NBCOT review 2

ALS

a type of motor neuron disorder that is characterized by steady, relentless, progressive degeneration of corticospinal tracts, anterior horn cells, bulbar motor nuclei, or combination.

agnosia

the inability to identify an object using one or more of the senses.

Why might a client with early-stage dementia appear less spontaneous when performing daily routines? A. The client may be compensating for memory loss. B. The client may be compensating for decreased orientation. C. The client may be compensating for decreased spatial orientation. D. The client may be compensating for decreased temporal organization.

A. The client may be compensating for memory loss. The client may be aware of memory loss at this stage and compensate by becoming rigid in routines so that the client still appears to others to have intact memory skills.

A client working as a receptionist in an office reports pain on the left side of the neck. The OTR® completed the evaluation and asked the COTA® to provide intervention. The COTA® observes the client holding the phone between the left ear and shoulder while scheduling appointments. The worker was observed to have 10 calls in 20 min. Which modification is BEST to improve the worker's performance during this task? A. Wear a hands-free headset for phone calls. B. Use a built-up writing utensil when taking notes. C. Align the computer keyboard with the computer monitor. D. Put foam on the phone handle to minimize neck rotation.

A. Wear a hands-free headset for phone calls. A hands-free headset allows workers to keep the head in neutral position and have both hands available for typing on the computer or writing while on the phone.

A COTA® is working with a teenage client who has autism and is nonverbal to determine the client's vocational interests. Which strategy would help the COTA® gain information about the client's preferences? A. Ask the client's teacher what the client likes to do in the community. B. Ask the client to sort pictures of work tasks into piles of things that the client would like to do and things the client would not like to do. C. Ask the client's parents what their goals are for their child and then begin working with the client on those tasks. D. Ask the client to sign to the COTA® a place in the community where the client would like to work one day.

B. Ask the client to sort pictures of work tasks into piles of things that the client would like to do and things the client would not like to do. People with autism benefit from the use of visual supports; given this client's communication status, this option is the most appropriate.

The movements of a client diagnosed with a TBI are exaggerated and oscillating. What term BEST describes the client's movements? A. Spasticity B. Ataxia C. Bradykinesia D. Tremor

B. Ataxia The client is exhibiting ataxic movements.

The upper-extremity movements of a client diagnosed with a traumatic brain injury (TBI) are exaggerated, and the client consistently over- or underreaches for an item. What term BEST describes the client's movements? A. Spasticity B. Ataxia C. Bradykinesia D. Tremor

B. Ataxia The client is exhibiting ataxic movements.

An OTR® is working with a child with Down syndrome and has been told not to allow the child to do a somersault (forward roll) because of congenital joint instability and risk of spinal cord injury. Which joint is the target of this precaution? A. Glenohumeral joint B. Atlantoaxial joint C. Patellofemoral joint D. Subtalar joint

B. Atlantoaxial joint The atlantoaxial joint is located at the first and second cervical vertebrae; instability at this joint could result in spinal cord damage if proper precautions are not taken. Many children with Down syndrome are at risk for instability at this joint.

Which task might a person with early-stage dementia have difficulty performing as a result of typical psychosocial and cognitive abilities present during this stage? A. Completing the morning ADL routine consistently B. Balancing a checkbook C. Maintaining social interaction with family D. Cooking a simple meal

B. Balancing a checkbook Balancing a checkbook is a higher level cognitive task that will most likely be difficult for a client with early-stage dementia. Typically, people with early-stage dementia have the most difficulty with IADLs that require executive function, such as money management and driving. Other IADLs and ADLs become impaired as the disease progresses.

A 4-year-old client sustained full-thickness burns on the volar surfaces of both wrists and forearms 4 months ago. In spite of using pressure garments and splinting for position, the child has developed thick scars across the wrists. Active and passive wrist extension and flexion are, respectively, as follows: right, 25/70 and 40/80; left, 30/70 and 50/85. Which activity would be MOST EFFECTIVE in improving wrist mobility? A. Finger painting on a vertical surface B. Crawling though a tunnel maze C. Playing an X-Box bowling game D. Throwing bean bags through vertical targets

B. Crawling though a tunnel maze Because the burns are on the volar surface, the client has the most limitation in both active and passive wrist extension movement. Crawling is a developmental activity that can develop both flexibility and strength at the wrists through weight bearing.

Workers at a meat processing plant are participating in a back injury prevention program. Which factor should be stressed as presenting a major ergonomic risk? A. Dynamic posturing B. Forceful exertions C. Standing position D. Armrest location

B. Forceful exertions Forceful exertions (e.g., heavy lifting, twisting through the spine) are an ergonomic risk factor.

Which of the following symptoms is characteristic of the early stage of Alzheimer's disease (AD)? A. Visual hallucinations B. Forgetfulness C. Confusion D. Elation

B. Forgetfulness Forgetfulness is characteristic of the early stage of AD.

A COTA®, in conjunction with an OTR®, is preparing a presentation on ergonomics to the local carpenters union. What factor is MOST associated with the onset of lower back pain? A. Low job satisfaction B. Poor physical fitness C. High anxiety behaviors D. High socioeconomic status

B. Poor physical fitness Typically, back pain results from poor physical fitness, obesity, lack of strength and endurance, and poor body mechanics.

A COTA® is working with a 5-year-old with autism on developing a toileting routine. Which intervention strategy is most appropriate? A. Teaching energy conservation techniques to incorporate into the routine B. Using a picture checklist that depicts the routine C. Encouraging the child to invite a peer to model the routine D. Incorporating adaptive equipment or orthotics into the routine

B. Using a picture checklist that depicts the routine Visual supports, such as picture checklists, have been found to be effective intervention strategies for children with autism.

An OTR® is evaluating a 9-year-old client with juvenile rheumatoid arthritis and determines that the child needs an orthosis to decrease morning stiffness and promote joint alignment. Which orthosis should the OTR recommend? A. Wrist cock-up orthosis B. Thumb loop orthosis C. Resting pan orthosis D. Ulnar deviation orthosis

C. Resting pan orthosis A resting pan orthosis keeps joints straight and prevents morning stiffness.

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The COTA® is assisting the OTR in writing the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." What conclusion can you draw about the assist level (or A) required for this client? A. The OTR intends for the client to complete the occupation with moderate assistance. B. The OTR intends for the client to complete the occupation independently. C. The OTR has not clearly communicated the assist level in this goal. D. The OTR intends for the client to complete the occupation with minimal assistance.

C. The OTR has not clearly communicated the assist level in this goal. The assist level must include information about the physical or verbal assistance that the client requires to complete the occupation. This goal does not include such information.

An OTR® is positioning a child with quadriplegic cerebral palsy in a wheelchair. The OTR recommends a chest strap. Which rationale supports the use of a chest strap? A. The child crosses the legs at the knees or ankles. B. The child laterally flexes at the trunk. C. The child is unable to maintain an upright posture. D. The child unable to maintain the head in midline.

C. The child is unable to maintain an upright posture. Some children with quadriplegic cerebral palsy have poor postural control. A chest strap would be an appropriate recommendation to promote an upright posture. A molded head rest is also recommended to promote neck stability and improve head control.

A COTA® has been working with a client recently diagnosed with complex regional pain syndrome of the upper extremity secondary to an improperly casted distal radius fracture. Which modality is BEST to reach the treatment goal of pain control for this client? A. Cold spray B. Neuromuscular electrical stimulation (NMES) C. Transcutaneous electrical nerve stimulation (TENS) D. Iontophoresis

C. Transcutaneous electrical nerve stimulation (TENS) A TENS unit will best aid the client in reaching the treatment goal of pain control.

A COTA® completes an intervention session with a client and documents it using the SOAP note format. In which section would the COTA® write "Client is making excellent progress toward goals and has met short-term goal #1"? A. O B. S C. P D. A

D. A A stands for the assessment part of the SOAP note. The data were interpreted by the COTA®, who used professional judgment to determine the progress the client made toward the goals.

A client who uses an ultra lightweight wheelchair asks whether the chair can accommodate a wraparound lapboard. The COTA® is not familiar with this type of lapboard. Who on the rehabilitation team would be the BEST person for the COTA® to consult to obtain this information? A. An OTR® B. A physical therapist C. A rehabilitation engineer D. A medical equipment supplier

D. A medical equipment supplier The medical equipment supplier would be the person most familiar with the range of rehabilitation products and their features.

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

D. Asking too many closed-ended questions Questions that have a simple yes-no or single-word answer do not capture the essence of an individual client as an occupational being. Although closed-ended questions might be helpful in filling out an assessment tool with single-word answers, they prevent the client from conveying his or her perspective, which is the core of client-centered practice.

A COTA® is working with a child who has a diagnosis of cerebral palsy. The child's tone fluctuates from low to normal with little spasticity. What would the COTA® expect to see when the child reached for a toy that was positioned on the table next to the child? A. Flaccidity B. Ataxia C. Choreoathetosis D. Athetosis

D. Athetosis Athetosis is characterized by tone that fluctuates from low to normal with little spasticity.

A COTA® is working with a client with Stage III amyotrophic lateral sclerosis. Which strategy is BEST to help this client maintain the current level of participation in daily activities? A. Pain management B. Decubitus ulcer prevention C. Strengthening activities D. Caregiver assistance with ADLs

D. Caregiver assistance with ADLs Having the caregiver assist the client with ADLs is the best strategy at ALS Stage III, which is characterized by an increased level of fatigue.

For a client with glaucoma, which activity would present difficulty? A. Seeing at night B. Reading labels C. Sorting colors D. Engaging in mobility

D. Engaging in mobility Glaucoma results in loss of peripheral vision, or visual field. When visual field deficit occurs, the person tends to narrow the scope of visual scanning secondary to visual completion. The person is not aware of unanticipated objects outside of the visual scanning area and may run into objects limiting mobility.

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

D. Instruction in the use of a self-evaluation checklist (i.e., "Did I complete all the steps?") Use of self-evaluation or self-reflection before or after a task are the most effective strategies for decreased awareness.

A client with glaucoma presents for treatment. What symptom is this client MOST likely to have? A. Blurriness of visual details B. Spotty areas of vision C. Loss of ability to see details D. Loss of peripheral vision

D. Loss of peripheral vision Glaucoma is a group of diseases that result in increased ocular pressure, causing damage to the optic nerve. When the optic nerve is damaged, gradual failure of the peripheral vision occurs.

A COTA® who has been certified to use physical agent modalities is treating a client in an outpatient clinic. The client is experiencing pain and swelling in the radial wrist extensor muscles. Treatment includes use of phonophoresis using hydrocortisone. For safe treatment of this client, what information is MOST important to be aware of? A. Length of time pain and swelling have been present B. Prior surgeries of the client C. Activities that aggravate the pain and swelling D. Medications and medication allergies of the client

D. Medications and medication allergies of the client Before applying any medication using phonophoresis, the COTA® needs to be aware of the client's current medications and any medication allergies.

An adolescent referred for occupational therapy has oppositional defiant disorder. During the initial interview, the parent reports that the youth never listens to requests, become angry several times a day, blames mistakes on an older sibling, and deliberately annoys a younger sibling. The youth also fails to respect others' space and complete assigned chores and is often disruptive and argumentative at the dinner table. Which area of occupation is MOST affected? A. Activities of daily living B. Rest and sleep C. Leisure D. Social participation

D. Social participation Social participation is an area of occupation that pertains to behavior in the context of a social system, in this case a family. This youth's interaction with others and fulfillment of roles in the family system are impaired by defiant behavior.

When considering a wheeled mobility device with a client, the OTR®-COTA® team proposes a scooter. Which of the following client characteristics was the primary reason for proposing a scooter versus a manual wheelchair? A. The client is unable to safely ambulate in the home or in the community. B. The client's home can easily accommodate a wheeled mobility device for moving from room to room in the home. C. The client claims he will consistently use any wheeled mobility device he is prescribed. D. The client is able to walk around his home, but cannot walk any distance in the community.

D. The client is able to walk around his home, but cannot walk any distance in the community. Because the client is able to walk around his home he does not qualify for a manual wheelchair.

A client was involved in a car accident and sustained an incomplete injury at the T12 spinal cord level. Before the injury, the client was employed as a heavy equipment operator. After some discussion, the client and COTA® determine it is no longer feasible for the client to return to this occupation. The client is interested in exploring other options for employment. What program is MOST appropriate to assist the client in identifying vocational options? A. Vocational rehabilitation program B. Work readiness program C. Ticket to Work program D. Community-based program

B. Work readiness program Work readiness programs help individuals who want to work identify vocational options that match their interests, skill, and abilities.

A COTA® believes that changing clients' negative beliefs ultimately reduces negative emotional statements and leads to a change in behavior. What is the COTA's main theoretical perspective? A. Cognitive disability B. Developmental C. Cognitive D. Sensorimotor

C. Cognitive The cognitive perspective deals with clients' emotional response to experiences and assists them in reframing their behavioral response.

What assistive technology would be appropriate to recommend to a caregiver of a client who has middle-stage dementia? A. Medication dispensers B. Medication reminder boxes C. Door alarms D. Electric hospital bed

C. Door alarms When used in middle-stage dementia, door alarms can be useful in improving safety of the client and reducing caregiver burden.

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

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

Which setting is MOST effective for job coaching with an adult client with mental illness? A. Sheltered workshop B. Community-based services C. Work readiness program D. Workplace environment

D. Workplace environment Support approaches with on-site training are recommended as the most effective setting for job coaching.

An OTR® and COTA® are providing back-neck training to workers at a food production service as a primary injury prevention program. The OTR® and COTA® can expect the target population to consist primarily of which type of worker? A. Workers with mild back or neck pain B. Workers with no back or neck symptoms C. Workers, human resource staff, employers, and family members D. Workers seeking treatment for back or neck injuries

B. Workers with no back or neck symptoms Primary injury prevention is aimed at workers who have not experienced symptoms of a work-related injury.

When working with a client with chronic pain, the OTA® needs to set a tone that will facilitate a therapeutic relationship with the client. Which statement sets an open and appropriate tone when working with a client who has chronic pain? A. "Your pain is all in your head. All you have to do is ignore it." B. "I have pain when I wake up in the morning. I have arthritis. It usually takes a while before it gets any better. Maybe you should try to exercise in the morning to get things moving, like I do." C. "I realize that you are in pain. Let's try this activity and see what happens. If you need to stop, let me know, but I would like to see you push yourself." D. "I think we should slowly increase the time you are spending at work-related tasks so that you can get back to work as soon as possible."

C. "I realize that you are in pain. Let's try this activity and see what happens. If you need to stop, let me know, but I would like to see you push yourself." The COTA needs to acknowledge that the client with chronic pain has pain; the COTA also needs to communicate the importance of the client's participating to the best of his or her ability.

An OTR® receives evaluation orders for a client who has recently experienced a traumatic brain injury. The OTR® asks the COTA® to score the client on the Glasgow Coma Scale, because service competency in this assessment has been established. The client only opens the eyes when the COTA® applies a mild pinch to the client's arm. What score should the COTA® give the client on the Glasgow Coma Scale Eye-Opening Response category? A. 7 B. 3 C. 2 D. 4

C. 2 Because the client is currently responding to pain only, the COTA® would give the client a 2 for the eye-opening response category.

A COTA® is working with a client who has a dorsal scar resulting in limited metacarpophalangeal (MCP) flexion of the fingers. When fabricating a dynamic MCP flexion splint, what is the correct angle of pull for a finger loop? A. 30° B. 60° C. 90° D. 100°

C. 90° A 90° angle of pull distributes the pressure most evenly to the proximal phalanx.

The Resident Assessment Instrument, part of the Minimum Data Set, is completed in which practice setting as part of Medicare's requirement? A. Hospice B. Outpatient C. Skilled nursing facility D. Hospital

C. Skilled nursing facility Completing the instrument is part of the Medicare regulations for skilled nursing facilities.

According to the Scope of Practice, which BEST describes an intervention strategy consisting of instructing a client in one-handed homemaking strategies? A. Health promotion B. Maintenance C. Prevention D. Compensation

D. Compensation One-handed home making techniques are generally considered compensatory strategies because the person would be learning to compensate for the inability to use both hands for homemaking.

A COTA® is preparing to discharge a client with a complete L2 spinal cord injury who is planning to go home. Which IADLs would the client likely need assistance with? A. Financial management B. Meal preparation C. Use of technology D. Home maintenance

D. Home maintenance The client may need assistance with heavy household maintenance and cleaning.

A COTA® is conducting a cooking group for people with schizophrenia. The COTA writes the following information in a progress note after a treatment session: "Client will continue to attend the cooking group twice per week for 4 weeks to address attention, sequencing, and task completion." In which section of a SOAP note would the COTA document this information? A. In the S section B. In the O section C. In the A section D. In the P section

D. In the P section The P, or plan, section outlines the frequency and duration of continued treatment for the client.

Which behavioral symptom might a client with early-stage dementia display? A. Pacing B. Violence C. Rude language D. Suspicion

D. Suspicion A client with early-stage dementia might become suspicious; it is common for clients to think misplaced items have been stolen or that their spouse may be unfaithful.

Which part of original Medicare covers stays at hospitals and inpatient rehabilitation facilities? A. A B. D C. B D. C

A. A Medicare Part A covers stays at these facilities.

A client has just undergone hip replacement surgery. Within what time period should a COTA® generally begin performing out-of-bed activities with the client? A. 1-3 days B. 12 hours C. 5-10 days D. 96 hours

A. 1-3 days Out-of-bed activity should occur early with hip replacement clients, traditionally between 1 and 3 days postoperation.

A COTA® working at a rehabilitation hospital is given orders for a client who recently underwent a right hip replacement. The COTA® notices a foam wedge between the client's legs. What is the wedge meant to prevent? A. Adduction of the client's lower extremities B. Abduction of the client's lower extremities C. Internal rotation of the client's lower extremities D. External rotation of the client's lower extremities

A. Adduction of the client's lower extremities The wedge is used to prevent adduction of the lower extremities.

A COTA® is working in a nonprofit transitional work program for people who have mental illnesses. Which assessment would be MOST effective for determining goals from the client's perspective? A. Canadian Occupational Performance Measure B. Valpar Component Work Samples C. Minnesota Rate of Manipulation D. Semmes-Weinstein monofilament test

A. Canadian Occupational Performance Measure The Canadian Occupational Performance Measure is a client-centered instrument that measures the client's perception of problem areas and goals for treatment, including productivity.

A client with early-stage Alzheimer's disease has increased difficulty with spatial orientation. Which occupational performance area does this difficulty most likely affect? A. Community mobility B. Grocery shopping C. Meal preparation D. Caring for pets

A. Community mobility B. Grocery shopping People with early-stage dementia have difficulty with IADLs because of memory loss and other cognitive impairments. Difficulty with spatial orientation has an impact on their community mobility.

A COTA® who has been certified to use physical agent modalities is treating a client with wrist tendinitis secondary to computer use. Before educating the client on wrist positions to avoid, the COTA® has applied iontophoresis to the affected area. Which medication would the COTA® be MOST likely to use with the iontophoresis? A. Dexamethasone B. Acetic acid C. Lidocaine D. Magnesium

A. Dexamethasone Dexamethasone is the most widely used medication by therapists using iontophoresis because of its anti-inflammatory properties.

A COTA® is working with a client who is being treated medically with a wound vacuum-assisted closure (wound VAC). What precaution does the COTA need to take during a therapy session with the client with a wound VAC? A. Do not turn off the wound VAC during treatment. B. Keep the client in a supine position. C. Do not have the client ambulate. D. Avoid moving the extremity with the wound VAC.

A. Do not turn off the wound VAC during treatment. The wound VAC should not be turned off without the nurse's knowledge because it can only be turned off for 2 hours within a 24-hour period.

To promote a client's residual vision, an OTR® has recommended interventions that include window coverings to reduce glare, task lighting for reading and writing, and removal of clutter from the environment. According to the Occupational Therapy Practice Framework: Domain and Process, on what has the OTR focused the intervention? A. Environment B. Occupations C. Education D. Advocacy

A. Environment Environments include the physical built environment that surrounds the client, including furniture, tools, and devices.

An OTR®; has been tasked with running psychoeducational group sessions for an after-school program for children with behavioral and sensory processing challenges. Which example is an ESSENTIAL characteristic of psychoeducational programming for this group? A. Facilitating parents and children to learn sensory modulation techniques and strategies for identifying challenging behaviors B. Planning activities and games that will allow participants opportunities to regulate arousal levels C. Allowing reflection time after group games so that children can discuss behaviors displayed during activities D. Ensuring that group dynamic principles are applied during task performance in sessions

A. Facilitating parents and children to learn sensory modulation techniques and strategies for identifying challenging behaviors In psychoeducational groups, the leader is tasked with teaching members and families new skills or strategies for managing specific life and developmental challenges.

A COTA® is working with a client with Guillain-Barré syndrome who is in the recovery phase. Which intervention BEST addresses the needs of the client in this phase? A. Instruct the client in energy conservation and fatigue management strategies B. Start progressive resistive activities for strengthening at the client's greatest level of tolerance C. Advise the client to use assistive devices as much as possible to avoid fatigue while performing ADLs D. Provide wrist and finger resting splints to help the client avoid overuse of the hands

A. Instruct the client in energy conservation and fatigue management strategies In the recovery phase of Guillain-Barré syndrome, taking rest periods without pushing to the point of fatigue is recommended while gradually increasing tolerance for activity.

A COTA® observes that another occupational therapy staff member at the same facility seems to provide more resources to clients of a particular ethnic background. The COTA does not share this observation with the supervising OTR®;. By not reporting this observation, what ethical principle may the COTA be indirectly violating? A. Justice B. Veracity C. Autonomy D. Nonmaleficence

A. Justice The principle of justice requires fair, equitable, and appropriate treatment of clients and other individuals and groups with whom occupational therapy practitioners interact. They should also respect the applicable laws and standards related to their area of practice. Justice requires the impartial consideration and consistent following of rules to generate unbiased decisions and promote fairness. By not reporting the discrimination concerns to the supervising OTR, the COTA may be perpetuating an injustice at the facility.

Which strategy is MOST appropriate strategy for resolving conflicts in the workplace? A. Listening effectively when others are speaking B. Using emotions during the conversation C. Commenting on staff's strengths and weaknesses D. Describing how the conflict will be resolved

A. Listening effectively when others are speaking Listening effectively helps ensure that each person feels heard and understands what others are saying.

A 4-year-old child with right hemiparesis has a goal to pick up and hold toys using the right hand. What type of orthosis would be MOST appropriate to help reduce the child's spasticity and increase functional use of the hand? A. Neoprene thumb loop splint B. Resting pan splint C. Wrist cock-up splint D. Ulnar deviation splint

A. Neoprene thumb loop splint A neoprene thumb loop splint helps reduce spasticity and enables an optimal position to pick up and hold toys

Retired NBCOT® Question A patient who has Guillain-Barré syndrome has made excellent progress and is preparing for discharge to home. The patient's spouse has requested a home exercise and activity program. What is the MOST IMPORTANT information to include in the home program? A. Pacing activities to prevent muscular fatigue B. Care and maintenance of adaptive equipment C. Daily stretching to maintain range of motion D. Cognitively simple activities to minimize stress

A. Pacing activities to prevent muscular fatigue Client's with Guillain-Barré syndrome will experience muscle weakness for a prolonged period of recovery. Pacing activities to prevent extreme fatigue will be important when going home.

An OTR® is evaluating a kindergarten student and determines that the child has form constancy issues. Which intervention would support this student's ability to successfully locate where to write the student's name on a worksheet? A. Provide materials for the student to develop a collage with the word "name" printed in different fonts B. Encourage the student to construct the letters in "name" on a pegboard or a light box toy C. Allow the student to spell the word "name" out loud before moving to the worksheet D. Eliminate unnecessary information and decorations from the worksheet

A. Provide materials for the student to develop a collage with the word "name" printed in different fonts Form constancy involves the recognition of forms regardless of the size, shape, or position; developing a collage with the word "name" printed in different fonts would help the student locate the correct space.

A client with age-related macular degeneration reports difficulty reading overhead menu boards at restaurants. Which intervention approach would be MOST beneficial to this client? A. Relative distance magnification B. Additional contrast on menu board C. Additional task light on menu board D. Relative size magnification

A. Relative distance magnification Moving closer to an object makes it relatively larger. By moving closer to the menu, the client can make the print appear larger.

client with age-related macular degeneration reports difficulty reading overhead menu boards at restaurants. Which intervention approach would be MOST beneficial to this client? A. Relative distance magnification B. Additional contrast on menu board C. Additional task light on menu board D. Relative size magnification

A. Relative distance magnification Moving closer to an object makes it relatively larger. By moving closer to the menu, the client can make the print appear larger.

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

A. Retention of primitive reflexes An extreme startle may be associated with a retained Moro reflex

When treating a client in a skilled nursing facility, the COTA® notes that the client's skin has a yellowish cast, the fingernail beds are bluish in color, and the client has noticeable edema in both lower extremities. What condition would MOST likely cause these symptoms? A. Right-sided congestive heart failure B. Left-sided congestive heart failure C. Aortic stenosis D. Aortic insufficiency

A. Right-sided congestive heart failure When the right side of the heart fails, blood flows back into the venous system. Symptoms of right-sided heart failure include cyanotic nail beds, jaundice, and lower-extremity edema.

A COTA® is working with an elderly client with mild cognitive impairment (MCI) resulting in deficits in information-processing speed. Which pattern can the COTA® expect to see in the driver's on-road performance? A. Slow recognition of signs, signals, or traffic scenes B. Difficulty distinguishing between a gray car and the environment on a rainy day C. Difficulty finding the way to the local grocery store D. Difficulty manipulating the vehicle controls

A. Slow recognition of signs, signals, or traffic scenes Impaired visual information-processing speed is associated with normal aging and mild cognitive impairment.

Which symptom may be attributed to typical visual aging changes? A. Slowing ability to adapt to light and dark B. Difficulty recognizing and reading facial expressions C. Increasing color blindness D. Improving ability to see objects at a close distance

A. Slowing ability to adapt to light and dark As people get older, they find it more difficult to adapt to light and dark conditions

Adults with vision impairment are at risk for which of the following problems? A. Social isolation and depression B. Exposure to increased lighting C. Forced use of sensory substitutions D. Forced use of eccentric viewing

A. Social isolation and depression Adults with vision impairment are at risk for social isolation and depression because of dissatisfaction with performance in valued occupations, restricted participation in daily activities, and decreased social interaction.

An OTR®; is working with a child with autism who gets easily frustrated with challenging tasks. The child's current goal is to learn how to hit a ball with a bat. The OTR decides to use shaping as an intervention strategy. Which technique BEST describes shaping as a teaching strategy? A. The OTR teaches successive approximations of the task such as picking up the bat, swinging the bat, and tapping a ball with the bat. B. The OTR teaches the child each prerequisite step of the activity in a systematic fashion and asks the child to combine each step, for example, holding the bat and then swinging the bat. C. The OTR helps the child hold the bat and swing the bat and then allows the child to hit the ball independently. D. The OTR systematically demonstrates to the child how to swing the bat, instructs the child to swing the bat, and implements a time delay before a ball is pitched to learn the new skill.

A. The OTR teaches successive approximations of the task such as picking up the bat, swinging the bat, and tapping a ball with the bat. Successively approximating or learning intermediate behaviors that are prerequisite components of the final behavior is part of the shaping technique.

A COTA® wants to use a cognitive strategy to address a motor learning deficit with a client. The client is having difficulty with lower body dressing after hip replacement. Which is the BEST example of a cognitive strategy to use with this client? A. The client imagines using a dressing stick while the COTA describes the process of lower body dressing as the client visualizes completing the activity. B. The client completes and repeats one step of the dressing task until the client can do it independently (e.g., putting the affected leg into the pant opening). C. The client uses various garments to practice lower-extremity dressing (e.g., shorts, sweatpants). D. The client practices dressing while on the edge of the bed, on a mat table, or on a chair until the client is comfortable getting dressed from a variety of surfaces.

A. The client imagines using a dressing stick while the COTA describes the process of lower body dressing as the client visualizes completing the activity. Guided imagery is an evidence-based cognitive strategy that can facilitate improved motor learning.

A client who has rheumatoid arthritis (RA) has difficulty with ADL tasks and has been referred to occupational therapy. Which statement does reflects a principle of joint protection? A. The client should use an alternate grip on a walker, to provide more stability during ambulation. B. The client should lift items on the kitchen countertop instead of sliding them. C. The client should use a handheld purse instead of a backpack, to reduce stress on joints. D. The client should modify daily tasks, such as replacing elastic shoelaces with regular shoelaces, to reduce stress on joints.

A. The client should use an alternate grip on a walker, to provide more stability during ambulation. Rather than using a tight grip, the client with RA would benefit from modifying the walker (e.g., attaching arm troughs or larger handles) to reduce the grip pressure needed during ambulation and protect the small joints of the hands.

A client with advanced amyotrophic lateral sclerosis (ALS) is new to a computerized communication device. What would the COTA® focus on for the first treatment session with the client with this device? A. The client's posture in the wheelchair for optimal use of the device B. Hand ROM exercises to enable the client to adequately reach the device C. Trunk strengthening to support upright sitting during use of the device D. Adapting the device with larger buttons and controls to enable independent use

A. The client's posture in the wheelchair for optimal use of the device The simplest and first approach would be to ensure positioning so that the client can see the device and stabilizing the neck and shoulder (proximal muscles) to allow the most distal control. The placement of the device is also important for optimal use of device.

A client sustained a C4 spinal cord injury in a car accident, and the OTR®-®is recommending a power wheelchair with a sip-and-puff controller. Which of the following options would be best for providing pressure relief to the buttocks by changing orientation in space but not body position? A. Tilt in space B. Recline C. Elevating leg rests D. Pelvic bar

A. Tilt in space A tilt-in-space feature rotates the seat around a fixed axis, does not change the client's position, and provides pressure relief for the buttocks.

A COTA® is treating a client who, because of increased right leg weakness, has recently begun using a right footrest to avoid foot drag during wheelchair propulsion. What would be the benefit of using a heel loop on the footplate of the wheelchair? A. To prevent the foot from sliding backward B. To accommodate for ankle flexion C. To accommodate for preferred knee flexion angle D. To prevent falls during transfers

A. To prevent the foot from sliding backward Heel loops can be attached to the back of the footplate to prevent the foot from sliding backward, especially when there is decreased control of the foot secondary to leg weakness.

A COTA® is assigned to treat a client with low vision. What assessment information can the COTA expect to find in the OTR®'s evaluation report? A. Visual acuity, visual fields, and contrast sensitivity B. Visual disability, visual fields, and search patterns C. Visual disability, visual acuity, and search patterns D. Visual acuity, visual disability, and search patterns

A. Visual acuity, visual fields, and contrast sensitivity The OTR completes basic assessments of visual acuity, visual fields, and contrast sensitivity to explain the client's occupational limitations in relation to the vision impairment and make an appropriate referral to an eye care specialist.

A COTA® is working with an 8-year-old client with muscular dystrophy who expresses the goal of being able to ride a bicycle with friends. Beyond addressing the client's physical capacities to ride a bicycle, what other intervention would be MOST appropriate? A. Work with the client on environmental awareness and knowledge of rules of the road for bicycle safety B. Provide strengthening exercises to boost the client's stamina for riding long distances C. Advise the parents not to encourage cycling because of the client's condition D. Suggest that the client use pedal clips to maintain good positioning of the feet while cycling

A. Work with the client on environmental awareness and knowledge of rules of the road for bicycle safety AOTA's (2010) "Statement on Driving and Community Mobility" specifically suggests a role for occupational therapy in addressing overall safety awareness relative to cycling.

A worker participating in back-neck rehabilitation is receiving education on proper standing workstations. The worker is required to move 10 lb. discs onto a dowel. Which design element should be considered for the client's workstation? A. Workstation height should allow some elbow extension during the task. B. The workstation area should provide for sitting or standing preferences. C. The workstation should enable the worker to reach overhead during the task. D. All workstation tools should be placed beyond arm's reach during the task.

A. Workstation height should allow some elbow extension during the task. A standing workstation is ideal for tasks requiring downward force; heavier tasks should be done with some elbow extension to minimize forces applied to the elbow musculature.

A COTA® in home health care is treating a client who has Stage III Alzheimer's disease. The client lives with an adult daughter. The client wanders around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no steps at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. The client requires close supervision on the stairs and seems to be very fearful when putting the foot down on each step. To further ensure the client's safety in getting up and down the stairs at the back door, what would be the MOST likely recommendation? A. Yellow contrasting tapes on the edge of each step B. Installing a ramp with handrails over the steps C. Teaching the client to use a cane on the stairs D. Referring the client to physical therapy for stair training

A. Yellow contrasting tapes on the edge of each step A client with Stage III Alzheimer's disease often begins to experience changes in vision and perception. Having yellow tape on the edge of each step helps to differentiate each step and prevent the client from missing one.

A COTA® is talking with a parent of a child who is hospitalized after a suicide attempt. The mother seems confused about the relevance of occupational therapy to help her child. The COTA decides to use the Kawa metaphor to explain the intervention process. Which statement is the BEST application of this metaphor? A. "At any stage of life, obstructions happen and impede our life flow. The goal of occupational therapy is to make sure that impediments do not happen." B. "Our life flow is like a flowing river, and many times the flow of life becomes obstructed. The goal of occupational therapy is to enhance and facilitate life flow." C. "There are many factors in the child's life that may impede life flow. The goal of occupational therapy is to identify ways to address these impediments." D. "The goal of occupational therapy is to ensure that your child is able to adapt to real-life challenges through the use of occupations."

B. "Our life flow is like a flowing river, and many times the flow of life becomes obstructed. The goal of occupational therapy is to enhance and facilitate life flow." This statement is the most complete depiction of the Kawa metaphor. It contains the river, flow, and obstruction components and describes occupational therapy's role.

A client with Stage 2 Parkinson's disease (PD) is working with the COTA® on facial expressions and social skills. Which feedback tool should the COTA® use to appropriately address these areas? A. Instruct the client in exercises focusing on facial movement and expression. B. Advise the client to practice different facial expressions in a mirror. C. Teach caregivers to provide cues that enhance the client's facial expressions. D. Suggest weekly PD support group sessions for the client to attend.

B. Advise the client to practice different facial expressions in a mirror. Using a mirror offers clients real-time visual feedback to make adjustments and fine-tune facial movements. Moreover, clients with PD benefit from external cues as a treatment approach.

A client with low vision has difficulty using kitchen appliances that have dials. Which intervention strategy would be MOST beneficial in promoting accuracy when setting dials on appliances? A. Recommend that the client obtain assistance in setting dials B. Apply tactile markers to specific settings on appliance dials C. Train the client in scanning techniques for the kitchen area D. Recommend that the client eliminate clutter in the kitchen area

B. Apply tactile markers to specific settings on appliance dials Applying tactile markers to specific settings on appliance dials enables sensory substitution to adapt for vision loss.

A client with Parkinson's disease has difficulty initiating performance of ADLs. Which intervention is BEST for this client? A. Written directions for steps in an unfamiliar task B. External cues and repetition for resuming task completion C. Consistent self-cueing for resuming task completion D. No external cueing and use of problem solving to resume tasks

B. External cues and repetition for resuming task completion External cues, including simple verbal instructions, and rehearsal of movements are beneficial in improving a client's ability to resume task completion, including initiating task performance.

An OTR® is observing a child with visual figure ground difficulties during an evaluation. Which daily activity could the OTR ask the child to do during the observation to better understand the child's figure ground difficulties? A. Navigate to the school's library B. Find a soup spoon in an unorganized silverware drawer C. Follow a color coding system to organize homework assignments D. Follow a checklist to complete a laundry task

B. Find a soup spoon in an unorganized silverware drawer Figure ground perception is the ability to distinguish the foreground from the background. Asking the child to find a soup spoon in an unorganized drawer is an appropriate task to observe as part of an assessment for figure ground difficulties.

A COTA® is working with a client who is unable to drive. The COTA is educating the patient on the benefits of a fixed transit system in comparison with a paratransit system. What might these benefits include? A. Fixed transit is easier to use independently than paratransit. B. Fixed transit is more economical than paratransit. C. Fixed transit does not take as much strength as paratransit. D. Fixed transit requires less cognitive training than paratransit.

B. Fixed transit is more economical than paratransit. Because fixed transit systems are on a scheduled route with specific stops, they cost less to use than paratransit systems, which have an obligation to provide origin-to-destination services.

According to the Occupational Therapy Practice Framework, which of the following elements is part of the domain of occupational therapy? A. Occupational profile B. Habits, routines C. Intervention plan D. Outcomes

B. Habits, routines Habits and routines fall under the domain of occupational therapy.

A client sustained facial burns that required several grafting surgeries. A COTA® is seeing the client in an outpatient setting 6 months post surgery. The client wishes to go out to lunch with a friend but is fearful of participating in this social activity. What treatment intervention would be MOST beneficial for this client? A. Advise the client to wear a facial pressure garment in public and practice putting it on, eating, and taking it off in the clinic B. Have the client participate in activities that can restore confidence and self-esteem, such as applying theater-type full-coverage makeup C. Advise the client to wear a clear facial mask in public and carry a letter from the physician indicating that the client has facial burns D. Have the client participate in stretching activities to improve movement of the facial muscles

B. Have the client participate in activities that can restore confidence and self-esteem, such as applying theater-type full-coverage makeup Applying makeup to well-healed burns can improve a client's ability to cope with a change in body image and to function psychosocially.

A COTA® is conducting a cooking group for people with schizophrenia. The COTA writes the following information in a progress note after a treatment session: "Client participated in a 60-minute group cooking session in the hospital kitchen to address attention and task completion secondary to delusional thinking." In which section of a SOAP note would the COTA document this information? A. In the S section B. In the O section C. In the A section D. In the P section

B. In the O section The O, or objective, section records measurable data obtained during the treatment session.

Which of the following symptoms is a COTA® likely to observe in a client in a hospital setting during the plateau phase of Guillain-Barré syndrome? A. Unilateral pain in a lower extremity B. Inability to communicate vocally C. Confusion from short-term memory loss D. Hyposensitivity to tactile input

B. Inability to communicate vocally Because of paralysis of muscles in the head and neck, spoken communication is often impaired in the plateau phase of Guillain-Barré syndrome.

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

B. Instruct the client to wipe between the legs while seated on an elevated toilet seat. All hip replacement clients should wipe between their legs in a sitting position to observe hip precautions.

A COTA® in a work conditioning program is treating a client who is employed as a roofer. The client has a history of low back sprain. When implementing the work conditioning program, which intervention is MOST appropriate to reduce the client's risk for reinjury? A. Completing a job demand analysis at the job site B. Instructing the client in proper body mechanics C. Improving the client's heavy material handling skills D. Modifying the client's work schedule to part time

B. Instructing the client in proper body mechanics Work-related musculoskeletal disorders (WSMDs) are a class of soft-tissue injuries affecting the muscles, tendons, and nerves. They are typically characterized by a slow and insidious onset and are thought to be the result of microtrauma. WSMDs account for one-third of all occupational injuries and illnesses in the United States. Poor body mechanics may be a contributing factor and result in repeated microtraumas; therefore, instructing the client in proper body mechanics should be included in the treatment plan.

Which psychiatric condition is MOST frequently seen as interfering with the occupational engagement of a client with cardiac disease? A. Panic attack B. Major depression C. Personality disorder D. Hypochondriasis

B. Major depression Among clients with cardiac disease, 15%-20% meet the criteria for major depression. Clients with depression have poorer outcomes and increased morbidity and mortality.

A client with low vision lives alone and has limited social support. Which safety concern would be MOST important to address with this client? A. The family's adjustment to the vision loss B. Medication management C. Nutrition maintenance D. Family history of eye disease

B. Medication management Difficulty reading medication labels and instructions may lead to errors in medication management.

An 88-year-old client has given up driving as a result of decreased vision. The client has a history of carpal tunnel syndrome, diabetes mellitus (poorly controlled), congestive heart failure, and osteoarthritis in both knees and thumbs. The client has frequent medical appointments within a 20-mile radius of home. The client lives alone and is 10 blocks away from the closest bus station. What is the BEST choice for community mobility for this client? A. Fixed-route transportation B. Paratransit transportation C. Neighbors providing rides D. Volunteer driver program

B. Paratransit transportation The most reliable transportation service for this client is paratransit. The client can call ahead of time to reserve rides for the frequent medical appointments.

A statement in the Occupational Therapy Code of Ethics (2015) reads, "Occupational therapy personnel shall refrain from actions that cause harm." Which principle is this statement part of? A. Principle 4, Justice B. Principle 2, Nonmaleficence C. Principle 3, Autonomy D. Principle 6, Fidelity

B. Principle 2, Nonmaleficence Principle 2, Nonmaleficence, directly relates to occupational therapy practitioners' obligation to refrain from harming others.

An OTR® is evaluating a 16-year-old client with attention deficit hyperactivity disorder who is learning how to set a table for a job at a banquet facility. The client has trouble remembering proper utensil placement and requires increased time to complete the task. Which intervention strategy would the OTR recommend to help the client place the utensils in the correct order? A. Construct single-step cards with pictures of single utensils and corresponding steps to follow when setting the table B. Provide a visual cue card that has a picture of a completed place setting to follow when setting the table C. Develop a visual reinforcement chart and put a star or check mark on it for every table successfully set D. Set a visual timer to a specified amount of time and require the client to complete the task in that time

B. Provide a visual cue card that has a picture of a completed place setting to follow when setting the table A visual cue card with a picture of a completed place setting provides a reminder to help the client properly place each utensil.

A COTA® is writing a SOAP note on a treatment with a client that focused on functional transfers in and out of a bathtub. Which is the BEST example of what might be written in the O section of the note? A. "Client's right knee pain interferes with standing balance in the tub." B. "Client reported pain in right knee when ambulating to/from shower room." C. "Client ambulated to/from shower room with modified independence using wheeled walker for stability." D. "Client will be seen for 30 minutes daily to address functional mobility with a specific focus on tub transfers."

C. "Client ambulated to/from shower room with modified independence using wheeled walker for stability." This statement is an example of O (objective); it is an observed and measurable statement that presents a picture of the intervention session.

A COTA® is working with a client who is interested in getting a power wheelchair. The client asks the COTA about the benefits of a reclining-back over a tilt-in-space wheelchair. What would be the MOST appropriate response to this question? A. A reclining-back wheelchair is best for someone who has a custom contoured seating system. B. A reclining-back wheelchair is beneficial for a person who has excessive extensor tone. C. A reclining-back wheelchair is advantageous when a person has a diagnosis of orthostatic hypotension. D. A reclining-back wheelchair is a good idea for someone who is concerned with shearing of the skin.

C. A reclining-back wheelchair is advantageous when a person has a diagnosis of orthostatic hypotension. A reclining back can be used to alleviate orthostatic hypotension, which is caused by a sudden drop in blood pressure when a person assumes an upright position quickly. It can allow the client to move slowly and in stages while letting the blood pressure adjust to the change.

A COTA® is working with a 9-year-old child with autism who has been on a new extended-release stimulant medication for 3 days. When the child comes to the clinic after school, the child is manic, has difficulty attending, and cries for no apparent reason. What is the MOST immediate course of action for the COTA®? A. Provide sensory activities to help the child become calmer, more attentive, and more organized. B. Change the therapy time so the medication is still in effect during treatment sessions. C. Ask the parents about possible side effects of the medication affecting behaviors and performance. D. Recommend taking a break from medication and observe whether behaviors improve during the session.

C. Ask the parents about possible side effects of the medication affecting behaviors and performance. COTA®s and OTR®s need to monitor and report possible effects of medications on performance and behaviors.

An OTR® is working with a 14-year-old with Down syndrome on doing laundry. The OTR notices that the client is able to observe the first three steps of the task and then complete the last step of the task with prompting. What type of intervention strategy is the OTR using to support this client's independence in doing laundry? A. Task simplification B. Hand-over-hand assistance C. Backward chaining D. Gradual increase in task demands

C. Backward chaining Backward chaining is a process in which the OTR supports the client in completing the last step of a task sequence. As the client improves, the OTR encourages the client to complete each preceding step in reverse order until the client is able to complete the entire task sequence independently.

To facilitate participation in familiar daily living tasks by clients with dementia, what would be an appropriate INITIAL stage of intervention? A. Recommend home modifications. B. Provide caregiver education. C. Develop strategies to simplify familiar tasks. D. Establish appropriate daily routines.

C. Develop strategies to simplify familiar tasks. Task simplification is a primary intervention used with clients with dementia to maintain independence in daily living tasks.

A COTA® is seeing a client with severe diabetes and obesity in a skilled nursing facility. The client is bedbound and has developed a decubitus ulcer. Where is the decubitus ulcer MOST likely to occur on the client's body? A. Upper back B. Abdomen C. Elbows D. Insulin injection site

C. Elbows A decubitus ulcer most commonly occurs at a boney prominence that has been compressed against an external surface for a prolonged period.

A COTA® was asked to treat a client in the acute phase of spinal cord injury. What is most likely the COTA®'s INITIAL role during this phase? A. Evaluation of the client's ADL ability B. Evaluation of the client's strength C. Evaluation of total body positioning D. Evaluation of possible discharge location

C. Evaluation of total body positioning During the acute, immobilized phase of spinal cord injury, the COTA® initiates total body positioning to prevent problems associated with body functions (ROM) or body structures (skin).

A COTA® is conducting a cooking group for people with schizophrenia. The COTA writes the following information in a progress note after a treatment session: "Paranoia and delusions continue to limit the client's independent living skills. Client remains unable to move through a task from beginning to end without being distracted by delusional thoughts." In which section of a SOAP note would the COTA document this information? A. In the S section B. In the O section C. In the A section D. In the P section

C. In the A section The A, or assessment, section contains an interpretation of subjective and objective information from a treatment session.

A client has Parkinson's disease and lives alone. The client had been in very good health until a neighbor discovered the client lying on the floor after a fall. Which recommendation is MOST appropriate for this client to return home? A. Meals on Wheels B. City-sponsored companion services C. Lifeline-type phone system D. Transport to the grocery store

C. Lifeline-type phone system Given that the client has a progressive condition that affects balance, the lifeline-type phone system would address the immediate safety concerns.

What is a primary goal in treating clients with dementia? A. Restore function B. Improve cognitive deficits C. Maintain functional capacity D. Maintain caregiver safety

C. Maintain functional capacity The primary goal in working with clients with dementia is to maintain functional capacity.

Through what type of interventions is the field of occupational therapy MOST likely to be successful in demonstrating a population impact on the problem of cocaine and amphetamine abuse disorder? A. Restorative B. Adaptive C. Preventive D. Consultative

C. Preventive Cocaine and amphetamine substance abuse disorder has been shown to be considerably resistant to intervention, be it restorative, adaptive, or consultative. Working in communities to prevent development of cocaine and amphetamine use is, therefore, the most likely avenue to successfully reducing this disorder.

A COTA® observes as a client with multiple sclerosis (MS) demonstrates ataxia in the upper extremities when reaching for an item on the table. Which intervention is BEST to modify tabletop activities to control ataxia in task performance? A. Support the trunk against the table B. Support the dominant arm on the table C. Support the arms and trunk against the table D. Support both arms on the table with no trunk support

C. Support the arms and trunk against the table Supporting the arms and trunk against the table provides three points of stability against a stable surface, offering optimum support for task performance.

A COTA® is intervening with a client who is "standby assist or contact guard assist for dressing tasks but minimal assistance for bathing tasks." What do these levels of assistance mean? A. The client can dress with someone within eyesight but needs someone within arm's reach for bathing. B. The client can dress with adaptive equipment but needs someone within arm's reach for bathing. C. The client can dress with someone within arm's reach but needs physical assistance for bathing. D. The client can dress with adaptive equipment but needs physical assistance for bathing.

C. The client can dress with someone within arm's reach but needs physical assistance for bathing. Standby assist or contact guard assist means that someone needs the caregiver within arm's length. Minimal assist assumes that the client cannot complete the task and needs someone to complete part of it (as much as 25%).

The client lives in a long-term care facility and uses a wheelchair to get to the dining room. The COTA® has removed the client's wheelchair footrests. Which reason BEST explains why the COTA® removed the footrests from the wheelchair? A. Staff push the client, and the footrests get in the way. B. The client's legs are short, so the client does not need the footrests. C. The client propels the chair using only the feet. D. The client propels the chair using only the hands.

C. The client propels the chair using only the feet. When a client propels a wheelchair using only the feet, footrests are removed because they are in the way.

A COTA® is working in a cardiac rehabilitation program. Of the four clients on the COTA's caseload, which client would require a longer warm-up and cool-down period during exercise and activity sessions? A. The client with congenital heart disease B. The client with a coronary artery bypass graft C. The client with a heart transplant D. The client with an automatic defibrillator

C. The client with a heart transplant Because a donor heart is denervated, the autonomic nervous system does not control the client's heart rate. The heart relies on circulating hormones, which take longer to increase and decrease the heart rate.

A COTA® is reviewing the medical chart of a client who has Parkinson's disease. The neurologist has indicated that the client has a festinating gait. What does the client's gait look like? A. The client's steps are stiff and slow. B. The client's steps are halting and unsteady. C. The client's steps are small and rapid. D. The client's steps are marked by pauses.

C. The client's steps are small and rapid. Festinating gait is marked by small, rapid steps resulting from a forward-tilted posture of the head and trunk.

A COTA® has accepted an assignment to go overseas to work with victims of a disaster in a culture that is new to the COTA®. In preparation for the trip and in consideration of the Occupational Therapy Practice Framework: Domain and Process, which of the following elements is part of the context in which activity occurs that the COTA® will need to consider when planning occupational therapy intervention? A. The process that is used to carry out the activity B. The tools the person uses to complete the activity C. The cultural beliefs of the person engaging in the activity D. The praxis skills required to complete the activity

C. The cultural beliefs of the person engaging in the activity The context of an activity comprises the interrelated cultural, personal, temporal, virtual, physical, and social conditions in which the activity takes place.

A COTA® is working in a skilled nursing facility and is on the restraint reduction team. A long-term resident has recently sustained several falls within a few days, and the team has been asked to assess the situation. What is the MOST important consideration during the assessment? A. The safest intervention that will eliminate all future falls B. The least restrictive intervention that reduces the need for staff intervention C. The least restrictive intervention that is also safe D. The safest intervention that is also not a financial burden to the facilty

C. The least restrictive intervention that is also safe When assessing for restraints, the type or technique of restraint used must be the least restrictive intervention that will be effective to protect the patient, staff member, or others from harm.

A COTA® is providing information on how to safely complete job tasks to nursing staff at a nursing home. Which instruction should be included in the training? A. "Keep feet close together for stability during client transfers." B. "Bend at the waist when performing dressing changes." C. "Arms should be at full length when transferring patients." D. "Bend at the knees, and keep shoulders and hips parallel."

D. "Bend at the knees, and keep shoulders and hips parallel." Bending at the knees ensures that the caregiver will use the large muscles of the lower extremities during heavy work. In addition, keeping shoulders and hips parallel protects the lower back from unnecessary and dangerous twisting when moving heavy objects. Both techniques together will ensure the best outcome for the caregiver.

A COTA® is working with a client diagnosed with fibromyalgia who is experiencing disturbed sleep patterns. Which cognitive areas of functioning are disturbed sleep patterns MOST likely to interfere with? A. Arousal and orientation B. Sequencing and categorization C. Initiation of movement and language D. Attention span and short-term memory

D. Attention span and short-term memory Nonrestorative sleep, fatigue, and pain interfere with the client's ability to pay attention and remember day-to-day events.

The topic of the February 7, 2013, newsletter MLN Matters, published by the Medicare Learning Network under the Centers for Medicare and Medicaid Services, was changes in the criteria for mobility assistive equipment and MRADLs, which OTR®s and COTA®s working with positioning, seating, and wheelchairs need to know for reimbursement. What does the Medicare acronym MRADLs stand for? A. Movement-related ADLs B. Motion-related ADLs C. Motor-related ADLs D. Mobility-related ADLs

D. Mobility-related ADLs The Medicare beneficiary must have significant limitations in one or more MRADLs that prevent task accomplishment, increase risk during task accomplishment, or prevent task accomplishment in a reasonable amount of time to qualify for coverage of mobility assistive equipment.

A COTA® is working with a 4-year-old who was recently diagnosed with Duchenne's muscular dystrophy (DMD). The client's parents are concerned and want to understand how this condition will progress and affect the child's participation in daily life. Which statement describes the progression of DMD? A. The condition progresses slowly, and children often experience difficulty with muscles around their pelvis and shoulder girdle. B. The condition progresses so that the facial muscles have decreased mobility; children eventually have a masklike appearance. C. The condition usually has an onset before adolescence, and it progresses until children cannot raise their arms above their heads. D. The condition progresses quickly, and children often need to use a wheelchair by age 9.

D. The condition progresses quickly, and children often need to use a wheelchair by age 9.

A client is injured while lifting a 50-lb box at his manufacturing job and files an injury report the next day. He is diagnosed with lower lumbar pain. After the OT completed the evaluation, the COTA® begins treatment at an outpatient therapy setting 3 days after the injury. Which of the following is the MOST likely source of reimbursement for occupational therapy services related to work injuries? A. Private insurance B. Individual medical plan C. Long-term disability D. Workers' compensation

D. Workers' compensation Workers' compensation is the most likely source of reimbursement for acute work injuries.

Which recommendation is appropriate for a client with arthritis who presents with a boutonniere deformity? A. A splint that blocks the proximal interphalangeal (PIP) joint in extension while leaving the distal interphalangeal (DIP) joint free to flex B. A splint to restrict unwanted PIP hyperextension motions during functional activities C. A splint that provides immobilization of the metacarpophalangeal (MCP) joints out of ulnar deviation D. A dynamic splint to facilitate finger flexion in daily functional activities

A. A splint that blocks the proximal interphalangeal (PIP) joint in extension while leaving the distal interphalangeal (DIP) joint free to flex This type of splint is a boutonniere splint, the primary aim of which is to restrict PIP extension with direct pressure applied over the dorsum of the PIP joint.

A COTA® in an outpatient clinic is working with a client with bilateral primary adhesive capsulitis. The OTR®'s assessment of the client revealed interrupted sleep patterns and decreased ability to perform ADLs because of pain. Range of motion (ROM) is close to functional but painful throughout the arc. What is the PRIMARY functional focus of occupational therapy intervention? A. ADL modifications and adaptive equipment education for grooming, bathing, and dressing B. Electrotherapeutic modalities followed by stretching exercises to facilitate increased ROM C. Rest, ice, elevation, and compression (RICE) to facilitate functional return D. Intra-articular corticosteroid injections to allow for better tolerance to stretch

A. ADL modifications and adaptive equipment education for grooming, bathing, and dressing The primary role of occupational therapy includes education regarding activity modifications and meaningful adaptive equipment choices to facilitate ADL performance.

Each COTA® has a responsibility to respect a person's autonomy, as stated in Principle 3 of the Occupational Therapy Code of Ethics (2015). One way in which this principle is demonstrated is through maintenance of confidentiality. Which of the following examples best illustrates maintenance of confidentiality? A. Display responsible conduct and discretion when engaging in social networking, including refraining from posting protected health information. B. Respect and honor the expressed wishes of clients. C. Facilitate comprehension and address barriers to communication with clients. D. Promote shared decision making with all relevant stakeholders.

A. Display responsible conduct and discretion when engaging in social networking, including refraining from posting protected health information. Compliance with HIPAA and using discretion during public communication are related to autonomy and confidentiality.

A COTA® is educating a client about what to expect in the process of wound healing after surgery. What are the expected phases of wound healing in the order they occur? A. Inflammation, proliferation, and remodeling B. Coagulation, tension, and scar formation C. Proliferation, inflammation, and remodeling D. Tension, coagulation, and scar formation

A. Inflammation, proliferation, and remodeling Wound healing occurs in phases that generally follow the process of inflammation, proliferation, and remodeling.

Which of the following should a COTA® consider as a likely need for a client during the early stages of Parkinson's disease? A. Interest in social and leisure activities B. Ability to feed self in a timely manner C. Seating and positioning for a wheelchair D. Availability of a full-time aide or caregiver

A. Interest in social and leisure activities People in the early stage of Parkinson's disease are at risk for decreased interest in social and leisure activities and resulting isolation.

An OTR® in a skilled nursing facility is responsible for upholding applicable Medicare regulations during supervision of the COTA®. Which ethical principle is the OTR upholding in this situation? A. Justice B. Fidelity C. Veracity D. Autonomy

A. Justice The OTR is upholding the principle of Justice, which requires occupational therapy practitioners to be aware of policies set by regulatory agencies, such as the Centers for Medicare and Medicaid Services. An OTR must provide appropriate supervision for OTA practitioners and follow policies related to reimbursement through all agencies.

In the waiting room of an occupational therapy clinic, a COTA® places fliers containing an invitation to worship at the church where the COTA is a deacon. The fliers contain a photo of the COTA and a caption stating, "Come join Deacon [Name], COTA, for worship this Sunday." The clinical director finds and removes the fliers. Which statement in the Occupational Therapy Code of Ethics (2015) provides the BEST rationale for removing the fliers? A. Occupational therapy personnel shall . . . avoid dual relationships, conflicts of interest, and situations in which a practitioner, educator, student, researcher, or employer is unable to maintain clear professional boundaries or objectivity. B. Occupational therapy personnel shall . . . refrain from actions that reduce the public's trust in occupational therapy. C. Occupational therapy personnel shall . . . make every effort to promote activities that benefit the health status of the community. D. Occupational therapy personnel shall . . . respect the client's right to refuse occupational therapy services temporarily or permanently, even when that refusal has potential to result in poor outcomes.

A. Occupational therapy personnel shall . . . avoid dual relationships, conflicts of interest, and situations in which a practitioner, educator, student, researcher, or employer is unable to maintain clear professional boundaries or objectivity. The role of deacon could be perceived as creating situations that make it difficult for the COTA to maintain clear professional boundaries or objectivity. Recruiting parishioners from among the occupational therapy clients suggests a lack of clear professional boundaries.

A COTA® is working with a client who fractured the distal radius of one arm 6 weeks ago. Within what time frame is controlled AROM typically initiated if the fracture is healing secondarily? A. 0-3 weeks postinjury B. 3-6 weeks postinjury C. 6-9 weeks postinjury D. 9-12 weeks postinjury

B. 3-6 weeks postinjury Initiation of controlled AROM can begin between 3 and 6 weeks postinjury if the fixation of the fracture is adequate.

A COTA® is working with clients who have delayed healing of wounds. Which client would be MOST likely to take the longest amount of time to heal? A. A 50-year-old client with hypertension and a finger amputation B. A 77-year-old client with a foot ulcer, diabetes, and shingles C. A 21-year-old client with a radial fracture and a dog bite D. An 18-year-old client with a flexor tendon and median nerve injury

B. A 77-year-old client with a foot ulcer, diabetes, and shingles Age, diabetes, and a compromised immune system (indicated by shingles) are all factors that delay the wound healing process.

A COTA® is treating a client with a cumulative trauma disorder resulting from work in an automotive assembly plant. Acute symptoms have subsided, and the client is preparing to return to work. Which strategies should the COTA® train the client in to prevent symptoms from recurring? A. Deep breathing and relaxation exercises B. Activity modification and proper body mechanics C. Joint protection and pacing techniques D. Energy conservation and work simplification techniques

B. Activity modification and proper body mechanics Activity modification and proper body mechanics are essential for long-term control of an inflammatory cumulative trauma disorder.

A client had surgery 6 weeks ago. The surgeon used a plate to fix a metacarpal shaft fracture. The client is experiencing moderate edema that makes it difficult to make a fist. Grasping containers and manipulating clothing fasteners are the most difficult tasks. What is the BEST approach for the COTA® to take to address the client's edema? A. Pneumatic pump and cold packs B. Cold packs and compression glove C. Deep retrograde massage and elevation D. A bulky dressing for the arm

B. Cold packs and compression glove Cold packs cause vasoconstriction, so they are appropriate to use for edema reduction. Compression will facilitate small molecule absorption by the venous system. A combination of the two is the best strategy to reduce edema.

A COTA® is seeing a client who sustained a severe wound to the right forearm 4 days ago. Given that the client is in the inflammatory stage of wound healing, what would the goal for therapy be with this client? A. Perform aggressive scar management to eliminate adhesions. B. Control excessive edema and inflammation. C. Ensure that no bleeding of the wound is occurring. D. Educate the client to move the involved limb as little as possible.

B. Control excessive edema and inflammation. During the inflammatory stage of healing, it is normal for a client to experience edema and inflammation; however, the COTA should strive to control excessive edema and inflammation.

A 10-year-old child who sustained a Zone 2 flexor digitorum superficialis tendon laceration and underwent primary repair. Which flexor tendon repair protocol would represent best practice standards? A. Active mobilization approach B. Immobilization approach C. Passive mobilization approach D. Controlled early active mobilization approach

B. Immobilization approach Children younger than age 12 are usually placed on an immobilization protocol because of their low maturity level and low ability to comply with the exercises and precautions of other protocols.

What has the AOTA Ethics Commission recommended that occupational therapy authors do to avoid plagiarism in the electronic age? A. Cite only sources that are no more than 10 years old B. Use electronic tools to check content for possible plagiarism C. Provide source citations for all statements in written and oral content D. Provide source citations for the work of other authors in written documents but not in oral presentations

B. Use electronic tools to check content for possible plagiarism Because it is challenging to ensure that authors have appropriately cited all sources, use of electronic tools is recommended to ensure that papers and presentations are not plagiarized.

A client with rheumatoid arthritis (RA) is beginning to experience ulnar drift. The client enjoys cooking but is finding it increasingly difficult to use a knife to chop food. Which is the BEST intervention for this problem? A. Instruct the client to use a knife with a built-up handle. B. Instruct the client to raise the kitchen counters to place the food to be chopped closer to the shoulder. C. Instruct the client to use a knife with a bent handle. D. Instruct the client to have the spouse do all the food chopping.

C. Instruct the client to use a knife with a bent handle. Using a knife facilitates a position of deformity (increased ulnar deviation). One important principle of joint protection is to prevent positions of joint deformity. An ergonomic knife with a bent handle will place the wrist and hand in neutral, reducing stress, but still allow the client to perform the occupational task.

Which outpatient treatment intervention is contraindicated for decreasing the arm edema and stiffness associated with complex regional pain syndrome of the upper extremity? A. Instruction in the use of contrast baths several times a day B. Instruction in performing gentle, pain-free AROM movements several times a day C. Provision of an arm sling to wear during the day D. Provision of a compression garment to wear during the day

C. Provision of an arm sling to wear during the day Wearing an arm sling will increase stiffness and edema because it places the extremity in a dependent and static position for long periods of time.

A client with rheumatoid arthritis (RA) is a salesman for a computer company. Part of the client's job is to work in a trade exhibition booth at conferences (10-15 times a month). This task requires the client to stand continuously for 2-4 hours talking with potential buyers. The client reports that at the end of this time, the client's feet, knees, hips, and back are in severe pain, and the client is so fatigued that the client has to go straight home to bed. What is the BEST reasonable accommodation for this job task? A. The client should obtain proper footwear (e.g., orthotic shoes) and wear them while at tradeshows. B. The client should bring antifatigue matting to stand on when talking to customers at tradeshows. C. The client should bring a tall, adjustable sit-stand stool and sit on it throughout tradeshows. D. The client should request that this task be shared with another worker so the client attends fewer tradeshows.

C. The client should bring a tall, adjustable sit-stand stool and sit on it throughout tradeshows. The sit-stand stool will allow the client to rest and efficiently unload the joints during the show, and it will allow the client to be at eye level when talking to customers. It will eliminate the client's having to repeatedly stand and sit and reduce fatigue by promoting rest.

A COTA® is describing a client with a hand injury to the OTR®. The COTA® states that the client presents with burning and stabbing pain in the hand, shiny skin, very stiff joints, and abnormal sweating and hair growth. What medical condition does this client MOST likely have? A. Rheumatoid arthritis B. Fibromyalgia C. Myofascial pain syndrome D. Complex regional pain syndrome

D. Complex regional pain syndrome Symptoms of complex regional pain syndrome often include pain, swelling, stiffness, and pseudomotor and trophic changes.

Over whom does the AOTA Ethics Commission have jurisdiction? A. All AOTA members B. All graduates of accredited OT and OTA programs C. Licensed OTs and OTAs but not occupational therapy educators D. OTAs and OTs with AOTA membership at the time of an alleged incident

D. OTAs and OTs with AOTA membership at the time of an alleged incident The AOTA Ethics Commission does not have jurisdiction over occupational therapy practitioners who were never AOTA members or who were not members when the incident in question occurred.

174; When providing a sensory reeducation program for a client with sensory loss following peripheral nerve injury, which intervention would the COTA® use FIRST? A. Sensory retraining, but only after signs of nerve regeneration are apparent B. Discriminative sensory reeducation involving graded localization and discrimination tasks C. Noxious sensory input to facilitate reduction of hyperalgesia D. Protective sensory reeducation because the client is at risk for injuring the insensate hand

D. Protective sensory reeducation because the client is at risk for injuring the insensate hand When protective sensation is diminished or absent, client education is initiated first to prevent potential harm from hot and cold or from sharp edges.

A COTA® is writing a SOAP note on a treatment with a client that focused on wheelchair mobility training. Which is the BEST example of what might be written in the A section of the note? A. "Client will be seen for 45 minutes daily to address independent wheelchair mobility." B. "Client requires supervision with wheelchair mobility secondary to short-term memory loss." C. "Client required verbal reminders to unlock brakes before beginning wheelchair propulsion." D. "Client states that propelling wheelchair is exhausting."

B. "Client requires supervision with wheelchair mobility secondary to short-term memory loss." This statement is an example of A (assessment); it expresses what the short-term memory loss means for the client to engage in the occupation of bathing.

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The COTA® is assisting the OTR in writing the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." Which of the following phrases is the MOST measurable formulation of the occupation (or O) element of this goal? A. "Cook an entrée and a side dish." B. "Cook an entrée using a recipe that has four steps." C. "Cook chicken soup." D. "Cook independently."

B. "Cook an entrée using a recipe that has four steps." The occupation part of the goal should contain specific and measurable information that relates to the problem statement written for the client.

A client is being evaluated for a standard wheelchair (K0001), but after the intake interview, the OTR®-COTA® team is concerned that Medicare will not reimburse the cost of the wheelchair. Which of the client's statements could make him ineligible? A. "I'm unable to walk safely with a cane or walker because of the stairs." B. "I don't have enough room to move the wheelchair between rooms in my home." C. "I'm unable to push myself up a ramp in a wheelchair." D. I'm unable to remove the armrest to transfer to my bed."

B. "I don't have enough room to move the wheelchair between rooms in my home." This criterion is one of the minimal criteria to be met for Medicare reimbursement for a mobility device.

An OTR®; is talking with a parent of a client who is hospitalized after a suicide attempt. The mother seems confused about the relevance of occupational therapy to help her child. The OTR decides to use the Kawa metaphor to explain the intervention process. Which statement is the BEST application of this metaphor? A. "At any stage of life obstructions happen and impede our life flow. The goal of occupational therapy is to make sure that impediments do not happen." B. "Our life flow is like a flowing river, and many times the flow of life becomes obstructed. The goal of occupational therapy is to enhance and facilitate life flow." C. "There are many factors in the child's life that may impede life flow. The goal of occupational therapy is to identify ways to address these impediments." D. "The goal of occupational therapy is to ensure that your child is able to adapt to real-life challenges through the use of occupations."

B. "Our life flow is like a flowing river, and many times the flow of life becomes obstructed. The goal of occupational therapy is to enhance and facilitate life flow." This statement is the most complete depiction of the Kawa metaphor. It contains the river, flow, and obstruction components and describes occupational therapy's role.

A client who presents at an outpatient occupational therapy clinic for an evaluation is crying, because the client will not be able to go home in time to attend the wedding of a family member. Which response BEST communicates empathy? A. "Why don't you come back later when you are feeling better?" B. "You seem upset that you are going to miss the wedding." C. "Life goes on. It will be OK." D. "You need to stop crying so we can complete your occupational therapy session today."

B. "You seem upset that you are going to miss the wedding." Paraphrasing what a client says is an effective strategy for demonstrating empathy.

What law allows in-school occupational therapy services to be provided? A. Individuals With Disabilities Education Act (IDEA), Part B B. Medicare Part C C. Health Insurance Portability and Accountability Act of 1996 (HIPAA) D. TRICARE

A. Individuals With Disabilities Education Act (IDEA), Part B IDEA provides for special services, including occupational therapy, to be provided to children with disabilities in the school.

An OTR®; is supervising a newly hired COTA®. The OTR comments that the COTA did not gather complete information regarding a client's occupational history. Which response from the COTA regarding the OTR's comment is appropriate? A. "How can my occupational histories be more comprehensive?" B. "I respectfully disagree with your opinion." C. "I did the best I could to be thorough." D. "I thought I asked the client the questions you told me to ask."

A. "How can my occupational histories be more comprehensive?" Receiving feedback requires being open to the ideas that are presented, asking for clarification, acknowledging mistakes, and avoiding becoming defensive. This response suggests an openness to feedback and a willingness to seek solutions and make changes in the future.

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The COTA® is assisting the OTR in writing the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." Which of the followingsentences is the MOST measurable formulation of the client (or C) element of this goal? A. "The client will complete all steps of cooking a meal." B. "The client will understand how to cook a meal." C. "The client will know how to cook a meal." D. "The client will do all parts of cooking a meal."

A. "The client will complete all steps of cooking a meal." Goals should describe what a client will be able to do after successful occupational therapy intervention. Accordingly, goals should be written using measurable action verbs such as demonstrate, perform, and complete.

A COTA® is following an intervention plan developed by the OTR® for a client with postacute myocardial infarction on the cardiac care unit. What metabolic equivalent of task (MET) should the client's early activity intervention not exceed? A. 1-2 METs B. 3-4 METs C. 5-6 METs D. 7-8 METs

A. 1-2 METs When a client is on the cardiac care unit, activities should not exceed 1-2 METs. Any higher MET level requires too much exertion, which results in increased oxygen consumption and a higher heart rate than may be tolerated.

Which client would be MOST appropriate for vocational evaluation? A. A client with a recent spinal cord injury who wants to pursue a new occupation B. An older worker who wants to find part-time job opportunities in preparation for retirement C. An employer who needs to know essential job functions of a position for a worker D. A work group at a manufacturing plant that needs ergonomic training to minimize work injuries

A. A client with a recent spinal cord injury who wants to pursue a new occupation Vocational evaluations are most appropriate for people who have never worked or are unable to return to a previous job due to disability.

An OTR® is evaluating a child with a developmental disability for feeding concerns. The OTR notes that the child presents with tongue thrust. Which description BEST describes this child's presentation? A. An exaggerated, uncontrolled pushing of food or liquid out of the mouth B. An open mouth posture in which the tongue passively hangs out of the oral cavity C. Low tone in the tongue D. Tongue movement to the sides of the mouth

A. An exaggerated, uncontrolled pushing of food or liquid out of the mouth Tongue thrust is characterized as an exaggerated, uncontrolled pushing of food or liquid out of the mouth.

Which of the following statements about occupational therapy assistant fieldwork is accurate? A. A health care professional other than a COTA®, under the supervision of an OTR®, can supervise occupational therapy assistant students on Level I fieldwork. B. Payers are not able to regulate the supervision of occupational therapy assistant students. C. Initial suggested supervision for Level II occupational therapy assistant students is indirect. D. A newly graduated OTR® or COTA®, under the supervision of an OTR®, can supervise an occupational therapy assistant Level II fieldwork student.

A. A health care professional other than a COTA®, under the supervision of an OTR®, can supervise occupational therapy assistant students on Level I fieldwork. According to the ACOTE® guidelines, other health care professionals can supervise Level I occupational therapy students.

A client with a transfemoral amputation who is being fitted for a prosthesis is reporting severe pain when placing weight on the end of the residual limb. The OTR® and COTA® examine the limb but do not see any reddened or open areas. What is this pain MOST likely the result of? A. A neuroma B. Phantom sensation C. Phantom limb D. A sebaceous cyst

A. A neuroma A neuroma is a ball of nerve tissue that occurs when axons attempt to grow back in the distal limb. They can be painful when pressed but are not necessarily visible.

A client with a hip replacement has been referred to a COTA® for a wheelchair evaluation. What type of wheelchair is the MOST appropriate to maintain hip precautions and preserve mobility? A. A reclining manual wheelchair B. A standard manual wheelchair C. A hemi-height wheelchair D. A lightweight folding wheelchair

A. A reclining manual wheelchair A wheelchair with an adjustable backrest allows a reclining position for clients with hip precautions

What piece of adaptive equipment is MOST IMPORTANT to address bathing needs for a hip replacement client with poor balance and weight-bearing restrictions? A. A shower chair B. Nonskid strips C. A long-handled sponge D. A shower caddy

A. A shower chair A shower chair or stool should be installed when balance or weight bearing are a problem.

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

A. Allow the child to adjust to the classroom setup for a few weeks and observe whether there are difficulties. The PEO Model focuses on the transaction between the child (person), the classroom (environment), and school-related tasks (occupation). By allowing time to adjust, the parent will be able to assess the fit between kindergarten and the child's strengths.

A school-based OTR® is evaluating a high school student with autism. The student has a high level of auditory sensitivity that limits the ability to successfully transition between classes. Which recommendation would support the student's ability to transition successfully to the next class? A. Allow the student to transition to the next class 3 minutes early B. Provide the student with a visual checklist to support the transition to the next class C. Reduce the amount of materials that the student needs to take to the next class D. Provide the student with a key lock for use in the locker

A. Allow the student to transition to the next class 3 minutes early Allowing the student to transition to the next class 3 minutes early would directly address the student's auditory sensitivity needs, because there will be fewer students in the hallways and less noise.

Which high school extracurricular activity would a youth with oppositional defiant disorder be MOST likely to succeed at? A. An art program with well-established boundaries in which students are encouraged to pursue their own interests B. A chess club in the library in which students participate in tournaments and, when not playing, participate as observers C. A school basketball team that has the rule that students cannot play in a game if they miss a practice or are tardy or absent from school D. A science club in which students work together in small groups to prepare science projects for the state science fair

A. An art program with well-established boundaries in which students are encouraged to pursue their own interests The art program has the fewest rules, the greatest degree of individual choice, and the potential for the least amount of authority or adult direction.

Which is the BEST example of an occupational therapy client population according to the Occupational Therapy Practice Framework? A. People who have arthritis B. A group of people within a larger society C. A statewide school system D. A health club within a community

A. People who have arthritis People with arthritis are considered a group of people who have similar problems (arthritis) and can be considered an occupational therapy client population.

A COTA® enters the hospital room of an adult client who is recovering from total knee replacement and sees that are other people are in the room. What action should the COTA take before beginning an intervention session in order to maintain confidentiality? A. Ask the visitors to step out of the room for a few minutes, and then ask the client whether he or she wants the visitors to stay or go. B. Greet the visitors, and then explain the goals of the client's occupational therapy session. C. Greet the visitors, and then explain that they cannot interrupt the session and ask them to leave. D. Explain the purpose of occupational therapy to everybody in the room.

A. Ask the visitors to step out of the room for a few minutes, and then ask the client whether he or she wants the visitors to stay or go. In the Occupational Therapy Code of Ethics (2015), Principle 3, Autonomy, states, "Occupational therapy personnel shall respect the right of the individual to self-determination, privacy, confidentiality, and consent." This approach ensures that the client's wishes with regard to the confidentiality of the session are maintained.

An OTR®; at an inpatient mental health facility is working with an adolescent hospitalized for depression and suicidal thoughts resulting from severe bullying at school. During a conversation with the teen, the teen mentions feeling demotivated, worthless, and incompetent at anything. The OTR, guided by the Theory of Occupational Adaptation (OA), believes that every client has an inherent desire for mastery of the environment. Which action BEST describes this OA principle? A. Asking the teen about any activity the teen previously enjoyed and liked and using that activity to start the teen doing anything in which the teen can show a level of participation and success B. Asking the teen about stressors that caused the depression, and working slowly to adapt the environment to allow the client to be successful in that environment C. Observing the teen perform previous activities and simulating a stressful environment to understand the client's adaptive capacities D. Allowing the teen some space and allow self-initiation and willingness to perform in any desired activity

A. Asking the teen about any activity the teen previously enjoyed and liked and using that activity to start the teen doing anything in which the teen can show a level of participation and success According to OA, the desire for mastery is inherent, and using meaningful occupations to provide a sense of mastery and competence will elicit adaptive responses.

A COTA® at an inpatient mental health facility is working with an adolescent hospitalized for depression and suicidal thoughts resulting from severe bullying at school. During a conversation with the teen, the teen mentions feeling demotivated, worthless, and incompetent at anything. The COTA, guided by the Theory of Occupational Adaptation (OA), believes that every client has an inherent desire for mastery of the environment. Which action BEST describes this OA principle? A. Asking the teen about any activity the teen previously enjoyed and using that activity to start the teen doing anything in which the teen can show a level of participation and success B. Asking the teen about stressors that caused the depression, and working slowly to adapt the environment to allow the client to be successful C. Observing the teen perform previous activities and simulating a stressful environment to understand the client's adaptive capacities D. Allowing the teen some space and self-initiation and willingness to perform in any desired activity

A. Asking the teen about any activity the teen previously enjoyed and using that activity to start the teen doing anything in which the teen can show a level of participation and success According to the OA, the desire for mastery is inherent, and using meaningful occupations to provide a sense of mastery and competence will elicit adaptive responses.

A COTA® has been treating a client with a distal radius fracture. Because normal pain-free ROM may not be possible after this injury, the OTR® has requested that efforts be focused on gaining pain-free motion within the client's functional ROM. How would the COTA assist the OTR in determining this client's functional range of motion? A. Assist the client in identifying activities the client wants or needs to be able to accomplish with the affected extremity and incorporate practice of these specific activities B. Measure passive ROM to determine the available range of the affected extremity and then focus on place and hold exercises within that available range C. Review the evidence to determine specific measurements that correspond to functional ROM and then formulate functional ROM goals for the client D. Use goniometric measurements of the unaffected extremity to create ROM goals for the affected extremity

A. Assist the client in identifying activities the client wants or needs to be able to accomplish with the affected extremity and incorporate practice of these specific activities Identifying activities with meaning for the individual client allows the OTR and COTA to measure functional ROM needed for those activities.

An older adult client with a history of falls and glaucoma is referred to occupational therapy for evaluation and intervention. Which visual impairment should the COTA® expect as a result of the client's glaucoma? A. Peripheral vision loss B. Central vision loss C. Fluctuating vision loss D. Decreased focusing ability

A. Peripheral vision loss Glaucoma results in peripheral vision loss.

A client who had a CVA is now being discharged from a hospital setting to home. The client continues to show signs of right-sided weakness and decreased balance. The COTA® provides information regarding the client's progress and current status in preparation for discharge. What referral for occupational therapy services is MOST appropriate for the COTA® to make? A. At home with a home health occupational therapist B. In an outpatient center C. In the acute-care hospital D. In a subacute rehabilitation hospital

A. At home with a home health occupational therapist The client is being discharged to home; therefore, continuing occupational therapy services in that setting is most appropriate.

Retired NBCOT® Question Which performance deficit is TYPICALLY observed in school-age children who have mild ataxic cerebral palsy? A. Balance problems during gross motor activities B. Difficulty swallowing thickened liquids C. Cognitive problems that affect class work D. Associated reactions during purposeful activity

A. Balance problems during gross motor activities Ataxia involves fluctuations in muscle tone, resulting in difficulty coordinating muscle movement and subsequent balance challenges during gross motor activities.

Retired NBCOT® Question A patient has multiple sclerosis and was admitted to a rehabilitation facility due to a recent decline in function. The patient now requires a wheelchair for outdoor mobility but still uses a cane to walk indoors. The patient completes BADLs independently using assistive devices. What is MOST IMPORTANT for the COTA® to recommend as part of the discharge planning process for this patient? A. Caregiver training to learn wheelchair transfer techniques B. Family counseling to deal with the steady decline in function C. Assessment to determine durable medical equipment needs D. Referral to driver rehabilitation for community mobility needs

A. Caregiver training to learn wheelchair transfer techniques The client has had a change in function and now requires wheelchair transfers for some aspects of mobility; caregivers need training for safe and proper transfers.

A COTA® is working with a client who has a diagnosis of obesity and is considered bariatric. The COTA needs to fit the client to a wheelchair while the client is at the facility. Which key issue must the COTA consider? A. Center of gravity B. Height of the client C. Upper-extremity strength D. Functional ability

A. Center of gravity The center of gravity of a person who is considered bariatric tends to be more forward than that of a nonbariatric person. Many wheelchairs have the axle on the rear wheel. When working with a bariatric client, it is important to have an axle that moves to accommodate the shift in the center of gravity.

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

A. Client will improve work tolerance use of right hand and wrist to lift 5 lb. bucket within 2 weeks. The goal includes the relevant outcome (improve work tolerance) and time to meet goal (2 weeks) and is understandable, measurable, behavioral (i.e., the outcome can be observed), and achievable in the time frame given.

An OTR® has written treatment goals for a client receiving occupational therapy services in a work conditioning program after a right shoulder sprain. The client is employed as a surgical technician in an outpatient surgery center. Which option is the BEST example of a long-term goal? A. Client will return to full duty as a surgical technician in a full-time capacity within 4 weeks. B. Client's employer will implement reasonable accommodations to promote the client's ability to complete full-time physical demands as a surgical technician within 4 weeks. C. Client will return to full duty as a surgical technician with the ability to carry over proper body mechanics to reduce risk for reinjury. D. Client will use proper body mechanics 100% of the time while completing the job of a surgical technician within 4 weeks.

A. Client will return to full duty as a surgical technician in a full-time capacity within 4 weeks. The goal is client centered, objectively focused on the goal of full-duty and full-time employment in the role of surgical technician within a specified timeline.

A COTA® is explaining to a client who was recently evaluated the value and benefit of a transitional work program. Which of the following components would be included in a transitional work program? A. Client's performance of work conditioning activities in the clinic followed by performance of worksite light-duty tasks. B. Client's exploration of options for full-time employment while participating in work conditioning program. C. Client's return to full-time employment while performing at modified work capacity. D. Client's return to part-time employment, performing all required physical job demands.

A. Client's performance of work conditioning activities in the clinic followed by performance of worksite light-duty tasks. Transitional programs include monitoring the client's progress and reassessing performance to determine when job tasks can be upgraded to full time or full duty.

According to the Standards of Practice for Occupational Therapy, which of the following is a requirement to practice as a COTA® in the United States? A. Completing licensure, certification, or registration requirements B. Passing state licensure examination for occupational therapists C. Graduating from a private occupational therapy assistant program D. Successfully finishing an independent fieldwork experience

A. Completing licensure, certification, or registration requirements Some states require licensure, some require certification, and some require registration for practicing as a COTA;.

A client with Parkinson's disease is experiencing bradykinesia and reports decreased ability to move from sitting to standing. What strategy should the COTA® recommend? A. Consistent use of a short self-cue, such as "rise," each time the client needs to stand B. Use of a standard walker for transferring between surfaces in the household C. Strengthening of bilateral lower extremities in collaboration with another discipline D. Education on the need for a caregiver to be available for functional mobility

A. Consistent use of a short self-cue, such as "rise," each time the client needs to stand Teaching self-cueing is useful in helping clients initiate movement to minimize the effects of bradykinesia.

Retired NBCOT® Question An inpatient who had a CVA 4 weeks ago is participating in a self-care session. The COTA® observes that the patient's shoes are very tight due to a significant increase in lower extremity edema. The patient reports discomfort in both legs. What INITIAL action should the COTA® take based on this information? A. Contact the charge nurse to report the findings B. Elevate the patient's legs for the duration of the session C. Have the patient rotate the ankles to pump the fluid from the legs D. Provide the patient with anti-embolism hosiery to wear

A. Contact the charge nurse to report the findings Increased edema in the lower extremities following a CVA may indicate a cardiovascular complication, such as deep vein thrombosis. This medical situation requires immediate attention from the nurse.

A COTA® is observing an inpatient complete morning self-care tasks at bedside. The patient had a myocardial infarction 2 days ago and has a resting heart rate of 75 bpm (beats per minute). After 2 minutes of face washing, the patient's heart rate rises to 85 bpm. What action should the COTA® take based on this finding? A. Continue the session and monitor the heart rate in one minute B. Stop the activity and alert the charge nurse of the patient's status C. Allow the patient to rest until the heart rate lowers to 75 bpm D. End the session and reschedule the activity for later in the day

A. Continue the session and monitor the heart rate in one minute The patient's heart rate continues to be in a normal range. It should be monitored throughout the rest of the session to make sure the rate does not increase further.

A client, 6 months post-stroke, has made almost a complete recovery except for weakness in the left leg and slight restriction with left ankle plantar flexion. The client has completed an on-road driving assessment, is driving independently, and entering and egressing the vehicle without any problems. The client asks the COTA® what the client can do to stay well and to prevent a decline in driver fitness. What would the COTA®'s BEST answer be? A. Continue to use the prescribed devices and home exercise program and return within 6 months for a follow-up consultation. B. Be fitted for a left ankle foot orthotic (AFO). C. Join a senior center to increase socialization and stimulation. D. Do hot and cold contrast baths for the left lower extremity.

A. Continue to use the prescribed devices and home exercise program and return within 6 months for a follow-up consultation. This answer contains the consultation and advocacy principles needed for health promotion, wellness, and prevention of a decline in the client.

According to the Standards of Practice for Occupational Therapy, which of the following tasks is within the standards of practice for a COTA® ? A. Contributes to intervention plan modification. B. Documents evaluation results. C. Determines when services should be discontinued. D. Revises intervention plan.

A. Contributes to intervention plan modification. The COTA® I s able to contribute to modification of the plan, can document intervention, and can select and implement intervention.

During an initial evaluation conducted by an OTR®, a client with Stage 1 Parkinson's disease (PD) identified grocery shopping as a valued occupation, but listed fatigue as a barrier and stated that occasional tremors could be embarrassing. What intervention approach would be meaningful as the COTA® prepares to accompany the client to the store for an occupation-based treatment session? A. Create a list of needed items and make a route to easily navigate the store. B. Provide the client with psychosocial support to focus on reducing the anxiety associated with symptoms. C. Instruct the client to don wrist weights to reduce tremors while reaching for items to put in the shopping cart. D. Instruct the client to use a rollator to take seated rest breaks while grocery shopping.

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

A COTA® is instructing a client diagnosed with rheumatoid arthritis on the use of energy conservation techniques. During treatment, the client informs the therapist of tingling in the right thumb and index and middle fingers and of night pain in that area of the hand that often keeps the client awake. The client works as a tailor. On the basis of these symptoms, what might the COTA® suspect is causing the client's disorder? A. Cumulative trauma B. Orthopedic impairment C. Autoimmune symptoms D. Neurological complications

A. Cumulative trauma Work-related musculoskeletal disorders are a class of soft-tissue injuries affecting the muscles, tendons, and nerves. They are typically characterized by a slow and insidious onset and are thought to be the result of microtrauma. These disorders account for one-third of all occupational injuries and illnesses in the United States.

The extremities of a client with brain injury in an acute care unit are in a position of spastic extension, adduction, and internal rotation. The client is displaying symptoms of which condition? A. Decorticate rigidity B. Torticollis C. Decerebrate rigidity D. Athetosis

C. Decerebrate rigidity Decerebrate rigidity involves the client's lower and upper extremities in a position of spastic extension, adduction, and internal rotation.

Which of the following exercise programs is MOST appropriate for a client with rheumatoid arthritis (RA) during an acute flare-up that involves significant pain and swelling? A. Daily PROM of the joints through full comfortable ROM B. Daily AROM of the joints through full comfortable ROM C. Isotonic progressive resistive exercises of the joints as tolerated D. Isometric, alternating resistance, exercises of the joints as tolerated

A. Daily PROM of the joints through full comfortable ROM Exercise to maintain ROM and strength is important for clients with RA. Although as a general principle AROM is preferred, during a flare-up PROM is indicated if pain makes it difficult for the client to do AROM.

A COTA® is providing occupational therapy services to a client in acute care diagnosed with a pulmonary embolism. What is the most typical cause of a pulmonary embolism? A. Deep vein thrombosis B. Pulmonary hypertension C. Pulmonary edema D. Lung cancer

A. Deep vein thrombosis Most pulmonary embolisms are caused by a deep vein thrombosis in a lower extremity

Retired NBCOT® Question An inpatient who has hemiplegia and unilateral neglect is progressing toward documented ADL goals but continues to have poor balance and requires verbal cuing during self-care. The case manager informs the COTA® that the insurance company has not authorized continued therapy and the patient will be discharged in 2 days to live at home with family. In addition to informing the OTR® about the patient's discharge, which task should the COTA® complete NEXT? A. Determine family and caregiver training needs B. Provide the patient with a written home program C. Modify the patient goals to reflect the discharge date D. Schedule the patient for outpatient occupational therapy services

A. Determine family and caregiver training needs The patient has continued needs and will require assistance to complete ADLs and IADLs; caregiver and family training is required to ensure safe performance in the home environment.

A client who lives in a fourth-generation family homestead in a remote area was referred to occupational therapy services after sustaining an above-knee amputation. The client does not drive and is concerned with being able to go shopping, attend church services, and make social visits to friends. The client has a strong emotional attachment to the homestead. Which intervention option is the best option to satisfy the client's community mobility needs? A. Develop a community mobility plan with acceptable, affordable, and reliable transportation options for the client to access multiple goods and services in the community. B. Adjust the physical environment for inclusiveness and accessibility specific to the client's needs, including incorporating family members as support. C. Ensure that the client is independent with the use of mobility devices including a wheelchair, scooter and transfer board. D. Suggest that the client interview volunteer drivers who can provide services as well as taxi vouchers.

A. Develop a community mobility plan with acceptable, affordable, and reliable transportation options for the client to access multiple goods and services in the community. The client is socially and culturally connected to the area and the family homestead, and the OTR® needs to formulate goals to optimize the client's independence in community needs.

An OTR®; who is working for a school district intends to apply the Ecology of Human Performance (EHP) Model as a guiding theory for practice. Which program BEST demonstrates the create intervention strategy of the EHP model? A. Developing a social skills program embedded in all students' recess time B. Planning an educational program to address potential bullying of students with behavioral challenges C. Discussing with teachers how to promote a classroom environment to support a child with learning challenges D. Suggesting the use of therapy balls as chairs in the classroom to address the needs of children with sensory processing issues

A. Developing a social skills program embedded in all students' recess time The create intervention strategy of EHP is meant to be used at the population level rather than at the client level. Create strategies and programming are applied in a larger contexts, not with individual clients.

A COTA® who is working for a school district intends to apply the Ecology of Human Performance (EHP) Model as a guiding theory for practice. Which program BEST demonstrates the create intervention strategy of the EHP Model? A. Developing a social skills program embedded in all students' recess time B. Planning an educational program to address potential bullying of students with behavioral challenges C. Discussing with teachers how to promote a classroom environment to support a child with learning challenges D. Suggesting the use of therapy balls as chairs in the classroom to address the needs of children with sensory processing issues

A. Developing a social skills program embedded in all students' recess time The create intervention strategy of the EHP Model is meant to be used at the population level rather than at the client level. Strategies and programming are applied in a larger contexts, not with individual clients.

Retired NBCOT® Question A COTA® working in a skilled nursing facility is attending a weekly multidisciplinary meeting. The nurse reports that a resident not on the occupational therapy caseload is having increasing difficulty with balance. As a result, the resident's self-care activities are becoming unsafe. What should the COTA® do in this situation? A. Discuss the resident's status with the OTR®, who can screen for needed services B. Complete a screening and request an occupational therapy referral from the resident's physician C. Recommend a referral to physical therapy for a mobility and gait evaluation D. Observe the resident during self-care and make recommendations to the nursing staff

A. Discuss the resident's status with the OTR®, who can screen for needed services A screening is completed to determine whether further occupational therapy services are necessary.

As part of an intervention plan, a client with multiple sclerosis has had training in strategies to limit energy expenditure on meaningful activities. The client reports increased fatigue when grocery shopping in the afternoon. Which of the following items is a recognized energy management strategy to address this fatigue? A. Do grocery shopping in the morning B. Maintain a lower body temperature to decrease fatigue C. Use adaptive equipment for meal preparation D. Participate in a water exercise program to reduce weakness

A. Do grocery shopping in the morning Moving important activities to the morning, when the client's energy is highest, can maximize activity completion.

Neglect, or visual attention deficits, may be prominent in clients recovering from stroke. An implication for everyday life may be that the client bumps into doorjambs or other obstacles. What are the performance implications of these deficits for driving? A. Drifting out of a lane and moving too close to other road users or objects B. Difficulty adapting to the dark or to bright lights from other vehicles C. Not recognizing road signs in advance D. Difficulty seeing other road users or objects in a tunnel

A. Drifting out of a lane and moving too close to other road users or objects The cuts in visual field and visual inattention will result in these behaviors.

A client who has Parkinson's disease reports increased tremors, problems knocking items over while eating, and poor articulation, leading to recent social isolation. Which intervention strategy would be MOST effective for this client? A. Educate about timing social activities when medication is most effective. B. Train in facial exercises to improve speech quality and communication. C. Provide utensils with built-up handles during mealtimes to decrease spills. D. Suggest a community support group to provide a social outlet.

A. Educate about timing social activities when medication is most effective. Activities should be timed during medication "on" times. Determining a client's optimal time of day for activities promotes increased success in occupational performance.

A corporate client has hired an OTR®-COTA® team as injury prevention consultants. How might the role of the OTR-COTA team BEST be described? A. Educating managers and other employees in ways to control and reduce workplace musculoskeletal injuries and in designing an ergonomic team B. Evaluating employees and treating those with upper-extremity musculoskeletal injuries C. Educating employees to be self-sufficient in ADL management after injury D. Prescribing therapeutic exercise and orthotics for injured employees

A. Educating managers and other employees in ways to control and reduce workplace musculoskeletal injuries and in designing an ergonomic team In a consultant role, the OTR-COTA team provides services to the corporate client as a whole, not to individual employees of the company.

A COTA® is working with a client who is concerned about resuming sexual activity after an amputation. What education strategy would be appropriate for the COTA to use with this client? A. Encourage the client's exploration of his or her "new" body. B. Suggest that the client speak with a psychiatrist. C. Provide educational materials in a group setting. D. Discuss the use of a sex surrogate.

A. Encourage the client's exploration of his or her "new" body. A client who has had an abrupt change in the body could benefit from encouragement from the COTA to explore ways in which the client's body has changed to encourage problem solving.

What strategy might a COTA® appropriately recommend to caregivers of a client with Alzheimer's disease to assist with fall prevention? A. Engage the client in daily, structured activity. B. Provide visual reminders in the home environment. C. Install grab bars in the bathroom. D. Engage the client in an exercise program.

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

Retired NBCOT® Question During a multidisciplinary continuing education course on sensory integrative dysfunction, a COTA® learns about a specific brushing protocol to reduce tactile defensiveness. The COTA® wants to use this protocol with several children currently on the caseload. What initial step MUST the COTA® take before this can be done? A. Ensure the protocol is within the scope of practice for a COTA® B. Review course information and practice protocol procedures with an OTR® colleague C. Demonstrate service competency using the protocol with the OTR® supervisor D. Request administrative permission to use the protocol within the department

A. Ensure the protocol is within the scope of practice for a COTA® Interventions must be within the scope of practice to ensure that services remain within the domain of occupational therapy practice.

A child in elementary school has difficulty attending to homework tasks due to symptoms associated with attention deficit hyperactivity disorder. The parents want recommendations for improving their child's on-task behavior. Which recommendation should the COTA® provide to the parents for supporting their child's participation during homework? A. Establish a routine schedule and location for completing assignments B. Allow the child to listen to calming music while completing assignments C. Purchase a bean bag chair for the child to sit in when working on assignments D. Read homework out loud to the student and write down the child's answers

A. Establish a routine schedule and location for completing assignments Structuring the environment by establishing a schedule and location for completing homework can provide organization for a child having difficulty attending.

A 7-year-old child presents with amelia. The OTR® recommends the use of a myoelectric hand. What type of terminal device would be appropriate? A. Externally powered prosthesis B. Body-powered prosthesis C. Passive prosthesis D. Hook prosthesis

A. Externally powered prosthesis A myoelectric hand is paired with an externally powered prosthesis, which involves the placement of an electrode to pick up electromyographic signals to move the electric hand.

A 12-year-old client with cerebral palsy and spastic quadriplegia wants to access the Internet and e-mail on the computer. The client has poor head control and is using a headband to maintain the head in midline. The client is able to turn the head to the right to operate the suction machine using head control input. The client's left upper extremity has no active movement, and the left elbow has 90° flexion contracture. The client is able to flex the right shoulder to 60° against gravity, and the right elbow has trace active movement. The client has no active wrist or finger movement except minimal right thumb adduction. What is the BEST input control for this client? A. Eye-tracking input B. Mouth stick control C. Head pointer D. Switch-encoding input

A. Eye-tracking input Given the client's lack of volitional head control and upper-extremity movement, eye-tracking is the best mode of input. The headband can help steady the client's head for eye-tracking movement for input on a virtual keyboard.

A COTA® is evaluating the occupational performance of a client with Parkinson's disease. Which client factor is MOST relevant to assess? A. Fine motor skills B. Deficit awareness C. Tactile function D. Vestibular function

A. Fine motor skills Fine motor incoordination often interferes with the ability to perform occupations such as writing, eating, shaving, and manipulating clothing fasteners in clients with Parkinson's disease.

During a hand evaluation, the OTR® asks the COTA® to have the client pinch a pinch gauge. The COTA® notices increased flexion of the thumb interphalangeal joint during this assessment What term is used to describe this phenomenon? A. Froment's sign B. Wartenberg's sign C. Jeanne's sign D. Ulnar claw

A. Froment's sign Froment's sign occurs when the flexor pollicis longus compensates for a weak or paralyzed adductor pollicis and flexor pollicis brevis. When a client attempts to pinch, the interphalangeal joint of the thumb flexes more than usual.

A client with a recent diagnosis of dementia is receiving occupational therapy. The caregivers are most distressed about significant behavioral changes that have occurred since the client was diagnosed. The client has become increasingly impulsive and difficult to redirect. What type of dementia does this client MOST LIKELY have? A. Frontotemporal dementia B. Alzheimer's dementia C. Vascular dementia D. Dementia with Lewy bodies

A. Frontotemporal dementia The distinguishing feature of frontotemporal dementia is behavioral changes with an increase in disinhibited behavior, decreased social tact, lack of empathy, and lack of interest.

A client has been referred to occupational therapy for a wheeled mobility assessment. The client has a standard wheelchair (K0001), which he can propel, but wants the OTR®-COTA® team to recommend a power wheelchair so that he can visit around the neighborhood with greater ease. His wife states that she is able to push him in the neighborhood if he needs help, but he tells the OTR®-COTA® team that he needs to get out of the house alone. Why is the client ineligible for a Certificate of Medical Necessary for a power wheelchair? A. He is able to propel a standard wheelchair. B. He prefers, but does not need, a power wheelchair. C. He refuses caregiver assistance, even though it is available. D. He wants a power wheelchair for community mobility.

A. He is able to propel a standard wheelchair. One of several criteria for prescription of a power wheelchair is that the client is not capable of self-propelling a manual wheelchair.

In which practice setting is the Outcome and Assessment Information Set (OASIS) completed to help identify the payer for services? A. Home health care setting B. Skilled nursing facility C. Inpatient mental health facility D. Outpatient community care

A. Home health care setting OASIS is a form that helps provide information about reimbursement of services in a home health setting.

Which statement accurately describes the eligibility determination for occupational therapy services under IDEA Part C in an early intervention program? A. Infants and toddlers with established risk because of a diagnosis automatically qualify for Part C services. B. Infants with marked developmental delays but without a specific diagnosis automatically qualify for Part C services. C. A COTA® is automatically the occupational therapy representative of an evaluation team in early intervention programs. D. Early intervention is always provided by a multidisciplinary team, and the COTA® is involved in treatment.

A. Infants and toddlers with established risk because of a diagnosis automatically qualify for Part C services. As part of IDEA Part C, all children with established risk are eligible for services.

A COTA® is treating a client in the recovery stages of Guillain-Barré syndrome (GBS). According to the biomechanical frame of reference, what is a preparatory method that would BEST address upper-body dressing? A. Instruct the client in hand-strengthening exercises using therapy putty. B. Provide night time resting hand splints to prevent contractures. C. Teach the client how to use a dressing stick. D. Develop a home exercise program for upper-body ROM.

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

A COTA® is providing intervention to a medically stable client who sustained upper-extremity partial-thickness burns of the dominant arm, 5% of the total body surface area, 2 days ago. Which intervention BEST represents a typical ADL intervention? A. Instruct the client in the use of a long-handled spoon and fork and a built-up-handled knife for self-feeding. B. Instruct the caregiver to assist the client in self-feeding and grooming tasks to prevent pain with movement. C. Instruct the client in donning and doffing a pressure garment sleeve after applying lotion to the arm. D. Encourage the client to independently self-feed without the use of adaptive equipment.

A. Instruct the client in the use of a long-handled spoon and fork and a built-up-handled knife for self-feeding. A 5% total body surface area burn in one of the upper extremities means that the client has approximately 50% surface area burns to the dominant upper extremity. Edema and bulky dressings in the early stage may interfere with the motion needed for ADLs, and short-term use of adaptive equipment would be indicated. Adaptation to environment and activity can facilitate the client achieving goals for independence in ADLs.

A dental hygienist is referred to occupational therapy for establishment of a work conditioning program after carpal tunnel release 1 month ago. The client is anxious to return to work but fearful of reinjury. Which intervention is MOST appropriate to include in the client's work conditioning program? A. Instructing the client in median nerve gliding exercises B. Instructing the client in ulnar nerve gliding exercises C. Guiding the client in progressive resistive exercises using therapy putty D. Writing simulated client progress notes

A. Instructing the client in median nerve gliding exercises The median nerve travels through the carpal tunnel. Active exercises of wrist, thumb, and fingers are encouraged 24-48 hours postoperatively. Median nerve glides can be incorporated into a work routine between dental clients to decrease the risk for reinjury

A 76-year-old client will be using a wheelchair after discharge from an acute rehabilitation facility. The client has achieved independence in wheelchair mobility on level surfaces but still requires minimal assistance for transfers. The client is planning to move into a daughter's home, which was not the client's previous residence. The COTA® is planning for an onsite home evaluation to be conducted with the client, the supervising OTR®, and the client's daughter. Before the home evaluation, what will be the MOST appropriate action for the COTA® to take? A. Interview the client and daughter to obtain an appropriate profile and determine role expectations that the client will assume on discharge. B. Discuss with the client functional mobility limitations and the level of assistance required for toilet transfer as part of fall prevention education. C. Interview the daughter regarding detailed measurements and the physical layout of the home and acceptance of the necessary home modifications. D. Provide the client and daughter with information regarding the Americans With Disabilities Act's (Pub. L. 101-336) accessibility guidelines for buildings and facilities.

A. Interview the client and daughter to obtain an appropriate profile and determine role expectations that the client will assume on discharge. Gathering information on role expectation helps to determine the performance assessments to be completed during the home evaluation (e.g., if the client is expected to do laundry, then accessibility to the laundry room will be assessed during the home assessment).

A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. When all the wounds are closed and the graft is stable, what is the BEST intervention to prevent hypertrophic scar development? A. Jobst or other custom made pressure sleeve with inserts B. Elastic bandage wrapping from distal to proximal C. Scar massage 3-5 times per day D. Frequent PROM and AROM

A. Jobst or other custom made pressure sleeve with inserts When most of the wounds are closed, a Jobst or other pressure garment is the best choice to prevent hypertrophic scarring. Adding inserts increases the effectiveness of compression therapy.

A 4-year-old child with arthrogryposis is being evaluated for ADLs. The child needs to use utensils that are angled to be able to put food into the mouth. Which characteristic of clients with this condition provides the rationale behind the use of these adapted utensils? A. Joint contractures in the arms and hands B. Spasticity in the arms and hands C. Hypotonia in the arms and hands D. Decreased sensation in the arms and hands

A. Joint contractures in the arms and hands Arthrogryposis is characterized by joint contractures. Angled utensils promote independence with feeding by allowing a client with contractures in the arms and hands to put food into the mouth.

A COTA® receives a small thank-you gift from a client at the end of the client's treatment session. The COTA still has several treatment sessions left with this particular client. The COTA does not report receiving the gift because the gift seems too insignificant to report. By not reporting the receipt of this gift, what ethical principle may the COTA be violating? A. Justice B. Veracity C. Autonomy D. Nonmaleficence

A. Justice The principle of justice requires that occupational therapy professionals provide services in a consistent and unbiased manner and report all gifts as directed by employer, state, and federal guidelines. Principle 4J of the Occupational Therapy Code of Ethics (2015) states, "Occupational therapy personnel shall refrain from accepting gifts that would unduly influence the therapeutic relationship or have the potential to blur professional boundaries, and adhere to employer policies when offered gifts." By not reporting the gift, the COTA may be creating a situation in which treatment will be biased toward clients who give gifts.

A client sustained a cerebral infarct 3 months ago with hemiparesis in the right lower extremity. The client has been discharged from physical and occupational therapy, walks with a quad cane, and is fully functional in the other extremities. The client completed an on-road driving evaluation and did fine with the use of adaptive devices. What device did the certified driver rehabilitation specialist MOST LIKELY prescribe? A. Left-foot accelerator B. Spinner knob on the steering wheel C. Right Veigel accelerator and brake pedal extension D. Additional mirrors to decrease blind spots

A. Left-foot accelerator This device will allow the client to continue to drive and to use the left foot to compensate for the right leg hemiparesis.

A client who has mild hemiplegia and constructional disorder is participating in home-based occupational therapy. The COTA® is observing the client's ability to use the dishwasher after a meal preparation activity. Which aspect of using a dishwasher would be MOST CHALLENGING for this client? A. Loading the dishes into the dishwasher B. Pressing the button to turn on the dishwasher C. Pouring dishwashing soap into the dispenser D. Pulling out the empty upper and lower dish baskets

A. Loading the dishes into the dishwasher Constructional disorder involves difficulty assembling pieces into a whole-item object such as organizing dishes in a dishwasher or food in a refrigerator.

Every generalist occupational therapy practitioner should be prepared to address community mobility within his or her practice setting. What is the MOST CORRECT procedure a COTA® can implement in preparation for the service area? A. Maintain a resource library or database about transportation options in the area B. Conduct on-road driving evaluations to determine fitness to drive C. Provide direct assistance to clients in boarding and riding public transportation vehicles D. Assist clients by providing rides to and from therapy sessions

A. Maintain a resource library or database about transportation options in the area Making transportation resources or information available to clients is pertinent to every practice setting and does not require specialized training or certification.

A client with multiple sclerosis (MS) presents with balance deficits and impaired lower-body ADL resulting from increased spasticity in both lower extremities. The OTR® asked the COTA® to promote safety during bathing tasks, What recommendation should the COTA® FIRST make to the client? A. Maintain at least 90° of hip flexion on a shower chair. B. Use a long-handled bath sponge to reach the lower extremities. C. Perform lower extremity stretching and strengthening exercises while in the shower. D. Place one foot at a time on a small stool while washing.

A. Maintain at least 90° of hip flexion on a shower chair. Using a shower chair addresses both the balance deficits and the spasticity that interfere with lower-body ADLs. By sitting down to wash, the client reduces the risk of falls, and flexed hips may lessen spasticity in the lower extremities.

A COTA® working at an outpatient clinic begins to provide occupational therapy intervention for a new client that the OTR® evaluated yesterday. During the first intervention session with the COTA®, the client asks, "Will Medicare pay for this?" How should the COTA® answer? A. Medicare Part B covers 80% of allowable costs after the yearly deductible. B. Medicare Part B covers 20% of allowable occupational therapy services. C. Medicare Part A covers 100% of allowable services after the deductible. D. Medicare Part A covers 50% of the allowable amount for the services.

A. Medicare Part B covers 80% of allowable costs after the yearly deductible. Medicare Part B covers 80% of the occupational therapy services in outpatient settings after the yearly deductible.

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

A. Medium Medium work requires exerting 20-50 lb of force occasionally, 10-25 lb of force frequently, or more than negligible weight to as much as 10 lb of force constantly to move objects.

The OTR®-COTA® team is performing a physical examination to determine the client's seating and positioning needs before ordering a new wheelchair. What rule of thumb would the OTR®-COTA® team use for the client's ability to sit upright? A. Minimal hip flexion of 90° B. Minimal hip flexion of 80° C. Minimal hip flexion of 70° D. Minimal hip flexion of 60°

A. Minimal hip flexion of 90° The ability to achieve 90° of hip flexion is necessary for postural stability when sitting upright without support.

An inpatient has acute congestive heart failure and is participating in Phase I cardiac rehabilitation. Which task is ESSENTIAL for the COTA® to do during self-care sessions with this patient? A. Monitor changes in the patient's physiologic responses during activities B. Instruct the patient to use compensatory strategies for lower body dressing C. Encourage the patient to complete as much activity as tolerated D. Provide the patient with adaptive equipment for bathing and hygiene

A. Monitor changes in the patient's physiologic responses during activities During Phase I, it is important to monitor the patient's physiologic responses to ensure that the patient remains medically stable, medication responses are monitored, and chest pain is addressed.

Which assessment assesses a client's visual closure, or the ability to visually identify forms or objects from incomplete presentations? A. Motor-Free Visual Perception Test, Third Edition B. Development Test of Visual Motor Integration C. Visual Screening Test D. Depth Perception Test

A. Motor-Free Visual Perception Test, Third Edition The Motor-Free Visual Perception Test, Third Edition, assesses the ability to visually identify forms or objects from incomplete presentations.

A large outpatient hand clinic employs certified hand therapists who are either licensed OTR®s or licensed physical therapists. COTA®s are used to efficiently manage caseloads. Which description of the supervision requirement for COTAs working in this environment is MOST accurate? A. Must be supervised by a licensed OTR in accordance with state licensure and scope of practice for COTAs B. Does not require supervision if the COTA has a minimum of 5 years of experience treating clients with upper-extremity conditions C. Can be supervised by a licensed OTR or physical therapist regardless of any other certifications D. Can be supervised by a licensed OTR or physical therapist as long as the supervisor is a certified hand therapist

A. Must be supervised by a licensed OTR in accordance with state licensure and scope of practice for COTAs COTAs typically require supervision by a licensed OTR in accordance with state licensure and scope of practice for COTAs.

A COTA® chooses to use preparatory activities to modulate muscle tone, promote proximal joint stability, and improve hand function during a handwriting intervention session. Which frame of reference is the COTA® using to guide intervention? A. Neurodevelopmental B. Acquisitional C. Sensorimotor D. Biomechanical

A. Neurodevelopmental A neurodevelopmental approach to handwriting would ideally be used for children who have tone issues, poor postural control, poor limb function, poor automatic reactions, and poor proximal stability. These preparatory activities would help mitigate the child's underlying deficits, promote better hand control, and ultimately lead to better handwriting.

Older women who are members of an ethnic minority and live on lower incomes have been identified as using public transportation more than most people in their age cohort. How might their reliance on public transportation influence the engagement in community occupations of this population? A. Participation in community occupations will be limited by the hours of transportation service and the cost to use it. B. Access to taxi services will expand this population's access to community occupations. C. Public transportation offers access to more geographic areas than does a private automobile, so this population will have unlimited occupational opportunities. D. Participation in community occupations will be severely restricted for this population because they use public transportation.

A. Participation in community occupations will be limited by the hours of transportation service and the cost to use it. The relationship between transportation access and community engagement is determined by the cost and scope of transportation relative to the resources and desires of the person.

A COTA® is assisting an OTR®; in evaluating an child with oppositional defiant disorder with aggressive behaviors. The parents report enjoyment in a very limited repertoire of activities. The OTR and COTA decide to use the Model of Human Occupation (MOHO) to guide assessment and intervention. Which MOHO-based assessment is BEST to use with this child to develop a list of meaningful occupations that can be used for intervention? A. Pediatric Interest Profiles B. Short Child Occupational Profile C. Pediatric Volitional Questionnaire D. Coping Inventory

A. Pediatric Interest Profiles The Pediatric Interest Profiles is a self-report that surveys children's play and leisure interests. This assessment asks the child to indicate his or her level of participation in and feelings of enjoyment associated with the activity.

An OTR®; is evaluating a child with oppositional defiant disorder with aggressive behaviors. The parents report that the child enjoys doing a very limited repertoire of activities. The OTR decides to use the Model of Human Occupation (MOHO) to guide assessment and intervention. Which MOHO-based assessment is BEST to use with this child to develop a list of meaningful occupations that can be used for intervention? A. Pediatric Interest Profiles B. Short Child Occupational Profile C. Pediatric Volitional Questionnaire D. Coping Inventory

A. Pediatric Interest Profiles The Pediatric Interest Profiles is a self-report that surveys children's play and leisure interests. This assessment asks the child to indicate his or her level of participation in and feelings of enjoyment associated with the activity.

Which of the following elements is an important component of the Recovery Model? A. Peer support and teaching B. Social-emotional learning C. Cognitive-behavioral therapy D. Sensory-motor interventions

A. Peer support and teaching The Recovery Model suggests a broad context for intervention, not specific intervention strategies provided by mental health providers. The Recovery Model is a client-centered approach to recovery that encourages the supports necessary for a person to recover within a context that is comfortable for that person. It may include peer support and teaching.

A COTA® is assisting an OTR®; in evaluating a child who is depressed and suicidal after experiencing severe bullying in school. On interviewing the child, the COTA identifies that the child's sense of self-efficacy and personal capacity have been severely affected, and the child does not want to go to school anymore. Using a Model of Human Occupation theoretical framework, which component of the child's volition should the OTR and COTA work on as a primary concern? A. Personal causation B. Values C. Interests D. Habituation

A. Personal causation Personal causation is defined as one's sense of self-competence and effectiveness while engaged in occupations. Because the child's self-efficacy and personal capacity have been severely affected, it is best to address the child's personal causation as a primary concern.

An OTR®; is evaluating a child who is depressed and suicidal after experiencing severe bullying in school. On interviewing the child, the OTR identifies that the child's sense of self-efficacy and personal capacity have been severely affected, and the child does not want to go to school anymore. Using a Model of Human Occupation theoretical framework, which component of the child's volition should the OTR work on as a primary concern? A. Personal causation B. Values C. Interests D. Habituation

A. Personal causation Personal causation is defined as one's sense of self-competence and effectiveness while engaged in occupations. Because the child's self-efficacy and personal capacity have been severely affected, it is best to address the child's personal causation as a primary concern.

When a COTA® completes documentation, which of the following actions is MOST in compliance with HIPAA regulations for maintaining client privacy and confidentiality? A. Positioning computer screens and client charts out of others' view B. Collaborating with other therapists in the COTA®'s discipline C. Maintaining electronic client documents D. Keeping hard-copy records in a central area

A. Positioning computer screens and client charts out of others' view HIPAA helps protect the privacy and confidentiality of client health records. Ensuring that unauthorized personnel and other clients cannot view client information helps protect privacy.

A COTA® is working with a student with autism spectrum disorder (ASD) to address impairments in social interaction skills, including turn taking, eye contact, and verbal and nonverbal communication. Which intervention embeds practice of these skills in the IADL of community mobility? A. Practicing interaction with the driver of a public transportation vehicle B. Practicing turn taking at an ice cream shop C. Asking the client to make eye contact five times during a therapy session D. Setting a goal for the client to sit without talking to anyone on the school bus

A. Practicing interaction with the driver of a public transportation vehicle Interaction with a public transportation driver must take place within the realm of community mobility. Case-Smith and Arbesman (2008) observed that naturally occurring opportunities for social interaction are potential occupational therapy interventions for people with ASD.

A COTA® is treating an inpatient who has myasthenia gravis and is preparing for discharge to live alone at home. What information is MOST IMPORTANT for the COTA® to discuss with the patient? (retired question) A. Precautions against overexertion, emotional stress, and fluctuations in temperature B. Types of communication devices and environmental control units that promote ADL independence C. The importance of resistive activities for improving muscular strength and endurance D. Compensatory strategies for adapting to changes in visual status

A. Precautions against overexertion, emotional stress, and fluctuations in temperature Overexertion, emotional stress, and temperature elevations may exacerbate the symptoms of myasthenia gravis, and patients should be educated to minimize these situations.

Retired NBCOT® Question A COTA® is completing a home health visit for a client who has Alzheimer's disease and lives alone. A family member reports finding an accumulation of uneaten meals in the refrigerator and the gas oven turned on. In addition to recommending a comprehensive home safety evaluation, what INITIAL action should the COTA® take based on this report? A. Provide resources and options for addressing the client's needs B. Help the family develop a schedule for mealtime family visits C. Recommend initiating Meals On Wheels community services D. Discuss with the caregiver the importance of aging in place

A. Provide resources and options for addressing the client's needs Providing caregivers with available community and national resources is essential as the COTA® becomes aware of client and family needs. Offering reliable resources and making necessary referrals is important in providing the needed assistance for this family.

A client with multiple sclerosis (MS) is displaying symptoms of depressed mood. The client has been referred to occupational therapy by a physician because of increasing feelings of difficulty with life tasks secondary to depression. The COTA® asks how the client feels, and the client responds, "I just don't feel like I can do anything right." Which strategy would be appropriate for the COTA to implement? A. Provide tasks that are graded for successful completion B. Implement energy conservation techniques C. Provide fine motor tasks to improve motor skills D. Discuss areas of life in which the client feels unhappy

A. Provide tasks that are graded for successful completion Providing the client with a task that is graded for successful completion gives the client an opportunity to feel a sense of mastery over the environment.

A COTA® is baking cookies with a client with apraxia. How would a fading approach to this intervention be described? A. Providing hand-over-hand feedback with repetition, then reducing tactile cueing as the client demonstrates more skill B. Allowing the client to roll the dough and cut with cookie cutters, but the COTA® places cookies on baking sheet. C. Instructing the client with verbal cues in the steps of the process and how to perform each step. D. Providing tactile cueing on an as-needed basis to prevent the client from becoming frustrated with the activity.

A. Providing hand-over-hand feedback with repetition, then reducing tactile cueing as the client demonstrates more skill A remedial strategy to working with people with apraxia is hand-over-hand techniques, in which the COTA® physically moves the affected body part; the COTA® can then grade the cueing and reduce it over time, which is fading.

A COTA® is working with a client who has cervical osteoarthritis. The client is currently working as a computer programmer. Which strategy would be contraindicated by the client's condition? A. Putting the computer monitor as low as possible to stretch the neck into flexion while working. B. Taking frequent breaks during work to move the head. C. Performing AROM exercises to maintain ROM. D. Providing a headrest for the work chair to support the head while sitting.

A. Putting the computer monitor as low as possible to stretch the neck into flexion while working. Joint protection principles dictate that clients avoid positions of deformity (neck flexion) and avoid keeping the joint in one position for long periods.

The client has fair minus (3−) strength in the bilateral shoulder muscles and fair plus (3+) strength in the elbow, forearm, and wrist joint motions. The client's grip strength bilaterally is just below the norm for the client's age and sex, and the client's pinch strength is normal in both hands. With which functional activity will the client have the MOST difficulty? A. Reaching into the closet above shoulder level for a pair of pants B. Using a fork and knife while sitting at the kitchen table C. Using a toothbrush and dental floss while standing at the sink D. Reaching for salt and pepper shakers on the table directly in front of the plate

A. Reaching into the closet above shoulder level for a pair of pants Because the client has increasing strength in the distal joints of the upper extremity, positioning and weight of items will likely be the primary determinants of whether the client has difficulty with a task. Overhead tasks would require significant shoulder strength, which the client does not have.

A client attending a low back education program is given an ergonomics checklist to complete. Which item is the BEST to include in an ergonomics checklist? A. Use wide bases of support when performing tasks. B. Increase muscle strength for better back stability. C. Use the dominant body side to complete tasks. D. Take frequent breaks between tasks and stretch often

A. Use wide bases of support when performing tasks. Principles of ergonomic training for back injury prevention include maintaining a wide base of support during task completion.

A child with a developmental disability and poor postural control is being evaluated for independent toileting in the bathroom. The child demonstrates poor postural control, which presents a high risk for falls when sitting on the toilet. Which equipment would the OTR® recommend to support the child's safety and independence with toileting? A. Safety rails B. Toileting schedule C. Floor-based toilet paper holder D. Handheld urinal

A. Safety rails Safety rails, or grab bars, would support the child's postural control while toileting and promote use of the hands to maintain balance.

For a client with multiple sclerosis, which compensatory cognitive strategy would BEST aid in performance of daily activities? A. Schedule demanding tasks at intervals throughout the day B. Simplify daily tasks to conserve energy C. Modify the environment to decrease clutter D. Decrease visual stimulation to promote focused attention

A. Schedule demanding tasks at intervals throughout the day Spreading demanding tasks throughout the day allows for rest periods to promote cognitive ability. Clients with multiple sclerosis typically have greater cognitive abilities in the morning and after rest breaks.

When measuring a client for a wheelchair, what are the four basic measurements the OTR®-COTA® team MUST take? A. Seat width, seat depth, seat height, seat-back height B. Seat width, seat depth, seat height, footrest length C. Seat width, seat depth, seat-back height, footrest length D. Seat width, seat depth, footrest length, seat-to-back angle

A. Seat width, seat depth, seat height, seat-back height These measurements must be provided when ordering a wheelchair. Other measurements are helpful for comfort (e.g., armrest height).

For clients who have arthritis, which aspect of the overall occupational therapy intervention plan is the MOST crucial? A. Self-efficacy B. Splinting C. Compliance with the independent home exercise program D. Instruction in compensatory strategies for ADL management

A. Self-efficacy Self-efficacy facilitates independent follow-through in the home context. The resulting confidence may ultimately lead to the desired behavior.

What piece of adaptive equipment is MOST IMPORTANT to address bathing needs for a client with a hip replacement who has poor balance and weight-bearing restrictions? A. Shower chair B. Nonskid strips C. Long-handled sponge D. Shower caddy

A. Shower chair A shower chair or stool should be installed when balance or weight bearing are a problem.

Which is the MOST appropriate position for a client with a hip replacement to perform lower-body dressing? A. Sitting on the side of the bed B. Sitting in a low chair without arm rests C. Sitting with the feet on a stool D. Sitting on a tub bench

A. Sitting on the side of the bed For lower-body dressing, the client should be seated on the side of the bed or in a chair with arms.

A COTA® is working with a client who suddenly complains of pressure and tightness in the chest. The client's symptoms resolve with rest and a nitroglycerin tablet administered under the tongue. What condition is the client MOST likely to have experienced during the treatment session? A. Stable angina B. Unstable angina C. Myocardial infarction D. Atrial flutter

A. Stable angina Stable angina usually resolves with rest, nitroglycerin, or both.

What is the BEST suggestion that a COTA® might provide to a caregiver who is living with a client who has Alzheimer's disease (AD)? A. Suggest appropriate activities that can engage the client during unoccupied time and improve daily structure. B. Suggest that the caregiver allow the client to continue cooking independently with adapted cooking utensils to improve safety. C. Suggest that the caregiver provide challenge to the client's daily routine by maintaining distance during routine tasks. D. Suggest modifications to the home environment to include arrows that lead to the bedroom and bathroom.

A. Suggest appropriate activities that can engage the client during unoccupied time and improve daily structure. Providing structure to unoccupied time is an important consideration for clients with AD to prevent behavior problems and maintain quality of life. In addition, structure promotes an increase in goal-directed activity and may aid in more regular sleep patterns.

A client employed full-time at a bakery began having numbness and tingling in both hands. An OTR® provided ergonomic assessment and the COTA® provided intervention to address the client's acute injuries. The client met the goals, and the OTR® and COTA® collaborated in preparing to discharge the client from outpatient services. The OTR® asked the COTA® what step should be taken to BEST minimize the client's risk of reinjury? A. Suggest that the client participate in an injury prevention program at the workplace. B. Refer the client for job retraining, because it is unlikely that the client will able to return to work. C. Recommend that the client return to the role as baker but seek light duty to minimize risk of reinjury. D. Postpone discharge and continue services to help the client maintain ADL performances at home.

A. Suggest that the client participate in an injury prevention program at the workplace. Injury prevention programs allow collaboration between the worker and employer to decrease work injuries by addressing safety and proper job task performance. Maximizing worker health and fitness may also be a part of the injury prevention program, which promotes worker wellness and reduces risk of reinjury.

A patient with deep partial-thickness burns has an extremely edematous right hand. The patient has multiple open wound areas on the dorsum of the hand and between the web spaces. What is the BEST approach for assessing the effectiveness of treatment in reducing swelling? A. Take circumferential measurements of the forearms, wrists, palms, and digits B. Use a volumeter to measure water displacement of the forearms and hands C. Ask the patient to elevate the right hand above the level of the heart D. Compare differences in time in completing the Nine-Hole Peg Test

A. Take circumferential measurements of the forearms, wrists, palms, and digits Even though both circumferential and volumeter measurements are appropriate for edema measurement, the patient has multiple open wound areas, and allowing the hand to get wet might not be appropriate. Circumferential measurement is the more appropriate approach.

A client has been diagnosed with age-related macular degeneration. Which is the BEST intervention strategy for the COTA® to use to improve the client's independence in meal preparation? A. Teach the client to use different tactile indicators on a few key microwave buttons. B. Teach the client to use central vision to see the microwave buttons. C. Prescribe an optical device for client to use to see the microwave buttons. D. Instruct the client to lower the general and task lighting in the kitchen and near the microwave

A. Teach the client to use different tactile indicators on a few key microwave buttons. This strategy would help the client supplement remaining vision with tactile sensation.

A school-based OTR® is evaluating how a 6-year-old student ties shoes so that the student can be more independent in getting ready for physical education (PE) class. The OTR plans to review the steps of shoe tying with the student right before it is time to get ready for PE class. Then, the OTR will have the student tie the shoes before lining up to go to PE class. What type of strategy is this? A. Teaching in context B. Visual support for sequencing C. Task simplification D. Forward chaining

A. Teaching in context Consistently having the student practice shoe tying at the time that the student actually needs to tie the shoes is an example of teaching the skill in context.

An 85-year-old client cannot access fixed-route transit and has chosen to use a supplemental transportation program operated by volunteer drivers. What characteristics of such a program might make it more appealing to this client? A. The "Five As": Availability, accessibility, acceptability, affordability, and adaptability B. The convenience and privacy of traveling in the client's own automobile C. The use of large vehicles that transport multiple people between fixed stops D. Curb-to-curb services at low or no cost to the traveler because the transportation is paid for through grant funding

A. The "Five As": Availability, accessibility, acceptability, affordability, and adaptability The Five As represent characteristics of best practice in the provision of senior-friendly supplemental transportation, as outlined by the Beverly Foundation.

A COTA® is conducting a cooking group for people with schizophrenia. During the group, one of the clients tells the COTA®, "I think I've seen some people from the government watching me this week." Where and how should the COTA document this information in a SOAP note? A. The COTA should include the client's statement in the S section of the note. B. The COTA should include the client's statement in the O section of the note. C. The COTA should include the client's statement in the A section of the note as part of treatment evaluation. D. The COTA should include the client's statement in the P section of the note to guide treatment planning.

A. The COTA should include the client's statement in the S section of the note. The S, or subjective, section of a SOAP note gives the client's perspective on his or her condition, treatment, or experience.

An entry-level COTA® begins working at a long-term care facility and needs direct continuous supervision. Which statement BEST describes this type of supervision? A. The COTA® and the supervising OTR® are in the rehabilitation gym, and the OTR® observes the COTA®'s performance. B. The COTA® and supervising OTR® meet at the end of each day to discuss the COTA®'s caseload and review documentation. C. The supervising OTR® is in the facility but in a different area from the COTA® during the morning. D. The COTA® texts the OTR® questions throughout the day as needed, and the OTR® reviews the COTA®'s documentation regularly.

A. The COTA® and the supervising OTR® are in the rehabilitation gym, and the OTR® observes the COTA®'s performance. Direct supervision offers the COTA® firsthand information on the COTA®'s performance as a result of in-person observation. Continuous supervision means the COTA® is in sight of the supervising OTR®.

Which statement BEST describes how a COTA® assists with performing an occupational therapy evaluation? A. The COTA® may perform delegated assessments and provide reports of a client's capabilities to the OTR®. B. The COTA® is not legally allowed to contribute to any part of the evaluation process. C. The COTA® may perform chart reviews and report findings and any initial observations of the client to the OTR®. D. The COTA® may analyze the standardized and nonstandardized test results and translate those results to help with goal setting.

A. The COTA® may perform delegated assessments and provide reports of a client's capabilities to the OTR®. According to AOTA's Guidelines for Supervision, Roles, and Responsibilities, the OTR® performs the evaluation and directs all parts of the evaluation process. The COTA® may contribute to the evaluation process by performing delegated assessments and delivering reports of observations and client capacities to the OTR®. The OTR® analyzes the feedback from the COTA® and incorporates that information into the evaluation process.

An OTR®; is using the Cognitive Orientation to daily Occupational Performance (CO-OP) approach to help a group of children with high-functioning autism develop effective problem-solving skills. Which example is the BEST application of the CO-OP during the goal-setting phase of the first group activity? A. The OTR allows the group to set its own goals and facilitates ways to redirect the goals as needed. B. The OTR performs dynamic performance analysis to identify the strengths and weaknesses of the group. C. The OTR directly informs the group whether the set activity goal is too easy or too difficult. D. The OTR facilitates strategies to help the group set its goals appropriately.

A. The OTR allows the group to set its own goals and facilitates ways to redirect the goals as needed. During the first goal-setting phase, the OTR allows the clients to develop meaningful goals for themselves.

An inpatient client post-hip fracture also has moderate rheumatoid arthritis (RA; Stage II) with no current signs of inflammation. The client is seen for dressing training first thing in the morning and requires maximum assistance to use the sock aid because of finger and ankle stiffness. The COTA® spends time training the client in using the sock aid. During an afternoon session, the COTA® has the client practice with the sock aid but finds that the client is now independent. What is the MOST likely explanation for this improvement? A. The client was experiencing morning stiffness during the initial session. B. The client had a flare-up during the initial treatment session. C. During the initial treatment session, the client was depressed. D. The client's performance improved through training in use of a sock aid.

A. The client was experiencing morning stiffness during the initial session. ble fluctuations in ability because of pain, stiffness, and fatigue. The client was experiencing morning stiffness that limited the ability to manipulate the aid appropriately.

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

A. The client's sexual drive and need for emotional intimacy has not been altered. Physical and emotional needs are not altered by spinal cord injury

Retired NBCOT® Question A COTA® has been teaching visual scanning techniques to a patient who has a CVA. When documenting progress, what information is BEST to include in the Objective section of a SOAP note? A. The patient's ability to use the techniques and level of assistance needed during a specific dressing activity B. Improvements noted in the patient's participation during ADLs when using the newly learned techniques C. Modifications needed to increase the patient's understanding of the specific techniques D. Family members' observations of the patient using the techniques during activity

A. The patient's ability to use the techniques and level of assistance needed during a specific dressing activity The Objective section provides concise information that reports what was observed and what occurred in the session; reporting the assistance levels and the techniques used for dressing is appropriate for the Objective section.

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The COTA® is assisting the OTR in writing the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." How should the timeline (or T) part of this goal be modified to make it more measurable? A. The timeline should specifically reference the anticipated discharge date. B. The timeline should list the number of weeks in which the goal should be accomplished. C. The timeline should list the number of sessions that are sufficient to address the goal. D. The timeline part of the goal does not need to be modified.

A. The timeline should specifically reference the anticipated discharge date. Having a long-term goal reference discharge for the timeline is appropriate; however, the specific discharge date should be included.

A COTA®, in conjunction with an OTR®, is developing a fall prevention program for an assisted living facility. Which environmental characteristic is MOST often associated with falls? A. Throw rugs B. Tile flooring C. Low furniture D. Pets

A. Throw rugs Throw rugs are hazards associated with falls.

When fitting a client to a wheelchair, why is it important to ensure that the wheelchair has appropriate seat depth? A. To distribute body weight along the entire sitting surface B. To maintain the thighs in a position parallel to the floor C. To keep the depth of the chair as small as possible D. To provide support and alignment for the upper extremities

A. To distribute body weight along the entire sitting surface Distributing body weight along the sitting surface (along the entire length of the thigh to just behind the knee) helps to prevent pressure sores on the buttocks and the lower back and to attain optimal muscle tone normalization to assist in prevention of pressure sores throughout the body.

A COTA® has a client who requires a new wheelchair, so the COTA is assisting the OTR in selecting the appropriate wheelchair. During this process, it is important to consider seat width. When considering seat width, what should be the COTA's MAIN objective? A. To distribute weight over the widest possible surface while keeping the width of the chair as narrow as possible B. To support the client's body in the wheelchair while maintaining the thighs in a position that is parallel to the floor C. To maintain proper posture and balance and to provide support and alignment for the upper extremities D. To provide for maximal function and support of the back while allowing for change in body positioning

A. To distribute weight over the widest possible surface while keeping the width of the chair as narrow as possible Distributing weight over the widest possible surface prevents too much pressure on any specific area. However, the narrower the width, the easier it is for the client to maneuver through the environment. Trying to find a balance between these two areas is key to good wheelchair selection.

What is the purpose of the Disciplinary Council as described in the Enforcement Procedures for the Occupational Therapy Code of Ethics and Ethics Standards? A. To give the Respondent an opportunity to present evidence and provide witnesses to answer and refute a charge B. To ensure that no additional ethical issues beyond those described by the Complainant are raised C. To discuss and examine the claim of ethical violation in the absence of the chairperson of the AOTA Ethics Commission D. To gather members of multiple disciplines affiliated with occupational therapy to judge the validity of the claim

A. To give the Respondent an opportunity to present evidence and provide witnesses to answer and refute a charge The Disciplinary Council provides a forum for the person against whom the ethical violation charge has been made to respond to the charge. Witnesses and evidence can be presented.

A COTA® is explaining the purposes of therapeutic exercise and therapeutic activity to a physician. What are the PRIMARY reasons that these interventions are used for musculoskeletal conditions? A. To improve function, increase strength, and prevent muscle imbalances B. To improve function, maintain joint range of motion, and maintain strength C. To improve coordination, maintain joint range of motion, and increase billable time in therapy D. To maintain strength and teach compensatory movement patterns for weak muscle groups

A. To improve function, increase strength, and prevent muscle imbalances Therapeutic exercise and activity assist the client with improving strength and function while preventing further complications, including muscle imbalances.

A COTA® is working with a teenager with developmental disabilities who hopes to acquire a driver's license. Which intervention MOST appropriately addresses this client's community mobility needs? A. Training to improve the client's comprehension of travel rules tested in the licensing process B. Practice in driving skills in the COTA®'s vehicle in the school parking lot C. Practice in handwriting skills to improve the client's communication about driving skills D. Use of cognitive-behavioral therapy to address the client's beliefs about the ability to drive

A. Training to improve the client's comprehension of travel rules tested in the licensing process AOTA's (2010) "Statement on Driving and Community Mobility" states that occupational therapy intervention for people with developmental disabilities may include evaluation, education, and training in preparation for obtaining a driver's license.

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

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

Which statement BEST describes supplemental transportation programs? A. Transportation services for older adults and people with disabilities who cannot use existing transportation options B. Commercial transportation providers who have specialized training in serving older adults C. Paratransit services funded by taxpayer money that serve specific regions D. Transportation services staffed by paid drivers who operate a fleet of limousines

A. Transportation services for older adults and people with disabilities who cannot use existing transportation options The term supplemental transportation program describes a wide array of volunteer, nonprofit, or community-based transportation options serving older adults and people with disabilities who either are unable to use existing transportation services or desire more flexible travel options.

A client who has had a stroke demonstrates disorganized, random scanning patterns when completing cancellation tasks. Which factor BEST explains the client's performance? A. Unilateral neglect B. Visual field deficit C. Smooth pursuits D. Tropia or strabismus

A. Unilateral neglect Disorganized, random scanning patterns are characteristic of unilateral neglect.

A client presents with decreased orientation. What is the most effective strategy for a COTA® to implement to assist with this cognitive impairment? A. Use an orientation poster in a common area with personal and day-time information listed. B. Provide auditory reminders throughout the day that provide basic personal and day-time information. C. Provide the client with orientation information only when requested to prevent undue anxiety. D. Allow the client to establish his or her own routine, even if that means allowing the client to dress for the day in the middle of the night.

A. Use an orientation poster in a common area with personal and day-time information listed. Visual reminders are an effective strategy for deficits in orientation.

A client with dementia is having difficulty locating the bathroom in the home, which is creating strain for the caregiver. What is the BEST recommendation the COTA® can give the caregiver to assist the client with this task? A. Use arrows on the walls to indicate the location of the bathroom. B. Paint the walls near the bathroom bright red to create contrast. C. Use low lighting in the hallway leading to the bathroom to reduce distraction. D. Place the names of commonly used bathroom items on the door of the bathroom.

A. Use arrows on the walls to indicate the location of the bathroom. Labeling physical structures with symbols, such as arrows for direction, is helpful to people with dementia.

A client left employment as an elementary school teacher because of impairments from a stroke 12 months previously. The client is now interested in pursuing a new occupation. A work skills interest assessment and performance skill measures indicate suitability for work as an administrative assistant. The client needs assistance in entering this new occupation and working with impairments. Which program would BEST provide this service? A. Vocational rehabilitation B. Supported employment C. Community center D. Employer consultation

A. Vocational rehabilitation Clients who leave a workplace because of impairments can receive assistance from vocational rehabilitation to return to that or another workplace.

A COTA® is asked to provide services to a placebound client. The COTA has limited experience in the setting, but no other COTAs in the nearby region are able to provide services. What should the COTA do next? A. Work with the supervising OTR to secure ongoing education in this area of practice as well as increase the level of supervision during administration of the assessment. B. Deny offering services to the client because of a lack of content knowledge. C. Refer the client to a qualified provider in a region that is less accessible to the client. D. Agree to provision of services immediately so as not to delay treatment.

A. Work with the supervising OTR to secure ongoing education in this area of practice as well as increase the level of supervision during administration of the assessment. This response is consistent with the ethical principle of Beneficence. Taking action to improve competency and oversight also further benefits the client without limiting access.

A client arrives for an occupational therapy evaluation upset because of an inability to travel home in time to attend the wedding of a family member. Which response by the COTA® communicates a professional use of empathy? A. "Why don't you come back later when you are feeling better?" B. "You seem upset that you are going to miss the wedding." C. "Life goes on. It will be OK." D. "You need to calm down so we can complete your occupational therapy for today."

B. "You seem upset that you are going to miss the wedding." This response best communicates empathy; it validates the client's feelings in a nonjudgmental manner.

A COTA® works at a skilled nursing facility that provides wheelchairs for clients who need them. As a result, the facility has a room full of wheelchairs of varying sizes. The COTA is often expected to find the wheelchair that best fits each new client, which requires determining whether the seat depth is appropriate for that client. Where should the front edge of the wheelchair seat be in relation to the client's hamstrings? A. 5 to 6 inches proximal to the posterior side of the bent knee B. 1 to 2 inches proximal to the posterior side of the bent knee C. At the knee crease on the posterior side of the bent knee D. 1 to2 inches distal to the posterior side of the bent knee

B. 1 to 2 inches proximal to the posterior side of the bent knee Having the seat of the wheelchair very close to the bent knee without touching it allows for the client's body weight to be evenly distributed, which prevents pressure sores, while allowing for knee clearance from the edge of the seat upholstery.

A COTA® is working with a client who has been placed on bedrest because of a deep vein thrombosis. After anticoagulation therapy has been initiated, what is the accepted waiting period to resume occupational therapy interventions involving ambulation? A. 12 hours B. 2-3 days C. 5-7 days D. 8-10 days

B. 2-3 days Recent literature has indicated that ambulation may be permitted on the 2nd or 3rd day after anticoagulation therapy has been initiated.

Which adult is MOST LIKELY to experience a hip fracture? A. A 40-year-old with diabetes B. A 55-year-old with osteoporosis C. A 60-year-old with early stages of glaucoma D. A 75-year-old with early stages of dementia

B. A 55-year-old with osteoporosis Osteoporosis is closely linked to hip fractures because of the decreased bone density in the neck of the femur.

Which client is MOST LIKELY to experience a hip fracture? A. A 40-year-old man with diabetes B. A 55-year-old woman with osteoporosis C. A 17-year-old athletic girl D. A 55-year-old man with dementia

B. A 55-year-old woman with osteoporosis Osteoporosis is closely linked to hip fractures because of the decreased bone density in the neck of the femur.

What piece of adaptive equipment is MOST useful for a client with an incomplete T2 spinal cord injury? A. A weighted spoon B. A long-handled sponge C. A plate protector D. A button hook

B. A long-handled sponge Clients with a T2 spinal cord injury will need assistance reaching and washing immobile lower extremities.

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

B. A redesign of the work space to minimize distractions Essential job functions are defined as job duties fundamental to the position the individual holds or desires to hold, as opposed to functions that are marginal. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Redesigning the office space to limit distractions to promote the client's ability to attend to tasks would be the most appropriate choice.

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

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

An OTR®-COTA® team is establishing reasonable accommodations for a client diagnosed with osteoarthritis in the left shoulder. The client is employed as a plumber. Essential job functions include reaching, bending, crawling, lifting, pushing and pulling, using tools, and lifting materials weighing 25-50 lb. Which accommodation is MOST appropriate for the OTR®-COTA® team to recommend? A. Provide the client with modified-handle tools to reduce torque on the shoulder joint. B. Allow the client a flexible work schedule and use of leave time as needed. C. Ensure materials and equipment are within functional reach. D. Recommend use of wheeled cart to transport tools.

B. Allow the client a flexible work schedule and use of leave time as needed. Essential job functions are job duties fundamental to the position the individual holds or desires to hold. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Allowing the client a flexible work schedule and use of leave time is the most appropriate choice. Flexibility will provide the client with the opportunity to vary the work schedule on the basis of symptoms.

A COTA® is working on sitting balance at the edge of the bed with a client who has had a CVA with residual left-sided hemiplegia. The client requires minimal assistance to maintain static sitting because of lateral leaning. How can the COTA® BEST adapt or modify this activity to improve sitting balance? A. Prop a wedge and pillows behind the client for trunk support and alignment. B. Allow the client to bear weight on the left upper extremity on the bed. C. Position the client's hips in an anterior pelvic tilt with forward weight shifting. D. Instruct the caregiver on proper hand placement to support the client during dressing.

B. Allow the client to bear weight on the left upper extremity on the bed. Weight bearing on the affected side will provide lateral support and can help reduce tone. This positioning technique changes the physical demands of static sitting to improve participation in the task.

Which legislation provides rights to children and adults with disabilities? A. Patient Protection and Affordable Care Act (2010) B. Americans With Disabilities Act of 1990 C. Health Insurance Portability and Accountability Act of 1996 D. Individuals With Disabilities Education Act of 1990

B. Americans With Disabilities Act of 1990 The Americans With Disabilities Act is legislation granted rights to people with disabilities to prevent and avoid discrimination

A COTA® is working with a client with a visual impairment who wishes to use public transportation buses. Which accessibility issue should the COTA® advocate for on behalf of this client? A. Use of a bus that lowers to the ground for boarding B. Announcement by the driver of the names of stops along the route C. Reserved seats near the front of the bus for clients with disabilities D. Discount vouchers for the client

B. Announcement by the driver of the names of stops along the route Clients with a visual impairment rely on auditory cues for orientation. Announcing stops orients them to their relative position along the route and to arrival at their destination.

Which class of psychopharmaceutical drugs is mood elevating but may increase suicidal tendencies in young adults and carries a small risk of causing hypomania or mania? A. Adrenergic receptor drugs B. Antidepressants C. Anticholinergics D. Antipsychotics

B. Antidepressants Antidepressants have a variety of mechanisms, but all are mood elevating and carry potential for risk of suicide. Mania and hypomania are risks with all antidepressants.

A client was provided with an ultra lightweight wheelchair. Because the client is at risk for falls, the drop seat was tilted posteriorly to help prevent the client from getting out of the chair; also, because of the client's short stature, the axle was moved forward to make it easier for the client to propel the chair. What two accessories would the OTR®-COTA® team recommend to improve the client's safety while using the wheelchair? A. Solid rubber casters, antitippers B. Antitippers, brake lever extenders C. Brake lever extenders, flip-up footrests D. Flip-up footrests, antitippers

B. Antitippers, brake lever extenders Because the client's center of gravity is now behind the axle and the drop seat is tilted posteriorly, the client is more vulnerable to tipping backward in the chair; thus, the OTR®-COTA® team would recommend antitippers. The OTR®-COTA® team would recommend brake lever extenders because the tilt of the drop seat and the client's short stature will make it difficult for the client to access the brake levers.

A COTA&#174, is working with an OTR® in an outpatient center with clients after organ transplantation. What psychiatric condition is a client with a long-term transplantation MOST likely to experience? A. Depression B. Anxiety C. Dementia D. Personality disorder

B. Anxiety Clients may experience anxiety because of the guilt they feel over benefiting from someone else's death or while waiting for a matching donor. Organ recipients may also be affected by a type of posttraumatic stress disorder.

A COTA® is treating a client who burned the bilateral lower extremities 10 days ago. The client refuses to participate in ADLs because of pain. The client rates the level of pain as 4 of 10 when resting in bed and 7 of 10 when standing. What is the BEST action for the COTA® to take? A. Report the client's pain levels to the medical doctor and request stronger pain medication B. Apply an elastic bandage wrap for vascular support before getting the client out of bed C. Allow the client to perform ADLs while lying in bed, and focus on bed mobility skill D. Explain to the client that nonparticipation may lead to an early discharge from therapy

B. Apply an elastic bandage wrap for vascular support before getting the client out of bed With lower-extremity burns, providing vascular support before standing decreases blood pooling in the lower extremity and therefore decreases pain in standing and ambulation. The client should learn an alternative strategy to manage pain early on in the intervention.

A COTA® suspects that her supervising OTR® is falsifying treatment session documentation in order to comply with documentation deadlines. If true, this constitutes a breach of Veracity and Justice. What is the BEST next step the COTA take? A. Report the person to the state regulatory board. B. Approach the person directly to refute the claim. C. Report the OTR to the OTR's supervisor. D. Contact the human resources department.

B. Approach the person directly to refute the claim. Approaching the person directly is most appropriate; it is the most respectful approach, and the COTA may be incorrect about the OTR's behavior.

A COTA® is working with a client who has decreased nerve function. The client has lost precision pinch, thenar opposition, and the ability to bend the index and long fingers at the proximal and distal interphalangeal joints. What deformity does the client MOST likely have? A. Ulnar claw B. Boutonniere deformity C. Swan neck deformity D. Ape hand deformity

D. Ape hand deformity Ape hand deformity is the result of a high median nerve injury at the elbow or proximal forearm.

A COTA® is working with a child in a treatment session focused on using constraint-induced movement therapy within the context of an art project. Why does the COTA® anticipate that this treatment will be effective? A. Because the COTA® is inhibiting the child's tone B. Because the COTA® is forcing the child to use the affected extremity C. Because the COTA® is using a familiar task D. Because the COTA® is encouraging the development of efficient habits

B. Because the COTA® is forcing the child to use the affected extremity Evidence has supported the use of constraint-induced movement therapy, or forced-use movement therapy, for children with hemiplegia. This technique involves the therapist restricting the child's ability to use the unaffected arm, thereby forcing the child to use the affected arm during functional tasks. Working on an art project may help encourage the child's participation and make the therapy more enjoyable.

A COTA® continues to work with and charge for services with a client after all goals are met and there is no further need for occupational therapy services. The supervising OTR® discovers this and meets with the COTA to explain why this behavior is unethical. Which Occupational Therapy Code of Ethics (2015) principle best describes this situation? A. Nonmaleficence B. Beneficence C. Justice D. Veracity

B. Beneficence Beneficence is the principle that occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services. Beneficence hold personnel accountable to integrity for goals related to treatment. Principle 1H of the Occupational Therapy Code of Ethics (2015) states, "Occupational therapy personnel shall terminate occupational therapy services in collaboration with the service recipient or responsible party when the services are no longer beneficial."

An order came in for a hand orthosis for a new client. The OTR® who completed the evaluation asked the newly graduated COTA® to fabricate the orthosis. The new COTA had not made an orthosis on a client before and requested assistance from the supervising OTR, who is a hand therapist. Which ethical principle did the newly graduated COTA follow? A. Veracity B. Beneficence C. Nonmaleficence D. Fidelity

B. Beneficence Beneficence relates to occupational therapy practitioners having concern for the safety of clients. The newly graduated COTA needed to establish a level of competence by working with the OTR to demonstrate proficient orthotic fabrication.

While participating in an occupational therapy activity group, a client becomes highly confrontational with other clients in the group for no apparent reason. During a discussion with the OTR® and COTA®, the client states that if she continues self-mutilating behaviors, her family will no longer allow the client to live at home. Documentation from the psychologist indicates that the client has behaved this way for years. What diagnosis does this client MOST likely have? A. Narcissistic personality disorder B. Borderline personality disorder C. Paranoid personality disorder D. Posttraumatic stress disorder (PTSD)

B. Borderline personality disorder Diagnostic symptoms for borderline personality disorder are self-mutilation and destruction, unstable mood, and fears of abandonment that lead to instability.

A client with dementia presents with decreased attention. What is the MOST effective strategy for a COTA® to implement to assist with this cognitive impairment? A. Encourage the client to persist in the task despite fading concentration. B. Break the task into manageable steps and provide them one by one to the client. C. Provide the client with self-talk strategies that allow the client to maintain attention to the task. D. Provide contrasting visual cues to enhance interest in the environment to improve attention.

B. Break the task into manageable steps and provide them one by one to the client. Breaking the task into manageable steps allows the COTA® to control the task and provide the "just-right" challenge to the client to maximize attention to the task and to reduce frustration.

What is an effective way to assist a client who has early- to middle-stage dementia with a complex task? A. Suggest that the caregiver complete difficult components of the task. B. Break the task into manageable steps and provide verbal or visual cueing. C. Remove the materials necessary for the task until the client forgets about it. D. Change the location where the task is performed so that the client can relearn the task.

B. Break the task into manageable steps and provide verbal or visual cueing. Breaking a complex task into manageable steps while providing some type of cueing (whether simple verbal or visual cueing) allows a client with dementia to perform a task more independently and with less frustration.

What is the MOST appropriate way in which a COTA® can address functional ambulation with a client? A. By creating an exercise program that increases strength, therefore improving ambulation B. By helping the client with valued roles and activities associated with ambulation C. By decreasing the use of assistive devices during daily ambulation activities D. By assessing whether an orthosis is necessary for a client with ambulation dysfunction

B. By helping the client with valued roles and activities associated with ambulation Functional ambulation integrates ambulation with ADLs and IADLs. By using an occupationally based approach, a COTA can focus on functional ambulation based on the client's valued roles and activities.

A COTA® in a home health setting is working with a client in the kitchen and hears a heated argument between the client's spouse and one of the client's children in the next room. The client begins to cry, indicating that the arguing is causing stress. What action would be MOST reasonable for the COTA® to take? A. Confront each of the people in the next room B. Call the medical social worker and report the incident C. Drive the client to a shelter D. Try to intervene and resolve the conflict

B. Call the medical social worker and report the incident Referral to an expert in dealing with these matters, such as a medical social worker, is the best course of action; direct intervention is outside the COTA®'s scope of practice.

A client with advanced amyotrophic lateral sclerosis (ALS) presents with a stiff forward-flexed neck that is at risk for developing a contracture and impairing social participation. Which intervention would the COTA® use to BEST prevent a contracture? A. A physical agent modality, such as diathermy or ultrasound, to minimize contractures B. Caregiver training on gentle neck stretching and how to help the client don a soft cervical collar C. A home exercise program of isometric neck exercises in all planes D. Patient and caregiver education on proper positioning at rest and during functional tasks

B. Caregiver training on gentle neck stretching and how to help the client don a soft cervical collar Because of ALS's progressive nature, many of the interventions for clients with ALS focus on client and caregiver education to address the increasing symptoms and preventing secondary complications such as contractures. Caregiver training on gentle neck stretching and how to help don a soft cervical collar is the most appropriate because using the collar will help maintain the neck in a neutral position, and gentle stretches to the neck will lessen stiffness and discomfort.

An OTR® working in an outpatient rehabilitation clinic evaluated a client who was recently hospitalized for dehydration and subsequently diagnosed with mild cognitive impairment. The client lives alone in an independent living facility. Before admission, the client was independent in ADLs and light homemaking and active in community and social activities, including driving independently. The client reports no crash record and no violations or citations but avoids night driving, highway driving, and driving in rush-hour traffic or heavy rain. After the initial evaluation, the OTR® determines that the client requires a complete clinical and road evaluation to determine the client's driving skills. To whom should the client be referred? A. Case manager, for discharge planning and reintegration into the independent living facility B. Certified driving rehabilitation specialist, for a comprehensive driving evaluation C. Department of Motor Vehicles, for license retesting D. Neuropsychologist, for cognitive testing

B. Certified driving rehabilitation specialist, for a comprehensive driving evaluation This referral is appropriate for ensuring that the client will function optimally in driving and community mobility after discharge.

The Children's Health Insurance Program provides coverage for which group of people? A. Children who are disabled and are able to be mainstreamed into a regular school classroom B. Children and families whose income is too high for Medicaid but too low to afford private insurance C. Children whose parents are disabled and are unable to work and therefore afford health insurance D. Children ages 0-3 who are disabled and living in a long-term care residential facility

B. Children and families whose income is too high for Medicaid but too low to afford private insurance The Children's Health Insurance Program covers children and families who are unable to afford private insurance but unable to qualify for Medicaid because their income is too high.

A COTA® is working with a new client and notes that the client has a bluish tinge to the skin and lips. The client also presents with significant edema. Which medical condition is this client most likely to have? A. Emphysema B. Chronic bronchitis C. Cystic fibrosis D. Cirrhosis of the liver

B. Chronic bronchitis A client with chronic bronchitis will have poor oxygenation, resulting in a bluish tinge to the skin and lips, along with edema.

On an inpatient rehabilitation unit, the COTA® observes a newly evaluated patient with Parkinson's disease eating breakfast seated in a bedside chair. The COTA® observes a fork on the floor and milk spilled on the patient's gown and tray. The patient begins coughing, spitting up pieces of pancake, and then says hello with unswallowed food in the mouth. What should the COTA® do FIRST with this patient? A. Instruct the patient on the use of adaptive feeding equipment to minimize spillage of foods and liquids. B. Clear the unswallowed food from the patient's mouth and then notify the nurse supervisor and the OTR®. C. Collaborate with the physical therapist to readjust the chair for optimal seating and positioning of the patient. D. Discuss with the patient and the nutritionist an immediate need to switch to a mechanical soft diet.

B. Clear the unswallowed food from the patient's mouth and then notify the nurse supervisor and the OTR®. B is the most important immediate action, because the food in the mouth could cause a choking episode. A speech therapist may be needed to evaluate for dysphagia and advise on appropriate diet changes or recommend further testing such as a video swallow. It is appropriate to discuss with the client whether the client wants increased independence with feeding using adaptive techniques or equipment, and providing education on the role of occupational therapy with feeding would help initiate this part of the intervention planning process.

When conducting an on-road assessment, which elements should the driver rehabilitation specialist consider? A. The client's performance in his or her own vehicle on a predetermined road course B. Client-centered principles and the client's context as referenced in the Occupational Therapy Practice Framework C. Parking lot, residential, suburban, urban, city, rural, and highway contexts D. The client's ability to engage in conversation or adjust controls (e.g., air conditioning) while driving

B. Client-centered principles and the client's context as referenced in the Occupational Therapy Practice Framework Conducting an assessment according to client-centered principles and the client's context is consistent with the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; AOTA, 2008).

A COTA® has been assigned to work with a 6-year-old student on completing writing tasks and worksheets. Which functional writing activities should a child this age be able to complete without adult assistance? A. Writing the upper- and lowercase letters of the alphabet without a model B. Copying a triangle, printing own name, and copying most letters C. Writing the numerals 1-10 without a model D. Copying a pentagon and an octagon, printing own address, and drawing a house with 12 details

B. Copying a triangle, printing own name, and copying most letters Typically, children between the ages of 5 and 6 are able to copy a triangle, print their own name, and copy most letters from a model.

A 2-year-old client was referred to an outpatient burn clinic for management of developing scar tightness in the left hand and wrist. The client's mother is the primary caregiver and has expressed severe guilt about the child being burned in a kitchen fire 6 months ago. The mother is feeling very overwhelmed with the postburn management program and has been having difficulty looking at the client's hand during therapy. What should be the INITIAL program for the mother to carry out at home? A. Compression glove worn 24 hours per day with 20 minutes of deep scar massage every 2 hours during waking hours B. Compression glove worn 24 hours per day with silicone gel pads inserted at all the web spaces and regular play time with play dough and toy building blocks C. Coban™ self-adherent wrap on each individual finger during the day, deep scar massage 3 times per day, and antideformity hand splint at night D. Coban™ self-adherent wrapping of each individual finger and elasticated tubular bandage 24 hours per day, regular PROM of left fingers and wrist

B. Compression glove worn 24 hours per day with silicone gel pads inserted at all the web spaces and regular play time with play dough and toy building blocks It is important that the mother accept the child after the accident, and having therapeutic playtime can help with mother-child bonding. To avoid further overwhelming the mother, the initial scar management program should be simple and yet efficient. The use of silicone gel pad inserts at the web spaces can soften the scar and maintain the web spaces.

A client needs a wrist orthosis. The OTA® is aware that the guidelines from the client's insurance company indicate that reimbursement is not provided for equipment and that the insurance company considers the wrist orthosis equipment. What should the OTA do in this situation? A. Dismiss the need for the wrist orthosis B. Consider the pros and cons of the making the wrist orthosis C. Fabricate the wrist orthosis without billing D. Suggest that the wrist orthosis be purchased at the local pharmacy

B. Consider the pros and cons of the making the wrist orthosis The OTA is faced with an ethical dilemma of providing an orthosis when there is no payment for the orthosis and the client needs the orthosis. Considering the pros and cons allows the OTA to identify the positive and negative situational variables involved in making the orthosis.

A COTA® is part of a team that is planning to implement a schoolwide positive behavioral intervention and supports (PBIS) program. Which statement reflects the application of schoolwide PBIS programming? A. Written expectations that state what behaviors the school considers inappropriate B. Consistent application of procedures for correcting misbehaviors at school C. Development of a detailed support plan to meet the needs of all students D. General strategies that teachers can modify to teach appropriate behaviors

B. Consistent application of procedures for correcting misbehaviors at school Consistent application of procedures to correct misbehaviors is a key feature of schoolwide PBIS programming. For the program to be effective, the majority of the school staff must agree to implement the intervention and receive training and support on an ongoing, consistent basis.

An OTR®; is part of a team that is planning to implement a schoolwide positive behavioral intervention and supports (PBIS). Which statement reflects the application of schoolwide PBIS programming? A. Written expectations that state what behaviors the school considers inappropriate B. Consistent application of procedures for correcting misbehaviors at school C. Development of a detailed support plan to meet the needs of all students D. General strategies that teachers can modify to teach appropriate behaviors

B. Consistent application of procedures for correcting misbehaviors at school Consistent application of procedures to correct misbehaviors is a key feature of schoolwide PBIS programming. For the program to be effective, the majority of the school staff must agree to implement the intervention and receive training and support on an ongoing, consistent basis.

In starting to treat a client with low vision who is experiencing difficulties with night driving and reading road signs well in advance, what is the occupational therapy practitioner's FIRST step? A. Report the client to the state licensing body and ask the Medical Advisory Board to investigate this case. B. Consult with the client's physicians, optometrist, and other health care providers. C. Discharge the patient to the ophthalmologist or optometrist to provide intervention and recommend that the client not drive. D. Discharge the client from occupational therapy and refer the client to a low vision specialist for general rehabilitation.

B. Consult with the client's physicians, optometrist, and other health care providers. The occupational therapy practitioner should work with the multidisciplinary team to develop the best treatment options for the client.

According to the Standards of Practice for Occupational Therapy, which BEST describes the role of the COTA® in client outcomes? A. Develops a transition plan. B. Contributes to discontinuation plan. C. Reduces the intensity of services. D. Interprets achieved outcomes.

B. Contributes to discontinuation plan. The COTA® is able to contribute information to a discontinuation plan but is unable to independently discontinue a client from occupational therapy services. Discontinuation falls under the role of the OTR®.

The topic of the February 7, 2013, newsletter MLN Matters, published by the Medicare Learning Network under the Centers for Medicare and Medicaid Services, was related to changes in the criteria for mobility assistive equipment and mobility-related ADLs (MRADLs), which OTR®s and COTA®s working with positioning, seating, and wheelchairs need to know for reimbursement. Which of the following is NOT an MRADL specifically cited by Medicare? A. Feeding B. Cooking C. Bathing D. Grooming

B. Cooking Cooking is not specifically cited by Medicare; Medicare regulations state that beneficiaries must have significant limitations in tasks such as "toileting, feeding, dressing, grooming, or bathing."

An OTR®; at a private outpatient clinic is working with a child with a severe anxiety disorder. The OTR decides to use an alter approach to intervention following the Ecology of Human Performance (EHP) Model. Which approach BEST exemplifies the alter intervention strategy? A. Teaching the child strategies to monitor arousal and anxiety levels in different situations B. Corresponding with the school personnel to discuss ways to support the child at school C. Discussing advantages and disadvantages of home schooling with the child's parents D. Developing an educational training program for parents to inform them about children's anxieties

B. Corresponding with the school personnel to discuss ways to support the child at school According to the EHP Model, the alter intervention approach focuses on the client's context. Interventions are geared toward providing appropriate contexts to support the client's needs.

In a pulmonary rehabilitation setting, what would a COTA® most likely instruct a client to do to ensure that the client is not holding his or her breath during the strenuous part of an activity? A. Hold the neck in midline B. Count out loud or talk C. Prop elbows on a countertop D. Lift both arms to 90° of flexion

B. Count out loud or talk Pulmonary rehabilitation clients may be instructed to count out loud, sing, or talk to ensure they are exhaling during the strenuous part of an activity.

A COTA® is reviewing the availability of paratransit systems that offer customized assistance for an older client with low vision difficulties. The COTA® explains to the client that most paratransit services require that the rider be functionally able to meet the vehicle at the street. What term is used to describe this type of service? A. Arm-through-arm service B. Curb-to-curb service C. Door-to-door service D. Demand-responsive service

B. Curb-to-curb service A transportation service that requires riders to meet the vehicle at the street is referred to as curb-to-curb service, reflecting the expectation that the traveler can enter and exit the home and the vehicle without assistance.

Nursing staff reports that an inpatient who has been on prolonged bed rest has been experiencing orthostatic hypotension. Which of the following causes the symptoms of this condition during a patient transfer from the bed to a chair? A. Drop in heart rate when moving from sitting to standing B. Decrease in blood pressure when moving from supine to standing C. Dyspnea after moving from standing to a supine position D. Sharp increase in heart rate after moving from standing to sitting

B. Decrease in blood pressure when moving from supine to standing Orthostatic hypotension is a decrease in blood pressure often occurring with a change in position, such as transfers from supine to sitting or sitting to standing.

A client with presbyopia has difficulty reading small print. How would the client's vision problem BEST be described? A. Difficulty focusing on images as they move away B. Difficulty focusing on images as they move closer C. Difficulty with peripheral or ambient vision D. Difficulty with low-contrast images and glare

B. Difficulty focusing on images as they move closer Presbyopia occurs when the lens of the eye gradually becomes less flexible, thereby reducing its ability to keep images in focus as they move closer. Presbyopia reduces acuity, and people with this condition often report difficulty reading small print.

What is the most important safety recommendation for clients with middle-stage Alzheimer's disease (AD)? A. Do not allow this client to complete ADLs independently because the client might not dress appropriately for the weather. B. Do not leave this client alone because the client might get lost, even in a familiar environment. C. Provide this client with activity to engage the client throughout the day to minimize behavioral disturbances. D. Provide this client with redirection to minimize behavioral outbursts and prevent self-injurious behaviors.

B. Do not leave this client alone because the client might get lost, even in a familiar environment. The most important safety issue would be leaving a client with AD alone, because the client might become lost or confused, even in familiar environments.

A COTA® is working with a client who has a distal radius fracture. Functional outcome reporting is required by the facility. Which approach to functional outcome measurement is MOST consistent with client-centered care? A. Continuously updated and recorded range of motion measurements, to facilitate functional return B. Documentation of quantitative and qualitative data in the medical record, to facilitate the OTR®'s assessment of the clinical outcomes C. Standardized assessment data within the medical record, to guarantee payment by third-party payers D. The Disabilities of the Arm, Shoulder and Hand (DASH) measure, to collect occupational profile data

B. Documentation of quantitative and qualitative data in the medical record, to facilitate the OTR®'s assessment of the clinical outcomes Research on qualitative and quantitative measures suggests that practitioners should assess clinical outcomes from both a qualitative and a quantitative perspective and that subjective information plays a crucial role in maximizing therapeutic outcomes.

A client with Alzheimer's disease (AD) reports getting lost when going to a daughter's apartment. The client's daughter has been living in the same apartment building for more than 10 years, but she lives 3 hours away from the client. In what stage of dementia is this client? A. End B. Early C. Middle D. Late

B. Early In the early stage of AD, higher level executive functions that affect IADL performance are the first observed signs of the disease process.

COTA®s can assist caregivers of clients with Alzheimer's disease (AD) with reducing stress and burden by providing what type of intervention? A. Habit training to improve independence in ADLs B. Education related to the progression of AD C. Environmental modifications to the home D. Recommendations related to assistive technology

B. Education related to the progression of AD Education related to the progression of AD would be the most important intervention because such knowledge would allow the caregiver to have more control in choosing what types of intervention would be appropriate for the client and would, in turn, reduce caregiver stress. In addition, they would learn to distinguish the normal progression of AD from abnormal progression to advocate for better care of the client with AD.

A COTA® in an outpatient facility is working with a patient with Guillain-Barré syndrome (GBS) who is in the recovery phase. During ADL and IADL tasks, what should patient education address? A. Skin integrity techniques B. Energy conservation strategies C. Adaptive techniques and equipment D. Caregiver training and support

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

A COTA® has been working on an oncology unit of a hospital for several years and has begun to acknowledge signs of risk for burnout. How can the COTA® MOST effectively prevent burnout? A. Arrange monthly social meetings with other members on the team B. Engage in mindful meditation or reflective writing to promote life balance C. Attend an oncology conference every 3 months D. Meet once a month with other COTA®s and OTR®s who work in oncology

B. Engage in mindful meditation or reflective writing to promote life balance COTA®s and OTR®s, as well as clients, can use stress management techniques and wellness activities such as reflective writing and mindful meditation to promote life balance and avoid burnout.

A client is experiencing headaches at work owing to increased neck and shoulder tension resulting from prolonged computer keyboarding. The client's job duty requires 6 hours of typing on an average workday. What is the BEST stress management approach for the COTA® to suggest to this client? A. Work hardening program to increase endurance for prolonged keyboarding B. Frequent stretching breaks at the computer station every 30 minutes of keyboarding C. Assertiveness training to advocate for having extra personnel to assist with the client's work D. Decreased work hours per workday but spread to 6 workdays per week to catch up

B. Frequent stretching breaks at the computer station every 30 minutes of keyboarding Aside from ergonomic workstation modification to prevent straining the neck and shoulder during keyboarding, moving away from the static posture of keyboarding and performing different stretching exercises at the workstation is also important.

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

B. Have the client complete one trial on each of the five handle settings of the Jamar dynamometer. The five-level grip test is used to determine maximum and consistent effort by clients. The OTR® should expect the strongest grip on the second and third handle settings

A client has been diagnosed with age-related macular degeneration. The client enjoys knitting but is having difficulty seeing the design being knitted. What strategy should the COTA® use to facilitate the client's ability to continue knitting? A. Have the client choose a design with low contrast. B. Have the client rotate the head and trunk to the side. C. Have the client use built-up handles on the knitting needles. D. Have the client use knitting needles the same color as the yarn.

B. Have the client rotate the head and trunk to the side. Rotating the head and trunk to the side would allow the client to use the remaining peripheral vision to see the pattern.

A client is scheduled for hip replacement surgery and the COTA® is educating the client and his family on important information. What is MOST IMPORTANT for the client to learn before returning home? A. Identification of home hazards associated with falls B. Hip precautions and proper transfer techniques C. Proper use of prescribed adaptive equipment D. Community mobility options and public transportation support

B. Hip precautions and proper transfer techniques Learning hip precautions and proper transfer techniques are important in preventing the aggravation of an injury.

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

B. IV Because the client is confused and agitated, the behavior most closely resembles Level IV: confused-agitated.

A Complainant is a person filing an ethical complaint with the AOTA Ethics Commission. What condition must a Complainant fulfill? A. Be a member of the American Occupational Therapy Association B. Identify in writing the person against whom the complaint is directed (i.e., the Respondent) C. Attach all supporting documentation to the formal complaint D. Inform the Respondent that he or she is submitting a formal statement of complaint

B. Identify in writing the person against whom the complaint is directed (i.e., the Respondent) Established procedures for filing a complaint mandate identification in writing of the person against whom the complaint is being filed.

Which symptom of autism spectrum disorder (ASD) may have an impact on the use of public transportation? A. Motor impairments may make it difficult for people with ASD to board public buses. B. Impaired executive functioning may result in a person with ASD misjudging when to get on or off a bus. C. Visual impairments may result in a person with ASD not being able to read bus schedules or bus identifiers. D. Impairments in regulating autonomic functions may make it difficult for people with ASD to wait outside for a bus in extreme temperature conditions.

B. Impaired executive functioning may result in a person with ASD misjudging when to get on or off a bus. Executive function deficits are a common symptom of ASD and may result in impaired judgment.

For clients with a neurodegenerative disease who are experiencing fatigue that impedes occupational performance, which recommendation is BEST? A. Cease performing all activities that affect energy levels B. Implement environmental accommodations C. Prioritize the daily routine based on the caregiver's needs D. Avoid ROM exercises to preserve energy

B. Implement environmental accommodations Environmental accommodations allow clients to maintain their current lifestyle as much as possible while preserving energy for occupational performance.

A COTA® in an outpatient setting is treating a client who underwent repair of multiple flexor tendons in Zones 2 and 3 approximately 6 weeks ago. The dorsal blocking splint has been removed, and the client is beginning to actively move the digits. The client is eager to return to work as a carpenter, and the COTA and OTR® are collaborating to revise the goals with the client. Which goal for this time period is MOST appropriate? A. Increase passive wrist and digit composite extension to improve flexor tendon length B. Increase digital active range of motion to facilitate holding a washcloth during bathing C. Increase grip strength to maintain grasp on woodworking tools D. String 25 beads of various sizes and shapes to improve fine motor coordination

B. Increase digital active range of motion to facilitate holding a washcloth during bathing Setting realistic, meaningful goals and revising them as clients progress is a critical component in treating traumatic injuries. At 6 weeks after operative tendon repair, the client may be ready for light, nonresistive functional activities that promote active flexion.

Ocular motor skills may impair a client's ability to scan a busy intersection or to effectively maneuver a vehicle in an unfamiliar area. What are the performance implications for driving? A. Difficulty seeing gray cars on a rainy day B. Increased time to identify objects in and along the road along with eye fatigue C. Tendency to drift out of a lane and move too close to other road users or objects D. Difficulty seeing other road users or objects inside a tunnel

B. Increased time to identify objects in and along the road along with eye fatigue Impaired pursuits, saccades, and scanning may cause the client to stare at a road scene for a longer duration than expected, causing eye strain or fatigue.

A client with Parkinson's disease has experienced a significant decrease in participation in activities in the home. The initial evaluation from the OTR® states that this decrease in activity is related to the client's postural instability and the caregiver's fear that the client will fall. Which intervention is BEST to restore this client's participation in home activities? A. Ask the OTR to refer the client to another profession to address mobility B. Instruct the caregiver in ways to assist the client's participation in activities C. Train the client in energy conservation techniques to improve posture D. Assist the client in finding new activities to be involved with at home

B. Instruct the caregiver in ways to assist the client's participation in activities Use of specific cueing methods and clear verbal and visual instructions may facilitate improved motor movements for activity participation.

Because information-processing speed may affect a driver's on-road performance, which is the BEST compensatory approach the COTA® can use? A. Discuss with the supervising OTR® the client's driving cessation. B. Instruct the client in proper visual search patterns and efficient scanning techniques. C. Limit driving to familiar areas, simple traffic scenes, and roads with reduced speed limits. D. Educate the client in rules of the road and signs of the road.

B. Instruct the client in proper visual search patterns and efficient scanning techniques. This option will reduce the cognitive load or the information-processing demands of the environment on the client and provide more time for the client to focus on the driving task at hand.

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

B. Instruct the client to sort the laundry using both hands together. The activity analysis skill here is grading; the COTA® recognizes the difficulty of performing this bilateral upper-extremity activity and appropriately downgrades the task to reduce the need for both hands.

While a COTA® is working with a client on the grooming task of brushing teeth, the client mentions having to take antibiotics before going to the dentist for any dental work. What condition is MOST likely a part of this client's medical history? A. Chronic obstructive pulmonary disease B. Lung cancer C. Hip replacement D. Endocarditis

D. Endocarditis People with a history of endocarditis generally take antibotics before any dental procedures to prevent an infection from migrating to the heart.

What intervention technique is MOST commonly used with clients in acute care who have recently received a hip replacement? A. Strengthening of hip flexors for improved ambulation B. Instruction in the use of adaptive equipment for dressing C. Instruction in energy conservation for home management D. Coordination of community resources for safe discharge

B. Instruction in the use of adaptive equipment for dressing The most important aspect of occupational therapy during the acute stage of treatment in hip replacement is to ensure that the client understands the hip precautions and has the resources necessary to adhere to them so that the integrity of the hip is maintained and the client's safety is preserved. Adaptive equipment is a primary focus.

A COTA® is working with a driver poststroke who has poor ocular motor skills. Which compensatory approach is MOST APPROPRIATE for this client? A. Awareness training B. Instruction in visual search patterns and efficient scanning techniques C. Adapting side mirrors to deflect bright lights from other vehicles D. Using a voice-activated GPS to compensate for way-finding problems

B. Instruction in visual search patterns and efficient scanning techniques Deficits in pursuits and saccades may lead to an inability to effectively search, track, and locate objects in the driving environment.

Which role is the AOTA Ethics Commission charged with? A. Maintaining and reviewing AOTA's governance documents B. Issuing advisory opinions on the interpretation and application of the Occupational Therapy Code of Ethics (2015) C. Informing and educating all students enrolled in occupational therapy academic programs about the Code of Ethics D. Determining AOTA's strategic direction

B. Issuing advisory opinions on the interpretation and application of the Occupational Therapy Code of Ethics (2015) Issuing advisory opinions is one of several roles the AOTA Ethics Commission is charged with.

Independence in community mobility may have many benefits for clients. Which benefit is most important the COTA® should always consider? A. The various ways for clients to move about the community. B. It represents connectedness to others, to goods and services, and to the occupations of everyday life. C. The different opportunities to keep the client safe to drive. D. It carries economic implications based on access to goods and services.

B. It represents connectedness to others, to goods and services, and to the occupations of everyday life. This option is the major benefit of community mobility.

An assembly-line worker is returning to work after being treated for cubital tunnel compression at the left elbow from prolonged pressure on surfaces. What is the MOST appropriate height for this client's workstation? A. Above elbow height B. Just below elbow height C. 4 inches below elbow height D. 8 inches below elbow height

B. Just below elbow height The ideal position for precision assembly is to position the workstation above elbow height, but for a worker with recent nerve compression at the elbow, it is important to set up the work environment so as to not induce further prolonged pressure at the elbow. Therefore, the workstation should be just below elbow height, eliminating all pressure at the elbow. In this case, use of a magnifying device will allow for precision in assembly, compensating for the lack of close proximity.

A client who is currently receiving occupational therapy services has become unemployed and lost access to health care insurance. The COTA® works with the OTR®; to explore the options of providing pro bono services to ensure that the client continues on the path to recovery. What ethical principle likely informed the practitioners' decision in this situation? A. Veracity B. Justice C. Fidelity D. Autonomy

B. Justice The principle of justice refers to the fair, equitable, and appropriate treatment of persons and access to occupational engagement for clients. The client lost access to occupational therapy services as a result of the structure of health care insurance and its link to employment, so the practitioners made a decision to facilitate the client's access to a needed resource.

A COTA® is working with a client who is planning to take fixed-route transportation from home to work. The client sustained a closed-head injury 2 years ago and has difficulty with problem solving, especially related to changes in routine. What is the MOST important step for the COTA® to practice with the client? A. Walking from home to the train station B. Learning how to read the train schedule C. Obtaining exact change for the fare D. Getting on and off the train safely

B. Learning how to read the train schedule A client with problem-solving difficulty should be provided with a strategy to address future changes in routine. Because both train and school schedules may change from time to time, it is important for the client to learn how to read the train schedule.

A COTA® is completing a functional ambulation task with a client when the client's legs begin to buckle. What is the MOST appropriate way for the COTA to manage this issue? A. Call for assistance, and put the client in the wheelchair. B. Lower the client onto the COTA's flexed leg, then down to the floor. C. Hold the client up with a gait belt until another practitioner can get a chair. D. Using the gait belt, pull the client into the closest chair.

B. Lower the client onto the COTA's flexed leg, then down to the floor. The COTA may be less prone to back injury by using his or her legs to support or lower the client to the floor.

A frail older adult client who uses an ultra lightweight manual wheelchair with a foam cushion comes to the clinic is complaining of low back pain. The client's caregiver indicates that the skin on the client's coccyx is very pink, and there is concern about skin breakdown. The OTR®-COTA® team observes that the client's seated position is stable without supports, the client's upper extremities rest on the armrests without the shoulders hiking, the feet rest on the foot plates bilaterally, and the hips are at a 45° angle, which keeps the knees higher than waist level. The client indicates that this sitting posture is usual and is maintained most of the day. What intervention would the OTR®-COTA® team try INITIALLY to relieve the client's pain and protect the skin? A. Add an adjustable-tension back support so that the client can lean back further B. Lower the footrests so that the thighs are level with the seat of the chair and the feet rest flat on the footrests C. Replace the client's foam cushion with a gel cushion for better support D. Analyze how pressure is distributed on the pelvis using pressure mapping techniques

B. Lower the footrests so that the thighs are level with the seat of the chair and the feet rest flat on the footrests The client's footrests are too high, resulting in increased pressure at the ischial tuberosities and the coccyx. When the hip joint is maintained in flexion, the pelvis is prone to tilt posteriorly, increasing pressure in the lumbar region. Lowering the footrests distributes pressure more evenly over the thighs.

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

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

A COTA® observes a client who is able to complete a toileting routine with light hands-on support of the caregiver for safety and balance and manipulating fasteners, but the client is independent with all other steps of the task. What would the COTA report to the OTR® as the client's assistance level? A. Standby assistance or contact guard assistance B. Minimal assistance C. Moderate assistance D. Maximum assistance

B. Minimal assistance This example describes minimal assistance, which is when a client is able to complete at least 75% of a task.

A COTA® has established service competency for administration and scoring of the Mini-Mental State Examination. Which supervision is the MOST APPROPRIATE for the OTR® to provide? A. Close supervision on an ongoing basis to ensure maintenance of service competency B. Minimal supervision to periodically recheck that service competency is maintained C. Supervision on an as-needed basis per the COTA®'s request to fine-tune service competency D. None, unless otherwise indicated by the facility, state law, or licensing changes

B. Minimal supervision to periodically recheck that service competency is maintained Once service competency is established, the supervising OTR® should periodically recheck to ensure maintenance.

For a client with an L2 spinal cord injury, which statement BEST describes the muscle segments below the injury level 1 to 2 months postinjury? A. Senses are elevated. B. Muscles are spastic. C. Sympathetic functions are hypoactive. D. Muscles are flaccid.

B. Muscles are spastic. Because the monosynaptic reflex arc is intact but separated from higher inhibitory influences, muscles below the level of injury generally develop spasticity.

At what stage of Alzheimer's disease (AD) does nerve cell damage cause significant motor impairments that limit the ability to complete life tasks? A. Mild cognitive impairment B. Early stage C. Middle stage D. Late stage

D. Late stage By the late stage of AD, nerve cell damage has become so significant that not only are cognitive processes impaired, but motor skills are also affected.

Retired NBCOT® Question A client is in the rehabilitation phase of Guillain-Barré syndrome. The client has full passive ROM of both shoulders but is unable to actively raise the arms high enough to hang clothing on a standard-height rail in the closet. Which condition would cause this discrepancy between passive motion and functional ability? A. Malingering B. Muscular weakness C. Low endurance D. Joint contractures

B. Muscular weakness The ability to demonstrate full passive ROM with limited active ROM against gravity is related to muscle strength in that the muscles lack the strength to move through the full ROM against gravity.

A summer picnic has been planned for clients in a day treatment program for people with mental illness. Before leaving, what medication-related precaution should the COTA® review with the clients? A. Effects of combining alcohol use with medications B. Need to protect oneself from direct sun when taking psychotropic medications C. Increased likelihood of temporary ataxia after consuming foods typically contraindicated for monoamine oxidase (MAO) inhibitors D. Need to take medications before leaving for the picnic to avoid losing them

B. Need to protect oneself from direct sun when taking psychotropic medications Photosensitivity is a side effect of many psychotropic medications. Avoiding direct exposure to sun is essential.

A COTA® is working with children with autism in an early childhood intervention program. Which practice BEST reflects an integrated developmental model of assessment for these children? A. Application and interpretation of the most appropriate standardized assessments B. Observation of the children's functional abilities in multiple contexts C. Evaluation of the children without their parents to see their behaviors D. Collection of data by an unfamiliar examiner to provide objective results

B. Observation of the children's functional abilities in multiple contexts Integrated developmental assessment incorporates multicontextual sources of information.

An OTR® and a COTA® work in a clinic for clients with low back pain. What is the BEST way for the COTA® to identify the client's spinal postures? A. Have the client complete a questionnaire identifying preferred postures B. Observe the client performing ADLs, IADLs, and work-related tasks C. Take AROM, PROM, and manual muscle testing measurements of the trunk D. Send a questionnaire to the client's employer to complete while observing the client working

B. Observe the client performing ADLs, IADLs, and work-related tasks Observing preferred postures of a client during ADLs and other occupations will give the COTA® and OTR® the best information.

A COTA® working in an outpatient rehabilitation clinic is treating a client who was recently hospitalized for dehydration and subsequently diagnosed with mild cognitive impairment. The client lives alone in an independent living facility. Before admission, the client was independent in ADLs and light homemaking and active in community and social activities, including driving independently. The client reports no crash record and no violations or citations but avoids night driving, highway driving, and driving in rush-hour traffic or heavy rain. During the multidisciplinary team meeting, the referring physician asks the COTA® to justify why occupational therapy clinicians are suited to assess this client's fitness to drive. How would the COTA® BEST respond? A. Driving is an ADL included in the scope of practice of occupational therapy and therefore within occupational therapy's domain to assess. B. Occupational therapy practitioners need to consider how clients will function in the community; making such an extrapolation, assessing driving fitness is no different from considering whether a client is fit to live alone. C. Occupational therapy practitioners use clinical reasoning to make determinations regarding a client's IADLs, including driving. D. OTR®s are trained to use clinical tests to assess domains of function. Because driving entails motor, sensory, cognitive, and visual functioning, occupational therapists may make fitness-to-drive decisions on the basis of functional performance of clients.

B. Occupational therapy practitioners need to consider how clients will function in the community; making such an extrapolation, assessing driving fitness is no different from considering whether a client is fit to live alone.

An OTR®; is developing social skills group programming for elementary-aged children with autism spectrum disorder. Which statement reflects the application of the essential elements of social skills group programming? A. Session formats should regularly be changed to improve participants' adaptive skills. B. Parents need to receive intensive training and home programming as part of the intervention. C. The OTR determines rules for behavior for the group at the beginning of each session on the basis of the assessments done. D. Parents and children are primary participants in goal setting to improve social skills.

B. Parents need to receive intensive training and home programming as part of the intervention. Parent involvement is critical to the success of social skills programming.

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

B. Participants should be encouraged to practice their new language skills in settings outside of the group context. People with autism spectrum disorder typically do not generalize skills well. A challenge in practice is to facilitate carryover of rehearsed skills from therapy sessions to other settings to ensure that participants can apply the skills in cross-contextual situations.

A client has nocturnal urge incontinence secondary to Parkinson's disease. Which environmental modifications would be MOST BENEFICIAL for promoting the client's safety for nighttime toileting? (retired question) A. Raised toilet seat and safety grab bars B. Urinal and a bedside commode C. Night light and off-set hinges on the doors D. Call light and an adjustable-height bed

B. Urinal and a bedside commode Using a urinal and bedside commode allows a client to void quickly at the bedside when urge incontinence occurs and would avoid the client having to hurry to the bathroom and risk a fall.

An older adult attending a wellness health fair says to the COTA® running the fair, "I am very familiar with using public transportation and enjoy it as an affordable and accessible alternative to driving, but I have concerns about my personal safety while traveling. How might the COTA® and an OTR® collaborate with well older adults to address personal safety concerns at the level of community? A. Refer the older adults for individual therapy sessions to improve their functional abilities B. Partner with older adults to advocate for strategies to improve the safety of waiting areas and vehicles C. Write a letter on behalf of the older adults to the transportation authority stating the concerns the older adults reported D. Encourage the older adults not to use the public transportation system and instead to ask for rides from friends and family

B. Partner with older adults to advocate for strategies to improve the safety of waiting areas and vehicles Partnering to advocate for strategies to improve safety is both collaborative and at the level of community rather than individual intervention.

A COTA® and OTR® are working with a client with severe kyphosis secondary to osteoporosis. What is the primary cause of kyphosis in osteoporosis? A. Pathological deterioration of the vertebrae of the cervical spine B. Pathological deterioration of the vertebrae of the thoracic spine C. Pathological deterioration of the vertebrae of the lumbar spine D. Pathological deterioration of the neck of the femur

B. Pathological deterioration of the vertebrae of the thoracic spine A kyphosis is an abnormal rounding of the upper back. In the case of osteoporosis, it is caused by compression fractures of the vertebrae weakened by the osteoporotic condition.

A COTA® is working with a client in acute care who is complaining of leg cramps and pain when walking. These problems are a common symptom of what condition or surgical procedure? A. Cardiac arrhythmia B. Peripheral artery disease C. Lung transplantation D. Coronary artery bypass graft

B. Peripheral artery disease Cramping and pain when walking—also known as intermittent claudication—are caused by decreased blood flow while exercising and are common symptoms of peripheral artery disease.

An older adult client with a history of falls and glaucoma was referred to occupational therapy for evaluation and intervention. After the OTR® completed the evaluation, the COTA® was requested to provide the intervention. Which strategy should the COTA® use to reduce the client's risk of having a fall? A. Using low-wattage glare free light bulbs B. Placing contrasting color stripes on each stair edge C. Encouraging client to look forward when ambulating D. Securing a beige throw rug on the beige carpet

B. Placing contrasting color stripes on each stair edge The use of contrast would make it easier for the client to see each stair tread.

A client was referred to occupational therapy because of persistent pain in the neck and shoulder and the recent onset of paresthesia in the right index and middle fingers.. After the ergonomic assessment, the OTR® assigns the client to the COTA® for intervention. The COTA® determines that a simple change in the set-up of the computer station could help to reduce the client's symptoms. What change to the computer monitor would MOST likely alleviate the client's neck and shoulder discomfort? A. Position the monitor a minimum of two arm lengths away from the client. B. Position the monitor at eye level and one arm length away from the client. C. Tilt the monitor up so that the client is looking at the lower half of the screen. D. Recommend that the client use a large type size of no less than 16 points.

B. Position the monitor at eye level and one arm length away from the client. Proper ergonomic principle recommends the monitor be approximately one arm length away and the top one-third of the monitor be at the user's eye level.

A COTA® is working with a client with quadriplegia who has reentered a rehabilitation center to work on improving community mobility skills 1 year post injury. Which intervention would BEST address the client's treatment priorities? A. Maximizing the recruitment of motor units in partially innervated musculature through the use of functional electrical stimulation B. Practicing advanced wheelchair skills on community outings, including navigating doorways and uneven terrain C. Cotreating with the physical therapist to address therapeutic standing in long-leg braces D. Practicing the use of a power wheelchair in anticipation of a future need

B. Practicing advanced wheelchair skills on community outings, including navigating doorways and uneven terrain AOTA's (2010) "Statement on Driving and Community Mobility" addresses community navigation by wheelchair users as a skill of the generalist COTA®.

A COTA® is working with a child with juvenile rheumatoid arthritis (JRA) in the home setting. The child is having difficulty generalizing the therapist's recommendations over to the school setting. Which strategy would help the child generalize the recommendations to the school setting? A. Provide training to the child's sibling related to the ROM program. B. Provide the child with a second set of textbooks to keep at home. C. Provide training to the school nurse on how to assist the child with managing pain. D. Provide the child with a color-coded folder to put homework in.

B. Provide the child with a second set of textbooks to keep at home. Children with JRA benefit from energy conservation techniques that put less stress on their joints. Allowing the child to have a second set of textbooks would mean that the child would not need to transport heavy books to and from school, thus protecting the joints.

In what setting do an OTR® and COTA® need to consider the client's Individualized Education Program (IEP) when completing documentation? A. Mental health B. Long-term care C. Home health D. School system

D. School system The IEP is a document used in the school system that discusses the functional and academic needs of the student.

The reliance on and dominance of the automobile in the United States is quite remarkable. Several realities pertinent to community mobility are evident for people. Which option represents the most comprehensive explanation for this phenomenon? A. Reliance on transportation by any means other than the private automobile is uncommon in all environments as a result of U.S. Department of Transportation policies. B. Public transit options, despite legislation such as the American With Disabilities Act of 1990 (Pub. L. 101-336), are primarily geared toward a fixed-route system. C. The urban sprawl phenomenon in the United States creates challenges for operational efficiency and financial solvency of transportation systems. D. Misconceptions about alternative transportation and stigma associated with medically necessary services limit the use of such transportation options.

B. Public transit options, despite legislation such as the American With Disabilities Act of 1990 (Pub. L. 101-336), are primarily geared toward a fixed-route system. This option represents the most comprehensive explanation of this phenomenon.

A COTA® is establishing reasonable accommodations for a client with history of Type 1 diabetes employed as a computer programmer. Which accommodation is LEAST appropriate for the COTA® to recommend? A. Alteration of the client's work schedule allowing for blood glucose monitoring and insulin injection B. Purchase of a refrigerator for the client's office to provide the client with ready access to insulin and snacks C. Alteration of lunch break duration from 60 minutes to permit the client two 30-minute breaks D. Provision of improved lighting at the client's desk area and use of an antiglare magnifying computer screen

B. Purchase of a refrigerator for the client's office to provide the client with ready access to insulin and snacks Although access to a refrigerator would be recommended, provision of an office with a refrigerator may be considered an undue hardship for a small company. The employee should have access to a break room while at work to store insulin and snacks. Undue hardship is an exception to the requirement that employers provide reasonable accommodations per ADA. Undue hardship refers to any accommodation that would be unduly costly, extensive, substantial, or disruptive to or alter the nature of the operation of the business.

A patient underwent a total hip replacement, posterior approach, 2 weeks ago. Which activity puts the patient MOST at risk for hip dislocation if compensatory methods are not used? A. Preparing a stovetop meal B. Putting on socks and shoe C. Showering in standing position D. Shopping at a grocery store

B. Putting on socks and shoe During this activity, the patient may flex the hip greater than 90°, which is a contraindication for a posterolateral approach hip replacement.

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

B. Recommend that the family use a rhythmic beat to each step as they walk with the client. External cueing and feedback from caregivers is an important strategy to improve safety and in this case reduce freezing episodes. The rhythmic nature of counting out loud or using a beat helps promote smoother movements that are more coordinated.

A cabinetmaker is referred to occupational therapy with a recent onset of trigger finger of the right middle and ring fingers. The client has a history of rheumatoid arthritis. As part of the ergonomic education, what will the COTA® MOST likely include? A. Prevent static wrist positioning, hold tools close to the fulcrum, and use a thick protective glove. B. Reduce use of excessive gripping force, prevent contact stress, and implement task rotation. C. Trigger finger is common in rheumatoid arthritis; no ergonomic education is needed D. Switch to manual tools to reduce vibration from power tools and conduct a regular tool check for wear and tear.

B. Reduce use of excessive gripping force, prevent contact stress, and implement task rotation. Trigger finger is a condition associated with prolonged or high repetitions in forceful gripping. All of these modifications prevent or eliminate exposure to forceful gripping.

The COTA® is treating a client in the late stage of Parkinson's disease Which of the following symptoms can the COTA® expect to see? A. Resting tremor, spasticity, tingling sensations, incoordination. B. Resting tremor, rigidity, oral motor deficits. C. Spasticity, paralysis, decorticate posture, contractures. D. Spasticity, rigidity, impaired respiratory muscles.

B. Resting tremor, rigidity, oral motor deficits. Swallowing difficulties become apparent in the late stage of the disease because of impairments in the oral motor muscles as motor control becomes further compromised. Resting tremor is a symptom that manifests in the early stage of Parkinson's disease and continues throughout the disease course. Rigidity often onsets in the early stage of Parkinson's disease and progresses in severity in later stages.

A COTA® is working on bed mobility with a client with Guillain-Barré syndrome (GBS) 2 weeks into the plateau phase. The client reports dizziness on performing supine to sit at the edge of the bed and begins to lie back down. What is MOST appropriate for the COTA® to do next? A. Encourage the client to remain upright and allow for the dizziness to subside, and then notify the supervising OTR®. B. Return the client to supine, raise the legs, monitor vitals, and then notify the nurse and OTR®. C. Assist the client back to bed slowly, and immediately notify the nurse supervisor to assess the client's vital signs. D. Educate the client on the importance of sitting upright to help regulate the nervous system and prevent secondary complications.

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

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

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

A COTA® is working with a client diagnosed with depression who does not seem to care about fulfilling the roles as a parent to teenage children and friend to a person who also is struggling emotionally. Additionally, this client does not show an interest in returning to work or singing in the choir at church. Which assessment would help identify whether the client is devaluing these roles? A. Work Environment Impact Scale B. Role Checklist C. Comprehensive Occupational Therapy Evaluation D. Performance Assessment of Self-Care Skills

B. Role Checklist The Role Checklist assesses the value the client places on each of 10 different roles.

In 2005, Congress passed a federal transportation bill, SAFETEA-LU, which included funding for a program that encouraged children (including those with disabilities) to bike and walk to school, acted to reduce air-polluting traffic near schools, and encouraged healthy lifestyles from a young age. What was the name of this initiative? A. WalkFit to School B. Safe Routes to Schools C. Children With Disabilities Act D. Healthy American Students

B. Safe Routes to Schools The Safe Routes to School program was funded from 2005 to 2012 as part of the SAFETEA-LU legislation (Pub. L. 109-59) and provided 100% federal funding to facilitate states' initiatives to create safe environments surrounding schools and encourage children to bike and walk to school as part of developing a healthy lifestyle. In 2012 these initiatives were combined with others as part of the federal Transportation Alternatives Program.

A 30-year-old construction worker has developed work-related right biceps tendonitis. In the past 2 weeks, the client has primarily been working on the drainage system, which requires sawing a lot of metal pipes. What risk factor should be closely assessed during a worksite evaluation? A. Handle size of the hand saw B. Sawing repetitions per minute C. Length of the saw blade D. Diameter of the metal pipes

B. Sawing repetitions per minute Tendonitis is a musculoskeletal injury resulting from repetition. A high-risk repetition rate for the elbow is more than 10 repetitions per minute.

A 9-year-old child with spina bifida has been referred for occupational therapy to promote independent health maintenance. Which task should the OTR® include in the initial intervention plan? A. Medication management B. Self-catheterization C. Prevention of further health care problems D. Navigation of the insurance system

B. Self-catheterization Children with spina bifida generally become independent in self-catheterization at home and at school between age 5 and 9 years.

An allegation of ethical misconduct is submitted against an occupational therapy practitioner. The AOTA Ethics Commission determines that the alleged behavior may not be a true breach of the Occupational Therapy Code of Ethics (2015) warranting sanctions, but the behavior is not in keeping with appropriate standards of practice. What action is the Ethics Commission MOST likely to take? A. Issue a reprimand to the Complainant for submitting a false ethics claim B. Send a letter to educate the Respondent, the Complainant, or both about standards of practice and professional behavior C. Temporarily suspend AOTA membership of the Complainant D. Report conclusions and sanctions applied to both the Complainant and the Respondent in official AOTA publications

B. Send a letter to educate the Respondent, the Complainant, or both about standards of practice and professional behavior It is part of the role and responsibilities of the AOTA Ethics Commission to educate the membership on issues related to the Code of Ethics. Educative letters can be issued as a final action to Complainants, Respondents, or both to clarify the issues involved in an ethics complaint.

A COTA® is working with a child that the OTR® has evaluated. During the evaluation process, the parent provided information indicating that the child may have tactile defensiveness. Which assessment would have most effectively measured the child's responses to sensory experiences? A. Occupational Self-Assessment B. Sensory Profile C. Semmes-Weinstein monofilament test D. Kohlman Evaluation of Living Skills

B. Sensory Profile The Sensory Profile is designed to evaluate behavioral responses to everyday sensory experiences.

A client did not attend the occupational therapy session because of an illness. According to the Guidelines for Documentation of Occupational Therapy, what is the BEST type of documentation to note nonattendance in a timely manner? A. Reassessment report B. Service contact C. Plan of care D. Monthly progress report

B. Service contact Service contact would be the best type of documentation because it can be completed as soon as the nonattendance occurs.

A client has 20/200 visual acuity in the better seeing eye. How is this client's vision BEST described? A. Near blindness B. Severe low vision C. Normal vision D. Profound low vision

B. Severe low vision Severe low vision is defined as visual acuity of 20/200 to 20/400 or visual field of 20° or less.

The COTA® assisted with evaluating a client who recently sustained an L2 spinal cord injury with lower-extremity paralysis. The evaluation found that the client's upper-extremity function is intact. During treatment, what would be the MOST appropriate way to teach the client to complete functional transfers? A. Dependent transfer B. Sliding board transfer C. Bent pivot transfer D. Stand pivot transfer

B. Sliding board transfer Sliding board transfers are the most functional way to transfer for a client who cannot bear weight through the lower extremities but can use the upper extremities to assist with the transfer.

A client is being discharged from a rehab facility. During the discharge interview, the OTR® and COTA® ask questions such as, "Who is available to assist the client in each physical context the client needs to be in?" "When are they available?" "Who will check the Roho cushion and reinflate it as needed?" "Who will clean the cushion cover?" Under which assessment category do these questions fall? A. Physical context B. Social context C. Physical skills context D. Equipment context

B. Social context The social context includes people who support and assist the client in multiple environments.

A client in the acute burn unit sustained full-thickness chemical burns to the bilateral anterior and inner thighs. The client underwent grafting operations 2 weeks ago, and the surgeon has confirmed graft adherence. What would be the COTA's BEST choice to initiate compression therapy? A. Custom-made Jobst garment B. Spandex bicycle pants C. Coban™ self-adherent wrap D. Thromboembolism-deterrent (TED) stocking

B. Spandex bicycle pants Spandex bicycle pants are sufficient to apply gentle pressure on the anterior and inner-thigh areas without causing excessive shear or pressure on the newly adhered graft.

A client has severe intention tremors secondary to multiple sclerosis. Which adaptive strategy would be MOST BENEFICIAL for this client to use when eating? A. Placing plastic eating utensils in a universal cuff B. Stabilizing both arms on a counter or table top C. Using a mobile arm support or suspended sling D. Fastening a 5-lb (2.27-kg) weight on each forearm

B. Stabilizing both arms on a counter or table top Intention tremors occur during voluntary movement, and providing proximal stabilization may be effective in decreasing the intensity of the tremor with eating.

An OTR® wrote a goal for modified independence with meal preparation for a client who recently sustained a fracture of the left humerus and is currently in a splint and sling. The client uses a straight cane for functional mobility. How should the COTA® instruct the client to remove items from the oven during meal preparation? A. Stand directly in front of the oven, open the door, reach in with the right arm, pull out the food, and place it on top of the oven. B. Stand to the left of the oven, open the door, reach in with the right arm, pull out the food, and place it on top of the oven. C. Stand to the right of the oven, open the door, reach in with the right arm, pull out the food, and place it on top of the oven. D. Stand directly in front of the oven, open the door, reach in with a reacher using the right arm, pull out the food, and place it on top of the oven.

B. Stand to the left of the oven, open the door, reach in with the right arm, pull out the food, and place it on top of the oven. Standing to the left of the oven allows the client to open the door easily with the right hand and remain as close as possible to the food item being retrieved when pulling it out of the oven.

A COTA® is working with a client who has decreased visual acuity. The client is concerned about falling while walking up and down the stairs. Which of the following environmental adaptions is BEST for this issue? A. Railings along the length of both walls of the stairwell B. Strips of various colors at the edge of each step C. Safety grip strips placed on the edge of each step D. A chair lift for the entire length of the stairwell

B. Strips of various colors at the edge of each step Although all of the options are environmental adaptions for stairs, placing strips of various colors at the edge of each step is the only one that addresses visual impairment. Placing strips of various colors on the edge of each step helps the client to distinguish each step and can be used to distinguish the top and bottom of the staircase as well.

According to AOTA's (2010) "Statement on Driving and Community Mobility," what training must an occupational therapy practitioner have to address the IADL of community mobility? A. Advanced training as a driver rehabilitation specialist B. Successful completion of training as an OTR® or COTA® C. Specialized training with transportation systems and departments D. A specific number of courses that address driving and community mobility

B. Successful completion of training as an OTR® or COTA® AOTA's (2010) "Statement on Driving and Community Mobility" states that all OTR®s and COTA®s possess the training and education necessary to address driving and community mobility as an IADL.

A client with Parkinson's disease is experiencing difficulty in executive functioning. The client's spouse would like the client to continue participating in leisure activities. Which intervention would be the MOST appropriate for this client? A. Recommend environmental modifications to support engagement in activities. B. Suggest that the spouse provide checklists or reminders that use simple instructions. C. Provide a facial exercise program to improve social expressions. D. Instruct the client and spouse in simple leisure activities.

B. Suggest that the spouse provide checklists or reminders that use simple instructions. Providing simple instructions best addresses the client's difficulty in executive functioning.

An OTR®-COTA® team is establishing reasonable accommodations for a client diagnosed with fibromyalgia. The client has been employed as a bookkeeper for a small website design company. The client's symptoms include fatigue, disturbances in sleep pattern, chronic headaches, and skin and temperature sensitivity. Essential job functions include filing, maintaining records of expenses using a computer accounting system, reconciling and balancing accounts, and managing the payroll for the company's eight employees. Which accommodation is MOST appropriate for the OTR®-COTA® team to recommend? A. Permit the client to set temperature controls and ventilation for the entire workplace. B. Suggest the client schedule periodic rest breaks away from the workstation and use relaxation techniques to avoid fatigue. C. Accommodate the client with a telephone headset to eliminate fatigue and the repetitive motion of lifting the telephone from the cradle. D. Provide the client with a computer with access to work accounts so that the client can work from home on a flexible schedule.

B. Suggest the client schedule periodic rest breaks away from the workstation and use relaxation techniques to avoid fatigue. Essential job functions are defined as job duties fundamental to the position the individual holds or desires to hold, as opposed to functions that are marginal. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Fibromyalgia is a complex, chronic condition that causes widespread pain and fatigue and a variety of other symptoms. Deep muscular pain is the most common symptom of fibromyalgia. The pain associated with fibromyalgia varies according to the time of day, weather, sleep patterns, and stress level. Use of scheduled rest breaks and relaxation techniques would assist the client with avoiding fatigue and completing essential job functions.

An OTR® and COTA® team begin to recognize the need for a program to promote work participation for the young adults with mental illness they serve. Which statement MOST accurately reflects the evidence about developing such a program? A. Prevocational training sufficiently prepares clients with mental illness for work. B. Supported employment programs with a "place-and-train" perspective are more effective than other vocational approaches. C. Transitional employment placement through a clubhouse model is a time-honored method for increasing job placement. D. Sheltered workshops are useful programs for advancing work participation.

B. Supported employment programs with a "place-and-train" perspective are more effective than other vocational approaches. Current rehabilitation focus is on the place-and-train supportive employment approach, and evidence supports its use.

A COTA® is treating a client who works on an assembly line. The client presents with symptoms of cubital tunnel syndrome. In educating the client, what position does the COTA® advise the client to avoid? A. Sustained elbow extension B. Sustained elbow flexion C. Sustained wrist extension while making a fist D. Sustained wrist flexion while making a fist

B. Sustained elbow flexion IncorrectC. Sustained wrist extension while making a fist Sustained elbow flexion provokes symptoms of cubital tunnel syndrome.

A client has moderately decreased hand dexterity secondary to multiple sclerosis. One of the client's goals is to be able to fasten and unfasten a front-opening jacket or shirt. Which of the following intervention methods would promote independence with these dressing tasks? (retired question) A. Providing the client with specific exercises to improve fine motor skill B. Teaching the client to use adaptive clothing closures and a buttonhook C. Teaching the client therapy putty exercises for increasing hand strength D. Using activities with the client to simulate buttoning, zipping, and snapping

B. Teaching the client to use adaptive clothing closures and a buttonhook Adapting clothing closures is an effective intervention to address incoordination with dressing activities. A client with multiple sclerosis will continue to have progressive decline in function, so compensatory strategies are appropriate

A COTA® is helping a client with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome) adjust to the employment demands of a fast-paced office that is noisy and filled with sensory stimulation. Which recommendation would be BEST? A. That the client ask the other workers to be quieter to better be able to concentrate B. That the client use a noise cancellation headset or white noise channeled into ear buds C. That the client's desk be located in the center of a large room with six other desks, providing the support of others D. That the client use a speaker phone to answer calls hands free while using the hands to manipulate a stress ball

B. That the client use a noise cancellation headset or white noise channeled into ear buds Screening out extraneous and distracting simulation from the environment will allow the client to focus on the job more effectively.

A COTA® is treating a client for agoraphobia and feels frustrated that the client is not making faster progress. The COTA discusses the client's case with a work colleague over lunch at a fast-food restaurant. The COTA does not use the client's name but does repeat verbatim statements made by the client. What can you conclude about the ethical nature of the COTA's conversation? A. The COTA behaved ethically: Confidentiality was preserved by omitting the client's name, and the COTA shared information only with a colleague who also works at the treatment facility. B. The COTA did not behave ethically: Confidentiality was not preserved because the COTA shared specific details in a public place without the client's permission. C. The COTA behaved ethically: By seeking feedback from a colleague without mentioning the client by name, the COTA demonstrated a desire to find solutions that would enable successful treatment. D. The COTA did not behave ethically: By seeking feedback from a colleague in a public location instead of a private one, the COTA did not preserve confidentiality.

B. The COTA did not behave ethically: Confidentiality was not preserved because the COTA shared specific details in a public place without the client's permission. Ethical standards, as well as the Health Insurance Portability and Accountability Act, prohibit the sharing of confidential information regardless of the form of communication. Principle 6A of the Occupational Therapy Code of Ethics (2015) states that "occupational therapy personnel shall preserve, respect, and safeguard private information about employees, colleagues, and students unless otherwise mandated or permitted by relevant laws." Information sharing is only permissible between people who have decision-making responsibilities or when the COTA believes that a client is in imminent danger.

Which statement describes the role of the COTA® in documenting occupational therapy services? A. The COTA may not be involved in the documentation of occupational therapy services. B. The COTA may document occupational therapy services as long as the documentation is cosigned by the supervising OTR®;. C. The COTA may document occupational therapy services as long as the documentation is cosigned by another health care professional. D. The COTA may assume full responsibility for the documentation of occupational therapy services.

B. The COTA may document occupational therapy services as long as the documentation is cosigned by the supervising OTR®;. COTAs are primarily responsible for the provision of occupational therapy services under the supervision of an OTR. Although the COTA may contribute to documentation of occupational therapy services, the COTA's contribution must be cosigned by an OTR.

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

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

A client with middle-stage Huntington's disease (HD) is displaying fatigue during lower body dressing tasks. What would be an appropriate intervention strategy for the COTA® to use with this client? A. The COTA® should engage the client in an intense cardiovascular exercise routine. B. The COTA® should encourage the client to take frequent breaks during lower body ADL tasks. C. The COTA® should train the client in the use of lower body adaptive equipment such as a sock aid. D. The COTA® should educate the client's caregivers on appropriate assistance to provide for the client during dressing.

B. The COTA® should encourage the client to take frequent breaks during lower body ADL tasks. Because the client's primary complaint is fatigue, taking rest breaks would be appropriate.

Which SOAP-format statement would be appropriate and objective in documenting a client's return-to-work modified duty program? A. The client stated, "My grip strength is not the same as it was before, but my work gets done." B. The client has decreased grip strength in the right hand of 15 lb with a standard dynamometer measure. C. The client's medical history includes a recent work injury resulting in a distal radius fracture and high blood pressure. D. The client has decreased grip strength in the left hand, limiting the client's ability to operate the machine handle.

B. The client has decreased grip strength in the right hand of 15 lb with a standard dynamometer measure. This objective statement provides a measure of client ability and the source of that measurement

A COTA® is working to establish a therapeutic relationship with a client in a skilled nursing facility. Which consideration is the MOST important in establishing an effective relationship? A. The OTR® and COTA® have the power to determine the client's goals. B. The client is an informed, equal member in the therapeutic relationship. C. The COTA® is solely responsible for any positive outcomes from therapy. D. The client is expected to follow the COTA®'s advice.

B. The client is an informed, equal member in the therapeutic relationship. In client-centered practice, the COTA® provides client education as necessary so the client becomes an informed and equal member of the therapeutic relationship.

A COTA® is performing a presurgical intervention with a client who will undergo hip replacement surgery in a few days. Which recommendation regarding sleep positioning is MOST appropriate? A. The client should sleep in the most comfortable position that is pain free. B. The client should sleep in supine position with a wedge or pillow in place. C. The client should sleep in prone position with a wedge or pillow in place. D. The client should sleep in side-lying position.

B. The client should sleep in supine position with a wedge or pillow in place. The supine position with a wedge or pillow in place is recommended to keep the legs abducted and prevent rotation.

A COTA® is working with high school students who have autism spectrum disorder (ASD). Which statement BEST represents a model for travel training relative to public transportation use for these clients? A. The travel training program should be classroom based to build confidence in their ability to successfully travel in the community using public transportation. B. The travel training program should provide a combination of classroom instruction and repetitive community-based practice to build confidence and competence in using public transportation. C. The travel training program should be largely classroom based, with one practice session actually using public transportation to balance the students' need for practice with the financial constraints of the program. D. The travel training program should consist of providing the students with a bus schedule, accompanying them to the bus stop, and ensuring that they safely board the bus three times to ensure they are competent to ride independently.

B. The travel training program should provide a combination of classroom instruction and repetitive community-based practice to build confidence and competence in using public transportation. Precin et al. (2012) noted that travel training is most successful for students with ASD when it combines classroom- and environment-based learning opportunities and builds in frequent repetition of skills.

An 8-year-old client with juvenile rheumatoid arthritis requires an ulnar deviation splint. Why would the OTR® recommend this type of splint? A. To provide stability at the wrist B. To prevent drifting of the metacarpophalangeal joints C. To provide stability and allow movement at the finger joints D. To keep joints straight and prevent morning stiffness

B. To prevent drifting of the metacarpophalangeal joints An ulnar deviation splint provides improved stability and alignment of the metacarpophalangeal joints and reduces ulnar drift, or drifting of the metacarpophalangeal joints toward the small finger.

A COTA® is asked by her organization to provide services to a famous actor with the expectation that the client will receive preferential treatment for therapy times and frequencies. What is the COTA's best next step? A. Pair the client with similar clients to maximize the client's therapy time. B. Treat all clients according to clinical need and guidelines for prioritization. C. Ask that the client be transferred to a COTA who has more time available. D. Agree to provide longer treatment sessions for the client to uphold the ethical principle of Fidelity.

B. Treat all clients according to clinical need and guidelines for prioritization. This option best upholds the principles of Beneficence and Justice; it meets the needs of all clients regardless of payor status.

An 8-year-old has just been evaluated by the speech language pathologist for a new augmentative and alternative communication (AAC) device to be used in the classroom. The client uses a wheelchair and has limited movement proximally at both shoulders and elbows. To develop the client's operational competence with the device, what would the COTA® and the supervising OTR® FIRST determine? A. Mounting system for the AAC B. Type of control interface suitable for the child C. Vocabulary to be included in the AAC D. Teachers' availability for AAC training

B. Type of control interface suitable for the child Once the type of AAC device has been determined, the next step is to determine a compatible control interface that matches the child's physical ability to interact with the AAC.

A COTA® is working with a client with chronic obstructive pulmonary disease (COPD) on a morning ADL routine. Which treatment strategy BEST describes how this client can be independent in showering? A. Use a shower chair, bathe with hot water from a handheld shower, use relaxation breathing, and inhale on exertion B. Use a shower chair, bathe with warm water from a handheld shower, use pursed-lip breathing, and exhale on exertion C. Sit in the tub for support, bathe with hot water from the tub spout, pace by washing one extremity at a time and then resting, and lean backward in the tub D. Sit in the tub for support, bathe with cool water from the tub spout, use a fan to decrease humidity, and rest arms on the sides of the tub

B. Use a shower chair, bathe with warm water from a handheld shower, use pursed-lip breathing, and exhale on exertion Using a shower chair, bathing with warm water from a handheld shower, using pursed-lip breathing, and exhaling on exertion all contribute to independent showering for a client with COPD.

A COTA® is asked to treat a client who has early-stage Huntington's disease (HD) at the client's home. The COTA® begins by asking the client basic questions. What should the COTA® remember about communicating with clients who have HD? A. Use open-ended questions to allow the client to give rich detail about the client's needs. B. Use close-ended questions to prevent frustration caused by difficulty in word retrieval. C. Use observation as a primary source of information from the client. D. Use the caregivers to provide the majority of the client's history.

B. Use close-ended questions to prevent frustration caused by difficulty in word retrieval. With a client with early-stage HD, it is important to use close-ended questions that require yes-no responses or use a list of choices to prevent frustration associated with word retrieval problems.

The caregiver of a client with middle-stage dementia requests assistance from the COTA®. The caregiver wants to ease the client's morning personal care routine. What is the BEST recommendation related to the bathroom environment that the COTA® can provide to the caregiver? A. Paint the bathroom a bright yellow. B. Use picture labels for hot and cold on the bathroom faucets. C. Use low levels of light to reduce eyestrain. D. Keep all bathroom items clearly visible to the client.

B. Use picture labels for hot and cold on the bathroom faucets. Labeling physical structures with symbols, such as arrows for direction, is helpful to people with dementia.

An OTR®-COTA® team is establishing reasonable accommodations for a client with Asperger syndrome. The client is employed as a dining room attendant in a restaurant. The client does not exhibit any physical limitations but does exhibit decreased appropriateness when socializing with others and will perform stimulatory behaviors when stressed. The essential job functions include refilling condiment containers, filling customer drink orders, ensuring restrooms are clean for customers, carrying dirty dishes from dining room to kitchen, wiping table tops and chairs, and setting tables with silverware and glassware. Which accommodation is MOST appropriate for the OTR®-COTA® team to recommend? A. Provide the client with a task list to assist with prioritizing job duties. B. Use role-play scenarios and training videos to demonstrate acceptable behavior in the workplace. C. Make the employee attend social functions with coworkers to promote socialization away from the work site. D. Provide written expectations and require the client to take frequent rest breaks to reduce stress.

B. Use role-play scenarios and training videos to demonstrate acceptable behavior in the workplace. Essential job functions are defined as job duties fundamental to the position the individual holds or desires to hold as opposed to functions that are marginal. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Use of role-play scenarios and training videos to provide guidelines for acceptable workplace behaviors is the most appropriate choice because the client has decreased appropriateness when socializing with others.

A COTA® is educating a client who recently underwent hip surgery and his family how to enter and exit a car while observing hip precautions. The client owns a very small car with bucket seats. What is the BEST recommendation the COTA® can make for the client's circumstances? A. Sit in the back with the affected leg elevated. B. Use temporary alternative transportation to limit stress on the hip. C. Use a swivel disk for ease of sliding and to face forward. D. Fold the seat back entirely down to increase client mobility.

B. Use temporary alternative transportation to limit stress on the hip. Bucket seats in small cars should be avoided.

How does the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; AOTA, 2008) define community mobility? A. As a variety of ways to move about the world and the fit between these means and the client's abilities B. Using public or private transportation, such as driving, walking, bicycling, and using buses, taxicabs, or other transportation systems C. Selecting, testing, or adopting with the client and the client's family or support system the most appropriate transportation options D. Opportunities for occupational therapy clinicians to be advocates with transportation providers, health and human service agencies, and policymakers

B. Using public or private transportation, such as driving, walking, bicycling, and using buses, taxicabs, or other transportation systems This definition is the one provided in the Occupational Therapy Practice Framework: Domain and Process.

Which of the following tasks would be MOST appropriate to use during the functional training phase for a client learning to use a unilateral myoelectric terminal device (TD)? A. Grasping and releasing different-sized blocks B. Using scissors to cut paper C. Typing on a computer keyboard D. Brushing teeth

B. Using scissors to cut paper During the functional training phase, a client is learning to incorporate the TD as a functional assist. Bilateral activities that require one dominant extremity (the hand) and one functional assist (the TD) are the best tasks for practice. Using scissors to cut paper requires the TD to be the functional assist (holding the paper).

A client who fell from a roof while at his roofing job suffered a traumatic brain injury and is unable to return to his job. The worker has identified computers as an interest and is enrolled in a work readiness program. Which vocational skill activity would MOST likely be part of his work readiness program? A. Typing class to maximize typing efficiency in support of the objective B. Work-related tasks using a computer aimed at assessing aptitude C. Completion of job applications for computer-based jobs posted in newspapers D. Ergonomic training for optimal positioning at computer workstation to reduce discomfort

B. Work-related tasks using a computer aimed at assessing aptitude Work readiness programs aim to identify a person's skills and interests to develop his or her readiness for work and to achieve the person's goals related to work. The client has expressed an interest in working with computers, and work-related tasks in this area will help the client identify skills and aptitudes in this area.

A client will initiate dressing at the appropriate time of the day but does not choose clothing appropriate to the day, temperature, or season. The client is able to don clothing slowly but has difficulty with fasteners or fails to see errors in the back (i.e., not tucking in the shirt). At what Allen Cognitive Level is this client? A. 2.0 B. 3.0 C. 4.0 D. 5.0

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

Which of the following clients is MOST likely to be characteristic of a person in the middle stage of Alzheimer's disease (AD)? A. A client who sees imaginary images B. A client who has gait and balance issues C. A client who is confused by simple directions D. A client who becomes extremely excited over simple events

C. A client who is confused by simple directions Confusion is commonly associated with the middle stage of AD.

A COTA&#174, with an OTR®, is working with transplant receipients who have recently been discharged from a major hospital. Which type of client would be MOST likely to develop an infection posttranplantation and require greater infection control measures? A. A client with a kidney transplant B. A client with a heart transplant C. A client with a lung transplant D. A client with a liver transplant

C. A client with a lung transplant A client with a lung transplant is the most susceptible to infection because the transplanted organ is exposed to bacteria and germs on inhalation.

A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. What is the OPTIMAL intervention to prevent formation of elbow contracture? A. A dorsal elbow flexion splint to position the elbow at 90° flexion and the forearm in supination. B. A volar elbow flexion splint to position the elbow at 90° flexion and the forearm in neutral. C. A dorsal elbow extension splint to position the elbow at extension and the forearm in neutral. D. A dorsal elbow extension splint to position the elbow at extension and forearm in supination.

C. A dorsal elbow extension splint to position the elbow at extension and the forearm in neutral. The antideformity position for the elbow is elbow extension and forearm in neutral position. Also, because the client has a partial-thickness skin graft at the anterior aspect of the forearm and to maintain maximum surface area of the grafted area, it is better to position the forearm in a neutral position.

A client presents with osteoarthritis of the thumb carpometacarpal (CMC) joint. The client reports moderate pain and weakness and experiences triggering during pinching tasks. What is the BEST treatment to improve functional hand use? A. Application of heat to the affected area B. A home program of resistive pinching exercises C. A hand-based thumb spica splint D. An AROM stretching program

C. A hand-based thumb spica splint CMC joint pain and weakness is often caused by instability of the thumb metacarpal on the trapezium, leading to joint subluxation. A hand-based thumb spica splint will support the thumb as a functional post, allowing the client to complete pain-free activities.

An OTR® is working with a client who is interested in getting a power wheelchair. The client asks the OTR about the benefits of a reclining-back over a tilt-in-space wheelchair. What would be the MOST appropriate response to this question? A. A reclining-back wheelchair is best for someone who has a custom contoured seating system. B. A reclining-back wheelchair is beneficial for a person who has excessive extensor tone. C. A reclining-back wheelchair is advantageous when a person has a diagnosis of orthostatic hypotension. D. A reclining-back wheelchair is a good idea for someone who is concerned with shearing of the skin.

C. A reclining-back wheelchair is advantageous when a person has a diagnosis of orthostatic hypotension. A reclining back can be used to alleviate orthostatic hypotension, which is caused by a sudden drop in blood pressure when a person assumes an upright position quickly. It can allow the client to move slowly and in stages while letting the blood pressure adjust to the change.

A client with visual field deficit secondary to glaucoma has difficulty navigating crowded environments. Which intervention strategy would be MOST helpful to address this deficiency in functional mobility? A. Pen-and-paper visual search tasks that include words and numbers B. Use of a prism on the nondominant eye C. A scan course using cards with numbers and letters taped onto the walls along a hallway D. Occlusion of the nondominant eye

C. A scan course using cards with numbers and letters taped onto the walls along a hallway Following a scan course helps clients develop the basic components of a search strategy, including initiation of a wide head turn, during a task that requires mobility.

During a treatment session, a client with Stage 2 Parkinson's disease (PD) explains to the COTA® the importance of the client's role as head of household and expresses a fear of being dependent on her children. The client's chief complaints are tremors and fatigue, which are starting to affect her performance of higher level ADL and IADL tasks. Which intervention should be the priority for the COTA®? A. Energy conservation education, such as delegating tasks to family members to reduce fatigue levels B. Stress management skills to address the symptoms such as tremors and reduce fatigue levels C. Activity and environmental modifications for home management skills to successfully maintain the client's roles D. Therapeutic exercise to improve balance and enhance the client's participation in her preferred roles

C. Activity and environmental modifications for home management skills to successfully maintain the client's roles The client has identified independence in managing the home as a treatment priority; therefore, interventions should be aimed at ensuring participation by means of environmental modifications, adaptive equipment where necessary, adaptive techniques, or positioning.

A client has been using a wheeled walker for many years but has begun to complain that arthritis in the right hand is making it difficult to grasp the walker for any extended period of time, making functional ambulation difficult. Which recommendation would BEST help maintain this client's mobility? A. Use a wheelchair for the majority of functional activities. B. Add bilateral forearm troughs to the current walker. C. Add a padded grip to the right side of the walker. D. Use a cane on the left side during all activities.

C. Add a padded grip to the right side of the walker. A padded grip can be used on a walker to increase grip for someone with marked hand limitations. It allows the client to have the least restrictive device but remain safe.

The provision of paratransit services is a legal mandate for public transportation providers, who must provide complementary and equivalent transportation services to those who cannot access fixed-route transportation because of a disability. Which law provides this mandate? A. Olmstead Act B. SAFETEA-LU Act C. Americans With Disabilities Act D. Rehabilitation Act of 1973

C. Americans With Disabilities Act The Americans With Disabilities Act of 1990 established the mandate to provide complementary paratransit services under Title II, Part B.

A COTA® is working in a hospital with a client who has hypertension and has an arterial line catheter inserted in the radial artery. What change in the client is the COTA MOST likely to record during treatment? A. A decrease in blood pressure when the head of the bed is elevated B. A decrease in heart rate when client is positioned from supine to short sitting at the edge of the bed C. An inaccurate blood pressure reading when the wrist is moved D. An increase in respiration rate when the client is positioned side lying

C. An inaccurate blood pressure reading when the wrist is moved An arterial line catheter is inserted in the radial artery at the wrist to continuously monitor arterial pressure. When the wrist is moved, it can disrupt the catheter and affect the blood pressure reading.

Community mobility has been described in the occupational therapy literature as a conduit for participation in valued occupations. In addition to being a means to move from one place to another, what is the relationship of community mobility to participation? A. An occupational performance skill B. An occupation aid C. An occupation enabler D. An occupational profile

C. An occupation enabler Community mobility is a set of activities that allow access to and support participation in occupation. This characterization encourages practitioners to recognize community mobility as more than a discrete set of services that allow clients to move between two points, but rather an essential form of support for occupational engagement.

A COTA® and client with multiple sclerosis (MS) collaborate to select client-centered interventions; the client expresses interest in developing an exercise program but states that weakness and fatigue are barriers. Occupational therapy goals include having the client learn an exercise program. What intervention should the COTA® FIRST recommend? A. A home program including bike riding, walking, and free weights with careful monitoring of fatigue B. A strengthening program to reduce weakness associated with the disease's deconditioning process C. Aquatic therapy to reduce the effects of weakness while promoting gentle exercise D. Progressive resistive exercises under the supervision of the COTA® to avoid overexertion

C. Aquatic therapy to reduce the effects of weakness while promoting gentle exercise The buoyancy of water helps reduce the effects of weakness. Aquatic exercise programs for clients with MS should be in room-temperature or cooler waters because of heat sensitivity.

A COTA® is working with a client population with severe intellectual disabilities. What risk factor MOST predisposes this client population to pneumonia? A. History of smoking B. Antibiotic overuse C. Aspiration of food D. Chest surgery

C. Aspiration of food Among people with severe intellectual disabilities, the most frequent cause of pneumonia is aspiration of food or liquids.

An OTA® is working with a client in an area of practice for which the OTA has not demonstrated competence. The client requires a seating and positioning evaluation for a wheelchair. This is not an area for which the OTA has any experience. The OTA asks the supervising OTR® to assign an OTA who has experience in this area. The OTA is following which ethical standard? A. Justice B. Nonmaleficence C. Beneficence D. Fidelity

C. Beneficence Beneficence includes actions intended to benefit others. Concerns for safety for service recipients are beneficial actions. Taking care to make sure that decisions are made which relate to training and competence.

A client served 18 months in a forensic facility and was released to a halfway house; the client is now participating in a community reentry program. Which of the following areas of occupation would be the best focus for an occupational therapy program? A. Dressing and bathing skills B. Decision-making skills C. Budgeting and shopping skills D. School readiness skills

C. Budgeting and shopping skills Community reentry should focus on engaging the client in the community with the skills needed to successfully live free from incarceration.

A physician has referred a client to an outpatient setting for an occupational therapy evaluation and intervention. The client has late effects from a stroke that occurred approximately 10 years ago. The OTR® conducts the evaluation and begins to formulate the client's goals in conjunction with the client and the COTA®. Which short-term objective would be MOST appropriate for improving independence in homemaking? A. Client will demonstrate one-handed homemaking techniques to the therapist in 5 days. B. Therapist will teach client five one-handed homemaking techniques for meal preparation. C. By 2 weeks, client will be independent in cutting vegetables using adaptive equipment. D. Using an adaptive cutting board, client will peel and cut up five vegetables.

C. By 2 weeks, client will be independent in cutting vegetables using adaptive equipment. This answer includes all the components necessary for a measurable goal (client, measurement, what client will achieve, condition required to achieve the goal, and how long it will take the client to achieve the goal).

An OTR®; is facilitating a group therapy session focused on social skills training that comprises five children with autism spectrum disorders. The OTR decides to use the Self-Determination Model to facilitate this group session. Which approach applies this model? A. A slightly older child is partnered with a younger child to serve as role model for appropriate behaviors. B. Group leaders are assigned to describe and model appropriate behaviors for other children to observe and follow. C. Children are facilitated to make choices, indicate their own activity preferences, and problem solve during therapy sessions. D. Children use a behavior chart to monitor their own behaviors and recognize inappropriate behaviors and are rewarded for appropriate behavior.

C. Children are facilitated to make choices, indicate their own activity preferences, and problem solve during therapy sessions. The Self-Determination Model facilitates satisfaction of needs for autonomy, competence, and promotion of one's own well-being.

A COTA® is working with a client experiencing a cumulative trauma disorder of the right upper extremity. To document client improvement as a result of therapy, which occupation-based statement would the COTA® be MOST likely to write? A. Client's pain-free AROM of right elbow is now 15° to 110°. B. Client can perform 30 repetitions of elbow flexion-extension using a 1-lb weight. C. Client can brush teeth using the involved upper extremity without pain. D. Client demonstrates grip strength to maintain grasp for 15 seconds.

C. Client can brush teeth using the involved upper extremity without pain. Occupation-based practice requires documentation of improvement in occupations such as ADLs.

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

C. Client will maintain effective safety strategies during independent light meal preparation while using visual cues for sequencing as needed. The primary goals for clients with dementia are related to maintaining functional capacity.

A COTA® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The COTA (with the client's permission) works with the employer to identify work tasks in which the client can be successful. What frame of reference does this intervention suggest? A. Cognitive-behavioral B. Psychodynamic C. Cognitive disability D. Behavioral

C. Cognitive disability The cognitive disability frame of reference uses the client's strengths to allow for function. An example of a cognitive disability intervention is training caregivers to provide appropriate environmental supports for the client.

The intervention plan for a client who has a new diagnosis of Parkinson's disease (PD), Stage 1, includes the client's goal to maintain employment as an administrative assistant in a moderate-paced law firm. What is the FIRST intervention with which the COTA® should begin treatment? A. Instruct the client in the use of adaptive equipment such as large-button telephones, distal wrist weights, and speech driven computer programs. B. Develop a home exercise program for the client to maximize balance and strength C. Collaborate with the client in planning the client's work day so that the most difficult tasks are completed when medications are at optimal effect. D. Advise the client to alert supervisors and coworkers to the new diagnosis in order to gain support and assistance with modifying work tasks.

C. Collaborate with the client in planning the client's work day so that the most difficult tasks are completed when medications are at optimal effect. A client with Stage 1 PD may present with a resting tremor, a typical first symptom; a resting tremor will make fine motor tasks more difficult. Most people with PD experience their worst symptoms just before the next medication dosage. Timing more difficult fine motor tasks with medication is the most nonintrusive intervention.

A COTA® is working toward service competency for adaptive feeding equipment instruction. How would an OTR® BEST establish service competency for the COTA®? A. Review the COTA®'s documentation of multiple clients whose feeding impairments warranted adaptive equipment, then discuss the outcomes with the COTA®. B. Observe the COTA® educating clients on how to use adaptive feeding equipment to ensure that the COTA® is consistent with the OTR®. C. Compare outcomes by rating the same client's performance with the adaptive feeding equipment. D. Collect information from various sources, such as other therapists, the COTA®'s documentation, observations, and feedback from clients, to determine competency.

C. Compare outcomes by rating the same client's performance with the adaptive feeding equipment. Service competency is defined as "the process of teaching, training, and evaluating in which the OTR® determines that the COTA® performs tasks in the same way that the OTR® would and achieves the same outcomes" (Youngstrom, 2009, p. 943). In this example, both the COTA® and OTR® observe the same client performing a task and rate that performance in a similar manner. Comparing outcomes helps to ensure clients receive care of equal quality.

A COTA® is reading the occupational therapy intervention plan for a client with Stage IV amyotrophic lateral sclerosis (ALS). On what will the home environment goal MOST LIKELY focus? A. Modifications to support the client's preferred occupations and activities B. Moving frequently used items within easy to reach. C. Creating a safe and accessible living space D. Technology changes, such as a motorized stair lift

C. Creating a safe and accessible living space Someone with Stage IV ALS is likely to have severe weakness in the lower extremities, causing an inability to ambulate. Working with a client and his or her family to create a safe, accessible living environment is the best option; the client and family will need recommendations for moving furniture, creating spaces that a wheelchair or power chair can navigate, and the most appropriate durable medical equipment such as a hospital bed and specialized mattresses to prevent pressure sores.

A client with middle-stage dementia has been wandering outside the house in the middle of the night. The client's caregivers have been using monitoring devices and recently added door alarms, but by the time someone can attend to the client's wandering, the client is usually at the neighbor's driveway. The weather has become colder, and the family is concerned that the client will get frostbite if the client wanders outside again. What would be the COTA®'s next appropriate recommendation? A. Install bed rails to keep the client from climbing out of bed. B. Place the client in a nursing home. C. Conceal the doorknobs so that the client cannot open the doors. D. Move the client's bed into one of the caregivers' rooms.

C. Conceal the doorknobs so that the client cannot open the doors. Visual barriers, such as concealing the doorknobs, have been found to be effective with people with dementia. The client might not attend to the doorknob because it is unseen or will find it difficult to open the door.

The client, a landscaper, fell from a ladder while trimming branches and sustained a Colles fracture. The client wore a short arm cast for 6 weeks. After the cast removal, the client began a work conditioning program. The COTA® is working with the client on job simulation tasks, strengthening, and endurance training. The client is anxious to return to work because the injury occurred during the busy season, and the COTA® is concerned about the potential for overexertion and reinjury. Which of the following signs is NOT an indication of overexertion? A. Difficulty completing the number of prescribed repetitions B. Sustained effort with an unstable respiratory rate C. Consistent speed while performing a job simulation task D. Decreased ROM and increased distractibility during job simulation

C. Consistent speed while performing a job simulation task Consistent speed is not an indication of overexertion. Decreased speed or rate of performance would indicate overexertion.

An OTR® and COTA® are working with a client with a transtibial lower limb amputation to develop a prosthetic wearing schedule. The client has been gradually increasing wear time from 15 minutes to 1 hour in 15-minute increments. However, after 1 hour of wear, they notice a reddened area on the residual limb that remains for 45 minutes after removing the device. What is the BEST course of action to take? A. Cut the wear time back to 30 minutes and gradually increase it, using 10-minute increments. B. Add additional socks to better pad the prosthetic device. C. Contact the prosthetist to adjust the device to improve the fit. D. Educate the client on proper residual limb care to prevent skin breakdown.

C. Contact the prosthetist to adjust the device to improve the fit. Reddened areas that last more than 20 minutes are indicative of pressure in the prosthetic device that will eventually cause skin breakdown. The prosthesis must be adjusted by the prosthetist to ensure proper fit.

A COTA® is writing a professional development plan. The COTA has identified personal needs for growth after completing a self-assessment. What step should the COTA take NEXT in developing the professional development plan? A. Review progress toward current professional development goals and objectives. B. Determine available resources for meeting goals and objectives. C. Determine what learning needs to occur. D. Set new goals for professional development.

C. Determine what learning needs to occur. The steps in developing a professional development plan are to (1) reflect on current performance to date and determine learning needs on the basis of the self-assessment results; (2) review progress toward previous professional development goals; (3) ascertain what resources exist to meet identified professional development goals; (4) modify previous professional development goals and set new ones; (5) take action to meet professional development goals; and (6) document completed professional development activities. Thus, after identifying personal needs for growth by means of a self-assessment, the next step a COTA would take would be to determine what learning needs to occur.

A COTA® is working with the OTR® in a neonatal intensive care unit to prepare a family for their infant's discharge home the next day. Which action addresses the MOST important occupational therapy-related consideration for these clients' community mobility needs? A. Ensuring that the parents have valid driver's licenses and a safe vehicle in which to transport the child B. Instructing the parents to consider the possible need for adaptive mobility equipment in their future vehicle choices C. Determining how the child will be transported in the immediate future and making recommendations regarding child passenger safety D. Educating the parents about future adaptive mobility options such as adapted seating, strollers, and tricycles

C. Determining how the child will be transported in the immediate future and making recommendations regarding child passenger safety Occupational therapy practitioners address community mobility as an IADL (AOTA, 2008), and the immediate needs of this family are for safe transportation as they leave the hospital.

A school-based COTA® is serving several children who use wheelchairs as their primary means of mobility. All of the children ride the public school buses between school and home. The director of special education services has noted that the school's responsibility for the well-being of the children includes their use of school-sponsored transportation. What might the COTA® do to help ensure the safety of these children on the school bus? A. Offer to ride with the children on the school bus to ensure they are safely seated and are not exposed to danger along the school bus route B. Suggest to the children's parents that they seek transportation other than the school buses C. Develop knowledge of safe seating strategies and wheelchair restraint use and help train bus personnel in safe body mechanics while assisting wheelchair users D. Educate the parents about how their wheelchairs should be restrained during travel and ask the parents to supervise the bus personnel.

C. Develop knowledge of safe seating strategies and wheelchair restraint use and help train bus personnel in safe body mechanics while assisting wheelchair users School-based COTA®s have skills in body mechanics, seating, and positioning and are part of the team addressing child school bus safety.

A manager of a COTA® tells the COTA to keep a client for a week more than originally planned. The COTA, who has a decade of experience in this particular clinical setting, believes that all the goals have been met and that the client can no longer benefit from occupational therapy services at this level of care. What is the COTA's most appropriate next step? A. Agree to provide services for the extra week of services. B. Preauthorize payment for the services from the payor. C. Discuss the COTA's concerns with the manager. D. Report the manager immediately to an employee hotline.

C. Discuss the COTA's concerns with the manager. This response is the best option, given that it reflects the client's right to benefit from services (Principle 1, Beneficence). The right to benefit is meant to determine the best decisions for provision of services to a client. Talking with the manager is a sufficient first response for this situation.

An OTR®; is assigned to a district that emphasizes schoolwide mental health promotion and problem prevention using a Response to Intervention Model. Which intervention approach is an example of Tier 1 of this model? A. Running group programs to facilitate social inclusion for students who struggle with maintaining peer relationships B. Holding meetings and conversations with schoolteachers to discuss the role of occupational therapy in mental health promotion C. Discussing with classroom teachers strategies to help children who are at high risk of being bullied D. Collaborating with mental health practitioners to provide the most appropriate care for students requiring intervention

C. Discussing with classroom teachers strategies to help children who are at high risk of being bullied This option is an example of Tier 1 programming. Tier 1 programs are indicated for the general school population.

A COTA® works on an Alzheimer's unit of a skilled nursing facility and is planning a group activity for residents who are functioning at Allen Cognitive Level 2 (postural actions). Which activity would be MOST BENEFICIAL for supporting the residents' participation during a session? (retired question) A. Singing along to familiar songs B. Preparing a snack for the evening C. Doing gross motor exercises to music D. Playing a game of bingo

C. Doing gross motor exercises to music At Allen Cognitive Level 2, a person is aware of his or her own body and movement and could best participate in gross motor exercises.

An OTR® is evaluating a kindergarten student's prewriting skills. The student has difficulty controlling writing utensils because the student does not spontaneously extend the wrist when drawing. Which intervention strategy would BEST help the student develop spontaneous wrist extension? A. Using stencils B. Playing with resistive putty before drawing C. Drawing shapes on an easel D. Using a built-up writing utensil

C. Drawing shapes on an easel An easel enables work in a vertical plane, which promotes spontaneous wrist extension.

An OTR® evaluated a client who has sustained a traumatic brain injury and used the Glasgow Coma Scale (GCS) to record the client's conscious state using the combined score. The COTA® reviews the GCS score in the client's chart in preparation for the first intervention session. Which of the following three responses is recorded with the GCS? A. Verbal, threat, autonomic B. Appropriate, motor, autonomic C. Eye opening, motor, verbal D. Eye opening, verbal, autonomic

C. Eye opening, motor, verbal The GCS is an evaluative and reassessment tool that uses eye opening, verbal, and motor responses to track the level of consciousness of clients with head injuries.

An OTR® receives orders to evaluate and treat a client with an S1 spinal cord injury. The COTA® will be assisting with the evaluation by performing a standardized assessment. Which instrument is MOST appropriate for assessing the client's current level of independence? A. Canadian Occupational Performance Measure (COPM) B. Nine-Hole Peg Test C. FIM™ D. Adult Sensory Profile

C. FIM™ The FIM is the most widely used disability measure in rehabilitation medicine and captures many basic disability areas.

A client diagnosed with C7 spinal cord injury requires a functional capacity evaluation to determine whether the client can perform the job of accountant. Which of the following abilities would be MOST appropriate to assess? A. Mathematical reasoning B. Speech clarity C. Finger dexterity D. Selective attention

C. Finger dexterity Because accountants often type on computer keyboards, finger dexterity is an ability used in the job, as defined by the O*NET Occupational Information Network. A C7 spinal cord injury could affect finger dexterity.

An OTR®-COTA® team is educating a group of supervisors from a furniture manufacturing company about common work-related risk factors for cumulative trauma disorder. What are some of the PRIMARY physical risk factors that the team would explain to the supervisors? A. Regulated temperatures, noise and lighting B. Body mass index greater than 25 C. Forceful exertions, repetition, and excessive vibration D. Older age, being female, and lower socioeconomic group

C. Forceful exertions, repetition, and excessive vibration Cumulative trauma disorder is a group of conditions that develop slowly over time from repeated microtrauma to the body. It is also known as repetitive strain injury when the body or muscles are engaged in an awkward position or used repeatedly. Hence, forceful exertions, especially performed in a repetitive manner, and excessive vibration from the use of power tools are risk factors for clients working in a furniture manufacturing company.

Retired NBCOT® Question A patient has hemiplegia secondary to having a recent CVA. The patient is nearing discharge from an inpatient rehabilitation facility to live at home with a spouse. What is MOST IMPORTANT to educate the patient and spouse about prior to discharge from the facility? A. Exercises for maintaining joint mobility and strength B. Assistive technology to increase independence during ADLs C. Home modifications needed to maximize mobility and safety D. Techniques to transfer from a wheelchair to a variety of surfaces

C. Home modifications needed to maximize mobility and safety The client may have physical and cognitive deficits that remain at discharge; identifying environmental home modifications to improve safety at home is an important component of the discharge plan.

A COTA® is working with a client who has sustained a low ulnar nerve injury to the hand. The client has been instructed in visual protection of the hand. Over the weekend, the client experiences burns to the injured hand. What area of the hand would have been burned? A. Thenar side of the hand B. Thumb and index fingers C. Hypothenar side of the hand D. Index and middle fingers

C. Hypothenar side of the hand Sensory distribution of the low ulnar nerve involves the hypothenar eminence and the ulnar side of the hand, primarily the ulnar side of the fourth and fifth fingers.

Retired NBCOT® Question A client who had a CVA is setting the table during a cooking group. The COTA® observes that the client consistently positions the eating utensils for each place setting to the right of the plate. What INITIAL action should the COTA® do based on this observation? A. Determine whether this functional deficit is evident during other tasks B. Ask the OTR® to evaluate the client for figure ground deficits C. Identify the typical routines the client uses for this task at home D. Teach the client proper techniques for preparing the dining environment

C. Identify the typical routines the client uses for this task at home How a client typically performs or sequences occupations in his or her daily life is important in determining whether the client's performance is deficit related or based on habit.

An OTR®-COTA® team is establishing reasonable accommodations for a client with a history of chronic fatigue syndrome. The client is employed as a receptionist for a small extermination company. The client exhibits decreased short-term memory, periodic joint pain and stiffness, and frequent headaches. The essential job functions include answering phone calls, taking messages, sending out statements for services rendered, and setting up appointments. Which accommodation is MOST appropriate for the OTR®-COTA® team to recommend FIRST? A. Change the client's work schedule to provide additional time for the client to complete the morning routine B. Provide a motorized scooter to minimize walking, conserving the client's energy and preventing pain C. Implement a day planner and list of prioritized job tasks to serve as memory aids D. Provide a flexible work schedule by permitting the client to work from home at least 3 days per week

C. Implement a day planner and list of prioritized job tasks to serve as memory aids Essential job functions are job duties fundamental to the position the individual holds or desires to hold. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Implementing use of a day planner is the most appropriate initial accommodation under these circumstances because it allows the client to continue to perform essential job functions while accommodating the short-term memory issue.

The COTA®'s next client has macular degeneration in both eyes. To prepare the treatment environment for this client, which course of action should the COTA® take? A. Close the blinds and the curtains B. Sit directly in front of the client C. Increase lighting and avoid glare D. Place dark objects on a black table

C. Increase lighting and avoid glare This client will see more clearly if the room lighting is adequate. However, glare should be avoided because the eye condition may make the person more sensitive to glare.

A client with multiple sclerosis (MS) states that fatigue is negatively affecting work performance. What is the BEST action for the COTA® to take next? A. Discuss with the OTR® the need for the client to have a worksite evaluation for energy conservation techniques and environmental modifications. B. Collaborate with the client to problem-solve work demands, such as breaking tasks down, increasing rest breaks, and performing more challenging tasks earlier in the day. C. Instruct the client to complete a journal identifying energy levels for tasks in preparation for collaborative COTA® and OTR® treatment planning. D. Advise the client to take frequent rest breaks during the day and further assess cognitive abilities for difficulty with executive functioning.

C. Instruct the client to complete a journal identifying energy levels for tasks in preparation for collaborative COTA® and OTR® treatment planning. Further evaluation is needed to determine appropriate interventions; this approach goes beyond typical energy conservation education and involves the COTA® and OTR® working with the client to identify the specific work tasks that cause fatigue.Work tasks must be identified before determining work demands.

A COTA® is working with a client who presents with lateral epicondylitis secondary to the leisure occupation of playing tennis. In the final 2 or 3 OT visits, what treatment intervention would be the most appropriate? A. Application of ice at the end of the treatment session B. Instruction in gentle AROM during functional activities C. Instruction in progressive resistive exercise D. Education to avoid movements that trigger pain

C. Instruction in progressive resistive exercise To prevent future flare-ups, progressive resistive exercise should be initiated at the end of therapy visits when the lateral epicondylitis has subsided.

A client has lost considerable weight since his admission to a long-term care facility, and his family is concerned because he constantly complains about how sore he gets from sitting in his wheelchair now that he is "nothing but bones." Why would the OTR®-COTA® team recommend a wheelchair cushion for this client? A. It will provide a cushioned surface on which to sit. B. It will raise the seat height for better mobility. C. It will redistribute pressure on his sitting surface. D. It will prop up the client so he is sitting upright.

C. It will redistribute pressure on his sitting surface. The purpose of a wheelchair cushion is to redistribute pressure on the sitting surface away from the ischial tuberosities and the coccyx.

A client is able to say only "yes," "no," or "hello." This client is also incontinent of bladder and bowel and is unable to walk. In which stage of Alzheimer's disease (AD) is this client? A. Early B. Middle C. Late D. End

C. Late Late-stage AD is characterized by limited speech, decreased ambulation, and incontinence.

A COTA® working in an inpatient mental health forensic facility is leading a group of clients who have histories of emotional outbursts and causing harm to themselves or others. Which group design element would have the highest priority? A. Cognitive and educational level of the participants B. Age and gender of the participants C. Location of the meeting room and exits D. Climate and temperature of the meeting room

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

To ensure appropriate and professional management of ethical complaints, what does the AOTA Ethics Commission strive to do? A. Complete an investigation within 15 days of notifying the Respondent that it is being conducted B. Disclose all details of complaints to AOTA members C. Maintain strict rules of confidentiality in every aspect of the Ethics Commission's investigational work D. Follow legal proceedings of the state in which the complaint was filed

C. Maintain strict rules of confidentiality in every aspect of the Ethics Commission's investigational work. Confidentiality guidelines are set and strictly enforced by the Ethics Commission and are applied to all parties involved in the complaint.

A COTA® is working with a client with Down syndrome to develop cooking skills. The client successfully makes a peanut butter and jelly sandwich. Which therapeutic activity would be BEST for the next treatment session? A. Making a turkey-and-cheese sandwich B. Heating up a frozen microwavable dinner C. Making a grilled cheese sandwich D. Cooking steamed vegetables over rice

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

What skills might a client with middle-stage dementia have difficulty performing on the basis of typical psychosocial or cognitive abilities present during this stage of dementia? A. Speaking B. Swallowing and chewing C. Managing finances D. Posture and balance

C. Managing finances In middle-stage dementia, a person will begin having moderate impairment in IADLs, such as finances, shopping, medication management, and complex meal preparation.

Which phrase BEST depicts a client factor, according to the Occupational Therapy Practice Framework: Domain and Process? A. Communication and interaction skills B. Home management abilities C. Neuromusculoskeletal functions D. Personal habits and routines

C. Neuromusculoskeletal functions Neuromusculoskeletal functions falls under the broad category of client factors in the Framework.

An OTR® is completing a feeding evaluation with a child who presents with limited neck extension during cup drinking. What type of feeding equipment would be MOST appropriate to introduce to this client? A. Drinking cup with handles B. Spouted sippy cup C. Nose cutout cup D. Dysphagia cup

C. Nose cutout cup A nose cutout cup is made of flexible plastic, and a portion of the cup is cut out so the client's nose is able to fit inside the glass rather than bump into the outside of it. This type of cup is appropriate for a client with limited neck extension because it does not require tipping the head back to take a drink.

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

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

A client 6 months poststroke has made almost a complete recovery except for weakness in the left leg and slight restriction with left ankle dorsiflexion. The client completed an on-road driving assessment and did fine. However, the client is complaining of difficulty with entering and egressing because of an inability to swing the left leg into the vehicle. What is the COTA®'s BEST consideration for this client? A. Prescribing a Handybar® (Avin, Victoria, British Columbia, Canada) for support during transfers B. Referring the client to physical therapy for lower-extremity strengthening and ROM exercises C. Prescribing a leg-lift device and a foot-drop splint D. Recommending a new vehicle with a turning seat for easy transfers, entry, and egress.

C. Prescribing a leg-lift device and a foot-drop splint These devices will enable the client to be independent in vehicle entry and egress.

A COTA® working in an acute care setting has just instructed a client with a hip replacement on a proper sit-to-stand technique from the chair. What is the BEST method to record the client's adherence to hip precautions? A. Ask the client to demonstrate the activity in the clinic. B. Have the client demonstrate the activity in the room. C. Observe the client in the dining room performing the activity. D. Require the caregiver to demonstrate how they are performing transfers.

C. Observe the client in the dining room performing the activity. By observing the client, a true level of occupational performance can be recorded.

Occupational therapy practitioners address community mobility as an IADL. Which document uses this terminology? A. AOTA Code of Ethics B. Occupational therapy state licensure laws C. Occupational Therapy Practice Framework: Domain and Process D. World Health Organization's International Classification of Functioning, Disability and Health

C. Occupational Therapy Practice Framework: Domain and Process The Occupational Therapy Practice Framework: Domain and Process includes community mobility as an IADL performance area in the domain of occupational therapy practice.

Which of the following symptoms would a COTA® expect to see with a client with Guillain-Barré syndrome in the acute inflammatory phase? A. Sensory loss, pain, cognitive impairment B. Pain, fatigue, cognitive impairment C. Pain, fatigue, swallowing problems D. Rigidity, pain, swallowing problems

C. Pain, fatigue, swallowing problems Because ascending paralysis is typical of Guillain-Barré syndrome, observations during sessions consistently focus on the constellation of symptoms including pain, fatigue, and swallowing problems.

A COTA® is working with a child in the second grade during handwriting assignments to remediate the child's pencil grip. Of the following types of pencil grips, which would require the most remediation because it is the least developmentally appropriate for a 2nd grader? A. Dynamic tripod grip B. Lateral tripod grip C. Palmar grip D. Quadrupod grip

C. Palmar grip This grip is not functional for handwriting. It is used for scribbling at 18 months of age and should be remediated.

According to the Standards of Practice for Occupational Therapy, which task can the COTA® complete in the evaluation process? A. Respond to the initial referral request. B. Interpret and document the evaluation results. C. Perform delegated assessments using current tools. D. Make recommendations to other professionals.

C. Perform delegated assessments using current tools. COTA®s are able to perform assessments delegated by the OTR®.

A COTA® is working with a client who had a pacemaker implanted 10 days ago. Which activity would be contraindicated because of pacemaker precautions? A. Heating tea in a microwave at waist level B. Lifting a light jacket from one surface to another C. Placing hair in a ponytail using both upper extremities simultaneously D. Brushing hair using the upper extremity opposite the pacemaker placement

C. Placing hair in a ponytail using both upper extremities simultaneously Pacemaker precautions include no shoulder flexion or abduction greater than 90° on the side on which the pacemaker was implanted for the first 4 weeks.

Although the driving performance of a client with a small body size may not necessarily be impaired, what might this person be more likely to experience? A. Poor visual acuity B. Poor stopping distance C. Poor accelerator and brake reach D. Difficulty merging on and off the interstate

C. Poor accelerator and brake reach A person with a small body size is more likely than people of taller stature to have difficulty reaching the accelerator and brake pedals.

A client with multiple sclerosis (MS) experiences ataxic movements when performing fine motor self-care tasks. During treatment addressing oral hygiene, what should the COTA® FIRST do? A. Instruct the client in the use of weighted equipment to reduce tremors. B. Provide a static wrist splint for stability in performing motor tasks. C. Position the client's trunk and upper extremities to provide proximal support. D. Massage the client's hand trigger points to release proximal muscular tension.

C. Position the client's trunk and upper extremities to provide proximal support. Proximal support of the trunk, shoulder, and elbow may help increase distal control of the hands and fingers. This client may be positioned to lean against a table and prop the elbows on it, which may provide enough support to allow for improved control of the hands while performing oral hygiene.

What is an effective strategy to facilitate maximal independence in self-feeding with a client who has middle- to late-stage dementia? A. Change the client's diet to foods that are palatable and easy to chew. B. Change the consistency of foods to allow for easier chewing and swallowing. C. Provide hand-over-hand guidance for food retrieval and utensil-to-mouth motions. D. Provide constant verbal cues throughout feeding to improve attention to the self-feeding task.

C. Provide hand-over-hand guidance for food retrieval and utensil-to-mouth motions. Hand-over-hand guidance is an effective strategy to encourage maximal independence through participation in daily living tasks, including self-feeding.

When dealing with clients who have dementia, what would be the primary role of the COTA® in addressing caregiver burden? A. Provide recommendations about community resources B. Provide recommendations about medication management C. Provide recommendations related to home modifications D. Provide recommendations related to safe transfers

C. Provide recommendations related to home modifications COTA®s have specific skill in providing recommendations about home modifications. Home modifications can benefit clients with dementia and their caregivers by providing a safe environment that prevents unsafe wandering and provides optimal occupational engagement for reduced caregiver burden.

A COTA® is working with a client with Alzheimer's disease (AD) in a skilled nursing facility. The client's adult child, who is the client's primary caregiver, appears to be stressed and fatigued and has asked the COTA® for advice about how to best manage the parent's progressive decline in function. What would be the BEST approach the COTA® could use? A. Refer the caregiver to a physician for adjustments in medications. B. Refer the caregiver to the social worker for community resources. C. Provide the caregiver with education about the progression of AD. D. Suggest that the caregiver use the massage services at the facility.

C. Provide the caregiver with education about the progression of AD. The most appropriate approach for a COTA® when dealing with caregivers of clients with AD is to provide education about the progression of AD along with strategies to improve the caregiver's self-efficacy in caring for the client.

A client with middle-stage dementia has maintained the ability to complete repetitive tasks common in middle adulthood. For example, if given a basket of socks, the client will reflexively fold them until the task is complete. Given this information, what recommendation would be appropriate for the COTA® to give caregivers? A. Provide challenge to the client by placing the laundry basket at various heights to improve trunk stability and balance. B. Provide challenge to the client by putting various types of clothing into the laundry basket, which will aid in maintaining this skill. C. Provide the client with a basket of socks at a set time each day, determined by the client's arousal level, to give structure to the client's day. D. Provide the caregivers with information about how they can use a basket of socks to decrease agitation in the client.

C. Provide the client with a basket of socks at a set time each day, determined by the client's arousal level, to give structure to the client's day. Interventions to control the daily structure of a person with dementia have been documented to provide balance between the times the person is in high arousal versus low arousal.

A COTA® is working with a 4-year-old on increasing independence with toileting at school. The child's parents indicate that toileting is also a problem at home. Which strategy would help the child to carry over what has been learned at school to home? A. Provide the parents with information about when other children with autism have mastered toileting. B. Provide the parents with the names and phone numbers of other parents of children with autism who have already mastered toileting. C. Provide the parents with an exact copy of the child's toileting picture checklist that is used at school. D. Provide the parents with a description of how the school's bathroom is set up.

C. Provide the parents with an exact copy of the child's toileting picture checklist that is used at school. Children with autism benefit from visual supports, such as checklists and communication boards. Providing the parents with an exact copy of the child's toileting picture checklist enables the parents to follow the same routine at home.

The COTA® reviews the cancellation test form in a client's chart. The form indicates that the client crossed out all letter Ms. What does this test assess? A. Visual acuity B. Literacy C. Spatial neglect D. Ocular motor control

C. Spatial neglect Cross-out assessments are used in visual scanning and can be beneficial in detecting spatial neglect or visual field impairments.

Which type of pressure do occupational therapy practitioners most commonly identify as leading to moral distress and organizational ethics violations? A. Deciding whether an intervention is within the scope of occupational therapy practice B. Describing progress by recipients of service when little change has occurred C. Providing interventions based on the likelihood of best reimbursement D. Extending work hours to treat more clients

C. Providing interventions based on the likelihood of best reimbursement Slater and Brandt (2011) described a study conducted in 2008 that identified reimbursement constraints as one of the top ethical concerns leading to moral distress in occupational therapy practitioners. Practitioners reported that being pressured to provide therapeutic service primarily for financial benefit rather than for the health and well-being of clients is highly distressing.

A young adult client with complete C4 quadriplegia from a spinal cord injury is being discharged from inpatient rehabilitation to the family home in a rural area. Which community mobility intervention would be MOST relevant to this client? A. Teaching the client to drive an automobile using hand controls B. Educating the client on use of the wheelchair to access a subway system C. Providing training for the family on how to safely transfer and secure the client and wheelchair in the family vehicle D. Working collaboratively with the client to read and understand a bus schedule

C. Providing training for the family on how to safely transfer and secure the client and wheelchair in the family vehicle AOTA's (2010) "Statement on Driving and Community Mobility" states that occupational therapy's role in addressing community mobility includes addressing passenger safety such as securing passengers and wheelchairs.

A client has visual acuity of 20/200 in the right eye and 20/400 in the left eye. With what technology will the client MOST likely be able to operate a microwave with a flat panel? A. A prescribed magnifier B. Color-coded buttons C. Raised dots on the panel D. Task light over the microwave

C. Raised dots on the panel D. Task light over the microwave The client's visual impairment is such that the remaining vision is not adequate as a sensory input, which means using an alternative sensory pathway. Tactile or auditory substitution is common. Putting raised dots on the microwave panel is an example of tactile substitution.

A COTA® is working with a client who is about to undergo a second lower-extremity amputation. The client did not use a wheelchair with the first amputation but wants to purchase one now for occasional mobility if lower-limb prostheses are not available. What is necessary for wheelchair safety for a client with bilateral lower-extremity amputations? A. Reclining back rest B. Elevating leg rests C. Rear antitippers D. Wedge cushion

C. Rear antitippers Because a person who has undergone a bilateral lower-extremity amputation has a different weight distribution when seated, the wheelchair is more likely to tip backward with less weight in the front. Antitippers prevent this.

Which recommendation should a COTA® make to the caregiver of a client with dementia who is experiencing caregiver stress? A. Recommend that the caregiver inquire about medication to reduce the caregiver's stress. B. Recommend that the caregiver inquire about additional sleep medication for the client. C. Recommend that the caregiver contact a local adult day care to inquire about its services. D. Recommend that the caregiver find a teenager in the neighborhood who can watch the client.

C. Recommend that the caregiver contact a local adult day care to inquire about its services. COTA®s have a responsibility to provide caregivers with information related to local resources to reduce caregiver burden.

A COTA® in a subacute care setting is working on independent bathing activities with a client who had a recent hip replacement. The client reports having a high-step tub with a shower door at home and no money to buy additional equipment. The COTA® shares this information with the OTR®. Which recommendation is MOST appropriate for bathing? A. Recommend the client substitute a plastic lawn chair for a shower chair. B. Recommend the client place nonskid strips on the floor of the stall. C. Recommend the client sponge-bathe at the sink until equipment can be purchased. D. Recommend the client stay at the facility until equipment can be purchased.

C. Recommend the client sponge-bathe at the sink until equipment can be purchased. Sponge-bathing at the sink is an alternative activity if hip precautions cannot otherwise be met.

A client who has had a stroke is displaying signs of visual field loss. How would the COTA® BEST determine whether visual field loss is present? A. Conduct automated perimetry or visual field testing B. Request that the OTR® complete automated perimetry testing C. Refer to an eye care professional for automated perimetry testing D. Refer to a low vision specialist for visual field testing

C. Refer to an eye care professional for automated perimetry testing Automated perimetry testing is completed by an eye care professional and is not in the occupational therapy scope of practice.

A client has difficulty with ankle flexion that is causing an issue with tripping over items. The client is especially concerned with tripping in the bathroom. Which is the MOST appropriate environmental adaptation that could be recommended for this issue? A. Removal of water spillage B. Installation of grab bars C. Removal of loose bath mat D. Installation of a shower chair

C. Removal of loose bath mat If a client is unable to lift the toes properly and is trying to manuver in a bathroom, a loose bathmat could catch the toe or foot and create a tripping hazard.

Which of the following is considered an area of occupation, as described in the Occupational Therapy Practice Framework? A. Drinking coffee with breakfast B. Hearing functions C. Rest and sleep D. A student in the fifth grade

C. Rest and sleep C: Rest and sleep fall under the areas of occupation in the Occupational Therapy Practice Framework: Domain and process (AOTA, 2008).

A client who has been a participant in a community integration program for adults with mental illness arrives at an occupational therapy group after not being seen for several weeks. The client's mood is noticeably elevated. The client switches from one topic to another in rapid succession and claims to have not slept for 3 days. The psychiatrist describes the client as having manic episodes. What is the BEST course of action for the COTA® to take? A. Recommend individual sessions to catch up on missed goals during the client's absence. B. Allow the client to rest, and then resume therapy. C. Resume group therapy sessions as soon as possible and apply cognitive-behavioral methods. D. Discuss with psychiatrist the possible need for the client to receive medication to improve behaviors.

C. Resume group therapy sessions as soon as possible and apply cognitive-behavioral methods. Resumption in group-based community programming with a cognitive-behavioral approach will help the client reorganize routines and be aware of behaviors.

During an initial interview with a young adult who has Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome), the COTA® becomes aware that the client lives alone and is isolated, does not go out much, does not value family relationships, and does not seem to have any friends. Additionally, the client is not gainfully employed and does not take care of the apartment. The client spends most of the day surfing the Web and watching TV. Using the Model of Human Occupation, which of the following assessments would be the MOST appropriate? A. A projective test such as House-Tree-Person B. Worker Role Interview C. Role Checklist D. Canadian Occupational Performance Measure

C. Role Checklist The Role Checklist gathers information on the client's former and current roles and the value the client places on these roles, consistent with the Model of Human Occupation.

An older adult client with a history of falls and glaucoma was referred to occupational therapy for evaluation and intervention. After the OTR® completed the evaluation, the COTA® was requested to provide the intervention. Which strategy should the COTA® teach the client to compensate for impaired vision due to glaucoma? A. Use a colorful, patterned tablecloth. B. Place dinner plate to the left of midline. C. Rotate head to choose clothing from a closet. D. Pour coffee into a dark colored mug.

C. Rotate head to choose clothing from a closet. Rotating the head would help the client use the remaining vision to compensate for peripheral vision loss

A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. The client would like to return to softball practice as soon as possible. What would be the BEST activity during the initial phase of rehabilitation? A. Elbow extension splint 2 hours on, 2 hours off B. Upper arm rehab bike for 30 minutes, twice daily C. Scar massage followed by interactive, virtual-reality computer sports games D. Wall pulley and wall ladder followed by skin care regimen

C. Scar massage followed by interactive, virtual-reality computer sports games Taking into consideration the client's previous occupation as a softball player, virtual-reality computer sports games can involve similar sports movements and be motivating. However, because newly healed skin might split open as a result of overstretching or shearing force during movement, it is important to perform scar massage with a lubricant before activity.

A client with hip osteoarthritis has been referred for an occupational therapy assessment and treatment. What can a COTA® contribute to the assessment and treatment process? A. Identify whether the client will need occupational therapy. B. Decide which evaluations should be completed. C. Select and implement therapeutic activities. D. Interpret from the outcome whether client is able to engage in occupations.

C. Select and implement therapeutic activities. COTA®s can select and implement therapeutic activities that meet client goals.

Which test assesses a client's ability to visually select features that differentiate objects? A. Depth perception B. Contrast sensitivity C. Selective attention D. Peripheral field

C. Selective attention Selective attention, also called focal attention, enables a client to visually select features that differentiate objects. It is the ability to disregard irrelevant information or stimuli and attend to what is relevant.

A COTA® is working with a client who recently sustained a right-sided cerebrovascular accident with left-sided paresis. The OTR® wrote a goal for functional transfers, and the COTA is assisting the client with a wheelchair-to-bed transfer. What instructions would the COTA give the client BEFORE initiating the transfer? A. Shift weight into an anterior pelvic tilt, place the right hand on the wheelchair armrest, and point the heels away from the bed. B. Shift weight into an anterior pelvic tilt, place the right hand on the COTA's back, and point the heels toward the bed. C. Shift weight into an anterior pelvic tilt, place the right hand on the wheelchair armrest, and point the heels toward the bed. D. Shift weight into a posterior pelvic tilt, place the right hand on the wheelchair armrest, and point the heels toward the bed.

C. Shift weight into an anterior pelvic tilt, place the right hand on the wheelchair armrest, and point the heels toward the bed. An anterior pelvic tilt moves the center of mass over the center of the client's body. Heels should point toward the surface to which the client is transferring for easier pivot. Pushing up from the wheelchair armrest assists in the transfer.

A client with morbid obesity and obstructive sleep apnea is collaborating with an COTA® on improved sleep routines and positioning. What sleep position is optimal for this client? A. Supine position with the head of the bed elevated B. Supine position with only the client's head elevated C. Side-lying position with the head of the bed elevated D. Side-lying position with only the client's head elevated

C. Side-lying position with the head of the bed elevated Because of the obesity, the client will be able to breathe better in a side-lying position with the entire upper trunk elevated.

In an outpatient setting, a COTA® is setting up electrical stimulation on a client with a significant cardiac history, including a pacemaker. The OTR® observes the COTA® perform the client set up. What action should the OTR® take? A. Discuss the situation with the COTA® after the session to learn the rationale for performing this treatment and to assess competency. B. Alert the rehabilitation manager to the situation immediately in order to stop treatment. C. Stop the COTA® from proceeding, check the evaluation and treatment plan and, if needed, review physical agent modalities and appropriate use. D. Ensure that the COTA® is using the proper settings, frequency, and lubricant.

C. Stop the COTA® from proceeding, check the evaluation and treatment plan and, if needed, review physical agent modalities and appropriate use. A pacemaker is a contraindication for using electrical stimulation. Thus, this treatment is inappropriate and should be stopped immediately. Perhaps the COTA® misread the evaluation and treatment plan or did not have the appropriate understanding of physical agent modalities; therefore, supervision around this area should occur.

To facilitate more independence in kitchen mobility and meal preparation, which recommendation would be appropriate for a client with bilateral upper-extremity weakness resulting from arthritis? A. Use mops, brooms, and dustpans with extended handles to do cleaning tasks. B. Use pull-out shelves to organize cupboards. C. Store frequently used items on the first shelves of cabinets and on counters where possible. D. Use a wheelchair during kitchen tasks to promote safe mobility.

C. Store frequently used items on the first shelves of cabinets and on counters where possible. The client should organize all kitchen items on the counter and the first shelves above and below the counter to reduce unnecessary reaching, thus reducing the amount of strength needed for kitchen mobility and meal preparation.

Six weeks after a wrist sprain, a client was diagnosed with complex regional pain syndrome (CRPS), Type 1. The client is employed as an electromechanical equipment assembler. The client is able to perform all ADLs and light meal preparation. The client reports previously enjoying baking and being unable to bake since the injury. The client's pain increases to 6 or higher on a 0-10 scale while using the hand. The skin presents with mild discoloration of the dorsal surface of the wrist. What should be included FIRST when establishing the client's work conditioning program? A. Kneading bread dough B. Upper-extremity PROM exercises C. Stress-loading tasks D. Progressive resistive exercises

C. Stress-loading tasks During Type 1 (traumatic stage) CRPS, treatment should focus on management of pain and edema along with AROM. The most recognized therapeutic intervention for CRPS is a stress loading program.

A client who is being seen by both occupational therapy and physical therapy requires an ankle foot orthosis to prevent foot drop while walking and completing standing ADLs. In this situation, what is the COTA® responsible for regarding lower-extremity orthoses? A. Assisting in evaluation for orthosis necessity B. Adjusting the orthosis when it does not fit C. Teaching the client to don and doff the orthosis during dressing D. Assisting with gait training after orthosis application

C. Teaching the client to don and doff the orthosis during dressing Because they are part of a normal ADL routine, donning and doffing orthoses during dressing is within the COTA's area of practice.

Eccentric viewing training can be useful in improving ADL performance for clients with vision impairment. Which description of eccentric viewing training is MOST accurate? A. Teaching the client to increase the visibility of objects by providing contrast between foreground and background B. Educating the client to eliminate clutter to reduce visual stress and environmental hazards C. Teaching the client to move the scotoma out of the line of vision by turning the head to one side D. Instructing the client in the use of the sighted-guide technique

C. Teaching the client to move the scotoma out of the line of vision by turning the head to one side Eccentric viewing training, which involves teaching the client to move the scotoma out of the line of vision by turning the head to one side, helps the client improve vision for ADL performance.

A COTA® has been treating a client who sustained a chemical burn to both hands 6 months ago while cleaning up a spill at the adhesive manufacturing plant where the client is employed as a janitor. The client has been participating in a work conditioning program for the past 6 weeks and has made gains in all areas. The client plans to transition back to full-time, full-duty employment within the next 2 weeks. The COTA® included instruction in proper body mechanics as part of the client's treatment program to reduce the client's risk for reinjury. What type of intervention would this treatment program be considered? A. Primary intervention B. Secondary intervention C. Tertiary intervention D. Wellness intervention

C. Tertiary intervention A tertiary prevention program occurs after the worker sustains an injury, illness, or disease. It includes treatment of medical problems and attempts to restore maximum function in the workplace and prevention of injury, illness, or disease-related complications.

A COTA® is working with a child with a learning disability who has been reported by a classroom teacher as consistently needing multiple bathroom breaks during their reading hour. The COTA® uses pragmatic clinical reasoning to investigate what is causing the need for multiple breaks and provide supports to the classroom teacher. Which actions BEST describe pragmatic clinical reasoning? A. The COTA observes and monitors whether the child also asks to be excused for bathroom breaks during fun occupational therapy activities and documents these observations. B. The COTA sits down during therapy and invites the child to talk about the reasons for the frequent bathroom breaks in a nonthreatening and safe context. C. The COTA explores further with the classroom teacher what activities happen during the reading time and gathers additional information from the child's parents. D. The COTA asks the child to create a story sharing the child's experiences and possible struggles during reading time in the classroom.

C. The COTA explores further with the classroom teacher what activities happen during the reading time and gathers additional information from the child's parents. Pragmatic clinical reasoning enables the COTA to incorporate knowledge about the client's contexts. By knowing features of the child's classroom context, the COTA may be able to identify reasons for the frequent bathroom breaks.

A COTA® who passed the initial NBCOT exam has decided not to be recertified through NBCOT. What events will result from this decision? A. The COTA will not be allowed to practice occupational therapy in the United States. B. The COTA's practice opportunities and credentials will remain unchanged. C. The COTA may practice occupational therapy in a state that does not require certification, but the COTA's credentials will change to OTA. D. The COTA may practice occupational therapy in a state that does not require certification, and the COTA's credentials will remain unchanged.

C. The COTA may practice occupational therapy in a state that does not require certification, but the COTA's credentials will change to OTA. NBCOT recertification is not required for occupational therapy assistants, and some states allow occupational therapy practitioners to practice without being recertified by NBCOT; however, choosing not to renew NBCOT certification means a change in credential from COTA to OTA.

A COTA® works in an early intervention facility that uses the Family Systems Model of care for its clients who have mental health concerns. In which example is the Family Systems Model of care applied? A. The COTA focuses on the specific needs of the child requiring early intervention programming. B. The COTA assesses the child and interviews each family member separately to identify their concerns. C. The COTA needs to gain an understanding of factors that may have an impact on family functions. D. The OTR®;, with the COTA, provides child-centered and child-focused clinical reasoning to guide assessment and treatment.

C. The COTA needs to gain an understanding of factors that may have an impact on family functions. Internal (family dynamics, values, beliefs) and external (insurance, employment, access to health care) factors influence family functions and need to be addressed in a Family Systems Model of care.

A COTA® in an acute rehabilitation facility has been working with a client for four consecutive sessions. The COTA® learns that the client has two cats at home for which the client is the sole caregiver. Which option BEST describes the COTA®'s role in making pet care a goal? A. The COTA® can write this IADL goal into the next progress note alerting the OTR® to the change in the plan of care. B. The COTA® cannot add a goal once the evaluation has been completed. C. The COTA® can discuss this possible IADL goal with the OTR® to determine its appropriateness and how to address it as an intervention. D. The COTA® can write this IADL goal into the daily treatment note and update the OTR® on the addition.

C. The COTA® can discuss this possible IADL goal with the OTR® to determine its appropriateness and how to address it as an intervention. Ultimately, the OTR® is responsible for creating the intervention plan, but the OTR® and COTA® partner with the client to develop this plan. After the evaluation is completed, new information may arise, such as learning that a client is responsible for pet care at home. The COTA® has valuable client-centered information that can help to adjust the intervention plan in a meaningful way.

An OTR®; is working with a child with learning disability who has been reported by a classroom teacher as consistently needing multiple bathroom breaks during their reading hour. The OTR uses pragmatic clinical reasoning to investigate what is causing the need for multiple breaks and provide supports to the classroom teacher. Which actions BEST describe pragmatic clinical reasoning? A. The OTR observes and monitors whether the child also asks to be excused for bathroom breaks during fun occupational therapy activities and documents these observations. B. The OTR sits down during therapy and invites the child to talk about the reasons for the frequent bathroom breaks in a nonthreatening and safe context. C. The OTR explores further with the classroom teacher what activities happen during the reading time and gathers additional information from the child's parents. D. The OTR asks the child to create a story sharing the child's experiences and possible struggles during reading time in the classroom.

C. The OTR explores further with the classroom teacher what activities happen during the reading time and gathers additional information from the child's parents. Pragmatic clinical reasoning enables the OTR to incorporate knowledge about the client's contexts. By knowing features of the child's classroom context, the OTR may be able to identify reasons for the frequent bathroom breaks.

An OTR®; is working with a child diagnosed with anxiety disorder. The child exhibits an increased sense of fear and anxiety during novel situations that significantly impedes participation in many school activities. The OTR decides to use a cognitive reframing approach to intervention. Which intervention applies the cognitive reframing approach? A. The OTR uses an engine metaphor and asks the child to identify whether his or her arousal level is high, medium, or low. B. The OTR uses stories with sentences to help the child be aware of his or her environment and context. C. The OTR facilitates the child to talk about and rate his or her fears. D. The OTR provides a set of movement-based activities to allow the child to regulate his or her arousal level.

C. The OTR facilitates the child to talk about and rate his or her fears. Cognitive reframing is a cognitive-behavioral therapy that uses positive self-talk to remove self-defeating and negative thoughts.

A COTA® who spent 2 years working on the orthopedics unit of an acute care hospital is now working on the neurological floor. How is appropriate supervision BEST described? A. The OTR® and COTA® decide to have supervision as needed by the COTA®. B. The COTA® requires minimal supervision because of the COTA®'s 2 years of orthopedics experience. C. The OTR® and COTA® agree that close supervision is best at this time. D. The OTR® and COTA® decide that continuous supervision is needed at this time.

C. The OTR® and COTA® agree that close supervision is best at this time. More frequent supervision may be necessary when the OTR®, COTA®, or both determine that additional supervision is needed as a result of changes in work demands, such as in caseloads or populations served. In this case, a COTA® who has experience working with patients with orthopedic conditions may require closer supervision when working with patients with myriad health conditions.

During the occupational therapy evaluation, an OTR® has determined that a visually impaired client can no longer drive. What should the treating COTA® expect the OTR® to include in the occupational therapy intervention to help this client be independent in the use of community mobility? A. Familiarize the client with the procedures for using paratransit. B. Obtain a bus schedule and start training the client to use the bus for fixed-route travel. C. Train the client and the client's family or support system in the use of the most appropriate transportation options. D. Educate the client on the need for driving cessation and the importance of maintaining independence in the community mobility.

C. Train the client and the client's family or support system in the use of the most appropriate transportation options. This is a comprehensive approach to follow after determining a client cannot drive.

A 76-year-old client will be using a wheelchair after discharge from an acute rehabilitation facility. The client has achieved independence in wheelchair mobility on level surfaces but still requires minimal assistance for transfer. The client is planning to move into a daughter's home, which was not the client's previous residence. The COTA® has been the client's primary clinician. The supervising OTR® and the COTA® conduct an onsite home evaluation with the client and the client's daughter. The client's goal is to be able to prepare lunch daily while the client's daughter is at work. What is the MOST important mobility performance to be observed during the home evaluation? A. The client's ability to stand and reach the cabinets B. The client's ability to stand at the stove while cooking C. The client's ability to maneuver the wheelchair in and out of the kitchen D. The client's ability to reach the faucet while seated in the wheelchair

C. The client's ability to maneuver the wheelchair in and out of the kitchen If the client cannot maneuver the wheelchair in and out of the kitchen, then an alternative cooking station will need to be set up so that the client can prepare lunch in another room.

A COTA® is gathering information to support the OTR®; in developing a functional behavior analysis plan for a child with autism who demonstrates severe behavioral problems. Which approach adheres to the essential elements of creating a comprehensive behavioral support plan? A. The behavioral plan must be applied at least half of the school day. B. The plan must include one intervention strategy that is effective for the child's needs. C. The elements of the plan must reflect the values and resources of the child and the person providing support. D. The plan must contain only standardized assessments of behavior.

C. The elements of the plan must reflect the values and resources of the child and the person providing support. The four essential components of a comprehensive behavioral support plan are (1) a functional assessment of behavior, (2) use of multiple interventions, (3) application of the plan throughout the day, and (4) elements that reflect the values and resources of the child and the person providing support.

An OTR®; is developing a functional behavior analysis plan for a child with autism who demonstrates severe behavioral problems. Which approach adheres to the essential elements of creating a comprehensive behavioral support plan? A. The behavioral plan must be applied at least half of the school day. B. The plan must include one intervention strategy that is effective for the child's needs. C. The elements of the plan must reflect the values and resources of the child and the person providing support. D. The plan must contain only standardized assessments of behavior.

C. The elements of the plan must reflect the values and resources of the child and the person providing support. The four essential components of a comprehensive behavioral support plan are (1) a functional assessment of behavior, (2) use of multiple interventions, (3) application of the plan throughout the day, and (4) elements that reflect the values and resources of the child and the person providing support.

A recently licensed COTA® employed by an outpatient clinic is being supervised by an OTR® who is a certified hand therapist. What is the purpose of the supervisory process, as defined by AOTA? A. To ensure that COTAs treat only clients with diagnoses about which they have extensive knowledge. B. To ensure that COTAs practice within their scope of practice with regard to state licensure laws C. To ensure the safe and effective delivery of occupational therapy services and to foster professional competence and development D. To ensure that COTAs with at least 2 years of experience in their area of practice can treat clients independently of collaboration with the OTR

C. To ensure the safe and effective delivery of occupational therapy services and to foster professional competence and development As stated in the Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services (AOTA, 2014), "Within the scope of occupational therapy practice, supervision is a process aimed at ensuring the safe and effective delivery of occupational therapy services and fostering professional competence and development" (p.S16).

A COTA® is conducting a group for older adult clients on preparation for driving cessation. Several group members express a fear of using public transportation because they have never done so. Which action would BEST address these clients' stated needs? A. Referrals to a psychologist to address issues of fear and anxiety regarding public transportation B. Driving evaluations to ensure that the clients can continue to drive for as long as possible C. Travel training to practice use of public transportation with the clients until they feel comfortable on their own D. Simulation of public transportation by driving the clients along the same routes used by the transit system

C. Travel training to practice use of public transportation with the clients until they feel comfortable on their own Travel training is short-term, direct, and intensive training to teach older adults and people with disabilities to use fixed-route public transportation safely and independently.

A COTA® is working with a client presenting with a claw hand deformity who has both decreased grip and lateral pinch strength. Before reading the medical notes, what type of injury would the COTA® suspect? A. Low median nerve injury B. High median nerve injury C. Ulnar nerve injury D. Radial nerve injury

C. Ulnar nerve injury A claw hand is the result of an ulnar nerve injury. The fourth and fifth interossei and lumbrical muscles are paralyzed, and the unopposed extensor digitorum musculotendon unit hyperextends the metacarpophalangeal joints.

A COTA® in home health care is treating a client who has Stage III Alzheimer's disease. The client lives with an adult daughter. The daughter reports that the client wanders around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no steps at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. The daughter has expressed fear that the client might fall down the stairs at the back door while wandering. To prevent the client from using the back door, what would be the MOST likely recommendation? A. Painting a big "STOP" sign on the back door B. Painting the door yellow to contrast with the environment C. Using a poster to camouflage the back door and the door knob D. Installing a motion-detecting light at the stairs to the garage

C. Using a poster to camouflage the back door and the door knob D. Installing a motion-detecting light at the stairs to the garage Evidence has shown that camouflaging a door and its doorknob can decrease way-finding behavior when a client with Alzheimer's disease wanders.

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

C. V The client is highly distractible and displays severe memory impairment but can respond to simple commands; therefore, the client most closely resembles Level V.

An OTA Level II fieldwork student gives an inservice to the occupational therapy staff at the fieldwork site. The next month, the OTA student attends a continuing education session that an OTR® from the site is conducting for physician assistants. The student recognizes most of the slides as being from the student's own previous presentation. No credit is given to the student or the sources the student used. Which ethical principle did the OTR® violate? A. Nonmaleficence B. Beneficence C. Veracity D. Autonomy

C. Veracity Veracity relates to being fair to colleagues, such as giving credit for other's ideas and avoiding plagiarism.

A client who suffered a stroke would like to return to work as a computer specialist. The OTR® asks the COTA® to explain vocational evaluation to the client. What explanation should the COTA® provide to the client? A. Vocational evaluation determines the essential functions of a job area to conduct work tolerance screenings. B. Vocational evaluation identifies safety risks that may impede a worker's ability to complete job tasks. C. Vocational evaluation assesses a client's readiness, skills and ability to engage in a particular occupation. D. Vocational evaluation establishes the organization's compliance with the Americans With Disabilities Act.

C. Vocational evaluation assesses a client's readiness, skills and ability to engage in a particular occupation. Vocational evaluation may be conducted for a person who has not worked previously, who has been injured and is preparing to return to work, or is unable to return to a previous job. Vocational evaluation may be general or specific addressing a person's potential for work or readiness to return to a specific occupation.

Which community mobility situation might pose a challenge for a person with autism spectrum disorder (ASD) who is hypersensitive to auditory stimuli? A. Waiting alone at a bus stop on a highway with light traffic B. Scheduling a ride by entering information into the online database of a taxi service provider C. Waiting on a crowded subway platform at a time of day when multiple trains are running D. Bicycling to school in a suburban neighborhood

C. Waiting on a crowded subway platform at a time of day when multiple trains are running Precin et al. (2012) noted that oversensitivity to sensory stimuli can be problematic for people with ASD and specifically mentioned loud transportation-related noises as difficult for people with auditory sensitivity.

A client with osteoarthritis is independent with ADLs using compensatory strategies. The client wants to participate in a fitness program at a community wellness center. Which activity would be MOST BENEFICIAL to recommend for this client? A. Progressive resistive weight activity B. Low-resistance circuit program C. Water aerobics exercise group D. Step aerobics and stretching class

C. Water aerobics exercise group Water-based exercises allow for low-impact ROM and isometric strengthening while providing social interaction and peer support.

A COTA® is working with a client in an outpatient center who has been diagnosed with Raynaud's syndrome affecting the fingers. What home program instruction is MOST appropriate for a client with Raynaud's syndrome? A. Wear a flexion glove at night. B. Use a cold pack to increase finger circulation. C. Wear gloves when exposing the fingers to cold. D. Visually inspect the fingers daily for tumor growth.

C. Wear gloves when exposing the fingers to cold. Raynaud's syndrome disrupts blood flow to the digits in vasospastic attacks. The client needs to be educated to wear gloves when exposing hands to the cold, such as reaching into a freezer.

A client with age-related macular degeneration has 20/200 visual acuity. How is the client's visual acuity BEST explained? A. When standing at a distance of 20 feet, the viewer can see an optotype that a person with normal vision can see at 20 feet. B. When standing at a distance of 20 feet, the viewer can see an optotype that a person with normal vision can see at 100 feet. C. When standing at a distance of 20 feet, the viewer can see an optotype that a person with normal vision can see at 200 feet. D. When standing at a distance of 20 feet, the viewer can see an optotype that a person with normal vision can see at 10 feet.

C. When standing at a distance of 20 feet, the viewer can see an optotype that a person with normal vision can see at 200 feet. Visual acuity is measured as a ratio of the distance from the optotype over the distance at which a person with 20/20 vision can see the same optotype. A person with 20/200 visual acuity standing at a distance of 20 feet can see an optotype that a person with normal vision can see standing 200 feet from that optotype.

A client with a unilateral transradial amputation is undergoing pre-positioning training for a myoelectric arm. Which of the following is the MOST appropriate goal? A. Within three sessions, the client will independently don the prosthesis and obtain good electrical contacts with the electrode sites 100% of the time. B. Within three sessions, the client will be able to open and close the myoelectric terminal device 100% of the time. C. Within 1 week, the client will be able to accurately identify how to arrange the wrist of the myoelectric terminal device to be able to optimally grasp different objects. D. Within 1 month, the client will be able to use the myoelectric terminal device as a functional assist and stabilizer in 100% of daily activities.

C. Within 1 week, the client will be able to accurately identify how to arrange the wrist of the myoelectric terminal device to be able to optimally grasp different objects. The pre-positioning phase focuses on teaching the client with an amputation to position the terminal device for optimal grasp.

A COTA® is working with a client who has chronic congestive heart failure. The client is displaying limited tolerance for light to moderate homemaking activities. Which compensatory strategy would be BEST for the OTR® to demonstrate to the client to improve tolerance to these activities? A. Diaphragmatic breathing B. Sternal precautions C. Work simplification techniques D. Use of adaptive devices

C. Work simplification techniques For clients who show limited endurance for or tolerance of activities, work simplification techniques can improve their ability to complete tasks independently.

A COTA® treating a client listens as the client says, "My pain is really bad, forcing me to stay in bed 24/7, and I am not able to take care of myself at all." Which clarifying response is BEST? A. "It appears that your pain is really bad, forcing you to stay in bed." B. "I feel bad that you are experiencing pain 24/7, forcing you to stay in bed." C. "You poor thing. That's awful! Where is the pain?" D. "It seems that your pain is so bad you can't get up to go to the bathroom or get yourself food from the kitchen."

D. "It seems that your pain is so bad you can't get up to go to the bathroom or get yourself food from the kitchen." This response solicits clarification of what the client meant by "forcing me to stay in bed" by adding to what the client has stated.

A COTA® in home health care is treating a client who has Stage III Alzheimer's disease. The client lives with an adult daughter. The daughter reports that the client likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no steps at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. To prevent the client from getting out of bed unnoticed at night, what would be an appropriate recommendation? A. A nightlight in the room B. Full bedrails on both sides of the bed C. A video room monitor D. A bed alarm system

D. A bed alarm system A bed alarm system will alert the daughter when the client is attempting to leave the bed and is more suitable for use when the daughter is not able to stay in the same room as the client for surveillance.

An occupational therapy group for adults who are working on regaining occupational engagement 1 year post stroke is designed to include sessions on community mobility and to address participants' stated concerns regarding use of assistive devices in public places. Which activity would BEST address these goals? A. A session with a physical therapist in the clinic to practice ascending and descending stairs like those on public buses B. An interactive conversation about places in the community to which one can travel by public transportation C. An educational session about the advantages of different walkers, canes, and wheeled mobility options D. A field trip to the local mall using public transportation and practice in the use of walkers, canes, and scooters in the mall

D. A field trip to the local mall using public transportation and practice in the use of walkers, canes, and scooters in the mall A field trip to the mall involving public transportation and practice using assistive devices best combines the goals for community mobility and use of assistive devices in public places.

Which type of chair is MOST appropriate for a client with hip replacement? A. A sturdy, wheeled secretary office chair B. A traditional recliner with raised footrests C. A wooden, high-back rocking chair D. A firm-based chair with armrests

D. A firm-based chair with armrests A firm-based chair with armrests is recommended for clients with hip replacement; chairs with cushions or rocking functions may negatively affect hip precautions because of variability in surface.

An OTR®; is setting social skills goals with a child with autism and the parent. The OTR decides to use Goal Attainment Scaling (GAS) to establish a baseline and measure outcomes of intervention. Which statement reflects the correct application of GAS? A. Four levels of achievement are established by the OTR with the child and parent. B. A level of +1 is set as the expected outcome. C. A negative level is understood as a strong regression from the expected performance outcome. D. A level of +2 is understood as greatly exceeding the expected level of performance.

D. A level of +2 is understood as greatly exceeding the expected level of performance. GAS sets five levels of performance from ranging from −2 to +2; 0 is set as the expected outcome; negative levels are understood as less than or much less than the expected outcome, and positive levels are understood as exceeding or greatly exceeding the expected outcome.

A COTA® is assisting an OTR®; with setting social skills goals with a child with autism and the parent. The OTR decides to use Goal Attainment Scaling (GAS) to establish a baseline and measure outcomes of intervention. Which statement reflects the correct application of GAS? A. Four levels of achievement are established by the OTR with input from the child and parent. B. A level of +1 is set as the expected outcome. C. A negative level is understood as a strong regression from the expected performance outcome. D. A level of +2 is understood as greatly exceeding the expected level of performance.

D. A level of +2 is understood as greatly exceeding the expected level of performance. GAS sets five levels of performance ranging from −2 to +2; 0 is set as the expected outcome; negative levels are understood as less than or much less than the expected outcome, and positive levels are understood as exceeding or greatly exceeding the expected outcome.

An OTR®; in a private clinic is discussing with other practitioners potential peers who can be paired or grouped with a 3-year-old client. The client has autism, and the goals include improving play and social skills. Which potential peer has appropriate characteristics to consider when choosing peers to partner with this client? A. A child of the other gender, to promote gender diversity and exposure to children of that gender B. A child with the same diagnosis who has not been paired with another child during therapy sessions C. A child with the same diagnosis and developmental level as the client D. A slightly older child with a slightly higher developmental level than the client

D. A slightly older child with a slightly higher developmental level than the client Peers of different ages and different developmental statuses can promote different types of play and leisure behaviors and can advocate a multitude of play skills.

A COTA® lived in a state in which the occupational therapy practice act required 10 hours of continuing education to provide a particular intervention (physical agent modalities [PAMs]) and was deemed competent by the COTA's previous employer. The COTA now works in a state where 20 hours of continuing education are required. The supervising OTR® tells the COTA to provide PAMs to the COTA's clients because competency was demonstrated with the previous employer. What is the COTA's best next step, considering the ethical principle of Justice? A. Provide the services that are clinically appropriate and in accordance with the current employer's standards. B. Contact the previous employer to confirm that service competency was met. C. Provide the intervention now so as not to delay client services and sign up for the additional 10 hours of continuing education. D. Acquire the 10 additional hours of continuing education before providing PAMs to clients.

D. Acquire the 10 additional hours of continuing education before providing PAMs to clients. The ethical principle of Justice requires the clinician to adhere to state credentialing requirements, which supersede organizational policies or practices.

An OTR® is conducting a job demand analysis in a food production company. The OTR® observes the workers in the shipping and handling department loading and unloading a delivery truck. According to the Occupational Therapy Practice Framework (2nd ed.; AOTA, 2008), which aspect of the occupational therapy domain is being assessed? A. Communication and social skills B. Habits and routines C. Motor and praxis skills D. Activity demands

D. Activity demands A job task analysis is a non-client-specific observation of the job's activity demands, including required body functions, required actions and tools used, and space and social demands needed to complete the task.

A COTA® is running a group in an innovative preventive program for parolees. The goal of the program is to assist parolees with establishing or restoring occupational balance and productive occupations. The current group has been meeting regularly for 6 months. The members have good insight, and they understand the goals of the program. What leadership style should the COTA use in this setting? A. Directive B. Facilitative C. Cooperative D. Advisory

D. Advisory An advisory style would be most appropriate because the group knows its goals and has been established for a while. The COTA can help the group by providing additional knowledge and resources for further action.

As part of the therapy process, a COTA® working with a client to access community transportation, evaluates the community context to determine available travel options. Which component is MOST appropriate in this community assessment process? A. Lobbying state representatives to provide more funding for public transportation B. Teaching the client how to read public transportation schedules C. Educating the client in personal safety practices to follow when walking in the community D. Analyzing community transportation options in terms of availability, affordability, and accessibility

D. Analyzing community transportation options in terms of availability, affordability, and accessibility AOTA's (2010) "Statement on Driving and Community Mobility" addresses assessment of community contexts and specifically includes analysis of availability, affordability, and accessibility of transportation options as components of this process.

A COTA® is working with a client who had hip replacement surgery and will be returning home alone upon discharge. What is the BEST recommendation that the COTA® should make regarding kitchen modifications? A. Keep items in current placements to encourage movement. B. Use only the microwave to prepare weekly meals. C. Order delivered, premade food to be brought in for all meals. D. Arrange for commonly used items to be located at counter level.

D. Arrange for commonly used items to be located at counter level. The OTR® should encourage the client to keep commonly used items at countertop level to prevent further injury and decrease fall risk from bending or stretching.

A COTA® determines that the client is no longer benefiting from occupational therapy services. The supervising OTR® insists that the COTA continue to treat the client because the caseload is low and discharging the patient may result in low productivity. What is the BEST next step for the COTA? A. Trade patients with a COTA who agrees to carry out the OTR's treatment plan. B. Immediately report the OTR to the organization's human resources department. C. Immediately document the request and pursue the topic no further. D. Ask to meet with the OTR and rehab manager to collaborate about the situation.

D. Ask to meet with the OTR and rehab manager to collaborate about the situation. Fidelity requires the COTA to work with the OTR and management to address organizational ethics issues affecting the ability to treat on the basis of clinical need (which is required under the principle of Beneficence).

A COTA® is asked to treat an older adult client with moderate-stage dementia who resides in a long-term care facility once the occupational therapy evaluation was completed. While the COTA® is conducting the intervention, it becomes apparent that the client is becoming agitated. The client expresses concern that the COTA® is going to make the client late to pick up the client's children from day care. What is the BEST approach for the COTA® to take in this situation? A. Remind the client that the children are grown adults. B. Attempt to engage the client in an alternative activity. C. Leave the client alone and plan to return later in the day. D. Assure the client that the children will get picked up on time.

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

A client with an acquired brain injury does not have private funds to pay for skilled occupational therapy services. The client does not have access to Medicaid. As a result, the client chooses to discontinue therapy. Which ethical principle requires the practitioner to respect the client's decision? A. Justice B. Beneficence C. Veracity D. Autonomy

D. Autonomy The practitioner should help the client locate other forms of funding, but if the client is unable to secure reimbursement, the client has the right to refuse treatment secondary to the burden of cost.

A COTA® is assisting an OTR® in a joint treatment session with an acute-care client who has a ventricular assist device. What precaution is essential when engaging this client in occupational activities? A. Do not administer an exercise stress test to the client. B. Instruct the client in sterile dressing changes to prevent infection. C. Educate the client to avoid yearly influenza and pneumonia vaccines. D. Avoid disconnecting the drive line to the power source during movement.

D. Avoid disconnecting the drive line to the power source during movement. A ventricular assist device requires a power source to function properly. The drive line connects to the power source. If the COTA is not careful, the drive line can become disconnected during activity.

A COTA® is working with a client 3 days post open-heart surgery. The COTA® emphasizes to the client to follow all sternal precautions during exercise and activities for 3 months. Which precaution is part of sternal precautions? A. Scar massage to the sternal scar B. Wearing of a sternal splint guard when out of bed C. Breathing out on exertion D. Avoidance of one-sided lifting or pulling up

D. Avoidance of one-sided lifting or pulling up The sternum is broken during open-heart surgery, so the client must avoid one-sided lifting over 10 lb, pulling up (body weight), and other movements that would strain the sternum for 6 to 12 weeks.

A COTA® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The COTA suggests that the client use breathing techniques and relaxation breaks during the work day to minimize the client's response to stressful events at work. What frame of reference does this intervention suggest? A. Cognitive-behavioral B. Psychodynamic C. Cognitive disability D. Behavioral

D. Behavioral The behavioral frame of reference relies on the idea that behavior is learned and that it can be unlearned. Introducing relaxation activities and breathing into this client's routine may allow the client to experience more time in a positive state of mind, thus reducing anxiety.

A client with rheumatoid arthritis (RA) presents with the right index finger in 30° of proximal interphalangeal (PIP) flexion and 20° of distal interphalangeal (DIP) hyperextension. What type of finger deformity does the client have? A. Swan neck deformity B. Mallet finger deformity C. Ulnar drift deformity D. Boutonnière deformity

D. Boutonnière deformity Boutonnière deformity is defined as PIP flexion combined with DIP hyperextension.

A COTA® is reviewing hard-copy client charts before a group treatment session. While reviewing the charts, the COTA receives an urgent phone call and must leave the chart room. How can the COTA ensure that the charts remain protected during the COTA's absence from the room? A. By closing the charts and stacking them on a table B. By locking the door to the chart room C. By covering the charts with other documents to obscure them from view D. By closing the charts and returning them to their original secure location

D. By closing the charts and returning them to their original secure location The Health Insurance Portability and Accountability Act requires that documentation be kept confidential and accessible only to individuals who are involved in a client's treatment. Even during a brief absence, charts should be returned to their original secure location if there is any possibility that another person may come into contact with them.

A COTA® is working with a client in the early rehabilitation phase in an outpatient facility. The client had a recent myocardial infarction. In reviewing the home program with the client, the COTA® discusses activity and exercise limitations according to metabolic equivalent (MET) levels. Which activity would be contraindicated within the first 4 weeks after a myocardial infarction because of the activity's MET level? A. Light housekeeping B. Knitting and crocheting C. Dressing and undressing D. Carrying groceries upstairs

D. Carrying groceries upstairs Healing of the heart muscle takes 4 to 8 weeks. During this time, activities are limited to the 2 to 4 MET range. Carrying groceries upstairs requires 6 to 10 METs.

An OTR®-COTA® team wants to design a work performance program based on AOTA's Occupational Therapy Practice Framework: Domain and Process (2nd ed.). According to the Framework, what would the therapist NOT include in the program? A. Interventions including wellness and prevention B. Consultative services and client education C. Restorative interventions and compensatory techniques D. Client-specific work productivity standards

D. Client-specific work productivity standards The occupational therapy process involves provision of occupational therapy interventions and approaches to facilitate work performance with the exception of implementation of work productivity standards.

A COTA® is reviewing electronic client charts before a group treatment session. While reviewing the charts, the COTA receives an urgent phone call and must leave the computer station momentarily. How can the COTA ensure that the charts remain protected during the COTA's absence from the computer? A. Minimize the chart windows. B. Turn off the computer's screen. C. Cover the chart windows with other program windows. D. Close the chart windows and log off the computer.

D. Close the chart windows and log off the computer. The Health Insurance Portability and Accountability Act requires that documentation be kept confidential and accessible only to individuals who are involved in a client's treatment. Even during a brief absence, charts should be returned to their original secure location if there is any possibility that another person may come into contact with them.

The initial evaluation documentation indicates that a client with multiple sclerosis (MS) reports feeling overwhelmed by choices for daily activities and symptom management. Which intervention is MOST appropriate for this client? A. Collaborate with the caregiver to plan routines for the client B. Suggest that the OTR® refer the client to a social worker to manage daily activities and symptoms C. Suggest that the OTR refer the client to a psychologist to discuss feelings of being overwhelmed D. Collaborate with the client to develop self-management skills

D. Collaborate with the client to develop self-management skills Clients who develop self-management skills have higher quality of life. Using self-management skills allows clients to make sure their needs are met and their unique circumstances are addressed.

Which tool should the COTA® use to assess peripheral visual fields in a client with low vision? A. Interview B. Amsler grid C. Snellen chart D. Confrontation testing

D. Confrontation testing Confrontation testing provides a gross assessment of how much peripheral vision the client has.

A client reports double vision. What is the role of the COTA® when working with this client? A. Determine whether the oculomotor system dysfunction is a result of cranial nerve injury B. Provide training using prisms to restore single vision C. Provide eye exercise training to restore single vision D. Determine whether the oculomotor dysfunction limits participation in daily occupations

D. Determine whether the oculomotor dysfunction limits participation in daily occupations The purpose of occupational therapy intervention is to determine whether the client is experiencing limitations in daily occupations, in this case because of dysfunction within the oculomotor system.

An OTR® has completed an initial evaluation with a client who has relapsing and remitting multiple sclerosis. Sensorimotor skills assessment indicates that the client's daily activities are limited by low endurance and decreased upper-extremity coordination. In addition, the client has been unable to remain in a job as a clerical worker. What additional information, that the COTA® can gather, is MOST important before developing an intervention plan? A. All medical test results, including blood test results, neurological and imaging exams B. Availability of home care services to support the client in the home C. Reports of other health professionals currently involved in the client's care D. Contextual and environmental factors that support the client's ability to adapt

D. Contextual and environmental factors that support the client's ability to adapt Contextual and environmental factors provide information about a client's available support systems, which can influence his or her ability to adapt to the diagnosis.

A client with secondary progressive multiple sclerosis (MS) is recovering from a recent relapse. During the evaluation with the OTR®, the client expressed interest in wanting to learn to manage anxiety associated with the disease and its effect on occupational performance. What strategy should the COTA® suggest? A. Participation in a cognitive retraining group B. Implementation of a home exercise plan C. Relaxation techniques, such as taking a hot bath or yoga D. Coping strategies for self-identified difficult tasks

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

A client presents with decreased memory resulting from dementia. What is the MOST EFFECTIVE strategy for a COTA® to implement to intervene with this cognitive impairment? A. Chunking or grouping similar items together B. Repeating information over and over again to oneself C. Rhyming strategies to recall information D. Cuing through cards or signs in key places

D. Cuing through cards or signs in key places Adaptations, as opposed to targeted interventions, are the most effective strategy for decreased memory in clients with dementia.

An inpatient who has a C6 spinal cord injury has met all occupational therapy goals and is preparing for discharge to live at home with caregiver assistance. What type of device should the OTR® recommend the patient use to maximize independence during self-care activities at home? A. Electronic aid to daily living B. Power wheelchair with head control C. Wheelchair-mounted mobile arm supports D. Custom-fitted tenodesis splint

D. Custom-fitted tenodesis splint A patient with a C6 spinal cord injury can use a tenodesis splint because he or she will have partial wrist extension.

A COTA® is working with a client who has ventricular tachycardia. The client's vital signs include a heart rate greater than 100 beats per minute. What is the appropriate therapeutic response to this client situation? A. Allow the client to rest 10 minutes, then begin an occupational task that focuses on upper-extremity movement. B. Work with the client in a supported sitting position with the client's legs elevated. C. Instruct the client in adaptation of performance for grooming and feeding tasks. D. Defer the client's participation in occupational therapy until later, because the client is medically unstable.

D. Defer the client's participation in occupational therapy until later, because the client is medically unstable. Ventricular tachycardia of more than 100 beats per minute can cause sudden cardiac death. Therapy should be deferred until the client is medically stable.

A client with a diagnosis of dementia has memory loss. The COTA® observes that the client has visual hallucinations. In addition, the client has decreased spontaneous motor movements and rigidity. What type of dementia does this client MOST LIKELY have? A. Frontotemporal dementia B. Alzheimer's disease C. Vascular dementia D. Dementia with Lewy bodies

D. Dementia with Lewy bodies Distinguishing features of dementia with Lewy bodies are visual hallucinations and Parkinson-like motor symptoms.

A COTA® is assisting the OTR® in completing a wheelchair evaluation, and there is concern over the client's sitting position. Because the client maintains a posterior pelvic tilt and a kyphotic thoracic spine when sitting unsupported, there is particular concern with the client's spinal alignment in the wheelchair. What effect can poor alignment have on compression of the client's diaphragm? A. Difficulty with pressure management B. Difficulty with tone normalization C. Decreased sitting tolerance D. Diminished vital capacity

D. Diminished vital capacity Correct alignment in a wheelchair will have an effect on all of these items, but only vital capacity is related to compression of the diaphragm. Proper alignment decreases compression of the diaphragm, which increases vital capacity.

A COTA® has been assigned to treat a new patient. The OTR® has evaluated this patient but has not yet written the necessary documentation for the COTA® to review. How should the COTA® proceed? A. Cancel the treatment session and document that intervention is on hold pending completion of the evaluation. B. Review the chart and ask the patient the priority of goals to be addressed in treatment. C. Co-treat with the physical therapist to learn the reasons for admission and special issues, and document accordingly. D. Discuss with the OTR® reason for admission, precautions, and goals, and proceed, documenting the supervisory visit.

D. Discuss with the OTR® reason for admission, precautions, and goals, and proceed, documenting the supervisory visit. The COTA® may not proceed with intervention implementation until the COTA® has a conversation with the OTR® to learn more about the patient. To choose appropriate therapeutic activities and interventions and modify them as needed, the COTA® must be knowledgeable about the patient's goals. In the documentation, the COTA® should describe the discussion with the evaluating OTR® that occurred before treatment.

A client with a herniated lumbar disk was referred to occupational therapy. The OTR® completes an initial evaluation and develops an intervention plan. Which task can the OTR® assign to the COTA®? A. Write up the initial evaluation addressing goals B. Alter the initial plan to address pain C. Do a complete reevaluation of abdominal strength D. Educate the client in proper body mechanics

D. Educate the client in proper body mechanics The COTA®'s focus is on intervention implementation under the guidance of the OTR®. The COTA® may carry out the plans detailed in the intervention plan, including educating the client.

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

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

A COTA® is working with a client with orthostatic hypotension. The client becomes lightheaded and complains of blurred vision while sitting on the edge of the bed. What action does the COTA need to take if the client remains lightedheaded? A. Instruct the client to raise both arms simultaneously. B. Have the client use a reacher to pick up items rather than bend over. C. Remove the client's thrombolitic stockings immediately. D. Elevate the client's lower extremities.

D. Elevate the client's lower extremities. If the client remains lightheaded and his or her blood pressure drops more than 20 mm HG systolic and 10 mm HG diastolic, then the client's lower extremities need to be elevated to return blood flow to the head.

A COTA® is treating a new client who physically presents with a "barrel chest." This appearance is most often associated with what condition? A. Cystic fibrosis B. Asthma C. Collapsed lung D. Emphysema

D. Emphysema Clients with emphysema have hyperinflated lungs, which partially expand the ribcage.

While reviewing work hardening program documentation, a COTA® realizes there is no entry in the client's medical record of a meeting conducted with the insurance case manager, client, and client's employer regarding light-duty options. According to best practice guidelines, how should the COTA® amend the client's medical record to include a summary of the meeting? A. Back-date the entry to correspond to the actual date of the meeting, and insert a summary of the meeting into the client's medical record. B. Insert a summary of the meeting into the margins of the client's medical record. C. Use correction tape or fluid to correct the client's medical record and insert details of the meeting in the proper sequence. D. Enter the information as a late entry into the client's medical record.

D. Enter the information as a late entry into the client's medical record. Information that must be entered out of sequence should be entered into the medical record as a late entry and must be identified as such per AOTA guidelines.

Why does the Occupational Therapy Code of Ethics (2015) encourage occupational therapy practitioners to use evidence-based evaluations, interventions, and therapeutic equipment whenever possible? A. Evidence-based practice ensures compliance with institutional rules. B. All clients have a right to self-determination. C. Failure to use evidence-based practice is malpractice. D. Evidence-based practice provides the greatest likelihood of benefiting others.

D. Evidence-based practice provides the greatest likelihood of benefiting others. Principle 1F (Beneficence) states that practitioners shall "take steps (e.g., continuing education, research, supervision, training) to ensure proficiency, use careful judgment, and weigh potential for harm when generally recognized standards do not exist in emerging technology or areas of practice." Principle 2A (Nonmaleficence) states that practitioners shall "avoid inflicting harm or injury to recipients of occupational therapy services, students, research participants, or employees." Use of evidence from empirical research and clinical expertise to inform occupational therapy practice provides the greatest likelihood that practitioners will provide best possible care and reduce the threat of doing harm

Why does the Occupational Therapy Code of Ethics (2015) encourage occupational therapy practitioners to use evidence-based evaluations, interventions, and therapeutic equipment whenever possible? A. Evidence-based practice ensures compliance with institutional rules. B. All clients have a right to self-determination. C. Failure to use evidence-based practice is malpractice. D. Evidence-based practice provides the greatest likelihood of benefiting others.

D. Evidence-based practice provides the greatest likelihood of benefiting others. Principle 1F (Beneficence) states that practitioners shall "take steps (e.g., continuing education, research, supervision, training) to ensure proficiency, use careful judgment, and weigh potential for harm when generally recognized standards do not exist in emerging technology or areas of practice." Principle 2A (Nonmaleficence) states that practitioners shall "avoid inflicting harm or injury to recipients of occupational therapy services, students, research participants, or employees." Use of evidence from empirical research and clinical expertise to inform occupational therapy practice provides the greatest likelihood that practitioners will provide best possible care and reduce the threat of doing harm.

An OTR® is evaluating a high school student with a history of traumatic brain injury to determine whether the student can take the bus to the library independently. During the evaluation, the OTR notes that the student has trouble remembering the directions to the library. Which intervention strategy is BEST to help the student follow the directions to the library and take the appropriate bus? A. Provide the student with a handheld listening device B. Shadow the student to ensure that the student is independent C. Provide the student with a bus route map and highlight the appropriate bus route D. Fabricate pocket-sized cue cards with pictures of landmarks and key information for the student to follow

D. Fabricate pocket-sized cue cards with pictures of landmarks and key information for the student to follow Pocket-sized cue cards are an appropriate intervention strategy for a high school student with a history of traumatic brain injury who has trouble remembering directions.

According to the Americans With Disabilities Act of 1990 (ADA), what is the definition of essential job functions when considering employment of a person with a disability? A. Functions that an employer determines are to be completed by each employee B. The physical functions of a job task, such as hand manipulation skills for writing C. The speed with which each task must be performed on the job to meet productivity standards D. Functions that an employee must be able to complete, with or without a reasonable accommodation

D. Functions that an employee must be able to complete, with or without a reasonable accommodation Essential job functions, as defined by the ADA, are those that the employee must be able to complete, with or without accommodation. The ADA distinguishes between job functions that are essential—that is, those that must be completed by the employee—and functions that can be carried out by other employees in the same environment when an employer is making decisions about hiring and accommodating someone with a disability in the workplace.

What test is MOST APPROPRIATE to determine the level of consciousness of a client with a traumatic brain injury (TBI)? A. Canadian Occupational Performance Measure (COPM) B. Mini-Mental State Examination (MMSE) C. Minnesota Multiphasic Personality Inventory (MMPI) D. Glasgow Coma Scale (GCS)

D. Glasgow Coma Scale (GCS) The GCS is the traditional method used by health care professionals to assess levels of consciousness after traumatic brain injury.

A supervising OTR® hires two newly graduated COTAs who have different learning styles. One prefers visual learning, and the other prefers a more hands-on approach. Which approach is the BEST way for the OTR® to supervise both COTAs? A. Demonstrate the tasks and have both COTAs return the demonstration. B. Provide written instructions, protocols and discuss them with the COTAs. C. Have both COTAs role play clinical scenarios followed by discussions. D. Have one COTA® perform new tasks and the other observe.

D. Have one COTA® perform new tasks and the other observe. This approach best addresses the different learning styles of each COTA; the COTA® who prefers kinesthetic learning can perform the new task and the visual learner can observe.

A high-level nerve injury may result in which characteristic deformity? A. Flexion of the ring and small finger metacarpophalangeal (MCP) joints because of loss of the extension-controlling forces of the third and fourth lumbricals B. Hyperextension of the index and middle finger MCP joints because of loss of the extension-controlling forces of the first and second lumbricals C. Unchecked abduction of the ring and small finger MCP joints because of lack of motor innervation the third and fourth lumbricals D. Hyperextension of the ring and small finger MCP joints because of loss of the extension-controlling forces of the third and fourth lumbricals

D. Hyperextension of the ring and small finger MCP joints because of loss of the extension-controlling forces of the third and fourth lumbricals The third and fourth lumbricals are innervated by the ulnar nerve. Loss of motor function in these muscles allows the extensor digitorum communis to extend the MCP joints without any opposing controlling forces, also known as "claw hand" deformity.

A client with multiple sclerosis (MS) was referred to occupational therapy because of impaired sensation in both upper extremities. After the COTA®'s service competency was established, the OTR® asked the COTA® to examine the client's stereognosis skills. Which action should the COTA® instruct the client to do after closing the eyes? A. Position the right hand to imitate the left hand. B. Use touch to identify sharp or dull objects. C. Participate in the Semmes-Weinstein standardized sensory assessment. D. Identify an object in the hand by touch only.

D. Identify an object in the hand by touch only. People with MS may experience sensory deficits that affect perceptual skills such as stereognosis.

Believing that treatment was not medically necessary, a third-party payer has denied payment for occupational therapy services. What step should the COTA® take to appeal the denial of payment? A. Write an appeal letter that explains the client's need for the occupational therapy services that were provided. B. Correct technical errors in previously submitted documentation. C. Write an appeal letter that requests reconsideration of previously submitted documentation. D. None; appealing payment decisions is outside the scope of practice for COTAs.

D. None; appealing payment decisions is outside the scope of practice for COTAs. Although a COTA may assist with documentation, appeals for payment of services must be written by an OTR®; or a representative of the treatment facility.

A COTA® has gone out on a date with a client whom the COTA is still treating. A colleague of the COTA finds out about the date and wants to report the incident as a breach of professional ethics. What ethical principle is the COTA violating? A. Beneficence B. Autonomy C. Justice D. Nonmaleficence

D. Nonmaleficence Explanation for correct answer:The principle of nonmaleficence requires that occupational therapy professionals refrain from behavior that could cause harm. The well-being of the client could be jeopardized by a personal relationship with the COTA, which by its nature cannot be therapeutic. The example in the question is about professional boundaries and the objective recommendations or actions by the COTA that could be influenced by a dual relationship. Dual relationships with clients are inappropriate and unethical, whether they are romantic in nature or simply involve taking on a family member as a client.

A COTA® is performing a standardized assessment of a client with Alzheimer's disease, as directed by the OTR®. The client is difficult to redirect while performing the assessment. What would be the BEST approach for the COTA® to use to gather appropriate information to complete the assessment? A. Decide that it is not the appropriate time to complete the assessment; plan to return later in the day. B. Talk to the physician about the client's inability to maintain attention to the assessment. C. Explain to the family members that they should contact the OTR® when the client is able to participate more fully in the assessment. D. Observe the client's behavior and reactions to environmental stimuli to gather information for the assessment.

D. Observe the client's behavior and reactions to environmental stimuli to gather information for the assessment. Observation can yield rich information about a person with dementia. It is one of the primary modes of assessment recommended for people with dementia.

A client is receiving occupational therapy after a right total hip arthroplasty. How would a COTA® using fading techniques to BEST address lower-body dressing tasks? A. Educate the client on the benefits of using a reacher to assist in donning pants and then allow the client to learn from his or her mistakes. B. Demonstrate the use of adaptive equipment and elastic shoelaces to don sneakers, then count the needed verbal cues the client requires for task completion. C. Instruct the client to dress the right leg first and undress the right leg last, and observe for carryover in the next few sessions. D. Offer a visual demonstration of how to use a sock donner, verbally cueing the client on first attempts, and lessening cues with subsequent trials.

D. Offer a visual demonstration of how to use a sock donner, verbally cueing the client on first attempts, and lessening cues with subsequent trials. D begins by providing detailed support in the form of visual demonstration and cueing and then reduces the number of cues as the client performs the task on subsequent trials. Fading approaches to treatment involve reducing or eliminating support as a client's skills improve or develop. The result is improved independence in the activity, in this case lower-body dressing.

A client is currently under partial weight-bearing (PWB) status after a recent hip fracture. How is this weight-bearing restriction BEST described? A. The client may judge how much weight to put on the affected leg. B. The client's affected large toe may touch the ground for balance purposes only. C. Only 10% of the client's weight should be placed on the affected leg. D. Only 50% of the client's weight should be placed on the affected leg.

D. Only 50% of the client's weight should be placed on the affected leg. PWB is defined as only 50% of weight resting on the affected leg.

A client is currently under partial weight-bearing (PWB) status after a recent hip fracture. How is this weight-bearing restriction BEST described? A. The client may judge how much weight to put on the affected leg. B. The client's affected toe may touch the ground for balance purposes. C. Only 10% of the client's weight should be placed on the affected leg. D. Only 50% of the client's weight should be placed on the affected leg.

D. Only 50% of the client's weight should be placed on the affected leg. PWB is defined as only 50% of weight resting on the affected leg.

An OTR® working in an outpatient rehabilitation clinic evaluated a client who was recently hospitalized for dehydration and subsequently diagnosed with mild cognitive impairment. The client lives alone in an independent living facility. Before admission, the client was independent in ADLs and light homemaking and active in community and social activities, including driving independently. The client reports no crash record and no violations or citations but avoids night driving, highway driving, and driving in rush-hour traffic or heavy rain. What occupations or activities can the treating COTA® use that will yield the BEST results for the client's continued independence in fitness to drive? A. Shoulder arch and pulleys to increase the client's ROM B. Light woodworking activities to increase the client's general endurance as a prerequisite for fitness to drive C. Planning routes and trips via Google maps using the computer in the clinic D. Passenger activities for visual scanning, processing, and divided attention skills

D. Passenger activities for visual scanning, processing, and divided attention skills These tasks are consistent with the deficits posed by the client's diagnosis of mild cognitive impairment.

Seating biomechanics take into account the client's stability, postural support, and mobility needs. When determining seating requirements, what would the OTR®-COTA® team FIRST assess? A. Head and neck B. Upper extremities C. Trunk D. Pelvis

D. Pelvis The pelvis and lower extremities need to be stabilized first for overall postural support, followed by the trunk, and then the head, neck, and upper extremities can be addressed for both stability and mobility needs.

A client presents at the occupational therapy clinic with a windswept deformity and needs to be assessed for a new wheelchair and a positioning device. In the documentation required for Medicare, the OTR® and COTA® use the term "windswept deformity" and also describe the impairment in body structure as follows: A. Pelvis rotates posteriorly, increasing trunk flexion B. Pelvis rotates anteriorly, increasing curvature of the lumbar spine C. One side of pelvis is lower than the other, causing lateral flexion on weight-bearing side D. Pelvis rotated to one side, resulting in spine, trunk, and thighs moving to the opposite side

D. Pelvis rotated to one side, resulting in spine, trunk, and thighs moving to the opposite side The thighs moving to the opposite side of the rotated pelvis is a classic sign of windswept deformity.

Public transportation systems might benefit in the long term from investing in greater accessibility and user training opportunities for young people with disabilities. Which statement BEST supports this argument? A. Public transportation providers will avoid financial penalties if they provide high-quality travel training for young people with disabilities. B. Better relationships between public schools and public transportation providers will result from more attention to the needs of young people with disabilities. C. Public transportation systems will have a larger pool of potential employees if they respond to the access and travel training needs of young people with disabilities. D. People who are taught early to use transportation systems that are accessible to their needs often become lifelong users of the system.

D. People who are taught early to use transportation systems that are accessible to their needs often become lifelong users of the system. Precin et al. (2012) noted that people with autism spectrum disorder who are provided with travel training at a relatively young age often become lifelong users of public transportation if it is accessible to them.

A COTA® working in an acute care setting is treating a client in the onset stage of Guillain-Barré syndrome (GBS) who requires total assistance for most tasks. At this stage, what should be the intervention's focus? A. Patient education on the progressive nature of this disease B. ADL performance, adaptive equipment training, and other compensatory strategies C. ROM and strengthening to prevent muscles from further weakening D. Positioning to prevent skin breakdown and allow access to needed items

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

A statement in the Occupational Therapy Code of Ethics (2015) reads, "Occupational therapy personnel shall refrain from actions that cause harm." Which principle is this statement part of? A. Principle 4, Justice B. Principle 2, Nonmaleficence C. Principle 3, Autonomy D. Principle 6, Fidelity

D. Principle 6, Fidelity Principle 2, Nonmaleficence, directly relates to occupational therapy practitioners' obligation to refrain from harming others.

A client with amyotrophic lateral sclerosis requires significant assistance with ADLs because of limited upper-extremity function and fatigue. The client reports an increase in shoulder pain, and edema is observed in the hand. The client uses a wheelchair, and during the occupational therapy evaluation the client's arm is observed hanging at the side of the wheelchair. Which intervention is BEST to address the shoulder pain and hand edema? A. Train the caregiver in PROM for the arm and hand B. Advise the client to continue normal activities using the arm as tolerated to provide active motion C. Fit the client with an adaptive device for grasp, such as a universal cuff D. Provide appropriate arm support using a sling or wheelchair device

D. Provide appropriate arm support using a sling or wheelchair device Because of the client's dependence on wheelchair positioning and loss of upper-extremity function, external arm support may be needed to facilitate proper positioning while in wheelchair and thereby minimize shoulder pain and hand edema.

A client with multiple sclerosis (MS) is experiencing memory deficits that are hindering the client's ability to take medications accurately. Which intervention is the MOST appropriate to support performance in medication management for this client? A. Simplify the task steps in managing medications B. Change the time when the client takes medications C. Have the client use a timer to take medication at designated times D. Provide the client with written directions for medication management

D. Provide the client with written directions for medication management The use of memory aids, such as written directions, has been shown to improve cognitive function for clients with MS, and providing written directions can promote independence and accuracy in managing medications.

A COTA® is scheduled to provide services to a client with multiple sclerosis. The OTR® has delegated the COTA to use the Canadian Occupational Performance Measure (COPM) to assess the client. What step should the COTA take NEXT once the COPM has been completed? A. Interpret the information summarized from the assessment B. Integrate the findings of the assessment into the evaluation C. Determine specific further assessments to use with the client D. Provide verbal and written reports of the findings to the OTR

D. Provide verbal and written reports of the findings to the OTR The COTA can contribute to the evaluation process by carrying out assessments that the OTR has delegated as long as the COTA has the skills to complete the assessment.

According to the Standards of Practice for Occupational Therapy, what is the role of the COTA® in the screening process? A. Completing the screening process B. Initiating the screening process C. Analyzing and interpreting screening results D. Providing observations to the OTR®

D. Providing observations to the OTR® The COTA® can contribute to the screening process and provide reports of observations to the OTR®.

A client with amyotrophic lateral sclerosis reports functional limitations when completing his daily routine. The OTR® has completed ADL and IADL assessments as part of the evaluation. The OTR® asks the COTA® to administer an assessment of the client's upper-extremity motor control. Which assessment would be MOST effective for assessing this client's upper-extremity ability, and appropriate for the client to perform after? A. Modified Ashworth Scale B. Trigger point evaluation C. FIM™ D. Purdue Pegboard test

D. Purdue Pegboard test The Purdue Pegboard test is a timed test of upper-extremity function and is useful in determining a client's functional limitations.

An OTR® is evaluating a 3-year-old child with autism for community-based occupational therapy. Which goal might the OTR recommend? A. Tying and untying knots B. Buttoning a series of buttons C. Buckling shoes or belt D. Putting on a pullover shirt

D. Putting on a pullover shirt Putting on a pullover shirt is recommended as an intervention activity for a 3-year-old child with autism. The other skills are more advanced and are generally achieved by typically developing children after age 3.5 years.

When the AOTA Ethics Commission determines that unethical conduct has occurred, it typically issues a disciplinary action. Which disciplinary action does NOT require public report of conclusions and sanctions? A. Suspension of AOTA membership B. Censure C. Revocation of AOTA membership D. Reprimand

D. Reprimand Reprimand is a formal expression of disapproval of conduct communicated privately by letter from the AOTA Ethics Commission.

An occupational therapy practitioner has identified a situation that is causing an ethical conflict. What should the occupational therapy practitioner do next to address the ethical conflict? A. Formulate possible resolutions to remediate the conflict B. Identify the resources available to resolve the conflict C. Report the ethical conflict to the state regulatory board D. Review professional obligations and validate the situation with trusted others

D. Review professional obligations and validate the situation with trusted others Once an ethical conflict or dilemma is identified, the practitioner should affirm the situation by discussing with trusted colleagues and reviewing the Occupational Therapy Code of Ethics and state regulations. The practitioner can the determine the pros and cons of various options by analyzing factors and prepare to take the most appropriate action.

A COTA® wants to develop a group activity for clients with personality disorder in an inpatient psychiatric facility. The group has Allen Cognitive Level (ACL) scores ranging from 5.0 to 5.4. What activity would be MOST appropriate to use with these clients in the initial stages of the group? A. Volunteer activities in the community B. Long-term budgeting for house repairs C. Vocational retraining and job seeking D. Role-playing social interactions

D. Role-playing social interactions Incorrect. You answered B. People with personality disorders and people with an ACL in the low 5s have difficulty with social interactions because they are egocentric. Role playing social interactions would be best option when initiating a group with these clients. Improving social interaction will form the basis for the rest of the interventions appropriate for this group.

A 76-year-old client will be using a wheelchair after discharge from an acute rehabilitation facility. The client has achieved independence in wheelchair mobility on level surfaces but still requires minimal assistance for transfers. The client is planning to move into a daughter's home, which was not the client's previous residence. A COTA® has been the client's primary clinician. The supervising OTR® and the COTA® conduct an onsite home evaluation with the client and the client's daughter. During the home evaluation, it is obvious that the hallway to the bathroom is too narrow for the client to turn the wheelchair without assistance. What would be the MOST APPROPRIATE transitional recommendation to include in the report? A. Referral to homecare occupational therapy for wheelchair mobility training B. Training in a 3-point wheelchair-turning technique in a narrow hallway C. Wearing an adult diaper and refraining from using the bathroom D. Securely placing a bedside commode between the bed and the side wall

D. Securely placing a bedside commode between the bed and the side wall Access the bathroom using a wheelchair is often challenging. A bedside commode provides an alternative means for toileting.

A client with a learning disability is interested in exploring work opportunities after high school graduation. The client has difficulty sequencing more than three-step directions and lacks attention to detail. Which option would be considered a component of the student's transitional program plan? A. Completion of a transition-related evaluation by a vocational rehabilitation counselor to identify the student's strengths, weaknesses, and interests B. Completion of a job site analysis with physical demands to determine the feasibility of the client's performing specific tasks C. Provision of written directions to complete a three-step task and use of samples to promote problem solving D. Situational observation, interview, and activity analysis to determine a match between the client's abilities and expected performance

D. Situational observation, interview, and activity analysis to determine a match between the client's abilities and expected performance Correct! You answered D. An effective transition-related evaluation primarily uses situational observation, interview, and activity analysis to determine a match between the client's abilities and expected occupational performance.

A COTA® is working with a client who is experiencing dyspnea while performing a daily occupation in sitting. What sitting position would BEST minimize the client's dyspnea while performing the occupational task? A. Sitting with trunk erect and rigidly in midline B. Sitting with trunk extended and slightly to one side in a more relaxed posture C. Slouching to one side and leaning on one arm for improved trunk support D. Slouching forward while avoiding maximum forward trunk bending

D. Slouching forward while avoiding maximum forward trunk bending To ease breathing, lean partially forward, propping the forearms on the upper thighs.

A client with traumatic brain injury is displaying decorticate rigidity. How would the client's upper-extremity position BEST be described? A. Flaccid and extended, with internal rotation and adduction B. Spastic and flexed, with external rotation and abduction C. Flaccid and flexed, with external rotation and abduction D. Spastic and flexed, with internal rotation and adduction

D. Spastic and flexed, with internal rotation and adduction Upper extremities in decorticate rigidity are spastic and flexed, with internal rotation and adduction.

A client with traumatic brain injury is displaying decorticate rigidity. How would the client's upper-extremity position BEST be described? A. Flaccid and extended, with internal rotation and adduction B. Spastic and flexed, with external rotation and abduction C. Flaccid and flexed, with external rotation and abduction D. Spastic and flexed, with internal rotation and adduction

D. Spastic and flexed, with internal rotation and adduction Upper extremities in decorticate rigidity are spastic and flexed, with internal rotation and adduction.

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

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

A COTA® is working with a client on functional transfers from the bed to the wheelchair. The client has a tendency to do unexpected things when transferring, requiring the COTA to be extremely aware of proper body mechanics to complete the transfer in a safe manner for both the COTA and the client. Which of the following principles should the COTA follow to avoid injury? A. Combine movements such as bending and rotating so that the transfer is more fluid. B. Keep a small base of support to avoid entangling the COTA's and the client's feet. C. Keep a slightly arched back to be prepared if the client begins to fall. D. Stay close to the client to keep the weight of the transfer next to the COTA.

D. Stay close to the client to keep the weight of the transfer next to the COTA. Keeping the weight of the client close while assisting with a transfer allows the COTA to lift with the strongest parts of the body. If the client is farther away, the COTA's arms will do the majority of the work.

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

D. Teach the client to inspect the skin on a daily basis. The client must learn to perform self-inspections regularly.

An OTR®; decides to use the Cognitive Orientation to daily Occupational Performance (CO-OP) approach to encourage use of effective and appropriate social behaviors for a 9-year-old with attention deficit hyperactivity disorder. Which example illustrates an application of the CO-OP approach? A. The OTR, with some input from the child, establishes goals for the child regarding essential skills that the parent thinks need to be developed. B. The OTR directly teaches important strategies to help the child remember how to respond in stressful social situations. C. The OTR targets multiple skills in social situations to optimize the learning environment. D. The OTR asks questions to allow the child to process what behaviors were appropriate and inappropriate in a situation.

D. The OTR asks questions to allow the child to process what behaviors were appropriate and inappropriate in a situation. This approach is an example of the "ask, don't tell" principle of guided discovery using CO-OP. The OTR asks rather than tells the child the sources of breakdown during performance in occupations.

An OTR®; is conducting a treatment session with a child who has low frustration tolerance for highly structured activities. During a writing activity, the child gets very frustrated. The OTR decides to divert the child's primary adaptive energy and facilitate secondary adaptive energy using principles from the Theory of Occupational Adaptation. Which strategy BEST exemplifies this approach? A. The OTR facilitates the use of a coping strategy to help the child get less upset with the challenging task. B. The OTR asks the child to put down the pencil, take a 30-second break, and go back to writing. C. The OTR asks the child to do two more sentences and then choose a reward activity of choice. D. The OTR asks the child to do a treasure hunt game instead and incorporates a writing task into the game.

D. The OTR asks the child to do a treasure hunt game instead and incorporates a writing task into the game. When facilitating the secondary adaptive energy according to the Theory of Occupational Adaptation, the OTR uses meaningful and engaging occupations to allow unloading of primary energy needed for a challenging activity. When tapping the secondary adaptive energy, the OTR uses meaningful and enjoyable occupations the client prefers and incorporates aspects of challenging tasks that the client needs to work on.

A COTA® working on an inpatient rehabilitation unit has had two patients fall during intervention sessions in the past month. The supervising OTR® has concerns about the COTA®'s safety awareness during certain interventions. Which approach can the COTA® expect the OTR® to take to help the COTA® BEST address these concerns? A. The OTR® will speak with the rehabilitation manager to discuss a possible disciplinary reprimand and course of action. B. The OTR® will review the documentation of the two patients who fell and interview COTA® to determine the causes of the falls. C. The OTR® will ask the COTA® whether more thorough supervision is needed and then proceed to provide close supervision during COTA®'s intervention sessions.. D. The OTR® will collaborate with the COTA® to determine potential causes of the falls and provide direct supervision with more deliberate feedback.

D. The OTR® will collaborate with the COTA® to determine potential causes of the falls and provide direct supervision with more deliberate feedback. Supervision that is more frequent may be necessary when the OTR®, COTA®, or both determine that additional supervision is needed to ensure safe and effective delivery of occupational therapy services. In this case, safety is a major concern, and therefore additional supervision may be necessary.

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The COTA® is assisting the OTR in writing the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." What conclusion can you draw about the specific conditions (or S) under which this client is supposed to complete the occupation? A. The client will complete the occupation in the hospital's kitchen with adaptive equipment. B. The client will complete the occupation at home with no adaptive equipment. C. The client will complete the occupation at a community transitional facility using modified techniques. D. The client will complete the occupation in the hospital's kitchen using no adaptive equipment or modified techniques.

D. The client will complete the occupation in the hospital's kitchen using no adaptive equipment or modified techniques. Because the goal contains no specifications for adaptive equipment or modified techniques, it is appropriate to assume that the client will not require special conditions for the completion of this goal. Given that the client is attending a predischarge hospital cooking group, it is appropriate to assume that the occupation will be completed in the hospital's kitchen.

An OTA student arrives at a facility for Level II fieldwork and discovers that the planned OTR®; supervisor has to take an unplanned leave for the duration of fieldwork. An entry-level COTA® is present at the facility. The student asks the COTA about the fieldwork supervision process. How should the COTA respond to the student? A. The student may be supervised by the entry-level COTA as long as the COTA consults with the OTR. B. The student may be supervised by an OTR who works at another facility. C. The student may be supervised by an entry-level COTA who works at another facility. D. The student cannot complete fieldwork at the facility because adequate supervision is not available.

D. The student cannot complete fieldwork at the facility because adequate supervision is not available. An OTA Level II fieldwork student may be supervised only by an OTR or COTA with more than 1 year of experience. Because neither an OTR nor a COTA with sufficient experience is available to supervise the student onsite, the student cannot complete fieldwork at the facility.

An OTA student arrives at a facility for Level II fieldwork and discovers that the OTR®; supervisor has to take unplanned leave for the duration of fieldwork. An entry-level COTA® is present at the facility. What options does the student have for appropriate fieldwork supervision at that facility? A. The student may be supervised by the entry-level COTA as long as the COTA consults with the OTR. B. The student may be supervised by an OTR who works at another facility. C. The student may be supervised by an entry-level COTA who works at another facility. D. The student cannot complete fieldwork at the facility because adequate supervision is not available.

D. The student cannot complete fieldwork at the facility because adequate supervision is not available. An OTA Level II fieldwork student may be supervised only by an OTR or a COTA with more than 1 year of experience. Because neither an OTR nor a COTA with sufficient experience is available to supervise the fieldwork student onsite, the student cannot complete fieldwork at the facility.

A COTA® has a client who came into the clinic with a wheelchair that was borrowed from a relative. The client asks whether it would be possible to use the wheelchair permanently to save money. After consulting with the OTR®, both the COTA and the OTR agree that the wheelchair is too tall for the client. How did they reach this conclusion? A. They observed that the client is sliding out of the chair. B. The client is complaining about pain in the ischial tuberosity. C. The client has to lean out of the chair to propel it. D. They observed that the client's feet do not touch the floor.

D. They observed that the client's feet do not touch the floor. The client's feet not touching the floor is an indication that the wheelchair is too tall and could cause pain, lack of activity, and edema in the lower extremities, among other issues

An OTR® and a COTA® are providing a back injury prevention program for workers at a food manufacturing plant. The OTR® and COTA® have provided education in proper body mechanics and on proper equipment use to decrease effort with tasks. Which component should they also include in the program? A. Support group to reinforce learned techniques B. Functional capacity evaluation to access aptitude C. Instruction in the use of physical agents D. Training in symptom identification for early recognition

D. Training in symptom identification for early recognition Workers should be educated to identify and report symptoms early; evidence indicates that early identification of musculoskeletal disorders in the workplace reduces the severity of the injury and associated costs.

An inpatient who has Stage III lung cancer undergoes surgery for removal of axillary lymph nodes of the dominant upper extremity, followed by palliative chemotherapy. The patient is referred to occupational therapy for ROM, edema management, and preparation for hospice care at home. Which intervention modality is CONTRAINDICATED for reducing edema of this patient's affected extremity? A. Gradient compression garments B. Superficial slow-speed vibration C. Manual decongestive therapy D. Transcutaneous electrical nerve stimulation

D. Transcutaneous electrical nerve stimulation Use of modalities may exacerbate edema conditions and are generally contraindicated in situations of cancer.

A client with multiple sclerosis has recently become more dependent on a manual wheelchair for functional mobility. The client lives alone and wants to remain independent. The client's house has two entrances: The front entrance has four steps with a total height of 28 inches. The entrance from the backyard has a 5-inch-high threshold and another separate 5-inch-high step 10 feet away from the threshold. What would be the MOST appropriate ramp modification for this client? A. A 14-foot-long ramp at the front entrance B. A 28-foot-long ramp at the front entrance C. A 20-foot-long ramp at the back entrance, covering the step D. Two 5-foot-long ramps for the back entrance and the step

D. Two 5-foot-long ramps for the back entrance and the step According to the Americans With Disabilities Act of 1990 (Pub. L. 101-336) accessibility guideline, the maximum slope of a ramp is 1:12. Using two ramps at the back entrance has the advantage of shorter ramps, which are easier for a wheelchair user.

An OTR® is evaluating an adolescent client with juvenile rheumatoid arthritis. As a result of the evaluation, the OTR recommends that the client use joint protection techniques during IADLs. Based on joint protection principles, which strategy would be appropriate for the OTR to recommend? A. Carry as many laundry baskets as possible when putting away laundry to reduce the number of trips required B. Engage in high-weight, high-resistance activities with frequent repetitions to maintain strength C. Use a medicine bag-style satchel to carry books and other materials in the hand rather than on the shoulder D. Use a backpack to carry books and other materials on the back by placing the straps at both shoulders

D. Use a backpack to carry books and other materials on the back by placing the straps at both shoulders Carrying items in a backpack on the back with the straps at both shoulders is an example of a joint protection technique; the client uses the largest joints possible to complete the task.

A school-based OTR®; is working with a child who has severe emotional disturbance. The child frequently responds "No!" to provoke a strong response from others, is extremely disorganized when provided a series of instructions, and has sudden emotional outbursts when frustrated with challenging tasks. Which strategy to enhance the client's behavioral performance in school will be MOST effective? A. Ask the child whether he or she wants to do a particular activity during therapy B. Plan activities that have a difficulty level that is no more than one or two levels higher than the child's ability C. Avoid the use of written rules because they will only provoke strong emotional reactions from the child D. Use a small, enclosed room to help contain behavioral expression during sudden outbursts

D. Use a small, enclosed room to help contain behavioral expression during sudden outbursts During emotional outbursts, using a small and enclosed room can help contain behavioral expressions and reduce attention seeking.

SafeKids USA is a nonprofit organization dedicated to eliminating preventable childhood injuries, including those related to childhood community mobility, such as pedestrian, bicycle, and car seat accidents. Which SafeKids resource would be MOST useful for a COTA® working in an early intervention program? A. Statistics on safety while walking to school B. Educational brochures on cycling safety for adolescents C. Information about effective driver training for teens D. Videos addressing car seat safety for young children with special needs

D. Videos addressing car seat safety for young children with special needs COTA®s working in early intervention need to be knowledgeable about car seat fit and safety for children with developmental disabilities. SafeKids USA resources addressing this topic would be most useful relative to the age and needs of children in early intervention.

When an occupational therapy practitioner assesses a client's visual range of view without eye or head movements, what is the practitioner examining? A. Stereopsis B. Depth perception C. Visual acuity D. Visual field

D. Visual field Visual field is the range of view without eye or head movements.

A client with low vision has difficulty with functional mobility, especially in dynamic environments, and becomes anxious when moving into an unfamiliar environment. What type of vision loss does this client most likely have? A. Visual acuity loss B. Reduced contrast sensitivity C. Oculomotor dysfunction D. Visual field deficit

D. Visual field deficit Visual field deficit results in a narrowing of visual search and scanning, slowing of scanning to the blind side, missing or misidentified visual detail, and reduced visual monitoring of the hand. The primary activities affected are functional mobility, reading, and writing. Anxiety is common in people with visual field deficit because of challenges using scanning and visual search to negotiate environments.

A 76-year-old client will be using a wheelchair after discharge from an acute rehabilitation facility. The client has achieved independence in wheelchair mobility on level surfaces but still requires minimal assistance for transfer. The client is planning to move into a daughter's home, which was not the client's previous residence. A COTA® has been the client's primary clinician. The supervising OTR® and the COTA® conduct an onsite home evaluation with the client and the client's daughter. In determining accessibility of the home environment during the onsite home evaluation, with what area of evaluation will the OTR® and COTA® be MOST concerned? A. Location and height of light switches B. Presence of clutter in the environment C. Arrangement of furniture in the bedroom D. Width of doorways and hallways

D. Width of doorways and hallways Clients who use a wheelchair as a primary means of functional mobility require wider doorways and hallways for accessibility. Structural modifications may need to be done if the entryway to the house has any barrier.

Which client factor is likely affected in a client in the hospital-based setting with Guillain-Barré syndrome? A. Sensation B. Cognition C. Vision D. Hearing

A. Sensation Because of the painful sensations that are intially reported with Guillain-Barré syndrome, the client's tolerance for tactile input and current sensory abilities will likely influence interventions with the client.

A COTA® is working with a client experiencing lower back pain, particularly after waking in the morning. What is the MOST APPROPRIATE recommendation that addresses the client's sleeping habits? A. Sleep on back with pillow under knees. B. Purchase a thick, cotton pillow. C. Sleep on stomach with pillow under knees. D. Purchase a soft pillowtop mattress.

A. Sleep on back with pillow under knees. When sleeping on the back, the client can put a pillow under the knees to reduce strain on the lower back.

A COTA® is working with a client in the acute phase of Guillain-Barré syndrome. Which client action demonstrates the ability to direct care? A. Stating that assistance is needed to change position in bed B. Reporting that less anxiety is experienced with ADL C. Making a phone call using the phone in the hospital room D. Telling nursing staff about the home living environment

A. Stating that assistance is needed to change position in bed A client in the acute phase of Guillain-Barré syndrome may not be able to participate directly in activities; statement of the need to change position in bed reflects an awareness of needs and ability to request assistance.

A client has fair (3/5) muscle strength of the shoulder flexors and is participating in a strengthening program. Which position and movement pattern would be MOST EFFECTIVE for initially increasing strength of the client's shoulder flexors? A. Seated, moving the arm in a sagittal plane B. Seated, moving the arm on a skateboard C. Side lying, moving the arm in a horizontal plane D. Supine, moving the arm in a non-resisted plane

A. Seated, moving the arm in a sagittal plane upine, moving the arm in a non-resisted plane Moving the arm in the sagittal plane will allow active movement against gravity, which in turn will facilitate the client's current strength with full active motion against gravity.

A COTA® is working with a client who was recently diagnosed with De Quervain's tenosynovitis. In addition to the medical treatment of corticosteroid injection, what nonoperative treatment is MOST appropriate for this condition? A. Forearm-based thumb spica splint B. Hand-based thumb spica splint C. Wrist cock-up splint to 10° extension D. Wrist cock-up splint with dynamic extension assist

A. Forearm-based thumb spica splint De Quervain's tenosynovitis is a stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis of the first dorsal compartment, so the thumb and wrist both need to be immobilized.

State laws vary with regard to use of physical agent modalities (PAMs) by COTA®s. When explaining how PAMs fit within the scope of occupational therapy practice in their state, which description of PAMs should COTAs use, provided in the Occupational Therapy Practice Framework: Domain and Process? A. Preparatory methods used as part of a treatment session in preparation for purposeful or occupation-based activity B. Occupation-based interventions that are systematically applied to modify specific client factors that may be limiting occupational performance C. Activities that support performance skills and patterns D. Preparatory tasks that target specific client factors or performance skills

A. Preparatory methods used as part of a treatment session in preparation for purposeful or occupation-based activity Preparatory methods are described in the Framework as "modalities, devices, and techniques to prepare the client for occupational performance" (AOTA, 2014, p. S29). They may be used as part of a treatment session or concurrently with occupations and activities that support occupational performance.

A statement in the Occupational Therapy Code of Ethics (2015) reads, "Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services." Which principle is this statement part of? A. Principle 1, Beneficence B. Principle 5, Veracity C. Principle 4, Justice D. Principle 3, Autonomy

A. Principle 1, Beneficence Principle 1, Beneficence, involves the commitment to benefit others and to be concerned with the well-being and safety of service recipients.

The Occupational Therapy Code of Ethics (2015) states, "Occupational therapy personnel shall treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity." What principle does this statement directly relate to? A. Principle 6, Fidelity B. Principle 1, Beneficence C. Principle 2, Nonmaleficence D. Principle 4, Justice

A. Principle 6, Fidelity This statement is used in Principle 6, Fidelity, of the Occupational Therapy Code of Ethics (2015).

An uninsured client asks to be referred to a nontraditional occupational therapy setting where services are billed privately at a reduced rate. What should the COTA® do next? A. Recommend referral to the OTR®, assist in optimizing transition of services, and help inform the client about the pros and cons of transfer. B. Share certain information as a means to protect the client. C. Decide to not pursue the referral because of the financial loss for the employer. D. Discourage referral and work with the OTR to retain the client within the traditional setting.

A. Recommend referral to the OTR®, assist in optimizing transition of services, and help inform the client about the pros and cons of transfer. A This option provides the client with the most control of the scenario through informative efforts by the clinician. It also upholds the ethical principle of Autonomy.

A COTA® observes that a client with Parkinson's disease has fine motor difficulties when dressing. Which strategy is BEST for improving performance in dressing? A. Reduce the need for fine motor skills by eliminating clothing fasteners B. Do fine motor exercises to improve this client factor for ADL performance C. Engage in sensory reeducation to compensate for fine motor difficulties D. Use a button hook and zipper pull to manipulate clothing fasteners

A. Reduce the need for fine motor skills by eliminating clothing fasteners Eliminating clothing fasteners is a task modification that decreases the level of performance difficulty. This strategy is also the most readily manageable option for this client, because of the progressive loss of fine motor function.

A COTA® is treating a client with a nondisplaced radial head fracture and is following the referring physician's order for an immediate mobilization protocol and the OTR®′s intervention plan. In which position would the client BEST tolerate early elbow flexion and extension? A. Supine with the upper arm supported on a folded towel along the torso B. Seated upright with the affected extremity free to flex and extend alongside the chair C. Standing with the affected extremity close to the torso D. Prone with the upper arm supported on a folded towel along the torso

A. Supine with the upper arm supported on a folded towel along the torso Positioning in supine with the upper arm supported on a folded towel along the torso facilitates gravity-assisted motion of the elbow with support to the affected extremity. Gravity-assisted motion allows for early, nonresistive motion of a stable fracture, which can promote bone healing.

174; A client with a chronic median nerve compression at the carpal tunnel has severely diminished functional pinch. In what position should the thumb be splinted to facilitate functional pinch? A. The thumb should be splinted in opposition and palmar abduction to facilitate thumb-to-tip prehension. B. The thumb should not be included in a carpal tunnel orthotic to allow for functional prehension. C. The thumb should be splinted in opposition and radial abduction to facilitate thumb-to-tip prehension. D. The thumb should be splinted in extension to limit shortening of the extensor pollicus longus.

A. The thumb should be splinted in opposition and palmar abduction to facilitate thumb-to-tip prehension. Opposition and palmar abduction represent the functional position of the thumb that best allows pinch.

What is the purpose of the Occupational Therapy Code of Ethics (2015)? A. To describe the core values and standards of conduct expected of occupational therapy practitioners B. To resolve legal and business disputes related to occupational therapy practice C. To provide access to professional ethicists to resolve disputes between occupational therapy practitioners and clients D. To uncover and expose inappropriate clinical practices that have no support in the research

A. To describe the core values and standards of conduct expected of occupational therapy practitioners The Occupational Therapy Code of Ethics (2015) provides aspirational core values to guide ethical courses of action and delineates enforceable principles and standards of conduct for AOTA members in practitioner, educator, researcher, student, or volunteer roles.

A COTA® is fabricating a splint for a patient who had a recent palmar contracture release. What is the PRIMARY purpose of the splint? A. To protect the surgical site B. To block MCP joint extension C. To increase MCP joint flexion D. To maximize finger extension

A. To protect the surgical site Palmar contracture release is to bring the fingers out of flexion and into extension; splinting postsurgically allows the fingers to rest in extension.

An OTA claims on a resume an ability to provide physical agent modality treatments. However, the OTA has not completed training in this area or ever provided such treatments. Which ethical principle is the OTA violating? A. Veracity B. Nonmaleficence C. Justice D. Freedom

A. Veracity The principle of Veracity requires personnel to be honest with claims of ability and professional skills. Personnel must "represent credentials, qualifications, education, experience, training, roles, duties, competence, contributions, and findings accurately in all forms of communication."

According to the AOTA Ethics Commission's advisory opinion on balancing patient rights and practitioner values, when is it ethically acceptable for an occupational therapy practitioner to refrain from providing services? A. When the environment poses a clear threat to the practitioner's safety B. When a client uses repugnant, harsh, or inappropriate language C. When the moral values of the client and practitioner are clearly in conflict D. When the practitioner feels an overwhelming aversion to the client

A. When the environment poses a clear threat to the practitioner's safety The Ethics Commission's advisory opinion reads, "Although there is an overarching professional duty to provide benefit to clients, there may be unsafe situations in which the practitioner may ethically refrain from providing service" (Brandt & Homenko, p. 123).

According the ethical principle of Justice, a COTA® is obliged to be aware of certain laws such as the Americans With Disabilities Act (ADA). A COTA who is also a rehab manager in a long-term care facility has an incoming fieldwork student who is requesting an accommodation for a disability. How should the COTA respond to the request? A. Work with management and the supervising OTR® to determine whether the site can reasonably accommodate the request. B. Deny the request, because the health care environment already accommodates people with disabilities. C. Work with the student and the student's occupational therapy program to determine specific needs. D. Refer the question to the facility's human resources department.

A. Work with management and the supervising OTR® to determine whether the site can reasonably accommodate the request. Reasonable accommodation for employees with disabilities is required under the ADA, so it is appropriate to attempt to accommodate the fieldwork student. Determining whether the site can accommodate the request, consulting with management as necessary as well as any practitioners who may be affected by the decision, is the best option.

A COTA® is conducting a treatment session with a client with chronic obstructive pulmonary disease. While engaging in a light work task from a seated position, the client suddenly experiences extreme shortness of breath, and panics. Which response by the COTA® would be MOST appropriate? A. Ask the client to lean backward and rest the arms on the chair arms, then practice pursed-lip breathing B. Ask the client to lean forward and place the forearms on the thighs, then practice pursed-lip breathing C. Ask the client to sit upright and allow the arms to dangle and guide the client to use visual imagery D. Ask the client to sit upright, use one arm for the work task, and use the other arm to bear weight and support the trunk

B. Ask the client to lean forward and place the forearms on the thighs, then practice pursed-lip breathing Resting the arms on the thighs releases the diaphragm, making breathing easier and lessening fear. Pursed-lip breathing can slow breathing and reduce anxiety.

During a seated lower-extremity screening, a client can flex the hips and knees bilaterally and demonstrates good plantar and dorsiflexion at the ankles. After manual muscle testing, the client's hips and knees are able to tolerate moderate resistance bilaterally. Given this information, what could the COTA® safely do with this client next? A. Ask the client to complete some light housekeeping tasks so that the COTA can assess IADL skills. B. Ask the client to stand up so that the COTA can assess the client's balance and ability to ambulate. C. Ask the client to do light hygiene tasks while seated at the edge of the chair. D. Ask the client to perform high-level balance tasks, such as standing on one foot while catching a ball.

B. Ask the client to stand up so that the COTA can assess the client's balance and ability to ambulate. The client demonstrates adequate strength to stand. The COTA can safely proceed to assess sit-to-stand transfer and stand the client with assist. If the client demonstrates good balance in static standing, the COTA can then proceed to ambulation with the client.

A COTA® is working in the burn unit of a hospital. A client has undergone skin grafting to close wounds on the dorsum of the hand. What occupational therapy treatment is MOST appropriate for the 5 to 7 days post skin graft? A. Instruct client in AROM of the wrist and hand but limit PROM until the staples are removed B. Fabricate and fit the client with a safe position splint over the dressings C. Involve the use of the grafted hand in ADLs that involve resistive grasp D. Perform PROM to the wrist and hand but instruct the client to limit use of the hand outside of occupational therapy treatment sessions

B. Fabricate and fit the client with a safe position splint over the dressings Splinting the hand in the safe position allows the graft to take and the wound to heal and prevents deformities.

A COTA® is treating a client with a proximal interphalangeal (PIP) flexion contracture secondary to a sports injury. To improve extension of the PIP for functional use of the hand, what is the BEST use of limited therapy time? A. Apply paraffin followed by joint mobilization techniques B. Fit the client with a prefabricated dynamic PIP extension assist splint C. Instruct the client in flexion blocking exercises D. Fabricate a customized dynamic PIP extension assist splint

B. Fit the client with a prefabricated dynamic PIP extension assist splint A prefabricated dynamic PIP extension assist splint will improve PIP extension and takes less therapy time to fit than to custom make this splint.

A COTA® is fabricating an orthotic for a client with radial nerve palsy. Which of the following orthotic designs is appropriate to improve function? A. Forearm-based, radial thumb spica which supports the lateral aspect of the wrist and hand B. Forearm-based wrist orthotic that maintains the wrist in 30° of extension C. Anti-claw orthosis D. Hand-based short thumb spica

B. Forearm-based wrist orthotic that maintains the wrist in 30° of extension This orthosis will usually allow the client to extend the fingers for object release using the intrinsic hand muscles

A client has been diagnosed with lateral epicondylitis (tennis elbow). The client works in the maintenance department of a large factory and has been unable to complete some work tasks because of pain. The client fears losing this job if the pain does not improve quickly. What is the BEST strategy to assist the client with work tasks while providing relief from pain? A. Ask the client for permission to call his boss and request 3 to 4 weeks off for his arm to heal. B. Identify environmental modifications to help the client complete work tasks without aggravating symptoms. C. Give the client a tennis elbow strap and a stretching home exercise program and follow up in 1 week. D. Suggest the client keep an ice pack at work, and instruct the client to ice the arm on breaks.

B. Identify environmental modifications to help the client complete work tasks without aggravating symptoms. Lateral epicondylitis is a repetitive strain injury. This client is likely experiencing these symptoms as a result of job tasks that require repetitive gripping and supination. The best approach is to discuss environmental modifications with the client and implement strategies during the work day to decrease symptom aggravation caused by job tasks.

An OTA student on Level II fieldwork came to the fieldwork site drunk and attempted to treat clients. The student was reported by the supervisor and found in violation of the NBCOT® Code of Conduct. What is the most severe sanction the student could receive? A. Public censure B. Ineligibility for certification C. Failed fieldwork D. Letter of reprimand

B. Ineligibility for certification Ineligibility for certification is the most severe discipline because the student would be unable to become certified as a COTA®.

A client sustained a nondisplaced humeral neck fracture after a fall. Which is the BEST course of occupational therapy that one would expect the OTR® to note on the evaluation? A. Instruct the client in use of a sling with no ROM for 3 weeks B. Instruct the client in use of a sling with supervised ROM C. Provide no occupational therapy intervention because the client will have a surgical reduction D. Fabricate a removable orthosis

B. Instruct the client in use of a sling with supervised ROM With a nondisplaced fracture of the humeral neck, support from a sling and supervised exercise lead to the most desirable outcome.

A COTA® is seeing a client 2 days post laminectomy surgery for back pain. The OTR® already completed the evaluation. What would the treatment session MOST likely emphasize? A. Instruction in use of a transcutaneous electrical nerve stimulation unit for pain relief B. Instruction in log rolling and sitting and standing postures C. Use of an ambulation device during functional activities D. Scar management techniques

B. Instruction in log rolling and sitting and standing postures Normal spinal alignment needs to be maintained post surgery and providing instruction for spinal alignment in early mobility tasks is essential.

A COTA® is treating a client who sustained second- and third-degree burns on the dorsal forearm and hand. Which splint would be appropriate for this client? A. Resting hand splint B. Intrinsic plus splint C. Cone antispasticity splint D. Dorsal flexor tendon repair splint

B. Intrinsic plus splint Burns to the dorsum of the hand require the metacarpophalangeal joints to be splinted in 70°-90° of flexion to prevent clawing of the fingers and shortening of the tendons and ligaments. This type of splint is also referred to as an antideformity splint or a safe position splint.

A COTA® is working in an inpatient setting with veterans who have upper-extremity amputations. Each morning the rehabilitation team, consisting of physician, nurse, psychologist, social worker, OTR, COTA, physical therapist, and orthotist, come together to discuss their patients' progress toward the goals set within their individual disciplines. What type of team is this? A. Transdisciplinary team B. Multidisciplinary team C. Interdisciplinary team D. Allied health team

B. Multidisciplinary team A multidisciplinary team is an interprofessional team composed of individuals representing the professional disciplines that serve the client.

A COTA® is treating a client who sustained dorsal hand burns secondary to a work-related injury. In the intensive care unit phase of treatment, which technique for completing ROM of the hand is safest? A. Passively range all digits and joints at once B. Passively range each digit and joint individually C. Instruct the client to actively flex and extend all digits D. Instruct the client to wear a resting hand splint at all times

B. Passively range each digit and joint individually Ranging each joint separately decreases the chance of rupturing finger extensor tendons with dorsal hand burns.

An OTR®-COTA® team is establishing reasonable accommodations for a client employee as a tax auditor. The client has recently been diagnosed with posttraumatic stress disorder (PTSD) characterized by panic attacks as a result of being stalked and harassed by a disgruntled taxpayer. The essential job functions include auditing financial records to determine tax liability; information gathering; analyzing finances to determine net worth or reported financial status and identify potential tax issues; conferring with taxpayer or representative via phone or in person to explain the issues involved and the applicability of pertinent tax laws and regulations; and participating in informal appeals hearings on contested cases. Which accommodation is MOST appropriate for the OTR®-COTA® team to recommend? A. Recommend that the employer allow the client to play soothing music using a digital music player and a headset throughout the work day to relax and reduce stress. B. Provide the client with a telephone with a caller ID function, call blocking function, or both so that the client can screen callers in advance. C. Institute a policy for employees to participate in daily meditation and yoga classes. D. Hire a full-time security guard and install a surveillance system throughout the workplace.

B. Provide the client with a telephone with a caller ID function, call blocking function, or both so that the client can screen callers in advance. Essential job functions are defined as job duties fundamental to the position the individual holds or desires to hold, as opposed to functions that are marginal. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. PTSD is a debilitating condition that can occur after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that can trigger PTSD include violent personal assaults such as rape or mugging and natural or human-caused disasters, accidents, or military combat. Many people with PTSD repeatedly reexperience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects reminiscent of the trauma. As a result of being stalked and harassed while performing job duties, this client may benefit from use of caller ID to screen calls in advance of answering the phone.

A client with bilateral transtibial amputation is being fitted for a wheelchair. Which of the following adaptations is MOST important? A. Swing-away elevating footrests B. Rear antitipping devices C. Padded swing-away arm rests D. Wheel-lock extensions

B. Rear antitipping devices Because of the change in their center of gravity, clients with bilateral amputations are more likely to tip over backward during weight shifts. Rear antitipping devices are necessary for safety.

A client with recent hip replacement surgery is concerned about how to shampoo hair while not able to use the shower at home. What recommendation from the COTA® will most appropriately address the client's concern? A. The client may shampoo the hair while standing in the shower, covering the hip with a plastic bag. B. The client may shampoo the hair while sitting on a stool or standing at the kitchen sink. C. The client may shampoo the hair while in a wheelchair at the bathroom sink. D. The client may shampoo the hair while standing at the bathroom sink.

B. The client may shampoo the hair while sitting on a stool or standing at the kitchen sink. Bending forward at the kitchen sink does not require as much hip flexion as bending forward at a typical bathroom sink; many clients are able to wash hair at the kitchen sink without compromising hip precautions.

Which consideration is MOST important for a safe transfer? A. The client's ability to complete upper-extremity ADL tasks B. The client's medical condition—both physical and cognitive status C. The type of surface on which the client will be transferring D. The amount of space between transfer surfaces

B. The client's medical condition—both physical and cognitive status The client's physical and cognitive status must be thoroughly assessed before deciding whether a transfer can be safely performed. Physical abilities will tell the COTA® how much the client might be able to help with the transfer, and cognitive status will tell the OTR how much the client might understand during the transfer. Cognitive status will also affect the technique and cueing used during the transfer.

What is the AOTA Ethics Commission's position on online social networking? A. Ethical guidelines do not apply to the use of online social networking during personal time. B. Discussion of clients between two occupational therapy practitioners on online social networking sites is appropriate as long as no names or other identifiers are used. C. Active participation in online social networking sites is subject to the same ethical constraints during both personal and professional time. D. Accepting a fieldwork educator's invitation to become Facebook friends is useful to the student-educator relationship.

C. Active participation in online social networking sites is subject to the same ethical constraints during both personal and professional time. Although personal and professional activities are typically regarded as separate entities, with personal time exempt from the expectations imposed on professional time, the AOTA Ethics Commission has stated that in the case of online social networking, ethical considerations extend into occupational therapy practitioners' personal life because of the ethical duty to preserve the confidentiality of work-related information and the inability to control who may view posts, including patients. It is important for practitioners to maintain professional boundaries and to be extremely careful about any online social networking posts; confidentiality is impossible to maintain (e.g., posts can be shared without knowledge), and patients can read personal posts, leading to information that probably should not be shared when engaged in a professional relationship.

A COTA® is competent in the type of services being requested for a client but has been asked to administer an unfamiliar standardized assessment. What is the most ethical response in this instance? A. Delay treatment, and collaborate with the supervising OTR® to acquire competency for administering the assessment. B. Refuse to administer the assessment. C. Ask the supervising OTR, who is familiar with the assessment, to administer the assessment while the COTA observes. D. Administer the assessment, but schedule time to demonstrate competence at a later date.

C. Ask the supervising OTR, who is familiar with the assessment, to administer the assessment while the COTA observes. This option is consistent with best practice and ensuring competence, and it adheres to the ethical principle of Beneficence. Additionally, this option is supported by Fidelity and the need to collaborate with the supervising OTR to promote best practice.

A client refuses occupational therapy because of what is described by the client as "personal reasons." The COTA® documents the refusal of services and discusses discharge with the OTR®, even though the client can still benefit from therapy. Under what principle is the client's choice to refuse services potentially acceptable? A. Beneficence B. Veracity C. Autonomy D. Justice

C. Autonomy The principle of Autonomy respects the client's choice. The reasons for which a client refuses services may be personal, but the client has the right to make this decision.

A participant in a research study who has provided informed consent tells the COTA® that she wants to withdraw. Which ethical principles require the COTA to bring the conversation to the attention of the primary investigator (PI)? A. Fidelity and Veracity B. Veracity and Justice C. Autonomy and Fidelity D. Autonomy and Justice

C. Autonomy and Fidelity The ethical principle of Autonomy relates to the participant's right to end any participation in a research study for any reason. Informed consent in research allows a person to stop participating in a research study. Because the COTA is not the PI, the principle of Fidelity would require her to communicate respectfully regarding the request with the PI. Fidelity acknowledges that "professional relationships are greatly influenced by the complexity of the environment in which occupational therapy personnel work. Practitioners, educators, and researchers alike must consistently balance their duties to service recipients, students, research participants, and other professionals as well as to organizations that may influence decision making and professional practice." The COTA must involve the PI to effectively balance these obligations.

A COTA® is working with a client who punched a wall after an argument. The client presents with inflammation and pain in the right fourth and fifth metacarpals. What type of fracture does this client most likely have? A. Bennett's fracture B. Colles fracture C. Boxer's fracture D. Kienbock's fracture

C. Boxer's fracture A boxer's fracture is the result of a clenched fist hitting an object with enough force to break the metacarpophalangeal neck, most commonly seen in the fourth and fifth digits.

A COTA® fabricated a thermoplastic splint for a client with carpometacarpal (CMC) osteoarthritis to support the CMC joint. The client is unable to wear it during work hours because some movement of the joint is required to complete tasks. Which positioning device would BEST suit this client's needs? A. CMC plaster of Paris cast B. CMC fiberglass cast C. CMC neoprene wrap support D. Thicker CMC thermoplastic splint

C. CMC neoprene wrap support A neoprene strap provides less support but allows some movement.

A COTA® is also a part-time salesperson for an adaptive equipment vendor. The COTA accepts a position in a rehabilitation hospital as a direct service practitioner and intends to keep the sales job, too. What should the practitioner do, consistent with the AOTA Ethics Commission's advice about engaging in business transactions with clients and ensuring ethical responsibility in a sales position? A. Avoid recommending the purchase of adaptive equipment sold by the vendor the COTA works for B. Sell the equipment to clients but reduce the cost by the amount of the COTA's sales commission C. Disclose the relationship with the outside business to clients and the employer D. Quit the job as an adaptive equipment salesperson

C. Disclose the relationship with the outside business to clients and the employer To avoid either conflict of interest or the perception of conflict of interest, disclosure to clients and employers of an outside business relationship is advised by the AOTA Ethics Commission.

A COTA® is teaching discriminative sensory reeducation techniques to a client who has had a median nerve surgical repair. Which method is BEST for reeducation of discriminative sensibility? A. Educate the client to avoid working around machinery. B. Advise the client to use vision to compensate for sensory loss. C. Educate the client to identify items by touch both with and without vision on a daily basis. D. Educate the client to avoid temperatures below 60°.

C. Educate the client to identify items by touch both with and without vision on a daily basis. This visual-tactile matching process is part of a discriminative sensory reeducation program.

S, an occupational therapy student, experiences major personal stress during a challenging time in school. Feeling behind schedule and overwhelmed by an assignment, S calls L, a classmate and friend, and asks for a copy of L's paper to get a sense of the format and content expectations of the assignment. To best adhere to the Occupational Therapy Code of Ethics (2015), what should L do? A. Be empathetic and avoid harm to S by providing a copy of the paper, under the agreement that S's paper will be worded differently from L's B. Claim not to understand the format and content guidelines and refer S to another classmate who knows more about them C. Express discomfort about sharing the paper because doing so may violate the Code and encourage S to seek help from the professor of the course D. Share the paper but report S to the AOTA Ethics Commission for possible violation of the principles of Nonmaleficence and Justice

C. Express discomfort about sharing the paper because doing so may violate the Code and encourage S to seek help from the professor of the course Taking action to avoid being exploited and to encourage ethical behavior is recommended for all occupational therapy professionals, including students.

A client diagnosed with amyotrophic lateral sclerosis (ALS) 2 years ago is admitted to the hospital because of worsening mobility at home. Before the hospitalization, the client was independent with ADLs but required assistance for IADLs, including cooking, shopping, and home management. Which approach is the COTA® MOST likely to use with this client in the acute care setting? A. Maximize the client's participation in IADLs B. Identify appropriate positioning for the client in bed C. Guide the caregiver in assisting the client with ADLs D. Facilitate increased strength to maximize abilities

C. Guide the caregiver in assisting the client with ADLs The caregiver should be trained in skills for assisting the client with ADLs because the client will require greater assistance for tasks as symptoms progress.

A blocking splint fabricated to maintain the metacarpophalangeal (MCP) joints in extension can be useful to isolate which joint movements? A. MCP joint flexion and flexor digitorum profundus (FDP) excursion B. Interphalangeal (IP) joint extension and FDP excursion C. IP joint flexion and FDP excursion D. Proximal IP joint extension and FDP excursion

C. IP joint flexion and FDP excursion MCP joint extension helps isolate proximal and distal IP joint flexion and allows maximum FDP excursion.

A therapy group of clients with rheumatoid arthritis is meeting once a week. These clients may benefit from a group education approach to teach which technique? A. Exercises to increase stability of the hands and digits B. Medication management to ensure proper use of prescribed medications C. Joint protection strategies to help prevent further joint stress or injury D. Night splinting in a position of antideformity

C. Joint protection strategies to help prevent further joint stress or injury Studies have shown a decrease in reported pain and disability after participation in a group program in which joint protection strategies have been taught.

A person with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome) is having difficulty in the transition to a new adult foster care home. An OTR® and COTA® are contracted to make four home visits to assess the client and provide appropriate intervention. When the OTR and COTA arrive for the first visit and attempt to interview the client, the client angrily refuses to speak with them. Which option is the BEST response to this client's behavior? A. Stay long enough to convince the client to cooperate so that the placement can be successful B. Engage the client in a favorite game and convince the client to play with the OTR and COTA C. Leave the home, allowing the client to refuse occupational therapy services D. Tell the client that the OTR and COTA will not return again as a result of this refusal

C. Leave the home, allowing the client to refuse occupational therapy services Recipients of occupational therapy services have the right to refuse services. As noted in the principle of Autonomy in the Occupational Therapy Code of Ethics, "Occupational therapy personnel shall respect the right of the individual to self-determination" (p. 5). Because the client's foster family is also a client, it would be acceptable to ask the client for permission to meet with the foster family to gather information and provide indirect recommendations.

The initial evaluation documentation for a client with Parkinson's disease indicates that the OTR asked the client to asks the client to "pretend you are brushing your teeth," that is, show the movement of brushing teeth without using the supplies needed for brushing teeth. The client was unable to initiate movement of the dominant arm toward the mouth to demonstrate oral hygiene. Which step should the COTA® take NEXT in the evaluation of this client? A. Try a wrist weight to stabilize the arm during teeth brushing B. Ask whether the caregiver can provide arm support to bring the hand to the mouth C. Observe as the client brushes teeth with toothbrush and toothpaste at the bathroom sink D. Provide a mobile arm support to compensate for arm movement when brushing teeth

C. Observe as the client brushes teeth with toothbrush and toothpaste at the bathroom sink The client may not have understood the verbal instructions, and performing the task in the actual context may allow for more accurate demonstration of the client's abilities.

174; A client with an acute mild brachial plexus stretch injury affecting the left side reports limited forward shoulder flexion because of pain; limited cervical mobility;, forward head and rounded shoulder posture; and decreased sensation in the thumb, index, and radial side of the long finger. The client has full range of motion in internal and external rotation of the shoulder. The occupational profile reveals that the client is an accountant who enjoys surfing and tennis on the weekends. What instruction should the COTA® provide on the first visit? A. Rotator cuff strengthening exercises for humeral head stability to reduce impingement pain noted with forward flexion B. Forward flexion active-assisted exercises to reduce capsular tightness C. Postural correction exercises, modification of the workstation to promote appropriate posture, and reduction of overhead activities D. Recommendation to maintain normal work activities but avoid tennis and surfing until further notice

C. Postural correction exercises, modification of the workstation to promote appropriate posture, and reduction of overhead activities Nonoperative treatment of a brachial plexus stretch injury includes education on how to minimize further irritation to the brachial plexus, including postural education and education regarding avoidance of provocative positions (e.g., overhead activities).

What principle of the Occupational Therapy Code of Ethics (2015) guides occupational therapy practitioners to accurately represent their credentials, qualifications, education, experience, and training to all service recipients, students, employees, research participants, and colleagues? A. Principle 1, Beneficence B. Principle 4, Justice C. Principle 5, Veracity D. Principle 6, Fidelity

C. Principle 5, Veracity Principle 5, Veracity, requires accurate representation of credentials, qualifications, education, experience, and training in all forms of communication.

A COTA® is working with a client with a peripheral nerve injury affecting sensation. The client is a chef and is eager to return to work but has diminished protective sensation. Which recommendation BEST fits this client's occupational profile? A. Wear a glove to protect the affected hand from cold weather. B. Use equipment with soft, textured grips to maximize gross grasp and in-hand manipulation during kitchen tasks. C. Protect the affected hand from exposure to sharp items and to cold or heat. D. Avoid using sharp tools to prevent injury to the affected hand.

C. Protect the affected hand from exposure to sharp items and to cold or heat. Client education for diminished protective sensation includes information about avoiding extreme temperatures and testing temperature with the affected hand. The client is a chef and therefore is unable to avoid exposure to knives. The client may be educated about specialized steel mesh gloves that can be worn to protect the insensate hand during cutting tasks.

What is the first course of action the AOTA Ethics Commission takes when it receives an ethics complaint? A. Conducts a full investigation B. Imposes a sanction or discipline C. Starts a preliminary assessment D. Writes an educative letter

C. Starts a preliminary assessment A preliminary assessment would be conducted before a full investigation, educative letter, or imposition of a sanction or discipline.

A COTA® is working with a client who experienced a radial head fracture 6 weeks ago. The COTA is concerned because the client has multiple complaints about pain and range of motion (ROM). Which statement about this client is TRUE? A. This client will need additional education in pain management because pain is the most common complication after elbow injury. B. This client will regain elbow ROM before wrist ROM, because wrist stiffness is the most common complication after elbow injury. C. This client will regain wrist ROM before elbow ROM, because elbow stiffness is the most common complication after elbow injury. D. This client will require only one visit for home exercise program (HEP) instructions, and the OTR can then discharge the client from therapy.

C. This client will regain wrist ROM before elbow ROM, because elbow stiffness is the most common complication after elbow injury. Elbow stiffness is the most common complication of elbow trauma.

What main neuromusculoskeletal feature is a client with multiple sclerosis likely to exhibit that a COTA® should consider during intervention? A. Slowed movement of the extremities B. Uniform resistance to passive movement C. Tremor when moving the extremities to reach D. Inability to initiate movement in the extremities

C. Tremor when moving the extremities to reach Intention tremor is commonly seen in people with MS.

A COTA® is treating a 77-year-old client who requires a resting hand splint. Which splint characteristics are MOST important in addressing the natural aging process of skin and adipose tissue? A. Use colored splints and no moving parts B. Use D rings and mark where straps go C. Use soft straps and thick padding D. Label the splint with client's name

C. Use soft straps and thick padding As a person ages, the skin thins, and adipose tissue is lost. Soft straps and padding add comfort and prevent skin breakdown.

A COTA® is treating a client with a boutonniere deformity using conservative splinting. Which statement can the COTA use to educate the client about the proper use of the circumferential proximal interphalangeal (PIP) joint orthosis? A. Wear the orthosis only at night to maintain the PIP joint in extension when at rest. B. Remove the orthosis every hour for passive motion exercises. C. Wear the orthosis continuously up to 6 weeks. D. Wear the orthosis during the day, but remove it at night.

C. Wear the orthosis continuously up to 6 weeks. Continuous use of the PIP joint extension splint allows the central slip to reestablish tissue continuity and prevents further flexion deformity.

An order came in for a hand orthosis for a new client. The OTR® who completed the evaluation asked the newly graduated COTA® to fabricate the splint. The new COTA had not made an orthosis on a client before and requested assistance from the supervising OTR, who is a hand therapist. The newly graduated COTA decided to attend a continuing education class to improve orthotic-making skills and increase the COTA's comfort level. By which ethical principle is the COTA biding? A. Autonomy B. Justice C. Fidelity D. Beneficence

D. Beneficence This principle relates to concern with the well-being and safety of clients. By becoming more proficient in orthosis making, the COTA is becoming more competent in delivering the services that are within their service provision. The COTA is also ensuring that the OTR knows the competence of the COTA so that duties delegated to the COTA are aligned with the COTA's competency.

A client with multiple sclerosis (MS) reports decreased ability to pay attention to daily work-related tasks, including keeping track of documents and phone calls. Which strategy is the MOST appropriate for this client? A. Change the work environment to work at home B. Modify the workload to decrease fatigue levels C. Improve lighting in the work environment D. Complete one task at a time and avoid multitasking

D. Complete one task at a time and avoid multitasking Attention to task is a cognitive skill that benefits from a cognitive compensatory approach in clients with MS. Avoiding multitasking helps the client pay attention to one task a time, improving focus on each task.

A COTA® is treating an outpatient client who has sustained burns to the face, neck, and hands. Customized pressure garments are being fitted to reduce hypertrophic scarring. Which item cannot be used under the pressure garments to increase conformity to the skin? A. Silicone gel sheet B. Neoprene sheet C. Silastic elastomer D. Dynamic splint

D. Dynamic splint Dynamic splinting is primarily used to decrease soft-tissue contractures surrounding joints, not to reduce hypertrophic scarring of the skin. Splints are worn over the pressure garment, not under it.

A COTA® completes a home assessment of a person with Parkinson's disease who lives at home but has begun to have mobility challenges. Which intervention is BEST to facilitate lifestyle changes to improve safety? A. Issue a long-handled reacher and teach the client how to use it B. Advise the client to continue to carry items during functional mobility C. Issue a rolling walker and educate the client how to use it D. Introduce use of a rhythmic beat to facilitate mobility

D. Introduce use of a rhythmic beat to facilitate mobility The use of rhythm has been shown to support mobility in people with Parkinson's disease. This approach can minimize the impact of the immobilization that may occur from this disease.

The occupational profile of a client recently diagnosed with bilateral osteoarthritis of the first carpometacarpal joints of the thumbs reveals that the client is retired and enjoys reading, playing cards with friends, and painting. The client has insurance coverage for only three occupational therapy sessions. What client education topics should the COTA® focus on FIRST? A. Hand-strengthening exercises the client can perform independently B. Orthotics that may be fabricated to support and protect affected joints C. Thermal modalities to reduce pain and stiffness D. Joint protection principles

D. Joint protection principles Joint protection principles are ideally taught early in the disease process to decrease joint stress and damage.

A client provides a gift to every person in the department, including the COTA® who worked with the client. This gift is consistent with cultural practices of the client and is valued at less than $5.00. Which ethical principle BEST helps determine whether it is appropriate for the COTA to accept the gift? A. Veracity B. Fidelity C. Beneficence D. Justice

D. Justice The guiding ethical principle is Principle 4, Justice. The amount of the gift is minimal, and the gift was given to everybody. It is appropriate to accept the gift. This scenario did not create a situation in which objectivity or boundaries were compromised, and the nominal amount of the gift does not "unduly influence the therapeutic relationship or have the potential to blur professional boundaries, and adhere to employer policies when offered gifts."

A COTA®, in conjunction with an OTR®, has been asked to provide an inservice for a facility's nursing assistants to prevent back pain or on-the-job injury. What principle BEST reflects safe patient lifting? A. Keep feet together to maintain a high center of gravity. B. Place foot on stool for ease of weight shifting. C. Use a stoop lift to assist clients in tub transfers. D. Maintain the client's body as close as possible while transferring.

D. Maintain the client's body as close as possible while transferring. Keeping the client close while lifting is associated with decreased lumbar stress and is easily addressed in prevention

A COTA® is treating a client with decreased digital range of motion and minimal subacute edema of the same hand. After ascertaining that there are no contraindications to modality use, which preparatory method is the BEST choice for before therapeutic activities? A. Pneumatic pump application to the hand and digits B. Contrast bath application to the hand and digits C. Mild cold pack application to the hand and digits D. Mild, superficial heating application to the hand and digits

D. Mild, superficial heating application to the hand and digits Heating between 71.6°F and 105.8°F increases lymph flow and helps soften tissues to promote increased range of motion. Heating does not exacerbate minimal edema.

An occupational therapy student asks the professor for additional time on a final exam because of an attention deficit disorder and claims to have been too busy to get the required accommodations letter from the university's office for students with special needs. The professor waives the requirement and grants the additional time. On the basis of the principles of the Occupational Therapy Code of Ethics (2015), how can the professor's behavior BEST be characterized? A. The professor behaved benevolently while protecting Principle 6, Fidelity. B. The professor supported the student's right to privacy while ensuring that no harm was imposed on other students. C. The professor behaved both empathically and prudently. D. The professor behaved altruistically but violated Principle 4, Justice.

D. The professor behaved altruistically but violated Principle 4, Justice. In behaving benevolently toward the student, the professor may not have weighed the fairness of the waiver to other students by giving the student an unfair advantage. Additionally, NBCOT® does not recognize a disability unless the student's university recognizes it. The professor should prepare the student to take the NBCOT and future course exams by denying any accommodations until they are properly designated by the university.

A COTA® has discontinued occupational therapy services with a client. A month after the completion of services, the client and the COTA see each other unexpectedly at the local grocery store. They both express interest in dating the other person. They start dating within a month of this meeting at the grocery store. A. This action is illegal and should be reported to the authorities immediately. B. This action is within the occupational therapy ethical guidelines for the principle of Nonmaleficence. C. This action is within the occupational therapy ethical guidelines for the principle of Beneficence. D. This action may or may not be ethically appropriate and needs to be investigated further.

D. This action may or may not be ethically appropriate and needs to be investigated further. D: Principle 2, Nonmaleficence, states that occupational therapy personnel shall intentionally refrain from actions that cause harm. Principle 2C states that practitioners shall avoid engaging in any sexual relationship or activity with recipients of services. Although the client and COTA are no longer in a professional relationship, Principle 2I requires the COTA to "avoid exploiting any relationship established as an occupational therapy clinician, educator, or researcher to further one's own physical, emotional, financial, political, or business interests at the expense of recipients of services, students, research participants, employees, or colleagues."

A COTA® is working with a client who received significant burns to the elbow. The client presents with a soft-tissue contracture at the elbow and is noncompliant with wearing an anterior elbow extension splint. What alternative would be BEST for effective treatment of the soft-tissue elbow contracture? A. Ace wrap the splint to hold it in place instead of using straps B. Talk to the OTR® about discharging the client from secondary to noncompliance C. Refer the client back to the plastic surgeon for surgery D. Use serial casting to gradually and slowly stretch the tissue

D. Use serial casting to gradually and slowly stretch the tissue A cast is more difficult to remove and may promote better circumferential pressure to reduce hypertrophic scarring in addition to reducing the elbow contracture.

174; A client with a nondisplaced shaft fracture of the right fifth metacarpal has a physician's order for full-time splinting. Which orthosis would the COTA® be MOST likely to fabricate? A. Dorsal hood splint with the wrist in approximately 20° flexion, all metacarpophalangeal (MCP) joints of the affected hand in 70°-90° flexion, and interphalangeal (IP) joints of the affected hand in 0° extension B. Volar-based ulnar gutter with MCP and IP joints of the ring and fifth fingers in 0° extension and the wrist in neutral C. Dorsal-based wrist cockup splint with MCP and IP joints free and the wrist in approximately 20° extension D. Volar-based ulnar gutter with MCP joints of the ring and fifth fingers in 70°-90° flexion, fourth and fifth IP joints in 0° extension, and the wrist in approximately 20° extension

D. Volar-based ulnar gutter with MCP joints of the ring and fifth fingers in 70°-90° flexion, fourth and fifth IP joints in 0° extension, and the wrist in approximately 20° extension Holding the MCP joints in flexion helps prevent contracture of the collateral ligaments.

What is the MOST effective method that an OTR® and COTA® team can use to prevent osteoporosis in community-dwelling adults? A. Distribute a pamphlet on the risk factors and preventive strategies for osteoporosis. B. Work with the community to provide vitamin D and calcium supplements to adults. C. Work in the community to evaluate all adults older than age 50 for symptoms of osteoporosis. D. Work with community leaders to develop a walking and education program for women older than age 50.

D. Work with community leaders to develop a walking and education program for women older than age 50. Low-impact weight-bearing exercises and education can help older adults to reduce osteoporosis.

A COTA® is asked to bill for occupational therapy services in a group setting to maximize billable hours. The principle of Justice requires that occupational therapy personnel comply with institutional rules, state laws, and relevant AOTA official documents. What is the BEST next step for the COTA to take? A. Report this request to the company hotline immediately. B. Comply with the request and make no other actions. C. Report this request to the state regulatory board. D. Work with the supervising OTR® to identify the best options for efficient and clinically appropriate provision of services.

D. Work with the supervising OTR® to identify the best options for efficient and clinically appropriate provision of services. The COTA cannot bill in a different way without violating the principle of Justice, and the COTA cannot comply with the request without violating the principle of Beneficence, because provision of occupational therapy services on the basis of reimbursement rather than clinical need is ethically problematic. The principle of Fidelity precludes the COTA from reporting the practice as a first step. Therefore, the best next step is to try to work it out with the employer.