things to study from practice exam 2

"An occupational therapist working for a home care agency is vacationing and sees a colleague at an all-day concert. Upon return from the vacation, the therapist notices that this colleague had billed for a full day of home visits on the day of the concert. Which action is best for the therapist to take first in response to this situation? Answer Choices: A. Inform the home care supervisor. B. Contact the state regulatory board. C. Contact the National Board for Certification of Occupational Therapy. D. Ask the colleague to clarify the situation."

A! Why? Supervisor will investigate and determine further action.

airborne precuations= droplet precautions = standard precautions=

Remain suspended in air transmitted from droplets from talking, sneezing, coughing always used!

Look at the Rood Approach

"Heavy work and reciprocal inhibition/innervation are techniques used in the Rood approach. In heavy work (also termed "mobility superimposed on stability"), proximal muscles contract and move, and the distal segments are fixed. According to the Rood approach, reciprocal inhibition/innervation is an early mobility pattern that is primarily a reflex governed by spinal and supraspinal centers"

Concurrent review= peer review= utilization review=

-evaluation of ongoing intervention programs -work reviewed by peers -plan to review use of resources within a facility for necessity/cost efficiency

A full-time equivalent (FTE) is the amount of work time assigned to one full-time staff member in a year. Part time employees are considered: Employees who devote half their time to direct care only are considered:

.5 of FTE .5 FTE

Phase 1 cardiac rehab: Phase 2:

1: "Putting away groceries, keyboarding, washing dishes, and playing tabletop board games are at a 1.0-2.5 MET level 2:"activities should begin at a 4-5 MET level and progress to higher METlevels. Weeding a garden and doing low-impact aerobics are at this level"

"Several residents of a skilled nursing facility report that they are bored with their individual daily range of motion exercise programs. The occupational therapist collaborates with the physical therapist to design a group format to facilitate participation in range of motion exercises. Which would be most beneficial for the therapist to recommend incorporating into the proposed group? Answer Choices: A. The use of several exercise videos with diverse exercise styles and music. B. The pairing of residents to perform gentle range of motion on each other. C. The use of exercises performed in rhythm to a marching band video. D. The provision of coffee and cake after the group"

A

A MRP approach provides _____ and ______ feedback to give a person the input needed to make postural and limb adjustments. Therapeutic handling to affect the central nervous system is consistent with a _______ therapy approach. Providing a stool to sit on during reaching activities can be used for safety purposes. This is consistent with a _________ approach. Joint compression is a technique used for _____ _____ _____ (e.g., tactile defensiveness, hypersensitivity/overresponsivity; and hyposensitivity/underresponsivity and sensory seeking)."

A MRP approach provides verbal and visual feedback to give a person the input needed to make postural and limb adjustments. Therapeutic handling to affect the central nervous system is consistent with a neurodevelopmental therapy approach. Providing a stool to sit on during reaching activities can be used for safety purposes. This is consistent with a compensatory approach. Joint compression is a technique used for sensory modulation disorders (e.g., tactile defensiveness, hypersensitivity/overresponsivity; and hyposensitivity/underresponsivity and sensory seeking)."

"An occupational therapist provides caregiver training to the spouse of an individual with cerebellar cortical degeneration. The focus of the session is on community mobility using a wheelchair. The individual is dependent upon the spouse's assistance for mobility. Which of the following is most effective for the therapist to recommend the spouse do when descending a steep grade? Answer Choices: A. Go down backward with all wheelchair wheels maintaining contact with the ground surface. B. Tilt the wheelchair backward to its gravitational balance point and then go down forward. C. Tilt the wheelchair backward to its gravitational balance point and then go down backward. D. Push forward as on flat surfaces but lean body back for extra drag"

A!

"An occupational therapist designs a qualitative research study to examine the efficacy of an after-school play-based program for the development of social interaction skills. Which method of data collection is best for the therapist to use? Answer Choices: A. The therapist's observations of the participating children in the classroom and during recess. B. The completion of a social skills Likert-scale questionnaire by the participants' teachers. C. The completion of a social skills Likert-scale questionnaire by the participants' parents. D. The administration of a standardized social skills evaluation pre- and postintervention"

A! Why "Qualitative research is a form of descriptive research that studies people individually or collectively in their natural social and cultural contexts. Data collection methods include direct observation in naturalistic settings, such as observing children in their classroom and during recess. The completion of Likert-scale questionnaires and the administration of a standardized evaluation are research methods that are used to collect quantitative data; therefore, they would not be used in a qualitative study."

"An occupational therapist designs a dining rehabilitation program in a long-term care facility. The occupa-tional therapist instructs paraprofessional staff in proper feeding techniques. Which point is most importantfor the therapist to include in this staff training?Answer Choices: A. Meals should occur in a homelike environment with staff conversing with the residents being fed. B. Residents with swallowing difficulties should be fed in a group so that staff can remind them to swallow atthe beginning of each meal. C. Placing three fingertips on the throat and pressing firmly will stimulate a swallow response. D. The head should be tilted slightly backward during feeding to facilitate an assisted swallow"

A! Why? "Proper feeding techniques include a facilitative environment. Dining in a homelike setting with staff who are attentive to the residents' needs and interests during feeding/mealtimes will facilitate eating and socialization during the activity"

"An adult incurred an injury to the anterior spinal artery at the T12 level. The occupational therapist completes a sensory evaluation with this client. Which sensation is most likely for the therapist to document that the individual has retained? Answer Choices: A. Proprioception. B. Pain. C. Crude touch. D. Temperature"

A! Why? "Proprioception is maintained with the condition of anterior spinal cord syndrome, which is caused by damage to the anterior spinal artery or anterior spinal cord. Dorsal (posterior) columns transmit proprioceptive information. The others are aspects of sensation that are impaired or absent in anterior spinal cord syndrome"

During an occupational therapy screening session, the therapist observes that a child bangs objects on a tabletop but is unable to give up a toy upon request. The occupational therapist documents these behaviors. Which developmental level is indicated by the child's observed behaviors and would be the most accurate for the therapist to report? Answer Choices: A. 3-4 months. B. 7-8 months. C. 9-10 months"

A! Why? At 3-4 months, children are able to bang toys on a tabletop, but they do not have a voluntary release. At 7-8months children begin to be able to give up objects with an assisted release, and at 9-10 months there is more efficient release.

"A high school student with a diagnosis of borderline personality disorder and a history of self-abusive behaviors attends a transitional school-to-work program co-led by an occupational therapist and a COTA®. During the vocational skills group, the student expresses feelings of hopelessness about the future and questions the point of participating in the program. The student asks to leave the group due to being too tired to concentrate as a result of sleepless nights. The occupational therapist asks the COTA® to assume leadership of the group while the therapist addresses the student's concerns. Which action is best for the therapist to take in response to the student's statements? Answer Choices: A. Pull the student aside from the group and ask if the student is feeling self-destructive. B. Allow the student to leave the group after reminding the student to relay concerns to the guidance counselor. C. Support the validity of the student's feelings and encourage the student to remain in the group. D. Remind the student that in a work setting the norm is to work even if fatigued.

A! Why? Feelings of hopelessness and lack of future vision should be taken seriously!

"An occupational therapist conducts an in-service at an outpatient wheelchair clinic for individuals with central nervous system dysfunction. According to the principles of wheelchair prescription, which of the following statements is accurate for the therapist to make during the presentation? Answer Choices: A. Firm seats are needed to provide stability. B. Soft seats are needed to prevent decubiti. C. Back heights should be extended to facilitate weight shifting. D. Seat angles should be 45° to prevent falling forward.

A! Why? Firm seats provide stability and a solid base for seating systems that can be used to prevent decubiti, contractures, and deformities, and to increase sitting tolerance, proper positioning, and functional abilities. Soft seats are contraindicated as they do not provide sufficient pressure relief. Soft seats can "collapse" under pressure and can increase the risk of decubiti. Extended back heights increase the difficulty of weight shifting because the person cannot hook their arm around the push handle. The recommended seat angle ranges from 80° to 110°.

"An individual attends a community day treatment program to assist in recovery from a major depressive disorder. The client has fair eye contact and responds verbally to interactions initiated by others. The person's cognition is intact. Which group level is best for the occupational therapist to recommend this client attend? Answer Choices: A. Project. B. Parallel. C. Cooperative. D. Mature.

A! Why? Project= good for one who is socially responsive and cognition intact

"An adult with amyotrophic lateral sclerosis frequently coughs and chokes when eating finely chopped foods and drinking thin liquids. The speech pathologist and occupational therapist collaborate and recommend a videofluoroscopy procedure. Which behavioral information would be most relevant for the occupational therapist to include on the referral? Answer Choices: A. The client demonstrates minimal limitations in cognitive level. B. The client is able to consume chopped foods and apple juice with no difficulty. C. The client demonstrates only oral stage problems during eating. D. The client cannot tolerate therapy focused on improving feeding and swallowing skills.

A! Why? The client with minimal cognitive limitations can be a candidate for the procedure. If a person can progress to swallowing thin liquids, a videofluoroscopy is usually not necessary. The client that shows only oral stage problems also does not need a videofluoroscope to rule out swallowing difficulties, which is the goal of the videofluoroscopy procedure. The client who tolerates therapies has a better chance of improvement and could benefit from the procedure. If the client with a swallowing disorder cannot tolerate therapy, an alternative intervention, such as a gastronomy tube, would be indicated.

"An adult has been referred to occupational therapy. The individual demonstrates decreased ROM in the dominant hand secondary to a nerve injury. Active thumb ROM for the IP and MP is within normal limits. Active ROM of the IPs of all four fingers is 0°-60°. The individual wants to be able to hold a knife, spoon, and fork. Which utensils are best for the therapist to recommend to this person? Answer Choices: A. Utensils with cylindrical foam handles, 1½′′ in diameter. B. Standard utensils with no adaptations. C. Utensils with custom-built handles made of low-temperature thermoplastic splinting material. D. Utensils held in a universal cuff"

A! Why? The custom ones would more likely be for someone with spasticity or more difficulty.

"During a home care intervention planning meeting, the team discusses a client with a right CVA. The physical therapist states the individual's ambulatory status is now within functional limits. Physical therapy services will be discontinued because the person is no longer homebound. The occupational therapist reports that the individual is frequently confused during home management task performance and becomes extremely anxious when community activities are discussed. Which recommendation should the therapist make? Answer Choices: A. Refer the individual to a psychiatrist for a mental status evaluation. B. Continue OT services as the person should continue to be considered homebound. C. Discontinue OT services as they are non-reimbursable since the person is no longer considered homebound. D. Contact the physician to discuss the need for OT services on an outpatient basis and for psychosocial counseling.

A! Why? The individual can be considered homebound for cognitive and psychosocial deficits. Discontinuing ser-vices can place the individual at risk because the person will not receive evaluation or intervention for their demonstrated cognitive and psychosocial deficits. There is no need for a consultation with a physician at this point. OT practitioners can continue to provide services in this scenario without physician input.

"An occupational therapist provides intervention to develop independent feeding skills in an 18-month-oldchild with significant developmental delays. The child has mastered the ability to hold a spoon and bang it on the tray of the high chair. The child can also hold and suck on a cracker. Which activity is best for the therapist to provide next during intervention? Answer Choices: A. Finger-feeding soft foods. B. Scooping food and bringing it to the mouth. C. Taking cereal from a spoon held by the therapist. D. Bringing a filled spoon to the mouth.

A! Why? The next developmental milestone after holding and banging a spoon is finger-feeding soft foods. Due to thechild's developmental delay, an occupational therapist would work on the acquisition of feeding skills ac-cording to normal developmental milestones. The typical developmental sequence of feeding is taking cerealfrom a spoon (5-7 months), self-feeding by sucking a cracker (6-9 months), holding and banging a spoon(6-9 months), finger-feeding soft foods (9-13 months), bringing a filled spoon to mouth (12-14 months),and scooping food and bringing it to the mouth (15-18 months). See Table 5-7 in Chapter 5 for more detailson the developmental sequence of self-feeding. In working with a child with developmental disabilities, it is the child's developmental age, not their chronological age, which guides intervention.

"During an intervention session in a school, the occupational therapist observes a young child turn the pages of a book. The therapist identifies this behavior as an example of an in-hand manipulation task. Which task should the occupational therapist document the child is capable of performing? Answer Choices: A. Shift. B. Simple rotation. C. Translation. D. Translation without stabilization.

A! Why? shift= linear movement= turning book page

"A preschool-aged child with recurring headaches and decreased gross and fine motor skills is hospitalized on an acute care unit for a diagnostic workup. Just prior to the occupational therapy evaluation, the parents are told that their child has cancer. The parents are upset when they bring their child to the evaluation session. Which are the best actions for the therapist to take in response to this situation? Answer Choices: A. Recommend the parents speak to their spiritual advisor or the social worker and proceed with the OT session. B. Cancel the OT session and recommend the parents speak to their spiritual advisor or the social worker. C. Spend the OT session providing support to the parents and addressing the parents' acceptance of the diagnosis. D. Recommend the parents speak to their spiritual advisor or the social worker and reschedule the OT session for later in the week."

A! Why? The child still needs the OT eval!

"An individual recovering from hepatitis, type C has decreased upper and lower extremity muscle strength and hypertension. Six months ago the client had an angioplasty and is very fearful of having a heart attack. Which should the occupational therapist instruct the client to perform to increase muscle strength? Answer Choices: A. Isotonic exercises. B. Isometric exercises. C. Contract-relax exercise. D. Muscle contractions and holds.

A! Why? Isotonics are the only exercises listed that are not contraindicated for a person with hypertension or heart disease. The other choices describe isometric exercises or activities that include isometric elements and are contraindicated in this case.

"A young adult with a ten-year history of serious mental illness is being discharged home in two days. The client collaborates with the care coordination team to plan discharge with the client's primary family members. The team consists of a psychiatrist, a registered nurse, a social worker, and an occupational therapist. The team conducts a predischarge family meeting to provide family members with information to assist them in supporting the client's recovery. Which is the most relevant information for the occupational therapist to provide to the client's primary family members at this meeting? Answer Choices: A. Family role activity suggestions and potential adaptations. B. The therapeutic effects and potential side effects of medications. C. Advocacy strategies and consumer/family resources. D. Family dynamics information and family support groups.

A! why? The occupational therapist is the only one on the identified care coordination team who is qualified to provide information about role activities and potential activity adaptations.

"An occupational therapist working in a skilled nursing facility conducts an in service on validation therapy for the recently hired staff of a new psychogeriatric unit. Which fundamental principle of validation therapy is important for the therapist to include in this presentation? Answer Choices: A. Listen to the words an individual uses to ascertain the person's underlying message. B. Provide highly structured activities to refocus the individual on reality. C. Provide unstructured activities to facilitate the expression of feelings. D. Listen to the words an individual uses and provide reality orientation for invalid statements."

A! why? "Validation therapy is an approach to working with individuals with neurocognitive disorders (formerly called dementia) founded on the principle that the unspoken messages an individual conveys in their speech are more important than the actual content of the speech."

"After six months of rehabilitation for a T2 spinal cord injury, a patient is being discharged. The occupational therapist conducts a home visit to evaluate accessibility. The individual lives with two roommates in an apartment in a private home. The doorway measurements currently range from 30 to 32 inches throughout the apartment. The patient's landlord is amenable to making changes in the apartment but has no financial resources. Which recommendation is best for the therapist to make for independent accessibility in the apartment? Answer Choices: A. Install offset hinges on all doors. B. Remove doorframes of doorways less than 32 inches and install wider frames. C. Remove all doors except for the apartment entrance door. D. Remove all doorframes and install 36-inch-wide doorframes

A! why? Offset door hinges increase width by 2 inches! and cost effective.

"A cooking group meets for 1½ hours each week at a partial hospitalization program. During the group, members do not smoke, they wait for everyone to be served before eating, and they clean up after the meal. When reporting these observations, which of the following is the most accurate statement for the therapist to make? Answer Choices: A. The group protocol is clear. B. Group norms are being followed. C. Group sanctions are effective.

B! Why? "Group norms are the expected and accepted behaviors in a group. These norms establish an atmosphere of mutual respect, safety, and support. Sanctions are implemented only in a group if members' behaviors fall outside of the group's norms and are considered deviant. A group protocol outlines the group's membership criteria, goals, and activities; it does not describe in vivo group member behaviors.

"An occupational therapist works with a child with pervasive developmental disabilities in order to develop self-care skills. In teaching the child to brush teeth, the therapist places the toothbrush in the child's hand and guides it to the mouth. To help the child learn to complete the activity the therapist uses the somatosensory system. Which of the following is most effective for the therapist to use next during intervention with this child? Answer Choices: A. Tell the child to brush up and down. B. Provide hand-over-hand assistance to brush the child's teeth. C. Touch the child's hand to prompt hand-to-mouth movements. D. Instruct the child to follow a pictorial sequence card depicting toothbrushing"

B! Why? In providing hand-over-hand assistance, the occupational therapist is using tactile, proprioceptive, and movement stimuli to cue the child. The somatosensory system is inclusive of these sensory systems. Providing auditory, tactile, or visual input does not provide sufficient input for the child to learn the task.

"An occupational therapist conducts a sensory evaluation of an individual recovering from a left cerebral vas-cular accident. The individual has right hemiplegia and expressive aphasia. During the evaluation of stereognosis, which should the therapist have the client use to identify responses to the testing stimuli? Answer Choices: A. Pictures of the objects. B. A set of identical objects. C. Cards with "one" and "two" printed on them. D. Cards with "yes" and "no" printed on them."

B

"The residents of an urban homeless shelter include individuals with histories of chronic alcohol abuse who are at risk for developing peripheral neuropathy. The occupational therapist consulting at this shelter monitors the residents' status to ensure early detection of this problem. Which is the most important observed status change for the therapist to report? Answer Choices: A. Progressive deterioration in visual acuity. B. Progressive deterioration of sensorimotor functions of the lower extremities. C. Rapid onset of intention tremors. D. Rapid loss of sensorimotor functions of the facial and neck muscles"

B!

"An occupational therapy administrator implements a quality improvement program at a large private hand therapy clinic. The administrator determines that the clinic's certified occupational therapy assistants (COTA®s) are not completing their assigned initial screenings in a timely manner. This has resulted in scheduling delays for complete functional evaluations. Which initial action is most effective for the administrator to take in response to this situation? Answer Choices: A. Counsel the COTA®s on the need to adhere to screening schedules. B. Examine the organizational structure of the screening process. C. Assign the occupational therapists to complete all screenings. D. Redesign the screening to simplify the process"

B! Why? "A fundamental principle of quality improvement (QI) is to view problems and limitations as opportunities to explore organizational improvement needs."

"An individual recovering from myasthenia gravis has fair minus (F-) muscle strength in both upper extremities. The occupational therapist develops an intervention plan to include the goal of increasing muscle strength. According to the biomechanical approach, which should the therapist work on with the patient during intervention? Answer Choices: A. Complete active ROM with gravity decreased. B. Complete active ROM against gravity. C. Incomplete active ROM against gravity. D. Complete active ROM against gravity and slight resistance.

B! Why? Kind of like 3 (a 3- would be more than 50% against gravity but not full) The next muscle grade after a minus Fair (F-) is fair (F) which indicates the ability of the body part to move through its complete ROM against gravity. An F- muscle grade indicates a body part can move through its in-complete ROM (more than 50%) against gravity. An F+ muscle grade indicates a body part can move through its complete ROM against gravity and slight resistance. The ability to move a body part through complete ROM with gravity decreased is indicative of a poor (P) muscle grade.

"A homemaker and parent is hospitalized for a major depressive disorder and prescribed Parnate to treat depressive symptoms. The patient's hobbies are gardening and jogging. Upon discussing the functional effects of medications with the patient, which is the most important precaution for the occupational therapist to review? Answer Choices: A. Photosensitivity. B. Dietary restrictions. C. Orthostatic hypotension.

B! Why? Parnate is a monoamine oxidase inhibitor (MAOI) and has serious side effects when a person eats foods that contain amino acid tyramine.

"An adult recently diagnosed with scleroderma receives occupational therapy services to deal with the functional changes caused by this disease. Which recommendation is best for the occupational therapist to make to this individual? Answer Choices: A. Dress in lightweight clothing for thermal comfort. B. Dress in layers for neutral warmth. C. Use pull-on clothing to ease donning and doffing. D. Use Velcro or a button hook to ease fastening."

B! Why? Sclerderma is a condition which includes Reynaud's syndrome and poor circulation.

"An occupational therapist plans intervention for an individual with cognitive perceptual deficits. In deciding whether to use a dynamic interactional approach or a deficit-specific approach, which is most important for the occupational therapist to consider? Answer Choices: A. The client's auditory processing skills. B. The availability of familial support. C. The client's social interaction skills. D. The client's problem-solving skills.

B! Why? The dynamic interactional approach utilizes awareness questioning to help the individual detect errors, estimate task difficulty, and predict outcomes. Therefore, the therapist must consider the client's level of auditory processing skills to determine if adaptations or modifications are needed when implementing this approach. If an individual has severe auditory processing deficits, it may indicate a need to use a deficit-specific approach, for cognitive perceptual remediation. Family support, social interaction skills and problem-solving skills can all influence intervention, but they are not determining factors in selecting which theoretical approach to use in this case.

"An occupational therapist provides home care services to a neonate with significant developmental delays. Two hours before the next scheduled home visit, the child's parent informs the therapist that one of three older children has developed chicken pox. While the other children do not show signs of chicken pox, the parent expresses concern that they are contagious. Which is the therapist's best response to this situation? Answer Choices: A. Cancel the scheduled session and reschedule after two weeks have passed. B. Complete the scheduled session using airborne precautions. C. Complete the scheduled session using standard precautions. D. Complete the scheduled session using droplet precautions.

B! Why? chicken pox is transmitted by airborne droplet nuclei. Need a mask.

"An individual prepares for discharge home following rehabilitation for a left cerebrovascular accident (CVA).Residual difficulties include fair dynamic balance and decreased proximal upper extremity (UE) strength. The individual's stated priority is to be able to ambulate safely to the senior center located in the client's apartment building. Which ambulatory aid would be most effective for the occupational therapist to recommend to this client? Answer Choices: A. A hemi-walker. B. A rolling walker. C. A side-stepper walker. D. A standard walker"

B! Why? rolling walkers are good for decreased UE strength when they cannot lift a regular walker

"An occupational therapist plans individual and group activities for a child with oppositional defiant disorder. Which is most important for the therapist to address during group activities? Answer Choices: A. The child's willingness to take on a variety of group roles. B. The child's ability to attend to and complete a task. C. The child's self-regulation of energy and activity levels"

B! Why? self-regulation of energy and activity is more hyperactivity than ODD

"An individual is transferred from an acute care hospital to a subacute rehabilitation unit in a long-term care facility. The patient incurred a left cerebral vascular accident (CVA) in the middle cerebral artery (MCA) one week ago. The individual is referred to occupational therapy. The referral states that the patient has right hemiplegia and a subluxed right shoulder. B92 C4The occupational therapist meets with the nursing staff that will be providing primary care to the patient at the patient's bedside. The occupational therapist recommends that the direct care staff position the patient in left side lying. Which is the best bed position for the therapist to recommend for placement of the patient's right arm? Answer Choices: A. In 90° of humeral abduction and internally rotated. B. Protracted with arm forward on a pillow and the elbow extended or slightly flexed. C. On the person's side, adducted and internally rotated. D. In 90° of abduction of the humerus with neutral rotation"

B! Why? "The best position of the upper extremities for sleeping or bed rest is to place the affected arm on a pillow in a position which ensures that the shoulder is approximated and that the extremity is well supported."

"While completing the screening, the occupational therapist observes that the patient uses only their left side to participate in activities. The therapist suspects that the patient has unilateral neglect and difficulties with body scheme. Which should the therapist have the patient do during the OT evaluation to determine if these deficits are present?Answer Choices: A. Point to various body parts named by the therapist. B. Complete upper and lower extremity dressing. C. Complete the draw-a-person test"

B! Why? It is best to have them complete a functional task

"In an acute inpatient psychiatric facility, an occupational therapist designs a therapeutic activity group forindividuals with poor orientation to reality. Which is the best activity choice for the therapist to provide inthis group? Answer Choices: A. A discussion of the effects of hospitalization on occupational roles. B. The assembly of wooden toys for a children's unit. C. Guided imagery for stress management. D. Structured verbalizations of personal assets and limitations."

B! Why? activities for an impatient acute psych unit should be structured and straight forward!

"An occupational therapist works in a school system with a child with developmental delays. One of the goals of treatment is to develop prewriting skills. The child exhibits the ability to grasp a pencil proximally with crude approximation of the thumb, index, and middle fingers and the ring and little fingers slightly flexed. The therapist develops an intervention plan. Which grasp should be the focus for the implementation of intervention? Answer Choices: A. Digital pronate grasp. B. Static tripod posture grasp. C. Dynamic tripod grasp. D. Palmar supinate grasp.

C! Why? The grasp pattern described in the case is static tripod posture grasp. The next grasp pattern to be masteredafter this grasp is the dynamic tripod grasp. The other grasp patterns are precursors to the static tripod grasp.

"A young adult recently diagnosed with schizophrenia is referred to an occupational therapy day treatment program. Which should the occupational therapist do first with the client? Answer Choices: A. Determine short-term and long-term goals for program participation. B. Model desired behaviors during occupational therapy groups. C. Have the client complete an occupational interest checklist. D. Encourage the client to maintain a daily log of medication intake"

C!

"An occupational therapist completes a cognitive screening for a person with chronic schizophrenia, undifferentiated type. The therapist uses Allen's cognitive disabilities model to guide the evaluation process. During the screening, the person is able to imitate the whipstitch but cannot imitate the single cordovan stitch. Based on these results, the occupational therapist determines that further evaluation is indicated. Which ability is most relevant for the therapist to assess? Answer Choices: A. Performance of multistep tasks using overt trial and error problem-solving. B. Performance of multistep tasks using analytical reasoning. C. Performance of simple tasks independently using visual cues. D. Performance of simple tasks with long-term repetitive training."

C!

"The client responds well to the compensatory approach when performing countertop meal preparation tasks. The therapist decides to use a dynamic interactional approach as the theoretical foundation for cognitive perceptual intervention for other meal preparation activities. During a session to train the client in scanning strategies, the client accurately finds two items in a refrigerator. Which is the therapist's most appropriate initial response to the client's task success? Answer Choices: A. Praise the client for successful task completion. B. Ask the client to now find three items in the refrigerator. C. Ask the client how they know that the items are correct. D. Ask the client to now find two items in the pantr"

C! Why The dynamic interactional approach uses awareness questioning

"A school-based occupational therapist consults with a teacher regarding a nonspeaking student who uses a wheelchair and an augmentative communication device. The teacher reports that the student has been making many errors on the communication device but that no difficulties had been observed when the student used the device in the past. Which is the most effective initial action for the therapist to take in response to the teacher's report? Answer Choices: A. Advise the teacher to contact the student's parents and recommend that they bring the child to a physician for an exam. B. Reassess the student's motor and communication abilities to determine needed modifications. C. Evaluate the position of the student in the wheelchair and the device on the wheelchair. D. Reposition the communication device on the wheelchair to facilitate access and increase accuracy.

C! Why? Even minor changes in a person's positioning can impact on their access to an assistive device; therefore, the therapist's initial action must be to evaluate the position of the student and the device!

"An individual with borderline personality disorder incurred a back injury while working as a stockperson fora large warehouse. The individual attends a work hardening program. The occupational therapist evaluates the individual and determines that the client's level of productivity is just below the warehouse minimum standards. The individual complains of pain when lifting the heaviest of boxes. The client frequently becomes angry and verbally abusive in response to directions or feedback. Which is the most important initial focus of the work hardening program for this individual? Answer Choices: A. An increase in productivity to meet minimum standards. B. The development of strength and ergonomic lifting abilities. C. The development of affective work behavior skills"

C! Why? Strengthening will come with the program. However, having proper social/work skills is something that will prevent them from keeping their job.

"A child with congenital anomalies has severe developmental delay. The child demonstrates motor and cogni-tive skills at the nine-month level. Which is the best adaptation for the occupational therapist to use duringintervention to develop the child's visual and auditory awareness? Answer Choices: A. A hand-held rattle of the child's favorite cartoon character. B. A wrist bracelet with blinking lights that makes noise when moved. C. A button switch that activates a CD player when the switch is pressed.

C! Why? The button switch encourages the child to develop the developmentally appropriate skill of cause and effect. Visual stimulation is provided when the child focuses on the device to activate it. Activating the CD player provides auditory feedback.

"A client with a lower brain stem injury is referred to occupational therapy. During the evaluation, which reflex would the person most likely demonstrate? Answer Choices: A. Tonic lumbar. B. Body-on-body righting. C. Tonic labyrinthine. D. Labyrinthine righting.

C! Why? lower brain stem= tonic labyrinthine reflex others (tonic lumbar, body on body righting, and labyrinthine righting) are righting reactions that are mediated in the upper brain stem.

"A Level II fieldwork student's first assigned case is an individual with right hemiplegia. The supervising therapist reminds the student that primitive reflexes can emerge when someone incurs a CVA. The therapist demonstrates this point by rotating the client's head to the right and stating that the observed response demonstrates a subtle asymmetrical tonic neck reflex (ATNR). The therapist asks the student to describe the client's reaction that resulted in the therapist's interpretation. Which is most accurate for the student to state the client is exhibiting based on this observation? Answer Choices: A. Increased flexor tone of the right upper extremity. B. Increased extensor tone of the left upper extremity. C. Increased extensor tone of the right upper extremity. D. Increased extensor tone in both upper extremities."

C! Why? ATNR- fencer's reflex- head turns/extremities extend that side, flex opposite side.

"A school-based occupational therapist is teaching orientation and mobility skills to an adolescent with a degenerative visual disorder. Which is the most effective motivational technique for the therapist to use with this student? Answer Choices: A. Provide concrete structure and frequent feedback to ensure accurate orientation and safe functional mobility. B. Keep sessions short to allow time for emotional adjustment to orientation and mobility challenges. C. Treat the student as an adult and incorporate the student's orientation and mobility goals into intervention sessions. D. Limit anxiety by practicing the techniques in a quiet and self-contained environment(e.g., an empty classroom)"

C! Why? Adolescents like to be treated like adults and incorporating their goals is meaningful.

"An occupational therapist provides intervention for an individual with a swallowing disorder. To elicit a swal-low reflex, the occupational therapist provides sensory input to the inferior faucial arches. Which should thetherapist use to provide this intervention? Answer Choices: A. A tongue depressor. B. A moistened cotton swab. C. A chilled dental exam mirror. D. A warmed metal teaspoon"

C! Why? COLD stimulation to inferior faucial arches elicits a swallow response

"A caregiver support group meets weekly at a community center. A new member attends the group for the third time and listens intently. The person nods in agreement when others speak but does not participate verbally. Which action is most effective for the occupational therapist to take to facilitate the individual's engagement in the group? Answer Choices: A. Reiterate the group's norm that active participation is expected from all group members. B. Ask the individual several questions to encourage verbal participation. C. Invite the individual to join in the discussion, if the person would like. D. Refer the individual to the center's social worker for individual, nongroup counseling"

C! Why? Doesn't add pressure.

"before.Now the teen wants a prosthesis "to look good at the prom and more 'normal' when doing things with my friends." Which action would be most beneficial for the occupational therapist to take to meet the teen'sexpressed needs? Answer Choices: A. Recommend a prosthesis with a cosmetic passive hand. B. Recommend a prosthesis with a voluntary opening hook. C. Recommend a prosthesis with a myoelectrically controlled hand. D. Recommend counseling to explore the client's sudden preoccupation with body image"

C- allows for some function as well

"An individual with bilateral proximal weakness identifies a goal of independence in self-feeding. Which equipment is most beneficial for the occupational therapist to recommend for goal attainment? Answer Choices: A. Extended long-handled utensils. B. Built-up handled utensils. C. An electric feeder. D. Mobile arm supports.

D! Why? Mobile arm supports= UE weakness Extended long-handled utensils= decreased ROM Built-up handles= decreased grasp Electric feeder= No functional UE use!

"The administrator of a home care agency tells the occupational therapist to submit all intervention plans to the client's third-party payers, prior to the implementation of treatment. Which is the most accurate term for the therapist to use when documenting these actions? Answer Choices: A. Concurrent review. B. Peer review. C. Utilization review. D. Prospective review.

D! Why? The evaluation and approval of proposed intervention plans by third-party payers is called prospective review

"The supervisor of an acute inpatient unit requests that a recently hired entry-level therapist write summa-ries of several evaluation sessions that were completed by another therapist. The evaluating therapist had toleave work unexpectedly due to a medical emergency and is not expected to return to work. Which is the best response for the therapist to make in response to this request? Answer Choices: A. Comply with the supervisor's request but ask for the supervisor to co-sign the notes. B. Request time to complete an independent evaluation of each individual previously evaluated. C. Report the supervisor's request to the facility's administration. D. Suggest that the therapist's evaluation results be documented by the supervisor"

D! Why? peers cannot complete notes of sessions they did not attend, however supervisors can.

"A child with developmental delay has poor oral motor control. Which should the occupational therapist do to facilitate lip closure? Answer Choices: A. Give pressure with the index finger under the jaw. B. Firmly place a spoon with food on the back part of the tongue. C. Place the thumbs on the lateral ends of the mandibles. D. Give a slight upward sweep of the index finger from the lower jaw to the lower lip"

D!

"A high school student is referred to occupational therapy for ADL training. The student has non-spastic cerebral palsy resulting in right side hemiparesis and decreased muscle tone. During a transition planning meeting, the student's teacher reports the student has had several accidents during a meal preparation class (i.e., incurring cuts when using a knife and burning hands when taking items out of the oven). As part of the transition plan, the occupational therapist will teach the student adaptive techniques used in a kitchen setting to compensate for right-side weakness. Which of the following adaptations should the therapist recommend to improve the student's independence in preparing meals safely? Answer Choices: A. Prepare foods that do not require cutting. B. Use a microwave oven to cook food. C. Use a weighted knife to cut food. D. Use oven mitts that extend to the elbows"

D!

"An occupational therapist conducts an intervention session with a client recovering from a CVA to develop transfer skills. The client has a comorbidity of epilepsy with primary generalized seizures. As the client stands to complete a transfer from the wheelchair to the bed, the client reports feeling sensations that are indicative of an aura. Which is the best immediate action for the therapist to take in response to this situation? Answer Choices: A. Provide reassurance and ask for guidance from the physician. B. Return the client to a seated position in the wheelchair until the sensations pass. C. End the session so the client can rest. D. Guide the person into a side lying position on the bed"

D! Why "An aura is the brief warning stage before the tonic phase of an epileptic seizure"

"A person with arthrogryposis undergoes serial casting with weekly cast changes of the right wrist. Upon cast removal during the fourth week, the therapist notes a small open area 0.25 cm by 0.25 cm and a red rash over the ulnar styloid. Which is the therapist's best response to these observations? Answer Choices: A. Pad the area and apply another cast. B. Refer the individual to the wound care team. C. Fabricate a static splint that does not impede on the ulnar styloid. D. Contact the physician and describe the observations"

D! Why Physician will determine if wound care is needed. They need to know about your observations.

"A Sensory Profile completed by a caregiver indicates that an elementary school-aged child has modulation impairments and sensation seeking patterns. The occupational therapist observes the child frequently wandering, bumping into objects in the room, and fidgeting. Which is the best intervention approach for the therapist to use to address this child's deficits? Answer Choices: A. Strategies to increase random sensory input and encourage high physical activity at home. B. An obstacle course that requires diverse movements for varied proprioceptive and tactile input. C. Sensory experiences that focus on body awareness and grading control during play activities. D. A sensory diet that includes controlled sensory input integrated into the child's daily routine."

D! Why? Basically, "sensory diet" was the BEST option.

"Upon evaluation, the therapist determines that the patient has right homonymous hemianopsia. The therapist provides recommendations to modify the patient's room to enhance independence. Which are the most appropriate recommendations for the therapist to make for the placement of the patient's call button and cell phone? Answer Choices: A. Call button on the left side and the cell phone on the left side. B. Call button on the right side and the cell phone on the right side. C. Call button on the right side and the cell phone on the left side. D. Call button on the left side and the cell phone on the right side."

D! Why? Call button needs to be in the line of sight. However, the cell phone is not an emergency and can be used as motivation to scan the environment.

"A graduate student with an anxiety disorder reports feeling confused about the future. During the OT evaluation, the client relates decreased feelings of competence for their chosen field of study and overall poor personal causation. Which is the best initial action for the therapist to take in response to the client's stated concerns? Answer Choices: A. Administer a vocational interest inventory. B. Provide activities related to the client's chosen field of study. C. Refer the client to the state office of vocational and educational services. D. Establish short-term goals with high potential for attainment.

D! Why? Decreased personal causation and feelings of incompetence are common symptoms of anxiety disorders. The establishment of short-term goals with high potential for attainment can provide the individual with the success experiences needed to develop a sense of competence and improve personal causation. Once these skills are developed, the need for further vocational exploration and/or services can be determined.

"A person recovering from a cerebral vascular accident has left-sided weakness and dysphagia. Which of the following is the most effective direct intervention approach to help the person successfully swallow ingested food? Answer Choices: A. Provide pureed, thick liquids. B. Provide thermal stimulation to the inferior faucial arches. C. Tilt the person's head back and toward the left side. D. Provide small, warm boluses"

D! Why? Direct intervention for oral motor control involves techniques that utilize a bolus. These techniques can involve modification of bolus amount, consistency and temperature

"An occupational therapist provides home-based services to a home maintainer who incurred a right CVA eight months ago. The individual and the therapist have chosen to focus on kitchen activities during the intervention session. The therapist has the client stand in front of the counter with an open dishwasher to the left. The therapist asks the client to put the clean dishes into an overhead cabinet to the right of the client using the affected UE. By setting up the activity in this manner, which proprioceptive neuromuscular facilitation (PNF)technique is the therapist using? Answer Choices: A. Heavy work/mobility superimposed on stability. B. Reciprocal inhibition/innervation. C. Diagonal patterns of D2 flexion/extension. D. Diagonal patterns of D1 flexion/extension

D! Why? PNF uses diagonal patterns. "D1 flexion pattern moves the person's left upper extremity "up and away"" "D2 is the PNF extension diagonalwhich moves the UE "down and in."

"A middle school student with learning disabilities exhibits no behavioral problems in the classroom. However, whenever the class is in a line waiting to switch classrooms, the student becomes agitated and often pushes classmates. The occupational therapy consultant advises the teacher that this behavior may be indicative of anunder lying disorder. Which of the following is most accurate for the therapist to identify as a potential disorder warranting further evaluation? Answer Choices: A. Gravitational insecurity. B. A conduct disorder. C. Antisocial tendencies. D. Tactile defensiveness.

D! Why? The tactile stimuli due to closeness of peers in a line can become overwhelming to an individual with tac-tile defensiveness. The behavior described in the scenario is not reflective of behavior indicative of the other disorders listed.

"An occupational therapist measures a person for a wheelchair. The widest point across the person's hips and thighs is 16 inches, and the greatest length from the person's posterior portion of the buttocks to the popliteal fossa is 18 inches. Which wheelchair seat dimensions should the therapist recommend? Answer Choices: A. 18 inches wide by 20 inches deep. B. 18 inches wide by 18 inches deep. C. 16 inches wide by 18 inches deep. D. 18 inches wide by 16 inches deep"

D! why? 2 inches added to width, 2 inches subtracted from butt to popliteal fossa. This makes sense if you think about it. Two extra inches on the butt measurement and your knee crease would be extended! Duh.

"An adolescent with spina bifida at the C8 level wants to access the new computerized play system that was received as a birthday gift. Which is the best adaptation for the occupational therapist to recommend the adolescent use to access this system? Answer Choices: A. A chin switch. B. A tenodesis splint. C. A universal cuff. D. A joystick control.

D! why? C8 can use a joystick control

A functional capacity evaluation (FCE) evaluates an individual's capabilities for...

demands for a specific job or group of occupations! someone coming in for a FCE is probably getting evaluated for return to work!

Monoamine oxidase inhibitors (MAOIs) (ex. Parnate)= Psychiatric meds=

dietary restrictions photosensitivity/orthostatic hypotension

"Tuning forks are used to test for the sense of ________. Nylon filaments are used to asses for: A disk-criminator or caliper is used to test for:

vibration cutaneous pressure thesholds 2-point discrimination

____ _____ _____ are a sign of a possible lithium overdose and should be reported to the physician immediately. ____ ____ ____ are a common side effect.

gross hand tremors fine hand tremors

isotonic exercise

involves contracting and relaxing your muscles through the full range of a joint's motion

Switches: c8= c6= c5= c3/4=

joystick tenodesis splint universal cuff chin switch

parallel group= cooperative/mature group=

no interaction good for self-expressive/socio-emotional roles

qualitative date= quantitative data=

observations/natural environment Likert scales/standardized tests

Behavior modification program provides...

positive reinforcement for desired behaviors. Not negative!

upper brain stem=

righting reactions!

developmental groups teach...

social interaction skills

First way infants roll:

supine to sidelying then prone to supine

simple rotation= translation=

turning/rolling object in finger pads (unscrew bottle cap) =fingers to palm/palm to fingers

"According to the Allen Cognitive Level (ACL) test, a person who is able to imitate a whipstitch but not able to imitate a cordovan stitch is at a cognitive level of 4. According to Allen's cognitive disabilities model, a person at Level 4 is able to complete simple tasks independently. However, the person relies heavily on _____ _____. According to Allen's cognitive disabilities model, a person at Level 3 can perform simple tasks with long-term _____ ______. According to Allen's cognitive disabilities model, a person who can use overt ____ ___ ___ ___ ____ is at Level 5. The use of ____ ____ is indicative of Level 6.

visual cues repetitive training trial-and-error problem solving analytical reasoning