification b. edema c. wound healing d. scar management

(C) Attending a rehabilitation program in a skilled nursing or extended care facility. The most appropriate recommendation for the person is to receive rehabilitation in a skilled nursing or extended care facility because the patient requires rehabilitation services provided at a lower level of intensity but has the goal of returning home. See reference: Neistadt and Crepeau (eds): Freda, M: Facility-based practice settings.

134. An elderly patient, who lives alone, has been briefly hospitalized following a car accident and is being discharged from the acute care setting. The patient continues to need rehabilitative services to maximize functional independence and eventually return home. This person is medically stable, motivated, and cognitively intact and has rehabilitation potential. But the person tires quickly, is weak, and tolerates only brief periods of therapy. The MOST appropriate recommendation for the OT to make regarding this patient is: A. Attending an inpatient physical dysfunction rehabilitation program B. Extending the patient's stay in the familiar acute care hospital to receive additional therapy C. Attending a rehabilitation program in a skilled nursing or extended care facility D. Seek nursing home placement for this patient

(C) Protrusion and lateralization. Protrusion is the motion of sticking the tongue out of the mouth in a forward manner, and lateralization involves the movement of the tongue from side to side.

134. During and oral motor evaluation, an OT practitioner asks the client to stick out her tongue. Next, the client is asked to move her tongue from side to side. The two functions that the OT practitioner is attempting to facilitate are: a. protrusion and humping b. lateralization and tipping c. protrusion and lateralization d. lateralization and humping

(B) Upright. For a child with increased tone, the upright position appears to give the best postural control. At all times, the child should sit squarely with even weight distribution on both buttocks with even weight distribution on both buttocks, never tilted asymmetrically.

134. When a fifth grader with hypertonicity is seated for schoolwork, she tends to adduct her legs and extend her hips and spine. The BEST way for the OTR to position the child in order to give her better postural control in sitting would be: A. Tilted forward 20 to 30 degrees B. Upright C. Reclining 45 degrees D. In a lateral tilt of 45 degrees

(B) Develop awareness about what produces anger and how the clients respond to anger. All of the answers are steps in the cognitive-behavioral process. Treatment begins, however, with developing awareness of what produces anger and how individuals respond.

135. An OT is running a group for individuals who have difficulty managing anger. Based in a cognitive-behavioral frame of reference, which of the following steps would the OT BEGIN with? a. Discuss the benefits of alternative beliefs about anger and responses to anger b. Develop awareness about what produces anger and how the client respond to anger c. Role play a situation that presents minimal difficulty to group participants d. Role play a situation that present significant difficulty to group participants

(C) A COTA contributes to the process but does not complete the task independently. The COTA participates in this process by providing factual information to the OTR and collaboratively identifying discharge needs. However because of the analytical nature of provision of discharge recommendations, the COTA does not complete this activity independently. See reference: AOTA: Occupational therapy roles.

135. An OTR/COTA team need to report discharge information and document the information in the patients‟ chart, at what level does the COTA participate in making discharge recommendations? A. An entry level COTA may perform the task independently. B. An intermediate-level COTA may perform the task independently. C. A COTA contribute to the process by does not complete the task independently. D. A COTA cannot perform the task.

(B) Increase the number of towels from 10 to 20. Endurance is improved by increasing the number of repetitions so the muscle has to work over a longer period of time. Placing towels on a higher shelf. See reference: Pedretti, LW, and Wade, IE: Therapeutic modalities.

135. An individual has been instructed to place towels, one at a time, on a high shelf in order to increase shoulder flexion. The individual is able to easily place 10 towels. Which of the following modifications would MOST effectively improve endurance in the shoulder flexors? A. Place the towels on a higher shelf B. Increase the number of towels from 10 to 20 C. Place the towels on a lower shelf D. Add a 1-pound weight to each arm

(A) A lightweight folding frame. A lightweight folding frame is needed when a wheelchair will be frequently lifted in and out of a car trunk or back seat and folded to fit into the space. This is much easier on the individual or family member who will be lifting the wheelchair.

135. What wheelchair feature would be MOST appropriate to recommend for an individual who will be traveling by car with the family to community outings and bringing his or her wheelchair? A. A lightweight folding frame B. A one-arm drive C. An amputee frame D. A reading backrest

(D) Aesthesiometer People with sensory loss in the hand often drop things because they are not receiving adequate sensory input. An aesthesiometer measures two-pointdiscrimination with moveable point attached to a ruler that has a stationary point at one end. See reference: Pedretti (ed) Kasch, MC: Hand injuries.

136. A newly referred patient complains of frequently dropping lightweight items and reports a numb feeling in both hands. Which of the following instruments is MOST important for evaluating this individual? A. Goniometer B. Dynamometer C. Pinch meter D. Aesthesiometer

(D) rationalization. Making excuses for or justifying other's behaviors that are generally considered to be unacceptable is called rationalization. See reference: Christiansen and Baum (eds): Bonder, B: Coping with psychological and emotional challenges.

136. A woman experienced repeated sexual abuse by her father as a child and now describes her father's abusive actions as being caused by his stress of being fired from a job because of new management. The defense mechanism she is MOST likely to be using is: A. identification B. projection C. denial D. rationalization

(B) Temperature and pain. The sensations of pain and temperature are carried along small, unmyelinated nerve fibers, which recover more rapidly than senses carried by larger, myelinated fibers. The sensations of pain and temperature are also part of the protective or primary sensory systems, which are the receivers of simple information. More complex information is carried through the discriminative or epicritic system. The senses carried on this system are vibration, light touch, proprioception, and tactile localization.

136. An OT practitioner is performing discharges teaching with a client who sustained a deep laceration of the median and ulnar nerves. The practitioner informs the clients that the two tactile senses that are the earliest to recover after a peripheral nerve injury are: a. vibration and pain b. temperature and pain c. light touch and proprioception d. tactile localization and proprioception

(B) Have the individual work at the keyboard for 30 minutes. Increasing the duration the individual is able to tolerate working on the computer is the most appropriate way to progress this individual.

136. An individual with C4 quadriplegia is able to independently use a mouth stick to strike keys on a computer keyboard for 15 minutes. To upgrade this activity, therapist should: A. Provide a heavier mouth stick B. Have the individual work at the keyboard for 30 minutes C. Progress the individual to a typing device that inserts into a wrist support D. Teach the individual how to correctly instruct a caregiver in use of the keyboard

(C) Can the child's feet reach the floor? A relaxed position during toilet use is essential to success in elimination training. The seat should below enough so the child's feet can be used to help with postural stability. In addition, a seat design featuring a wide base, back support will give the child's sense of comfort and security.

136. When adapting toilet for use by a child with poor postural control, the OT practitioner should pay PRIMARY attention to which of the following issues? a. Can the toilet paper be reached without a major weight shift? b. Is the flush handle easy to manipulate? c. Can the child‟s feet reach the floor? d. Is a non-skid mat placed in the floor to prevent slipping?

(B) Provide strong color contrast at key areas to identify steps, pathways, etc. Using contrast is a key environmental adaptation strategy for people with visual impairments. The more contrast, the easier it is to locate objects, steps, entrances, and pathways, thereby improving accessibility by maximizing remaining vision

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

(B) Dry cereals with milk. Foods selected for this child's diet should reflect the current skill level. To increase oral tolerance and control of food, textures are gradually modified from smooth and consistent (answer C) to smooth and slightly varied (answer A and D), to increasingly resistive foods and a combination of contrasts, for example, hard and crunchy mixed with soft or liquid (answer B). After the child has mastered this level of control and tolerance, he/she can safely proceed to an even greater variety of textures, tastes, and temperatures offered at family meals.

137. A toddler has feeding difficulties because of deficient oral-motor control and oral defensiveness. The child's parents would like to eat family meals together and include such foods as meats (cut up), sandwiches, and vegetables. The OT practitioner explains to the parents that they can start to introduce these foods when their child is able to tolerate which foods? a. Apple sauce and mashed bananas b. Dry cereals with milk c. Strained fruits and vegetables d. Scrambled eggs

(B) Self-assessment. Self-assessment of the each individual's stressors and stress reactions is the first step in designing a stress management program.

137. An OT practitioner has been asked to design a series of stress management sessions for individuals with multiple sclerosis (MS). The FIRST session should include: A. Time management technique B. Self-assessment C. Aerobic exercise D. Progressive resistive exercise

(B) Activity adaptation. Modifying how directions are provided is one way to adapt activities. See reference: Early: Analyzing. Adapting, and grading activities.

137. An OT practitioner is working with an individual with impaired memory. When the client is unable to follow verbal instructions, the practitioner changes the approach to demonstration. This is an example of: A. Activity analysis B. Activity adaptation C. Grading of the activity D. Clinical reasoning

(C) interpreting results of assessments for the purposes of treatment planning. Interpretation of assessment results for purposes of treatment planning must be performed by the OTR. The functions noted in answers A, B, and D may all be performed by the COTA in a long-term care facility. See reference: AOTA: Occupational therapy roles.

137. Many COTA are employed in long-term care facilities and perform many functions. The function which the OTR MUST perform in this setting is: A. activity programming, environmental adaptations, and caregiver and staff educations B. ADL training and running feeding and leisure activity groups C. interpreting results of assessments for the purposes of treatment planning D. positioning, providing adaptive devices, and instructing in use of splints

(C) Folding laundry. Sorting and folding laundry (answer C) challenges balance and UE function in ways that are more functional than stacking cones or throwing a ball. Rather than seeking contrived activities (answers A, B, C) that challenge single-component deficits, the focus of home care is to find ways for the patient to actually perform the daily activities that are presenting the challenges. Because this patient is the mother of 4, it is presumed that her occupational role includes homemaking activities.

138. A mother of four teenage children who was diagnosed with a right CVA is receiving home care OT services. The treatment plan includes "activities" to improve left upper extremity function@ and activities to improve balance in sitting and standing. Which of the following activities would be most appropriate? a. Stacking cones b. Door pulley c. Folding laundry d. Throwing a ball

(D) Carpal tunnel and chronic tension. CTS and chronic cervical tension are just some of the work-related occurrences secondary to the arrival of visual display terminals and specialized technology that require repetition and unusual body positioning.

14.A computer programmer arrives at an OT clinic complaining of pain while on the job. Which of the following are MOST likely to be considered work-related injuries specifically linked to the age of technology? A. Systemic disease B. Edema and paresthesia C. Burns and electrocution D. Carpal tunnel and chronic cervical tension

(B) Recommendations of environmental adaptations and assistance for ADL. A patient who exhibits no capacity for new learning will be unable to benefit from therapy interventions that require the ability to transfer learning (answers A, C, and D). A compensatory approach of adapting the environment and recommending assistance for safe performance of daily activities is the MOST appropriate intervention.

138. A patient with neurological deficits has been unable to carry over skills learned previously in therapy and has exhibited no capacity to learn new information. The MOST appropriate intervention approach to improve ADL functioning for this patient would be: a. repetitive practice of simple ADL under therapist guidance b. recommendation of environmental adaptations and assistance for ADL c. ADL training in the familiar home environment d. forward or backward chaining techniques

(C) The sidelying position. The sidelying position reduces the influence of reflexes, extensor tone, and gravity, all of which make protraction of the SH and forward reach difficult.

138. A young child with hypertonicity is unable to bring his hands to midline to reach for a toy while in the supine and sitting positions. The BEST position to use in order to reduce the effects of abnormal patterns and facilitate midline grasp is: A. The standing position B. The prone position C. The sidelying position D. The quadruped position

(A) Modifying the environment to protect the infant from overstimulation and inappropriate stimuli. See reference: Case-Smith (ed): Hunter, JG: Neonatal Intensive Care Unit.

138. An OT manager is developing a proposal for OT services in the NICU. Using the developmental support care approach as the basis for services, how would the OT BEST describe OT‟s scope of practice in the NICU? A. Modifying the environment to protect the infant from overstimulation and inappropriate stimuli B. Providing PROM positioning and handling fabrication of splints, and referral to early intervention C. Educating parents and hospital staff D. Implementing motor and behavioral skill acquisition through developmental milestone positioning

(C) Implement compensatory strategies to manage the environment. Interventions directed toward improvement are typically unrealistic when working with individuals diagnosed with cognitive disorders. These disorders are characterized by deteriorating courses. See reference: Early: Understanding psychiatric diagnosis: the DSMHV.

138. Which of the following is the MOST appropriate goal to address when working with clients diagnosed with cognitive disorders? A. Improve their social skills in relating to others B. Create new habits of time use C. Implement compensatory strategies to manage the environment D. Facilitate resumption of previous life roles

(A) Perform PROM and then position and elevate the affected extremity. Positioning, the use of a compression glove, edema massage, and PROM exercises are all effective methods for reducing edema and preventing further edema. The goal is to promote the movement of fluid back into normal circulation rather than allowing it to collect in one area or body part. Gentle PROM is necessary to help maintain joint structure and provide nutrients to the joint. The actual movement of the extremity may serve as a "pump" to assist in moving excess fluid back into the body. These techniques are contraindicated for individuals who have DVT. Edema is caused in part by the loss of movement in an extremity because there is no contraction of muscles, which helps to pump the fluid to the heart.

139. An OT practitioner enters the room of a patient who recently had a RCVA with flaccidity to the left UE. The therapist begins to perform upper extremity passive range of motion (PROM) treatment when marked pitting edema of the left hand is noted. What is the FIRST thing the OTR should do? A. Perform PROM and then position and elevate the affected extremity B. Fabricate a resting splint for the affected extremity C. Take no action at this time and wait for the edema to subside D. Have the individual attempt to squeeze a ball

(B) Back up the body to the passenger seat, hold onto a stable section of the car, extend the involved leg, and slowly sit in the car. This is the safest way to perform a car transfer after surgery for a total hip replacement.

139. An OT practitioner is instructing a client with a total hip replacement how to perform a passenger side car transfer. Which of the following BEST represents the initial steps of this transfer? a. Stand the body parallel to the car, hold onto a stable section of the car, lift and place the left leg into the car, and slowly sit and follow with opposite leg. b. Back up the body to the passenger seat hold onto a stable section of the car extend the involved leg, and slowly sit in the car. c. Back up the body to the passenger seat, hold into a stable section of the car, flex both legs simultaneously, and slowly sit in the car. d. Back up the body to the passenger seat, hold onto a stable section of the car, flex the involved leg, and slowly sit in the car.

(B) Emotional lability. Emotional lability is the rapid shifting of moods. Emotional lability may be one of the symptoms observed in individuals experiencing mania. See reference: Early: Responding to symptoms and behaviors.

139. An individual alternately exhibits laughing and crying throughout a treatment session. This behavior should be documented as: A. Mania B. Emotional lability C. Paranoia D. Denial

(C) Practice social and life skills. Answer C is correct because practicing life skills is essential for learning and has been found to be helpful in improving functional performance. Structured, supportive milieus with an emphasis on enhancing positive social and life skills have been found to be helpful.

139. Inpatient OT treatment groups for individuals with schizophrenia are MOST appropriate when they provide the opportunity for group members to: a. disclose themselves in the groups b. develop insight into their feelings c. practice social and life skills d. deal with expression of anger

(A) A vacuum feeding cup. Individuals with impulsive behavior or poor judgment often attempt to drink too quickly. The rate of intake can be limited by using a drinking spout with a small opening, pinching a straw, or using a vacuum feeding cup with a control button. See reference: Trombly (ed): Konosky, KA: Dysplegia

139. Which of the following would be the BEST cup for the OT practitioner to recommend using when working with an individual who tends to drink too quickly? A. A vacuum feeding cup B. A nosy cup (cut out for the nose) C. A mug with two handles D. A cup with a large drinking spout

(D) Accommodation. Visual accommodation is the ability to focus efficiently from near to far distance, and vice versa. See reference: Kramer and Hinojosa (eds): Todd, VR: Visual information analysis: Frame of reference for visual perception.

14.A student is unable to focus on a blackboard 20 feet away and then refocus on the book on her desk to copy a mathematics problem. This MOST likely indicates a problem with: A. Ocular motility B. Binocular vision C. Convergence D. Accommodation

(C) implement compensatory strategies to manage the environment. Interventions directed toward improvement are typically unrealistic when working with individuals diagnosed with cognitive disorders. These disorders are characterized by deteriorating courses. A social skills emphasis. See reference: Early: Understanding psychiatric diagnosis: the DSMHV

14.Which of the following is the MOST appropriate goal to address when working with clients diagnosed with cognitive disorders? A. Improve their social skills in relating to others B. Create new habits of time use C. Implement compensatory strategies to manage the environment D. Facilitate resumption of previous life roles

(B) Child's speed over long distances becomes less than that of a walking person. This child should be considered for a power wheelchair when the current means of locomotion proves less efficient and slower than locomotion by walking. Because the child will be experiencing progressive muscle weakness, energy conversations is of primary importance.

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

(A) Controlled stimulation with meaningful sensory cues. An environment that provides controlled stimulation with visual, tactile, and auditory cues that are meaningful to the resident is preferable because it will best facilitate correct perception of the environment. Difficulty in perceiving or misunderstanding environmental cues can lead to behavioral problems or agitation. See reference: Larson, Stevens-Ratchford, Pedretti, and Crabtree (eds): Christianson, MA: Environmental design, modification, and adaptation.

140. An OT practitioner is working as a consultant to a long-term care facility that is designing a dementia care unit. The OT would MOST likely recommend which type of environmental attributes as therapeutic? A. Controlled stimulation with meaning full sensory cues B. High sensory stimulation, to encourage active engagement C. Subdued, low sensory stimulation environment, to prevent agitation D. Stimuli that are very similar to that found in the residents‟ home environments

(C) Pencil gripper. These are all adaptive devices that can be used with a child who has JRA for various reasons. However, the correct answer is C because the pencil gripper will probably make grasping the pencil easier and reduce hand grasp fatigue. Because of hand weakness and because printing and handwriting are common tasks for children this age, it is important that fatigue be reduced.

140. An OT practitioner is working on hand function with a school-age child diagnosed with juvenile rheumatoid arthritis. Which of the following devices will MOST effectively prevent hand fatigue? a. Reacher b. Jar opener c. Pencil gripper d. Plate guard

(C) complete a review of the literature. Reviews of the written material is necessary in preparing the design of the research project. The literature review helps the researcher to state purpose clearly and establish boundaries. Stating the purpose and the hypothesis follows the identification of the research question. See reference: DePoy and Gidin: Developing a knowledge base through review of the literature.

140. The OT practitioner is attempting to better understand a particular phenomenon by conducting a small research study. Initially, the OTR identifies a potential research question. The NEXT step in the process would be to: A. state the purpose B. design the research C. complete a review of the literature D. establish boundaries for the study

(B) Wearing permanent-press clothing. Using a wrinkle-resistant fabric eliminates or decreases the amount of ironing needed.

140. The OT practitioner is instructing a patient who has had a myocardial infarction in energy conservation techniques. The BEST example of limiting the amount of work needed for a task is: A. Using a side-loading washer B. Wearing permanent-press clothing C. Using an extended-handle dustpan D. Using good body mechanics

(A) Replace the spoon with a blunt-ended fork. For a child with incoordination and tremors, stabbing food with a blunt-ended fork is often more effective for feeding than using a spoon. The food will not fall off the fork, and the blunt tines will prevent any injury to the child.

141. A child diagnosed with ataxic CP exhibits tremors in the upper extremities. When she feeds herself, the tremors cause most of the food to fall off her spoon before it can reach her mouth. Which of the following adaptations should the OT practitioner recommend? A. Replace the spoon with a blunt-ended fork B. Build up the handle of the spoon C. Give the child a swivel spoon D. Bend the spoon handle 45 degrees

(B) Teaching the person to use a diary or log. Compensation techniques are used to work around a deficit are by using alternative methods to accomplish the same task. Teaching the use of a diary or log is an example of an external memory deficits. See reference: Trombly (ed): Quintana, LE, Remediating cognitive impairments.

141. A patient needs assistance with memory problems. The strategy BEST reflects an external compensation method of intervention is: A. Teaching the person to retrace steps mentally to stimulate memory. B. Teaching the person to use a diary or log. C. Training the person to repeat important pieces of information aloud to aid memorizing. D. Working with a memory training computer program.

(C) radial nerve. Injury to the radial nerve in the wrist area causes sensory damage only. This damage occurs to the radial two thirds of the dorsum of the hand. Damage to the median nerve at the wrist cause decreased thumb and prehensile strength and complete or partial loss of sensation in the distal portion of the second digit (index finger) and third digits (ring finger). Damage to the ulnar nerve at the wrist causes decreased grip strength and complete or partial loss of sensation to half of the fourth digit (ring finger) and all of the fifth digit (little finger) as well as the proximal hypothenar region. The ulnar and median nerves are frequent entrapped together. A brachial plexus injury causes peripheral nerve damage to any or all of the fibers from C5 to T1. See reference: Pedretti (ed): Kasch, MC: Hand injuries.

141. An OT practitioner is evaluating a young cabinet maker who complains of sensory changes over the dorsal thumb and proximal phalanx of the index, long, and half of the ring finger. The practitioner will MOST likely suspect involvement of the: A. ulnar nerve B. median nerve C. radial nerve D. brachial plexus

(A) Transferring on and off a commode seat. The patient will most likely utilize a walker to transfer on and off a commode seat. In this case, the assistive device (the walker) will permit the patient to adhere to the mandated toe touch precautions, while providing balance, decreasing pain and encouraging safe transfers.

141. An elderly man admitted to the hospital after a car accident. He sustained a right pelvic fracture and verbalizes extreme pain with ambulation. The orthopedic doctor has recommended that the patient perform "toe touch only" weight bearing on his right foot for 6 to 8 weeks. The OT should instruct the patient to use a walker when performing which of the following activities? a. transferring on and off a commode seat b. working on bed mobility c. performing self-feeding d. working on distal lower extremity dressing

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

141. An individual with quadriplegia complains of frequently slumping to the side when sitting in a wheelchair. The wheelchair adaptation that would BEST enable this individual to maintain an optional position is: a. a reclining wheelchair b. an arm trough c. lateral trunk supports d. lateral pelvic supports

(B) Block hyperextension of the MCP joints and allow MCP flexion. An ulnar nerve splint's primary purpose is to support the hand secondary to ulnar intrinsic muscle paralysis. This splint also allows for MCP flexion.

142. An OT practitioner is fabricating a splint for a client who sustained a low-level ulnar nerve injury. The OTR explains that the PRIMARY purpose of an ulnar nerve splint is to: a. block hyperextension of the PIP joints and allow PIP flexion. b. block hyperextension of the MCP joints and allow MCP flexion. c. block PIP flexion and allow for PIP hyperextension. d. block MCP flexion and allow for MP hyperextension.

(D) suggesting furniture and accessories that promote better positioning at work. The best recommendation is for ergonomically correct furniture and accessories. Additional adaptations may include tool modification and the training of workers in appropriate positioning. See reference: Pedretti (ed): Kasch, MC: Hand injuries.

142. An OT practitioner is requested to evaluate and make recommendations to a jobsite that is in search of ergonomic adaptations. An example of this type of adaptation might be: A. introducing relaxation seminars for employees decrease stress while on the job B. treating corporate clients for cumulative trauma disorders C. initiating a smoking cessation program D. suggesting furniture and accessories that promote better positioning at work

(A) Perform a job analysis. Job analysis identifies essential functions of a particular job.

142. An individual with depression is ready to return to the job held before taking a leave of absence. Which of the following is the FIRST action the OT practitioner should take? a. perform a job analysis b. request reasonable accommodation c. emphasize activities that promote a sense of self efficacy d. encourage the individual to participate in a weekly support group

(D) Assess the individual's topographical orientation skills. In order to plan an appropriate intervention, the individual's community mobility skills must first be assessed. Constantly getting lost is a strong indicator that the individual may be impaired in the area of topographical orientation. See reference: Early. Activities of daily living

142. An individual with mental illness wants to travel to the library independently but keeps getting lost. Which of the following actions should the OT practitioner take FIRST? A. Take the individual to the library and obtain a library card B. Assess the individuals ability to read C. Identify the bus that goes to the library and obtain a bus schedule D. Assess the individual's topographical orientation skills

(C) Further decline. Because MS is a degenerative disease, it is likely that the individual receiving a wheelchair will eventually decline further in functional performance.

142. When ordering a wheelchair for an individual with MS, the MOST important consideration is the adaptability of the wheelchair in anticipation of: A. Gradual gains in strength B. Growth of the individual C. Further decline D. Improved wheelchair mobility

(C) By tilting backwards up to 60 degrees while rocking. By lowering the child backwards from the sitting position, the child is required to activate increasing degrees of antigravity control in the neck musculature. As the child's strength increases, the degree of incline can be increased.

143. A 1-year-old child is working on increasing neck flexor strength. At this time, the child can maintain head alignment when tilted backward from an upright supported sitting position, to a 45-degree incline, but loses control when tilted further back. The NEXT important step in the intervention is to work on head and head neck alignment: a. in a sidelying position while batting a toy b. in a prone position while watching a peek a boo game c. by tilting backwards up to 60 degrees while rocking d. in a supine position, while watching an overhead mobile

(A) Skin inspection. Visual inspection of an insensate area is essential for preventing pressure sores, which may develop when there are no sensory cues to alert a person to skin breakdown.

143. A 60-year-old automobile mechanic with diabetes has been referred to OT following an above-knee amputation. The patient has impaired sensation in the remaining LE and will be using a wheelchair for the foreseeable future. The FIRST patient education subject the OT practitioner should cover is: A. Skin inspection B. Grooming techniques (shaving, trimming, toenails, etc.) C. Retirement planning D. Returning to work

(C) Incorporating simple, familiar activities such as hanging up clothing or catching a ball. Incorporating simple activities would be most effective for gaining active cooperation participation from a person with Alzheimer's.

143. A nursing home resident with Alzheimer's disease also has limitations in shoulder range of motion. The OT goal for this patient is to improve shoulder motion so that the person can resume selfcare activities. Which strategy which would be MOST effective in getting the client actively engaged? a. Telling the resident to perform repetitions of active UE range of motion exercises independently. b. Training the resident to use long handled adaptive devices to compensate for decreased shoulder motion. c. Incorporating simple, familiar activities such as hanging up clothing or catching a ball. d. Performing PROM exercises on the resident.

(C) Radial, median, and ulnar. Radial, median, and ulnar are the terms used to describe the nerves that supply the hand.

5. Before treating a client referred to the hand center for a nerve injury, the OTR must understand the nerve pathways that innervate the hand. The nerves of the hand are MOST commonly referred to as: A. Lateral, medial, and central B. Femoral, obdurator, and sciatic C. Radial, median, and ulnar D. Dorsal, lateral, and volar

(C) Hallucinations. The symptoms of schizophrenis are generally classified as either negative or positive. Negative symptoms tend to persist after the positive, or acute, symptoms are treated with medications. Negative symptoms greatly impact an individual's level of functioning. See reference: Early: Understanding psychiatric diagnosis: The DSMV.

143. An OT practitioner is assessing a client who has schizophrenia and appears to be experiencing acute symptoms of the disease. Which of the following is considered to be an acute or positive symptom of schizophrenia that the OT might document in her assessment? A. Flat affect B. A lack of pleasure C. Hallucinations D. Withdrawal from others

(D) Explain to the administrator this is not an appropriate solution and then develop an alternate solution. OT departments frequently are understaffed and need to operate as efficiently as possible. The collaborative teamwork between an OTR and COTA is vital in treatment planning and implementation. When a collaborative relationships is operational, the COTA may participate in evaluation and treatment planning, provide treatment, and carry out documentation. See reference: Neistadt and Crepeau (eds): Sands, M: Practitioners' perspectives on the occupational therapist and occupational therapy assistant partnership.

143. OT services in a long-term care facility are provided by two OTRs and one COTA through a contract agency. When the absence of one of the OTRs creates a staffing shortage, the administration instructs the present OTR to perform evaluation only and instructs the COTA, a new graduate, to perform all treatment planning and implementation until they are full staffed again. No time is designated for supervision. What is the MOST appropriate way for the OT staff to respond? A. Follow the administrator's instructions. B. Express concern to the administrator about inadequate supervision and then follow administrator's instructions. C. Express concern in writing contract agency and then carry out the administrator's instructions. D. Explain to the administrator this is not an appropriate solution end then develop an alternate solution.

(D) provide wrist extension, MCP extension, and thumb extension. The purpose of this splint is to prevent the extensor tendons from overstretching as well as provide proper positioning of the hand for functional use. See reference: Pedretti (ed): Kasch, MC: Hand injuries.

144. An OT practitioner is fabricating a dynamic splint for a butcher who sustained a low-level radial nerve injury should: A. provided wrist extension, MCP flexion, and thumb flexion B. prevent wrist extension, MCP extension, and thumb extension C. prevent wrist extension, MCP flexion, and thumb flexion D. provide wrist extension, MCP extension, and thumb extension

(D) Having him place his feet through loops of therapeutic band. A prefunctional activity is when an individual is unable to perform a specific task, so an activity is used that practices the same movement as placing his feet into his pants legs. A prefunctional activity provides a base to improve a functional activity and may be practiced before or at the same time as a functional task.

144. An OT practitioner is working with a confused patient who is having difficulty placing both feet into his pants legs. An example of a pre functional treatment activity would MOST likely be: a. pulling up pants during toileting activities. b. teaching the individual to use a reacher to pull up his pants to knee level. c. pulling off socks using a dressing stick. d. having him place his feet through loops of therapeutic band

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

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

(D) The measurability of activity performance. The potential to measure an activity results is central to a behavioral frame of reference,. See reference: Neistadt and Crepeau (eds): Crepeau, EB and Neistadt, ME: Activity analysis: A way of thinking about occupational performance.

144. An OT practitioner treats most clients under the behavioural FOR. The activity feature that is MOST consistent with a behavioural FOR is: A. The level of skill is appropriate for the generally expected skills for that age B. The symbolic potential of the activity C. The combined activity demands of sensations, perceptions and motor skills D. The measurability of activity performance

(D) No assistive devices. A person with SCI at the C8 level would have full UE function and would be able to perform self-feeding independently without using equipment.

144. An individual with c8 quadriplegia is most likely to require which of the following in order to perform self-feeding? a. total assistance b. support of the upper extremity against gravity c. a universal cuff d. no assistive devices

(B) (1) Position shirt on lap; (2) Place left hand into sleeve and pull up sleeve past elbow; (3) Place right hand into sleeve and pull up sleeve; (4) Pull shirt up over head. Answer B would be the best sequence because positioning the shirt first on the lap may provide cues for patients with unilateral neglect. Starting with the left side allows the unaffected right hand to perform the first part of the task successfully and requires the eyes to then scan to the left to locate the left arm.

145. An OT practitioner is instructing a patient with left hemiplegia and unilateral neglect to put on a t-shirt. The BEST sequence to teach the patient would be: a. (1) place left had into sleeve and pull up sleeve past elbow; (2) place right hand into sleeve and pull up sleeve; (3) pull shirt up over head; (4) pull shirt down over trunk. b. (1) position shirt on lap; (2) place left hand into sleeve and pull up sleeve past elbow; (3) place right hand into sleeve and pull up sleeve; (4) pull shirt up over head. c. (1) position shirt on lap; (2) place right hand into sleeve and pull up sleeve past elbow; (3) place left hand into sleeve and pull up sleeve; (4) pull shirt up over head. d. (1) pull shirt up over head; (2) place left arm into sleeve; (3) place right arm into sleeve; (4) pull down shirt over trunk.

(C) National Alliance for the Mentally Ill. This is a support group that is open to clients and families and focuses on education and support related to all mental illness.

147. The spouse of an individual being treated for bipolar disorder describes the frustration he experiences in regard to the ups and downs of his wife's condition. The support group that the OT practitioner would MOST likely refer this individual to is: a. Al-Anon b. family therapy c. National Alliance for the Mentally III d. Recovery, Inc

(D) weight-bearing over a small bolster in prone. Weight-bearing on the arms can help with overall inhibition of tone before participating in hand skill activities. Inhibition of flexor spasticity occurs through slow joint compression from weight-bearing, as well as facilitation of ulnar to radial function in the hand. See reference: Case-Smith (ed): Exner, CE: Development of hand skills.

145. On completion of an evaluation of a child with CP. The OT has identified the primary objective of inhibition of flexor spasticity in the hand. The activity that would be MOST appropriate in meeting this objective would be: A. building a block tower B. active release of blocks into a container C. traction on the finger flexors D. weight-bearing over a small bolster in prone

(C) Applying grout to a tile trivet and waiting for it to dry. Activities provide a variety of opportunities for therapeutic gains. The process of grouting a tile trivet involves covering the individual's tile design with the grout mixture and is o messy step. The individual then sees that the tile pattern is emphasized with the addition of the grout. Waiting for the grout to dry requires and individual to delay gratification. See reference: Neistadt and Crepeau (eds): Creapeau: Activity analysis, a way of thinking about occupational performance.

145. The therapist need to identify an activity that will address psychosocial goals by (1) allowing the individual to experience success using a messy process and (2) requiring the individual to delay gratification. The activity process that is the BEST for providing this experience is: A. Working in a group of three other individuals B. Selecting the design pattern for a tile trivet C. Applying grout to a tile trivet and waiting for it to dry D. Encouraging the individual to clean off the table at the end of the group session

(D) Remove scatter rugs throughout the house. The client would face the greatest safety hazard from the presence of scatter rugs in the house, which could cause the client with shuffling gait to trip and fall. Persons with Parkinson's disease are at high risk for falls.

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

(C) The client should enroll in a work-hardening program. Work-hardening prograns are designed to "incorporate job-specific work tasks that progress the client to the physical demand levels of the actual job" (p.390). See reference: Ryan (ed): Practice Issues in Occupational Therapy: Engh, J, and Taylor, S: Work hardening.

146. An OT practitioner is working with an individual who is about to be discharged from OT after rehabilitation for a hand injury. The client has not been able to work for 3 months and is still unable to perform the job requirements as a sales manager in a clothing store. Which of the following recommendations should the OT practitioner recommend concerning OT services? A. The client should continue to perform a home program at time of discharge. B. The client should receive home health OT. C. The client should enrol in a work-hardening program. D. The client should discontinue OT services at the time of discharge.

(B) Remote memory. The ability is to recall events from one's distant past is remote memory and is commonly assessed through verbal interviews and informal testing, such as this question about an individual's recall of childhood events. See reference: Neistadt and Crepeau (eds): Golisz, KM, and Toglia, jp: Evalutaion of perception and cognition.

146. While evaluating a middle-aged individual, the therapist asks the client about the grade school he or she attended. This is an example of the OT practitioner attempting to obtain data pertaining to the individual's: A. Retention B. Remote memory C. Orientation D. Recent memory

(C) Describe how using a shower chair improves safety. Informing the patient of various options is the first response. By describing the shower chair and how it make showering safer, the OT practitioner is conveying the concept that occupational performance is based on the interaction of performance contexts (physical environment) and performance components (balance) and that there are methods to ensure safety. See reference: Piersol and Ehriich (eds): Seibert, C: The clinic called home.

147. A 78-year-old individual who is ambulating with a walker in the home informs the OT practitioner that improving balance is a major concern. Although the patient took showers in the past, now his fear of falling limits him to sponge baths. The OT practitioner tells the individual that it is wise to avoid situations in which the risk of falling is high. Which of the following should the OT practitioner advise the individual to the NEXT? A. Try the bathtub instead of the shower B. Purchase a shower char C. Describe how using a shower chair improves safety D. Explain that therapy will improve his balance

(D) Cut the paper in 2 following a straight line. Scissors skills develop from first cutting snips to cutting a single straight line.

147. A child with developmental delays has just developed the strength and stability in his right hand to hold scissors properly and make snips in the paper. Which of the following would be the NEXT scissors skill to develop? a. Cut cardboard and cloth b. Cut along curved lines to cut out a circle c. Cut along straight lines to cut a triangle d. Cut the paper in two following a straight line

(B) Adult day care. This environment (answer B) provides programming for an elderly patient that is psychosocial in nature and focuses on vocational skills and social activities.

147. An elderly client was hospitalized for an episode of acute depression after the death of his spouse. The client is preparing for discharge and would like to return to his home but is fearful of spending his days alone. The BEST environment for the client to continue socialization and participation in meaningful occupation would be: A. Partial hospitalization B. Adult day care C. Home health care D. Psychosocial rehabilitation center

(D) Ask the employer to provide an isolated cubical as the work space. An isolated cubical is a reasonable accommodation for an individual who is highly distractible. The Americans with Disabilities Act (ADA) requires employers to provide reasonable accommodations for individuals with documented disabilities that will enable them to work despite the disability. See reference: Early: Work, homemaking and childcare.

147. An individual with mental illness has accepted a secretarial position but is concerned about high levels of distractibility that may interfere with concentration and job performance. Which of the following interventions is MOST appropriate for this individual? A. Arrange for the individual to have a job coach B. Ask the employer to provide more frequent breaks C. Explain the problem of distractibility to the employer D. Ask the employer to provide an isolated cubical as the work space

(B) Continue the same positioning and splinting program that was indicated before discharge. It is necessary to continue positioning and splinting after discharge because active scar development continues for many weeks, depending on the severity of the burn. The same positioning and splinting devices used at the hospital are used at home, with changes made as needed during follow-up visits. Individuals stay in the hospital until their conditions can be managed at home with outpatient visits to maintain status. Individuals are not kept until they are completely healed, which would be the only situation in which a home program would not be necessary. If an individual follows the home program only as he/she deems appropriate during the day or night instead of as scheduled by the therapist, the position time may not be sufficient to prevent deformity from occurring.

148. An OT practitioner is preparing an individual with burns to perform a home program of positioning and splinting. To prevent deformity, the OT practitioner would be MOST likely to recommend that the individual: A. Discontinue the positioning and splinting program upon returning home‟ B. Continue the same positioning and splinting program that was indicated before discharge C. Continue with the positioning and splining program only during the day D. Continuing with positioning and splinting program only during the night

(A) Use of time. By comparing interests and actual participation reported, the OT practitioner may identify discrepancies between interests and actual play and leisure behavior. This information can help address the client's use of time and facilitate temporal organization.

148. By using an interest checklist that includes a report of both interests and actual participation in activities, an OT practitioner will MOST likely collect information on client's: a. use of time b. developmental level c. mood and affect d. communication skills

(D) Arrange for the patient to attend a discharge group to discuss these concerns. The OTR can structure a discharge planning group to encourage patients to share similar concerns regarding adjustment after hospitalization. The group can provide support and encouragement for fellow patients as well as opportunities for brainstorming and problem solving issues related to the return to community living. See reference: Psychosocial skills and psychological components.

148. During discharge planning, the patient asks the OTR, "What should I do when people at work ask me where I have been all this time?" How can the OTR BEST address this concern? A. Arrange for the patient to discuss this with the social worker B. Suggest that the patient tell the truth C. Suggest that the patient report having been on an extended vacation D. Arrange for the patient to attend a discharge group to discuss these concerns

(C) National Alliance for the Mentally Ill. This is a support group that is open to clients and families and focuses in education and support related to all mental illness.

148. The husband of an individual who is being treated for bipolar disorder describes his frustration with the ups and downs of his wife's condition. Which of the following is the BEST support group to recommend to this husband? a. Al-Anon b. Family therapy c. National Alliance for the Mentality III d. Recovery, Inc

(C) steps, width of doorways, and threshold heights. The first area of evaluation would be steps, width of doorways, and presence and height of door thresholds to determine whether the wheelchair user will be able to enter or exit interior spaces in the wheelchair or whether structural modifications are required. See reference: Pedretti (ed): Foti, D, Pedretti, LW:: Activities of daily living.

149. A young client who will be using a wheelchair after discharge from the rehabilitation facility is going home. In determining accessibility of the interior home environment, the FIRST area of evaluation the OT will be concerned with is: A. location of telephones and appliances. B. arrangement of furniture in bedrooms. C. steps, width of doorways, and threshold heights. D. presence of clutter in the environment.

(D) Refer him to her OTR supervisor, who has attended a workshop on sexuality and SCI. Anyone providing sexuality counseling must not only be comfortable with his/her own sexuality but must have certain competencies as well. These competencies include awareness of personal and societal attitudes concerning sexuality, knowledge of male and female reproductive systems and how different disabilities affect sexuality, and the interpersonal skills to communicate with patients about sensitive and personal issues concerned with sexuality.

149. An OT practitioner is working on LE dressing with a young adult with a SCI. As the client attempts to put on his underwear, he notices and erection and asks the practitioner how it is possible for him to have an erection and if he will be able to have sexual intercourse. The OT practitioner is slightly embarrassed and uncomfortable with the questions. The BEST action for her to take is to: A. Tell him she will find out the answers to his questions and get back to him with an answer by the next morning B. Answer his questions to the best of her ability and quickly return to the LE dressing program C. Refer him to his psychiatrist D. Refer him to her OTR supervisor who has attended a workshop on sexuality and SCI

(A) Concise objective information. All medical documentation should be accurate, concise, and objective. Personal opinions and statements that are speculative, judgmental, or subjective are not appropriate to be included into the patient's chart.

149. An OT practitioner working in an acute care hospital is writing a progress note in the chart for a treatment session hold earlier that day. Medical documentation should include which of the following? a. concise objective information b. speculative and judgmental information c. objective and speculative information d. subjective information and personal opinions

(B) Raise the toilet. The minimum doorway width that allows a standard wheelchair to pass through easily is 32 inches. A standard toilet is 15 inches, which is 3 inches lower than the standard wheelchair seat. Raising the toilet 18 inches would make transfers easier for this individual.

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

(D) Flushing, blanching, or perspiration. These responses are autonomic nervous system signs of sensory overload. See reference: Case-Smith (ed): Parham, Ld, and Mailloux, Z: Sensory integration.

7. An OT practitioner is instructing a family how to observe for sensory overload when carrying out a sensory integration home program. The MOST important autonomic response to watch for is: A. Nausea and dizziness B. Self-stimulation C. Head banging D. Flushing, blanching, or perspiration

(A) Provide each patient with an individual project and have him or her choose a tile color for the project. The activity should begin with the most basic level of decision making. Each of the other choices provide increasingly more challenging decision making abilities. See reference: Early: Analyzing, adapting, and grading activities.

149. The goal of an arts and crafts group for chronically mentally ill individuals is to improve their decision-making abilities. The MOST appropriate approach to initiating a mosaic tile activity would be to: A. Provide each patient with an individual project & have him/her choose a tile color for the project B. Have the patients choose from a variety of projects C. Have the patients decide on a design, size, shape, and colors for a group mosaics project D. Have each patient decide on a pattern and two tile colors to use in his or her mosaic project

(C) A grief response. Grief is an adaptive mechanism used for dealing with a disabling condition because a loss of function has occurred. Dependency, stress reactions, and unrealistic goals are responses that would not normally pass with time. They also interfere with the recovery process when they are present in the extreme, as with grief.

15.An individual that an OT practitioner is treating is suddenly diagnosed with a disabling condition. Which would be the FIRST adaptive response that would MOST likely pass in time without intervention? A. A dependency reaction B. A stress reaction C. A grief response D. A desire to set unrealistic goals

(B) "The client will initiate one request to one other group members for sharing or using grourp materials within a 1 week period." Reducing the number of requests and the variety or number of individuals the client is expected to interact with is the best way to simplify the initial goal. Extending the amount of time to accomplish the goal. See reference: Early: Analyzing , adapting, and grading activities.

15.An individual was unable to achieve the goal "the client will initiate two requests to other group members for sharing materials within a 1- week period." The NEST revised goal is: A. "The client will initiate two requests to other group members for sharing group materials within a 2-week period." B. "The client will initiate one request to one other group member for sharing or using group materials within a 1-week period." C. "The client will initiate two requests to each of the five group members for sharing one group tool within 2 weeks." D. "The client will say hello to the group leader at the start of each group session."

(D) Pervasive developmental disorder of childhood. This disorder "is characterized by severe and complex impairments in social interaction, communication and behavior". Children with ADHD display behaviors of inattention, hyperactivity, and impulsivity: therefore, answer A is incorrect.

15.During an initial interview, parents describe their child as having severe difficulty in communication and interacting with others. The OT practitioner also observes that the child exhibits many repetitive and ritualistic behaviors. The behaviors described are MOST likely to be associated with: A. Attention-deficit hyperactivity disorder (ADHD) B. Childhood conduct disorder C. Obsessive-compulsive disorder D. Pervasive developmental disorder of childhood

(C) Observation of play and hand function. The observation of play and hand function is the most appropriate way to obtain assessment information during infancy and preschool ages. "Much of the assessment, during infancy and preschool, centers around observation of play and hand function" (p. 609).

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

(D) Plan section. The plan section of SOAP note includes statements related to continuing treatment: the frequency and duration of the treatment: Suggestions for additional activities or treatment techniques: the need further evaluations: and, when needed, recommendations for new goals. See reference: Borcherding : Writing the "P"-Plan.

15.The OT practitioner has written the following statement: "Continue social skills training program and encourage client to attend one new after school club activity within the next week." The MOST appropriate section to place this statement is the: A. Subjective section B. Objective section C. Assessment section D. Plans section

(B) Give praise for completed dressing; do not help the child get dressed. Since the child has achieved dressing independence he does not need assistance (answer A), clothing adaptations (C), or verbal prompts (D) to complete the task. In fact, assisting him now may cause him to lose his independence and regress to relying on his parents again.

150. A 9-year-old with a diagnosis of mental retardation has been receiving OT in order to become independent in dressing and feeding and is now being discharged. The BEST advice for the OT practitioner to give his parents in order to maintain the child's independence in dressing at home is: A. Give assistance when the child asks for it to provide a successful experience B. Give praise for completed dressing; do not help the child get dressed C. Give him oversize clothing with Velcro closures and large snaps D. Give him verbal prompts when needed and help him with closures only

(C) Alcoholics Anonymous (AA). Self-help groups focus on personal growth in which leadership comes from the membership. AA is an example of such a group. MADD is an example of an advocacy group that focuses in changing the legal system. Group therapy involves leadership and expertise from outside of the membership itself. Al-Anon is a combination of support group and self-help group for family members of the alcoholics. See reference: Posthuma: Self-help groups

150. A client who is an alcoholic is in search of a group to attend upon discharge that will assist with the rehabilitative process. The MOST appropriate self-help group for the OT to recommend to an individual who abuses alcohol is: A. Mothers Against Drunk Drivers (MADD) B. Al-Anon C. Alcoholics Anonymous (AA) D. Group therapy

(A) The mother's concerns and goals for her child. The caregiver's concerns are essential in planning effective intervention within the context of the family.

150. A young child with a diagnosis of spina bifida has been referred for an assessment. When collecting the initial data by interviewing the child's mother, the OT should focus PRIMARILY on: a. the mother's concerns and goals for her child b. medical management c. equipment needs d. the physical layout of the home

(D) Program evaluation. Program evaluation is a systematic collection and reporting of outcomes data to document program effectiveness and cost efficiency. See reference: Neistadt and Crepeau (eds): Perinchief, JM: Management of occupational therapy services.

150. An OT providing services to a community mental health program has been asked to example the effectiveness of the OT groups that have been provided over the past 6 months. Which of the following procedures should be used to accomplish this goal? A. Quality assurance B. Peer review C. Utilization review D. Program evaluation

(A)"Jaw opening and closing are controlled with your index and middle fingers; place your thumb on the child's cheek." The correct position of the adults hand for jaw control is as described in Answer A when the child is fed from the side. If the child is fed from the front, the adult's thumb is placed on the chin, with middle finger under the chin to control opening and closing of the jaw. The index finger then rests on the side of the child's face to provide stability.

150. An occupational therapist is discharging a 4-year-old child with athetoid cerebral palsy from a rehabilitation setting to home. The MOST appropriate instructions for the OTR to provide to the family for maintaining correct jaw control while feeding the child from the side are: a. "Jaw opening and losing are controlled with your index and middle fingers; place your thumb on the child's cheek." b. "Jaw opening and closing are controlled with your index and middle fingers; place your thumb on the child's larynx for stability." c. "Jaw opening and closing are controlled with your whole hand on the child's jaw" d. "Jaw opening and closing are controlled with your index and middle fingers; place your thumb on the child's ear for stability."

(C) Memory impairment. Cognitive abilities such as memory are most often the first to be effected in individuals with Alzheimer's disease. Receptive and expressive aphasia. See reference: Ryan (ed): Practice Issues in OT: Brown, I, and Epstein, CF: The elderly with Alzheimer's disease.

151. An OT is participating in the evaluation of an older adult in the early stage of Alzheimer‟s disease. The deficit MOST likely to be evident is: A. Aphasia B. Incontinence C. Memory impairment D. The inability to dress and undress

(D) Managing stigma. More stigma is attached to issues surrounding mental health than physical health, and individuals with mental illness frequently experience prejudice. It is important for individuals reentering the community to be prepared for this with strategies that will enable them to cope with stigmatization.

151. An individual about to be discharged from an inpatient psychiatric unit asks, "When I apply for jobs, what should put down when it asks if you have been hospitalized in the past 6 months?" The therapist's response should include strategies that address: A. Developing assertive ness B. Improving self-esteem C. Anger management D. Managing stigma

(C) To get up slowly from a standing, sitting, or lying position. This strategy can be used to avoid postural hypotension, a sudden decrease in blood pressure resulting in feeling faint or loss of consciousness when moving from lying or sitting to standing. All of the above are possible side effects of neuroleptic medications, but answer C is most important because it is the only one the client has experienced.

154. A client diagnosed with schizophrenia is taking a neuroleptic medication to control hallucinations. While in the hospital, the client experienced postural hypotension as a side effect of the medication. Before discharge, the MOST important advice to give this client concerning medication management is: A. To keep time in the sun as brief as possible B. To avoid using power tools and sharp instruments C. To get up slowly from a standing, sitting, or lying position D. About the dehydrating effects of caffeinated drinks and alcohol

(B) wear noist bracelets on the wrist as a reminder to visually scan toward the affected side. Although hazards may be removed from the environment, or padded to prevent injury to an individual, use of these interventions is only feasible in a person's home. It is best to teach the individual visual scanning of the affected area and the environment, a technique that the person may use anywhere. An individual may avoid using sharp tools or extreme water temperature, but this avoidance does not teach him or her how to monitor the affected side visually, because it is a precaution that addresses only the problem with sensation. Noisy bracelets are one technique that may be used to accomplish compensation for both unilateral neglect and absence of sensation. Visual impairments that are not accompanied by sensory or perceptual deficits are more readily overcome with retraining. See reference: Trombly (ed): Quintana, LA: Remediating perceptual impairments.

151. The MOST effective method of compensation for both unilateral neglect and absence of sensation in an upper extremity with good motor control is to: A. avoid the use of sharp tools or scissors and to avoid extreme water and temperatures. B. wear noisy bracelets on the wrist or ankle as a reminder to visually scan toward the affected side. C. use an electric shaver. D. wear elbow pads on the affected side.

(C) Stabilizing the pelvis, hips, and legs. Answer C is correct because when the pelvis, hips, and legs do not provide a good central base of support, the child resorts to compensatory movements. See reference: Case-Smith (ed): Nichols, DS: Development of postural control.

152. The benefits that a correct sitting position has in relation to hand function is explained to the parents of a child with CP. The child currently uses compensatory movements because of the inability to sit independently. Which aspect of therapeutic positioning should the OTR stress? A. Stabilizing the trunk B. Placing weight on the arms C. Stabilizing the pelvis, hips, and legs D. Stabilizing the head and neck

(D) Select appropriate evaluation begins with the initial interview and chart review, which guide the OT in deciding on a frame of reference and the identification specific evaluation procedures or assessments are complete, the OT uses clinical reasoning skills to analyze date. See reference: Pedretti (ed): Pedretti, LW: OT evaluation and assessment of physical dysfunction.

152. Upon completion of the initial interview and chart review, the NEXT step to be taken by the OT is to: A. Analyze the data B. Develop a treatment plan C. Perform selected assessments D. Select appropriate evaluation procedures

(D) Are easily accomplished by the client. Answer D is correct because activities which are easily accomplished offer no challenge and, therefore, will not enhance learning of skills and development of competence. During the process of reassessment, such activities require changing through the process of grading to make them somewhat more difficult.

152. When a therapist reevaluates a client's treatment plan, the therapist would be MOST likely to change activities when the activities: a. continue to provide some degree of challenge b. the activities reflect the client's priorities c. the activities help to achieve help to achieve the client's goals d. are easily accomplished by the client

(B) Methods of accommodation in the classroom. The MOST essential information for parents and teachers to receive from the OT is how to provide accommodations for the child in the classroom, along with information on juvenile RA and how to participate in school activities.

152. When preparing to discharge a child with juvenile rheumatoid arthritis, what is the MOST important information to share with the child's teacher? A. A summary of the child's cognitive and visual perceptual skills B. Methods of accommodation in the classroom C. Information on the child's range of motion status D. A summary of the child's progress in OT

(B) Outpatient OT. "It is no longer expected that patients discharged to home will be totally independent... These patients are frequently capable of achieving further gains and could appropriately be followed... in an outpatient setting."

153. A patient is being discharged after hospitalization for a cerebrovascular accident and a 2-week inpatient rehabilitation program. He requires minimal assistance in advanced ADL but is independent in most basic ADL, and his RUE function is improving. He plans on eventually returning to work as a cashier. What would be the MOST appropriate recommendation concerning OT services? A. Home health OT B. Outpatient OT C. A work-hardening program D. Discontinuation of OT services

(A) The goals have been met and the individual can no longer benefit from OT services. Discontinuation of OT should occur when an individual has met the goals and further progress is not anticipated within the therapeutic environment.

153. An OT practitioner should discontinue OT services when which of the following has taken place? a. The goals have been met and the individual can no longer benefit from OT services b. The goals have not been met and the individual could benefit from continued services c. The goals have been met but the individual could benefit from continued services d. The individual feels that he or she has not made gains despite objective measures to the contrary

(D) provide a stockinet for the individual to wear inside the splint. A stockinet liner worn inside the splint keeps the perspiration from irritating the skin by absorbing the perspiration and keeping the skin away from the damp plastic. A stockinet liner is inexpensive enough to have several, so the individual can always have a clean one available. See reference: Ryan (ed): The Certified Occupational Therapy Assistant: Schober-Branigan, P: Thermoplastic splinting of the hand.

153. An individual complains of perspiration which is causing his resting hand splint to be uncomfortable. The BEST action to be uncomfortable for the OT practitioner to take is to: A. recommend putting talcum powder in the splint. B. line the splint with moleskin C. fabricate a new resting hand splint with perforated material. D. provide a stocking for the individuals to wear inside the splint.

(B) The child's writing, dressing, and self-feeding skills. Because the child was being treated for difficulties with fine motor skills, discharge criteria should focus on fine motor function.

154. A school-age child with fine-motor difficulties is ready for discharge from outpatient OT services. Which of the following is the MOST important to focus? a. The child's interests and hobbies b. The child's writing, dressing and self-feeding skills c. The child's academic achievement d. The availability of the child's parents for follow up services

(C) follow administration instructions and note changes in behavior. Although the tester may not deviate from the protocol, changes in behavior represent important test data and should be recorded. See reference: Case-Smith (ed): Richardson, PK: Use of standardized tests in pediatric practice.

154. An OT practitioner is administering a standardized test to a young client who suddenly becomes uncooperative and complains that the test is too hard. The MOST appropriate response for the OT practitioner would be to: A. switch to easier items to improve the child's self-esteem B. terminate the session and schedule another session for the remainder of the test. C. follow administration instructions and note changes in behavior. D. adapt the remaining test items to ensure success.

(C) Baking cookies using a recipe. This is a well-delineated meal preparation activity that provides structure with a specific sequence of tasks. See reference: Early: Responding to symptoms and behaviors.

154. An OT practitioner is planning a meal preparation activity for an adult client with attentional and organizational deficits secondary to alcohol abuse. The treatment goals address the client's difficulties in properly sequencing tasks. The MOST appropriate activity to use FIRST is: A. Setting the table B. Planning an entire meal C. Baking cookies using a recipe D. Preparing a shopping list

(C) Supervision. At this level, the child performs the task on his/her own but cannot be safely left alone, or the child may need verbal cueing or physical prompts for 1 to 24% of task.

155. A preteen with a history of TBI is relearning to prepare simple foods but has been having difficulties with sequencing so the OT practitioner has provided the patient with a chart of steps to follow. The child has just learned to prepare his favorite sandwich without "losing his place" in the process but continues to need occasional verbal reminders to look at the chart and to ensure safety. At this point, the child's MOST recent level of independence would be documented as: A. Independent B. Independent with setup C. Supervision D. Minimal assist

(C) "The client independently selected one of six craft designs presented." The notation of the client's response to treatment that contains the MOST objective information is answer C. The notations that address the client's wants and hostility are interpretations of behavior versus directly observable response. The use of the word "appropriate" reflects the OT practitioner's judgment.

155. An OT practitioner in a psychosocial setting is documenting a client's responses to an activity. Which of the following is the most OBJECTIVE statement? a. "the client did not want to finish her stenciling activity" b. "the client was hostile to another client in the activity group" c. "the client independently selected one of six craft designs presented" d. "the client demonstrated an appropriate level of frustration tolerance during most of the activity"

(A) soft to hard to rough. Hypersensitivity stimuli is graded by texture and force. Texture begins with soft, progresses to hard and moves rough. The force begins with touch, progresses to rub, and moves to tapping. The texture and force of the stimuli are graded together. Light, medium, and heavy do not specify what the texture and force of the stimuli would be during training. A person with hypersensitivity would be unable to tolerate training beginning with a rough texture. See reference: Trombly (ed): Bentzel, K: Remediating sensory impairment.

155. An OT practitioner is assessing hand sensation in an older adult with diabetic neuropathies who frequently complains of hand pain it appears that the client would benefit from a desensitization program. The OT informs the client that hypersensitivity training is typically graded from: A. soft to hard to rough B. tap to rub to touch C. light to medium to heavy D. rough to hard to soft

(D) Home observation and parent interview. "Observation of children in familiar settings and routines allows more characteristics views of their abilities and may be actually more reflective of how children can be expected to perform... "(p.207). Parent interviews provide information about the child's abilities from the parent's point of view and can identify the priorities of the child's caregiver. See reference: Case-Smith (ed): Stewart, KB: Purposes, processes, and methods of evaluation.

156. A child with motor delays is being evaluated to determine how he performs self-care activities. Which evaluation procedure is MOST likely to provide relevant information about self-care function? A. Standardized tests of motor development. B. Review of the medical record. C. Developmental screening test. D. Home observation and parent interview

(C) To teach the caregiver how to lift and turn the client safely. Individuals unable to move themselves and those with sensory loss are susceptible to the development of decubiti. Skin damage results from pressure on the skin over a prolonged period of time. The skin over body prominences is particularly prone to the development of decubitus ulcers. Frequent position changes are essential for these individuals to prevent skin breakdown and the risk of serious infection.

156. An OT practitioner providing home-based care to an individual with AIDS learns from his caregiver that he has become too weak to turn himself in bed. What is the MOST important modification to the treatment plan for the OT practitioner to recommend? a. to begin a strengthening program b. to begin a bed mobility program c. to teach the caregiver how to lift and turn the client safely d. to provide an environment control unit to the client

(A) "It sounds as if you're not sure whether you are ready to be discharged." Paraphrasing is repeating what someone has said in your own words. See reference: Denton: Effective communication.

156. An individual tells the OT practitioner, "I don't know about going home tomorrow, I wanted to be discharge yesterday and the doctor suggested I stay in the hospital another day". Which of the following responses MOST accurately reflects an active listening approach? A. "It sounds as if you're not sure whether you are ready to be discharged" B. "You know, your doctor is a very intelligent person" C. "How about calling your doctor when you get home if you feel a panic attack coming on." D. "You've been doing extremely well; what are you afraid of?"

(A) The time he spends at the computer. Since computer work requires very little active movement, and LE, trunk, and neck are generally held in a static position, it is essential to assess how much time the child spends in this position. The OT practitioner needs to instruct the child to take regular breaks and maintain proper positioning while at the computer to avoid further strain.

157. A preteen with a diagnosis of spastic cerebral palsy is enjoying computer assisted learning while making significant progress in written communication, but he complains of general fatigue, body aches, and eye strain. Based on this information, which area would be most relevant for the OT practitioner to reassess FIRST? a. The time he spends at the computer b. The size of the computer screen c. The challenge level of the learning program d. His control of the keyboard

(C) Coping strategies for continuing medication compliance. Medication noncompliance is a primary factor related to frequent readmissions for individuals with psychiatric conditions. The other strategies listed are also important but are not the primary issue

157. An OT practitioner is considering possible topics for a discharge planning group for individuals on an inpatient psychiatric unit. Which of the following topics would be MOST important to cover because it is significantly related to the possibility of rehospitalization? A. Managing family conflicts B. Living skills needed for keeping aftercare appointments C. Coping strategies for continuing medication compliance D. Education about problems with alcohol and substance abuse

(B) Socialization, task performance, daily living skills, and time management. Evaluation of children who have psychosocial problems is centered on behavioral, effective or interpersonal areas, with visual motor and motor assessment following when screening suggest the need. Nut specific emphases in evaluation vary according to the age of the client with psychosocial disorders. See reference: Neistadt and Crepeau (eds) Florey, LL: Psychosocial dysfunction in childhood and adolescence.

157. In evaluating an adolescent with psychosocial problems, an OTR would be MOST likely to begin the process by screening the adolescent's level of functioning in which areas? A. Play and social behavior, overall development, and visual motor skills B. Socialization, task performance, daily living skills, and time management C. Interest in work; leisure, and self-care D. Motor skills, sensory processing, and cognition

(A) A mutual process. The supervisory process is one that requires the attention of both parties involved. The COTA needs to develop his or her own role and identity within the institution and profession. In addition, the OTR supervisor needs to provide the COTA with opportunities for growth and development. As part of this relationship, ongoing evaluation and counseling may take place to enhance learning and role development. See reference: Early: Supervision.

158. A COTA and OTR have effectively worked together for the past 5 years. Which of the following BEST describes the supervisory process between a COTA and a supervising OTR at this level? A. A mutual process B. A evaluative process C. A counselling processing D. A learning process

(B) Boy Scout. While answers A,C, and D describe activities that may help build his sense of competence, only participation in Boy Scouts includes the necessary interaction with pers. Noncompetitive activities, a uniform to signify belonging, predictable routines, and exposure to role models are all elements of the Boy Scouts that can help him develop social competence.

158. An 8-year-old is being treated in OT for social withdrawal and depression. At the time of discharge, the BEST recreational activity for the OT practitioner to recommend for the child is: A. Swimming lessons B. Boy scouts C. Computer games D. Piano lessons

(C) Ease the child to a lying position, remove or pad nearby objects, loosen clothing. The most important action to take is to protect the child during the seizure by preventing injuries which can occur from falling or hitting objects during movements. Other protective measures include loosening clothing that is restrictive and placing a blanket or cushion underneath the child if possible.

158. During OT treatment, a child has a seizure. The MOST important actions for the OT practitioner during the seizure are to: a. check breathing and administer mouth to mouth resuscitation if necessary b. attempt to restrain the child's movement to prevent injury c. ease the child to a lying position, remove or pad nearby objects, loosen clothing d. take no actions except observation of the child

(C) Use simple and highly structured activities, projective media, isolation, and discussing delusions are all contraindicated for people with schizophrenia. See reference: Early: Responding to symptoms and behaviors.

158. In carrying out inpatient treatment groups for individuals with schizophrenia, the OT practitioner should routinely: A. Use projective media such as clay to facilitate expression of feelings B. Allow an individual group member to work in an isolated area away from the group C. Use simple and highly structured activities D. Discuss the individuals‟ delusions with them

(B) A class about job-seeking strategies. The OT practitioner's remediation of identified deficits can be organized into three general approaches in psychosocial settings: enhancing the individual in adjusting his or her perspective on skills and performance, and altering the environment. Teaching and training methods predominate the skill and performance remediation approach. See reference: Zoltan: Executive functions.

159. An OT practitioner uses a remediation of functional performance deficits approach in addressing individuals treated in a psychosocial setting. The activity that is MOST consistent with this approach is: A. An expressive group magazine collage\ B. A class about job-seeking strategies C. The modification of the environment to provide familiar visual cues D. A review of the individual's balance of time among ADL, work, and leisure activities

(C) AC MRDD. The AC MRDD stands for Accreditation Council for services for the Mentally Retarded and other Developmentally Disabled persons. See reference: AOTA: The Occupational Therapy Manager: MaoRse, N: Accreditation council on services for people with disabilities.

159. An OT practitioner working in a sheltered workshop with individuals with mental retardation must be aware of how the agency that provides series to the developmentally disabled population is accredited. Which of the following is responsible for accrediting these workshops? A. JCAHO B. CARF C. AC MRDO D. NLN/APHA

(B) activity adaptation. Modifying how directions are provided is one way to adapt activities. See reference: Early: Analyzing, adapting, and grading activities.

85.An OT practitioner is working with an individual with impaired memory. When the client is unable to follow verbal instructions, the practitioner changes the approach to demonstration. This is an example of: A. Activity analysis B. Activity adaptation C. Grading the activity D. Clinical reasoning

(C) Swing-away footrests and removable armrests. After swinging away the footrests and removing the armrests, the individual can perform a sliding board transfer without being blocked by the wheelchair.

159. An individual will be performing sliding board transfers with assistance from family members upon discharge. When ordering the wheelchair, which features will be MOST important to include? a. one-arm drive and low backrest b. reclining backrest and elevating footrests c. swing-away footrests and removable armrests d. elevating footrests and removable armrests

(A) Wrist cock-up splint. CTS is a condition that result from compression of the median nerve at the wrist. A wrist cock-up splint positions the wrist in 10 to 20 degrees of extension to alleviate symptoms and prevent further damage

159. The OT practitioner has completed patient education with an individual who has just received a splint for carpal tunnel syndrome. When documenting this session, the OT practitioner will indicate that the patient was instructed in precautions, wearing schedule, and care of a: A. Wrist cock-up splint B. Thermoplastic splint C. Resting hand splint D. Dynamic MP flexion splint

(B) median nerve. The median nerve passes through the carpal tunnel at the wrist. Impingement in this region causes sensory change in the thumb, index finger, long and half of the ring finger. Prolonged impingement in the carpal tunnel results in atrophy if the thenar eminence and weakness of the opponents pollicis. Injury to the radial nerve in the wrist area causes sensory damage only. Damage to the ulnar nerve at the wrist causes decreased grip strength and complete or partial loss sensation over half of the fourth digit (ring finger) and all of the fifth digit (little finger) plus the proximal hypothenar region. A brachial plexus injury may result in damage to any or all of the UE peripheral nerves. This may cause motor and/or sensory impairments. See reference: Pedretti (ed): Kasch, MC, Hand injuries.

16.An OT practitioner is treating a client who demonstrates pain, progressive weakness of the thumb, atrophy of the thenar muscles and numbness and tingling in the thumb, index, long and half of the ring fingers. The client is not experiencing proximal upper extremity limitations so the practitioner will MOST likely suspect problems with which of the following? A. Ulnar nerve B. Median nerve C. Radial nerve D. Brachial plexus

(A) Work locks and latches on doors or windows. Checking the individual's ability to work the locks and latches on the doors and windows at home needs to be assessed because the style and stiffness may vary from those available in the clinic. The locks and latches may not be maintained in the same way and maybe stiffer of smoother to work. The ability to work the locks and latches is also a safety concern because the individual may not be able to open them to let family into their home or close them to keep intruders from entering.

16.In an OT clinic, a patient with severe hand weakness as a result of arthritis is preparing for discharge. The OT is performing an evaluation to determine the person's ability to function at home. In terms of home safety, the skill that would be MOST important for this person to demonstrate would be the ability to: A. Work locks and latches on doors or windows B. Manipulate built-up utensils while eating C. Demonstrate energy conservation technique D. Manipulate fasteners on clothing for easy dressing and undressing

(C) Prone over a wedge. Considering the information given, answer C is the best answer because head control is isolated, with the trunk supported. See reference: Case-Smith (ed): Nichols, DS: Development of postural control.

16.Which of the following is the BEST position for promoting isolated head control in a child with very limited postural control and significant upper and lower extremity weakness? A. Standing in a standing frame with knee and hip support B. Quadruped with chest supported in a sling C. Prone over a wedge D. Sitting on a therapy ball with hips supported by the therapist

(A) pull-to-sit leaning back against therapy ball. While at answers involve antigravity control, answer A addresses beginning control in neck and shoulders. Since control develops cephaiocaudally, neck and shoulder control should be addressed first. By using an incline, the pull of gravity can be reduced, thus facilitating maximum control. See reference: Case-Smith (ed): Nichols, DS: The development of postural control.

160. A child displays poor postural stability because of low muscle tone. To promote beginning antigravity control, the FIRST activity that should be performed is: A. pull-to-sit, leaning back against therapy ball B. prone scooter obstacle course C. hippity-hop races D. batting a balloon while the child is suspended in net

(B) A 3-inch screw-top jar. Since the goal was written as a functional behavioral objective, the OTR should reassess the child for functional progress made in performance areas.

160. A child short-term goal is to "demonstrate increased manipulation skills by opening a 3 inch screw top jar independently." The MOST important tool the OTR will need to reassess the child‟s progress is: a. a goniometer b. a 3-inch screw top jar c. a dynamometer d. a developmental fine motor assessment

(D) A clustered independent living arrangement. These are usually composed of "apartment clusters or other types of housing in close proximity to each other, in which groups of residents with disabilities share services such as attendants and transportation."

160. A client that the OT practitioner is working with uses a wheelchair and requires minimal assistance with all transfers and basic ADL. The client is expected to remain at this functional level. Which of the following would be the MOST appropriate community living option for this client at discharge? A. A cradle-to grave home B. A transitional living center C. An adult day program D. A clustered independent living arrangement

(D) Encourage group members to share similar experiences and reactions with each other. See reference: Early: Group concepts and techniques.

160. An OT practitioner is conducting an ongoing assertiveness training group. Which of the following strategies would be MOST helpful in the development of group cohesion? A. Define assertiveness, passivity, and aggression for the group members B. Allow and encourage all group members physically and verbally to release their aggressive feelings toward inanimate objects C. Demonstrate commonly used assertiveness techniques to the group members D. Encourage group members to share similar experiences and reactions with each other

(C) Marking the end of each step with high contrast tape. Difficulty in seeing contrast and color are 2 forms of decreased visual acuity that cannot be addressed by corrective lenses. Two effective environmental adaptations to these deficits are increasing background contrast and increasing illumination. Using tape or paint to make the edge of each step contrast sharply with the rest of the step is an inexpensive way to adapt the environment for the patient.

161. A patient is about to be discharged after completing a rehabilitation program following a total hip replacement. In assessing the home environment, the OT practitioner takes into consideration the patients poor visual acuity. The MOST appropriate adaptation to ensure that the client can go up and down the stairs safely is: a. installing a stair glide b. installing hand rails in both sides of the steps c. marking the end on each step with high contrast tape d. instructing the patient to take only one step at a time when going up or down

(D) The staff may need to monitor water temperature and the amount of soap being used. This individual is functioning within the level 4 range of Allen's Cognitive Levels. Because this individual can recognize whether items are clean or dirty, cueing to place dirty items in the hamper. See reference: Allen, Earhardt, and Blue: Analysis of activities.

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

(C) Bring the sent in for reevaluation within 6 months. Fit and function of seating and mobility should be reassessed within 6 months to account for the child's growth as well as any changes in posture.

161. The OT practitioner has fitted a 6-year-old child for an adapted seat for use in the home for mealtime and other table-top activities. Which of the ff. instructions is MOST appropriate to convey to the parents? A. Adapt the seat as needed B. Bring the seat in for each weekly therapy session in order to adjust it according to the child's growth C. Bring the seat in for reevaluation within 6 months D. Keep the seat until the end of the IEP

(D) 5 feet by 5 feet. An outward opening door needs a space of 5 feet by 5 feet to allow for the wheelchair to be maneuvered around the door. A standard wheelchair requires 5 feet of turning space for a 180- or 360-degree turn.

162. An OT practitioner is helping a family plan a wheelchair ramp to the front door of their home. What is the minimum amount of space needed in front of the door to allow easy access by wheelchair? A. 3 feet by 5 feet B. 4 feet by 4 feet C. 4.5 feet by 3 feet D. 5 feet by 5 feet

(C) Initiation. Initiation, or the ability to begin a task, affects a person's spontaneity in performing activities and how much he or she is able to perform. An individual with initiation problems may be unable to begin until prompted by another person. See reference: Zoltan: Executive functions.

162. An OT practitioner is working with an individual who demonstrates the inability to begin a task or activity. The practitioner documents that the client MOST likely has problems with: A. Attention B. Concentration C. Initiation D. Apraxia

(B) Developing vocational interests, social skills, and community mobility skills. Answer B is correct because these skills are essential in functioning in the environment after school. See reference: Case-Smith (ed): Rogers, SL, Gordon, CY, Schanzenbancher, KE, and Case-Smith, J: Common diagnosis in pediatric occupational therapy practice.

162. An adolescent with mental retardation is planning to enter a supported employment program in the community after leaving school. Which area of intervention would the OT practitioner be MOST likely to focus on? A. Developing the student's leisure interests and play skills. B. Developing the student's vocational interest, social skills, and community mobility skills. C. Facilitating development of the student's gross motor skills. D. Facilitating development of the student's fine motor skills.

(A) Practice regular skin inspection. Children with LE paralysis resulting from myelomeningocele usually experience impaired LE sensation, placing them at risk for developing decubitus ulcers or burns due to contact with hot water or objects.

162. Which of the following is the MOST important precaution to emphasize to parents when discharging a child with lower extremity paralysis as a result of myelomingocele? A. practice skin inspection B. avoid feeding the child chewy foods that may cause choking C. monitor apnea episodes D. avoid situations that can stimulate tactile defensiveness

(A) further observations and evaluation of right-sided dysfunction is indicated. Answe A is correct because infants usually use a bilateral approach at this age. Although unilaterally occurs several months later, most children alternate hands in many activities until age 6 years. This meant that this infant should be observed for possible right-sided dysfunction. See reference: Neistadt and Crepeau (eds): Kohlmeter, K: Evaluation of sensory and neuromuscular performance components.

163. A 4-month old infant being seen for OT assessment shows a strong preference for the left hand when reaching for a rattle at midline. Considering the development of dominance in normal children, the OT practitioner should conclude that: A. further observation and evaluation of right sided dysfunction is indicated. B. development of hand dominance is proceeding in a typical manner. C. had dominance will not develop until age 1 year. D. unilaterally precedes bilaterally in typical development.

(C) Needs assessment. Needs assessment is the necessary first step of gathering data about the population, treatment needs, and resources available. See reference: Cottrell (ed): Grossman, J, and Bortone, J: Program developmental.

163. An OT practitioner has been hired to develop a communitybased program for patients with chronic mental illness. The FIRST step in the process which the practitioner must complete is: A. Program planning B. Program implementation C. Needs assessment D. Program evaluation

(B) Aftercare. Aftercare is the arrangement for discharge services, which may be needed by the individual after he/she is discharged from an OT program. For individuals having received services in a rehabilitation unit, this may include linkages with the Bureau of Vocational Rehabilitation in order to prepare for gainful employment. Another example would be a psychiatric patient being referred to a community center to continue the program that has been established on an inpatient unit.

163. The discharge disposition of an individual is: "The patient will return home upon discharge and receive services from the Bureau of Vocational Rehabilitation for vocational placement." This type of discharge plan is BEST described as: A. A follow-up plan B. Aftercare C. A home program D. Home health services

(A) Linoleum floor. Linoleum floors are the easiest and least expensive surface over which to maneuver a wheelchair.

163. The family of an individual with paraplegia is moving into a new apartment and they need to select a surface for the living area. Finances are limited, but they are looking for the surface that will be easiest for maneuvering a wheelchair. Which of the following is the MOST appropriate surface for this situation? a. linoleum floor b. short pile carpeting c. deep pile carpeting d. several area rugs

(A) refine the question and develop the background. Once the question has been identified, a review of the literature should occur. The next step in research is to refine the question and develop the background. See reference: Royeen: Quality in research.

164. A research question had been identified and a literature review completed by an OT practitioner. The NEXT step for the OT researcher is to: A. refine the question and develop the background. B. decide on methodology. C. establish boundaries for the study. D. collect and analyze data

(D) "Patient stated that he likes to read sports magazines." This statement provides a basis for an objective judgment on what the patient likes because it has been made by the patient.

164. An OT practitioner is writing a daily SOAP note in order to document treatment for a client in the rehabilitation unit. Which of the following documented statements BEST describes an objective basis for judgment? a. "patient enjoys reading photography magazines" b. "patient likes news magazines" c. "patient obviously likes to read sports magazines" d. "patient stated that he likes to read sports magazines"

(C) Righting reactions. Righting reactions develop after the integration of primitive reflex patterns, which are thought to be necessary for survival in the normal newborn. Righting reactions allow children to right their heads against gravity and to realign their bodies around the movement of the head in that process. Prehensile reactions refer to grasping patterns and reach, which differentiate human from other primates. Equilibrium reactions develop after righting reactions and allow the child to maintain a standing and walking posture.

164. The OT observes that a child moves from a completely prone position to a prone-on-elbow position. In reporting the child's progress, the OTR documents that the child is gaining control in the midline position through the development of: A. Primitive reflexes B. Prehensile reactions C. Righting reactions D. Equilibrium reactions

(B) "This program will help you to learn about the skills you have that are needed on MOST jobs and about your potential for work." Prevocational evaluation programs are designed to assess work skills that the client possesses, to identify their potential for work, and to help participants acquire skills by practicing skills that are important in the work environment. Vocational evaluations programs identify the actual interests and skills for specific types of work, such as assembly line work. See reference: Early: Treatment settings.

164. Which of the following statements would BEST explain the purpose of a prevocational evaluation program to a new participant? A. "The program will help you to learn about your interests, talents, and skills for assembly jobs" B. "This program will help you to learn about the skills you have that are needed on MOST jobs and about your potential work" C. "This program will help you identify the responsibility you have to your employer while you are in treatment and to inform your employer of these responsibilities" D. "This program will help you to develop skills for getting a job"

(C) by tilting backwards up to 60 degrees while rocking. By lowering the child backwards from the sitting position, the child is required to activate increasing degrees of antigravity control in the neck musculature. As the child's strength increases, the degree of incline can be increased. See reference: Case-Smith (ed): Nichols, DS: Development of postural control.

165. A 1-year-old child is working on increasing neck flexor strength. At this time, the child can maintain head alignment when tilted backward from an upright supported sitting position, to a 45- degree incline, but loses control when tilted further back. The NEXT important step in the intervention is to work on head and neck alignment: A. in a side lying position while batting a toy. B. in a prone position while watching a peek-boo game. C. by tilting backward up to 60 degrees while rocking. D. in a supine position, while watching an overhead mobile

(B) Instruct the client to take "one white and one blue pill" with the morning and evening meals. Cognitive disabilities' levels of function distinguish the types of assistance an individual needs to safely complete everyday tasks. Cognitive level 4 functioning involves having a routine goal in mind. Linking medications with meals helps the goal become routine.

165. An individual who is being discharged in one week is functioning at Allen's Cognitive level 4 and needs to take 2 different psychotropic medications twice daily. Which of the following is the MOST appropriate discharge recommendation? a. instruct the client to take medication at 9 AM and 9 PM b. instruct the client to take "one white and one blue pill" with the morning and evening meals c. instruct the caregiver to remind the client to take medication twice daily d. instruct the caregiver to place pills into client's hands at the designated times

(C) Provide a summary of observations of the patient's behavior, including what the patient said and did during the interview. An observation summary should present a concise and accurate picture of what happened so that the OTR can understand almost as well as if she were present during the interview. See reference: Early: Data collection and evaluation.

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

(B) Strategies the husband can use to prevent the patient from wandering. Although wandering, incontinence, and failure to recognize family members (answers A, C, and D) are all issues, wandering is the only potentially dangerous one. Because the patient's dementia is advanced, most of the discharge planning is directed toward the husband. Discussion with the patient will have no effect on her ability to manage her incontinence. At this point, environmental adaptation will be more effective than attempting to change the patient's behavior.

166. An elderly has Alzheimer's disease and is about to be discharged to home, where she lives with her husband. She does not always recognize her children, shows a tendency to wander, and has frequent episodes of incontinence. Which of the following is the MOST important item for the OT practitioner to include in the family discharge planning conference? a. strategies the patient can use for incontinence b. strategies that the husband can use to prevent the patient from wandering c. strategies that the patient can use to prevent wandering d. reality orientation techniques to increase recognition of her children

(C) Tardive dyskinesia. Long-term use of antipsychotic medications can lead to tardive dyskinesia in approximately 15% of individuals. Because the behavioral side effects described in this question can seriously impact the individual's daily living skill performance as well as his or herself-concept, OTs are responsible for knowing these side effects. Tremors, muscular weakness, and "rigid gait" are behaviors of pakinsonian syndrome, sometimes seen as side effects of antipsychotic medication ingested. See reference: Early: Psychotropic medications and other biological treatments.

166. Before working in a chronic psychiatric unit, a practitioner must understand the effect that certain medications have on daily function. The extrapyramidal side effect syndrome experienced by individuals receiving antipsychotic medications that impairs swallowing and leads to involuntary jerky arm and leg movements can BEST be described as: A. Parkinsonian syndrome B. Antipsychotic medication overdose C. Tardive dyskinesia D. Lithium toxicity

(B) wearing permanent-press clothing. Using a wrinkle resistant fabric eliminates or decreases the amount of ironing needed. See reference:Trombly (ed): Trombly, CA: Retraining basics and instrumental activities of daily living

166. The OT practitioner is instructing a patient who has had a myocardial infarction (MI) in energy conservation techniques. The BEST example of limiting the amount of work needed for a task is: A. using a side-loading washer. B. wearing permanent press clothing. C. using an extended handle dustpan. D. using good body mechanics

(B) Self-help groups. Self-help groups are supportive and educational and focus on personal growth around a single major life disrupting problem.

167. An OT practitioner is working with an individual who has identified alcohol abuse as a contributing factor to the depression that he has been experiencing. The practitioner is discussing discharge plans with this individual. At discharge, the MOST appropriate type of group to refer this individual to is a(an): a. advocacy group b. self-help group c. support group d. psychotherapy group

(A) Baking brownies. A correctly sequenced progression of difficulty in meal preparation is access a prepared meal: prepare a cold meal: prepare a hot beverage, soup, or prepared dish: prepare a hot one-dish meal: and prepare a hot multidish meal. See reference: Neistadt and Crepeau (eds): Rogers, JC, and Holm, MB: Evaluation of activities of daily living (ADL) and home mangament.

167. An individual has demonstrated competence in heating canned soup. The OT practitioner recommends modifying the treatment plan and upgrading the cooking activity to: A. Baking brownies B. Making an apple pie C. Making toast D. Making a fresh fruit salad

(A) Arrhythmic and unexpected. Sensory integration treatment is complex and highly individualized and must be monitored carefully to observe the effects of sensory input of varying types on the individual. The characteristics of facilitatory sensory input are unexpected, arrhythmic, uneven, or rapid input. See reference: Bruce and Borg: Movement-centered frame of reference.

167. An individual with underactive sensory processing has been referred to OT. Based on a SI frame of reference, activities for this individual should have which of the following facilitatory characteristics? A. Arrhythmic and unexpected B. Arrhythmic and slow C. Sustained and slow D. Unexpected and rhythmic

(D) Facilitate effective treatment. The primary purpose of documentation is to facilitate the treatment process. By defining the problem, goals and objectives, and a treatment plan, the practitioner's thoughts are organized in order to carry out goal directed services. Additional purposes of documentation are to serve as legal documentation; report services provided for reimbursement; and provide communication among the team patient, or family.

167. Each day, an OT practitioner spends a portion of the day on documentation procedures. One of the MOST important purposes of documentation is to: A. Occupy the therapist's time between treatments B. Satisfy accrediting agencies C. Be used as a research tool D. Facilitate effective treatment

(B) Back up the body to the passenger seat, hold onto a stable section of the car, extend the involved leg, and slowly sit in the car. This is the safest way to perform a car transfer after surgery for a total hip replacement. See reference: Pedretti (ed): Adler, C, and Tipton-Burton, M: Wheelchair assessment and transfers.

168. An OT practitioner is instructing a client with a total hip replacement how to perform a passenger side car transfer. Which of the following BEST represents the initial steps of this transfer? A. Stand the body parallel to the car, hold onto a stable section of the car, lift and place the left leg into the car, end slowly sit and follow with opposite leg B. Back up the body to the passenger seat, hold onto a stable section of the car, extend the involved leg, and slowly sit in the car. C. Back up the body to the passenger seat, hold onto a stable section of the car, flex both legs simultaneously, and slowly sit in the car D. Back up the body to the passenger seat, hold onto a stable section of the car, flex the involved leg, and slowly sit in the car

(D) the measurability of activity performance. The potential to measure an activity's resuits is central to a behavioral frame of reference. See referenne: Neistadt and Crepeau (eds): Crepeau, EB and Neistadt, ME: Activity analysis: A way of thinking about occupational performance.

17.An OT practitioner treats most clients under the behavioral frame of reference. The activity feature that is MOST consistent with a behavioural FOR is: A. The level of skill required is appropriate for the generally expected skills for that age B. The symbolic potential of the activity C. The combined activity demands of sensations, perceptions and motor skill D. The measurability of activity performance

(B) "The client will initiate 1 request to 1 other group member for sharing or using group materials within a 1-week period." Reducing the number of request and the variety or number of individuals the client is expected to interact with is the best way to simplify the initial goal.

168. An individual was unable to achieve the goal "the client will initiate two requests to other group members for sharing materials within a 1-week period." The BEST revised goal is: A. "The client will initiate two requests to other group members for sharing group materials within a 2-week period." B. "The client will initiate one request to one other group member for sharing or using group materials within a 1-week period." C. "The client will initiate 2 requests to each of the 5 group members for sharing one group tool within 2 weeks." D. "The client will say hello to the group leader at the start of each group session."

(C) Relapse prevention. Relapse prevention, symptom identification and reduction, and medication management are the areas that are emphasized in discharge planning groups.

168. Several clients are about to be discharged from an inpatient psychiatric unit to a variety of community programs. Which of the following areas is MOST important to address in a discharge planning group? a. developing ADL routines b. self-awareness c. relapse prevention d. social skills

(A) Specific measurable statements with time frames. Goals can be either short term (i.e., in the immediate future) or long term (i.e., over an extended period). The purpose of a goal is to provide a specific statement that is measurable and indicates what is to be accomplished. Patients and significant others play vital roles in working with the therapist to establish goals that are meaningful and realistic. See reference: AOTA: The OT Manager: Acquaviva, JD: Documentation of OT services.

168. While completing the assessment and treatment planning process, an OT practitioner confers with the client to establish program goals. As the OT writes these goals, they should MOST appropriately reflect: A. Specific measurable statements with time frames B. Time frames for what will be accomplished C. Specific measurements of the individual's skills and performance D. Activities to be completed that corresponds with the goals and objectives

(C) CARF. The Commission on Accreditation of Rehabilitation Facilitates (CARF) is the regulatory agency for the provision of rehabilitation services.

169. An OT manager is preparing the OT staff for a visit from an accrediting agency. The accrediting agency that surveys the inpatient and comprehensive outpatient rehabilitative programs is BEST represent by which of the following: a. AOTA b. JCAHO c. CARF d. NBCOT

(D) Providing OT expertise to run the program and solve problems. An OT practitioner could perform all of the functions identified. The OT consultant in this setting typically offers information and skill knowledge to both OT and non-OT staff and administration to help plan programs that meet the needs of the clients.

169. An OT practitioner functioning in the role of a consultant in an adult day care facility would be MOST likely to provide which of the following services: a. evaluating clients to determine OT needs. b. implementing recreational activity groups. c. serving as personal advocate for the client and family liaison. d. providing OT expertise to run the program and solve problems.

(B) Walking as part of a walking club. Walking as part of a walking throughout a facility can provide an outlet for the movement needs of some people with dementia. Walking in a structured way can be calming, provide an activity of exploration, and help to refocus the resident.

169. An OT practitioner in a long-term care facility would like to provide an activity to engage a number of residents with dementia who wander and pace the halls throughout the day. The BEST type of activity to plan for these residents would be: A. Reminiscing about previous jobs B. Walking as part of a walking club C. Singing oldies in a group D. A craft activity requiring concentration

(B) club foot. Pes varus or equinovarus is also called club foor. This deformity involves forefoot inversion and supination, heel varus, equinus through the ankle, and medial deviation of the foot in relationship to the knee. See reference: Smith, Weiss, and Lehmkuhl: Ankle and foot.

169. An OT practitioner is working on functional mobility skills with a child who has a pes varus deformity of the foot. The OT can BEST document this as a(n): A. enlarged great toe B. club foot C. pronated foot D. unstable heel

(A) Begin with activities that have obvious solutions and high probabilities of success and then gradually increase the complexity. This strategy is effective in developing problem-solving skills. See reference: Early: Analyzing, adapting, and grading activities.

169. An OTR is using leather stamping as part of a group activity but feels the need to increase the problem solving processes within the group. The BEST approach for encouraging problem solving in a craft media group is to: A. Begin with activities that have obvious solutions and high probabilities of success and then gradually increase the complexity B. Begin with activities that require gross motor responses and progress to activities that require fine motor responses C. Structure the number and kinds of choices available D. Gradually increases the time used in the activity by 15-minute increments.

(B) Form constancy perception. Form constancy perception is the ability to match similar shapes regardless of change in their orientation in space. See reference: AOTA: Uniform Terminology for OT, third edition.

17.A child is lacing a series of geometric beads from a stimulus card and is unable to identify a moon-shaped bead when it is turned sideways on the table. This MOST likely indicates difficulty with: A. Figure-ground perception B. Form constancy perception C. Position in space perception D. Visual sequencing

(B) Identify and analyze the tasks and occupations that the client will be performing in the home. The first step in the process is to analyze the tasks occupations that the client will be performing at home because this forms the basis of the entire assessment and recommendations that will be offered. This will also provide a framework for determining how well the client can perform the tasks within the particular environment being surveyed.

17.An OT practitioner is performing an environmental assessment to determine accessibility for a client who will be returning home. The FIRST step in this process is to: A. Identify the barriers to movement and function in the home environment B. Identify an analyze the tasks and occupations that the client will be performing in the home C. Identify the aspects of the environment which support movement and function in the home D. Determine the social environment of the client

(B) Good (4). The individual's "available" range is the range through which point the joint may be move passively. Therefore, if an individual is able to move the joint actively through the entire movement that is completed passively and then take maximum resistance, the grade is normal (5). Good (4) is the grade given when an individual is able to move apart through the available stage range against gravity and is able to sustain moderate resistance. Fair (3) is the grade given when an individual is able to move a part through the full range against gravity but lacks the strength for any resistance. Fair minus (3-) is the graded given when an individual moves a part against gravity through less than the full ROM. Fair minus is the last graded range for movement against gravity. Grades poor and trace are for gravity-eliminated movements.

17.During evaluation, the OTR asks a client with rheumatoid arthritis to raise her arm. The client's range of motion is limited to 90 degrees and she can tolerate moderate assistance in this position. The OTR further observes that passive range of motion (PROM) is the same as active range of motion. The manual muscle test grade would MOST likely be documented as: A. Normal (5) B. Good (4) C. Fair (3) D. Fair minus (3-)

(A) Poor modulation of tactile input. This is the only answer that describes both his hypersensitive and hyposensitive responses to tactile input. The child with autism may be unpredictable in terms of response to sensory stimuli, both avoiding and craving stimulation at various times.

17.During the evaluation of a child diagnosed with autism, the child demonstrates craving for tactile stimulation, rubbing objects on his arms and legs. He also avoids being touched by others, The OTRs FIRST interpretation is that this is a sensory integration related to: a. poor modulation of tactile input b. hypersensitivity to tactile input c. hyposensitivity to tactile input d. poor modulation of proprioceptive input

(B) Use a walker. Ambulatory aids may be used to substitute for lost motion, reduce weight bearing in the lower extremities, or widen the base of support to increase stability. An individual with a balance deficit requires a wider base of support, which is provided by walkers and quad canes. See reference: Dutton: Rehabilitation postulates regarding intervention.

170. A home health OT is working with individual who is ambulatory but demonstrates poor balance. The individual has a walker, a standard cane and a wheelchair at home, but financial constraints have prevented any home modifications. Which of the following ambulatory methods would be MOST appropriate for use during meal preparation training? A. Use a standard cane B. Use a walker C. Use a wheelchair D. Hold on to counters and walls

(A) Parkinson's disease. People with Parkinson's disease can benefit from rhythmic exercises, movement strategies, and handwriting activities. Providing these interventions in a group format is of particular benefit to this population because of the added advantage of social interaction. From a planning point of view, group treatment for this condition is also cost efficient.

170. An OT is employed by a community health center has determined that there is a need to provide groups of clients with specific diagnoses. One group the therapist is recommending starts with the clients engaging in a game of rhythmic exercises performed to music. The group activity also includes teaching the clients strategies to get up from chair and start walking and specially adapted handwriting activities. This is MOST likely and OT group for people with the diagnosis of: a. Parkinson's disease b. Guillain-Barre c. COPD d. SCI

(C) Simply stated, concrete verbal instructions. Answer C is correct because the individual is most likely able to understand simple concrete verbal instructions and abstract information may be very difficult to understand. See reference: Pedretti (ed): Pedretti, LW, Smith, JA, and Pendleton, HM: Cerebral vascular accident.

170. An OT practitioner is working with an individual who has had an injury to the nondominant right cerebral hemisphere. The MOST relevant communication strategy to enhance this person's understanding of directions would be to provide: A. Written information presented on the left side of the body B. Exaggerated facial expressions and body gestures rather that words C. Simply stated, concrete verbal instructions D. Pictures of instruction presented on the left side of the body

(D) The Americans with Disabilities Act of 1980. Also referred to as the ADA, this act provides civil rights protection for disabled individuals in 5 specific areas. These areas include telecommunications, transportation, public accommodations, employment, and the activities of state and local government.

170. An OT practitioner who makes recommendations to improve accessibility in the community and advocates the rights of individuals with disabilities for employment, housing, public accommodations, public service, public transportation, and telecommunications is working to implement: A. The Architectural Barriers Act of 1969 B. The Federal Rehabilitation Act of 1973 C. The Fair Housing Amendment Act of 1988 D. The Americans with Disabilities Act of 1990

(B) Members share their experiences and struggles with alcohol use. Shared experiences can build feelings of understanding, hope, and acceptance among the members of a self-help group.

170. An OT practitioner working in a drug and alcohol rehabilitation center is educating clients about discharge options. The PRIMARY expectation for becoming a member in a self-help group for alcohol problem is: a. members are encouraged to tell the other members their names and where they live and work b. members share their experiences and struggles with alcohol use c. members are required to attend a set number of meetings d. members are encouraged to give advice to others

(D) A sheltered workshop. Sheltered workshops are designed to help individuals master basic work skills.

171. Adults with mental retardation can be offered with a variety of work alternatives. Which if the following MOST likely involve simple assembly or sorting and packaging tasks with supervision and subcontracted piecework? a. an adult activity center b. supervised employment c. job coaching d. sheltered workshop

(C) AC MRDD. The AC MRDD stands for Accreditation Council for services for the Mentally Retarded and other Developmentally Disabled persons.

171. An OT practitioner working in a sheltered workshop with individuals with mental retardation must be aware of how the agency that provides services to the developmentally disable population is accredited. Which of the following is responsible for accrediting these workshops? a. JCAHO b. CARF c. AC MRDD d. NLN/APHA

(A) Discharge recommendations. The COTA would contribute to the process of making discharge recommendations (answer A), but this section of the discharge evaluation is to be completed by the OTR. See reference: AOTA: OT roles.

171. An OTR and COTA are each completing sections of a discharge summary. The section LEAST appropriate for the COTA and MOST appropriate for the OTR to complete is the: A. Discharge recommendations B. Patient's current level of independence in ADL C. Patient's most recent strength and coordination measurements D. Patient's discharge disposition

(C) Tai Chi. Tai Chi would be the best activity because it incorporates slow stretching movements. This type of movement can help improve balance which is often affected when muscles become rigid, particularly muscles of the neck and trunk.

171. In a long-term care facility, a number of residents have Parkinson's disease and would benefit from regular group activity which would help decrease the effects of muscular rigidity. The BEST activity the OT could recommend for this purpose would be: A. Weight training B. Walking C. Tai Chi D. Gardening

(C) National Alliance for the Mentally III. This is a support group that is open to clients and families and focuses on education and support related to all mental illness. See reference: Early: Who is the consumer?

171. The husband of an individual who is being treated for bipolar disorder describes his frustration with the ups and downs of his wife's condition. Which of the following is the BEST support group to recommend to this husband? A. Al-Anon B. Family therapy C. National Alliance for the Mentally III D. Recovery, Inc.

(B) reflex sympathetic dystrophy. This diagnosis is typically "a disabling reaction to pain that is generated by an abnormal sympathetic reflex" (p.680). Signs include pain, edema, coolness of the hand, and blotchy skin. The level of trauma does not typically correlate to the amount of pain that the client is experiencing. See reference: Pedretti (ed): Kasch, MC: Hand injuries.

172. An OT practitioner is working with a client diagnosed with a mild sprain. The client cradles her hand and appears to be hypersensitive to light touch. The individual also presents with edema, pain, shiny skin, and excessive dryness of the extremity. Based on this, the OTR assumes that the client is MOST likely suffering from: A. Neuromas B. reflex sympathetic dystrophy C. carpal tunnel syndrome D. desensitization

(C) Work simulation to increase strength and endurance for necessary work-related skills. Work stimulation is considered to be a primary goal of work hardening, in addition to increasing productivity and feasibility through work-simulated activities. OTs typically measure and assess a client's overall physical ability to perform the requirements of a particular job.

172. An OTR is a team member of a work hardening program. Which of the following would BEST represent the goal that an OT practitioner would document regarding this type of program? a. ADL retraining to increase the ability to perform household skills independently b. progressive resistive exercise to increase endurance for selfcare skills c. work simulation to increase strength and endurance for necessary work related skills d. vocational retraining to increase the ability to re-enter the job market

(D) Sitting in a circle and reciting a short poem. The purpose of a closure activity in a Five-Stage group is to provide a familiar activity to end the group on a positive, affirming note.

172. The OT is using the Five-Stage group process for adults diagnosed with moderate levels of mental retardation. As a closure activity, which one of the following is the MOST appropriate? A. Reviewing the rules for appropriate behavior in the group B. Discussing emotional reactions to the crafts activity done earlier in the group C. Walking through an obstacle course to music D. Sitting in a circle and reciting a short poem

(A) Punctuality, accepting directions from a supervisor, and interacting with coworkers. Psychosocial components include time management, social conduct, interpersonal skills, and selfcontrol. Punctuality and accepting feedback are examples of prevocational skills within these psychosocial performance components and are important prevocational skills. See reference: AOTA: Uniform Terminology for OT, third edition.

172. Which aspects of psychosocial performance are MOST important to emphasize in developing a client's work potential in a prevocational program? A. Punctuality, accepting directions from a supervisor, and interacting with co-workers B. Memory, sequencing of the work tasks, attending to work tasks, and making decisions C. Standing tolerance, eye-hand coordination, and endurance D. Maintaining personal cleanliness and adhering to safety precautions

(B) Improved verbal and nonverbal communication skills. Improved verbal and nonverbal communication skills would be the most relevant behavioral outcome indicating program effectiveness.

173. An OT has been hired to develop social skills training programs for persons with long-term mental illness in a community mental health facility. The OT needs to select a behavior to assess as an outcome measure. Which would BEST indicate that the program was successful in achieving goals for this population? A. Improved ability to balance rest, work, and play and leisure B. Improved verbal and nonverbal communication skills C. Improved ability to identify areas for vocational exploration D. Improved ability to perform daily self-care and home management activities

(A) Reminiscence group. In a reminiscence group, the focus is on providing social opportunities for sharing life stories and feelings, expressing pride in past life experiences, and gaining support for past life difficulties, all of which would enhance self-esteem and help the resident to achieve acceptance of past and present life. See reference: Hellen: Appendix 9-10, activity therapy care conference report form information: therapeutic value.

173. An OT practitioner in a long-term care facility is working with several residents who seem very isolated and disengaged from the other residents. The OT has identified a need to provide these residents with a group activity that would enhance self-esteem, provide opportunities for social skills and assist residents in integrating past experiences with present life. The BEST type of group to accomplish these goals is a: A. Reminiscence group B. Meditation group C. Grooming activities group D. Movement activities and games group

(B) use moderately heated water. Hot water may contribute to fatigue in individuals with MS and should therefore be avoided. Moderate water temperature is recommended. See reference: See reference: Ryan (ed): Practice Issues in Occupational Therapy: Jensen, D, and Linroth, R: The adult with multiple sclerosis.

183. A young individual with MS is about to be discharged to home. The client is independent in bathtub transfers using a grab bars. The MOST important self-care recommendation the OT practitioner can make regarding bathing is to: A. use cool water B. use moderately heated water C. take showers and avoid bathing D. bathe at the sink with a basin

(D) Outpatient counseling. Transitional programs after hospitalization offer a range or continuum of support to mental health consumers. Outpatient counseling is the least restrictive situation because it provides support through counseling is the least restrictive situation because it provides support through counseling but does not require any residential treatment.

173. An OT practitioner working in an acute psychiatric facility is meeting with a client who has mental health issues. The client is preparing for discharge and is ready for the least restrictive level of care. The facility the BEST represents the least restrictive level of care is: a. a quarter way house. b. a halfway house. c. a supervised apartment. d. outpatient counselling.

(B) Increase physical activity and fitness. Wellness programs focus on developing personal control of behaviors through educational approaches and active participation in activities that promote health, such as increasing level of physical activity to improve physical fitness.

173. In establishing a wellness program for older adults, the OT practitioner is MOST likely to incorporate activities that: a. improve weakness following a CVA b. increase a physical activity and fitness c. improves social skills for depressed elders d. increase independent performance

(C) I think baking would be a helpful activity to try. Baking something you like offers you several choices and decisions. These choices and decisions can help you feel more positive about making other decisions. You can choose a cake mix or a cookie mix. See reference: Denton: Effective communication.

173. The OT is working with and individual in a psychosocial partial hospitalization program who is having difficulty making decisions. The therapist has suggested a baking activity but the client as unsure if she wants to do this activity. The therapist's response that would BEST facilitate decision making is: A. I think baking would be a helpful activity to try. Baking something you like offers you several choices and decisions. You wanted to bake cookies today, didn't you? B. I think baking would be a helpful activity to try. Baking something you like offers you several choice and decision. Why do you want to bake? C. I think baking would be a helpful activity to try. Baking something you like offers you several choices and decisions. You wanted to bake cookies today, which would you like? D. I think baking would be a helpful activity to try. Baking something you like offers you several choice and decision. Do you want to bake cookies?

(B) observe him in his home during feeding time. "Considering the context of the child's environments is a critical process in occupational therapy assessments" (p.167). The reason he does not feed himself may be environmental-for instance, his parents may have taught him not to touch food with his fingers or he may not have learned to feed himself because his grandmother always feeds him. Or the child may not be able to transfer skills learned at home to the clinic-that is, he may believe that "the place to eat is home, not the clinic." See reference: Case-Smith (ed): Stewart, KB: Occupational therapy assessment in pediatrics.

174. A toddler diagnosed with developmental delays does not finger-feed when presented with food in the clinic. The BEST way to obtain further information about his feeding skills is to A. interview his parents to determine his favorite foods. B. observe him in his home during feeding time. C. review his chart for food allergies. D. repeat the observation in a quiet area (in order to minimize distractions).

(A) Improving accessibility in building access, building interiors, and rest rooms. Title ill of the ADA addresses accessibility of facilities used by the public and focuses on removal of structural barriers to allow access to the premises and use of the facilities, including, parking areas, walks, ramps, entrances, etc.

174. An OTR working as a consultant to a health care facility to assist the facility in achieving compliance with the Americans with Disability Act, title III. The PRIMARY focus of the OT‟s efforts would be to make recommendations about: a. improving accessibility in building access, building interiors, and rest rooms b. modifying equipment, providing assistive aids, and training in adaptive so a disabled person can perform a particular job c. providing education to persons who hire personnel concerning non-discriminatory behaviors and procedures regarding persons with disabilities d. assistive technology systems to facilitate job performance of disabled employees

(A) Pain management techniques. Work hardening programs focus on requiring individuals to work in physically appropriate settings as quickly as feasible through reconditioning. As part of that program, pain management techniques (answer A) are included to assist the person with managing and coping with pain during work-related activities.

174. Which of the following components is MOST essential to include when designing a work-hardening program? a. Pain management techniques b. Achieving a balance between work and leisure c. Energy conservation techniques d. Vocational counselling

(B) Aerobic exercise. Gross motor activities, involving either aerobic exercise or stretching and relaxation, can help to reduce the physical symptoms associated with anxiety. See reference: Early: Responding to symptoms and behaviors.

174. Which of the following is the BEST activity for reducing the physical symptoms of muscle tension associated with anxiety disorders? A. Copper tooling B. Aerobic exercise C. Line dancing D. A woodworking kit

(C) Preparing and consuming nutritional and normal-sized portions of food. Individuals with eating disorders are generally well versed in weight loss techniques (answer A), as well as making food look appealing for other to eat (answer D). "They have extensive knowledge of the caloric content of foods (answer B) but little knowledge of other aspects of food content, such as vitamin and nutritive value... A cooking group would support the experience of preparing and consuming normal-sized portions of food."

174. Which of the following is the most appropriate emphasis for a cooking group for young women with eating disorders? A. Increasing knowledge of a variety of weight loss techniques B. Information on the calorie content of different foods C. Preparing and consuming nutritional and normal-sized portions of food D. Preparing healthy and appealing looking meals

(B) Implement a pureed diet and allow adequate time for eating. As ALS progresses, speaking and swallowing become more difficult and a pureed diet becomes necessary. The individuals runs the risk of aspiration or choking if meals are rushed. See reference: Pedretti (ed): Pedretti , LW, and McCormack, GL: Amyotrophic lateral sclerosis.

179. An OT practitioner is working on a feeding program for an individual with amyotrophic lateral sclerosis (ALS) who is in the late stages of the disease process. Which of the following is the MOST appropriate intervention for this individual? A. Provide is rocker knife, plate guard, and nonskid mat B. Implement a pureed diet and allow adequate time for eating C. Emphasize upper extremity strengthening D. Minimize the use of adaptive equipment

(A) Develop a protocol for environmental modification to reduce fall risks in the life-care retirement community. Developing a protocol for environmental modification of general hazards to reduce falls throughout the community is an example of a primary prevention strategy.

175. A fall prevention program is being implemented by an OT who works in life-care retirement community. The BEST way to implement this type of program at the primary level of prevention would be to: a. develop a protocol for environmental modification to reduce fall risks in the life-care retirement community b. observe ADL performance to identify those residents at highest risk for falls c. make recommendations for wheelchair positioning for those who have had at least one fall d. provide intervention to improve balance for those residents who demonstrate the need

(B) To offer even-tempered acceptance, reflecting back what is heard without agreeing the situation is hopeless. See reference: Early: Responding to symptoms and behaviors.

175. An OT practitioner is leading a discussion with a group of individuals who are diagnosed with major depression. The MOST helpful approach for the therapist to take is to: A. Be upbeat, positive, and cheerful when encouraging the individuals to discuss their feelings B. Offer even-tempered acceptance, reflecting back what is heard without agreeing the situation is hopeless C. Remain silent and still while the individuals are describing their feelings D. Allow the individuals to structure and lean the group discussion

(B) assisted stand pivot transfer. An assisted stand pivot transfer is implemented when the client assists with the transfer. See reference: Pedretti (ed): Adler, C, and Tipton-Burton, M: Wheelchair assessment and transfers.

175. An OT practitioner is transferring a client with hemiplegia from a wheelchair to an elevated mat. The client is able to place both feet on the floor and move the buttocks to the edge of the wheelchair. The therapist then places one had on the client's right anterior pelvis and the other hand on the client's left shoulder. The client is set up so the transfer can be performed toward the client's stronger side. The client then pushes to a standing position and pivots with the therapist's guidance. This is MOST likely an example of a(n): A. independent transfer from wheelchair to mat B. assisted stand pivot, transfer C. pneumatic lift transfer D. dependent stand pivot transfer

(C) Program evaluation. Program evaluation is the compilation of the intervention results for a population of individuals.

175. An OT wishes to assess the results of a life-skills training program provided to individuals at a shelter for abused women. Which of the following methods would be BEST for obtaining this Information? a. Final evaluation of each client involved b. Client satisfaction survey c. Program evaluation d. Utilization review

(D) Meeting the vocational instructor weekly to discuss adaptations to work tasks. Effective consultation involves ongoing communication that helps team members problem solve are effectively.

176. An OT consults to a vocational instructor in a high school program for students with moderate mental disabilities. Which of the following activities would be MOST appropriately provided by the OT? a. Developing an in-house prevocational work program b. Bringing in outside speakers from different job settings c. Teaching the vocational instructor different assessment tools and scoring procedures d. Meeting the vocational instructor weekly to discuss adaptation to work tasks

(B) Insecurity. Feelings of insecurity are often covered up by projecting difficulties into other objects (the collage) or other people. See reference: Posthuma: Observations and analysis.

176. During group activity, an OT practitioner observed a client making frequent negative comments pertaining to the collage activity that the group is working on. These comments are most likely an indication of: A. Passivity B. Insecurity C. Hopelessness D. Indecision

(D) Collaboratively develop an IFSP. The service plan required by federal law (I.D.E.A. 99457, Part H) and provided through early intervention programs is called an individual family service plan.

176. Following initial evaluation of children needing early intervention services, the OT should: A. Independently develop an IEP B. Collaboratively develop an IEP C. Independently develop an IFSP D. Collaboratively develop an IFSP

(D) Scoop dish. This is the most correct answer because the sides of the scoop dish provide a shape that aids the scooping movement. A high baclto to the plate provides a surface to push the food against to aid in getting the food onto the spoon. See reference: Case-Smith (ed): CaseSmith, J, and Humphrey, R: Feeding intervention.

176. The OT treatment goal for a child with athetoid CP is self-feeding. Which of the following adaptations would BEST solve the problem of food sliding off the plate when the child attempts to pick it up with spoon? A. Swivel spoon B. Nonslip mat C. Mobile arm support D. Scoop dish

(A) Stocking the shelves at a local grocery. OT interventions for the transition from school to adult life should focus on real-life functional activities in actual work settings. Working in the natural setting affords students opportunities to develop skills necessary for success in community jobs. Working in a sheltered workshop in their own school environment does not provide real-life settings for job training.

176. Which of the following activities would be MOST appropriate for vocational skills training for high school students with severe learning disabilities? a. stocking shelves at a local grocery b. packaging items in a local sheltered workshop c. cleaning the school cafeteria after lunch d. reading want ads and role playing interviews

(A) Completing the chart reviews. An identified role of the COTA is to complete data collection records such as a record review, general observation checklist, or behavior checklist. A COTA can contribute to the development of a treatment plan, but it is not within the COTA scope of practice to develop treatment plans independently.

177. An OTR and COTA share and coordinate therapy for a caseload. Which of the following jobs would be MOST appropriate for the COTA to perform: a. completing the chart reviews. b. completing the no standardized portions of the evaluation. c. interpreting the results of the no standardized portion of the evaluation. d. independently designing a treatment plan for the individual.

(A) Oral preparatory phase. The oral preparatory phase is typically initiated through the process of looking at and reaching for food.

18.An OT practitioner is treating a client who has a swallowing limitation, partly caused by the inability to receive visual and olfactory stimulation before eating. This limitation typically occurs in which stage of the swallowing process? a. Oral preparatory phase b. Oral phase c. Pharyngeal phase d. Esophageal phase

(A) When the COTA consistently obtains the same results as the OTR The term "service competency indicates interrater reliability between two OT professionals. Service competency is determined by skill level, not by years of experience. See reference: Neistadt and Crepeau (eds) Sands, M: Practitioners perspectives on the OT and OT assistant partnership.

177. An OTR with expertise in hand rehabilitation is assessing a COTA‟s service competency in hand function assessment. At what point is service competency established? A. When the COTA consistently obtains the same results as the OTR B. After the COTA passes the NBCOT examination C. When the COTA has obtained a specified number of continuing education credits in hand rehabilitation D. After the COTA has practiced for a minimum number of years, as specified by state licensure

(A) Use disposable cotton swabs and have clients bring their own cosmetics. Universal precautions are related to the prevention of the spread of infection. Using disposable cotton swabs and having clients use their own cosmetics would be effective in reducing the risk of infection.

177. The OT is leading a grooming group for female clients in a psychosocial treatment setting. Which if the following options BEST complies with universal precautions? a. use disposable cotton swabs and have client bring their own cosmetics b. use disposable gloves when combing the client's hair c. wash and dry makeup brushes between uses d. avoid bringing cosmetics in glass containers to the group

(C) Activities which provide tapping, application of textures, and weight bearing to the residual limb. Massage, tapping, use of textures and weight bearing on the distal end of the residual limb are techniques used to develop tolerance to touch and pressure in the hypersensitive limb. Trombly (ed): Celikol, F: Amputation and prosthetics.

177. The OT practitioner is treating a patient with a standard above elbow amputation who is experiencing hypersensitivity of the residual limb. The OT would most likely perform which of the following interventions in this preprosthetic phase of treatment? A. Activities to strengthen the residual limb B. Activities to increase the range of motion of the residual limb C. Activities which provide tapping, application of textures, and weight the range of motion of the residual limb D. Activities for practicing putting on and taking off the UE prosthesis

(D) Obtain the same results as another OT practitioner who has demonstrated service competency. In order to establish service competency, it is necessary to obtain the same results as a competent OT practitioner when performing a treatment technique or evaluative procedure. Demonstrating service competency often requires more than 1 trial in order to refine techniques to obtain the same result.

177. Which of the following is the BEST method for demonstrating service competency in a standardized evaluation? A. Observe performance of the standardized test by a competent OT practitioner B. Observe a competent OT practitioner, the practice, them teach another individual how to administer the test C. Follow procedures exactly as outlined in the test manuals D. Obtain the same results as another OT practitioner who has demonstrated service competency

(A) A mutual process. The supervisory process is one that requires the attention of both parties involved. The COTA needs to develop his/her own role and identity within the institution and profession. In addition, the OTR supervisor needs to provide the COTA with opportunities for growth and development. As part of this relationship, ongoing evaluation and counseling may take place to enhance leaning and role development.

178. A COTA and OTR have effectively worked together for the past 5 years. Which of the following BEST describes the supervisory process between a COTA and supervising OTR at this level? a. mutual process b. evaluative process c. counselling process d. learning process

(C) Advanced supervision. Advanced levels of supervision occur on an as-needed basis. Individuals being supervised at this level have demonstrated skill and expertise in the area of OT in which they are working. They may also serve as a resource person and assist in continuing education or research as it relates to their expertise.

178. A clinical manager of OT supervises an employee who has demonstrated specialized skills in treatment and serves as an expert for her peers. This practitioner has completed research, leadership training, and assisted in continuing education activities. The manager of the department is MOST likely to supervise this individual at what level? A. Close supervision B. Intermediate supervision C. Advanced supervision D. Educator supervision

(D) Senioer COTA will evaluate, guide, and teach the staff COTAs. A supervisor has administrative, evaluative, and teaching roles. COTAs as always require at least a general level of supervision never minimal. See referernce: Early: Supervision.

178. A senior COTA has been given the responsibility of supervising staff COTAs in an OT department. This means that the: A. Staff COTAs will require only minimal supervision from an OTR. B. The senior COTA‟s caseload will be reduced. C. The senior COTA can redefine the role of COTAs in the department. D. The senior COTA will evaluate, guide, and teach the staff COTAs

(D) disorganized psychosis. Directive group treatment is a highly structured approach that is used in acute care psychiatry for minimally functioning individuals. This approach is useful for disorganized and disturbed functioning with patients with psychoses and other neurological disorders. See reference: Early: Group concepts and techniques.

178. An OT practitioner is attempting to decide which type of group to institute within an acute psychiatric setting. The supervising OT suggests the directive group treatment approach because it is MOST appropriate in acute care mental health for individuals with: A. substance abuse problems B. eating disorders C. adjustment disorders D. disorganized psychosis

(D) Health promotion. Health promotion is the advancement of healthy lifestyles, which may include educational, behavioral change, and cultural support.

178. As health care changes through the next century, the focus will move more toward health status and away from health care. This trend focuses on enhancing wellness and health through activities using various strategies, including education and behavioral change efforts. The OT practitioner's role in this trend is BEST described as: a. occupational behavior b. intervention c. self-efficacy d. health promotion

(C) Somatosensory system. Many children who use an excessively tight grip on the writing tool and press too hard with the pencil on their paper have poor proprioceptive awareness (somatosensory).

19.An OT practitioner observes a child with a learning disability use an unusually tight grip when writing with a pencil. The child also frequently breaks his pencil from applying too much pressure on the paper. This type of problem is MOST likely caused by inadequate sensory information from the: A. Vestibular system B. Auditory system C. Somatosensory system D. Visual system

(D) Intermediate-level OTR with routine supervision. Supervision is the oversight required of an OT and may be at 1 of 4 levels based on the expertise of the professional. This therapist sees the supervisor every other week, indicating a routine or general level of supervision which is appropriate for an intermediate-level practitioner. An intermediate therapist will have gained skill mastery, begun to specialize, and have the ability to participate in education of others. However, he or she has not yet gained the refinement of special skills to be considered advanced.

179. An OTR has been working in the area of mental health for 3 years and continues to meet with her supervisor every other week. This therapist has mastered basic role function, begun specialization and participates in the education of other personnel. Based on the AOTA document, Occupational therapy roles, this OTR is functioning as an: a. entry-level OTR with close supervision b. intermediate-level OTR with minimal supervision c. advanced-level OTR with general supervision d. intermediate-level OTR with routines supervision

(C) Once a month. The description of general supervision given by the AOTA includes a minimum of mothly direct contact with supervision available as needed by phone or other forms of communication. see reference: AOTA: Guide for supervision of OT personnel in the delivery of OT services

179. An OTR needs to provide "general supervision" to an experienced COTA in a long term care treatment setting. As defined by the AOTA, the OTR will have contact with the COTA: A. Once a day B. Once a week C. Once a month D. Ass needed

(D) Explain to the administrator this is not an appropriate solution and then develop an alternate solution. OT departments frequently are understaffed and need to operate as efficiently as possible. The collaborative teamwork between an OTR and a COTA is vital in treatment planning and implementation. When a collaborative relationship is operational, the COTA may participate in evaluation and treatment planning, provide treatment, and carryout documentation.

179. OT services in a long-term care facility are provided by two OTAs and COTA through a contract agency. When the absence of one of the OTRs creates a staffing shortage, the administration instructs the present OTR to perform evaluations only and instructs the COTA, a new graduate, to perform all treatment planning and implementation until they are full staffed again. No time is designated for supervision. What is the MOST appropriate way for the OT staff to respond? A. Follow the administrator's instructions B. Express concern to the administrator about inadequate supervision and then follow administrators‟ instructions C. Express concern in writing to contract agency and then carry out the administrator's instructions D. Explain to the administrator this is not an appropriate solution and then develop an alternate solution

(B) Rinse the eye with an eye wash or water immediately. It is necessary to immediately wash the eye because the "backwash" fluid in the IV is unidentifiable body fluid and universal precautions should be followed. It is recommended to flush an exposed area with warm water or normal saline immediately. Following the cleansing of the eye, it is recommended to contact the immediate supervisor and report the exposure through the facility reporting system.

179. The OT is working with a patient on an acute care floor when the patient's IV equipment disengages, splashing the therapist in the eye with the medication and IV "backwash" fluid. The therapist's FIRST response should be to: a. rub the eye and continue treatment. b. rinse the eye with an eye wash or water immediately. c. write an incident report. d. cover the eye with a bandage and contact the immediate supervisor.

(A) Never, because children with flaccid bladders typically cannot be toilet trained. Answer (A) is correct because, "when the lesion is in the lumber region or below, the bladder is flaccid (lower motor neuron bladder)... the reflex arc is not intact, and the bladder has lost all tone... children with a flaccid bladder cannot be trained because the bladder has no tone to empty". These children are commonly provided with some type of catheterization technique after medical testing is performed. Typically, nighttime bowel and bladder control may not be accomplished until the normally developing child is 4 or 5 years of age. Other developmental trends in toilet training are that daytime control is usually attained by 30 months and that girls may precede boys 2.5 months.

18.A child with spina bifida has a lesion at the lumbar level that causes her bladder to be flaccid. At what age should the OT practitioner consider lack of bladder control as a delay and institute a toilet training program? A. Never, because children with flaccid bladder typically cannot be toilet trained B. At 3 years of age when normally developing children recognize the need to urinate C. At 4 years of age because normally developing children tend to get toilet trained at this age D. At 4 to 5 years of age

(A) Short-term recall. Short-term recall is the ability to recall information that has just been received and to hold it in temporary use from 1 to 5 minutes or more. Short-term recall is not just a selected part of the information.

18.An OT practitioner asks a client who recently sustained a head injury to repeat a random list of numbers 1 minute after hearing the list. The OTR is MOST likely evaluating: A. Short-term recall B. Attention C. Hearing D. Abstraction

(A) within normal limits. The normal range of motion for internal rotation is 70 degrees. Rotation can be assessed with the humerous adducted against the trunk or with the shoulder abducted at 90 degrees. If the humeral movements for internal of external rotation are observed during the performance of activities and found to be adequate for the performance of any functional activities, the range of motion may be noted as WFL. The OT practitioner may choose not to perfrom a formal joint treasurement if the joint is WFL, even though the end of the range may be lacking a few degrees, because the loss of movement may not be significant to the individual. Hypermobility at a joint is motion past the average range of motion, which at the shoulder would be past 70 degrees of internal rotation. If hypermobility is a deformity caused by an unstable joint as might occur after a surgical repair or a disease process, then splinting or another form of stabilization or immobilization can be used to correct the problem. If the practitioner observes hypermobility during range of motion to that on the individual's opposite side in order to assess normal range. A limitation of internal rotation at the shoulder would be less than 70 degrees of motion. If a limitation is apparent, the rehabilitation team may choose not to treat it unless it interferes with the function of the upper extremity. See reference: Trombly (ed): Trombly, CA: Evaluation of biomechanical and physiology aspects of motor performance.

18.An OT practitioner is assessing the ROM of an individual who demonstrates internal rotation of the shoulder to 70 degrees. The practitioner would MOST likely document the patient's AROM as: A. Within normal limits B. Within functional limits C. hypermobility that requires further treatment D. limited mobility that requires further treatment

(C) Hallucinations. The symptoms of schizophrenia are generally classified as either negative or positive. Negative symptoms tend to persist after the positive, or acute, symptoms are treated with medications. Negative symptoms greatly impact an individual's level of functioning. See reference: Early: Understanding psychiatric diagnosis: The DSM-IV.

180. An OT practitioner is assessing a client who has schizophrenia and appears to be experiencing acute symptoms of the disease. Which of the following is considered to be an acute or positive symptom of schizophrenia that the OT might document in her assessment? A. Flat affect B. A lack of pleasure C. Hallucinations D. Withdrawal from others

(A) Selected tasks in which sides have been trained, with intense close supervision. To maximize efficiency and cost effectiveness of therapy services, there has been increasing use of OT aides. Such aides must be closely supervised and are expected to receive site specific training in selected activities determined by the supervising OT practitioner and must be utilized in accordance with state regulations.

180. An OT practitioner is supervising an OT aide. The MOST appropriate kinds of activities and level of supervision for the aide include: a. selected task in which aides have been trained with intense close supervision. b. various intervention activities with routine supervision. c. completing ADL training with a patient without supervision. d. selecting adaptive equipment from a catalog with general supervision.

(B) Yes, as long as state regulations allow autonomous practice and the COTA recognizes situations that require consultation with or referral to an OTR. OT plays a significant role working with consumers in the independent living movement by working both with individuals and their environments. According to the AOTA position statement The Role of Occupational Therapy in the Independent Living Movement, AOTA "supports the autonomous practice of the advanced COTA practitioner in the independent living setting." In this situation it would be the responsibility of the COTA to recognize and seek out OTR consultation when appropriate. However, this does not supersede state regulations when they prohibit autonomous practice by the COTA.

180. An advanced-level COTA who has worked at an independent living center for the past 7 years has been offered the position of director of the program. There are no funds to pay for OTR supervision. According to the AOTA, can the COTA accept the position? a. only if the COTA can find some way to fund OTR supervision b. yes, as long as state regulations allow autonomous practice and the COTA recognizes situations that require consultation with referral to an OTR c. no, the COTA cannot work in this practice setting without OTR supervision d. only if the COTA relinquishes use of the credentials "COTA"

(C) Frequent hand washing. Hand washing is the primary prevention against infection from blood borne pathogens in the health care environment. Hand washing is one of 4 workplace strategies that aid in the prevention of exposure. Other strategies include using engineering controls, protective equipment, and universal precautions

180. The precaution MOST frequently used by OT practitioners and others in the health care field to prevent infection is: A. The wearing of goggles B. The wearing of a mask C. Frequent handwashing D. The wearing of a gown over work clothes

(C) Notify NBCOT of the situation and reassign the patient to a different therapist. According to the Code of Ethics, therapist are responsible for maintaining relationship that "do not exploit the recipient of services sexually, physically, emotionally, financially, socially or in any other manner." The patient-therapist relationship is compromised when the therapist enters into a social or intimate relationship with a patient. Every therapist is responsible to report" any breaches of the Code of Ethics to the appropriate authority, " whether they are a supervisor or not because the issue is practice related, the NBCOT to determine if and what type of disciplinary action should be taken. See reference: AOTA: OT Code of ethics.

180. The supervisor of OT is off work and in a local establishment listening to a band with her friends. She observes one of the therapists she supervises at another table being intimate with a gentleman she is currently treating on an outpatient basis. Which of the following actions should the supervisor take in order to be consistent with the OT Code of Ethics? A. Indicate to the therapist that she may maintain the relationship as long as it does not impair the patient's treatment B. Notify the state licensure board and terminate the employee C. Notify NBCOT of the situation and reassign the patient to a different therapist. D. Discipline the employee and refer the patient to another outpatient center.

(B) At or above the minimal entry level of competence. The AOTA statement "Purpose and value of OT fieldwork education" state that "Upon completion of Level II fiedwork education, the student is expected to function at or above the minimum entry level of competence (p.845). See reference: AOTA: Purpose and value of OT fieldwork education.

181. A fieldwork supervisor is completing the final evaluation of a student who is in the last week of level-11 fieldwork, the supervisor must determine that the student is functioning: A. Slightly below entry level B. At or above the minimal entry level of competence C. At an intermediate skill level based on the Occupational Therapy Roles D. At an advanced skill level based on the Occupational Therapy Roles

(A) From a home health OTR or COTA. Home health services which may include nursing, OT, PT and speech therapy are provided in the patient's home. Individuals who require continued care following discharge from the hospital may be appropriate for home health services if they are unable to travel to the hospital for outpatient services. If the decision to discharge the person has already been made, recommendation for a continued stay in the acute care hospital or transfer to a rehabilitation cancer (answer B and C) are not appropriate. The person's weakness and continuing requirement for intravenous drug therapy would make it extremely difficult for the patient to return to the hospital for outpatient therapy (answer D).

181. A patient who has had surgery for a malignant tumor was seen once in OT and is being discharged home, though the patient is weak and needs to continue receiving IV chemotherapy with a home health nurse. The MOST appropriate recommendation the OT practitioner could make for this patient to receive OT services would be: ] a. from a home health OTR or COTA b. staying in the hospital a little longer. c. going to a rehabilitation center. d. coming back for outpatient OT.

(C) Tip prehension is accomplished by flexing the IP joint of the thumb and the PIP and DIP joints of the finger and bringing the tips of the thumb and fine together. This type of prehension is used to pick up objects such as a pain, nail, or coin. See reference: Pedretti (ed): Belkin, J, English, CB, Adler, C, and Pedretti, LW: Orthotics.

190. An individual demonstrates the ability to pick up a penny from a flat surface. This represents which of the following prehension patterns? A. Lateral B. Palmar C. Tip D. Three-jaw chuck

(B) Providing staff education, recommendations, and support for restraint alternatives. Providing education on the effects of restraints and recommendations and program support for alternatives to the use of restraints, such as activities, distraction techniques, and environmental adaptations would be the MOST appropriate functions for the OT

181. An OT practitioner is working to reduce the application of restraints for the population of a long-term care facility. The MOST appropriate form of intervention for the OT to provide is: A. Identifying legal issues related to restraint reduction. B. Providing staff education, recommendations, and support for restraint alternatives. C. Investigating incidents of resident abuse related to restraint reduction. D. Assessing the level of risk and liability involved with restraint use.

(D) Recommend hospice OT. OT in hospice care focuses on role performance, the components of which are quality of life, focus and control, and adaptation. This type of intervention may bring quality and meaning to the individual's remaining days.

181. An individual with advanced lung cancer is about to be discharged from an acute care setting to home. She is depressed, although she remains ambulatory and independent in basic activities of daily living; she tries very quickly and no longer participates in most of her life roles. Which of the following is the BEST action for the OT practitioner to take? a. provide her with a home program b. recommend home health OT c. recommend discontinuation of OT services d. recommend hospice OT

(B) Bend both knees, keep the back straight and bring object close to the body when lifting. Bending with both knees while keeping the back straight and the object close to the body will prevent low back bending and strain. Seer reference: Pedretti (ed): Smithline, J: Low back pain.

181. When working with clients who experience low back pain, it is important is practice functional technique such as lifting and carrying. Which of the following BEST represents a correct lifting method? A. Keep both knees straight, flex the back, and keep object an arm's distance away from the body B. Bend both knees, keep the back straight, and bring object close to the body when lifting C. Keep both knees and back straight and bring object close to the body when lifting D. Bend one knee while keeping the other leg straight and keep the object arm's length away from the body

(A) Partial hospitalization. Partial hospitalization is appropriate for individuals who are experiencing acute psychiatric symptoms and who have a place or family to stay with a night. Except for overnight care, partial hospitalization offers most of the structure, staffing, and services available on an inpatient unit. See reference: Neistadr and Crepeau (eds): Treatment settings.

182. An OT practitioner is a member of a treatment team reviewing the treatment options for an individual who is experiencing acute psychiatric symptoms but not suicidal. This individual has been living with family members. The BEST treatment environment for this individual to receive OT services would be: A. Partial hospitalization B. Day care C. Home health care D. Community mental health center

(A) "It sounds as if you're not sure whether you are ready to be discharged." Paraphrasing is repeating what someone has said in your own words. See reference: Denton: Effective communication.

182. An individual tells the OT practitioners, "I don't know about going home tomorrow. I wanted to be discharged yesterday and the doctor suggested I stay in the hospital another day." Which of the following responses MOST accurate reflects an active listening approach? A. It sounds as if you're not sure whether you are ready to be discharged. B. You know, your doctor is very intelligent person. C. How about calling your doctor when you get hoe if you feel a panic attach coming on. D. You've been doing extremely well what are you afraid of?

(D) Call 911. The OT practitioner should be knowledgeable of situations that may be potentially dangerous for patients. This question requires that the practitioner be knowledgeable about the appropriate ranges for heart rate and blood pressure. Both of the measure are above safe ranges and indicate that the patient is medically unstable. Therefore, immediate medical services would be necessary.

182. During a group community reentry outing, one of the individuals complains of chest pain. The OT practitioner monitors the client's heart rate and blood pressure. The therapist interprets the client's resting heart rate at 120 bpm, and blood pressure at 220/180 mm Hg. The MOST appropriate action for the OT practitioner to take is to: A. Continue the community reentry outing B. Immediately return the patients to the hospital C. Help the patient lie down and wait until his vital signs return to normal D. Call 911

(A) Incident report. Facilities use incident report to document incidents such as this.

182. During a routine transfer, a patient's legs buckle, causing him and the OT practitioner to fall to the floor. The most appropriate way for the OT practitioner to document this accident is in a(n): a. incident report. b. daily progress note. c. letter to the department head. d. verbal report to the department head.

(D) An exposure has occurred; put on gloves, clean up the spill with paper towels, put the soiled paper towels in a plastic bag, seal the bag, disinfect the area, and finish the patient's session with whatever time is still left. The Occupational Safety and Health Administration (OSHA) has identified materials that require universal precautions to include blood, semen, vaginal secretions, CSF, synovial fluid, pleural fluid, any body fluid with visible blood, any unidentifiable body fluid, and saliva from dental procedures. Items OSHA has identified as not needing universal precautions include feces, nasal secretions, sputum, sweet, tears, urine, and vomitus.

182. While practicing wheelchair-to-tub transfers in individual's external catheter is dislodged and urine spills onto the floor. The therapist notes that the urine appears to have blood in it. Which one of the following response is the MOST appropriate? a. an exposure has not occurred; clean up the area with paper towels and resume treatment as quickly as possible b. an exposure has occurred; close off the area until it can be disinfected and resume treatment as quickly as possible c. an exposure has occurred; clean up the spill with towels, place towels in the dirty laundry bin and resume treatment as quickly as possible d. an exposure has occurred, put on gloves, clean up the spill with paper towels, out the soiled paper towels in a plastic bag, seal the bag, disinfect the area and finish the patient's session whatever time is still left

(A) Holding the hammer. Holding the hammer is the only activity listed that requires gripping with the entire hand. See reference: Breines: Folkcraft.

85.An OT practitioner provides a leatherworking activity to an individual with C7 quadriplegia in order to increase grip strength. Which component of this activity would be MOST effective in promoting this goal? A. Holding the hammer B. Holding the stamping tools C. Squeezing the sponge to wet the leather D. Lacing with a needle

(D) Interdisciplinary care improvement teams. Healthcare professionals who are part of an interdisciplinary care improvement team work together to "address such issues as patient flow, the discharge process, patient outreach, and promotion and cost-efficiencies."

183. An OT manager is attempting to find a way to have financial success in the department while ensuring patient satisfaction. Which of the following is MOST likely to be implemental to assess patient flow, develop critical pathways and cut costs? a. quality improvement b. peer review teams c. cost accounting d. interdisciplinary care improvement teams

(C) Home health care. Home health care provides treatment services to individuals in their homes who have chronic or debilitating illnesses in order to increase their functional independence. Although most individuals who receive home health services have primarily physical disabilities, secondary psychiatric disorders are quite common.

183. An elderly patient was hospitalized for a total hip replacement and is preparing to be discharged to a caregiver's home. The OT practitioner has recommended a program to address the patient's decreased mental abilities, specifically poor memory and difficulty with orientation to place and time. The BEST way for this individual to receive OT services is: A. Partial hospitalization B. Adult day care C. Home health care D. A psychosocial rehabilitation center

(D) Wear gloves, a gown, a mask, and goggles. Answer D is the action that is consistent with universal precaution guidelines for working with an individual when there is a risk of coming in contact with body fluids such as sputum from coughing. See reference: Neistadt and Crepeau (eds): Pizzi, M, and Burkhardt, A: OT for adults with immunological diseases

183. An individual who has a productive cough is scheduled to have an ADL evaluation by the OTR in an acute care facility. The MOST important action for the OTR to take, according to universal infection precautions, is to: A. Wash hands before and after seeing the client B. Wear gloves C. Wash all surfaces the individual comes in contact with before and after D. Wear gloves, a gown, a mask, and goggles

(B) Document services provided and data the note as a late entry. It is the responsibility of the OT practitioners to document services provided. After the error was found, the OT should document the services as she recalled.

183. While documenting the week's OT sessions in an individual's chart, an OT practitioner notices that a progress note from 2 weeks ago was not completed. The therapist recalls providing treatment that week and how the patient responded. The ONLY appropriate action for the OTR take is to: a. complete the note using the original date. b. document services provided and date the note as a late entry. c. leave the chart as is without documenting services provided. d. write a brief note stating that documentation was not completed for the specified dates.

(B) Transitional living center. Transitional living centers "provide temporary living arrangements for individuals who are in a transitional phase between hospital or institution and independent community living. Professional staff, including OTs, assist the residents in gradually assuming responsibility in self-maintenance."

184. A client uses a wheelchair and is independent in transfers and basic ADL. With continued OT intervention, he is expected to be able to function independently in the community. The MOST appropriate community living option for him, at this time, would be a(n): a. cradle-to-grave home b. transitional living center c. adult day program d. clustered independent living arrangement

(A) Total quality management. This model "encourages health care institutions to move away from a focus on compliance to standards and refocus on improvement goals in an effort to deliver high quality."

184. A hospital-based multidisciplinary team meets bimonthly to monitor their services in regard to the creation of an environment that meets or exceeds consumer needs. This model is MOST appropriately called: a. total quality management. b. cost accounting. c. employee empowerment. d. horizontal structuring.

(A) restore and maintain functional performance of self-chosen occupations that chance competent performance of valued occupational roles. The depression is likely to be in reaction to the individual's AIDS disease and major loss of functioning at stage 4. Stage 4 of AIDS generally means severe physical and neurological changes. Because the change of function can be broad, answer A is the most comprehensive approach. See reference: Neistadt and Crepeau (eds): Pizzi, M and Burkhardt, A: Occupational therapy for adults with immunological diseases.

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

(B) Have at least 1 year of experience as a certified OT practitioner. An individual who passes the NBCOT examination becomes a certified OT practitioner. In order to be a primary supervisor of a level-II OT student, the individual must be a registered OT with at least 1 year of experience. There is no minimum experience requirement for supervising level-I students. See reference: AOTA: Standards for an accredited educational program for the OT.

184. An OT manager in a large department is trying to determine which staff will be able to supervise level-11 fieldwork students in the upcoming months. OT practitioners may only be selected to be primary student supervisors if they: A. Are certified OT practitioners with at least 6 months of experience B. Have at least 1 year of experience as a certified OT practitioner C. Are certified by the NBCOT D. Have supervised a level-1 student before the level -11 student

(B) The source of the referral, the reason for the referral, and the date the referral was received. The initial note is used to record basic information, results of initial evaluations, and, often, the treatment plan. In addition to documenting the items in (answer B), the COTA may also contribute data collected from assessments he/she has performed.

184. An OTR has requested that a COTA document an initial note in the chart of a new patient. The COTA should document which of the following in the initial note? A. The treatment and changes in the patient's condition B. The source of the referral, the reason for the referral, and the date the referral was received C. A summary and analysis of the patient's assets and deficits D. The projected outcome of treatment

(A) Uniform Terminology for Occupational Therapy. Uniform Terminology is a document that defines OT in relationship to performance areas and performance components. This document provides a common language for OTs to use to describe individuals and their performance abilities.

185. An OT is establishing a department in a rural long-term care facility. When developing the policies and procedures for documentation in the facility, which of the following documents would be MOST useful? a. Uniform Terminology for Occupational Therapy b. Occupational Therapy Code of Ethics c. Occupational Therapy Standards of Practice d. Occupational Therapy Roles

(D) Lightweight wheelchair and hospital bed. Durable medical equipment is defined by Medicare as "that which can withstand and repeated use, is primarily and customarily used to serve a medical purpose, and generally is not useful to a person in the absence of illness or injury." Depending on the patient's medical condition, a bedside commode may be covered.

185. An OT practitioner completing a home assessment has recommended a hospital bed, lightweight wheelchair, bedside commode, reachers long-handled sponge, shower chair, and handheld shower. The family states they can be billed as durable medical equipment. Which of the following can be billed as durable medical equipment? a. Lightweight wheelchair and reachers b. Shower chair, hand-held shower and bedside commode c. Hospital bed, shower chair and hand-held shower d. Lightweight wheelchair and hospital bed

(A) levels of self-care skills attained by clients with head trauma at discharge. The process of program evaluation includes reviewing the outcomes of providing services. Evaluating the levels of self-care skills attained by clients with head trauma on standardized tests would provide data trauma on standardized tests would provide data about the effectiveness of therapy in achieving goals and would be an example of area of program evaluation. See reference: Neistadt and Crepeau (eds): Perinchief, JM: Management of OT services.

185. An OT practitioner is conducting a program evaluation for the quality assurance program in the OT department. The MOST appropriate area for the OT to evaluate would be the: A. Levels of self-care skills attained by clients with head trauma at discharge B. Number of patient visit in 1 month C. Pay scale of therapists compared with others in area facilities D. Annual department expenditures on supplies

(C) increase swimming time to 25 minutes or to tolerance. This individual's goal is to maximize strength and endurance. Although ALS is a progressive degenerative disease, improvements in strength and endurance are possible if the individual was not previously functioning at maximum capacity. This individual's performance indicates potential for further improvement. See reference: Dutton: Biomechanical postulates regarding intervention.

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

(C) Evidence of interrater reliability. Interrater reliability is a measure of the variation among various observers' perceptions of a subject's performance or some other characteristic.

185. When an experienced OT practitioner completes a ROM evaluation of an individual and asks the supervisor to retest the person to check the results, the OT practitioner is MOST likely seeking: A. Supervisory feedback B. Evidence of competence C. Evidence of interrater reliability D. Evidence of incompetence

(A) Infection control plan. An infection control plan most likely includes appropriate techniques and procedures for storing and handling foods within the OT department. Such plans specify the shelf lives of certain foods, standards for storage of food, use of hair nets, and cooking temperatures and times.

186. An OT practitioner is coordinating a cooking group, as a part of the competency training program for leading the group, the OTR must demonstrate an awareness of the policies and procedures that relate to the storage and maintenance of a staple products, as well as food handling. This policy will MOST likely be part of the facility's: a. infection control plan b. risk management plan c. emergency procedures plan d. environmental survey plan

(B) Complete a tool count of departmental sharps. Although answers A and C are required and necessary; the only activity that would be done daily is a tool count. It is recommended that tool counts be completed before and after patient activities. This ensures that sharps are not removed by patients that may provide them the opportunity to harm themselves or others.

186. An OT practitioner is working in a psychiatric OT department that uses a variety of craft paints, stains, and sharp tools. In order to ensure patient safety, the practitioner MUST complete which of the following activities on a daily basis? A. Label chemicals used within the department B. Complete a tool count of departmental sharps C. Obtain a locked storage cabinet for sharps D. Decline suicidal clients the opportunity to participate in craft groups

(D) A patient with the diagnosis of a CVA and left neglect caught his left arm in the wheel of the wheelchair, resulting in a cut and bruise. An incident report should be completed whenever a situation occurs that is harmful to the patient or practitioner. This includes but is not limited to falls, burns, cuts, and contact with hazardous materials. See reference: AOTA: OT roles.

186. An OTR is filling out an incident report regarding a patient who was seen on the rehabilitation unit. Which of the following scenarios is the MOST likely to be the subject of an incident report? A. The patient complained of nausea during a standing activity B. A patient with a spinal cord injury indicated that his hand splints were uncomfortable C. A patient who had a total hip replacement did not follow precaution while completing dressing activities but did not complain of discomfort. D. A patient with the diagnosis of a CVA and left neglect caught his left arm in the wheel of the wheelchair, resulting in a cut and bruise

(C) lower back. Touching the lower back requires shoulder abduction and internal rotation. See reference: Trombly (ed): Trombly, CA: Evaluation of biomechanical and physiological aspects of motor performance

186. An OTR is performing an UE functional assessment on an elderly client with rheumatoid arthritis. The OTR is MOST likely to determine that the client has limited internal rotation if the client is unable to touch the: A. back of the neck B. top of the head C. lower back D. opposite shoulder

(B) Medical necessity. Medicare defines medical necessity as "necessary and reasonable to treat an illness or an injury or to improve the functioning of a malformed body member." Medicare part B does not typically cover items such as elevated toilet seats, grab bars, or adaptive equipment because they are not considered to be medically necessary.

186. An OTR is working with a patient that has Medicare part B. The OTR informs the patient that Medicare part B will MOST likely reimburse for assistive devices, such as a wheelchair, if it meets the criteria of: a. increasing functional independence. b. medical necessity. c. maintaining patient function. d. reducing deformity.

(C) have the patient get dressed in a certain way, then change the task at the next session. Giving the patient a functional task, then changing and observing how he responds will tell the therapist how well the patient can transfer learning to new situation. If the patient can't perform the activity when it is changed slightly. It suggests there may be difficulty with new learning. If the patient can perform the activity with many changes a d in a different setting, it suggests that he has more capacity for transfer of learning to new situations. See reference: Neistadt and Crepeau (eds): Neistadt, ME: Theories derived from learning perspectives.

187. A patient who has had a TBI beginning OT. The OTR practitioner needs to access whether this person can transfer learning from one activity to another in order to plan treatment appropriately. The MOST appropriate way for an OT to: A. describe situations that might be unsafe and ask the patient how he would respond. B. give the patient a simple jigsaw puzzle to solve. C. have the patient get dressed in a certain way, then change the task at the next session. D. give the patient simple calculations to perform.

(B) Federal and state governmental agencies and third-party payers. AOTA (included in answers A, C, and D) does not require physician referral for the provision of OT services. Federal, state, and local government agencies; third-party payers; regulatory and state agencies; and individual facilities may require physician referral.

187. A physician's referral for OT services may be required by which of the following: a. AOTA, federal and state governmental agencies b. federal and state governmental agencies and third-party payers c. third-party payers, individual facilities and AOTA d. AOTA, third-party payers and state governmental agencies

(A) Allows the therapist to obtain facts. Fact gathering is the primary advantage to closed questions. The OT practitioner should be aware that posing mostly closed questions can lead to biased information gathering, as with answers B and D. although you can generally ask more closed questions in a short amount of time, this is generally not a patient-focused goal.

187. An OT practitioner is collecting data for a quality assurance project. The advantage of asking a closed question is that the format: A. Allows the therapist to obtain facts B. Avoids emphasizing feelings being expressed by the patient C. Can help the therapist who is in a hurry D. Forces the person to give the answer that the therapist needs

(B) 1 year experience. Fieldwork educators, or supervisors, may be COTAs or OTRs with a minimum of 1 year of experience. These individuals should be competent and knowledgeable and able to function as good role models. There is no similar guideline indicating the amount of experience needed to supervise level-I students.

187. An OT practitioner working in a school based setting is interested in training students in level-II fieldwork. Before accepting level-II students, the OT practitioner should have at least: a. 6 months experience b. 1 year experience c. 2 years experience d. 3 years experience

(C) Both OTRs and COTAs should liability insurance. Liability insurance protects OT practitioners may choose to insure themselves at a higher level. See reference: Ryan (ed): Practice Issues in OT: Jones, RA: Services operations

187. An entry-level OT practitioner wants to know the extent of her liability when providing occupational therapy. Which of the following answers is MOST accurate? A. Only OTRs need to have liability insurance B. Only COTAs need to have liability insurance C. Both OTRs and COTAs should have liability insurance D. Neither OTR or the COTA need to have liability insurance

(B) No, it violates the OT Code of Ethics. Despite the level of training she has achieved according to the code it is still necessary for the COTA to demonstrate service competency in order to or in preparation for purposeful activity by a practitioner who has demonstrated service competency" (p.1075). Service competency in this area includes the theoretical background and technical skills for the safe and effective use of the modality. Although study and practice are necessary to establish service competency, they are not by themselves sufficient: an OTR must determine that the COTA is competent before she can administer PAMs. See reference: AOTA: Registered OTs and certified OTs and certified OT assistants and modalities

188. A COTA working in outpatient rehabilitation teaches herself how to use paraffin by reading books on physical agent modalities (PAMs), carefully reading the instructions that came with the paraffin bath unit, and practicing on herself for several weeks. Is it now acceptable for this COTA to provide paraffin treatments? A. No, COTA may not administer PAMs B. No, it violates the OT Code of Ethics C. Yes, she has demonstrated service competency D. Yes, only when an OTR is on duty in the facility

(A) Review and update annually. The JCAHO supports a long-term ongoing emphasis on quality and therefore recommends that policies and procedures be reviewed and updated annually. Facilities that attempt to update their manual specifically for JCAHO surveys will not be able to demonstrate a program of continual process assessment and improvement.

188. According to the Joint Commission on Accreditation of Hospital Organization (JCAHO) an OT managing delivery of therapy services in a hospital setting would have to review and update occupational therapy policies and procedures as follows: a. review and update annually. b. review and update on years in which JCAHO surveys are performed. c. review and update when new occupational therapy managers take over a department. d. review every other year

(C) Indicating initiative and beginning task-directed behavior. Because this child is very withdrawn, any spontaneous action should be seen as a very positive sign. It is very important to encourage the child in independent exploratory behavior in order to develop task competence and become less withdrawn.

19.A pre-schooler with a diagnosis of developmental delay is very withdrawn and passive. While working on toilet skills, the child reaches out for a toothbrush and starts brushing her hair with it. The OT practitioner recognizes the PRIMARY importance of this behavior as: a. demonstrating attention-getting behavior b. a sign of cognitive limitation c. indicating initiative and beginning task-directed behavior d. demonstrating misinterpretation of cues because of a visual deficit

(D) The title of the job, organizational relationships, essential job functions, and the job requirements. Job requirements usually contain the title of the job, organizational relationships, essential job functions, work performed, job requirements, and environmental risks. Items that are not required but may complement an individualized job description are personality characteristics, past experience requirements, and accomplishments.

188. An OT practitioner is graduating from an OT program and is seeing employment. An OT job description would MOST likely contain: a. the title of the job, post experience required and job requirements b. a summary of primary job functions, references and job requirements c. the organizational relationships, personality characteristics desired in a job candidate and accomplishments of the candidates d. the title of the job, organizational relationships, essential job functions and the job requirements

(C) righting reactions. Righting reactions develop after the integration of primitive reflex patterns, which are thought to be necessary for survival in the normal newborn. Righting reactions allow children to right their heads against gravity and to realign their bodies around the movement of the head in that process. Prehensile reactions refer to grasping patterns and reach, which differentiate humans from other primates. Equilibrium reactions develop after righting reactions and allow the child to maintain a standing and walking posture. See reference: Neistadt and Crepeau (eds): Kohlmeyer, K: Evaluation of sensory and neuromuscular performance components.

188. The OT observes that a child moves from a completely prone position to a prone on elbow position. In reporting the child's progress, the OTR documents that the child is gaining control in the midline position through the development of: A. primitive reflexes B. prehensile reactions C. righting reactions D. equilibrium reactions

(B) The OTR must assume responsibility for all OT services delivered. An OTR is always responsible for services provided by the COTA under his/her supervision. The AOTA does not require that the patient have a referral for provision of services. However, it is important to note that state licensure laws and accrediting agencies may require a formal referral.

188. When there is not a referral for OT services, it is MOST important for the COTA involved in the provision of service to know that: A. The OTR is operating outside the scope of practice and regulating agencies should be notified B. The OTR must assume responsibility for all OT services delivered C. A written letter of consent must be received for the patient or a significant other D. The COTA should seek a referral from the patient's family physician

(C) A physician's order identifying services to be provided. Within the home-care setting, the therapist must have a physician's order, which identifies the services that are to be provided. Following the OT's assessment, identification of deficits as well as short-term and long-term goals (answers A and B) can be established. The individual's history of the current illness (answer D) is contained within the initial assessment.

189. A home health OT has received a referral for a Medicare patient. Which one of the following items is MOST necessary to have before the therapist can initiate evaluation or treatment? a. Identification of the deficits that impair functional abilities. b. Established short-term and long-term goals. c. A physician's order identifying services to be provided. d. The individual's history of the current illness.

(D) Merit increases. A merit increase is based on demonstrated ability and performance. A merit increase typically is awarded after a performance review or assessment of an employee's demonstrated work skill (answer B).

189. An OT practitioner in a busy rehabilitation department consistently exemplifies the abilities and performance skills of an outstanding clinician. The manager of the department may financially reward this particular employee through: A. Disciplinary actions B. Performance reviews C. Clinical education D. Merit increases

(D) Yes, if the state law does not require a physician referral. AOTA does not require individuals to have physician referral or prescription. See reference: AOTA: Statement of OT referral.

189. An individual who has been attending a stress management group led by an OTR/COTA team in a private practice brings a long a friend one day. The friend would like to attend the group to learn how to better handle personal stress. This individual, however, does not have a physician's referral. The fee is reasonable, and like the others in the group, this new client will pay out of pocket. Will the OT practitioners be able to accept this new person into the stress management group? A. No, the OT cannot be provided without a physician referral B. Only if the client brings a prescription to the next visit C. Yes, because it is a group and not individual treatment D. Yes, if the state law does not require a physician referral

(D) hold him firmly when picking him up. Holding the child firmly inhibits responses to light touch which are usually uncomfortable or intolerable for a child with tactile defensiveness. A strong stimulus such as loud music causes further startling and discomfort during a time when the child is MOST vulnerable to the sensation of the light touch (i.e., when clothing is being removed). See reference: Case-Smith (ed): Parham, LD, and Mailloux, Z: Sensory integration.

189. The BEST method for handling a child who exhibits tactile defensiveness is to: A. ticket him during play times B. play loud music when undressing him C. lightly stroke his arms and legs during baths D. hold him firmly when picking him up

(D) The OT problem solves with the teacher. Answer D is correct because the consultation relationship in the school is based on a shared relationship with the school staff for whom the OT is hired to consult. Answer D reflects one of the essential tenets of consultation - that the consultee, by sharing in problem solution, will become committed to a child's program.

189. When working within a school system to assist the mainstreaming of a child with spina bifida into a regular classroom, the OT consults with the classroom teacher. The nature of this "consultation" relationship is BEST characterized by the following statement: a. the OT teaches the teacher b. the OT provides therapy to the child c. the OT directs he teacher d. the OT problem solves with the teacher

(D) Post-traumatic stress disorder (PTSD) PTSD is an anxiety disorder that follows a traumatic event in a person's life. Answers A and B are mood disorders. See reference: Neistadt and Crepeau (eds): Giles, GM, and Neistadt, ME: Treatment for psychosocial components: Stress management.

19.After assessing a client who had recently lost his spouse in a house fire, the psychiatrist classifies the client as having an anxiety disorder caused by the occurrence of major life event. Which of the following BEST represents this disorder? A. Cyclothymic disorder B. Dysthymia C. Schizophrenia D. Post traumatic stress disorder (PTSD)

(D) Productivity evaluations. "Productivity is the ratio between the output and the resources expended to obtain the desired output." High productivity is often associated with costeffectiveness. Analysis of productivity data can contribute to program development, improving staff effectiveness and containing costs.

190. The OT department has been asked to provide information to the hospital administration regarding the cost effectiveness of services provided. Which of the following methods would MOST effectively obtain this information? a. outcomes measurements b. utilization review c. program evaluation d. productivity evaluations

(C) Analyzed the work flow. An organized work flow is one in which the employees and patients can move smoothly through the department. Environment with poor work flow may have areas that are "bottlenecks" or cause a congestion of individuals at one or more areas. Identifying the patterns in which work may most efficiently be completed is helpful in designing a new floor plan so that all areas may be optimized.

190. The manager of an OT department is planning for reallocation of space that the department occupies. The manager studies and identifies the flow of staff and patients through the clinic, offices, and ADL apartment. In so doing, the manager has MOST likely: A. Identified elements critical for selecting a new location for the department B. Determined equipment needs C. Analyzed the work flow D. Determined functional areas

(D) "The patient has been provided with a lumbar support and a written copy of the home program." The plan section of a discharge disposition (e.g., to a nursing home or to outpatient therapy), recommendations for additional therapy actions on the part of the patient (e.g., outpatient therapy, home health, or performing a home program), equipment needs or equipment provided to the patient, and plans for discharge. See reference: AOTA: Effective documentation for OT.

190. Which of the following is the BEST example of the plan section of a discharge summary when using the SOPA note format? A. "The patient reports intentions to continue to practice proper body mechanics at work" B. "The patient demonstrates independence in performing the home exercise program" C. "The patient expressed a desire to return to work but does not yet demonstrate the capacity for the required sitting tolerance" D. "The patient has been provided with a lumbar support and a written copy of the home program"

(C) Worker's compensation. Worker's compensation is a state-supported program into which employers pay. Beneficiaries receive coverage for services that are identified to be covered within their respective state.

191. An OT practitioner is treating a middle-aged client who has CTS. The industrial nurse indicated that the condition was a result of repetitious fine motor skill execution required as an essential job function. The OT suggests to the client that the payment program MOST likely to reimburse for OT service is: A. Medicare B. Medicaid C. Worker's compensation D. The Education for All Handicapped Children Act

(B) Evaluate clients who are admitted on the weekends. The primary role of the COTA is to implement treatment such as that described in answers A, C, and D. AOTA guidelines about OT roles (AOTA, 1993) indicate that a COTA may not independently evaluate patients. Depending on the site and its policies, the COTA may be able to begin the process of assessment by making contact with the client and collecting data that the OTR would use in performing the evaluation.

191. An OT practitioner works with an entry-level COTA on an inpatient psychiatric unit. They each work 4 days a week, overlapping schedule only on Mondays. It would be inappropriate for the OTR to ask the COTA to: a. lead the daily craft group b. evaluate clients who are admitted on the weekends c. assist individuals in carrying out their ADL on Saturday and Sunday mornings d. lead a leisure planning group on Saturday afternoon

(C) texture of the cords she will be using. Coarse materials like jute may shred and give splinters or injure the skin on hands and fingers. This is particularly important for individuals with diabetes who frequently have poor sensation and circulation in their extremities. Skin damage must be avoided since healing is compromised. See reference: Reed and Sanderson (eds): Diabetes mellitus-type II.

191. An older adult with diabetes is working on a macramé project as a way increasing standing tolerance. The MOST relevant safety factor for the OT practitioner to take into consideration is the: A. length of the cords she will start with B. thickness of the cords she will be using C. texture of the cords she will be using D. type of surface she will be standing on

(A) Objectives vary in each facility. Objectives are behavioral descriptors of the expectations the student will be required to achieve. Each fieldwork site is unique in the provision of OT and, therefore, the objectives may vary from site to site.

191. At the beginning of fieldwork, a student asks an OTR who is the clinical supervisor about student objectives. The MOST accurate statement about student objectives for fieldwork is: a. objectives vary in each facility. b. objectives are standardized for all facilities. c. are written by the NBCOT. d. must meet state licensure requirements

(C) Interpret the results based on data collected by the COTA. Once the OTR has assigned performance of an evaluation to a COTA, the OTR is responsible for analyzing and interpreting the results.

192. A COTA frequently administers the ACLS test and then discusses it with the supervising OTR. Which of the following MOST accurately describes the OTR‟s role during these discussions? A. Determine the COTA‟s service competency B. Collect data on the patient's performance C. Interpret the results based on data collected by the COTA D. Develop the treatment plan

(D) Discuss her concerns with an OTR who is present. Although the COTA's own supervisor is absent, an OTR present would become the acting supervisor for the COTA for the day. The COTA should always discuss concerns with the supervisor first.

192. A new COTA works in a busy rehabilitation department. Half of the department's OT staff, including the supervisor, is out with the flu. The COTA observes an aide carrying out a session of training in ADL with a patient who is scheduled for discharge the next day. The MOST responsible action for the COTA to take is to: a. allow the aide to finish so the patient will be prepared for discharge b. terminate the aide and complete the session herself c. bring the issue to the attention of the facility administrator d. discuss these concerns with an OTR who is present

(D) Help place food on the spoon for a patient practicing the use of a universal cuff in the patient's room at lunchtime, while the OT supervisor runs a lunch a group in the dining room. An aide may be delegated client related tasks when (1) the outcome of the task being delegated is predictable; (2) the situation is stable and will not require judgment or adaptation; (3) the client has previously demonstrated the ability to perform the task; (4) the aide has demonstrated competence in the specific task: (5) the aide has been instructed in how to carry out the task with the specific client; (6) the aide knows the relevant precautions; and (7) continuous supervision is provided. See reference: AOTA: Guidelines for the Use of Aides in OT practice.

192. An OT practitioner is writing a job description for an aide position in the OT department. According to AOTA guidelines, which of the following is BEYOND the scope of practice of an aide? A. Cue an individual with schizophrenia to maintain attention to task during a weekly OT-lad cooking group B. Practice use of sock-aid and shoe-horn in OT department with a patient who has had a hip replacement and is able to perform the task safely but takes an excessive amount of time C. Help place food on the spoon for a patient practicing the use of a universal cuff in the patient's room at lunchtime, while the OT supervisor runs a lunch group in the dining room D. Help a child maintain correct positioning during paper and pencil activities while the OT works with the child at the next desk

(C) precipitating conditions and events that elicit stress reactions. The condition and events that elicit stress reactions are known as stressors. Stressors can be either short term or long term. See reference: Christiansen and Baum (eds): Christiansen, C: Performance deficits as sources of stress.

192. An OT practitioner who is leading a stress management group explains to the members that stressors can be MOST accurately described as the: A. process by which individuals adjust to daily stressful events within their environments. B. body's reactions to the, often described as flight, or flight. C. precipitating conditions and events that elicit stress reactions. D. process of fit between the individual and his or her environment.

(D) Program evaluation. Program evaluation is a systematic collection and reporting of outcomes data to document program effectiveness and cost-efficiency.

192. An OT providing services to a community mental health program has been asked to examine the effectiveness of the OT groups that have been provided over the past 6 months. Which of the following procedures should be used to accomplish this goal? a. Quality assurance b. Peer review c. Utilization review d. Program evaluation

(C) Inform the administrator they are unable to provide services to individuals who can no longer benefit form OT. Answers A, B, and D involve falsifying documentation, financial exploitation of insurance carriers, and inaccurate recording of professional activities, and are violations of the Code of Ethics. It is unethical to bill for services not rendered or to provide services to individuals who can no longer benefit. In this case, the individual reached his full potential for independence in self-care and no longer requires OT services.

193. A COTA and OTR jointly decide to discharge an individual after the goal of independence has been achieved. However, they are instructed by the facility administrator to continue treating, or at least billing, the individual for two sessions per day for the next week, because his insurance will allow it. What is the most appropriate action for the OT practitioners to take? a. continue to work on activities the individual particularly enjoys twice a day whenever possible b. discontinue treatment but continue to bill as directed by the administrator c. inform the administrator they are unable to provide services to individuals who can no longer benefit from OT d. compromises with the administrator and agree to drop in and check on the individual once a day and bill accordingly

(A) Contact with supervisor once a day. The Guide for Supervision of Occupational Therapy Personnel document provides definitions for levels of supervision. Close supervision is defined as "daily, direct contact at the site of work." Other levels of supervision are routine, general, and minimal.

193. A new, inexperienced COTA has joined the staff of a rehabilitation facility and the OTR is required to provide close "supervision" for the first few months. As specified by AOTA, the amount of supervisory by AOTA, the amount of supervisory contact the OTR should provide to the COTA is: a. contact the supervisor once a day. b. contact with supervisor once a week. c. contact with supervisor once a month. d. contact with supervisor as needed.

(A) Collecting chart review information. After a certified OT has demonstrated service competency, it is appropriate for him/her to complete data collection through record reviews, interviews, general observations, and behavior checklists.

193. A supervising OT asks an experienced COTA to complete a portion of an assessment. The portion that is MOST appropriate for the COTA to complete independently would be: A. Collecting chart review information B. Analyzing and interpreting assessment information C. Establishing the treatment goals D. Establishing the treatment plan

(C) altered task method. "When the task method is altered, the same task objects are used in the same environment, but the method of performing the task is altered to make the task feasible given the performance deficits" (p.338). An example would be substituting one-handed techniques for someone who previously used both hands (i.e., one handed shoe tying for an individual who recently had an above-elbow amputation). Problem solving is the ability to organize information from several levels to generate a solution to a problem. Petraining teaches the same skills of an activity on the person who previously had mastery of those skills. (e.g., having a person with hand weakness practice tying knots). Compensation would be avoiding performance of the activity entirely by using an alternative piece of equipment or method. See reference: Neistadt and Crepeau (eds): Holm, MB, Rogers, JC, and James, AB: Treatment of activities of daily living

193. An OT practitioner is teaching a client who recently sustained an above elbow amputation how to dress with one hand. Teaching a client to perform a familiar activity or skill is called the: A. problem-solving method B. retraining method C. altered task method D. compensation method

(A) Negotiate the contract. Many OT practitioners have moved into consultation roles. The first step in the consultation process should include negotiation of a contract. This immediately establishes the general terms of agreement and a focus of the activities that are to be completed by the therapist.

195. An OT practitioner in private practice is preparing to act as a consultant to a community agency. The FIRST step would be to: a. negotiate the contract b. establish trust c. assess the environment d. identify problems

(A) Treatment from the OT plan provided by an OT practitioner. Based on the OT Code of Ethics regarding competence, OT may only be done by "those individuals holding appropriate credentials are certification from NBCOT and, when appropriate credentials for providing services. "These credentials are certification from NBCOT and, when appropriate, state licensure as an OT or OT assistant. See reference: AOTA: OT code of ethics.

193. Which of the following inpatient services can be billed as OT services for a client whose hospitalization is covered by Medicare? A. Treatments from the OT plan provided by an OT practitioner B. Treatments from the OT plan provided by a music therapist C. Treatments from the OT plan provided by a recreational therapist D. Treatments from the OT plan provided by an art therapist

(B) Any equipment that has come into contact with body fluids must been sterilized before using the equipment again. OSHA has set out strategies to protect individuals from potential exposure to HIV and hepatitis B virus. This situation would be an example of an engineering control. These controls are to modify the work environment to reduce risk of exposure. Other examples are using sharps containers, eyewash stations, and biohazard waste containers.

194. A clinical manager of an OT department is reviewing sterilization policies based in universal precautions. The manager revealed that this policy will MOST likely state that: a. all equipment is to be sterilized annually b. any equipment that has come into contact with body fluid must be sterilized before using the equipment again c. all equipment is to be sterilized at the end of each day d. all equipment is to sterilized after each use

(C) Change to a power wheelchair to reduce effort. Considering the progressive nature of the child's disease, as well as strength and endurance, the best recommendation would be to change to a power wheelchair. The child would be better able to participate in the cognitive cases of school if less effort was required for mobility. See reference: Case-Smith (ed): CaseSmith, J, Rogers, J, and Johnson, JH: School-based occupational therapy.

194. A school age child has Duchenne muscular dystrophy. Although he is able to use a manual chair for distances between classes, he is tired on arrival. What would be the BEST recommendation the OTR could make for wheelchair use at school? A. Retain the manual chair to build up strength B. Change to an ultralight sports model because it requires less strength C. Change to a power wheelchair to reduce effort D. Encourage walking with a walker to alternate mobility methods

(C) A numbers table to select the population. Numbers tables are used to select members of a population at random. An example is an OT department's choosing to study the charts of patients who had rehabilitation services to identify the typical OT charges that these patients are most likely to incur. For example, within 1 year, the OT department treated more than 170 individuals with the diagnosis of CVA. Instead of reviewing all of the cases, the department may choose to review 10% of the cases and use a numbers table to identify which charts should be reviewed. See reference: Neistadt and Crepeau (eds): Deitz, JC: Research: Discovering knowledge through systematic investigation.

194. An OT practitioner is completing research on patients with hemiplegia and functional return of the upper extremity. The practitioner is attempting to obtain a random sample of patients. Collecting a random sample MOST likely means that the therapist will use: A. The entire population of the facility's stroke patients B. All patients who have had a CVA with resulting deficits in the upper extremity function C. A numbers table to select the population D. A small group of patients who are representative of the population with each individual meeting criteria, which validates that they are a representative subset of the population

(B) Universal precautions. Health-care personnel should follow universal precautions when blood or body fluids are present. Suicidal, escape, and medical precautions are guidelines developed for individuals identified with risks that are not noted in this question.

194. An OTR is working with an individual who tests positive for HIV. The individual is working on a copper tooling project when he cuts his finger on the edge of the copper. Which of the following are the MOST APPROPRIATE precautions to follow? A. Suicidal precautions B. Universal precautions C. Escape from unit precautions D. Medical precautions

(C) Interpreting results of assessments for the purposes of treatment planning. Interpretation of assessment results for purposes of treatment planning must be performed by the OTR.

194. Many COTAs are employed in long-term care facilities and perform many functions. The function which the OTR MUST perform in this setting is: a. activity programming, environmental adaptations, and caregiver and staff education. b. ADL training, and running feeding and leisure activity groups. c. interpreting results of assessments for the purposes of treatment planning. d. positioning, providing adaptive devices, and instructing in use of splints.

(B) The patient's written consents to take the photographs and use them for publicity. A photograph of a person who is being treated at a health care facility would release privileged information and would violate confidentiality just as much as releasing the individual's name or diagnosis (answers A and D). No information about a person may be released without a written consent. It is not necessary to obtain permission of the department head to use a photograph to promote a positive image for the facility (answer C).

195. A hospital's public relations department plans to take some pictures of the OT staff working with patients. Before proceeding, which of the following MUST be obtained? A. The correct spelling of the patients‟ names for the photograph caption B. The patients‟ written consents to take the photographs and use them for publicity C. The department head's written consent to take the photographs and use them for hospital purposes D. The correct spelling of the patients‟ diagnoses and names for the photographs‟ captions

(C) Make a report to appropriate authorities. In many states, the OT practitioner, as a health professional, is in the position of being a "mandated reporter" who must make a report if there is reason to believe a child has been abused. A report of the injury should be made to appropriate authorities. Answers A, B, and D delay or prevent proper assistance to a family involved in the occurrence of child abuse. All agencies serving children have policies and procedures for reporting injury in these situations.

195. An OT practitioner evaluation a child notices a bruise on the child's shoulder that looks like an adults' hand and fingerprint. Which of the following actions is it MOST critical for the OT practitioner to take? a. Discuss this with the family member who picks up the child. b. Observer further additional injuries. c. Make a report to appropriate authorities. d. Avoid becoming involved in personal family matters.

(D) 5 feet by 5 feet. An outward opening door needs a space of 5 feet by 5 feet to allow for the wheelchair requires 5 feet of turning space for a 180- or 360- degree turn. See reference: Pedretti (ed): Smith, P: Americans with disabilities act: accommodating persons with disabilities.

195. An OT practitioner is helping a family plan a wheelchair ramp to the front door of their home. What is the minimum amount of space needed in front of the door allow easy access by wheelchair? A. 3 feet by 5 feet B. 4 feet by 4 feet C. 4.5 feet by 3 feet D. 5 feet by 5 feet

(D) Transdisciplinary. In the transdisciplinary method of teamwork, one member provides the perfect intervention and other team members function in collaborative consultant roles. See reference: Case-Smith (ed): Stephens, LC, and Tauber, SK Early intervention.

195. At a team planning meeting for a 2-year-old child with multiple handicaps, it is decided that the OT will fulfil the roles of other therapies needed as well. This decision requires a "role release" from the teacher, PT, and speech therapist. Which of the following team approaches for young children does this method describe? A. Unidisciplinary B. Multidisciplinary C. Interdisciplinary D. Transdisciplinary

(B) A presentation to physicians. Answer B, a presentation to physicians, is correct because this is an example of internal marketing. Other internal marketing strategies are site-based open houses, progresses notes, service reports and in-service for nursing staff.

196. A manager of an OT department is attempting to increase the visibility of the OT department within the setting. This type of promotion is commonly done through internal marketing. In order to market internally, the OT manager would MOST likely employ which of the following? a. a community newsletter b. a presentation to physicians c. a local community workshop d. a booth at a local health fair

(D) Reinforcement and enhancement of performance. The emphasis of OT is on performance: specifically, performance of work, play, or ADLs. As OTs, the focus has been on reinforcing and enhancing the execution of these occupations and the activities which are part of the occupations.

196. An OT practitioner is asked, "What is the primary emphasis of occupational therapy services?" by another health professional. The MOST accurate response for the OT to give is that the emphasis is on: a. skill acquisition. b. compensation for deficits. c. environmental adaptation. d. reinforcement and enhancement of performance.

(B) COTA updates the OTR on the progress a patient has made in the past week, and both provide information to update the goals. A collaborative relationship between an OTR and a COTA supports sharing of information and the use of each professional's skills. See reference: AOTA: OT roles.

196. An OTR and a COTA work in a collaborative relationship. The teamwork between the two professionals is BEST exemplified by which of the following examples? A. The OTR completes the assessment and instructs the COTA to provide a specific intervention B. The COTA updates the OTR on the progress a patient has made in the past week, and both provide information to update the goals C. The COTA gives a progress note to the OTR and the OTR writes the discharge summary based of the progress note D. The OTR tells the COTA what type of equipment to order for a patient and the COTA orders the equipment from a medical equipment company

(C) Complete a review of the literature. Review of the written material is necessary in preparing the design of the research project. The literature review helps the researcher to state the purpose clearly and establish boundaries.

196. The OT practitioner is attempting to better understand a particular phenomenon by conducting a small research study. Initially, the OTR identifies a potential research question. The NEXT step in the process would be to: A. State the purpose B. Design the research C. Complete a review of the literature D. Establish boundaries for the study

(D) instruction in how to perform the activities safely. Instructing caregivers in methods that will promote safe performance of functional activities, such as locking wheelchair brakes before standing up, is the first focus for caregiver training. See reference: Neistadt and Crepeau (eds): Hom, MB, Rogers, JC, and James, AB: Treatment of activities of daily living.

196. The spouse of a patient with a progressive disease has come into the OT department to learn how to help the spouse perform functional activities at home. The FIRST focus of caregiver education for this person should be: A. methods for motivating the patient to perform ADL. B. how to analyze activities to solve problems. C. instruction in how to provide cues to the patient. D. instruction in how to perform the activities safely

(A) Refine the question and develop the background. Once the question has been identified, a review of the literature should occur. The next step in research is to refine the question and develop the background

197. A research question has been identified and a literature review completed by an OT practitioner. The NEXT step for the OT researcher is to: a. refine the question and develop the background b. decide on methodology c. establish boundaries for the study d. collect and analyze data

(D) A small group of patients who are representative of the population, with each individual meeting criteria which validate that they are a representative subset of the population. Answer D is the MOST correct answer because the question asks for a sample (subset) population (defined group of people). In research, a sample is a small subset of a group or population. The sample is to be representative of the entire population.

197. An OT practitioner is conducting a research study on the effects of using a sling with individuals who sustained a stroke with resultant hemiplegia. If the researcher were to choose a sample population for his research, he would MOST likely use: a. the entire population of the facility's stroke patients. b. all patients who have had a CA with resulting deficits in upper extremity function. c. a numbers table to select the population. d. a small group of patients who are representative of the population, with each individual meeting criteria which validate that they area representative subset of the population.

(D) Not to use PAMs in the new state. Although AOTA policy supports the use of PAMs by qualified practitioners as an adjunct to or in preparation for purposeful activity, state laws supersede AOTA policies.

197. An OTR who has demonstrated service competency in the use of paraffin baths moves from on state to another to take a position in a hand rehabilitation center, the licensure act in the new state prohibits OT practitioners from using PAMs. The MOST appropriate action for the therapist to take is: A. To use PAMs only under the supervision of a licensed PT B. To use PAMs inly under the supervision of a doctor C. To us only paraffin D. Not to use PAMs in the new state

(C) Supervision of noncertified persosnnel. Under the supervision of an OTR, COTAs often participate in orienting, training, and evaluating the performance of unlicensed programs and not independently. See reference: AOTA: OT roles.

197. An advanced-level COTA has expressed interest in taking on some administrative duties in an OT department. Which of the following tasks would be MOST appropriate for the OTR to assign the COTA? A. Development of a quality-assurance program B. Supervision of entry-level OTRs and COTAs C. Supervision of noncertified personnel D. Development of marketing strategies to promote a new program

(C) Provide a screen to reduce peripheral visual stimuli. Although all the answers describe techniques that could assist the student, the use of a carrel is most appropriate in a mainstreamed classroom, because the other methods or adaptations (answer A, B, and D) could have a negative impact on the other children's ability to learn. See reference: Case-Smith (ed): Schneck, CM: Visual perception.

197. Direct OT services are being discontinued for a student with attention deficit disorder, but consultation will be provided to help the child adjust to the new classroom. Which of the following recommendations is MOST appropriate? A. Use dim lighting and reduce glare by turning down lights B. Remove all posters and visual aids to reduce visual distractions C. Provide a screen to reduce peripheral visual stimuli D. Restructure classroom activities into a series of short term task

(C) A COTA contributes to the process but does not complete the task independently.

198. An OTR/COTA team need to report discharge information and document the information in the patient's chart. At what level does the COTA participate in making discharge recommendations? a. an entry-level COTA may perform the task independently b. an intermediate-level COTA may perform the task independently c. a COTA contributes to the process but does not complete the task independently d. a COTA cannot perform the task

(D) Use brochures, postures, videotapes, and films available from the AOTA to enhance the presentation. The emphasis of this question is that it is every OT practitioner's responsibility to promote the profession. Simple, daily public relations activities occur each time an OT practitioner (whether it is COTA or an OTR) describes the services to be provided to patients and families. More complex public relations may include developing a plan to promote community awareness regarding the profession. A public relations program is designed to increase the public's awareness about the role and importance of OT services. See reference: Ryan (Ed): Practice Issues in OT: Jones, RA: Service operation.

198. An instructor from a local nursing school has asked an OTR to speak about OT to a class of first-year nursing students. The OTR feels uncertain about doing the lecture because of a lack of resources. The MOST appropriate action for the OTR to take is: A. Recommend to the nursing course instructor that they call AOTA and obtain public relations information to share with her students B. Decline to do the in-service but send information to the instructor C. Decline to do the in-service and find an OT to do the lecture D. Use brochures, posters, videotapes, and films available from the AOTA to enhance presentation

(C) NBCOT. The NBCOT grants certification to OT practitioners upon successful completion of the certification exam. Only NBCOT can revoke or suspend certification. An individual may not practice or call himself/herself an OTR or COTA if certification has been suspended or revoked, regardless of location.

198. One OT practitioner witnesses another OT practitioner under the influence of alcohol treating patients. The practitioner decides to take actions to prevent this practitioner from practicing in the United States. Which of the following would be MOST appropriate organization to contact? a. AOTA b. State regulatory board c. NBCOT d. Administration of the facility

(C) get the shirt all the way on, then line up the buttons and holes and begin buttoning from the bottom. See reference: Pedretti (ed): Foti, D, Pedretti, LW, and Lillie, S: Activities of daily living.

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

(C) IEP. The individual education plan is a form that must be completed for children receiving services in the school system. This documentation standard was defined in the Education of the Handicapped Act (1975 and 1986). See reference: Neistadt and Crepeau (eds): Perinchief, JM: Management of occupational therapy services.

199. An OT practitioner is speaking with parents who believe that their child with CP could benefit from OT consultation at school. In order for a school aged child to receive OT services within a school system, which of the following forms must be completed FIRST? A. UB-82 B. FIM C. IEP D. HCFA-1500

(C) Unacceptable because it violates the Code of Ethics. Whether or not an alternate date has been arranged (answer A) or the agency the practitioner works for allows it (answer B), stating services were provided on a day when they, in actuality, were not, is falsification of documentation and violates the OT Code of Ethics.

199. An OTR arrives for a home health visit on a Thursday morning (1/14/01), but the client is not feeling well, so they reschedule for the following day. The practitioner's charges for the week are due on alternating Thursday afternoons. Anticipating a follow-up visit with the client the next day (1/15/01) and reluctant to wait another 2 weeks to submit for payment, the practitioner bills for treatment using the 1/14/01date. The OT practitioner's action is: A. Acceptable because treatment has been scheduled for the next day B. Acceptable if the agency she works for allows it C. Unacceptable because it violated the Code of Ethics D. Unacceptable because if the patient is still ill and unable to participate in therapy on 1/15/01, a delay of more than 1 day is unacceptable for billing purposes

(B) Receptive aphasia. Individuals with receptive aphasia cannot comprehend spoken or written words and symbols; therefore, they cannot understand verbal directions or consistently respond to stimuli. Individuals with receptive aphasia may be able to imitate or follow a demonstration, but these techniques do not work for sensory evaluation.

2. An OT practitioner is evaluating an individual who recently sustained a cerebrovascular accident (CVA). The sensory portion of the test would be invalid for an individual with which one of the following impairments? a. Expressive aphasia b. Receptive aphasia c. Agnosia d. Ataxia

(B) Having the worker put only the last piece into the game package. Working backwards from the last (successful) step of a sequence is known as "backward chaining". See reference: Pedretti (ed): Pedretti, LW, and Umphred, DA: Motor learning and teaching activities in occupational therapy.

2. An OT practitioner realizes that an adult worker with a developmental disability is having difficulty learning an assembly sequence. The practitioner decides to use backward chaining. Backward chaining can BEST be implemented by: A. Encouraging the individual to reverse the packaging sequence B. having the worker put only the last piece into the game package C. Putting only the pencil or the pad into the game box D. Having the therapist demonstrate and repeat the correct sequence before each of the worker‟s attempts

(A) Make recommendations for ways of accessing the technology. The OT on the assistive technology team usually determines which part of the body has sufficient motor control for accessing technology and then recommend the type of input access device (switch, keyword, software, etc.) that will best meet the client's needs.

2. In the assistive technology evaluation process, the OT on an assistive technology team is MOST likely to: A. Make recommendations for ways of accessing the technology. B. Recommend communication strategies. C. Seek funding sources for the technology. D. Solve mechanical or software problems.

(C) Parents should be considered as part of a collaborative partnership with therapists. "The first interactions of the therapist with a family open the door to establishing a partnership" in which "the family and therapist collaborate using agreed upon roles to obtain agreed upon goals for the child" roles to obtain agreed upon goals for the child" (p.117). See reference: Case-Smith (ed): Richardson, PK, and Schultz-Krohn, W: Planning and implementing services.

20.OTs working in the area of early intervention have frequent contact with a child's parents. Which of the following statements BEST describes how parents should be involved in the OT program? A. Parents should not be present during OT sessions B. Parents should be trained as substitute therapists C. Parents should be considered as part of a collaborative partnership with therapists D. Only on parent needs to be present when the OT program is discussed

(B) Trace. Trace muscle strength equals a 1 on the numerical scale of muscle testing

20.On an assessment report, the OT practitioner documents that a person exhibits elbow flexion strength of grade 1. According to the manual muscle test system of letters and numbers, the word that would be the equivalent of grade 1 would be: A. Absent B. Trace C. Good D. Normal

(D) View of the problem and an overall goal. The interview is generally the component of the assessment process in which the OT practitioner asks about the individual's goals for treatment and gains an understanding of the problems from the person's perspective.

20.When a new patient is referred for psychiatric services, the COTA and OTR both review the chart. The OTR then completes performance measures, and the COTA performs an interview. The COTA/OTR team relies on the interview part of the assessment to address the individual's: a. diagnosis b. current medications c. ability to concentrate and solve the problems d. view of the problem and an overall goal

(A) Punctuality, accepting directions from a supervisor, and interacting with coworkers. Psychosocial components include time management, social conduct, interpersonal skills, and self-control. Punctuality and accepting feedback are examples of prevocational skills within these psychosocial performance components and are important prevocational skills. See reference: AOTA: Uniform Terminology for Occupational Therapy, third edition.

20.Which aspects of psychosocial performance are MOST important to emphasize in developing a client's work potential in a prevocational program? A. Punctuality, accepting directions from a supervisor, and interacting with co-worker B. Memory, sequencing of the work tasks, attending to work tasks and making decisions C. Standing tolerance, eye-hand coordination, and endurance D. Maintaining personal cleanliness and adhering to safety precautions

(B) Identify and analyze the tasks and occupations that the client will be performing in the home. The first step in the process is to analyze the tasks and occupations that the client will be performing at home because this forms the basis of the entire assessment and recommendations that will be offered. This will also provide framework for determining how well the client can perform the tasks within the particular environment being surveyed.

200. An OT practitioner is performing an environmental assessment to determine accessibility for a client who will be returning home. The FIRST step in this process is to: A. identify the barriers to movement and function in the home environment. B. identify and analyze the tasks and occupations the client will be performing in the home. C. identify the aspects of the environment which support movement and function in the home. D. determine the social environment of the client

(A) Community newsletter. Community newsletters are examples of external marketing, commonly used to educate consumers about OT. Answers B, C, and D are all examples of internal marketing strategies.

200. An OT public relations campaign is being instituted in your state. It was suggested by the OT state representative that a committee be formed in order to externally educate potential consumers of OT. Which of the following BEST represents an appropriate form of external marketing? A. Community newsletter B. Departmental open house C. In-service to all rehabilitation nurse D. Participation in conferences

(B) Do not treat the individual based on his refusal and document the interaction in the chart. As stated in principle 1 of the Code of Ethics, "the individual shall inform those people served of the nature and potential outcomes of treatment and shall respect the right of potential recipients of service to refuse treatment.

200. OT practitioner spends 15 minutes reviewing a new patient's chart and talking to the nurse, who indicates that the patient is preoccupied with finances. As the OT practitioner enters the room, the patient states that he does not want to be seen by any of the therapists because his insurance has run out and he cannot afford to pay for the treatment. Which of the following action would be MOST appropriate for the OT practitioner to take? a. Treat the individual per the physician's order and notify the nurse that the man's preoccupation with finances continues. b. Do not treat the individual based on his refusal and document the interaction in the chart. c. Treat the individual but do not charge or document the services. d. Do not treat the individual and only charge for the time spent completing the chart review.

(D) Federal, state and local regulations and third-party payers. "To provide OT services, the type of referral required (e.g. whether a physician's referral is necessary) is determined by federal, state, and local regulations and the policies of third-party payers. AOTA does not dictate whether a physician/s referral is required" (p.125). See reference: Sabonis-Chafee and Hussey: Overview of OT process.

200. The OTR is responsible for overseeing the first step in the OT process, which is the referral. Referral practices vary widely from setting to setting, but the OTR needs to know that the types of referrals required are determined by: A. The AOTA B. The American Medical Association C. State OT associations D. Federal, state and local regulations and third-party payers

(C) Use the handout only as resource while developing the presentation.

200. While preparing for his first presentation at a professional conference, an OT realizes he does not have the name of the author of an article containing critical information he planned n photocopying and distributing. Which of the following is the MOST appropriate action for the OT to take? a. distribute the handout and apologize for not having the author's name b. show the handout with an overhead projector and apologize for not having the author's name c. use the handout only as resource while developing the presentation d. refrain from using the handout in any way

(C) Combine task with sensory input (tactile, proprioceptive, and auditory). Answer C is correct because additional sensory input when combined with a visual memory task, facilitates memory. See reference: Kramer and Hinojosa (eds): Todd, VR: Visual information analysis: Frame of reference for visual perception.

21.A child with a learning disability has significant problems with visual memory. An OT practitioner may use which of the following to better enhance visual memory? A. Provide memory tasks that are of low interest to the child B. Decrease visual attention before doing memory tasks C. Combine task with additional sensory input (tactile, proprioceptive, and auditory) D. Repeat the visual memory task once

(D) Home observation and parent interview. "Observation of children in familiar settings and routines allows more characteristic views of their abilities and may be actually more reflective of how children can be expected to perform..." (p.207). Parent interviews provide information about the child's abilities from the parent's point of view and can identify the priorities of the child's caregiver.

21.A child with motor delays is being evaluated to determine how he performs self-care activities. Which evaluation procedure is MOST likely to provide relevant information about self-care function? A. Standardized tests of motor development B. Review of the medical record C. Developmental screening test D. Home observation and parent interview

(A) Videofluoroscopy. A videofluoroscopy should be performed when it is suspected that the individual is aspirating. An individual who suddenly has a wet voice when there was no prior difficulty may have had a sudden change in medical status causing aspiration. He or she should be reevaluated to determine if there is aspiration into the larynx or trachea.

21.An OTR observes that an individual on a purees diet has demonstrated a gurgle or wet voice after swallowing a second time. The diet had not been difficult for the individual until this instance. The MOST appropriate recommendation for the OTR to make is for this person to have a: a. videofluoroscopy b. diet change to include thin liquids c. tracheostomy d. regular diet

(C) Developmental dyspraxia. The motor problem described as it occurs during the evaluation is characteristic of developmental dyspraxia. Children with dyspraxia often learn tasks such as jumping rope with great difficulty, effort, and considerable practice. However, when the task is altered, such as in this case by asking the child to skip backwards, the child is unable to adapt the task for a long while.

21.An OTR performing a motor skills evaluation observes that a child is awkward at many gross motor tasks, particularly those which require relating the body to objects in space. Though able to skip rope in the regular forward pattern of movement, the child is unable to skip rope backwards, even after several attempts. This information would lead the therapist to be particularly observant for additional signs of: A. Delayed reflex integration B. Inadequate bilateral integration C. Developmental dyspraxia D. General incoordination

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

22.In administering an assessment of finger pinch strength, the OT practitioner would instruct the individual being tested to place the fingers in which position? A. Thumb against the tip of the index finger B. Thumb against the side of the index finger C. Thumb against the tips of the of the index and middle fingers D. Thumb against the tips of all the fingers

(D) Sitting position. Answer D is correct because the upright sitting positions provides the child with the opportunity not only to further control head movement (stability has developed in horizontal positions). Weight bearing, and weight shifting, but to rotate the trunk as he or she reaches toward the opposite side of the body. See reference: Kramer and Hinojosa (eds): Schoen, SA, and Anderson, J: Neurodevelopmental treatment frame of reference,

22.The BEST position that the OT practitioner can place a 15-month-old child in to provide the opportunity to further develop trunk rotation is the: A. Supine position B. Prone position C. Sidelying position D. Sitting position

(B) All group members construct one tower that incorporate all the pieces provided in a set of constructional materials (e.g., Legos™, Tinkertoys™, or Erector™, set). Activities used in evaluation groups should require group collaboration that can be done in approximately 45 minutes and emphasize process rather than end product.

22.Which of the following activities would MOST effectively evaluate group interaction skills? A. The clients make individual collages, sharing a set of magazines to complete the activity. B. All group members construct one tower that incorporates all of the pieces provided in a set of constructional materials (e.g., Legos™, Tinkertoys™, or Erector™ set). C. All group members work together to make pizza and salad for their lunch that day. D. Each client selects a short-term craft activity from four available samples.

(D) Phantom limb pain. Phantom limb pain is present when the amputated limb is perceived to be present with accompanying pain.

23.A client who was fitted for an upper extremity prosthetics complains of pain at the stump site. The client comments that the absent limb still feels intact and that the pain is severe. This is the MOST likely an example of: A. Paresthesias B. Phantom link sensation C. Neuromas D. Phantom limb pain

(D) Post-traumatic stress disorder. Posttraumatic stress disorder is an anxiety disorder that follows a traumatic event in a person's life.

23.After assessing a client who had recently lost his spouse in a house fire, the psychiatrist classifies the client as having an anxiety disorder caused by the occurrence of a major life event. Which of the following BEST represents this disorder? A. Cyclothymic disorder B. Dysthymia C. Schizophrenia D. Post-traumatic stress disorder

(D) Disorganized psychosis. Directive group treatment is a highly structured approach that is used in acute care psychiatry for minimally functioning individuals. This approach is useful for disorganized and disturbed functioning with patients with psychoses and other neurological disorders.

23.An OT practitioner is attempting to decide which type of group to institute within an acute psychiatric setting. The supervision OT suggests the directive group treatment approach because it is MOST appropriate in acute care mental health for individuals with: a. substance abuse problems b. eating disorders c. adjustment disorders d. disorganized psychosis

(C) inferior to the anterior superior iliac spine. A seat belt placed across the lap inferior to the anterior superior iliac spine prevents the hips from being extended into a posterior pelvic tilt. See reference: Trombly (ed): Deitz, J, and Dudgeon, B: Wheelchair selection process.

23.In order for an individual sitting in a wheelchair to achieve maximal pelvic stability, the seat belt should be positioned: A. Inferior to the ischial tuberosity B. Superior to the iliac crest C. Inferior to the anterior superior iliac spine D. Superior to the posterior superior iliac spine

(A) Chaining. Chaining with a child who demonstrate a cognitive disability shows the entire process of a task with all sequences. Initially, the child performs only the beginning or end of the task. Thus, the task and gradually increases participation in all sequences in their correct order. See reference: Early: Medical and psychological models of mental health and illness.

23.When teaching children with moderate mental retardation to feed, groom, and dress themselves, the OT is MOST likely to use which technique? A. Chaining B. Practice and repetition C. Demonstration D. Role modelling

(B) Observe him in his home during feeding time. "Considering the context of the child's environments is a critical process in occupational therapy assessments." The reason he does not feed himself may be environmental - for instance, his parents may have taught him not to touch food with his fingers or he may not have learned to feed himself because his grandmother always feeds him. Or the child may not be able to transfer skills learned at home to the clinic - that is, he may believe that "the place to eat is home, not the clinic."

24.A toddler diagnosed with developmental delays dos not finger-feed when presented with food in the clinic. The BEST way to obtain further information about his feeding skills is to: a. interview his parents to determine his favorite foods b. observe him in his home during feeding time c. review his chart for food allergies d. repeat the observation in a quiet area (in order to minimize distractions)

(D) use active listening techniques. Active listening (answer D) is an effective response that enables the patient to know that his or her message has been communicated. See reference: Ryan (ed): The Certified Occupational Therapy Assistant: Blechert, TF, and Kari, N: Interpersonal communication skills and applied group dynamics.

24.A young client who is diagnosed with depression tells an OT practitioner abut feelings associated with being alone and afraid. A chart review reveals that the individual leads a very isolated lifestyle. The BEST way for the practitioner to respond is to: A. Reassure the client that they can be friends B. Tell the client, "I know how you feel." C. Encourage the client to socialize more often D. Use active listening techniques

(B) Forgetting to turn off the stove burner. The progression of dementia of the Alzheimer's type is often described by its phases of impairment in functioning. Whereas behavior linked to memory impairments usually occur in the early stages, social and motor impairments occur later.

24.An OT practitioner is working with the caregiver of a newly diagnosed client with Alzheimer's disease. The caregiver insists on keeping the client out of a skilled nursing facility. In this case, caregiver education is vital. It is important to make the caregiver aware that the early stages of dementia, Alzheimer's type, may be detected in behaviors such as: A. Difficulty swallowing food B. Forgetting to turn off the stove burner C. Angry outbursts at close family members D. Restless pacing around the house

(A) Within 6 months, the client will participate in classroom activities for 1 hour without disruptive outbursts, twice a day. A functional goal relates the skill to be developed to a child's environment or life tasks. See reference: Case-Smith (ed): Richardson, PK, and Schultz-Krohn, W: Planning and implementing services.

24.Poor impulse control has been identified as the primary deficit in a 12- year-old boy with conduct disorder. Which of the following is the MOST effectively written functional OT goal? A. Within 6 months, the client will participate in classroom activities for 1 hour without disruptive outbursts, twice a day B. Within 6 months, the client will attend to an activity for 30 minutes, demonstrating improved impulse control C. The client will show a 50% reduction in the frequency of disruptive outbursts within 6 months D. When presented with a new activity, the client will follow directions without protest, four out of five times, within 6 months

(C) "The infant is exhibiting ulnar palmar grasp." Ulnar palmar grasp precedes the other types of grasp. The infant first grasps on the ulnar side of the hand against the palm, then with all 4 fingers against the palm (palmer grasp), and finally the grasp moves to the radial side of the hand (radial grasp). The highest level of grasp is pincer grasp, in which the pad of the index finger meets the opposed thumb.

24.The OT practitioner working with an infant observes the presence of the first stage of voluntary grasp. Which of the following would be the MOST appropriate statement for documenting this behavior? A. "The infant is exhibiting radial palmar grasp" B. "The infant is exhibiting pincer grasp" C. "The infant is exhibiting ulnar palmar grasp" D. "The infant is exhibiting palmar grasp"

(A) Dual diagnosis. Examples of dual diagnostic categories are mental health and mental retardation and mental health and substance abuse. Multiply handicapped is the coexistence of physical and mental health types of problems.

28.During an initial evaluation, an OT practitioner documents that the client's chart reveals a history of both depression and substance abuse. The term that indicates a diagnosis from two mental diagnostic categories is: A. Dual diagnosis B. Multiply handicapped C. Axis I and II duplicity D. Primary and secondary diagnoses

(A) Within normal limits. The normal ROM for internal rotation is 70 degrees. Rotation can be assessed with the humerus adducted against the trunk or with the SH abducted at 90 degrees. If the humeral movements for IR or ER are observed during the performance of any functional activities, the ROM may be noted as WFL. The OT practitioner may choose not to perform a formal joint measurement if the joint is WFL; even though the end of the range may be lacking a few degrees, because the loss of movement may not be significant to the individual. Hypermobility at a joint is motion past the average ROM, which at the SH would be past 70 degrees of IR. If hypermobility is a deformity caused by an unstable joint as might occur after a surgical repair or a disease process, then splinting or another form of stabilization or immobilization can be used to correct the problem. If the practitioner observes hypermobility during ROM, he/she should compare the ROM to that on the individual's opposite side in order to assess normal range. A limitation of IR at the SH would be less than 70 degrees of motion. If a limitation is apparent, the rehabilitation team may choose not to treat it unless it interferes with function of the UE.

25.An OT practitioner is assessing the range of motion of an individual who demonstrates internal rotation of the shoulder to 70 degrees. The practitioner would MOST likely document the patient's active range of motion: a. within normal limits b. within functional limits (WFL) c. hypermobility that requires further treatment d. limited mobility that requires further treatment

(B) Decreased muscle tone. Decreased muscle tone is usually characterized by joints that are lax and hyperextensible. Low muscle tone and joint hyperextensibility are also frequent characteristic of Down syndrome. See reference: Krammer and Hinojosa (eds): Colangelo, CA: Biomechanical frame of reference.

26.During assessment of a 10-month-old child with Down syndrome, the OT notes hyperextensibility of all joints, which MOST likely reflects: A. Increased muscle tone B. Decreased muscle tone C. Anterior horn cell disease D. Muscle and joint disease

(A) Apply the stimuli beginning at an area distal to the lesion progressing proximally. The general guidelines for sensation testing are that the person's vision should be occluded, the stimuli should be randomly applied with false stimuli intermingled (opposite of answer C), a practice trial should be performed before the test, and the unaffected side or area should be tested before the affected side or area (opposite of answer B). Also, the tested individual should be given a specified amount of time in which to respond; therefore, answer D is incorrect.

26.The OT practitioner is evaluating two-point discrimination in an individual with a median nerve injury. The MOST appropriate procedure is to: a. apply the stimuli beginning at an area distal to the lesion progression proximally b. test the involved area first, then the uninvolved area c. present test stimuli in an organized pattern to improve reliability during retesting d. allow the individual unlimited time to respond

(B) Initiation. The inability to perform the first step of an activity without prompting indicates that the individual has initiation problems. Memory deficits could also be evidenced by the performance of task steps out of correct sequence. The individual with initiation problems may be able to plan or carry out activities but be unable to begin until prompted by someone else. An individual who has difficulty with impulsivity, memory, or attention would have no difficulty with beginning the activity but would have difficulty in completing the task successfully.

27.An OT practitioner is working on morning activities of daily living with a young adult who recently sustained a traumatic brain injury. The client requires prompting to apply shaving cream to his face and to pick up his razor. After these cues, to client is then able to complete the activity. This is MOST likely to be documented as a deficit in which of the following performance components? A. Impulsivity B. Initiation C. Memory D. Attention

(D) Presence of self-stimulatory behavior. Self-stimulatory behavior is often seen in autistic children and frequently interferes with function. The other answers are less relevant in terms of essential data for intervention planning.

27.An OTR observes a child with autism waving his hand in front of his eyes repeatedly in an apparently purposeless manner. The MOST relevant observation is the: A. Child's ability to focus his eyes at close range B. Degree of wrist mobility C. Hand preference D. Presence of self-stimulatory behavior

(B) Avoid use of power tools and sharp instruments. Individuals experiencing extrapyramidal syndrome, which may cause muscular rigidity, tremors, and/or sudden muscle spasms, should avoid using power tools or sharp instruments. All of the above are possible side effects of neuroleptic medications, but answer B is most important because it relates to the only side effect the client has experienced.

27.While in the hospital, a 48-year-old roofing contractor experienced extrapyramidal syndrome after being placed on neuroleptic medications. The patient is to continue taking the medications after discharge from the hospital. It is MOST important to advise the patient to: a. keep time in the sun as brief as possible b. avoid use of power tools and sharp instruments c. get up slowly from a standing, sitting or lying position d. be aware of the dehydrating effects of caffeinated drinks and alcohol

(D) Applesauce. Food with even consistency, uniform texture, and increased density such as aplsauce are the easiest to control and swallow. See reference: Case-Smith,J, and Humphry, R: Feeding intervention.

28.A child has difficulty controlling food in her mouth when swallowing. In helping the parents to plan snacks, the OT practitioner would be MOST likely to recommend: A. Chicken noodle soup B. Peanut butter C. Carrot sticks D. Applesauce

(C) Digging a garden with a shovel. Activities that include bilateral use of tonic muscles against resistance, such as digging a garden, playing volleyball, or playing tug of war, can help to normalize tone in this population. See reference: Bruce and Borg. Movement-centered frame of reference.

28.An adult with schizophrenia walks with a shuffling gait and hunched posture. Using a movement-centered FOR, which of the following activities would MOST effectively contribute to normalization of this individual's posture? A. Dancing with rapid alternating movements B. Playing the game Twister C. digging a garden with a shovel D. Rocking in a rocking chair

(D) Visual perceptual. Running, hopping, using a tripod grasp, drawing a stick figure, and putting together a 10-piece puzzle are all developmentally appropriate skills for a 5-year-old child. Although the child cannot put together the 10-piece puzzle, the gross and fine motor skills that doing a puzzle require have been observed. Because gross, fine, and developmental skills appear to be appropriate, visual perception should be evaluated.

28.During an initial visit with a 5 year old child with a suspected learning disability, the OT observes the child run across the room, hop around on one foot, pick up a pencil, and draw a stick figure using a tripod grasp. When asked to complete a four-piece puzzle, the child gives up after several unsuccessful attempts. Which type of assessment would MOST effectively address this child's area of difficulty? a. Fine motor b. Gross motor c. Developmental d. Visual perceptual

(D) The effect of personal traits and the environment on role performance. Evaluation according to MOHO would focus on the effect of personal traits and the environment on role performance.

28.Using the Model of Human Occupation as a frame of reference, evaluation of an individual should focus PRIMARILY on which of the following? A. Identification of problem and behaviors that need to be extinguished B. Clarification of thought, feelings, and experiences that influence the behavior. C. Cognitive function, including assets and limitations D. The effect of personal traits and the environment on role performance

(D) Block out all areas of the page except important words. Answer D is correct because this compensatory technique is a way of dealing with visual figure-around or visual discriminations problems. The child needs to learn how to rule out extraneous stimuli and focus on the important area of a task, such as reading. See reference: Krammer and Hinojosa (eds): Todd, VR: Visual information analysis: Frame of reference for visual perception.

29.A school-age child with visual perceptual deficits is being discharged from OT. Which compensatory technique for dealing with visual figure-ground problems should the OT practitioner recommend to the child's teacher? A. Place a red line on the left side of the paper B. Use a timer for certain activities C. Teach the child to use lists and color coding of books and folders D. Block out all areas of the page except important words

(D) Determine the need for further evaluation. The purpose of screening is to determine whether further assessments are needed and, if so, which test would be appropriate for that child. A screening test is not designed for planning programs (answer C) or consultation (answer A), and they do not test any skills (answer B) in a comprehensive way.

29.In screening a child who has been referred to occupational therapy, the PRIMARY goal of the occupational therapist is to: A. Obtain necessary information for an occupational therapy consultation with teachers and parents. B. Test a wide variety of developmental behaviors C. Establish an information base for the occupational therapy treatment plan D. Determine the need for further evaluation

(A) Age appropriate. The child being observed is performing dressing activity which is age appropriate for child of 5 years. A typical child at this age can dress unsupervised and is able to tie and untie a bow independently. See reference: Case-Smith (ed): Sheperd, J: Self-care and adaptations for independent living.

3. In assessing the dressing skills of a 5-year-old child, the OT practitioner observed that the child is able to put on a jacket, zip the zipper, and tie a knot in the draw string but needs verbal cueing to tie a bow. The OT practitioner would MOST likely determine that the child's dressing skills are: A. Age appropriate B. Delayed C. Advanced D. Limited

(C) Has a standard format. Standardization of a test means that the test is administered in a prescribed manner and that scoring and interpretation of scores are also completed in a prescribed way. The presence of data concerning the test's "norms" and the establishment of reliability and validity (answers A, B, and D) may be, and often are, provided with standardized tests but are not assumed to be part of the test unless this information is included. The aspects of standardized tests that are always assumed is the specific and standardized method of administration, scoring, and interpretation.

3. In selecting a standardized test to use with a child, an OT practitioner can assume that the test: a. is valid b. has normative data c. has a standard format d. is reliable

(D) Observe the child entering the clinic and taking off his coat and shoes. "In a naturalistic observation the therapist gathers information in the typical or natural setting [in which] the activity occurs" (p.494). The most reliable information can be gained by observing the child as he/she normally does the activity: this is especially true of children with developmental delay, who may have difficulty generalizing learning from one situation to another.

3. When performing a "naturalistic observation" of dressing skills with a young child diagnosed with developmental delay, an OT practitioner should FIRST: A. Provide oversized clothing to ensure success. B. Have the child dress and undress in a distraction-free corner of the clinic. C. Provide assistance as needed to minimize frustration. D. Observe the child entering the clinic and taking off his coat and shoes.

(B) Measure the distance from the fingertip to the distal palmar crease with the hand in a fist. The distance from the fingertip to the distal palmar crease with the hand fisted may be measured in either inches or centimeters. This measures how close the fingertip comes to the palm. A person who has full flexion would have a measurement of 0.

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

(C) Have the patient get dressed in a certain way, then change the task at the next session. Giving the patient a functional task then changing and observing how he responds will tell the therapist how well the patient can transfer learning to new situations. If the patient can't perform the activity when it is changed slightly, it suggests there may be difficulty with new learning. If the patient can perform the activity with many changes and in a different setting, it suggests that he has more capacity for transfer of learning to new situations.

30.A patient who has had a traumatic brain injury is beginning OT. The OTR practitioner needs to assess whether this person can transfer learning from one activity to another in order to plan treatment appropriate way for an T to observe this learning ability would be to: a. describe situations that might be unsafe and ask the patient how he would respond b. give the patient a simple jigsaw puzzle to solve c. have the patient get dressed in certain way, then change the task at the next session d. give the patient simple calculations performs

(A) Modifying the environment to protect infant from overstimulation and inappropriate stimuli. See reference: Case-Smith (ed): Hunter, JG: Neonatal IntensiveCare Unit.

30.An OT manager is developing a proposal for OT services in the neonatal intensive care unit (NICU). Using the developmental support care approach as the basis for services, how would the OT BEST describe OT‟s scope of practice in the NICU? A. Modifying the environment to protect the infant from overstimulation and inappropriate stimuli B. Providing passive range of motion (PROM), positioning and handling, fabrication of splints, and referral to early intervention C. Educating parents and hospital staff D. Implementing motor & behavioral skill acquisition through developmental milestone positioning

(C) Clothing care, cleaning, and volunteering. Doing laundry, cleaning, and volunteering are all examples of work and productive activities.

30.An OT practitioner is assessing a client's ability to perform work and productive activities. Examples of these occupational performance areas include: A. Health maintenance, socialization, and community mobility B. Feeding, eating, and sexual expression C. Clothing care, cleaning, and volunteering D. Reading, watching television, and doing small handicrafts

(C) demonstrating typical development for a child with Down syndrome. Answer C is correct because "W" sitting is commonly seen in children with low muscle tone. The child is compensating for an inability to achieve stability in a variety of positions that require dynamic postural control, depending on skeletal rather than neuromuscular structures for stability. See reference: Kramer and Hinojosa (eds): Schoen, SA, and Anderson, J: Neurodevelopmental treatment frame of reference.

30.An OT practitioner observes a 5 year old child with Down syndrome who has low muscle tone sitting on the floor exclusively using a W sitting position. This observation MOST likely indicates that the child is: A. Developing abnormally B. Using a noncompensatory position to achieve stability C. Demonstrating typical development for a child with Down syndrome D. Using a position normal for a younger child not for a 5 year old child

(C) 8 months. This is correct because 3 months (number of months premature) are subtracted from the child's chronological age to adjust for prematurity. This child is then given the benefit of time lost because of a shorter gestation period.

31.An 11-month-old child who was born 3 months prematurely is being evaluated at an OT outpatient clinic. The MOST accurate assessment profile can be obtained if the OTR compares this child's abilities with those of a normal child aged: A. 11 months B. 14 months C. 8 months D. 10 months

(C) IEP. The individual education plan is a form that must be completed for children receiving services in the school system. This documentation standard was defined in the Education of the Handicapped Act (1975 and 1986). See reference: Neistadt and Crepeau (eds): Perinchief, JM: Management of OT services.

31.An OT practitioner is speaking with parents who believe that their child with CP could benefit from OT consultation at school. In order for a school-age child to receive OT services within a school system. Which of the following forms must be completed FIRST? A. UB-82 B. FIM C. IEP D. HCFA-1500

(B) edema. Contrast baths cause vasodilation and vasoconstriction, which facilitate a pumping out of the edema. Retrograde massage assists with the facilitation of blood and lymph movement. Pressure wraps (coban) are spoiled distal to proximal to address edema issues. See reference: Pedretti (ed): Kasch, MC: Hand injuries.

31.An OT practitioner requests that an OT student treat a client with a condition involving the upper extremity. The OTR suggests the use of contrast baths, retrograde massage, and pressure wraps. The OT student can consider these interventions as PRIMARY techniques to address: A. Heterotropic ossification B. Edema C. Wound healing D. Scar management

(B) Line bisection. Line bisection is used as a method of determining unilateral neglect. The block assembly (used for constructional apraxia) is not a paper-and-pencil task, and the other tests may be performed with or without the individual writing. Proverb interpretation (abstraction) may be performed verbally, and overlapping figures (figure ground discrimination) testing may be performed by pointing.

31.The BEST way for the OT practitioner to evaluate the presence of unilateral neglect is by using which of the following paper-and-pencil tests: A. Six-block assembly B. Line bisection C. Proverb interpretation D. Identification of the square on four overlapping fingers

(A) A goniometer. A goniometer measures available joint movement.

31.The MOST appropriate assessment instrument for the OT practitioner to use for measuring range of motion of the hand is: a. a goniometer b. a dynamometer c. a pinch meter d. an aesthesiometer

(C) Repeated protecting of the joints while moving. An individual's protecting the joints while moving is an example of a motor response associated with chronic pain.

32.A client experiences chronic pain while engaged in household chores. Because of this pain, the client avoids actions that require motor performance. OTR observes a MOTOR response to pain, as demonstrated by the patient's: a. inability to concentrate on tasks because of pain b. frequent complaints of aching pain c. repeated protecting of the joints while moving d. refusal to partake in certain ADL to prevent the accompanying pain

(C) A concrete response. Literal and concrete responses to general inquiries indicate the difficulty that people with schizophrenia have in understanding questions with several possible meanings.

32.An individual with schizophrenia who is newly admitted to the hospital is asked by the therapist to tell about what brought the person to the hospital for admission. The individual responds by saying, "I took a cab". In the report, the therapist is MOST likely to identify this response is an example of: A. Delusional thinking B. A distractible response C. A concrete response D. An insightful response

(A) -15 degrees to 140 degrees. Negative ROM documentation may vary from one setting to another. However, this range may be written as a negative (minus) sign preceding the degree (- 15 degrees) or as a positive number preceding the natural position (15 degrees to 0 degrees to 140 degrees).

32.The OT practitioner is assessing an individual who demonstrates normal range of motion when flexing the elbow but hyperextends by 15 degrees when the elbow extended. The practitioner will MOST LIKELY record the measurement as: A. -15 to 140 degrees B. 0 to140 degrees C. 15 to 140 degrees D. -15 to 120 degrees

(B) Mounting a safety rail next to the toilet. In order to sit independently on the toilet and relax sufficiently to control muscles needed for elimination, the child has to feel posturally secure. Safety rails next to the toilet, low toilets that allow the child to put both feet on the ground, and reducer rings to decrease the size of a toilet seat all help to provide maximal stability for the child with unstable posture. See reference: Case-Smith (ed): Sheperd, J: Self-care and adaptations for independent living.

32.When preparing a home program with the goal of independent toileting for a young child with postural instability, the MOST important adaptation the OT practitioner can recommend is: A. Replacing zippers and buttons with Velcro closures B. Mounting a safety rail next to the toilet C. Introducing toilet paper tongs D. Placing a colorful "target" in the toilet bowl

(A) ADHD. This behavior exemplifies the excessive fidgeting and restlessness, inattention, and impulsiveness characteristic of ADHD.

33.A child is observed grabbing toys from others, becoming easily frustrated, and is unable to sit still. This behavior MOST likely indicates: A. ADHD B. Mood disorder; manic episode C. Conduct disorder D. Anxiety disorder

(A) The doorway width needs to be expanded to have a minimum clear opening of 32 inches. According the ADA accessibility guidelines, a doorway needs to have a minimum clear opening of 32 inches with the door open 90 degrees, measured between the face of the door and the opposite stop. In an environmental evaluation process, according to ADA guidelines, the doorway rather than the individual's wheelchair needs to be adapted.

33.A client who recently started using a wheelchair will be returning to work and OTR is evaluating the client's work place for accessibility, according to ADA guidelines. The doorway to the client's office has a clear opening of 28 inches. Which of the following recommendations would be MOST appropriate to facilitate clear passage of the wheelchair through the doorway? a. The doorway width needs to be expanded to have a minimum clear opening of 32 inches b. The client needs to obtain a wheelchair narrower than 28 inches c. The doorway width needs to be expanded to have minimum clear opening of 45 inches d. The doorway width is satisfactorily and needs no modification

(B) Working on a mock car engine. Working on a mock car engine provides a work simulation that would be required by the client's job. This activity would assist with increasing his endurance, strength, and productivity. See reference: Pedretti (ed): Kasch, MC: Hand injuries.

33.An auto mechanic is currently in a work hardening program after being in a car accident that left him with numerous UE and LE impairments. The ultimate goal for this individual is to return to full employment as an auto mechanic. Which of the following BEST represents a work-hardening activity for the individual? A. Lifting weights B. Working on a mock car engine C. Visiting the work site garage D. Preparing a light lunch for mealtime

(B) Radial-digital grasp. Children usually develop a radial-digital grasp at age 9 months: they use the grasp for precision control. See reference: Case-Smoth (ed): Exner, CE: Development of hand skills.

33.During a coloring activity, an OT practitioner observes a preschooler stabilizing a crayon between the thumb and fingers. The practitioner MOST accurately documents this grasp as: A. Pincer grasp B. Radial-digital grasp C. Palmar grasp D. Lateral pinch

(B) Flexion righting reaction. The flexion righting reaction (answer B) is correct because "the development of antigravity neck strength is first associated with the ability to maintain the head aligned with the body when pulled to a sitting position."

33.During the evaluation of a 6-month-old baby, the OT practitioner gently pulls the infant from a supine position into a sitting position by the hands. The child demonstrates the ability to hold her head and trunk in alignment against gravity. This observable movement can MOST accurately be described by the OT as: A. Protective reaction B. Flexion righting reaction C. Body righting on body reaction‟ D. Optical righting reaction

(C) Follow administration instructions and note changes in behavior. Although the tester may not deviate from the protocol, changes on behavior represent important test data and should be recorded.

34.An OT practitioner is administering a standard test to a young client who suddenly becomes uncooperative and complains that the test is "too hard." The MOST appropriate response for the OT practitioner would be to: a. switch to easier items to improve the child's self-esteem b. terminate the session and schedule another session for the remainder of the test c. follow administration instructions and note changes in behavior d. adapt the remaining test items to ensure success

(D) Anosognosia. Anosognosia is a form of neglect in which an individual denies any deficits. Compensation techniques cannot be taught to someone who has no awareness of his or her deficits.

34.An OT practitioner is working with a motivated and alert adult who recently had a cerebrovascular accident (CVA) affecting the parietal lobe. The client appears to be unaware of his limitations and is unable to learn compensation techniques for neglect despite many training sessions regarding ADL. This condition can MOST be described as: A. A visual field cut B. Apraxia C. Aphasia D. Anosognosia

(C) Bring the seat in for reevaluation within 6 months. Fit and function of seating and mobility should be reassessed within 6 months to account for the child's growth as well as any changes in posture. See reference: Case-Smith (ed): Wright Go, C: and Egilson, S: Mobility.

34.The OT practitioner has fitted a 6 year old child for an adapted seat for use in the home of mealtime and other table top activities. Which of the following instructions is MOST appropriate to convey to the parents? A. Adapt the seat as needed B. Bring the seat in for each weekly therapy session in order to adjust it according to the child‟s growth C. Bring the seat in for reevaluation within 6 months D. Keep the seat until the end of the IEP

(D) Scoop dish. This is the most correct answer because the sides of the scoop dish provide a shape that aids the scooping movement. A high back to the plate provides a surface to push the food against to aid in getting the food onto the spoon. See reference: Case-Smith (ed): CaseSmith: J, and Humphrey, R: Feeding intervention.

34.The OT treatment goal for a child with athetoid CP is self-feeding. Which of the ff. adaptations would BEST solve the problem of food sliding off the plate when the child attempts to pick it up with a spoon? A. Swivel spoon B. Nonslip mat C. Mobile arm support D. Scoop dish

(A) At the lateral epicondyle of the humerus. The lateral epicondyle of the humerus is the bony prominence on the lateral side of the elbow.

34.When measuring elbow range of motion with a goniometer, the OTR must position the axis of the goniometer: A. At the lateral epicondyle of the humerus B. At the medial epicondyle of the humerus C. Parallel to the longitudinal axis of the humerus on the lateral aspect D. Parallel to the longitudinal axis of the radius on the lateral aspect

(C) Backward chaining in backward chaining the OT practitioner completes all of the steps except the last one. As the child becomes competent. The practitioner completes all but the last two steps and so on, until the child is able to perform the entire activity. This method provides immediate gratification and is particularly useful for children with low frustration tolerance and poor self-esteem. See reference: Case-Smith (ed): Sheperd, J: Self-care and adaptationsfor independent living.

35.A child with learning disabilities that have resulted in low frustration tolerance and poor self-esteem is learning how to tie shoelaces. Which of the ff. methods would be MOST appropriate for this child? A. Physical guidance B. Verbal cues C. Backwards chaining D. Forward chaining

(B) Confusion. Medication side effects are observe and reported by OTs and OT assistants. Antianxiety medications often cause confusion.

35.A therapist reviews an individual's chart as part of the screening process. The psychiatrist has written "observe for side effects with current anti-anxiety medications." The OT practitioner is MOST likely to report about which of the following side effects? a. akathisia b. confusion c. extrapyramidal syndrome d. tardive dyskinesia

(D) Rationalization. Making excuses for or justifying others' behaviors that are generally considered to be unacceptable is called rationalization.

35.A woman experienced repeated sexual abuse by her father as a child and now describes her father's abusive actions as being caused by his stress of being fired from a job because of new management. The defense mechanism she is MOST likely to be using is: A. Identification B. Projection C. Denial D. Rationalization

(C) Dysphagia evaluation. A dysphagia evaluation usually consists of a client's mental status; oral motor structure; and head, trunk, and extremity motor functions.

35.An OT practitioner is assessing a client's mental status, oral structures, and motor control abilities of the head, extremities, and trunk. The practitioner has MOST likely received a referral for a: A. TMJ evaluation B. Cranial nerve evaluation C. Dysphagia evaluation D. Dysmetria evaluation

(A) figure-ground discrimination. Figure-ground discrimination is the ability to distinguish an object from the background. A person with impaired figure-ground discrimination would have difficulty finding the sock despite its position on the bed. Other deficits that may be demonstrated by the person would be an inability to see the sock on one side of the bed (unilateral neglect), to find it in relation to the bed (position in space), and to know how to get back to the bed to look for the sock (cognitive mapping). See reference: Trombly (ed): Quintane, LA: Evaluation of perception and cognition.

35.An OTR observes an individual having difficulty trying to find white socks on a bed with white sheets. The MOST appropriate performance component for the OT to address is: A. Figure ground discrimination B. Unilateral neglect C. Position in space D. Cognitive mapping

(A) Safety and stability. Incoordination, tremors, ataxia and athetoid movements may result from conditions that affect the CNS, such as Parkinson's disease, CP, multiple sclerosis (MS), and head injuries. "The major problems encountered in ADL performance are safety and adequate stability of gait, body parts and objects to complete the task."

36.An OT practitioner is performing a home management evaluation of an ambulatory individual with cerebral palsy (CP) who is cognitively intact but exhibits and ataxic gait pattern. The PRIMARY focus if the evaluation should be on: a. safety and stability b. the individual's ability to reach and bend c. whether the individual has adequate strength to perform homemaking tasks d. fatigue and endurance level

(B) an interest checklist. An interest checklist is frequently used to initiate discussion of how a patient usually spends his leisure time and to identify areas of specific interest. See reference: Early: Data gathering and evaluation.

36.An OTR has asked a COTA to identify how a patient spends his leisure time, which leisure activities he especially enjoys, and which others he has participated in that he would be interested in renewing. The MOST appropriate tool for the COTA to use is: A. An evaluation of living skills B. An interest checklist C. An activity configuration D. A self-care evaluation

(A) Figure-ground discrimination. Figure-ground discrimination is the ability to distinguish an object from the background. A person with impaired figure-ground discrimination would have difficulty finding the sock despite its position on the bed.

36.An OTR observes an individual having difficulty trying to find white socks on a bed with white sheets. The MOST appropriate performance component for the OT to address is: A. Figure-ground discrimination B. Unilateral neglect C. Position in space D. Cognitive mapping

(A) Measures the skill or function it claims to measure. There are several kinds of validity, including logical, content, and construct validity; however, they all indicate whether the test measures what it claims to measure. Scores obtained on a sample population are usually compared with scores on tests measuring similar functions in order to establish validity.

36.When deciding if a standardized test is valid, the MOST important aspect for the OT practitioner to determine is whether the test: A. Measures the skill or function it claims to measure B. Provides similar scores on serial test administrations C. Provides similar scores when administered by two different examiners D. Is based on a normative population

(D) Motor planning. Motor planning or praxis problems are often seen in young children when they are dealing with novel equipment. Motor planning requires an adequate body concept and the ability to cognitively plan movements. See reference: AOTA: Uniform Terminology for OT, third edition.

36.Working with a preschooler in the home, the OT practitioner observes the child climb into a highchair and jump up and down on a toy trampoline. When presented with a new rocking horse as a birthday present, however, the child is unable to determine how to mount the horse. This MOST likely indicates a problem in the area of: A. Fine motor skills B. Gross motor skills C. Reflex integration D. Motor planning

(C) Gravitational insecurity. Gravitational insecurity is described as "excessive fear during ordinary movement activities." The child easily experiences a fear of falling and prefers to keep his or her feet firmly on the ground. Gravitational insecurity, on the other hand, is associated with the utricle and saccule.

37.A child avoids playground equipment that requires her feet to be off the ground. This behavior MOST likely indicates: a. tactile defensiveness b. developmental dyspraxia c. gravitational insecurity d. intolerance for motion

(C) 9 and 12 months. Children usually begin to cruise (walk sideways holding onto furniture) between 9 and 12 months.

37.A parent observes her infant "cruise," while holding onto furniture, and asks the OT practitioner at what age a normal child begins to cruise, while holding onto furniture. The OT practitioner tells the parent that this behavior typically occurs between the ages of: A. 3 and 5 months B. 6 and 8 months C. 9 and 12 months D. 13 and 15 months

(A) Mount lever handles on doors and faucets. For children with reduced strength and endurance, using less complex movements and less force results in energy conversation. Lever handles require less energy than knob handles on doors, faucets, and appliances. See reference: Case-Smith (ed): Dudgeon, BJ: Pediatric rehabilitation.

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

(A) Arrhytmic and unexpected. Sensory integration treatment is complex and highly individualized and must be monitored carefully to observe the effects of sensory input of varying types in the individual. The characteristics of facilitatory sensory input are unexpected, arryhtmic, uneven, or rapid input. See reference: Bruce and Borg: Movement-centered frame of reference.

37.An individual with underreactive sensory processing has been referred to OT. Based on a SI FOR, activities for this individual should have which of the following facilitatory characteristics? A. Arrhythmic and unexpected B. Arrhythmic and slow C. Sustained and slow D. Unexpected and rhythmic

(A) Swimming. Swimming provides active movement through wide ranges of motion with minimal impact on the joints. See reference: Neistadt and Crepeau (eds): Newman, EM, Echevarria, ME, and Digman, G: Degenerative diseases.

38.A sixth grade student has a diagnosis of juvenile rheumatoid arthritis. Which of the following leisure activities would BEST suit this child for helping him maintain range of motion? A. Swimming B. Basketball C. Soccer D. Aerobics

(C) Ask the questions as they are stated on the interview sheet. A structured interview requires following procedure, order, and wording of the questions to be asked.

38.An OTR requests that the COTA conduct a structured interview. During this type of interview, it is MOST important for the COTA to: A. Rephrase the interview question in his or her own words B. Ask questions that he or she thinks are pertinent to this patient. C. Ask additional question as they are stated on the interview sheet D. Ask additional questions (other than those listed) to gain further insight into the patient

(B) Catching and bursting soap bubbles. This activity involves visually tracking a slow-moving target and requires minimal fine motor precision to accomplish a successful "hit".

66.A pre-schooler has poor visual tracking skills, which affect her performance on tasks requiring eye-hand coordination. Which of the following activities is most appropriate for OT practitioner to recommend to the child's parents in order to promote beginning visual tracking skills during summer vacation? a. Tossing and catching a water balloon b. Catching and bursting soap bubbles c. Throwing and catching a beach ball d. Playing softball

(A) Assist with skill development in the areas of leisure, cognition and perception, selfexpression, and ADL. In general, the areas of focus with OT intervention for individuals identified with substance abuse problems are alternative leisure time use, improved expression of feelings, and the acquiring of social and occupational roles.

38.The OT treatment approach that will MOST likely meet the overall needs experienced by individuals with substance abuse problems is to: a. assist with skill development in the areas of leisure, cognition and perception, self-expression, and ADL b. educate the family members about making safety modifications to the kitchen area c. encourage Alcoholics Anonymous (AA) involvement; provide retraining of neglected ADL; explore work-related values d. make aftercare arrangements for vocational counselling and AA; provide time management; education for self-care activities

(D) Early morning and again in the afternoon. Individuals with arthritis should be evaluated at both times to assess the functional abilities of the individual during and after morning stiffness. Individuals with arthritis have many changes in functional status after morning stiffness has disappeared.

39.Evaluation results for a person with arthritis will MOST accurately reflect true functional abilities if scheduled: a. early morning (8 to 10 AM) b. afternoon c. late morning (10 to 11 AM) d. early morning and again in the afternoon

(B) Dressing habits. Certain dressing habits may indicate tactile defensiveness; for example, the child may show poor tolerance of certain textures or avoid wearing turtlenecks, socks, or shoes. Conversely, some children may never take off their shoes in order to avoid tactile overstimulation. Answer A, C, and D could be affected secondarily, as a result of intolerance of certain textures or human touch or the inability to concentrate. However, because of the close connection between dressing and tactile tolerance, knowledge of the child's dressing habits will give the OT practitioner the most reliable information.

39.When working with a child who exhibits tactile defensiveness, which of the following areas should be evaluated FIRST? A. Reading skills B. Dressing habits C. Social skills D. Leisure interests

(D) Assess the individual's topographical orientation, the individual's community mobility skills must first be assessed. Constantly getting lost is a strong indicator that the individual may be impaired in the area of topographical orientation. See reference: Early activities of daily living.

4. An individual with mental illness wants to travel to the library independently but keeps getting lost. Which of the following actions should the OT practitioner take FIRST? A. Take the individual to the library and obtain a library card B. Assess the individual's ability to read C. Identify the bus that goes to the library and obtain a bus schedule D. Assess the individual's topographical orientation skill

(B) The client can usually handle routine daily functions. Answer B is correct because it describes the skills of an individual with moderate or trainable mental retardation. This child would most likely be able to complete ADL, live in a group home setting, and do unskilled work in a sheltered workshop.

4. The OT practitioner is making recommendations to a community living site for a 13-year-old child who has mental retardation. Which of the following statements most accurately describes the functional ability of this child who is in the moderate (trainable) range of intellectual ability? A. The client requires nursing care for basic survival skills. B. The client can usually handle routine daily functions. C. The client requires supervision to accomplish most tasks. D. The client is able to learn academic skills at the third to seventh grade level.

(D) A clustered independent living arrangement. These are usually composed of "apartment clusters or other types of housing in close proximity to each other, in which groups of residents with disabilities share services such as attendants and transportation" (p.362). See reference: Trombly (ed): Law, M, Stewart, D, and Strong, S: Achieving access to home, community and workplace.

40.A client that the OT practitioner is working with uses a wheelchair and requires minimal assistance with all transfers and basic ADL. The client is expected to remain at this functional level. Which of the following would be the MOST appropriate community living option for this client at discharge? A. A cradle to grave home B. Transitional living center C. Adult day program D. Clustered independent living arrangement

(B) SH flexion and abduction and elbow extension. Protective arm reactions allow one to return to a support base or to protect the body when there are environmental changes. Answer B is the correct answer because the shoulders flex and abduct while the elbows extend during this protective movement. Facilitation of protective reactions may be a beginning point for the development of arm extension in treatment.

40.After many months of therapy, a pre-school child with Down syndrome has begun to demonstrate protective reactions when falling forward. Which of the following BEST describes the type of movement that has been demonstrated? a. Shoulder flexion, internal rotation and shoulder adduction b. Shoulder flexion and abduction and elbow extension c. Shoulder internal rotation and elbow extension d. Shoulder hyperextension and external rotation and elbow flexion

(D) The ability to recognize objects. Answer D is correct because a child must be able to recognize an object before he/she can discriminate among its specific visual attribute.

69.When planning a therapeutic program for a child who has deficits in visual discrimination, the FIRST step is to provide matching activities that require: a. discrimination among the colors of objects b. discrimination among the shapes of objects c. discrimination among the positions objects d. the ability to recognized objects

(C) The ability to engage in superficial social conversation. The onset of most dementias is slow and progressive. Cognitive abilities such as reading and writing are most often initially affected. Sensorimotor abilities such as dressing tend to follow. Superficial social abilities are often preserved until the last stages of dementia and may often hide the earlier cognitive and sensorimotor changes.

40.In the assessment of individuals in whom the early and middle stages of dementia are diagnosed, the functional ability that will MOST likely remain intact for the longest duration is: A. The ability to read the written information B. The ability to write basic information C. The ability to engage in superficial social conversation D. The ability to dress and undress oneself.

(A) Exploratory play. Exploratory play provides children with experiences that develop body scheme, sensory integrative and motor skills, and concepts of sensory characteristics and actions on objects. Therefore, the obstacles course is an example of exploratory play. Symbolic play is associated with the development of language and concepts (use of "dress-up" materials would be an example of this type of play). Creative play and interest are characterized be=y refinement of skills in activities that allow construction, social relationships, and dramatic play (finger painting is an example of creative play). Recreational play is leisure experiences that allow the exploration of interests and roles such as arts and crafts or sports. See reference: Case-Smith (ed): Morrison, CD, and Metzher, P: Play.

40.Setting up an obstacle course that provides several options for allowing a child to choose the direction he will take (unstructured) would be MOST appropriate if the OT practitioner wished to encourage: A. Exploratory play B. Symbolic play C. Creative play D. Recreational play

(B) Demonstrate the procedure on the unaffected extremity, then occlude the individual's vision. The presentation of stimuli in sensory evaluation is extremely important. Because of the compensation that may occur with vision, it is necessary to occlude the individual's vision.

40.The OT is assessing sensory awareness in an individual whose diagnosis is CVA. The MOST appropriate technique to use is to: A. Test the individual's affected extremity before the unaffected extremity. B. Demonstrate the procedure on the unaffected extremity, then occlude the individual's vision. C. Demonstrate the procedure on the affected extremity, then establish rapport with the individual. D. Interview the individual and assess only the areas that he or she reports are impaired.

(A) Pull-to-sit, leaning back against therapy ball. While all answers involve antigravity control, answer A addresses beginning control in neck and shoulders. Since control develops cephalocaudally, neck and shoulder control should be addressed first. By using an incline, the pull of gravity can be reduced, thus facilitating maximum control, see reference: Case-Smith (ed): Nichols, DS: The development of postural control.

41.A child displays poor postural stability because of low muscle tone. To promote beginning antigravity control, the FIRST activity that should be performed is: A. Pull-to-sit, leaning back against therapy ball B. Prone scooter obstacle course C. Hippity-hop races D. Batting a balloon while the child is suspended in net

(B) Examining an analysis of the individual's job. The job analysis is a detailed description of the physical, sensory, and psychological demands of a job. Examples of performance requirements include tasks such as lifting, walking, sitting, standing, and reaching, as well as seeing, hearing, and interpersonal skills.

41.An OT practitioner in a work-hardening program needs background information about an individual's work history. The BEST method for obtaining detailed information about the individual's job requirements is: a. interviewing the individual b. examining an analysis of the individual's job c. looking up the individual's job in the Dictionary of Occupational Titles d. requesting information from the referring physician

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

41.An OT practitioner is performing sensation testing on an individual with hemiplegia. The therapist should FIRST: A. Apply the stimuli distally to proximally B. Test the involved area then the uninvolved area C. Present test stimuli in an organized pattern to improve reliability during retesting D. Apply the stimuli to the uninvolved area proximally to distally in a random pattern.

(D) Read the social worker's report. The social worker's report includes details about the patient's family situation, occupational, educational, and cultural background, and expected environment. Referring to this document eliminates the need to duplicate this information.

41.What should the OT practitioner do FIRST to obtain accurate information about a patient's family situation and occupational, cultural, and educational backgrounds? A. Read the medical record B. Interview the patient's family C. Interview the patient D. Read the social worker's report

(B) Follow test manual directions. When administering a standardized test, directions from the test manual should be followed closely to ensure reliability of test results. See reference: CaseSmith (ed): Richardson, PK: Use of standardized tests in pediatric practice.

41.Which of the following instructions should the OT practitioner follow when administering standardized tests to young children? A. Test in a stimulating environment B. Follow test manual directions C. Always administer test in a single session D. Carry on a conversation with the child

(D) A child with spina bifida with LE paralysis. Usually, a child in this condition has enough UE coordination and strength to propel himself on a scooter on which the LEs are supported. Such a child also has the cognitive and sensory awareness to negotiate a scooter in its environment.

42. Which of the following children with neuromotor impairment would benefit MOST from using a prone scooter for exploratory play? A. A child with cerebral palsy (CP) with predominant extensor tone B. A child with low tone who is easily fatigued C. A child with cognitive limitations and poor sensory awareness D. A child with spina bifida with lower extremity paralysis

(D) Praise her for what she does well; reinforce he independence. Since the child has just achieved independence in spoon feeding, she may still need frequent reinforcement of the new skill it is more effective to encourage her for what she does well than to point out her mistakes. See reference: yan (ed): Practice Issues in OT: McFadden, SA: The child with Mental retardation.

42.An OT practitioner is preparing the family of 5-year-old child diagnosed with developmental delay for discharge. The child has just achieved independence in self-feeding with a spoon. The BEST suggestion for the parents to help the child maintain her skill level at home is to: A. Use hand-over-hand technique to reinforce correct technique B. Consistently point out incorrect hand placement and or movement patterns C. Let the child's older sister feed her occasionally as a reinforcement D. Praise her for what she does well; reinforce her independence

(A) Procedural reasoning. Reasoning based on corresponding an individual's deficits and physical symptoms with a procedure that may benefit the area is referred to as procedural reasoning. Procedural reasoning is the process of identifying a particular treatment or procedure.

42.An OT practitioner is reviewing a patients chart before evaluating the patients chart before evaluating the patient. Based on the physician's history and physical examination, the practitioner is able to identify the patient's deficits and assessments that will best assess the problem areas. This form of clinical reasoning is MOST likely an example of: a. procedural reasoning b. conditional reasoning c. interactive reasoning d. narrative reasoning

(C) Demonstrating typical development for a child with Down syndrome. Answer C is correct because exclusive "W" sitting is commonly seen in children with low muscle tone. The child is compensating for an inability to achieve stability in a variety of positions that require dynamic postural control, depending on skeletal rather than neuromuscular structures for stability.

42.An OT practitioner observes a 5-year-old child with Down syndrome who has low muscle tone sitting on the floor exclusively using a "W" sitting position. This observation MOST likely indicates that the child is: A. Developing abnormally B. Using a non-compensatory position to achieve stability C. Demonstrating typical development for a child with Down syndrome. D. Using a position normal for a younger child, not for a 5-yearold child

(C) To teach the caregiver how to lift and turn the client safely. Individuals unable to move themselves and those with sensory loss are susceptible to the development of decubiti. Skin damage results from pressure on the skin over a prolonged period of time. The skin over bony prominence is particularly prone to the development of decubitus ulcers. Frequent position changes are essential for these individuals to prevent skin breakdown and the risk of serious infection. See reference: Trombly (ed): Bentzel, K: Remediating sensory impairment.

42.An OT practitioner providing home-based care to an individual with acquired immunodeficiency syndrome (AIDS) learns from his caregiver that he has become too weak to turn himself in bed. What is the MOST important modification to the treatment plan for the OT practitioner to recommend? A. To begin a strengthening program B. To begin a bed-mobility program C. To teach the caregiver how to lift and turn the client safely D. To provide an environmental control unit (ECU) to the client

(A) 2 inches wider than the widest point across the individual's hips while he/she wears the brace. Measuring the individual with the brace on and adding 2 inches, as in answer A, allows the individual to easily get in and out of the chair, while preventing pressure to the individual's sides. The correct length of the seat should be 2 inches shorter than the distance from the back of the bent knee to the back of the buttocks.

43.An individual who wears a hip brace is being measured for a wheelchair. The correct seat dimension for the OT practitioner to recommend would be: A. 2 inches wider than the widest point across the individual's hips while he or she wears the brace B. 2 inches wider than the widest point across the individual's hips C. 2 inches more that the distance from the back of the bent knee to the buttocks D. The same as the distance from the back of the bent knee to the buttocks

(D) Support. Answer D is correct because the term "support reaction" refers to the ability to coactivate muscle groups of the appropriate extremity or about the midline in order to support the body weight or posture in a certain position.

43.An infant has begun to sit and is leaning forward onto its arms. The OT practitioner notes during assessment that the infant is able to coactivate muscle groups around the shoulder and arm in order to bear weight on arms in sitting. This demonstrates that the infant has MOST likely developed which type of reactions? A. Protective B. Equilibrium C. Rotational righting D. Support

(C) The cultural context family interaction patterns. Cultural expectations may determine behavior standards and the expression of family roles. Continued feeding of a young child with a handicap may be the expression may be viewed as more important than the promotion of independence and self-reliance. Case-Smith (ed): Case-Smith, J: Self-care and adaptations for independent living.

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

(B) Lateral trunk stability. An individual who is uncoordinated or has poor head control would not be able to control the mobile arm support to bring the hand safely to the mouth without hitting the face or some other area. Also poor head control would mean that the individual's head would be out of alignment for the hand to reach, or the person would be unable to see properly to control the mobile arm support. An individual with fair plus (3+) elbow flexion would be able to stabilize the elbow on the table to bring the hand to the mouth and would have enough strength to move the arm without the mobile arm support. For the mobile arm support to perform properly, the individual's trunk needs to be stabilized laterally by his/her own control or with positioning devices to provide a stable base from which the arm may move.

43.In assessing if a person is a candidate for using a mobile arm support, the OT practitioner would have to determine if the person demonstrate which of the following? a. incoordination b. lateral trunk stability c. fair plus elbow flexion d. poor head control

(C) Weight-bearing on hands. This is the only activity that will facilitate hand function in the preparation phase. Weight-bearing on the hands gives deep pressure to the surface of the hand and facilitates wrist and arm extension, as well as shoulder cocontraction, to prepare the arm for reach and stabilization of the hand for grasping. The other answers all provide different, types of grasp activities that could be used as therapy. See reference: Case-Smith (ed): Exner, CE: Development of hand skills.

43.The treatment goal for a 4 year old child with hypotonia is to improve grasp. Which of the following activities would be BEST for preparing the child's hand for grasp activities? A. Dropping blocks into a pail B. Placing pegs on pegboard C. Weight-bearing on hands D. Holding and eating a cookie

(C) School newspaper. Anxiety disorder is characterized by extreme self-consciousness and anxiety about competence. Public exposure and pressure for on-the-spot performance heighten the anxiety. Becoming involved in the newspaper preparation, the student will have an opportunity to develop a sense of competence without the pressure of face-to-face audience and judged competition, as a represented by activities described in answers A, B, and D. see reference: Case-Smith (ed): Cronin, AF: Psychosocial and emotional domains.

44.A 12-year-old will be discharged after having received treatment for anxiety disorder. Which would be the MOST appropriate recommendation for an extracurricular school activity: A. Competitive gymnastics team B. Debating club C. School newspaper D. Basketball team

(B) Ability to grade movement. The "grading of movement" goal best addresses the difficulty with control of the midrange of a movement pattern (common in children with athetosis).

45.A therapist who is planning treatment for a child with athetoid CP is concerned about the child's inability to control flexion and extension of the arm when reaching for a toy. The child flexes too much or extends too much, which makes placements of the hand very difficult. The MOST appropriate goal for this type of problem in hand function would be to improve the: A. Ability to isolate movement B. Ability to grade movement C. Ability to control how fast movement occurs D. Bilateral integration of arm movements

(B) Vestibular stimulation and gross motor exercise. The SI treatment approach, which aims to improve the reception and processing of sensory information within the CNS, uses both vestibular stimulation and gross motor exercises (answer B).

45.An OT practitioner is selecting treatment activities to see with a young adult diagnosed with a young adult diagnosed with schizophrenia, undifferentiated type that would help to increase the patient's ability to receive, process, and respond to sensory information. The MOST suitable activities for this patient would include: a. social skills training b. vestibular stimulation and gross motor exercise c. role-playing d. discussion group

(B) emotional lability. Emotional lability is the rapid shifting of moods. See reference: Early: Responding to symptoms and behaviors.

45.An individual alternately exhibits laughing and crying throughout a treatment session, this behavior should documented as: A. Mania B. Emotional lability C. Paranoia D. Denial

(A) Putting blankets in the overhead compartments. When distributing magazines, the flight attendant uses negligible reaching and bending. Upgrading the activity increases the degree of reaching and bending and adds more resistance than that provided by magazines.

46.A flight attendant with a back injury is participating in a work hardening program. The client can successfully simulate distributing magazines to all passengers in a plane using proper body mechanics. To upgrade the program gradually, the OT practitioner should NEXT request that the client simulate: A. Putting blankets in the overhead compartments B. Distributing meals to the passenger C. Distributing magazines to half of the passengers in the plane D. Putting luggage in the overhead compartments

(B) Extending the elbow in mid-range 30 to 40 degrees with the forearm arm resting on the table surface. Extending the elbow in mid-range 30 to 40 degrees while the arm is resting on a table surface would be active assisted ROM with gravity eliminated. Muscles with poor minus strength would only be able to move a body part through partial ROM in a gravity eliminated position. The individual would then need assistance to complete the ROM while using what strength is available in the body part.

46.After a radial nerve injury, an individual initially had trace muscle strength in elbow extension. One week later, strength is noted to have increased to poor minus. The individual is ready for which activity? a. passively self-ranging the injured arm b. extending the elbow in mid-range 30 to 40 degrees with the forearm resting on the table on the table c. pushing a cup filled with pennies with the back of the hand, with arm resting on the table d. lifting a book placed on the back of the hand up off the table

(B) Writing a soap opera. Although answers A, C, and D would benefit the self-confidence and stress management needs of women struggling with the issues associated with emotional and physical abuse, they are not expressive group activities. Writing a soap opera would most likely be a creative approach implemented to assist individuals in expressing their inner thoughts, feelings, anxieties, and beliefs.

46.An OT practitioner has been assigned to develop an expressive activity group for women who have experienced emotional and physical abuse. The BEST choice would be: A. Mediation and yoga exercises B. Writing a soap opera C. Personal hygiene and grooming classes D. Aerobics and fitness program

(A) Decrease joint stress and pain. It is very important to preserve joint integrity in individuals with arthritis by using adaptive equipment to avoid or reduce the wear and tear stresses on fragile joints.

69.When providing adaptive equipment to an individual with arthritis, the OT practitioner would explain that the PRIMARY purpose of using this equipment is to: A. Decrease joint stress and pain B. Correct deformity C. Simplify work D. Decrease independence

(C) Significantly delayed by several months. Answer C is correct because at 6 months of age a child should initiate head flexion when pulled into a sitting position. The child assists with pulling of the arms and some trunk flexion or use of the abdominals at this age. See reference: Neistadt and Crepeau (eds): Kohnleyer, K: Evaluation of sensory and neuromuscular performance components.

47.A 6-month-old child, when pulled into sitting with several trials, demonstrates head lag. The OT practitioner evaluating this child should MOST accurately conclude that head control is: A. Developing in a typical manner B. Slightly delayed by 1 month C. Significantly delayed by several months D. Advanced

(B) Wide-base sitting on the floor while reaching for a suspended balloon. The child first practices skills in unsupported sitting on a stable surface using a wide base of support. As skills improve, the wide base is reduced to a more narrow one. Reaching activities are used to promote postural reactions, because they involve displacement of the center of gravity and weight shifting.

47.A child has poor independent sitting skills as a result of inadequate postural reactions. The FIRST activity the OTR would use to promote the development if independent sitting: a. swinging on a playground swing with a bucket seat b. wide-base sitting on the floor while batting a ball c. straddling a bolster swing while batting a ball d. riding a hippity-hop, while hand for support

(C) initiation. Initiation, or the ability to begin a task, affects a person's spontaneity in performing activities and how much he or she is able to perform. An individual with initation problems may be able to o plan or carry out activities but may be unable to begin until prompted by another person. See reference: Zoltan: Executive functions.

47.An OT practitioner is working with an individual who demonstrates the inability to begin a task or activity. The practitioner documents that the client MOST likely has problems with: A. Attention B. Concentration C. Initiation D. Apraxia

(B) Positioning, adaptive equipment, and patient education. Positioning and adaptive equipment are necessary to maintain the integrity of the musculoskeletal system and prevent deformity; patient education about the disease and ways of dealing with its effects can also be started at this point.

47.Which of the following intervention is MOST appropriate for an individual who has recently been diagnosed with rheumatoid arthritis and is in the acute stage of the disease: A. Strengthening with restrictive exercises B. Positioning, adaptive equipment, and patient education C. Discharge planning D. Preparing the patient for surgical intervention

(A) Ballet. To promote the development of anticipatory control, movement should be slow, predictable, and controlled from a stable base. Participation in a dance class would involve controlled movement from a stable base. See reference: Case-Smith (ed): Nichols, DS: The development of postural control.

48.A child with poor anticipatory postural control demonstrates inadequate playground skills, losing her balance when trying to anticipate movement. Which of the following activities will BEST promote the development of these skills? A. ballet B. soccer C. basketball D. ping pong

(B) Are structured by the OT practitioner to encourage self-reflection and feedback. For a graded program designed to develop an individual's self-awareness, the most essential ingredient is the opportunity to verbalize one's ideas and feelings and to receive feedback from others in a safe setting. Therefore, it is not the activities that are graded but the way the OT practitioner structures the activities to encourage self-reflection and feedback.

48.An OT practitioner has been asked to develop a program of self-awareness activities for a group of substance abusers. A graded program to develop an individual's self-awareness MUST include activities that: a. encourage self-awareness b. are structured by the OT practitioner to encourage self-reflection and feedback c. provide opportunities for the patient to be self-aware d. allow for increasing social interaction

(C) Recommend activities to develop fine coordination that teachers can incorporate into classroom programming. Recommending classroom activities that will develop the performance component of fine coordination would be the best population-based intervention since it involves addressing the occupational performance needs of many students. See reference: AOTA (ed): Guide to OT Practice.

48.An OT practitioner working for the school system has identified a general need to enhance the fine coordination skills of the elementary school students to facilitate better writing skills. The BEST population-based intervention would be to: A. Screen students for writing problems and provide in-depth assessment of those identified B. Provide remedial activities for those students identified having fine coordination deficits C. Recommend activities to develop fine coordination that teachers can incorporate into classroom programming D. Recommend additional OT staff to provide direct services for students

(B) Observe performance at the job site and make recommendations to increase productivity. One of the roles of the OT in transition services includes consulting with the employer on adaption to the job activities to accommodate individuals with disabilities. The other members of the educational team can provide classroom-based instruction as in A, C and D

48.The occupational therapist is a member of the interdisciplinary team providing transition services for a 17-year-old male with moderate learning disabilities. The goal is to help the student engage in parttime work at a local stationery store. Which of the following interventions is MOST appropriate: A. Have student practice work tasks in the classroom with peers B. Observe performance at the job site and make recommendations to increase productivity C. Teach math and money management skills to help the student handle his pay check. D. Teach the student interviewing skills to increase the likelihood of eventually obtaining full-time employment.

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

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

(A) Sit straddling a bolster with both feet on the floor. Once the child has learned to sit independently on the floor, external stabilizing support is in longer necessary (answer D). After having developed independent postural reactions on a stable surface, that is, the floor, the child can now further refine sitting skills by learning to maintain posture when placed on an unstable surface. At first, the child should be left in control of the movement on this surface, and she should have both feet on the floor for maximal stability. Later, these skills can be refined by placing the child on more challenging surfaces, such as on the hippity-hop (answer C) or on a scooter pulled by another person (answer B).

49.A young child has just learned to sit independently on the floor. Which of the following is the NEXT step toward refining her postural reactions in sitting? A. Sit straddling a bolster with both feet on the floor B. Maintain sitting balance on a scooter while being pulled C. Ride a hippity-hop without falling off D. Maintain floor-sitting position with the therapist providing pelvic support

(D) Removing a nut from a bolt. Answer D describes one type of in-hand manipulation called rotation. Rotation is the movement of an object around one or more of its axes, where objects may be turned horizontally or end over end with the pads of the fingers, as when one would unscrew a nut from a bolt.

49.An OT practitioner is working with a child who has a mild spastic cerebral palsy. The evaluation has shown that the child has poor in-hand manipulation skills. What type of activity would be BEST for practicing this ability? a. grasping blocks to build a building b. placing pegs from one pegboard to another c. carrying a bag of Lego blocks with a handle d. removing a nut from a bolt

(D) Weight bearing over a small bolster in prone. Weight bearing on the arms can help with overall inhibition of tone before participating in hand skill activities. Inhibition of flexor spasticity occur through slow joint compression from weight bearing, as well as facilitation of ulnar to radial function in the hand. See reference: Case-Smith (ed): Exner, CE: Development of hand skills.

49.On completion of an evaluation of a child with CP, the OT has identified the primary objective of inhibition of flexor spasticity in the hand. The activity that would be MOST appropriate in meeting this objective would be: A. Building a block tower B. Active release of blocks into a container C. Traction on the finger flexors D. Weight bearing over a small bolster in prone

(C) Avoid resistive materials. For a child with acute juvenile RA, the OT practitioner should always use techniques for joint protection and energy conservation. Activities requiring the manipulation of highly resistive materials such as clay, leather, and cooper sheets should be avoided; the pressure applied to the joints could exacerbate the condition.

49.When developing play activities for a child with acute juvenile rheumatoid arthritis, which of the following precautions should the OT practitioner follow? A. Avoid light touch B. Avoid rapid vestibular stimulation C. Avoid resistive materials D. Avoid elevated temperature

(C) anxiety and confusion among group members. It is important for group leaders to demonstrate consistency by showing the same degree of respect, interest, and authority toward every group member. See reference: Early: Group concepts and techniques.

49.When leading groups, OT practitioners should demonstrate consistency from day to day. Inconsistent behavior would MOST likely result in: A. Overdependence of group members B. Group members knowing what to expect from the group leader C. Anxiety and confusion among group members D. Group members receiving too much praise

(D) Decreased attention. An attention deficit is indicated if the individual recognizes the letter and marks it accurately on both the right and left sides of the paper but misses letters in a random pattern.

5. An OTR is evaluating an individual who has sustained a left-hemisphere cerebrovascular accident (CVA). After determining that the person was able to read before the CVA, the therapist's presents a paper with typed letters of the alphabet randomly dispersed across the page. The individual is then asked to cross out all the M‟s. The OTR observes that that the individual has missed letters in a random pattern throughout the page. This MOST likely indicates: A. A left visual field cut. B. A right visual field cut. C. Functional illiteracy. D. Decreased attention.

(D) Child, caregiver, and therapist priorities. The problems established in the OT evaluation are not the only basis for writing OT goals and objectives. The child's priorities as well as the caregiver's needs and concerns must be addressed so that immediate needs are met there is a commitment on every one's part to the success of the program. See reference: Case-Smith (ed): Richardson, PK, and Schult-Krohn, W: Planning and implementing services.

5. To develop the MOST relevant goals and objectives for a child's OT program, the OT practitioner should focus goals on: A. The child's priorities B. The priorities of the parents or caregivers C. The therapist's priorities for solution of problems identified in the OT evaluation D. Child, caregiver, and therapist priorities

(B) Flaccidity. Flaccidity, or hypotonicity, is often present immediately after a stroke and may later change to spasticity. See reference: Pedretti (ed): Undzis, MF, Zoltan, B, and Pedretti, LW: Evaluation of motor control.

5. While observing a client who has just been admitted to the rehabilitation unit after a right CVA with left hemiplegia, the OT practitioner notices that the patient's right arm lays limply by the patient's side. In documenting this observation, the OT will MOST likely use the term: A. Paralysis B. Flaccidity C. Subluxation D. Spasticity

(C) Trim lines of the splint should extend proximal to the MCP crease. Trim lines of a splint that extend proximal to the MCP crease allow for adequate MCP digit extension and flexion.

50.An OT practitioner is fabricating a splint for an individual who has a carpal tunnel syndrome. Which of the following splint fabrication techniques should be adhered to in order to allow for adequate digit motion? a. Trim line of the splints should extend distal to the MCP crease b. Trim lines of the splint should extend proximal to the DIP joint c. Trim lines of the splint should extend proximal to the MCP crease d. Trim lines of the splint should extend distal to the ulnar 5th MCP crease

(D) Provide a vertical work surface where writing and hand skills can be practice. A vertical work surface encourages an upright posture, upper body strengthening, and eye-hand coordination. See reference: Neistadt and Crepeau (eds): Erhardt, PP, and Merrill, SC: Neurological dysfunction in children.

50.An OT practitioner is working with a preschooler with spina bifida who is about to transition to a fully inclusive kindergarten. Lower extremity weakness and postural control are primary concerns, along with bilateral and fine motor coordination. Knowing there will be significant emphasis on writing activities, which of the following should be the OT practitioner recommends? A. Send the child to the OT room for fine motor activities when the class is working on writing skills B. Arrange for the child to work in areas of the classroom where distractions can be minimized C. Arrange for the child to have a flat desk to work on, in either standing or sitting positions D. Provide a vertical work surface where writing and other hand skills can be practiced

(B) Raise the toilet. The minimum doorway width that allows a standard wheelchair to pass through easily is 32 inches. A standard toilet is 15 inches, which is 3 inches lower than the standard wheelchair seat. Raising the toilet 18 inches would make transfers easier for this individual. See reference: Neistadt and Crepeau (eds): Holm, MB, Rogers, JC, and Stone, RG: Person-task-environment intervention: a decision-making guide.

50.An individual with lower extremity paralysis uses a standard manual wheelchair and is ready to be discharged to home. During the home evaluation, the OT practitioner notes that the entrance to the bathroom is 32 inches wide and the toilet is 15 inches high. Which of the following recommendation will MOST facilitate use of the bathroom for this individual? A. Widen the doorway B. Raise the toilet C. Widen the doorway and raise the toilet D. Widen the doorway and lower the toilet

(D) Create a comfortable foundation for fostering parent skills through parent-therapist collaboration. All 4 answers describe possible ways for an OT to impact an infant's developmental outcome. However, the most permanent action would capitalize upon developing family-centered mutual collaboration. With this approach, communication is the key to creating a relationship that will foster parental skill development and expertise. This then provides the parents with effective tools to best nurture and care for their infant at any time and in any environment and has a permanent impact on the developmental outcome for the infant.

50.The OT is developing a treatment plan to promote developmental acquisition for an infant in the neonatal intensive care unit. Which of the following actions will have the most PERMANENT impact? A. Modify the environment to protect the infant from additional stressful stimuli B. Recommend early intervention referral to assess infant upon discharge home C. Complete the neurobehavioral assessment and identify interventions emphasizing developmental skill acquisition D. Create a comfortable foundation for a fostering parent skills through parent-therapist collaboration

(B) The client will use facial expressions and gestures that are consistent with stated emotions during assertive, passive, and aggressive role-play situations. Self-expression is the use of a variety of styles and skills to express thoughts, feelings, and needs. It is also the ability to vary one's expressions, thoughts, feelings, and needs. Being able to vary one's expression during 3 different styles of expressing feelings is an example of this.

50.The treatment goal that BEST addresses the psychosocial skill of self-expression is: A. The client will identify and pursue activities that are pleasurable to the self B. The client will use facial expressions and gestures that are consistent with stated emotions during assertive, passive, and aggressive role-play situations. C. The client will recognize his or her own behavior and possible negative and positive consequences D. The client will identify his or her own assets

(B) Combing the hair. An individual normally abducts and externally rotates the SH to comb his/her hair.

7. A person with functional limitations in shoulder abduction and external rotation is performing self-care activities. The OTR is MOST likely to observe the client having difficulty during which self-care activity? A. Buttoning a shirt B. Combing the hair C. Tucking in a shirt in the back D. Tying a shoe

(B) Add the two new clients and then divide the members into two groups it is generally not cost-effective to run groups of less than three individuals, and it is not effective to have more than eight in a group. Maintaining an appropriate group size enables the OT practitioner to adequately observe the interpersonal skills of the members. See reference: Cole: Writing a group treatment protocol.

51.An OT practitioner has planned to assess group interpersonal skills in an activity-based group of seven individuals. Shortly before the group is to begin, the therapist is asked to add two newly admitted clients to the group. Which of the following actions would yield the MOST efficient and effective result? A. Ask one or two of the original seven members to wait until later and include the two new clients in the group B. Add the two new clients and then divide the members into two groups C. Interview the two new clients separately and continue with the original evaluation group of seven D. Proceed with the group as planned, adding both new clients to the original seven

(C) Pouring a glass of orange juice. Meal preparation is graded from cold to hot foods or beverages and from simple to multiple steps. An individual beginning meal preparation training should start with a cold item involving the least number of steps possible, such as pouring a glass of juice or other cold beverage.

51.An OT practitioner is beginning training in meal preparation with a homemaker after a TBI. The activity that should be introduced FIRST is: a. making a peanut butter and jelly sandwich b. preparing a hot cup of tea with sugar c. pouring a glass of orange juice d. cooking a grilled ham and cheese sandwich

(C) Applying grout to a tile trivet and waiting for it to dry. Activities provide a variety of opportunities for therapeutic gains. The process of grouting a tile trivet involves covering the individual's tile design with a grout mixture (which tends to be very liquid in consistency) before setting up the material to dry. Waiting for the grout to dry requires an individual to delay gratification.

51.An OT practitioner is working with a group of individuals with substance abuse disorders. The practitioner wants to use an activity that will allow the clients to experience success after making amess and one that will delay gratification. The activity process that BEST provides this experience is: A. Working in a group with three other individuals B. Selecting the design pattern for a tile trivet C. Applying grout to a tile trivet and waiting for it to dry D. Encouraging the individual to clean off the table at the end of the group

(C) The client should enroll in a work-hardening program. Work-hardening programs are designed to "incorporate job-specific work tasks that progress the client to the physical demand levels of the actual job" (p.380). See reference: Ryan (ed): Practice Issues in Ot: Engh, J, and Taylor, S. Work hardening.

51.An OT practitioner is working with an individual who is about to be discharged form OT after rehabilitation for a hand injury. The client has not been able to work for 3 months and is still unable to perform the job requirements as a sales manager in a clothing store. Which of the following recommendations should the OT practitioner recommend concerning OT services? A. The client should continue to perform a home program at time of discharge. B. The client should receive home health OT. C. The client should enroll in a work hardening program. D. The client should discontinue OT services at the time of discharge

(C) Weight-bearing on hands. This is the only activity that will facilitate hand function in the preparation phase. Weight-bearing on the hands gives deep pressure to the surface of the hand and facilitates wrist and arm extension, as well as shoulder cocontraction, to prepare the arm for reach and stabilization of the hand for grasping. The other answers all provide different types of grasp activities that could be used as therapy.

51.The treatment goal for a 4-year-old child with hypotonia is to improve grasp. Which of the following activities would be best for preparing the child‟s hand for grasp activities? a. Dropping blocks into a pail b. Placing pegs on a pegboard c. Weight-bearing on hand d. Holding and eating a cookie

(B) Objective. The objective portion of the SOAP note (answer B) focuses on measurable or observable data obtained by the OT practitioner through specific evaluations, observations, or use of therapeutic activities.

52."The patient has taken a more active role in the task group, as evidenced by the willingness to contribute ideas and offer to assist in designing the unit mural." This statement would MOST appropriately be documented in which portion of a SOAP note? a. Subjective b. Objective c. Assessment d. Plan

(B) High contrast and defined borders. Answer B is correct because it provides the only combination of features when adapting visual material that assist children with visual discrimination problems. High contrast of the stimuli (shape, letter, numbers, and so on) in relation to the background and defining important areas of the stimuli with a border attract the eye and provide clear input.

52.A treatment plan for a child with a visual discrimination problem would MOST likely include which of the following adaptations of visual materials? A. Low contrast and defined borders B. High contrast and defined borders C. High contrast and unclear borders D. Low contrast and unclear borders

(A) work locks and latches on doors and windows. The ability to manipulate the locks and latches is a safety concern because the individual may be unable to open them to let family members into their home or close them to keep intruders from entering. See reference: Trombly (ed): Feinberg, JR, and Trombly, CA: Arthritis.

52.An OT practitioner is making a home visit to an elderly client who lives alone. The client exhibits severe hand weakness. When addressing safety in the home, the OTR should be MOST concerned with the client's ability to: A. Work locks and latches on doors and windows B. Use built-up utensils while eating C. Use energy conservation techniques D. Manipulate fasteners on clothing

(A) An electric razor. An electric razor is the safest for shaving because a rotary head or foil, instead of a blade, is in contact with the skin. Any shaving over the incision area or near it would not be recommended until the incision area is heated. The other razors have blades that could nick or cut the skin, which would need to be avoided until the patient is no longer treated with blood thinners and normal blood coagulation can occur. See reference: Trombly (ed): Trombly, CA: Retraining basic and instrumental activities of daily living.

52.An individual begins therapy with a blood-thinning medication after surgery for an endarterectomy. Which would be the BEST grooming tool for the OT practitioner to recommend for use in the hospital and after discharge? A. An electric razor B. A single-blade safety razor C. A straight razor D. A double-blade safety razor

(D) Cognitive planning. Praxis or motor planning refers to the ability to attend to and plan a motor act cognitively, based on adequate sensory input (answer D). Dr. Ayres referred to this function as the highest, most complex of children's motor functions, involving conscious attention that is closely linked to metal and intellectual functions. Automatic and reflex motor activity, as well as coordination of the motor act, do not require attention or volition; it is enough to have a general goal in mind.

52.The occupational therapist is developing a treatment plan for a child with motor planning deficits. The MOST important emphasis of motor planning activities for the child will be on activities that promote: a. automatic movement b. reflexes c. coordination d. cognitive planning

(A) Loosening nuts and bolts. Loosening nuts and bolts is the activity that most closely resembles a tip or lateral prehension activity. Prehension is a hand position that permits finger and thumb contact while facilitating the manipulation of objects.

53.A client is working on prehension skills in order to return to work as a mechanic. Which of the following BEST resembles a prehension activity? a. Loosening nuts and bolts b. Removing an air filter c. Cranking a car jack d. Grasping a hammer

(D) Provide a sensory cue, such as saying "stop!" The use of auditory, visual, or tactile sensory cues can help the person with Parkinson's disease to change the motor program in which they are engaged. See reference: Trombly (ed): Newman, EM, Echevarria, ME, and Digman, G: Degenerative diseases.

53.A patient with Parkinson's disease has particular difficulty with both starting movement and stopping movement. The BEST strategy for the OT to teach the person and the person's caregivers is to: A. Encourage the person to perform deep breathing exercise when movement is "frozen." B. Have the person practice the starting phase of the movement repeatedly. C. Have the person mentally identify the series of steps needed to initiate the movement. D. Provide a sensory cue, such as saying "stop!"

(B) Boy Scouts. While answers A, C, and D describe activities that may help build his sense of competence, only participation in Boy Scouts includes the necessary interaction with peers. Noncompetitive activities, a uniform to signify belonging, predictable routines, and exposure to role models are all elements of the Boy Scouts that can help him develop social competence. See reference: Case- Smith (ed): Cronin, AF: Psychosocial and emotional domains.

53.An 8 year old boy is being treated in OT for social withdrawal and depression. At the time discharge, the BEST recreational activity for the OT practitioner to recommend for the child is: A. Swimming lessons B. Boy scouts C. Computer games D. Piano lessons

(C) Vestibular processing, postural control, and muscle tone. Vestibular processing and postural control are required of maintaining balance. Muscle tone that is too high or too low will limit the individual's ability to move the LEs for ambulation: hence, these 3 components are important for successfully walking in the pool.

53.An OT practitioner is working with a group of individuals with Parkinson's disease in an aquatic exercise program. The 3 performance components MOST important for successfully walking across the pool are: A. Strength, fine motor coordination, and kinesthesia B. Visual motor integration, postural control, and gross motor coordination C. Vestibular processing, postural control, and muscle tone D. Range of motion, praxis, and crossing the midline

(B) Provide enough chairs around a round table. Circular seating arrangements generally facilitate the most communication among members. Rectangular tables can lead to unbalanced communications. Difficulties in maintaining comfort and attention are problems related to floor seating arrangements. Using available chairs and couches frequently provides different seating heights often in rectangular or square arrangements.

53.An OT practitioner wants to alter the seating arrangement of a community skills group in order to facilitate communication amongst the members. The BEST arrangement would be to: a. provide enough chairs around a rectangle table b. provide enough chairs around a round table c. provide enough pillows to sit on the floor d. use the couches and chairs that are already in the room

(D) Maintain a normal curve of the back, slowly shifting feet as the turn is completed. A correct transfer is performed slowly with the knees bent and the feet a shoulder with apart, while the normal curve of the back is maintained and the lifting is performed with the legs. See reference: Palmer and Toms: Body mechanics and guarding techniques

54.According to proper body mechanics, the BEST way for an OT practitioner to perform a stand pivot transfer with a patient is to: A. Move slowly, twisting the body from the trunk B. Keep feet a shoulder-width apart, lifting with the arms. C. Keep knees bent and feet planted when moving D. Maintain a normal curve of the back, slowly shifting feet as the turn is completed

(B) Holding a class about job-seeking strategies. The purpose of applying remedial strategies is to enhance underlying abilities. Teaching and training methods are commonly used techniques.

54.An OT practitioner is planning to use remedial strategies to prepare individuals treated in a psychological setting for job hunting. The activity MOST consistent with this approach is: A. Reviewing an interest checklist B. Holding a class about job-seeking strategies C. Modifying the work environment to reduce stress D. Using an expressive group magazine collage using pictures of different types of jobs

(B) Forward and side-to-side movement with the child sitting on the therapist's lap. Answer B is correct because the position of the child requires the least resistance to gravity. By tilting the child in this position, the practitioner controls how much the child will work against gravitational pull and assures that the child is well supported.

54.An OTR is about to begin working with a 2-year-old child with hypotonia and extremely poor head control who is unable to maintain a sitting position. The FIRST pre-sitting activity the OTR should introduce, while providing stability as needed, is: a. Forward and backward movement on a ball with the child in a prone position b. Forward and side-to-side movement with the child sitting on the therapist's lap c. Forward and side-to-side movement on a tilting board with the child in a quadruped position d. Placing the child supine on a mat and pulling him or her into a sitting position

(C) Have the individual trace lines across the page with the right index finger from the left to the right side. A person who follows a line when wheeling a wheelchair is focusing on midline positioning, not crossing the midline. Placing objects commonly used on the unaffected side is a compensatory technique that does not involve crossing the midline. The individual with midline problems would need cueing to avoid starting at the midline when attempting to lay cards out from the right to left side. Also, the person would have difficulty accurately completing a sequencing task on the neglected side, making it difficult to complete the midline crossing successfully. However, when tracing a line across the page, the individual receives the same proprioceptive input from the movement, and uses the same amount of space in the visual field, as when writing on paper. This task makes the transfer of skills easier when performing writing

54.An individual with right unilateral neglect is able to track from the left side to the midline of the body on paper and pencil tasks. The BEST treatment activity for this person to work on crossing the midline to improve writing would to be: a. have the individual practices wheeling a wheelchair following a taped line in the floor b. place commonly used self-care items on the left side c. have the individual trace lines across the page with the right index finger from the left to the right side d. place playing cards in a horizontal row from right to the left in sequence

(C) instructing caregivers in task breakdown. Instructing the caregivers in task breakdown, or breaking down tasks into simple steps and then providing step-by-step instructions, will allow the client to perform activities as capabilities decline. See reference: Pedretti (ed): Atchinson, P, Pedretti, LW, McCormack, GL: Alzheimer's disease.

54.The home health OT practitioner is seeing a client in the middle stages of Alzheimer's disease. The family is very concerned that the client's memory loss is now interfering with performance of daily activities, even familiar self-care activities. The MOST relevant OT intervention at this point would be to: A. Memory retraining activities for the client B. ADL retraining program for the client C. Instructing caregivers in task breakdown D. Leisure activity planning

(D) To arrive at work on time consistently. Time management mandates that one "recognize one's values and priorities, structure a daily routine, schedule one's time, and organize tasks efficiently."

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

(B) Start by having the members make a collage or drawing which symbolizes how they handle anger. Providing an initial activity encourages group members to become involved in the process more quickly. Having a concrete product related to the topic provides group members with something to talk about and refer to during discussion. Beginning with an activity helps the group members to focus on the topic and on each other.

55.An OT practitioner is leading a group session on the topic of "handling anger" with a group of clients who have deficits in psychosocial functioning. The MOST effective way for an OT practitioner to structure this group would be to: A. Begin with "Today we are going to discuss how we handle anger" and wait for discussion to start B. Start by having the members make a collage or drawing which symbolizes how they handle anger C. Ask each member what activities they would like to do during this session D. Begin with a personal anecdote related to handling anger, and ask each member to do the same

(C) Have the individual trace lines across the page with the right index finger from the left to the right side. A person who follows a line when wheeling a wheelchair is focusing on midline positioning, not crossing the midline. Placing objects commonly used on the unaffected side is a compensatory technique that does not involve crossing the midline. The individual with midline problems would need cueing to avoid starting at the midline when attempting to lay cards out from the right to left side. Also, the person would have difficulty accurately completing a sequencing task on the neglected side, making it difficult to complete the midline crossing successfully. However, when tracing a line across the page, the individual receives the same proprioceptive input from the movement, and uses the same amount of space in the visual field, as when writing on paper. This task makes the transfer of skills easier when performing writing

55.An individual with right unilateral neglect is able to track from the left side to the midline of the body on paper-and-pencil tasks. The BEST treatment activity for this person to work on crossing the midline to improve writing would be to: a. Have the individual practice wheeling a wheelchair following a taped line on the floor. b. Place commonly used self-care items on the left side. c. Have the individual trace lines across the page with the right index finger from the left to the right side. d. Place playing cards in a horizontal row from right to left in sequence

(B) The client can usually handle routine daily functions. Answer B is correct because it describes the skills of an individual with moderate or trainable mental retardation. This child would most likely be able to complete ADL, live in a group home setting, and do unskilled work in a sheltered workshop. See reference: Case-Smith (ed): Rogers, SL, Gordon, CY, Schanzenbacher, KE, and Case-Smith, J: Common diagnosis in pediatric occupational therapy.

55.The OT practitioner is making recommendations to a community living site for a 13 year old child who has mental retardation. Which of the following statements most accurately describes the functional ability of this child who is in the moderate (trainable) range of intellectual ability? A. The client can requires nursing care for basic survival skills B. The client can usually handle routine daily functions C. The client requires supervision to accomplish most tasks D. The client is bale to learn academic skills at the third to seventh grade level

(C) Have the child roll around in a carpeted barrel. Because tactile defensiveness is an area of SI treatment that should be approached cautiously, the child-controlled rolling on a textured surface is less intrusive to the nervous system than gentle brushing or rubbing lotion (answers A and B), when the therapist is providing sensory stimulation to the MOST sensitive areas of the body.

57.Which of the following activities should be introduced FIRST when treating a child for tactile defensiveness? a. Gently brush the child's face and neck b. Rub lotion on the child's arms c. Have the child roll around in a carpeted barrel d. Swing the child in a hammock swing

(C) Modify the activity to make it less challenging. The practitioner should recognize subtle signs of fatigue, such as frustration, slowing down, hurrying to finish, lessening range of motion, and use of substitution movements, which indicate the training level was too difficult and should be downgraded. Other signs include the hearts rate's exceeding the target hear: increase of more than 20 bpm above resting pulse; failure to return to resting heart rate after 5-minute rest; systolic pressure that does not increase at all or that increases more than 20 mm Hg from baseline. See reference: Dutton: introduction to biomechanical frame of reference.

55.While performing endurance training activities, an individual on a cardiac rehabilitation unit begins to slow down, using progressively smaller movements to perform the activity. Which of the following is the most appropriate action for the OT practitioner to take? A. Stop the activity B. Upgrade the activity for the next session C. Modify the activity to make it less challenging D. Replace the activity with isometric exercises

(A) the use of energy conservation. Energy conservation techniques reduce the amount of energy expenditure an individual requires to perform various activities. For a client with COPD and limited endurance, energy conservation techniques should be taught early so they can be implemented and reinforced while performing other activities, such as preparing meals. See reference: Trombly (ed): Atchison, B: Cardiopulmonary diseases.

56.A client with a history of COPD has limited endurance. The long-term goal for this client is to prepare three meals a week. The MOST relevant short-term goal for the OT practitioner to focus on is: A. The use of energy conservation B. Work-hardening activities C. Graded activities to increase strength D. Safety in the kitchen

(C) Use of a tub transfer bench and leg lifter. The use of a tub transfer bench would allow the client to back up to the tub bench, sit, and manually lift the leg over the side of the tub, either by using her own hands or a leg lifter.

56.A homemaker is learning how to perform transfers into a bathtub after a total knee replacement. Despite having surgery 2 weeks ago, the client is still unable to extend or flex the knee greater than 20 degrees. Which of the following would MOST likely allow for safe tub transfers? a. Wait another 2-4 weeks, because showering and bathing are contraindicated for individuals with total knee replacements for 4-6 weeks after surgery b. Use of handrail attached to the side of the tub c. Use of a tub transfer bench d. Use of a beach chair in the tub

(D) This individual asks for more beverages during meals, but appears surprised when the therapist indicates beverages in closed containers are on the meal tray. The subjective portion of the SOAP note should contain information that is gained though a chart review, or communication with the patient, his or her family, or staff. This information is not measurable and therefore is considered subjective. See reference: Trombly (ed): Trombly, CA: Planning, guiding, and documenting therapy.

56.An OT practitioner in an acute care hospital is using the SOAP note format to document information about an individual with dementia. Which statement is the BEST example of subjective information? A. The therapist will establish a daily self-feeding routine using verbal and physical cues to encourage the individual to open containers on the lunch tray B. The individual has been able to identify closed liquid-beverage containers on the meal tray for four of six presentations C. The individual is able to identify and drink liquids presented in cups without lids but leaves beverages in closed containers untouched D. The individual asks for more beverages during meals but appears surprised when the therapist indicates beverages in closed containers are on the meal tray

(A) Promote open-ended symbolic play, such as using action figures, and dolls. Toys that elicit feelings and expression can be used to promote beginning play skills and beginning interaction and communication skills. Inherit in open-ended play is the fact that there is no right or wrong way - that failure is not possible.

56.To promote play skills and self-expression in a child who is withdrawn, an OT practitioner should FIRST select activities that: a. promote open-ended symbolic play, such as using action figures, puppets and dolls b. provide a defined structure, such as simple craft activities with instructions c. promote social interaction, such as game of tag with peers d. provide a means of tension release, such as leather tooling or wedging clay

(B) Pass around a scent box and ask each patient to smell the contents. SI theory holds that individuals can learn by receiving, processing, and responding to sensory stimulation. Starting a group for regressed individuals with sensory stimuli such as touch and smell helps to get the individuals' attention and arouse their interest.

57.An OT practitioner is using a sensory integration approach with a group of regressed individuals with limited attention spans. Most group members can tolerate a group situation for no more than a half-hour. Which of the following activities would be BEST for beginning the session? A. Go around the circle and ask each patient to introduce himself or herself B. Pass around a scent box and ask each patient to smell the contents C. Ask each patient to select a favorite person and read it D. Discuss the lunch menu and healthy eating habits

(A) Meal preparation techniques using a wheelchair. As the disease progresses, individuals with ALS lose the strength required for ambulation and begin to use wheelchairs. Therefore, the development of meal preparation skills using a wheelchair, such as transportation of items, addressing work heights, using adaptive equipment (answer A encompasses answer B), and safety issues, is the best answer.

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

(C) Parents should be considered as part of a collaborative partnership with therapists. "The first interactions of the therapist with a family open that door to establishing a partnership" in which the family and therapist collaborate using agreed upon roles to obtain agreed upon goals for the child" (p.117). See reference: Case-Smith (ed): Humphry, R, and Case-Smith, J: Working with families.

57.OTs working in the area of early intervention have frequent contact with a child's parents. Which of the following statements BEST describes how parents should be involved in the OT program? A. Parents should not be present during OT sessions B. Parents should be trained as substitute therapist C. Parents should be considered as part of a collaborative partnership with therapist D. Only one parent needs to be present when the OT program is discussed

(C) Copper tooling using a template. When choosing activities to address self-competence and self-confidence, it is important first to choose activities that are relatively simple, structured, of short duration, and guaranteed to provide a successful experience to the patient.

58.A middle-aged client with a diagnosis of reactive depression is admitted to the hospital following an overdose of sleeping pills. The client was recently forced to retire from a job in public relations and his present goals are to increase his sense of competence and encourage development of enjoyable leisure activities. Based on the client's OT goals, what is an appropriate FIRST activity to recommend for this patient? a. Pouring and glazing chess pieces b. Designing and building a doll house c. Copper tooling using a template d. Learning how to play bridge

(C) baking cookies using a recipe. This is a well-delineated meal preparation activity that provides structure with a specific sequence of tasks. See reference: Early: Responding to symptoms and behaviors.

58.An OT practitioner is planning a meal preparation activity for an adult client with attentional and organizational deficits secondary to alcohol abuse. The treatment goals address the client's difficulties in properly sequencing tasks. The MOST appropriate activity to use FIRST is: A. Setting the table B. Planning an entire meal C. Baking cookies using a recipe D. Preparing a shopping list

(A) Plaster cylindrical splint. A plaster cylindrical splint would encourage a static stretch of the PIP joint contracture.

58.An OT practitioner is treating a client who developed a severe PIP joint contractures in the third digit, 2 months after a burn injury. Which of the following static splinting techniques would BEST address the needs of this individual? A. Plaster cylindrical splint B. Dynamic outrigger splint C. Blocking splint D. PIP-DIP splint

(A) Give one- or two-step instructions frequently repeated. The best method to use with an individual with Alzheimer's disease is short instructions of one to two steps keeping them to the point and repeating them frequently.

58.An individual with Alzheimer's disease has difficulty following multiple step instructions. Which method will the OT practitioner instruct the caregiver to use when presenting instructions? a. Give one or two-step instructions frequently repeated b. Provide three-step instructions with gestures for demonstration c. Write instructions down that are over three steps for the individual d. Have individual verbally repeat instruction after the therapist gives them

(C) Patient will be independently in grooming in 1 week, in UE and LE dressing in 2 weeks, and in toileting in 3 weeks. OTRs must be careful to establish goals in all performance areas that will be addressed and permit progress to be documented.

59.After completing the initial evaluation of a home care patient, the home care OTR expects the patient to achieve independence in selfcare activities at different times - that is, grooming first, then upper and lower extremity dressing, then toileting. When writing the treatment goals, which of the following choices MOST appropriately reflect incremental improvements? A. Patient will be independent in self-care in 3 weeks. B. Patient will be independent in grooming, dressing, and toileting in 3 weeks. C. Patient will be independent in grooming in 1 week, in upper and lower extremity dressing in 2 weeks and in toileting in 3 weeks. D. Patient will be independent in upper extremity dressing in 2 weeks and independent in lower extremity dressing in 3 weeks.

(D) Place dishes near the dishwasher, bend down on one or both knees, and load. Bending down on one or both knees increases balance while reducing the need to bend at the waist. See reference: Pedretti (ed): Smithline, J: Low back pain.

59.An OT practitioner is working with a client who complains of pain while completing kitchen cleaning tasks. Which of the following positions would be MOST effective in alleviating low back pain when the patient s loading the dishwasher? A. Place dishes next to dishwasher and load from a standing position B. Wash dishes in the sink C. Place dishes near the dishwasher and load from the front of the dishwasher D. Place dishes near the dishwasher, bend down on one or both knees, and load

(B) Assembling packets that include a knife, fork, spoon, and napkin based on a sample. This individual is functioning at Allen's Cognitive Level 4. Individuals functioning at this level are able to copy demonstrated directions presented one step at a time. They find it easier to copy a sample than to follow directions or diagrams.

59.An individual with a cognitive disability has recently joined a sheltered workshop setting and has been referred to for assignment to the appropriate group. The individual demonstrates the ability to copy demonstrated directions presented one step at a time and visualizes an end product. However, the individual is unable to recognize errors and may not be able to correct them when they are pointed out. The MOST appropriate group for this individual is the one involved with: a. sorting plastic utensil into separate containers b. assembling packets that include a knife, fork, spoon, and napkin based on sample c. selecting matching shoelace from a mixed pile and lacing them onto a display card d. gluing labels to cans and placing them in the appropriate container according to color

(A) Canister vacuum cleaner. A canister vacuum cleaner may be managed by someone with weakness and balance problems while the person is sitting. The hose is light enough to be easily pushed, and the canister is on wheels and may be moved by a seated person pushing it with the foot or having someone move it for him or her. An upright vacuum cleaner is too heavy for repetitive pushing and pulling and its use can cause exhaustion or pull the person off balance. A self-propelled vacuum cleaner could also pull a person off balance by moving too fast for the person to respond with appropriate postural adjustments. A handheld vacuum cleaner requires too much stooping to do anything but a very small area of the floor, because repetitive bending can cause fatigue quickly and challenges decreased balance. See reference: Trombly (ed): Stewart, C: Retraining housekeeping and child care skills.

59.An individual with left hemiparesis and impaired balance wishes to vacuum the floors upon return home. The BEST type of vacuum cleaner for the OT practitioner to recommend is a(an): A. Canister vacuum cleaner B. Upright vacuum cleaner C. Self-propelled vacuum cleaner D. Handheld cordless vacuum cleaner

(A) A can of soup. Grading activities according to complexity is an important part of the therapist's selection of appropriate activities for each individual. Complexity increases as the number of steps, number of different ingredients or tools used, and time to complete the task increases.

64.A therapist is planning a simple meal preparation activity that will result in success for a patient with cognitive deficits. The SIMPLEST activity would be preparing: a. A can of soup b. A casserole c. Brownies from a box mix d. A meal with two side dishes and an entrée

(C) Edema, contracture, muscle tone, and pain. Edema limits ROM because of the increase of fluid in the extremity. A contracture can result when joint motion is limited by a prolonged spasticity or change in the tissues, causing resistance to passive stretch. Muscle tone may also be a limiting factor in one's ability to complete ROM. If an individual is unable to remove a part through full range against gravity, the therapist may put the individual in a gravity-eliminated position to attempt the same movement. Finally, pain may be a limiting factor. This may particularly be seen in individuals with arthritis or changes in joint structure. Pain generally occurs in the end ROM. Other options listed (proprioception and diadokinesis) may affect the quality of active movement or coordination but do not limit AROM or PROM.

59.The therapist is performing UE activities for an individual with left hemiparesis following a CVA. She observes that active range of motion is limited throughout the LUE. In analyzing this client's performance, the therapist is most likely to consider the impact of which factors on range of motion: a. Muscle tone, edema, sensation, and diadokinesis b. Edema, proprioception, and muscle tone c. Edema, contracture, muscle tone, and pain d. Contracture, stereognosis, and sensation

(A) STNR. The correct answer is A because the STNR, when present, provides the child with bilateral arm extension and hip flexion with the head raised (and bilateral arm flexion and hip extension with the head lowered), which can be used to move forward.

6. A preschool child with spastic cerebral palsy uses "bunny-hopping" for functional mobility during an OT evaluation. This indicates that a primitive pattern is being used for mobility. Which of the following reflexes is MOST likely being used by the child? a. STNR b. ATNR c. TLR d. neck righting reflex

(C) cumulative trauma disorders. Cumulative trauma disorders are viewed as a mechanism of injury for tendonitis, nerve compression syndromes and myofascial pain because of the nature of repetitive strain and motion disorders. See reference: Pedretti (ed): Kasch, MC: Hand injuries

6. An OT practitioner is working in an outpatient upper extremity and hand clinic. The practitioner's case load consists of clients who have tendonitis, nerve compression syndromes and myofascial pain. The OT practitioner can assume that these diagnoses are MOST commonly associated with: A. Osteoarthritis conditions B. Peripheral vascular diseases C. Cumulative trauma disorders D. Neuroma-related conditions

(C) Topographic disorientation. Topographical disorientation is difficulty in finding one's way in familiar surroundings or in learning new routes and would be exhibited as the patient's inability to find the therapy clinic.

6. An OT practitioner observes the following: A patient who's asked to show the path she would take to get from her room to the therapy clinic at the other end of the corridor becomes easily confused and makes several wrong turns. This behavior MOST likely indicates: A. Spatial relations disorders B. Figure-ground discrimination deficits C. Topographical disorientation D. Form discrimination deficits

(A) Fluctuating. Children with athetoid CP have fluctuating muscle tone (answer A), which usually fluctuates from low to normal. Spastic muscle tone is characteristic of children with spastic CP. See reference: Case-Smith (ed): Rogers, SL, Gordon, CY, Schanzenbacher, KE, and Case-Smith, J: Common diagnosis in pediatric OT practice.

6. The OTR is assessing the muscle tone of a child with athetoid CP. In documenting the assessment results, the therapist would MOST likely describe the quality of the muscle tone as: A. Fluctuating B. Spastic C. Flaccid D. Rigid

(A) Interviews. Interviews provide "an opportunity for the parents to identify their values and priorities about the skills being evaluated by the therapist" (p.207). Open-ended questions are best for eliciting information about the family's feelings about the intervention.

6. Which of the following assessment methods would an OT practitioner MOST likely choose to learn about a family's values and priorities? A. Interview B. Skilled observation C. Inventory D. Standardized test

(B) Labeling and calendars. An external memory device uses environmental adaptations or structure to assist the person in remembering specific information. Examples include setting an alarm clock to wake up in the morning, labeling drawers according to contents, and using a log or calendar to keep track of events and activities. An internal memory device would be the use of internalized memory techniques to structure information. Examples would be rehearsal, visual imagery, mnemonics, or elaborating on the information.

60.An OT practitioner is working with a homemaker who sustained a mild head injury. The client frequently forgets appointments and wakes up late for work. The practitioner suggests the use of external memory devices. Examples of external memory devices that might assist this individual would be: A. Visual imagery and a diary B. Labeling and calendars C. Mnemonics and verbal cues D. Log and repetition

(A) Poor postural responses. Poor postural responses, such as poor balance and postural control against gravity, are often symptoms of an under-reactive vestibular system.

60.Development of a treatment plan for a child with an under reactive vestibular system would MOST likely include specific activities to address: a. Poor postural responses b. Discomfort with motion activities c. Anxiety when his or her feet are off the ground d. Gravitational insecurity

(D) Reinforcement of competence. According to Erikson, and 8-year-old is usually at the stage of industry versus inferiority, during which he or she develops a sense of competency. For a client who is expected to lost motor function gradually, a treatment plan that will provide him with an ongoing sense of competence (possibly in other areas) is especially relevant. See reference: Case-Smith (ed): Law, M, Missiuna, C, Pollock, N, and Stewart, D: Foundations of occupational therapy practice with children.

60.The OT practitioner is selecting activities for an 8-year-old child with Duchenne's muscular dystrophy. Which of the following developmental issues is MOST important to consider when identifying activities for this child? A. establishment of basic trust B. freedom to use his initiative C. development of self identity D. reinforcement of competence

(B) Play and self-care activities. "When providing OT care for children with terminal illness, the underlying principle is to add quality to their remaining days. There are 2 performance areas that OTs should address in children with terminal illness: (1) play activities and (2) ADL."

60.When providing occupational therapy for children who have been diagnosed with a terminal illness, the PRIMARY focus for OT intervention would be: a. educational activities b. play and self-care activities c. socialization activities d. motor activities

(A) "Pt. reports overall pain levels are lower and ability to perform ADL has improved," The subjective section of the discharge summary should indicate "whether the patient believes the goals set were achieved and whether the patient feels already to function at home" (p.35). See reference: Kettenbach: Writing subjective (s).

60.Which of the following is the BEST example of the subjective section of a discharge summary? A. "Pt. reports overall pain levels are lower and ability to perform ADL has improved." B. "Pt continues to c/o back pain with activity." C. "Pt. has improved from minimal assistance to independence in ADL performance." D. "My back hurts when I get in and out of the tub, and when I lift bags of groceries."

(C) Provide enjoyable activities in a safe and accepting environment. Children who learn to enjoy activities alone will be more likely to cooperate with peers in a group activity.

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

(A) Sequencing of picture symbols. A person needs to use picture symbols to indicate 2 or more part thought or sequence of activities. For example, pointing to pictures of a shoe and a closet would indicate the place to find a shoe in response to a question.

61.An individual learning to use an augmentative communication system has mastered the task of understanding picture symbols and their use. Next step would be: a. Sequencing of picture symbols b. Recognizing letters of the alphabet c. Recognizing whole words d. Spelling letter by letter

(D) "Pt. has improved significantly in his ability to work at the computer by using periodic stretch breaks." The assessment section of a discharge summary identifies the functional performance deficits and indicates whether they have been resolved or, if they still exist, to what degree. See reference: Kettenbach: Writing assessment (A).

61.An individual who has been receiving treatment for an overuse syndrome is about to be discharged. Which of the following is the BEST example of the assessment section of a discharge summary? A. "Pt. can work for up to 3 hours at the computer using periodic stretch breaks." B. "Pt. will take stretch breaks every 30 minutes when working at the computer." C. "Pt. reports being able to work at the computer much longer and more comfortably than initially." D. "Pt. has improved significantly in his ability to work at the computer by using periodic stretch breaks."

(D) chaining. Teaching a task one step at a time, gradually adding more steps as steps are mastered, is called chaining. Chaining is frequently used when teaching a multistep task because it is easier to learn one step at a time than it is to learn a complete activity. See reference: Zoltan: Executive functions.

61.Each morning, an OT practitioner performs ADL training with a teenage client who has quadriplegia. On the first day, the practitioner works with the client, arranging the shirt on the lap. When the client masters that particular skill, they work on sliding both arms into the sleeves and pushing the shirt up past the elbows. When this skill is mastered, they will work on gathering the shirt up at the collar and pulling it on over the head. This technique is BEST known as: A. Repetition B. Cueing C. Rehearsal D. Chaining

(D) State strengths and limitations regarding performance in the activity. Self-concept is defined as the value of one's physical and emotional self. Stating one's strengths and limitations about one's own performance is a reflection of an individual self-concept.

61.The goal for an adolescent with anorexia is to improve self-concept. Which component of a meal preparation activity BEST addresses this goal? a. Participate in a nutrition group and plan a healthy meal b. Develop a budget and shop for ingredients with three other group members c. Delegate tasks and prepare the meal with three other group members d. State strengths and limitations regarding performance in one activity

(D) Burn hand splints prevent stress on the tendons and ligaments, decreasing edema. Burn hand splints prevent stress on the superficial tendons and ligaments, decreasing edema secondary to the avoidance of dependent positioning. See reference: Neistadt and Crepeau (eds): River, EA, and Jordan, CL: Skin system dysfunction: Burns.

62.A OT practitioner is educating a family member whose sibling was admitted to the intensive care unit alter sustaining an inhalation injury and full-thickness dorsal hand burns while lighting a campfire. The family member does not understand why the client would benefit from hand splints. Which of the following would be the MOST appropriate response to the family member? A. Burn hand splints decrease pain and allow for active range of motion. B. Burn hand splints prevent hypertrophic scarring. C. Burn hand splints prevent the need for skin grafting. D. Burn hand splints prevent stress on the tendons and ligaments, decreasing edema

(A) Ballet. To promote the development of anticipatory control, movement should be slow, predictable and controlled from a stable base. Participate in a dance class would involve controlled movement from a stable base

62.A child with poor anticipatory postural control demonstrates inadequate playground skills, losing her balance when trying to anticipate movement. Which of the following activities will BEST promote the development of these skills? A. Ballet B. Soccer C. Basketball D. Ping-pong

(A) Complete independence with self-care and transfers. An individual with T4 paraplegia will have sufficient trunk balance and UE strength and coordination to complete self-care and transfers independently.

62.In establishing long term goals for an individual with T4 paraplegia in a rehabilitation setting, the OT practitioner would MOST likely predict that the patient will attain what level of independent with bathing, dressing, and transfers? a. complete independence with self-care and transfers b. independence with self-care and minimal assistance with transfers c. minimal assistance with self-care and moderate assistance with transfers d. dependence with both self-care and transfers

(B) mounting a safety rail next to the toilet. In order to sit independently on the toilet and relax sufficiently to control muscles needed for elimination, the child has to feel posturally secure. Safety rails next to the toilet, low toilets that allow the child to put both feet on the ground, and reducer rings to decrease the size of a toilet seat all help to provide maximal stability for the child with unstable posture. See reference: Case-Smith (ed): Shepherd, J: Self-care and adaptations for independent living.

62.When preparing a home program with the goal of independent toileting for a young child with postural instability, the MOST important adaptation the OT practitioner can recommend is: A. Replacing zippers and button with velcro closures B. Mounting a safety rail next to the toilet C. Introducing toilet paper tongs D. placing a colourful "target" in the toilet bowl

(A) Getting dressed without becoming fatigued. Prevention of fatigue is the primary purpose of energy conversation. Energy conservation techniques may often result in slower, not faster (answer D), performance.

62.Which of the following activities would BEST represent an expected outcome for an individual who completes an energy conservation program? a. Getting dressed without becoming fatigued b. Lifting heavy cookware without pain c. Doing handicrafts without damaging his or her joints d. Dusting and vacuuming more quickly

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

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

(B) Hammering a nail into a piece of wood. Hammering a nail into a piece of wood requires the individual to stabilize the object against the palm and fingers while the thumb is positioned to perform as an opposing force.

63.An OT practitioner is simulating cylindrical grasping activities with a client who desires to work on the skills necessary to be a carpenter. Which if the ff. activities would MOST likely address these needs? A. Positioning a nail on a piece of wood B. Hammering a nail into a piece of wood C. Carrying a pail of bolts D. Unscrewing a lunchbox thermos

(A) Drawing a picture titled "This is me". Children who have trouble expressing their emotions verbally are sometimes able to express their feelings in open-ended drawing activities. Among the answers given, answer A is the only projective activity.

63.An OT practitioner is working with a withdrawn child whose occupational therapy objectives include increasing the ability to express feelings and conflicts. Which of the following activities will MOST effectively promote this skill? a. Drawing a picture titled "This is me" b. Playing adapted soccer with a large ball c. Playing structured board game, such as Monopoly d. Singing folk songs in a group

(A) Transferring on and off a commode seat. The patient will most likely utilize a walker to transfer on and off a commode seat. In this case, the assistive device (the walker) will permit the patient to adhere to the mandated toe touch precautions, while providing balance, decreasing pain and encouraging safe transfers. See reference: Bernstein (ed): Bernstein Lewis, C and Daleiden, S: Clinical implications of neurologic changes in the aging process.

63.An elderly man was admitted to the hospital after a car accident. He sustained a right pelvic fracture and verbalizes extreme pain with ambulation. The orthopaedic doctor has recommended that the patient perform "toe touch only" weight bearing on his right foot for 6 to 8 weeks. The OT should instruct the patient to use a walker when performing which of the following activities? A. Transferring on and off a commode seat B. Working in bed mobility C. Performing self-feeding D. Working on distal lower extremity dressing

(D) Chaining. Teaching a task one step at a time, gradually adding more steps as steps are mastered, is called chaining. Chaining is frequently used when teaching a multistep task because it is easier to learn on step at a time than it is to learn a complete activity. See reference: Zoltan: Executive functions.

63.Each morning, an OT practitioner performs ADL training with a teenage client who has quadriplegia. On the first day, the practitioner works with the client, arranging the shirt on the lap. When the client masters that particular skill, they work on sliding both arms into the sleeves and pushing the shirt up past the elbows. When this skill is mastered, they will work on gathering the shirt up as the collar and pulling it on over the head. This technique is BEST known as: A. Repetition B. Cueing C. Rehearsal D. Chaining

(B) Catching and bursting a soap bubbles. This activity involves visually tracking a slow-moving target and requires minimal fine motor precision to accomplish as successful "hit." See reference: Case-Smith (ed): Dubois, SA: Preschool services.

64.A preschooler has poor visual tracking skills, which affect her performance on tasks requiring eye-hand coordination. Which of the following activities is most appropriate for the OT practitioner to recommend to the child's parent's in order to promote beginning visual tracking skills during summer vacation? A. Tossing and catching a water balloon B. Catching and bursting soap bubbles C. Throwing and catching a beach ball D. Playing softball

(C) Texture of the cords she will be using. Coarse materials like jute may shred and give splinters or injure the skin on hands and fingers. This is particularly important for individuals with diabetes who frequently have poor sensation and circulation in their extremities. Skin damage must be avoided since healing is compromised.

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

(A) Monitor the individual's response to activity levels that are too high and unsafe. Denial is a common defense mechanism is (individuals with) coronary artery disease because of the vague characteristics of symptoms and the hidden nature of the disability. At times, denial is considered a healthy response, and health professionals must be careful not to strip the patient of this coping mechanism by forcing the patient to face reality. See reference: Pedretti (ed): Matthewss, MM, Foderaro, D, and O'Leary, S: Cardiac dysfunction.

64.Following a heart attack, an individual report to the OT practitioner that his wife overreacted and that there is really nothing wrong with him. The nurse reports poor compliance with cardiac precautions. Which of the following is the MOST important action for the OT practitioner to take? A. Monitor the individual's response to activities to prevent him from performing at activity levels that are too high and unsafe. B. Instruct the individual in energy conservation techniques to minimize energy expenditure. C. Emphasize the consequences of not observing cardiac precautions and provide concrete proof of the myocardial infarction (MI) to the individual. D. Refer to the individual for psychological services

(A) Increasing self-awareness through expressive activities. Increasing self-awareness would be an initial goal area because people with eating disorders are often out-of-touch with their bodies as well as their psychological and social needs. Expressive activities address psychosocial needs to increase self-awareness by providing opportunities for emotional self-expression and self-assertion.

64.When planning treatment for individual diagnosed with eating disorders the OT practitioner's initial OT treatment goals would MOST likely address: A. Increasing self-awareness through expressive activities. B. Increasing awareness of nutritional issues. C. Improving school performance skills. D. Making recommendations or referrals for family therapy.

(C) Biomechanical. According to Colangelo, "The biomechanical FOR is applied when a person cannot maintain posture through appropriate automatic muscle activity because of neuromuscular or musculoskeletal dysfunction." This child's physical status has changed with decreasing postural control. Adaptive support devices need to be considered, and a biomechanical FOR provides this approach.

65.A fifth grade child with significantly low muscle tone caused by Duchenne's muscular dystrophy is losing trunk control in sitting. Which of the following frames of reference should the OT practitioner consider when reevaluating the treatment program? A. Neurodevelopmental treatment B. Sensory integration C. Biomechanical D. Visual perceptual

(C) By learning to use a sliding board with car transfers. Using a sliding board with all functional transfers is the primary way to educate a client with paraplegia to perform independent car transfers. See reference: Pedretti (ed): Adler, C, and Tipton-Burton, M: Wheelchair assessment and trasnfers.

65.A middle-aged client with paraplegia is learning to perform wheelchair to car transfers with an OT practitioner. Which is the BEST way for the OTR to recommend independent car transfers? A. By teaching a family member to assist with all car transfers B. By teaching the client to use public transportation in place of practicing car transfers C. By learning to use a sliding board with car transfers D. By learning to use tenodesis functions when transferring to the car

(C) CARF. The Commission on Accreditation of Rehabilitation Facilities (CARF) is the regulatory agency for the provision of rehabilitation services. See reference: Neistadt and Crepeau (eds): Bailey, DM: Legislative and reimbursement influences on occupational therapy: Changing opportunities.

65.An OT manager is preparing the outpatient OT staff for a visit from an accrediting agency. The accrediting agency that surveys inpatient and comprehensive outpatient rehabilitation programs is BEST represented by which of the following; A. AOTA B. JCAHO C. CARF D. NBCOT

(C) Wrist splints to promote development of tenodesis. Hand splinting to promote tenodesis is implemented in the acute phase of rehabilitation. A tenodesis grasp is developed by allowing the finger flexors to shorten. The person is then able to achieve a functional grasp by extending the wrist. This improves the ability of an individual with a C6 or C7 SCI to grasp and hold objects.

65.An individual with a C6 spinal cord injury has been referred to OT two days‟ post injury. Immobilized with a Halo brace, the individual demonstrates fair plus wrist extension and poor minus finger flexion. Which of the following interventions should be implemented FIRST? a. Volar resting pan splints to prevent flexion contractures b. Wrist support with universal cuff to promote independence c. Wrist splints to promote development of tenodesis d. Instruction in bed mobility techniques to prevent decubiti

(D) Reinforcement of competence. According to Erikson, an 8-year-old is usually at the stage of industry versus inferiority, during which he or she develops a sense of competency. For a client who is expected to lose motor function gradually, a treatment plan that will provide him with an ongoing sense of competence (possibly in other areas) is especially relevant.

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

(D) "The child will correctly identify, by feel only, 5 out of 5 common objects". Identifying an object by touch is termed "stereognosis" or "identification of solids". Stereognosis is a tactile discrimination of skill needed for the development of fine hand manipulation.

66.A child's long-term goal is to increase fine motor skills. The assessment has revealed a deficit in tactile discrimination, specifically stereognosis. The MOST relevant short-term goal would be: A. "The child will correctly identify five out of five finger touched when given tactile stimulus." B. "The child will correctly identify five out of five shapes drawn on the dorsum of her hand." C. "The child will correctly identify five out of five matching textures." D. "The child will correctly identify, by feel only, five out of five common objects."

(B) "Scoot forward to the edge of the wheelchair." When the therapist a\has the individual scoot forward the edge of the wheelchair, this helps the individual position the body over the feet and causes the weight to shift forward during a transfer. The individual position the body over the feet and causes the weight to shift forward during a transfer. The individual is much easier to transfer when the weight is shifted forward. See reference: Palmer and Toms: Body mechanics and guarding techniques.

66.An OT practitioner is assisting an individual with mild hemiparesis in transferring from the wheelchair to a mat table using a stand pivot transfer technique. The FIRST verbal cue the OT gives to the individual is: A. "Stand up." B. "Scoot forward to the edge of the wheelchair." C. „Unfasten the wheelchair brakes." D. "Position the wheelchair so that it directly faces the mat table."

(A) Prevent loss of joint and skin mobility. During the acute stage, when burn wounds are partial or full thickness in nature, maintenance of joint range of motion and skin mobility is the primary goal of intervention. See reference: Pedretti (ed): Jordan, CL, and Allely, RR: Burns and burn rehabilitation.

66.An individual has sustained a large, full thickness burn to both upper extremities while running a fireworks display. The client is in the acute care phase of treatment. Which of the following BEST represents an acute care rehabilitation goal? A. Prevent loss of joint and skin mobility B. Provide adaptive equipment C. Provide compression and vascular support garments D. Prevent scar hypertrophy through scar management techniques

(C) Games of chance. Because winning a game of chance is based essentially on luck. Individuals functioning at various functional levels have "equal" opportunities to win.

66.The OT practitioner working in partial hospitalization program needs to select a game that allows group members equal opportunities to win and can be played by individuals functioning at various levels. The game type the BEST suits this purpose is: a. games of strategy b. hobbies c. games of chance d. competitive games

(C) Biomechanical. The biomechanical approach uses voluntary muscle control during performance of activities for people with deficits in strength, endurance, or range of motion. The biomechanical approach focuses on decreasing deficits in order to improve performance of daily activities. See reference: Trombly (ed): Zemke, R: Remediating biomechanical and physiological impairments of motor performance

67.An OT practitioner applies weights to the wrists of a woman who is making a macramé planter to improve strength in her shoulder. The MOST accurate description of this treatment approach is: A. Neurophysiological B. Neurodevelopmental C. Biomechanical D. Rehabilitative

(D) During 1 to 2 conversations with female group members, the client will make eye contact for 8 to 10 seconds, two times in each half-hour socialization group. The short-term goal that describes appropriate verbal and nonverbal interactions with female peers is the best answer.

67.An OT practitioner is working with a man diagnosed with schizophrenia. He states that his main goal is to have a girlfriend. Which of the following statements is the MOST appropriate example of a short term goal? a. The client will develop a friendship with a female within 6 months b. After each group session, the client will identify the ways in which his disability has interfered with his thinking processes. c. The client will initiate appropriate, casual greetings when beginning casual conversations with female staff. d. During one to two conversations with female group members, the client will make eye contact for 8 to 10 seconds, two times in each half-hour socialization group.

(D) Each member will remain in the group without disrupting the work of others for 15 minutes. Parallel groups are most appropriate for people who do not have the ability to interact successfully with other group members. Participants in parallel groups are involved individual task that require minimal, if any, interaction. Therefore, appropriate expectations for parallel groups focus on remaining in the group and working alongside others.

67.An OT practitioner is working with three individuals in a cooking group. The individuals demonstrate difficulty attending to task, frequently ask to leave the room, and do not interact with each other. Based on the developmental group concept, which of the following is the MOST appropriate goal for this group? a. Each member will take a leadership role within the session b. Members will share materials with at least one other group member c. Each member will express two positive feelings about themselves with in the group session d. Each member will remain in the group without disrupting the work of others for 15 minutes

(C) Avoid having these individuals in close proximity to others to reduce opportunities for physical contact. Avoiding close proximity situations is the recommended environmental modification for sexual acting-out behaviors.

67.Staff members in a group home report to the OT practitioner that several of the men repeatedly try to touch female clients and staff and often make sexual gestures and comments. Which of the following environmental modifications would be MOST likely to reduce this behavior? A. Provide a relatively active and stimulating environment with opportunities for these individuals to engage in real-life activities. B. Stand to the side of these individuals instead of face to face during interactions with them C. Avoid having these individuals in close proximity to others to reduce opportunities for physical contact D. Advise these individuals in a calm, nonjudgmental manner about the behavior you expect

(B) rinse the eye with an eye wash or water immediately. It is necessary to immediately wash the eye because the "backwash" fluid in the IV is unidentifiable body fluid and universal precautions should be followed. It is recommended to flush an exposed area with warm water or normal saline immediately. See reference: Occupational Safety and Health Administration: Standard #1910, 1030, 1 FR 5507, February 13, 1996.

67.The OT is working with a patient on an acute care floor when the patient's IV equipment disengages, splashing the therapist in the eye with the medication and IV "backwash" fluid. The therapist's FIRST response should be to: A. Rub the eye and continue treatment B. Rinse the eye with an eye wash or water immediately C. Write an incident report D. Cover the eye with a bandage and contact the immediate supervisor

(C) Radial nerve. Injury to the radial in the wrist area causes sensory damage only. This damage occurs to the radial two thirds of the dorsum of the hand.

7. An OT practitioner is evaluating a young cabinet maker who complains of sensory changes over the dorsal thumb and proximal phalanx of the index, long, and half of the ring finger. The practitioner will MOST likely suspect involvement of the: a. ulnar nerve b. median nerve c. radial nerve d. brachial plexus

(D) Sensory compensation. When protective sensation is severely decreased or absent, the primary focus of intervention becomes protection of the insensate part through educational methods to increase awareness of potential injury dangers, teach safety procedures, and train in the use of vision to compensate for sensory loss.

68.A person with peripheral neuropathy exhibits loss of pinprick, light touch, pressure and temperature sensation. The most appropriate form of intervention to address this type of sensory loss would be a program of: a. sensory re-education b. sensory desensitization c. sensory bombardment d. sensory compensation

(B) Folding laundry and putting it in a basket while standing. Work-hardening programs prepare individuals to return to work by combining work simulation, strengthening, and behavioral components. A cashier stands during the job: removes clothing from hangers; folds it; puts it in a bag; runs price tags through a scanner; and operates a cash register and makes change.

68.An individual who previously worked as a cashier in a clothing store has been referred to a work-hardening program following knee surgery. Limitations are present in standing tolerance and balance. The activity that will BEST prepare this individual to return to work is: A. Moving piles of clothing from one end of the clinic to the other B. Folding laundry and putting it in a basket while standing C. Washing dishes while standing D. Putting price tags on clothing while sitting

(B) A call system for emergency and nonemergency use. A call system for emergency and nonemergency use. A call system is necessary for a person with a high-level spinal cord injury to allow the caretaker to leave the room, but remains available to answer the person's call for assistance for daily needs or an emergency. This is frequently the first opportunity that a person with a spinal cord injury would have to control some part of his or her life, giving some feeling of independence in operating appliances, lights, and so on through the use of switches or voice control but would not be necessity for safety. A remote control power door opener that would allow a caretaker to enter would be useless if the person is unable to call for assistance. An electric page turner is useless without the ability to call for someone to position or replace reading material. See reference: Trombly (ed): Dow, PW, and Rees, NP: High-technology adaptations to overcome disability.

68.An individual with a high-level SCI is returning home. Which type of adaptive technology would the client MOST likely require to ensure safety in the home? A. An environment control unit (ECU) B. A call system for emergency and nonemergency use C. A remote control power door opener D. An electric page turner

(B) show acceptance and understanding to the individual. Paraphrasing is used to clarify and relay acceptance of what an individual has communicated. The OT practitioner paraphrases by repeating in her or his own words what the client has said. See reference: Denton: Treatment planning and implementation.

68.During an interview, the OT practitioner decides to respond to an individual by paraphrasing. The PRIMARY reason for this type of response is to: A. Refocus or redirect the individual's comments B. Show acceptance and understanding to the individual C. Force the individual to make a choice D. Encourage an individual to give additional information

(D) Interdisciplinary care improvement teams. Health care professionals who are part of an interdisciplinary care improvement team work together to "address such issues as patient flow, the discharge process, patient outreach and promotion and cost-efficiencies" (p.47). See reference: Jacobs and Logigian (eds): Logigian, MK: Cost management.

69.An OT manager is attempting to find a way to have financial success in the department while ensuring patient satisfaction. Which of the following is MOST likely to be implemented to assess patient flow, develop critical pathways, and cut costs? A. Quality improvement B. Peer review teams C. Cost accounting D. Interdisciplinary care improvement teams

(C) Multisensory input. Each of the possible 4 answers describes appropriate treatment interventions for infants in the NICU. However, an infant approaching full term or post term is now equipped with a maturing sensory system tolerant and in demand of a multisensory diet including oral stimulation, vestibular input, and auditory and visual orientation, to assist with age-appropriate motor and behavioral skill acquisition. It is often found that these very premature infants are limited in the amount of social interaction and appropriate sensory stimuli because of necessary medical equipment and procedures: e.g., ventilators, IV catheters, isolettes, warmers, bililights, and nasogastric tubing. Therefore, stable, growing post-term premature infants would most benefit from a multisensory diet, answer C, to best meet the demands of their maturing sensory system and capitalize and their socialization skills. Answers A, B, and D are all possible treatments for the 32 to 35-week-old infant who responds best to unimodal sensory input and minimal direct intervention, e.g., ROM and positioning, because of immature sensory systems and compromised respiratory systems.

69.An infant born 15 weeks prematurely has a history of multiple medical issues including retinopathy of prematurity, mechanical ventilation for 5 weeks, and a poor feeding skills. The infant is now a 43-week-old, medically stable and engaging infant, with a G-tube and oxygen supplement of 2 liters by nasal cannula. Which of the following is the MOST appropriate intervention to pursue at this time? a. Positioning and handling b. PROM of all extremities c. Multisensory input d. Music therapy

(D) Has good UE range of motion but difficulty accessing small targets. A large keyboard would be best for someone who has good range of motion but difficulty accessing small targets. A person with limited range of motion but adequate fine coordination. See reference: Pedretti (ed): Cook, AM, and hussy, SM: Electronic assistive technologies in OT practice.

69.To improve written communication, an OT practitioner would be MOST likely to recommend a large keyboard to enhance computer access when the client: A. Has limited UE range of motion but adequate fine coordination B. Fatigues rapidly when reaching for the keys C. Uses only one hand to access the keyboard D. Has good UE range of motion but difficulty accessing small targets

(A) Shoulder flexion and protraction. Answer A is correct because the infant changes from extensor influences on posture to development of flexion in the supine position. This requires the ability to flex and protract the shoulders against gravity in order to reach forward and upward to grasp toys. See reference: Kramer and Hinojosa (eds): Colangelo, CA: Biomechanical frame of reference.

7. An OT practitioner positions and places attractive toy overhead to provide an opportunity to work against gravity. This position is MOST effective for developing which ability? A. Shoulder flexion and protraction B. Shoulder extension and retraction C. Development of head control D. Development of trunk control

(B) Assessment of UE function in ADL, work, and leisure activities. Assessment of UE function in ADL, work, and leisure activities is evaluated both through the involved and uninvolved extremity.

7. An OT practitioner works on the trauma unit of a hospital and often sees patients with trauma and disease of the upper extremity musculoskeletal system that can impact their motor control function. Assessment of motor control MOST likely include: A. Evaluation of developmental factors. B. Assessment of upper extremity functions in ADL, work and leisure activities. C. Evaluation of pain, postural control and alignment. D. Assessment of self-concept and self-awareness.

(B) An activity exploring leisure opportunities and problems. In the process of making choices about activities, the first step is developing awareness and knowledge. OT practitioners "... assist the clients in developing awareness of options and limits."

70.After administering an interest checklist, the therapist documents that the individual has identified a few solitary leisure interest and no interests involving social interaction. Based on this information, what is the BEST activity to use in the next session of a leisure counseling group? A. A leisure inventory assessment B. An activity exploring leisure opportunities and problems C. A magazine picture collage D. A calendar of community leisure activities for the first week after discharge

(D) A volar resting splint. A volar resting splint is indicated for acute synovitis of the wrist, fingers and thumb.

70.An OT practitioner is fabricating a splint for a client who has rheumatoid arthritis. Which of the following splints is MOST appropriate for the purpose of resting the joint, decreasing of pain, and preventing contractures? a. a protective MP joint splint b. a wrist stabilization splint c. an ulnar drift positioning splint d. a volar resting splint

(B) A noise machine producing white noise at bedtime. For a child who is easily aroused, a constant, monotonous auditory input can be calming to the degree of inducing sleep. The other answers may actually increase arousal.

70.During an evaluation, you learn that a young child is easily aroused because of a sensory-processing disorder. Which environmental adaptation would be MOST effective in assisting this individual to fall asleep? a. A mini-trampoline in the bedroom to tire the child out before going to bed b. A noise machine producing white noise at bedtime c. A lightweight, fuzzy blanket, providing light touch d. Shutters on the windows to produce total darkness

(B) increase physical activity and fitness. Wellness programs focus on developing personal control of behaviors through educational approaches and active participation in activities that promote health, such as increasing level of physical activity to improve physical fitness. See reference: Cottrell (ed): Swabrick, P: A wellness model for an acute psychiatric setting

70.In establishing a wellness program for older adults, the OT practitioner is MOST likely to incorporate activities that: A. Improve weakness following CVA B. Increase physical activity and fitness C. Improve social skills for depressed elders D. Increase independent performance of transfers

(C) Get the shirt all the way on, then line up the buttons and holes and begin buttoning from the bottom. It is easier to see the buttons and buttonholes at the bottom of the shirt than at the top. See reference: Pedretti (ed): Foti, D, Pedretti, LW, and Lilli, S: Activities of daily living.

70.The BEST way to instruct a n individual with hemiparesis to button a shirt is to: A. Button all the buttons before putting the shirt on B. Get the shirt all the way on, then line up the buttons and holes and begin buttoning from the top C. Get the shirt all the way on, then line up the buttons and holes and begin buttoning from the bottom D. Use a buttonhook with a built-up handle

(B) Concentration. This game requires the player to remember visual cues.

71.A deficit in visual memory is affecting a child's reading skills. Which would be the BEST game to promote visual memory? a. Dominoes b. Concentration c. Pickup sticks d. Checkers

(B) Visual attention skills. According to Todd, answer B is correct because development of visual attention skills should be worked on first because they prepare and provide foundation skills for other aspects of visual perception.

71.An OT practitioner is using a visual perceptual frame of reference. Which of the following would be the FIRST step in planning a program for a child with visual perceptual problems? a. Visual memory skills b. Visual attention skills c. General visual discrimination skills d. Specific visual discrimination skills

(B) Sip-and-puff switch. A sip-and-puff switch allows control through respiration: blowing air into and sucking air out of a straw positioned in front of the mouth activates the switch. This method would be particularly appropriate for a client with no functional movements. See reference: Neistadt and Crepeau (eds): Bain, BK: Assistive technology in OT.

71.An OT practitioner is working with a patient with a high-level spinal cord injury who has no functional movements to determine the best method of input access for a powered wheelchair. The MOST likely recommendation for this patient to activate the wheelchair would be to use a: A. Joystick B. Sip-and-puff switch C. Single-switch digital control D. Mouth stick

(B) Developing vocational interests, social skills, and community mobility skills. Answer B is correct because these skills are essential in functioning in the environment after school.

71.An adolescent with mental retardation is planning to enter a supported employment program in the community after leaving school. Which area of intervention would the OT practitioner be MOST likely to focus on? A. Developing the student's leisure interests and play skills B. Developing the student's vocational interests, social skills, and community mobility skills C. Facilitating development of the student's gross motor skills D. Facilitating development of the student's fine motor skills

(C) "I'm just too tired." One of the main symptoms of severe depression is decreased energy, therefore, the response of "I'm too tired" indicates fatigue. See reference: Bonder: Mental disorders.

71.In an acute mental health, an individual refuses to participate in OT activities, and the therapist notes the refusal in the subjective section of a documentation note. Which form of refusal would MOST likely reflect acute depression? A. "I had an argument with another group member and I'm too angry." B. "I don't want to participate because I don't know how to do the activity." C. "I'm just too tired." D. "I'm waiting for my visitors to come."

(B) have at least 1 year of experience as a certified OT practitioner. An individual who passes the NBCOT examination becomes a certified OT practitioner. In order to be a primary supervisor for a level-II OT student, the individual must be a registered OT with at least 1 year of experience. To supervisor level-II OTA students, the individual must be a certified OT practitioner at least 1 year of experience. There is no minimum experience requirement for supervising level-I students. See reference: AOTA: Standards for an accredited educational program for the occupational therapist.

72.An OT manager in a large department is trying to determine which staff will be able to supervise level-II fieldwork students in the upcoming months. OT practitioners may only be selected to be primary student supervisors if they: A. Are certified OT practitioners with at least 6 months of experience B. Have at least 1 year of experience as a certified OT practitioner. C. Are certified by the NBCOT D. Have supervised a level-I student before the level-II student

(A) Elevate the arm on pillows so it rests higher than the heart. Elevation, contrast baths, retrograde massage, pressurewraps, and active range of motion are effective methods for managing edema. When massaging an edematous extremity, stroking should be performed from the distal area to the proximal, not the reverse. See reference: Pedretti (ed): Kasch, MC: Hand injuries.

72.An OT practitioner making a bedside visit finds her patient poorly positioned with an edematous upper extremity caught between the mattress and the bed rail. The MOST appropriate intervention to address the edema in the upper extremity is to: A. Elevate the arm on pillows so it rests higher than the heart B. Massage the arm gently, stroking toward the fingers C. Instruct him to avoid active range of motion D. Instruct him to avoid PROM

(C) Modify the environment to protect the infant from excessive and/or inappropriate sensory stimulation prior to direct intervention. Neonatal Abstinence Score (NAS) infants have multiple sensory needs often resulting in poor self-regulation and behavioral organization. Answers C and D both incorporate SI approaches; however, answer C best demonstrates an initial intervention to promote neurobehavioral organization required to tolerate direct handling. Answers A and B are important in determining appropriate treatment plans for the infant and family. However, a social work referral should be made after initial assessments are completed, to make the most appropriate recommendations for social service involvement if needed. Although identifying maternal medical status and treatment compliance issues are of great importance for an OT to best determine educational and disposition recommendations, it is not the OT's primary sensory intervention focus.

72.An OT receives a consult for an infant in the neonatal intensive care unit (NICU) with a history of maternal drug abuse during pregnancy. Using a sensory integrative approach, what is the FIRST action the OT should take? a. Determine the mother's current medical status, parental involvement and support systems. b. Recommend a social work referral to address social concerns, provide emotional support and community program information and make a referral to the department of human services. c. Modify the environment to protect the infant from excessive and/or inappropriate sensory stimulation prior to direct intervention. d. Assess motor and behavioral skills to identify areas of developmental delay in order to educate family and medical staff of necessary positional and environmental strategies for skill acquisition

(D) Slicing a prepared roll of sugar cookies at room temperature and placing them on tray using a spatula. This answer describes the lowest level of physical exertion and may be completed within the time frame designated by the therapist. The sugar cookie dough would be soft enough to provide minimal resistance without causing immediate fatigue. In addition, the activity provides for isotonic contractions during the repetitive grasp and release of the knife and the spatula. While muffin and cake better provide the least amount of resistance, the hand is using sustained isometric grasp on the electric or hand-powered mixer, which combined with the minimal resistance of the batter and mixer weight is fatiguing. The chocolate chip cookie dough is resistive whether it is warm or cold and to maintain an isometric grasp while mixing with a spatula or scooping with an ice cream scooper would cause the individual to fatigue before the activity is finished. If the individual becomes fatigued while performing any of the activities, only the sugar cookies or the chocolate chip cookies would allow the individual time to rest without affecting the final product.

72.An individual with weak grip strength and poor endurance wishes to bake something for family member's birthday. The OTR wants to plan an activity during which a client can work on grasp/release for 5 minutes without becoming exhausted. The MOST appropriate activity for both purposes would be: a. Mixing blueberry muffins from scratch using a hand powered mixer and scooping them into muffin tins with a cup b. Mixing an angel food cake from a box mix using an electric mixer and pouring into a pan c. Mixing cold chocolate cookie dough using a spatula with a built-up handle and dropping dollops onto a tray using an ice cream scoop d. Slicing a prepared roll of sugar cookies at room temperature and placing them on a tray using a spatula

(C) Instructing caregivers in task breakdown. Instructing the caregivers in task breakdown, or breaking down tasks into simple steps and then providing step-by-step instructions, will allow the client to perform activities as capabilities decline.

74.The home health OT practitioner is seeing a client in the middle stages of Alzheimer's disease. The family is very concerned that the client's memory loss is now interfering with performance of daily activities, even familiar self-care activities. The MOST relevant OT intervention at this point would be: a. memory retraining activities for the client b. ADL retraining program for the client c. instructing caregivers in task breakdown d. leisure activity planning

(B) Wear noisy bracelets on the wrist or ankle as a reminder to visually scan toward the affected side. Although hazards may be removed from the environment, or padded to prevent injury to an individual, use of these interventions is only feasible in a person's home. It is best to teach the individual visual scanning of the affected area and the environment, a technique that the person may use anywhere. An individual may avoid using sharp tools or extreme water temperature, but this is avoidance does not teach him or her how to monitor the affected side visually, because it is a precaution that addresses only the problem with sensation. Noisy bracelets are one technique that may be used to accomplish compensation for both unilateral neglect and absence of sensation. Visual impairments that are not accompanied by sensory or perceptual deficits are more readily overcome with retraining.

72.The MOST effective method of compensation for both unilateral neglect and absence of sensation in an upper extremity with good motor control is to: A. Avoid the use of sharp tools or scissors and to avoid extreme water temperatures. B. Wear noisy bracelets on the writs or ankle as a reminder to visually scan toward the affected side. C. Use an electric shaver. D. Wear elbow pads on the affected side.

(D) A weighted pen and weighted wrists. Weighting body parts and utensils (or writing tools) are effective for individuals with ataxia in improving control during performance of a task.

73.A client who is s/p traumatic brain injury (TBI) exhibits good strength with ataxia in both upper extremities. The writing adaptation that would be MOST appropriate in compensating for the patient's deficit areas would be: A. Using a keyboard B. A universal cuff with pencil-holder attachment C. Using a balanced forearm orthosis with built-up felt-tip pen D. A weighted pen and weighted wrists

(D) Position the patient so she is facing a blank wall. One way to modify the environment for an individual who is easily distracted is to position him or her facing a blank wall (answer D), thereby lessening possible distracters.

73.After one session with a new patient in a psychosocial treatment setting, it has become apparent that the patient is highly distractible and cannot complete a magazine collage in a group. The BEST approach for the OT practitioner to take is to: a. speak slowly and softly to the patient b. coax and praise the patient until she completes the task c. ask the rest of the group member to stop talking d. position the patient so she is facing a blank wall

(A) repetition, high force, and awkward joint postures. Repetition, high force, and awkward joint postures are work-related risk factors that are frequently associated with cumulative trauma disorders. See reference: Pedretti (ed): Kasch, MC: Hand injuries.

73.An OT practitioner is educating a client with a cumulative trauma disorder about common work related risk factors. The OTR explains to the client that many of the PRIMARY risk factors are: A. Repetition, high force and awkward joint postures B. Progressive resistive exercise, joint mobilization and weight bearing C. Inflammation, swelling, and pain D. Fatigue, muscle cramps and paresthesias

(B) Explain to the patient and caregiver that one must be "homebound" In order to be eligible for home care services. In order to be eligible for home care services, the patient must be confined to home, a condition referred to as homebound. The patient need not be bedridden, but leaving the residence must require a considerable or taxing effort. Absences from the home are permitted but must be infrequent in nature, short in duration, or for the purpose of receiving medical treatment. Given that this patient is able to leave the home for a social visit and tolerate riding in a car for 30 minutes, he is not considered homebound. See reference: Fiersol and Ehrlich (eds): Zahoransky, M. the system and its okayers.

73.An individual covered by Medicare who has been receiving OT and PT in the home is now able to transfer in and out of the car with supervision of a caregiver. The individual has visited friend who lives 30 minute away. OT services are still required to improve mobility, upper extremity function, and home management skills. Which of the following actions should the OT practitioner take FIRST? A. Provide a home program and discharge the patient B. Explain to the patient and caregiver that one must be "homebound" in order to be eligible for home care services C. Refer the patient for outpatient therapy and provide a comprehensive discharge summary to the outpatient setting D. Communicate with the PT and inform her of the patient's status

(D) A raised-bed garden. The individual which back pain must avoid activities that stress the lumbar spine such as "prolonged static postures with a flexed lumbar spine, repetitive bending with a flexed spine, and lifting and carrying when the normal lumbar curve is not maintained" (p.723). See reference: Pedretti (ed): Smithline, JR. Low bak pain.

74.A student OT practitioner needs to design an adaptation and decides to focus on gardening for a client with a back injury. The MOST appropriate adaptation for him to design would be: A. Ergonomically correct hand tools B. A wheelbarrow with elongated handles C. A 12-inch-high eat with tool holders D. A raised-bed garden

(D) (1) gather shirt up at the back of the neck; (2) pull gathered back fabric off over head; (3) remove shirt from unaffected arm; and (4) remove shirt from affected arm. Answers A, B, and C are examples of incorrect sequences that would result in failure to remove the shirt successfully.

74.An OT practitioner is instructing an individual with left hemiplegia how to remove a t-shirt. The correct sequence is: a. (1) remove shirt from unaffected arm; (2) remove shirt from affected arm; (3) gather shirt up at the back of the neck; and (4) pull gathered back fabric off over head. b. (1) remove shirt from affected arm; (2) remove shirt from unaffected arm; (3) gather shirt up at the back of the neck; and (4) pull gathered back fabric off over head. c. (1) gather shirt up at the back of the neck; (2) pull gathered back fabric off over head; (3) remove shirt from affected arm; and (4) remove shirt from unaffected arm. d. (1) gather shirt up at the back of the neck; (2) pull gathered back fabric over head; (3) remove shirt from unaffected arm; and (4) remove shirt from affected arm.

(A) Use disposable cotton swabs and have clients bring their own cosmetics. Universal precautions are related to the prevention of the spread of infection. Using disposable cotton swabs and having clients use their own cosmetics would be effective in reducing the risk of infection. See reference: Early: Safety technique.

74.The OT practitioner is leading a grooming group for female clients in a psychosocial treatment setting. Which of the following options BEST complies with universal precautions? A. Use disposable cotton swabs and have clients bring their own cosmetics B. Use disposable gloves when combing client's hair C. Wash and dry makeup brushes between uses D. Avoid bringing cosmetics in glass containers to the group

(C) Provide lateral trunk support. A lateral trunk support in the frontal plane stabilizes the side, helping to maintain correct alignment of the pelvis and trunk in the chair by counteracting the twisting, effect of asymmetrical muscle tone. By providing upper extremity support, the lateral trunk support would also prevent improper loading onto an unstable shoulder joint. See reference: Neistadt and Crepeau (eds): Dutton, R: Treatment of performance components.

75.An OT practitioner in working on keyboarding activities with a client with asymmetrical muscle tone who keeps falling to the side while sitting in a wheelchair. What is the MOST appropriate wheelchair adaptation the practitioner can use to stabilize the upper body in a midline position? A. Change to a reclining wheelchair B. Use an arm trough C. Provide lateral trunk support D. Provide lateral pelvic support

(B) Assisted stand pivot transfer. An assisted stand pivot transfer is implemented when the client assists with the transfer.

75.An OT practitioner is transferring a client with hemiplegia from a wheelchair to an elevated mat. The client is able to place both feet on the floor and move the buttocks to the edge of the wheelchair. The therapist then places one hand on the client's right anterior pelvis and the other hand on the client's left shoulder. The client is set up so the transfer can be performed toward the client's stronger side. The client then pushes to a standing position and pivots with the therapist's guidance. This is most likely an example of a/n: a. independent transfer from wheelchair to mat b. assisted stand pivot transfer c. pneumatic lift transfer d. dependent stand pivot transfer

(B) Training in residual limb wrapping. Residual limb wrapping would help prepare the residual limb by shrinking and shaping it to fit in the prosthesis.

75.An OT practitioner is working with a patient who has recently experienced a traumatic amputation of his right upper extremity at the short below-elbow level. Which of the following areas of patient education would the practitioner work on FIRST in the OT intervention program? a. Training to put on and take off the prosthesis b. Training in residual limb wrapping c. Activities to teach grasp and prehension functions d. Training to resume vocational activities

(B) a tub bench and toilet rails. A tub bench and toilet rails make bathroom transfers easier and safer and allows the person with a unilateral LE amputation to transfer independently. See reference: Pedreti (ed): Pasquinelli, S: Lower extremity amputations and prosthetics.

75.In preparing a patient with a unilateral below-knee amputation for discharge from a rehabilitation facility, the MOST important adaptive equipment for the OT to recommend is: A. Lightweight cooking utensils B. A tub bench and toilet rails C. Long-handled dressing devices D. A reacher

(A) Ask group members to discuss how they feel about taking their medications. "Any effort to help a client manage medication independently should begin with a discussion of his/her feelings about it." Clients can often benefit from hearing about the experiences of others. Knowledge of the medication schedule is critical, but the FIRST action the OT should take is leading the discussion on feelings about taking medications.

75.While participating in the first session of a relapse prevention group, a client reports that he often misses a dose of his medication because he forgets when to take it. Which of the following actions should the OT take FIRST? A. Ask group members to discuss how they feel about taking their medications. B. Suggest using a diary to record each dose of medication C. Instruct him in the use of a timer to assist in medication management D. Make sure he knows what his medication schedule is

(D) A cutting board with two nails in it. The potato is placed on the nails to hold it in place while working.

76.A homemaker who sustained a CVA with subsequent left hemiparesis is returning home to live with her husband and children. To enable the individual to carry out her prior responsibility of meal preparation, which item would MOST likely to recommended for stabilization when cutting a potato? a. A piece of non-skid backing under the cutting board b. A plate guard around the edge of the board c. A rocker knife d. A cutting board with two nail in it

(D) In the upper cabinet to the left side. This pattern of movement promotes the greatest degree of weight shift to the affected side.

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

(B) Sliding board transfer. Sliding board transfers, or push-up-and-over transfer techniques, are the safest and most efficient techniques when transferring to a tub seat. See reference: Pedretti (ed): Adler, C, Tipton-Burton, M: Wheelchair assessment and transfers.

76.An OT practitioner is working on transfer training with a young client who recently underwent bilateral below the knee amputations. Which of the following should the OTR FIRST suggest for independent transfers from the wheelchair to the bathroom tub seat? A. Stand pivot transfers B. Sliding board transfers C. Dependent lift transfer D. Transfers should not be initiated until receiving prosthetics

(D) determine the need for further evaluation. The purpose of screening is to determine whether further assessments are needed and, if so, which tests would be appropriate for that child. See reference: Solomon (ed): Peralta, AM, and Kramer, P: General treatment considerations.

76.In screening a child who has been referred to OT, the PRIMARY goal of the OT is to: A. Obtain necessary information for an OT consultation with teachers or parents B. Test a wide variety of developmental behaviors C. Establish an information base for the OT treatment plan D. Determine the need for further evaluation

(B) Practicing the whole task of putting on a shirt in a setting similar to the real environment. Retention of a skill will be enhanced if the task is practiced in its entirely during each performance trial because whole task performance is easier to recall than separate steps. Generalization of skills is enhanced when an activity has been acquired in a setting that resembles the natural environment where the skill will be performed.

76.The goal for patient who has had a CVA is to be able to put on a shirt independently. The MOST effective way to structure dressing training for maximum learning retention and generalization of the skills is: A. Teaching and practicing each segment of the dressing procedure during consecutive treatment sessions B. Practicing the whole task of putting on a shirt in a setting similar to the real environment C. Providing dressing simulation activities (button boards, etc.) D. Allowing the client to view a videotape on how to put on a shirt and written directions for completing steps for dressing

(B) Use pillow to prop up body parts into desired position. An individual with low tone may benefit from supportive positioning devices such as pillows, towels, or bolsters that can help to prevent overstretching and fatigue.

77.An individual confides to the OT practitioner that he is concerned that lower extremity flaccidity may cause problems during sexual activity. The BEST strategy for the OT practitioner to recommend is: a. use a side lying position b. use of pillows to prop up body parts into the desired position c. incorporate slow rocking into movements d. avoid movements that elicit a quick stretch

(C) Activities which provide tapping, application of textures, and weight bearing to the residual limb. Massage, tapping, use of textures and weight bearing on the distal end of the residual limb are techniques used to develop tolerance to touch and pressure in the hypersensitive limb.

77.The OT practitioner is treating a patient with a standard above-elbow amputation who is experiencing hypersensitivity of the residual limb. The OT would most likely perform which of the following interventions in the pre-prosthetic phase of treatment? a. Activities to strengthen the residual limb b. Activities to increase the range of motion of the residual limb c. Activities which provide tapping, application of textures, and weight bearing to the residual limb d. Activities for practicing putting on and taking off the UR prosthesis

(C) Stabilizing the pelvis, hips, and legs. Answer C is correct because when the pelvis, hips, and legs do not provide a good central base of support, the child resorts to compensatory movements.

77.The benefits that a correct sitting position has in relation to hand function is explained to the parents of a child with CP. The child currently uses compensatory movements because of the inability to sit independently. Which aspect of therapeutic positioning should the OTR stress? A. Stabilizing the trunk B. Placing weight on the arms C. Stabilizing the pelvis, hips, and legs D. Stabilizing the head and neck

(D) Incoordination. A person who has tremors or poor coordination could limit much stability by stabilizing the limb proximally before working distally. Stabilization adds a secure base of support from which to work. Reduce vision, poor endurance, and limited fine movement would not require stabilization when writing, but they would require stronger contrast of guiding lines or link on paper, more frequent rests, or built-up writing tools. See reference: Trombly (ed): Trombly, CA: Retraining basic instrumental activities of daily living.

77.The technique of stabilizing a person's forearm on the table when writing would MOST likely be used by the OT practitioner if the person exhibited: A. Decreased vision B. Poor endurance C. Limited fine movement D. Incoordination

(D) An exposure has occurred; put on gloves, clean up the spill with paper towels, put the soiled paper towels in a plastic bag, seal the bag, disinfect the area, and finish the patient's session with whatever time is still left. The Occupational Safety and Health Administration (OSHA) has identified materials that require universal precautions, cerebrospinal fluid, synovial fluid, pleural fluid, any body fluid with visible blood, any unidentifiable body fluid, and saliva from dental procedures. Items OSHA has identified as not needing universal precautions include feces, nasal secretions, sputum, sweat, tears, urine, and vomitus. See reference: Early: Safety techniques.

77.While practicing wheelchair-to-tub transfers an individual's external catheter is dislodged and urine spills onto the floor. The therapist notes that the urine appears to have blood in it. Which one of the following responses is the MOST appropriate? A. An exposure has not occurred; clean up the area with paper towels and resume treatment as quickly as possible B. An exposure has occurred; close off the area until it can be disinfected and resume treatment as quickly as possible C. An exposure has occurred; clean up the spill with towels, place towels in the dirty laundry bin and resume treatment as quickly as possible D. An exposure has occurred; pout on gloves, clean up the spills with paper towels, put the soiled paper towels in a plastic bag, seal the bag, disinfect the area and finish the patient's session with whatever time is still left

(B) Progressive relaxation exercises and autogenic training. Progressive relaxation exercises, answer B, is the answer most relevant to the client's shoulder tension. This technique "involves tensing and relaxing muscle groups, one group at a time, from head to foot", while autogenic training utilizes the concept of mental imagery in order to "achieve muscle relaxation and vasodilation."

78.A physician has informed an OTR that her client's headache problem at work is primarily caused by the increased neck and shoulder tension that the individual experiences while typing on a computer. The BEST stress management approach for the OTR to suggest in this situation is: a. assertiveness training focusing on increasing the individual's assertiveness with his or her boss b. progressive relaxation exercises and autogenic training c. training in cognitive reappraisal to decrease the frequency of the individual's tendency to generalize and exaggerate the negative side of work events d. teaching the individual more effective problem-solving strategies

(C) Implement compensatory strategies. "The compensation approach focuses on using remaining abilities to achieve the highest level of function possible..." Compensatory strategies include modifying the environment and are most appropriate for this patient because his prognosis is poor and he is unlikely to improve. An example would be placing the food all on the right side of his meal tray

78.An individual with a fast-growing brain tumor gas begun ignoring food on the left side of the meal tray. Which of the following approaches would be MOST appropriate for this individual? A. Focus on remediation B. Educate the patient to increase left-side awareness C. Implement compensatory strategies D. Select appropriate adaptive equipment

(C) A client with a C6 injury. An individual with C6 quadriplegia has some use of the abductor pollicis longus, extensor carpi ulnaris. The extensor tone of the muscles in conjunction with the splint will operate the power for prehension force. Individuals with C1 or C3 injuries have higher level lesions and lack the wrist extension strength needed to operate the wrist-driven flexor hinge splint. An individual with a T1 injury is able to grasp and manipulate utensils without difficulty or need for assistance. See reference: Trombly (ed): Hollar, LD: Spinal cord injury.

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

(D) installation of a bidet with a spray wash and air-drying mechanism. Use of a bidet for hygiene after use of the toilet eliminates any upper extremity reach requirement. See reference: Case-Smith (ed): Shepherd, J: Self-care and adaptations for independent living.

79.A child with limited upper extremity range of motion is being readied discharge. The MOST important home adaptation for the OT practitioner to recommend concerning use of the toilet is: A. Installation of safety bars next to the toilet seat B. Mounting a wide base toilet seat C. Placement of a skid proof stepping stool next to the toilet D. Installation of bidet with a spray wash and air-drying mechanism

(D) Present only a few blocks at a time. Similar to other children with this diagnosis, this child most likely has poor impulse control and experiences great difficulty completing a task. By presenting a few blocks at a time, the OT practitioner can help the child focus on a few relevant stimuli and make it possible to complete a short-term task successfully. This experience will then help the child increase his attention span.

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

(B) Learning the self-monitoring technique of asking oneself if any part of the task has been missed. Teaching the client to self-monitor is an example of a strategy to control the tendency to miss details involved in the task process.

79.An OT practitioner is treating a patient who has difficulty maintaining attention to a task but is aware of the problem. The best example of a strategy that the OT can teach the patient to control effects of attention deficits would be: a. simplifying the instructions given to accomplish the task so only one step is presented at a time b. learning the self-monitoring technique of asking oneself if any part of the task has been missed c. providing practice is shape and number cancellation worksheets d. removing unnecessary objects from around the task area to decrease distractions

(A) Remedial treatment, such as rubbing or stroking the involved extremity. When sensation begins to return, it is appropriate to initiate remedial activities for sensory retraining. Stimulating the involved extremity by rubbing or stroking (to provide tactile input) or through weight-bearing activities (to provide proprioceptive input) are examples of remedial activities. Compensatory activities, which are essential for individuals with decreased or absent sensation, would have been part of the original treatment plan. See reference: Pedretti (ed): Evaluation of sensation and treatment of sensory dysfunction.

79.An elderly patient who was hospitalized for a right CVA with left UE flaccidity and decreased sensation is beginning to experience sensory return in the left UE. The OTR should recommend modifying the treatment plan to include: A. Remedial treatment, such as rubbing or stroking the involved extremity B. Remedial treatment, such as the use of hot mitts to avoid burns C. Compensatory treatment, such as testing bathwater with the uninvolved extremity D. Compensatory treatment, such as using a one-handed cutting board to avoid cutting the insensate hand

(B) Head slightly flexed. Postural alignment is important in promoting oral motor function. The spine and pelvis should be in a neutral position. Normally, the head should be a neutral or slightly flexed (answer A). When a child has difficulty swallowing, however, tucking the chin slightly can reduce the risk of aspiration and facilitate swallowing.

79.During an infant's first OT session, the mother reports she has observed that the baby has difficulty with swallowing and frequently chokes. Which of the following feeding positions will MOST effectively reduce the risk of aspiration and facilitate swallowing? a. Head in neutral position b. Head slightly flexed c. Head slightly extended d. Head rotated toward the feeder

(C) Constructional. Constructional play involves building and creating things. It is in this area of play that children develop a sense of mastery and problem-solving skills.

8. A child has considerable difficulty with a problem solving when playing with Legos and become frustrated and gives up easily. This MOST likely indicates a problem in which area of play? a. Sensorimotor b. Imaginary c. Constructional d. Game

(C) In the social worker's notes. The social worker's notes include "details about the patient's family and occupation, education, cultural background, financial situation, and habits."

8. A teenage patient is hospitalized with anorexia nervosa. An OT practitioner has been assigned to collect data on the child's family background, education, and habits through a chart review. Where will the practitioner MOST likely find this information? A. In the nurse's notes B. In the doctor's notes C. In the social worker's notes D. In the admitting note

(C) Steps, width of doorways, and threshold heights. The first area of evaluation would be the steps, width of doorways, and presence and height of door thresholds to determine whether the wheelchair user will be able to enter or exit interior spaces in the wheelchair or whether structural modifications are required.

8. A young client who will be using a wheelchair after discharge from the rehabilitation facility is going home. In determining accessibility of the interior home environment, the FIRST area of evaluation the OT will be concerned with is: A. Location of telephones and appliances. B. Arrangement of furniture in bedrooms. C. Steps, width of doorways, and threshold heights. D. Presence of clutter in the environment.

(A) A body length prone scooter. Spastic diplegia is defined as abnormal tone affecting all four extremities but with primary involvement of the lower extremities; therefore, the child may use his upper extremities to propel himself through space while having his lower extremities positioned on the scooter. See reference: Case-Smith (ed): Schneck, CM: Visual perception.

8. An OT practitioner is working with a 3-year-old who has spastic diplegia. The mobility device which would be MOST appropriate to use in assisting this child to explore space would be: A. A body length prone scooter B. An airplane mobility device C. A tricycle D. A power wheelchair

(D) endurance. A deficit in endurance is demonstrated by the person's inability to sustain cardiac pulmonary, and musculoskeletal exertion for the duration of the activity. See reference: AOTA: Uniform Terminology for Occupational Therapy, third edition.

8. The OT practitioner is observing dressing skills in an individual with chronic obstructive pulmonary disease (COPD). While putting on his shirt, the individual becomes short of breath and stops to rest before finishing with the shirt and going on to his trousers. The OTR would recognize this as a deficit in: A. Postural control B. Muscle tone C. Strength D. Endurance

(A) total quality management. This model "encourages health care institutions to move away from a focus on compliance to standards and refocus on improvement goals in an effort to deliver high quality care" (p.121). See reference: Jacobs and Logigian (eds): Logigian, MK: Quality management.

80.A hospital-based multidisciplinary team meets bimonthly to monitor their services in regard to the creation of an environment that meets or exceeds consumer needs. This model is MOST appropriately called: A. Total quality management B. Cost accounting C. Employee empowerment D. Horizontal structuring

(B) Discuss precautions necessary for sex when an indwelling catheter is present. Individuals with an indwelling catheter may safely participate in sexual intercourse when certain precautions are observed. If the catheter becomes kinked or closed off, pressure on the bladder must be avoided and the length of time urine flow is restricted should remain under 30 minutes. It is also advisable to avoid drinking fluid for 2 hours before intercourse and to void the bladder before sexual activity. Sexuality is a part of human performance that therapist should be knowledgeable about and comfortable in discussing.

80.A patient with an indwelling catheter asks his therapist for advice concerning sexual activity. Which of the following responses is MOST appropriate? A. Refer the patient to his physician B. Discuss precautions necessary for sex when an indwelling catheter is present C. Teach the individual how to remove and replace the indwelling catheter D. Explain that it is dangerous and difficult to have sex when an indwelling catheter is present

(D) Observe for signs of pain, redness, and irritation, then discontinue use and report to therapist. Of the answers listed, the most important aspect of splint education is the need of monitoring splinted skin areas for presence of problems related to splint use, such as pain, redness, blisters or skin irritations, which can lead to injury. If such exist the next step is to discontinue use of the splint and report the problem to the therapist, who can then reevaluate the splint. See reference: Neistadt and Crepeau (eds): Wylett-Rendall, J: Treatment of performance components.

80.An OT practitioner is preparing an outpatient who has received a resting hand splint for discharge. It is MOST important that the patient and caregivers understand the need to: A. Bend the splint if it doesn't fit comfortably. B. Discontinue use of the splint if it isn't cosmetically pleasing C. Care for the splint with special washing directions D. Observe for signs of pain, redness, and irritation, then discontinue use and repot to therapist

(B) Ask the individual to try some lacing with distant supervision and praise her for what she has been able to do. All of the responses are increments of approaches used for decreasing dependency needs, but answer B is best next step in this case because it allows the individual to attempt some lacing in the presence of the OT, who in turn offers reassurance that the individual is actually able to do the activity.

80.An individual with strong dependency needs is able to lace a leather wallet only with consistent verbal cueing. Which is the BEST way to grade this activity in order to decrease dependency? a. Provide lacing instructions on lacing techniques and ask the individual to continue on her own b. Ask the individual to try some lacing with distant supervision and praise her for what she has been able to do c. Ask the individual to take the lacing to her room and continue without the OT‟s assistance d. Tell the individual to complete a small amount of lacing while the OT assists another patient in the same room

(D) A long-handled bath sponge. A person with a total hip arthroplasty needs to avoid hip flexion of 80 degrees or more, hip adduction with internal rotation at the knee or ankle, and lifting the knee higher than the hip during self-care or home management activities. A wire basket attached to the walker would not allow the person to come close to a counter without having to step sideways, which causes hip adduction to either move toward or away from the counter. A padded toilet seat of 1 inch height or a short-handled sponge would be inadequate in that it would cause the person to flex the hip past 80 degrees while performing of self-care activities.

80.Which of the following pieces of adapted equipment would the OT practitioner MOST likely recommend a client continue to use at home after a total hip arthroplasty? a. A wire basket attached to a walker b. A padded foam toilet seat 1 inch in height c. A short-handled bath sponge d. A long-handled bath sponge

(C) Express disagreement with coworkers in a productive manner. Assertiveness is the ability to express feelings in an appropriate and productive manner.

81.A client is participating in an assertiveness training group within a work setting. The expected outcome of this intervention is that the client will MOST likely improve the ability to: A. Engage in relevant conversations with coworkers B. Use appropriate facial expressions when disagreeing with coworkers C. Express disagreement with coworkers in a productive manner D. Use courteous behavior when disagreeing with coworkers

(A) Lying on the left side while propped with pillows. This positioning allows the unaffected right extremities to remain free and provides weight bearing to the affected side to assist with tone reduction. The pillows behind the individual allow support and the individual may lean against the pillows to also provide pressure relief as needed to the affected side because sensation may be reduced on that side along with movement.

81.An OTR is addressing concerns about sexual activity with a person with left sided hemiplegia with spasticity. The BEST recommendation for positioning during sexual intercourse for this person would be: a. lying on the left side while propped with pillows b. lying on the right side while propped with pillows c. lying in a supine position d. lying in a prone position

(A) Perform a job analysis identifies essential functions of a particular job. See reference: Early: Work, homemaking and childcare.

81.An individual with depression is ready to return to the job held before taking a leave of absence. Which of the following is the FIRST action the OT practitioner should take? A. Perform a job analysis B. Request reasonable accommodation C. Emphasize activities that promote a sense of self-efficacy D. Encourage the individual to participate in a weekly support group

(B) A seat belt placed at a 45-degree angle at the hips. A seat belt correctly placed at a 45 degree angle to the child's hips would inhibit extensor tone

81.The MOST effective way to adapt a chair to inhibit a child's extensor tone and allow the child to maintain a sitting position is to use: a. lateral trunk supports b. a seat belt placed at a 45-degree angle at the hips c. a wedge-shaped seat that is higher in the front d. a lapboard

(C) Have her put the utensil down until she swallows. The individual needs to learn to pace herself during feeding.

82.A woman with a head injury is impulsive during self-feeding and frequently attempts to place too much food in her mouth at one time. Which of the following methods would MOST effectively control her rate of intake during self-feeding? a. Cut her food into smaller pieces b. Have her count to 10 between bites of food c. Have her put the utensil down until she swallows d. Serve the various food items in separate containers on the meal tray

(D) Swivel spoon. A swivel spoon allows the head of the spoon to rotate as the individual moves he handle into varying positions, thus compensating for poor supination.

82.An individual is unable to bring her hand to her mouth for feeding because of weakness in supination. The MOST helpful adapted utensil for this person would be a: A. Spoon with an elongated handle B. Spork C. Spoon with a built-up handle D. Swivel spoon

(B) Use heavy utensils, pots, and pans. Heavy kitchen items increase stability for individuals with incoordination. Other suggestions include using prepared foods, nonskid mets, easy-open containers, serrated knives, and tongs. See reference: Pedretti (ed): Foti, D, and Pedretti, Lw in Self-care/home management.

82.During a cooking evaluation, an individual with a history of TBI exhibits moderate UE incoordination. Which of the following recommendations would be MOST beneficial for this individual? A. Use a built-up utensil handles B. Use heavy utensils, pots, and pans C. Use a high stool to work at counter height D. Place the most commonly used items on shelves just above and below the counter

(A) Textured material, rubbing, taping, and prolonged contact. Sensory desensitization helps the individual recalibrate altered sensory perceptions and improve sensibility. This type of program is initiated when light-touch sensation is intact. The above listed modalities are used as graded tactile stimuli. Treatment is most successful when carried out and controlled by the individual. With a severe injury such as burn, it is also necessary to train the individual in protective precautions. Any techniques that provide an ungraded or nonspecific level of touch, such as message, pressure, percussion, or electrical stimulation, would be tolerated with difficulty by a person with hypersensitivity, because much of the input is facilitory and would be interpreted as painful. Visual compensation and functional use of the extremity are techniques used with individual who have impaired sensation.

82.Which of the following sequence of method is MOST appropriate to achieve sensory desensitization? a. Textured material, rubbing, tapping, and prolonged contact b. Massage, facilitory electrical stimulation and a progressive desensitization program c. Pressure, percussion, vibration, icing and edema massage d. Visual compensation and functional use of the extremity

(A) Soft to hard to rough. Hypersensitivity stimuli is graded by texture and force. Texture begins with soft, progresses to hard, and moves to rough. The force begin with touch, progresses to rub, and moves to tapping. The texture and force of the stimuli are graded together. Light, medium, and heavy do not specify what the texture and force of hypersensitivity would be unable to tolerate training beginning with a rough texture. See reference: Trombly (ed): Bentzel, K: Remediating sensory impairment.

83.An OT practitioner is assessing hand sensation in an older adult with diabetic neuropathies who frequently complains of hand pain. It appears that the client would benefit from a desensitization program. The OT informs the client that hypersensitivity training is typically graded from: A. Soft to hard to rough B. Tap to rub to touch C. Light to medium to heavy D. Rough to hard to soft

(C) Altered task method. "When the task method is altered, the same task objects are used in the same environment, but the method of performing the task is altered to make the task feasible given the performance deficits". An example would be substituting one-handed techniques for someone who previously used both hands (i.e., one-handed shoe trying for an individual who recently had an above-elbow amputation). Problem solving is the ability to organize information from several levels to generate a solution to a problem. Retraining teaches the same skills of an activity to the person who previously had mastery of those skills (e.g., having a person with hand weakness practice tying knots). Compensation would be avoiding performance of the activity entirely by using an alternative place equipment or method.

83.An OT practitioner is teaching a client who recently sustained an above-elbow amputation how to dress with one hand. Teaching a client to perform a familiar activity or skill is called the: a. problem-solving method b. retraining method c. altered task method d. compensation method

(D) A problem-solving task with a "self-talk" cueing strategy. Finding phone numbers is a task that requires some problem solving and the cards are a strategy for providing cues for questioning oneself about the process of problem solving.

83.An OTR is implementing cognitive rehabilitation interventions with a client and has given the client the task of finding telephone numbers of a specific people in the phone book. The client has also been given a card with a series of questions written on it including, "Do I understand what I am supposed to do?" and "Do I have all the information I need?" and "Is this the best way to do this?" This intervention is MOST accurately described as: a. a self-management task with an environment cue b. a task to improve visual scanning c. a memory task with external aid d. a problem-solving task with a "self-task" cueing strategy

(D) Ice application, immobilization, and splinting ice, immobilization, and splinting are all interventions that are considered to be appropriate adjunct activities to be used during the acute stages of tennis elbow. See reference: Cailliet: Elbow pain

84.A client that the OT practitioner is treating brings an order from his physician requesting treatment for epicondylitis. Which of the following adjunct activities should be used to treat the ACUTE symptoms of tennis elbow? A. Passive range of motion (PROM), weight bearing and mobilization B. Resistive exercises, heat application and work simulation C. Heat application, PROM and strengthening D. Ice application, immobilization and splinting

(C) Position stander at 75 to 90 degrees from the floor. Answer C is most correct because by adjusting the prone stander nearer to vertical (the least effect of gravity on the head or posture), the child will be able to tolerate working on head righting.

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

(A) Postural hypotension. A frequent side effect of neuroleptic drugs is a decrease in blood pressure in response to sudden movements, specifically up and down movements, resulting in faintness or loss of consciousness. The parachute activity involves significant up-and-down body movements and therefore warrants the therapist's attention with patient population.

84.An OTR is preparing to do a parachute activity as part of a sensory integration program and several of the patients in the group are taking antipsychotic medications. The OTR should be alert for which possible side effect that could occur as a result of this activity? A. Postural hypotension B. Photosensitivity C. Excessive thirst D. Blurred vision

(A) Prevent loss of joint and skin mobility. During the acute stage, when burn wounds are oartial or full thickness in nature, maintenance of joint range of motion and skin mobility is the primary goal of intervention. See reference: Pedretti (ed): Jordan, CL, and Allely, RR: Bums and Burn rehabilitation.

84.An individual has sustained a large, full-thickness burn to both upper extremities while running a fireworks display. The client is in the acute care phase of treatment. Which of the following BEST represents an acute care rehabilitation goal? A. Prevent loss of joint and skin mobility B. Provide adaptive equipment C. Provide compression and vascular support garments D. Prevent scar hypertrophy through scar management techniques

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

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

(C) Oversized t-shirts and elastic-top pants. For a child with difficulty in self-dressing due to incoordination (as seen in athetoid CP), clothing should be loose fitting with simple or fasteners.

85.A child with a diagnosis of athetoid CP would like to be able to dress herself independently. Which of the following clothing features could the OT practitioner recommend that would be MOST useful in facilitating self-dressing? A. Mini tees made of elasticized fabric B. Dresses with side zippers and zipper pulls C. Oversized t-shirts and elastic-top pants D. Shirts with front closures, such as snaps or large buttons

(C) Have client predict his performance before an activity, then have him self-evaluate the performance. Having the client predict his performance before an activity (self-estimation) and comparing his predicted performance with a self-evaluation of the actual performance can provide meaningful self-initiated feedback and would be the best way to increase awareness.

85.A new client exhibits no awareness of functional limitations resulting from his recent head injury, and he attempts to perform transfers without assistance. He also has expressed that he doesn't see the need for therapy. The BEST approach to promote awareness and insight is to: a. have the patient explain why he believes he is impaired b. provide the client with a checklist of the skills he must have to perform various activities and review these c. have the client predict his performance before an activity, then have him self-evaluate the performance d. disregard the client's perceptions and proceed with therapy

(B) Put the dried dishes away and begin to hand her wet dishes. Compensating for mistakes helps to increase the sense of self-worth and integrity of individuals with dementia. This approach is preferable to drawing attention to errors, especially in situations in which safety is not an issue.

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

(D) Weaving on a framo loom. Use of and attention to the entire loom area is essential for weaving on a frame loom. The shuttle must slide across the entire width of the loom, which involves crossing the midline. See reference: Breines: Folkcraft.

86.An individual demonstrates a left visual filed cut as a result of a TBI, and demonstrates difficulty crossing the midline during many selfcare activities. Which of the following activities would MOST effectively promote this individual's ability to cross the midline? A. Making a coil pot out of clay B. Making a macramé planter C. Stringing a bead necklace D. Weaving on a frame Joom

(A) Independent with a sliding board. An individual injured at the C7-8 level should be able to perform sliding board transfer independently.

86.An individual who sustained a C7-8 spinal cord injury 5 years ago has been admitted to an inpatient psychiatric unit. The OT practitioner should inform the staff that this individual will MOST likely be able to perform wheelchair-to-commode transfers at which of the following levels? A. Independent with a sliding board B. Assisted, using a stand-pivot transfer C. Dependent in all transfers D. Independent without adaptive equipment

(D) Arm trough. An arm trough would provide a stable surface that would keep the individual's arm in a safe and appropriate position. In addition, the arm trough approximates the humeral head into the glenoid fossa at a natural angle. If the individual has edema in his hand, a foam wedge may be placed in the trough to elevate the hand.

86.An individual with left upper extremity flaccidity is observed sitting in a wheelchair with his left arm dangling over the side. The FIRST positioning device that should be assessed for this individual is a(n): a. lap tray b. wheelchair armrest c. arm sling d. arm trough

(B) Ask the individual to try some lacing with distant supervision and praise her for what she has been able to do. Al of the responses are increments of approaches used for decreasing dependency needs, but answer B is the best next step in this case because it allows the individual to attempt some lacing in the presence of the OT, who in turn offers reassurance that the individual is actually able to do the activity. See reference: Early: Analyzing, adapting, and grading activities.

86.An individual with strong dependency needs is able to lace a leather wallet only with consistent verbal cueing. Which is the BEST way to grade this activity in order to decrease dependency? A. Provide written instructions on lacing techniques and ask the individual to continue on her own B. Ask the individual to try some lacing with distant supervision and praise her for what she has been able to do C. Ask the individual to take the lacing to her room and continue without the OTs assistance D. Tell the individual to complete a small amount of lacing while the OT assists another patient in the same room

(B) An activity exploring leisure opportunities and problems in the process of making choices about activities, the first step is developing awareness and knowledge. OT practitioners"...assist the clients in developing awareness of options and limpits" (p.387). See reference: Neistadt and Crepeau (eds): Knox, SH: Treatment through play and leisure.

87.After administering an interest checklist, the therapist documents that the individual has identified a few solitary leisure interests and no interests involving social interaction. Based on this information, what is the BEST activity to use in the next session of a leisure counselling group? A. A leisure inventory assessment B. An activity exploring leisure opportunities and problems C. A magazines picture collage D. A calendar of community leisure activities for the first week after discharge

(A) Repetition, high force, and awkward joint postures. Repetition, high force, and awkward joint postures are work-related risk factors that are frequently associated with cumulative trauma disorders.

87.An OT practitioner is educating a client with a cumulative trauma disorder about common work-related risk factors. The OTR explains to the client that many of the PRIMARY risk factors are: a. repetition, high force, and awkward joint postures b. progressive resistive exercise, joint mobilization and weightbearing c. inflammation, swelling, and pain d. fatigue, muscle cramps and paresthesias

(D) Eggs. Eggs provide a uniform texture and density. See reference: Pedretti (ed): Nelson, KL: Dysphagia: Evaluation and treatment.

87.An OT practitioner is selecting foods for an initial treatment session with a client with dysphagia. In general, which of the following foods would BEST represent an adequate selection for intervention? A. Vegetable soup B. Salad C. Watermelon D. Eggs

(D) Incoordination. A person with tremors or poor coordination can reduce instability by stabilizing the limb proximally before working distally. Stabilization adds a secure base of support from which to work.

87.An OT practitioner is working with a student on handwriting skills when she instructs the client to stabilize his forearm on the table when writing. The client is MOST likely to be demonstrating: a. decreased vision b. poor endurance c. limited fine movement d. incoordination

(B) Show acceptance and understanding to the individual. Paraphrasing is used to clarify and relay acceptance of what an individual has communicated. The OT practitioner paraphrases by repeating in her/his own words with the client has said.

87.During an interview, the OT practitioner decides to respond to an individual by paraphrasing. The PRIMARY reason for this type of response is to: A. Refocus or redirect the individual's comments B. Show acceptance and understanding to the individual C. Force the individual to make a choice D. Encourage an individual to give additional information

(A) Contrast baths, active and passive ROM, and massage. Contrast baths, AROM and PROM, and massage are all initial techniques considered for the prevention or relief of joint stiffness.

88.A client is experiencing acute right upper extremity and hand lymphedema after a recent mastectomy. The client's primary complaint is joint stiffness. The INITIAL techniques the OTR can implement to alleviate joint stiffness would MOST likely be: a. contrast baths, active and passive range of motion and retrograde massage b. ultrasound, electrical stimulation, and dynamic splinting c. resistive exercises, weight-bearing and lifting d. joint mobilization, serial casting and dynamic splinting

(C) Ask another OT practitioner for help. Trying to attempt this transfer alone could result in injury to the patient and/or the OT practitioner, even if she uses proper body mechanics (answer A). It is often necessary to get assistance when transferring obese individuals.

91.An OT practitioner who needs to transfer an obese man is not confident she can manage the transfer alone. The BEST action for the OT practitioner to take is to: A. Use proper body mechanics B. Ask someone from PT to do the transfer C. Ask another OT practitioner for help D. Refrain from transferring the patient

(C) Environmental modification. Environmental modification is the area of intervention that can best assist in maintaining safety and supporting function at home by providing the physical and sensory environments to compensate for deficits. See reference: Pedretti (ed): Atachison, P, Pedretti, LW, McCormack, GL: Alzheimer's disease.

88.An OT is planning to provide a program to address the needs of persons with Alzheimer's disease and their families as part of a hospital outreach program. One of the areas of intervention which would be MOST beneficial to maintaining safety and supporting function at home in the advanced stages of Alzheimer's is: A. Strength and endurance activities B. Cognitive rehabilitation techniques C. Environmental modification D. Assertiveness skills

(D) Use dust mitt to keep fingers fully extended. Using dust mitts "keep fingers straight and prevents the static contraction and potentially deforming forces of holding a dust cloth" (p.644). See reference: Pedretti (ed): Hittle, JM, Pedretti, LW, and Kasch, MC: Rheumatoid arthritis.

88.An OT practitioner is instructing a person with arthritis how to maintain range of motion while performing household activities. Which of the following activities MOST effectively accomplishes this? A. Use short strokes with the vacuum cleaner B. Keep elbow flexed when ironing C. Keep lightweight objects on low shelves D. Use dust mitt to keep fingers full extended

(A) Perform pursed lip breathing when doing activities. Pursed lip breathing is a technique that narrows the passage of air during expiration. This technique helps individuals with COPD to keep the airway open and improve breathing efficiency. The overall effect is improved endurance and tolerance for activities.

88.An individual who is being discharged home after practicing in a patient pulmonary rehabilitation program for chronic obstructive pulmonary disease (COPD) is given a list of tips to use in the home to promote function. Which one of the following items is MOST likely to be on the list? A. Perform pursed lip breathing when doing activities B. Use a long-handled sponge while in the shower C. Take hot showers to reduce congestion D. Avoid air conditioned rooms during warm months

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

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

(B) Encouraging any available hemiplegic limb movements before or during a task. Any contralesional limb movement (even shoulder elevation) will activate additional motor units which will then increase attention to the left.

89.Of the following, which would be MOST effective strategy for increasing attention to the left for a person who has a diagnosis of unilateral neglect? a. encouraging participation in bilateral activities b. encouraging any available hemiplegic limb movements before or during a task c. participation in tasks that do not cross the midline d. participation in tasks placed on the uninvolved side

(D) The effect of personal traits and the environment on role performance. Evaluation according to the Model of Human Occupation would focus on the effect of personal traits and the environment on role performance. See reference: Bruce and Borg: Model of human occupation.

89.Using the MOHO as a FOR, evaluation of an individual should focus PRIMARILY on which of the following? A. Identification of problem behavior that need to be extinguished B. Clarification of thoughts, feelings and experiences that influence behavior C. Cognitive function, including assets and limitations D. The effect of personal traits and the environment on role performance

(D) "The infant uses a wide base of support and high arm guard position and takes short steps." Answer D is correct according to Case-Smith. "The infant's first efforts toward unsupported movement through walking are often seen in short erratic steps, use of a wide based gait, and arms held in a high guard."

89.Which of the following BEST describes how an OT practitioner would document a normally developing infant's first steps? a. "The infant uses a narrow base of support and low arm guard position and takes big steps." b. "The infant uses a wide base of support and is independent in stopping and turning." c. "The infant uses a narrow base of support and low arm guard position." d. "The infant uses a wide base of support and high arm guard position and takes short steps."

(B) Flaccidity. Flaccidity, or hypotonicity, is often present immediately after a stroke and may later change to spasticity. See reference: Pedretti (ed): Undzis, Zoltan, B, and Pedretti. LW: Evaluation of motor control.

89.While observing a client who has just been admitted to the rehabilitation unit after a right CVA with left hemiplegia, the OT practitioner notices that the patient's right arm lays limply by the patient's side. In documenting this observation, the OT will MOST likely use the term: A. Paralysis B. Flaccidity C. Subluxation D. Spasticity

(C) Reducing competing sensory input-use head phones during work. Resucing competing during sensory input is helpful in increasing visual attention. See reference: Case-Smith (ed): WrightOtt, C, and Egilson, S: Mobiility

9. A child has poor visual attention, which affects the child's school work. To improve the child's attention during a visual task, the OT is MOST likely to recommend: A. Increasing competing sensory input - work with lively background music B. Increasing competing visual input - work against a patterned background C. Reducing competing sensory input - use headphones during work D. Reducing visual input - use dim lighting

(B) Clubfoot. Pes varus or equinovarus is also called club foot. This deformity involves forefoot inversion and supination, heel varus, equinus through the ankle, and medial deviation of the foot in relationship to the knee.

9. An OT practitioner is working on functional mobility skills with a child who has a pes Varus deformity of the foot. The OT can BEST document this as a(n): A. Enlarged great toe B. Club foot C. Pronated foot D. Unstable heel

(B) Left unilateral neglect. This is the inability to respond or orient to perceptions from the left side of the body. Evidenced as left unilateral neglect, this deficit is also apparent in the draw a man test, flower copying test, house test, and completing a human figure or face puzzle. Unilateral neglect is contralateral to the side of a brain lesion; therefore, left unilateral neglect would result from right-sided brain damage. Left neglect occurs most commonly in right hemisphere lesions.

9. An individual who had a stroke is copying a picture of a clock. The drawing appears as a lopsided circle with a flat side on the left. The numbers 1 through 8 are written in numerical order around the right side of the clock. The hands are correctly drawn on the clock to represent three o'clock. The individual's performance appears to demonstrate: a. right hemianopsia b. left unilateral neglect c. cataracts in the left eye d. bitemporal hemianopia

(D) Create a comfortable foundation for fostering parent skills through parent-therapist collaboration. All four answers describe possible ways for an OT to impact an infant's developmental outcome. However, the most permanent action would capitalize upon developing family-centered mutual collaboration. With this approach, communication is the key to creating a relationship that will foster parental skill development and expertise. This then provides the parents with effective tools to best nurture and care for their infant at any time and in any environment, and has a permanent impact on the developmental outcome for the infant. See reference: Case-Smith (ed): Hunter, JG: Neonatal Intensive Care Unit.

9. The OT is developing a treatment plan to promote developmental acquisition for an infant in the neonatal intensive care unit (NICU). Which of the following have the most PERMANENT impact? A. Modify the environment to protect the infant additional stressful stimuli B. Recommend early intervention referral to assess infant upon discharge home C. Complete the neurobehavioral assessment and identify interventions emphasizing developmental skill acquisition D. Create a comfortable foundation for fostering parent skills through parent therapist collaboration

(C) Change to a power wheelchair to reduce effort. Considering the progressive nature of the child's disease, as well as strength and endurance, the best recommendation would be to change to a power wheelchair. The child would be better able to participate in the cognitive tasks of school if less effort was required for mobility. The team's recommendation should also be integrated with the family's needs and resources.

90.A school age child has Duchenne muscular dystrophy. Although he is able to use a manual chair for distances between classes, he is tired on arrival. What would be the BEST recommendation the OTR could make for wheelchair use at school? a. retain the manual chair to build up strength b. change to an ultralight sports model because it requires less strength c. change to a power wheelchair to reduce effort d. encourage walking with a walker to alternate mobility methods

(D) Identify alternative methods for meeting sexual needs that don't cause pain. Because the individual's pain cannot be seen or felt by the sexual partner, communication is particularly important. The couple can discuss alternate positions and methods for achieving sexual fulfillment that are acceptable to them and that do not cause pain, such as alternate positions, masturbation, and fantasy.

90.An individual reports that back pain during sexual activity is so severe that it prevents any enjoyment. The BEST strategy for the therapist to recommend is: a. use a side lying position b. time sexual activity for periods of high energy c. do not discuss pain with sexual partner because it may be a "turn off" d. identify alternative methods for meeting sexual needs that don't cause pain

(A) Stop the activity. Activity should be stopped immediately when symptoms occur during evaluation of an acute cardiac patient. Symptoms, including confusion; SOB; profuse sweating; cold clammy skin; chest pain; nausea; and lightheadedness, should be reported to the physician.

90.An individual who is several days s/p myocardial infarction experiences nausea during a bathing evaluation. Which of the following is the FIRST action the OT practitioner should take? A. Stop the activity B. Document the symptoms C. Instruct the individual to sit and then continue the activity D. Ask the individual if he feels like he can continue the activity

(A) Isometric muscle contractions. Isometric muscle contraction involves contracting the muscle without joint movement or a change in muscle length. See reference: Pedretti (ed): Pedretti, LW, and Wade, IE: Therapeutic modalities.

90.An individual with an UE fracture has asked an OT practitioner how to maintain strength in her arm until the cast is removed. The activities that would BEST accomplish this goal are those which incorporate: A. Isometric muscle contractions B. Isotonic muscle contractions C. Progressive resistance D. Passive movement

(B) flexed at all joints. When weight bearing the fingers should be flexed at all joints (the fisted position). This preserves the tenodesis function by protecting the finger flexors from overstretching. Another reason for this position is to prevent claw-hand deformity by protecting the intrinsic hand muscles from overstretching. See reference: Pedretti (ed): Adler, C: Spinal cord injury.

91.An OTR is working on sitting balance with an individual with C6 quadriplegia. The BEST position for the individual's hands to be in when using them for support is to have the fingers: A. Extended and adducted B. Flexed at all joints C. Extended and abducted D. Adducted and flexed only at the MCP joints

(C) Repeatedly squeeze with the hand against increasing amounts of resistance. The biomechanical approach is a treatment approach used when a person has a deficit in strength, endurance, or ROM but has voluntary muscle control during performance of activities. The biomechanical approach focuses on decreasing the deficit area to improve the person's performance of daily activities.

91.An individual with hand weakness has difficulty holding a fork. Using a biomechanical frame of reference, which of the following interventions would be MOST appropriate? a. elicit functional grasp using reflex inhibiting postures b. stimulate the hand flexors to promote a functional grasp c. repeatedly squeeze with the hand against increasing amounts of resistance d. build up utensil handles

(A) Biofeedback, distraction, and relaxation techniques. Biofeedback, distraction, and relaxation techniques are all examples of measures that are implemented to manage pain.

91.The OTR instructs a client with chronic neck pain to use psychosocial pain management techniques. Which if the following BEST represents psychosocial strategies commonly used by OT practitioners? a. biofeedback, distraction and relaxation techniques b. specific skill training c. strength and endurance building techniques d. cognitive retraining techniques

(B) Figure-ground perception. Figure-ground perception is the ability to visually separate an object from the surrounding background. An example of this would be an individual's having the ability to find a button on a plaid shirt. A problem with spatial relations is seen in dressing when a person for reaching when attempting to button buttons. The person is unable to judge the relationship between the object and the body. Body image is a mental picture of the person's body that includes how the person feels about the body. Visual closure is the ability to recognize an object even though only part of it is seen, for example, recognizing a partially covered button. See reference: Zoltan: Visual discrimination skills.

91.While assessing dressing skills with a patient who recently had a stroke, the OT practitioner notes that the individual is unable to see buttons on a printed fabric. This MOST likely indicates that the client may be having difficult with: A. Spatial relations B. Figure-ground perception C. Body image D. Visual closure

(B) Selective attention. The client demonstrated difficulty in attending to the activity because the presence of other environmental stimuli was distracting. This suggests a deficit in selective or focused attention.

92.A client with neurological deficits resulting from a head injury was performing the task of reaching for her brush on the shelf of her bathroom cabinet. During this task the OT practitioner observed that the client located the brush but became very distracted by the other items on the shelf. As a result of this observation, the OT is most likely to provide activities that will improve: a. Learning b. selective attention c. figure-ground perception d. problem solving

(A) Work locks and latches on doors and windows. The ability to manipulate the locks and latches is a safety concern because the individual may be unable to open them to let family members into theirs home or close them to keep intruders from entering. See reference: Trombly (ed): Feinberg, JR, and Trombly, CA: Arthritis.

92.An OT practitioner is making a home visit to an elderly client who lives alone. The client exhibits severe hand weakness. When addressing safety in the home, the OTR should be MOST concerned with the client's ability to: A. Work locks and latches on doors and windows B. Use built-up utensils while eating C. Use energy conservation techniques D. Manipulate fasteners on clothing

(C) Hand-over-hand assistance. In this method, the caregiver places one hand over the resident's hand and provides assistance while guiding the resident's hand through the steps of the task, guiding the hand from the food up and into the resident's mouth. This method provides maximum assistance while still allowing the person to feel involved and connected to the task.

92.An OT practitioner is providing instruction to caregivers in long term care facility concerning assisting a resident whose severe attention span deficits impair the ability to participate in self-feeding. The OT practitioner is MOST likely to recommend which method? a. Demonstration of feeding process for the resident b. Providing verbal feedback to the resident about how he or she is progressing c. Hand-over-hand assistance d. Chaining

(A) Jogging. Forceful gross motor activities that involve no physical contact, such as exercising, wedging clay, and woodworking, can provide a physical outlet for sexual tension.

92.An individual in an adult day program demonstrates poor social skills and frequent sexual acting-out. The activity that would MOST effectively provide release for this individual's sexual tension is: A. Jogging B. Macramé C. Reading Playboy magazine D. Ballroom dancing

(B) Dressing habits. Certain dressing habits may indicate tactile defensiveness: for example, the child may show poor tolerance of certain textures or avoid wearing turtlenecks, socks, or shoes. Conversely, some children may never take off their shoes in order to avoid tactile overstimulation. See reference: Case-Smith (ed): Parham, LD and Mailloux, Z: Sensory integration.

92.When working with a child who exhibits tactile defensiveness, which of the following areas should be evaluated FIRST? A. Reading skills B. Dressing habits C. Social skills D. Leisure interests

(D) The individual traces letters through a pan of rice with her fingers. This method involves greater input of sensory information to the brain by performing a gross movement in a more stimulating environment

93.A patient is beginning to demonstrate return in the right upper extremity following a CVA, but has mildly impaired proprioception in the right hand, which results in uneven letter formation during writing activities. Which would be the BEST method to help improve letter formation during writing activities? A. The OT practitioner verbally describes how to make a letter as the individual writes. B. The individual watches her grip on a felt-tip pen while writing. C. The individual works with thera-putty to strengthen her hand. D. The individual traces letters through a pan of rice with her fingers.

(C) Minimizing scar hypertrophy through compression garments and proper skin care. Minimizing scar hyper trophy through compression garments and proper skin care is imperative upon wound closure. See reference: Pedretti (ed): Jordan, CL, and Allely, RR: Burns and burn rehabilitation.

93.An OT practitioner is working with a homemaker who sustained a partial-thickness burn 6 months ago. Which scar management technique is MOST appropriate for the OTR to introduce during the rehabilitative phase of treatment? A. Preventing scar development through static splinting B. Controlling edema to prevent loss of range of motion C. Minimizing scar hypertrophy through compression garments and proper skin care D. Promoting self-care skills in order to resume the role of homemaker

(C) When the child has achieved a maintenance level of functioning. Because this child may never be considered completely recovered (answer D) or may refuse OT services because of his head injury (answer A), discharge should be discussed when the child is no longer making significant progress. Transition to the 1st grade (answer B) is an educational consideration that is not directly relevant to the provision of services under a medical model.

93.An OTR has been working in a medical setting with a 6 year old child who has had a traumatic brain injury. At what point should the OTR recommend discharge? a. When the child refuses to attend OT b. When the child is ready to make the transition to first grade c. When the child has achieved a maintenance level of functioning d. When the child is considered to be completely recovered

(D) Dynamometer. This individual exhibits difficult in the area of strength. A dynamometer measures grip strength through gross hand grasp. See reference: Trombly (ed): Trombly, CA: Evaluation of biomechanical and physiological aspects of motor performance.

93.An individual who works as a nurse reports difficulty squeezing the bulb of the sphygmomanometer when taking blood pressures and difficulty opening pill bottles. Which of the following instruments would be MOST appropriate for assessing this individual? A. Goniometer B. Aesthesiometer C. Volumeter D. Dynamometer

(D) Unexplained sensory loss. The major signs of shunt malfunction in children are irritability, nausea and vomiting, irritability, changes in behavior or school performance, fever, pallor, visual perceptual difficulties, and headaches.

93.When working with a child who is at risk for shunt malfunction, it is MOST important for the therapist to observe for: a. increased tone b. headaches c. back pain d. unexplained sensory loss

(A) "Client will purchase 10 items at the supermarket with supervision." Short-term goals must relate to the long-term goal being addressed. Since the long-term goal being addressed is independence in grocery shopping. See reference: AOTA: Effective documentation for OT: Writing goals.

94.A 45-year-old client with COPD has this long-term goal of being able to shop independently for groceries. The client has achieved the short-term goal of going to a convenience store and purchasing three items. Which statement is the BEST example of a revised short-term goal? A. "Client will purchase 10 items at the supermarket with supervision." B. "Client will cook a one-dish meal." C. "Client will shop independently for a birthday present for her daughter." D. "Instruct client in energy conservation techniques that apply to grocery shopping.‟"

(D) Electronic augmentative communication device. An augmentative communication keyboard is a high-technology aid that can compensate for expressive deficits and assist a student with communication.

94.An OT is explaining to a teacher the kind of high-technology aid that can be used to help a multiply handicapped student with speech and writing deficits function in the classroom. The OT is MOST likely to describe a(n): A. Environmental control unit B. Wanchick writer C. Head pointer D. Electronic augmentative communication device

(C) Use a board game to introduce the concept of receiving and spending money. This activity provides an opportunity provides an opportunity for the individuals to experience the value and purpose of money. Although it is important to introduce the actual value of coins and paper money, it is essential to combine this with concrete applications.

94.An OT practitioner is planning a community living program for clients who are to be discharged after an average of 25 to 30years of hospitalization. One of the goals of this program is to train the clients to effectively manage their money. Which of the following activities should be used first? a. provide each client with $23 to spend during a group trip to the local shopping center b. provide sample of coins and paper money c. use a board game to introduce the concept of receiving and spending money d. establish a hospital-based community store where the clients can buy clothing

(C) Provide project samples for clients to duplicate. Individuals functioning at cognitive level 4 are able to copy demonstrated directions presented one step at a time. They find it easier to copy a sample than to follow directions or diagrams. See reference: Early: Some practice models for occupational therapy in mental health.

94.An OT practitioner working in a sheltered workshop with adult clients with developmental disabilities is preparing for a group of clients functioning at Allen‟s Cognitive Level 4. Which of the following is the BEST method for introduction an assembly activity? A. Provide repetitive, one step activities B. Demonstrate a three-step assembly process C. Provide project samples for clients to duplicate D. Provide written directions for the individuals to follow

(C) Ability to consistently follow hip precautions. Many factors are considered when a short-term goal is reset. These factors may include items such as consistency of performance, cognitive or perceptual impairments, the amount of time required, and any change in attention or concentration. For the short-term goal to be changed, the individual needs to be able to demonstrate a consistency of performance in the use of hip precautions, because improved performance in the dressing has already been demonstrated. The amount of time needed or concentration have not been problems or they would have been part of the original goal. The ability to use the adaptive equipment appropristely has also been demonstrated. See reference: Trombly (ed): Trombly, CA: Planning, Guiding, and documenting therapy

95.After evaluation, a short-term goal for an individual who had a total hip replacement was to dress with minimal assistance, using adaptive equipment and verbal cues to follow hip precautions. After 1 week of treatment, the individual is able to dress with standby assistance, using adaptive equipment and verbal cues to follow hip precautions. What skills does this person need to demonstrate before changing the goal? A. Less time needed to perform dressing B. Improved concentration C. Ability to consistently follow hip precautions D. Ability to use adaptive devices appropriately

(D) Alternative tasks that require standing with those that can be performed sitting. The performance component at issue in this question is fatigue. When fatigue impedes occupational performance, energy conservation techniques should be considered. Alternating sitting and standing activities is one method that can be applied to conserve energy; others include avoiding bending and stooping, avoiding unnecessary trips, using an appropriate work height, and relaxing homemaking standards. See reference: Pedretti (ed): Hittle, JM, Pedretti, LW, and Kasch, MC, in Rheumatoid arthritis.

95.An individual with MS reports extreme frustration because her house is so dirty. When she does attempt to clean it, she is too exhausted to do anything else afterward. She does not think she can afford to pay someone else to clean. Which of the following strategies is MOST appropriate for this individual? A. Convince the individual to hire a house cleaner B. Prescribe activities that will increase strength C. Use the largest joint available for the task D. Alternate tasks that require standing with those that can be performed sitting

(D) Hand controls for acceleration and braking. Hand controls use hand motions to control the accelerator and brake mechanisms, eliminating the need for LE function.

95.An individual with paraplegia wishes to become independent in driving an automobile. The most appropriate piece of adaptive equipment for this individual is: A. A palmar cuff for the steering wheel B. A spinner knob on the steering wheel C. Pedal extensions for acceleration and braking D. Hand controls for acceleration and braking

(B) Bend both knees, keep the back straight, and bring object close the body when lifting. Bending with both knees while keeping the back straight and the object close to the body will prevent low back bending and strain.

95.When working clients who experience low back pain, it is important to practice functional techniques such as lifting and carrying. Which of the following BEST represents a correct lifting method? a. Keep both knees straight, flex the back and keep object an arm's length away from the body b. Bend both knees, keep the back straight, and bring object close to the body when lifting c. Keep both knees and back straight and bring object close to the body when lifting d. Bend one knee while keeping the other leg straight and keep the object an arm's length away from the body

(B) A cup of instant soup. The most basic level of meal preparation is accessing a prepared meal, which involves tasks such as opening a thermos and unwrapping a sandwich. When an individual becomes proficient at this level, he or she should progress to a higher level.

96.An OT practitioner is working with a client who is has had a TBI and demonstrates deficits in sequencing and problem solving. The client has successfully prepared a cold meal in today's treatment session. The next meal preparation activity the OTR should have client prepare is a: A. Fruit salad B. Cup of instant soup C. Casserole D. Spaghetti dinner with salad and garlic bread

(D) Fracture to the distal radius. A fracture to the distal radius is most commonly referred to as a Colles' fracture. Colles' fractures are one of us the "may result in limitations to the wrist flexion and extension, as well as pronation and supination resulting from the involvement of the radioulnar joint" (p.669). See reference: Pedretti (ed): Kasch, MC: Hand injuries.

96.An OTR is working with a client who sustained an injury to the right upper extremity while rollerblading. The referral states that the client sustained a Colles‟ fracture. The OTR explains to the client that a Colles‟ fracture is a: A. Fracture to the pisiform B. Fracture to the ulnar styloid C. Fracture the carpometacarpal joint D. Fracture to the distal radius

(B) Proceed only to the point of pain. Care must be taken to avoid fatigue and irritation of inflamed nerves when working with individuals with Guillain-Barre syndrome, so ranging only to the point of pain is the most important concept in this question.

96.An individual with Guillain-Barre syndrome complains of pain during passive range of motion to the shoulder. Which is the MOST important technique for the OT practitioner to use while performing PROM with this individual? a. work proximal to distal b. proceed only to the point of pain c. limit the number of repetitions to 10 d. gently encourage the individual to work through pain

(D) distractibility. Distractibility involves losing one's focus because of other stimuli. See reference: Early: Responding to symptoms and behaviors.

96.An individual with the goal increasing attention span is frequently observed watching the person next to her instead of performing her assigned task. This behavior MOST likely indicates: A. Memory deficits B. Spatial operations C. Generalization of learning D. Distractibility

(A) Checking for irritation and pressure problems. Because a toddler cannot communicate discomfort effectively, skin irritation may go unnoticed for too long. A young child, therefore, is at higher risk for developing skin and pressure problems than an older, more verbal one.

96.When instructing the parents of a toddler in the use and care of a hand splint, the OT practitioner should put MOST emphasis on: a. checking for irritation and pressure problems b. avoiding excessive heat exposure c. cleansing the splint regularly d. adhering strictly to the wearing schedule

(B) Project group. The next level of group interaction is termed project group, since the group members are now able to share the completion of a group project; however, they still require strong group leadership to guide them.

97.A child diagnosed with mental retardation has been participating in a craft group structured as a parallel group. The child is now developing skills such as sharing materials and interacting with other group members. The NEXT level of structured activity which the OT practitioner would recommend for the child is in a(n): A. Egocentric cooperative group B. Project group C. Cooperative group D. Mature group

(D) Obtain a narrower wheelchair because this one is too wide. The recommended wheelchair seat one is too wide. The recommended wheelchair seat width is 2 inches wider than the widest point across the hips and thighs of the seated individual. Is the seat is 2.5 inches wider than the patient. See reference: Trombly (ed): Deitz, J, and Dudgeon, B: Wheelchair selection process

97.A patient's weight has changed during the course of hospitalization, and the wheelchair seat is now 2.5 inches wider on each side of the patient's hips. Which is the BEST recommendation the OT practitioner can make regarding proper wheelchair fit? A. Obtain a wider wheelchair because this one is too narrow B. The patient should be encouraged to lose weight C. The sides of the chair should be padded to improve the fit D. Obtain a narrower wheelchair because this one is too wide

(A) checking for irritation and pressure problems. Because a toddler cannot communicate discomfort effectively, skin irritation may go unnoticed for too long. A young child, therefore, is at higher risk for developing skin and pressure problems than an older, more verbal one. See reference: Case-Smith (ed): Exner, CE: Development of hand skills.

97.When instructing the parents of a toddler in the use of common household objects. the practitioner document this as: A. Checking for irritation and pressure problems B. Avoiding excessive heat exposure C. Cleansing the splint regularly D. Adhering strictly to the wearing schedule

(C) Anxiety and confusion among group members. It is important for group leaders to demonstrate consistency by showing the same degree of respect, interest, and authority toward every group members.

97.When leading groups, OT practitioners should demonstrate consistency from day to day. Inconsistent behavior would most likely result in: a. overdependence of group members b. group members‟ knowing what to expect from the group leader c. anxiety and confusion among group members d. group members‟ receiving too much praise

(B) Implement a pureed diet and allow adequate time for eating. As ALS progresses, speaking and swallowing become more difficult and a pureed diet becomes necessary. The individual runs the risk of aspiration or choking if meals are rushed. See reference: Pedretti (ed): Pedretti, LW, and McCormack, GL: Amyotrophoc lateral sclerosis.

98.An OT practitioner is working on a feeding program for an individual with ALS who is in the late stages of the disease process. Which of the following is the MOST appropriate intervention for this individual? A. Provide a rocker knife, plate guard, and nonskid mat B. Implement a pureed diet and allow adequate time for eating C. Emphasize upper extremity strengthening D. Minimize the use of adaptive equipment

(D) A buttonhook attached to a cuff that fits around the palm. Individuals with C6 quadriplegia may have a tenodesis grasp or no grasp at all available to them. Therefore, a buttonhook that fits onto the palm or a buttonhook with a built-up handle are the only appropriate choices.

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

(D) Conduct a group discussion about responsibilities people have when living in a group home. A cognitive approach is most appropriate with individuals "who must learn to do situational problem solving... when the individual has deficits in attention span, memory, or other cognitive abilities... or when the skills being learned need to be generalized." Discussion that heightens awareness in an attempt to modify behavior is one example of a cognitive intervention.

98.An individual with a history of substance abuse live in a group home. The residential manager has asked the OT practitioner to work with the individual to develop house cleaning skills. Which of the following interventions is most appropriate when a COGNITIVE approach is desired? A. Reward the individual with a snack bar token when chores have been successfully completed. B. Praise the individual when chores have been successfully completed C. Post a schedule of each individual's chore responsibilities in a highly visible location D. Conduct a group discussion about responsibilities people have when living in a group home

(D) Respond to the emotional tone expressed by the words; provide extra attention and reassurance.

98.In a long term care facility, an elderly resident with dementia repeatedly asks for her mother and becomes increasingly upset. The MOST therapeutic strategy for responding to this resident is to: a. use reality orientation; explain that the person's mother has been dead a long time b. set limits: firmly tell the person to stop asking for her mother c. therapeutic "fibbing": tell the person that her mother will be coming shortly d. respond to the emotional tone expressed by the words: provide extra attention and reassurance

(B) Help the child develop cognitive strategies for anxiety-producing activities. Children with innate temperament problems need cognitive strategies to help them to overcome anxiety in order to approach and participate in activities. Parents need to understand the innate temperament problem and the discomfort the child feels during activities, and limit setting (answer A) will not promote understanding.

99.A child with a behavior disorder has an innately difficult temperament. Which of the following treatment approaches is MOST appropriate? a. emphasize limit setting with the child during activities b. help the child develop cognitive strategies for anxiety producing activities c. help care providers develop an unpredictable routine for activities that disorganize the child d. provide a play environment in which the parent and child can demonstrate conflicts

(A) Summary feedback, given at the end of the patient's attempts. According to learning theory, providing summary feedback after several trials aids retention and learning by encouraging the person to rely on inner or intrinsic feedback to self-correct errors in performance, rather than the extrinsic feedback given by the therapist.

99.An OT practitioner has been working with a cognitively intact patient to train him in the safe use of a tub bench for transferring for several sessions. According to motor-learning principles, the BEST way to give feedback about the person's performance to ensure that this person learns the skill is to provide: A. Summary feedback, given at the end of the patient's attempts. B. Continuous feedback to let the person know how he is processing. C. Feedback about the performance whenever the patient makes a mistake. D. Give no feedback during or after the practice session

(B) Hyperextension of the PIP joint and flexion of the DIP joint. Answer B is the only answer provided that describes a swan-neck deformity. The pattern of hyperextension of the PIP and DIP joints. See reference: Pedretti (ed): Hittle, JM, Pedretti, LW, and Kasch, MC: Rheumatoid arthtritis.

99.An OT practitioner is fabricating a splint for a client with swan-neck deformities. This splint is designed to maintain the client's fingers in a position which prevents further: A. Hyperextension of the PIP and DIP joints B. Hyperextension of the PIP joint and flexion of the DIP joint C. Flexion of the PIP joint and hyperextension of the DIP joint D. Hyperextension of the MP joint and flexion of the PIP joint

(D) Cooperative group activity that both provides and elicits consistent and accurate feedback about interactions within the group.

99.An OT practitioner is planning treatment for individuals with a variety of personality disorders who have inaccurate perceptions of others and unrealistic perceptions of themselves. The treatment method that might BEST address these problem areas is a: a. small group that provides a wide range of craft activities from which the members are encouraged to select b. session focused on understanding and changing the individual's way of relating with the therapist c. social skills training program completed in small groups d. cooperative group activity that both provides and elicits consistent and accurate feedback about interactions within the group