Troublemakers

An individual with left upper extremity flaccidity is observed sitting in a wheelchair with his left arm dangling over the side. The FIRST positioning device the COTA should introduce to the client is a: A. lap tray B. wheelchair armrest C. arm sling D. arm trough

D. Arm Trough

An individual with under-reactive sensory processing has been referred to OT. Based on a sensory integration frame of reference, activities for this individual should have which of the following faciliatory characteristics? A. arrhythmic and unexpected B. arrhythmic and slow C. sustained and slow D. unexpected and rhythmic

A. Arrythmic and unexpected

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

A. Neck flexion

A third-grader's readiness for discharge from direct OT, as a related service, has been determined on the basis of: A. whether the areas of concern to the OT interfere with the child's education B. the degree of functional skills possessed by the child C. the level of independence in ADL D. the degree of accessibility of the learning environment

A. Whether the areas of concern to the OT interfere with the child's education

A COTA is working with a client who had a TBI and demonstrates deficits in sequencing and problem solving. The client has successfully prepared a cold meal in today's treatment session. The nest meal preparation activity the COTA should have the client prepare is: A. brownies B. a cheese sandwich C. a casserole D. a spaghetti dinner with salad and garlic bread

B. A Cheese Sandwich

When treating individuals in the acute phase of cardiac rehabilitation, it is important for the COTA to FIRST select activities that: A. can be accomplished without causing fatigue B. decrease the effects of prolonged inactivity C. promote strength, ROM, and endurance D. can be carried out independently after discharge

B. Decrease the effects of prolonged inactivity

A young patient with neurological deficits has been unable to carry over skills learned previously in therapy, and has exhibited the inability to learn new information. The MOST appropriate strategy the COTA can suggest to the patient's mother to improve ADL functioning would be to recommend: A. repetitive practice of simple ADL under the COTA's guidance B. environmental adaptations and assistance for ADL C. ADL training in the familiar home environment D. forward or backward chaining techniques

B. Environmental adaptations and assistance for ADL

During the evaluation of a 6-month old baby the COTA gently pulls the infant from a supine position into a sitting position by the hands. The child demonstrates the ability to hold her head and trunk in alignment against gravity. This observable movement can MOST accurately be described by the COTA as a: A. protective reaction B. flexion righting reaction C. body righting on body reaction D. optical righting reaction

B. Flexion righting reaction

An individual who had a stroke is copying a picture of a clock. The drawing appears as a lopsided circle with a flat side on the left. The numbers 1-8 are written in numerical order around the right side of the clock. The hands are correctly drawn on the clock to represent 3 o'clock. The individuals performance appears to demonstrate: A. right hemianopsia B. left unilateral neglect C. cataracts in the left eye D. bitemporal hemianopia

B. Left unilateral neglect

A patient in an acute care facility with severe depression is withdrawn and exhibiting a low energy level. Of the following, which would be the MOST appropriate type of intervention activity for the COTA to present in the initial stages of treatment for this patient? A. selecting leisure activity of interest and identifying materials needed B. performing a clerical task such as sorting papers C. practicing meditation D. writing suggestions for coping with daily life stresses

B. Performing a clerical task such as sorting papers

The COTA is working with a child with low muscle tone who has difficulty engaging in activities against gravity. The COTA also wants to encourage the child to play. To best address these issues, the COTA would MOST likely position the child: A. long sitting along a wall B. side-lying on a mat C. supine on a large wedge D. prone over a bolster

B. Side-lying on a mat

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

B. The child demonstrated tongue thrust

The COTA is observing a 3-year old child during tooth brushing. The child demonstrates good bilateral upper extremity/hand strength, but decreased dexterity. Which piece of equipment would the COTA MOST likely encourage the child use during brushing? A. a small soft bristle toothbrush B. a velcro strap attached to the toothbrush C. an electric toothbrush D. a soft sponge-tipped toothette

C. An electric toothbrush

A mother of 4 teenaged children who was diagnosed with a right CVA is receiving home care OT services. The treatment plan includes "activities to improve left upper extremity function" and "activities to improve balance in sitting and standing". The MOST appropriate activity for the COTA to recommend would be: A. stacking cones B. door pulley C. folding laundry D. throwing a ball

C. Folding laundry

A COTA is positioning a child with low muscle tone and postural instability into a prone stander to develop head righting. The child rapidly shows fatigue and associated reactions. How can the COTA BEST adjust the stander to decrease these reactions while continuing to address the goal of head righting? A. place the child in prone on the floor B. position the stander at 45 degrees from the floor C. position the stander at 75-90 degrees from the floor D. position the child upright in a prone or supine stander

C. Position the stander at 75-90 degrees from the floor

An OT practitioner is providing accessibility consultation services to a local library. In the back of the library there is a reference room with a doorway that has a threshold height of 1 in. Concerning the threshold and accessibility according to the ADA guidelines, which of the following recommendations would be best? A. Keep the threshold as is, and place a sign near the door alerting people to the threshold B. Provide a throw rug that covers the threshold C. Remove the threshold altogether D. Ramp the threshold

C. Remove the threshold altogether

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

C. Side-lying position

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

C. Supervision

A COTA working with an infant observes the presence of the first stage of voluntary grasp. Which of the following would be the MOST appropriate statement for documenting this behavior? A. the infant is exhibiting radial palmar grasp B. the infant is exhibiting pincer grasp C. the infant is exhibiting ulnar palmar grasp D. the infant is exhibiting palmar grasp

C. The infant is exhibiting ulnar palmar grasp

An individual with a C6 spinal cord injury has been referred to OT 2 days post-injury. Immobilized with a halo brace, the individual demonstrates fair plus wrist extension and poor minus finger flexion. Which of the following interventions should be implemented FIRST? A. volar resting pan splints to prevent flexion contractures B. wrist support with universal cuff to promote independence C. wrist splints to promote development of tenodesis D. instruction in bed mobility techniques to prevent decubiti

C. Wrist splints to promote development of tenodesis

A child has difficulty controlling food in her mouth when swallowing. In helping the parents plan snacks, the COTA would be MOST likely to recommend: A. chicken noodle soup B. peanut butter C. carrot sticks D. applesauce

D. Applesauce

A COTA provided information about adaptations that will assist in resuming sexual activity to a patient with a spinal cord injury. Afterward, the patient confides to the COTA that there are serious personal issues affecting his sexual relationship with his wife. What is the BEST action for the COTA to take? A. encourage the patient to explain further about the problems he is having with his wife B. explain that this is normal, and that divorce rates are actually higher after serious injuries C. direct the patient to speak with his physiatrist about his concerns D. encourage the patient to speak with the rehabilitation psychologist to discuss his concerns

D. Encourage the patient to speak with the rehabilitation psychologist to discuss his concerns

The COTA is selecting activities for an 8-year old child with Duchenne's Muscular Dystrophy. Which of the following developmental issues is MOST important to consider when identifying activities for this child? A. establishment of basic trust B. freedom to use his initiative C. development of self-identity D. reinforcement of competence

D. Reinforcement of competence

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

Solution: The correct answer is A. 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. B, C, D: Although these models of practice would also be appropriate to guide handwriting, the activities presented in the question are aligned with the neurodevelopmental model of practice and not the others.

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

Solution: The correct answer is A. Disorganized, random scanning patterns are characteristic of unilateral neglect. B: A client with visual field deficit would demonstrate an abbreviated and organized scanning pattern. C: Smooth pursuits are an organized pattern of eye movements that maintain continued fixation on a moving target and have a significant role in activities that require movement of the person or the object. D: Tropia, or strabismus, is a misalignment of the eyes and does not affect scanning patterns.

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

Solution: The correct answer is A. 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. B: Wartenberg's sign is the little finger held in abduction. C: Jeanne's sign is hyperextension of the proximal phalanx of the thumb when pinching. D: Ulnar claw refers to hand posture with ulnar nerve injury.

A client presents with osteoarthritis of the thumb carpometacarpal (CMC) joint. The client reports moderate pain and weakness and experiences triggering during pinching tasks. Which occupational therapy interventions are likely to improve functional hand use? Select the 3 BEST choices. A. Educate to avoid pinching activities B. Teach joint protection techniques C. Fabricate a hand-based thumb spica splint D. Apply heat to the affected area E. Instruct in a home program of resistive pinching exercises F. Provide AROM exercises for the thumb

Solution: The correct answers are A, B, and C. A, B, C: CMC joint pain and weakness are often caused by instability of the thumb metacarpal on the trapezium, leading to joint subluxation. The client should avoid painful pinching and observe joint protection techniques to limit further damage to the CMC joint. A hand-based thumb spica splint will support the thumb as a functional post, allowing the client to complete pain-free activities. D: Heat may reduce pain but will not improve stability. E: Strengthening is often contraindicated for CMC joint arthritis because of the stress it places on the joints. F: Although AROM may reduce pain and potentially maintain the web space, it will not address the underlying instability of the thumb joint.

A client arrives at the occupational therapy clinic 10 minutes late for an appointment, crying uncontrollably. When the COTA® attempts to engage the client in conversation, the client responds, "I don't want to talk about it. Is that so bad?" What responses from the COTA would be appropriate? Select the 3 BEST choices. A. "It must be very difficult." B. "I understand; would you like to take a few more minutes?" C. "Thank you for being here; take your time and speak when you are ready." D. "Let's have our session later, after you've stopped crying." E. "You are upset. How can I help you?" F. "Come on, now; that's enough of that."

Solution: The correct answers are A, B, and C. A: "It must be very difficult" acknowledges the client's feelings without being judgmental and lets the client know that the COTA sees that the client is upset. It also provides the client with an opportunity to further clarify his or her feelings. B, C: Acknowledging understanding and letting the client determine the right time to enter the session, if able, communicate respect and support for the client's autonomy. D, F: Postponing the session or telling the client to stop crying does not demonstrate empathy toward the client and will hinder the establishment of trust and rapport. E: Restating the obvious as a stand-alone statement such as "you are upset" may make the client feel worse by making assumptions about the client's feelings and providing no opportunity for the client to clarify or object to the assumption; it adds little therapeutic value.

A COTA® working in an outpatient psychiatric setting has been meeting monthly with a closed-membership group of people with depression to promote socialization. Up to this point, the group has been functioning as a parallel group, but the participants are ready to progress to the next level, a cooperative group. Which activities would be appropriate to facilitate this transition? Select the 3 BEST choices. A. Organize making a quilted wall hanging for the reception area to which each participant contributes a square B. Design a music playlist for the next group meeting that includes the music interests expressed by each group member C. Have participants plant seeds in ceramic pots that they decorate themselves D. Distribute journals in which participants write their own poetry collection E. Have participants plan a dinner to which each participant contributes a dish F. Appoint a leader to organize a sale of baked goods that the participants are responsible for promoting

Solution: The correct answers are A, B, and E. A, B, E: The group can progress from a parallel to a cooperative group by taking an already mastered skill, such as making a quilt square, selecting favorite music, or cooking a dish, and adding the component of coordination and cooperation. To make quilted wall hanging, design a playlist, or plan a dinner, participants still work on their own, but they need to interact with one another to complete the activity using each participant's contribution. C: Decorating one's own pot and planting seeds in it are parallel group activities. D: Writing poetry in a journal instead of as a group is a parallel activity that would fail to advance the participants' social skills. F: Going from parallel group activities to planning and organizing a bake sale is a huge leap, not a logical next step.

A COTA® has been working on increasing the attention span of an 8-year-old child with autism who is distractible during handwriting activities in the classroom. Which environments can support concentration and attention skills? Select the 3 BEST choices. A. A small classroom with two other children doing handwriting and with soft background music B. An isolated room free from any kind of distraction C. A small corner of a sensory gym where two other children are swinging D. A quiet corner in the child's classroom separated from the rest of the room by a chalkboard divider E. The very front of the child's classroom where there are fewer visual stimuli F. The back corner of the child's classroom with the child's seat distanced slightly from peers

Solution: The correct answers are A, E, and F. A: A small classroom with two other children doing handwriting tasks is a naturalistic environment that minimizes unnecessary sensory stimulation. E, F: Having the child's desk placed where there are fewer distractions is a naturalistic environment that minimizes unnecessary sensory stimulation. B, D: An isolated, distraction-free room is not a naturalistic environment. C: A sensory gym will likely provide more stimulation than necessary to support the client's concentration and attention skills

A client with age-related macular degeneration reports difficulty completing meal preparation activities. Which interventions are appropriate for this client? Select the 3 BEST choices. A. Reduce room and task lighting in the kitchen area B. Remove window coverings in the kitchen area C. Use items with busy patterns in the kitchen area D. Provide background contrast in the kitchen area E. Use tactile markers on appliances F. Use talking devices such as a talking thermometer

Solution: The correct answers are D, E, and F. D: Changing the background to increase contrast in the kitchen allows items to be seen and identified easier. For example, using a dark cutting board to chop an onion promotes the visibility of the onion. E, F: Sensory substitution is an important strategy. Tactile markers on appliances to mark settings uses touch to improve accuracy in setting appliances, and auditory devices use hearing to tell when meat is cooked. A: Room and task lighting should be increased, not reduced, to increase visibility for meal preparation tasks. B: Lighting modifications can increase visibility to promote occupational performance. Window coverings should not be removed, however, but used to reduce glare in the kitchen while maximizing the amount of sunlight coming through the window. C: Busy patterns are often visually confusing and are likely to decrease the client's occupational performance. Solid colors, instead of busy patterns, would be a better option.

A COTA® is working in an inpatient psychiatric setting where the average length of stay is 5 days. Which group activities would be appropriate for patients with depression? Select the 3 BEST choices. A. A parallel group in which participants work on a free-form clay project of their choice B. A cooperative group in which participants plant a garden C. A project group in which participants paint a watercolor picture on a blank canvas D. A parallel group in which each participant completes his or her own solid-color ceramic tile trivet E. A parallel group in which participants paint simple, preconstructed birdhouses using only two or three colors F. A parallel group in which each participant is involved in a simple activity that requires little decision making and interaction with others

Solution: The correct answers are D, E, and F. D: Simple and concrete activities are most appropriate for clients hospitalized with depression. For the trivet activity, the solid color removes the need to make decisions about color and pattern, the trivet provides clear physical boundaries, and gluing the tile onto the backing is simple and concrete. E: The painting of a preconstructed birdhouse with limited colors to choose from can provide a result that can be realized before discharge and requires little interaction with others. F: Participation in a parallel group minimizes the need for decision making and social interaction but allows physical proximity to others. A: Working on a free-form clay project of their choice would be too overwhelming for most patients hospitalized for depression, who have difficulty making decisions and initiating activity. B: A cooperative group is not a good choice for most people hospitalized for depression because it requires them to interact and problem solve with each other, which they may be unable or unwilling to do. Planting a garden would be a poor choice for a 5-day-average hospitalization because the results would not be visible before patients are discharged. C: Painting a watercolor picture would not provide enough structure and might overwhelm patients hospitalized for depression.

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

Solution: The correct answer is D. Adaptations, as opposed to targeted interventions, are the most effective strategy for decreased memory in clients with dementia. A, B, C: Chunking, repeating information, and rhymes are effective strategies for clients whose memory loss is not progressive in nature.

A COTA® is helping a 3-year-old child with autism develop functional play skills. Which play activity is BEST for achieving this goal? A. Feeding and dressing dolls B. Stacking various colored rings C. Locating items buried in a rice table D. Pretending to be an imaginary character.

Solution: The correct answer is A. Functional play uses real objects to re-create real-life situations. B: Stacking colored rings is manipulative play, C: Locating items in a rice table is exploratory play. D: Pretending is symbolic play.

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

Solution: The correct answer is A. Identifying activities with meaning for the individual client allows the OTR and COTA to measure functional ROM needed for those activities. B: Passive ROM is not a clear indicator of the client's functional ROM. C: Functional ROM must be determined individually for each client. D: Goniometry of the unaffected extremity does not identify functional ROM for the affected side.

A COTA® assigned to the stroke unit of an acute care hospital is implementing treatment for a patient with ahemiplegic hand. Based on the expected pattern of progression in the acute phase after a stroke, which areas of focus should be considered at this stage to enable the patient to overcome barriers to ADL performance? A. Passive range of motion and positioning of the affected upper extremity, bed mobility B. Visual and cognition issues, upper-extremity orthotic needs C. Transfers, therapeutic exercise for upper-extremity strengthening D. Community mobility, fine motor coordination

Solution: The correct answer is A. In the acute stage of recovery, passive range of motion, positioning of the affected extremity, and bed mobility are critical components in restoring function for ADL performance. B, C, D: Although visual and cognition issues, upper-extremity orthosis needs, transfers, therapeutic exercise for upper-extremity strengthening, community mobility, and fine motor coordination all are areas of concern, in an acute care setting, passive range of motion, positioning of the affected extremity, and bed mobility are areas of focus critical to overcoming barriers to self-care.

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.

Solution: The correct answer is A. Labeling physical structures with symbols, such as arrows for direction, is helpful to people with dementia. B: Bright colors are not recommended, because they might be overly stimulating for people with dementia. C: Low lighting would not be beneficial, because it might not be adequate for a person to identify items, leading to confusion. D: At the middle stage of dementia, written words may create confusion. Picture labels are more effective.

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

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

A COTA® is performing upper-extremity activities with a client experiencing left hemiparesis. The COTA® notes a decrease in ROM in the left upper extremity. What factors BEST describe this decrease in ROM? A. Edema, joint contracture, and weakness B. Edema, muscle tone, and sensation C. Sensation, muscle tone, and proprioception D. Sensation, ataxia, and proprioception

Solution: The correct answer is A. The client is most likely experiencing weakness, edema, and contracture of the left upper extremity as a result of the left hemiparesis. B, C, D: Although the client is likely experiencing edema, "muscle tone" is not sufficient to describe hypertonicity or hypotonicity. Sensation may affect the client's awareness of the upper extremity and contribute to decreased ROM, but it does not best describe the decrease. Proprioception simply describes a measure of the arm in space as determined by the client. Ataxia is primarily related to the inability to perform small adjustments for coordinated movement, not gross ROM.

A COTA® is working with a client with C5 spinal cord injury. The OTR® asked the COTA® to make a splint for the client. What is the BEST position in which to splint the wrist to prevent deformity in the acute stage of injury? A. Wrist extension, thumb opposition B. Wrist neutral, thumb opposition C. Wrist extension, thumb adduction D. Wrist extension, thumb free

Solution: The correct answer is A. When splinting in acute spinal cord injury, the wrist should be extended with thumb opposition to preserve web space and prevent deformity B: This position may promote shortening of the finger and wrist flexors. C, D: Thumb adduction will contribute to a loss of web space.

A client who has a C5 spinal cord injury wants an electronic aid to daily living for operating devices in the home. Which feature is MOST IMPORTANT for the device to have? A. Speech recognition B. Contoured trackball C. Joystick control D. Touch screen

Solution: The correct answer is A. A client with a C5 spinal cord injury will not have hand or wrist function, so operating switches and other devices in the home will require a speech-recognition electronic aid to daily living. B, C, D: A client with a C5 spinal cord injury will not have hand or wrist function, so devices such as a trackball, joystick, or touchscreen that require fine motor control are not appropriate as electronic aids to daily living.

A client who has a T2 spinal cord injury is learning to independently transfer to a variety of surfaces. Which type of transfer is BEST for this client to use when transferring from a wheelchair to a car? A. Sliding board B. Stand-step C. Stand-pivot D. Bent-pivot

Solution: The correct answer is A. A client with a T2 spinal cord injury is able to complete independent transfers that may require the use of a sliding board. B, C, D: A client with a T2 spinal cord injury is not able to use active lower-extremity muscle strength to support stand-step or pivot transfers.

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

Solution: The correct answer is A. A screening is completed to determine whether further occupational therapy services are necessary. B: A screening is completed to determine whether a referral is needed from the physician; requesting a screen and a referral would not be necessary at the same time. C: Although a physical therapy referral may be needed to address some balance areas of function, the occupational therapy practitioner should screen for self-care function first because other factors may be affecting balance with self-care activities. D: A referral is necessary for legal purposes in providing intervention for a client, and it is required for practitioners to receive reimbursement for their services. Requesting a referral if the screen indicates the need for it is important so that occupational therapy services are documented.

A patient has an anxiety disorder and has been undergoing treatment in a psychiatric facility. During an occupational therapy session, the COTA® observes the patient's anxiety increasing and level of concentration has diminished compared to the behaviors observed in previous sessions. What INITIAL action should the COTA® take based on these observations? A. Talk with the patient about the changes in function B. Divert the patient's attention away from the anxious feelings C. Redirect the patient's attention to positive thoughts D. Inform the nursing staff about the behavioral changes

Solution: The correct answer is A. Clients who begin demonstrating increased anxiety should be encouraged to express their feelings. B: Avoiding what a client is feeling will not effectively address what the client is experiencing. C: Once the client expresses what he or she is feeling, the COTA® should redirect the client to a neutral topic or constructive activity; positive thoughts are not a specific component. D: Keeping the client in a consistent environment and maintaining interaction with the client would be important in getting him or her to talk; leaving the situation to talk to the nursing staff would not benefit the client.

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

Solution: The correct answer is A. 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. B: Compensatory strategies may be a component of the intervention plan, but they are not the most essential component to address during self-care interventions. C: The patient should be closely monitored through low-level activity and complete self-care activities within allowed levels of exertion based on precautions. Completing tasks as tolerated is not the most essential component. D: Adaptive equipment may be needed for bathing and hygiene, but a patient in Phase I will not be able to complete bathing because of the metabolic level of the task, which exceeds low-level activity.

A COTA is approaching a client with stroke to begin an intervention session in inpatient rehabilitation. The client is sitting at the dining table in a wheelchair with hips extended and is leaning on the unaffected left upper extremity. What should the COTA's FIRST approach be? A. Reposition the client in the wheelchair with hips flexed at 90° and the upper extremity resting in the lap B. Transfer the client to another wheelchair that provides a lap tray for upper-extremity support C. Transfer the client to a standard chair with arms for positioning in posterior pelvic tilt D. Recommend further assessment by the OTR®; to determine the client's postural needs

Solution: The correct answer is A. Ideal seated posture for a client with hemiparesis is hips flexed at 90° with shoulders over hips and arms relaxed in lap; the upper extremities should not be used to provide support in sitting. B: Clients with hemiparesis need frequent repositioning in sitting to maintain upright posture; information has not been presented that indicates the client needs a different wheelchair. Providing a lap tray may interfere with the client's spontaneous use of the affected upper extremity, so lap tray use should be avoided unless absolutely necessary. C: Changing the chair surface does not necessarily improve the client's positioning in the chair. D: Although further assessment may be needed, correcting the client's positioning is the first priority.

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

Solution: The correct answer is A. 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. B: With a significant increase in edema and a change in the patient's status, elevation is not indicated; the nurse needs to be notified of the situation. C: With a significant increase in edema and a change in the patient's status, edema control techniques are not indicated; the nurse needs to be notified of the situation. D: Because this is a change in the patient's status, the situation must be assessed medically before beginning new interventions such as antiembolism hosiery.

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

Solution: The correct answer is A. 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. B, C, D: The client has full ROM against gravity, and none of these positions and movement patterns require active movement against gravity.

A COTA® is working with a patient who has spastic hemiplegia and decreased trunk control secondary to a CVA. The patient is beginning to ambulate using a quad cane with standby assistance. The COTA® observes that the patient has decreased trunk stability during dressing activities. Which activity would promote increased trunk control during a dressing task while seated? A. Using the unaffected arm to reach for clothing positioned next to the affected side B. Putting the affected arm in a shirt sleeve while looking into a mirror C. Reaching with the unaffected arm to pick up a shoe from the floor D. Weight-bearing on the affected arm while buttoning a front-opening shirt with the unaffected hand

Solution: The correct answer is A. Reaching across the body with the unaffected arm while the affected side provides weight-bear support will facilitate trunk control in the client with a CVA. B: Observing dressing in a mirror while dressing will not address improving trunk control, because the client is not facilitating trunk movement. C: A client with decreased trunk stability may not be able to reach to the floor safely without balance loss when first providing interventions for increasing trunk control. D: Performing a fine motor task while maintaining weight bear through the affected arm would not address trunk control.

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.

Solution: The correct answer is A. 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. B: The current accessibility of the health care environment is irrelevant; what is at issue is whether it is accessible to the fieldwork student. C: The student's request for accommodation may be reasonable, but determining how the facility can best meet the student's needs is not a decision that is solely the COTA's. D: This option is not the best because the COTA should work collaboratively with management rather than abdicate all responsibility for the situation.

A COTA® is working with a 3-year-old child with autism and oral defensiveness to improve feeding skills. Which activity is BEST to begin desensitization of this child's oral defensiveness? A. Ask the child to hold a vibrating toy and put it close to the face. B. Provide deep pressure on distal parts of the upper extremities and provide slow linear rocking. C. Ask the child to touch the lips with a piece of cracker, providing positive reinforcement. D. Provide only preferred foods and allow the child to select the food during feeding sessions.

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

A student in the second grade has mild cerebral palsy. During a session, the student tells the COTA® about wanting to play computer games, "like other kids." After consulting with the OTR® about this, what action should the COTA® take NEXT to determine if this is an appropriate activity to include as part of the student's school-based occupational therapy intervention? A. Identify the impact of computer use on curriculum-based activities B. Have the student practice on different computer operating systems C. Complete an analysis of the activity components D. Assess the student's fine and gross motor development

Solution: The correct answer is A. Services provided in a school setting need to be educationally based activities that facilitate the child's ability to learn. The use of the computer in this situation must relate to a curriculum activity that meets the child's educational outcomes. If other students are playing computer games in the classroom to meet educational needs, then this would be an appropriate activity. B, C, D: The use of computer games within the educational components and learning outcomes of the child must be determined before other assessments can be made and before the intervention can be implemented.

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

Solution: The correct answer is A. 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. B, C, D: Visual disability is the focus of occupational therapy intervention as a targeted outcome. Search patterns are the target of an intervention approach to address visual field deficits.

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

Solution: The correct answer is A. 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. B: Reporting changes in patient performance on the basis of interventions provided interprets what occurred in the session and is appropriate for the Assessment section. C: Reporting modifications to an intervention on the basis of how the patient understands the information is interpreting the session, which is appropriate for the Assessment section. D: Family members' observations are reported in the Subjective section.

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

Solution: The correct answer is A. 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. B: The client's height is always important to consider when choosing a wheelchair. However, height is not a specific consideration when a person has a diagnosis of obesity. C: Upper-extremity strength will determine whether a person can independently propel a nonpowered wheelchair and could make a difference in the type of wheelchair recommended, but the consideration is not specific to a person considered to be obese. D: A client's functional ability is always taken into consideration in wheelchair selection, but it is not specifically related to a person who requires a bariatric wheelchair.

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.

Solution: The correct answer is A. 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. B: The goal is not client centered; the focus is on the employer. C: The goal lacks a specified timeframe in which the outcome is to be achieved D: The goal lacks an objective measure specifying full-time and full-duty employment

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

Solution: The correct answer is A. Therapeutic exercise and activity assist the client with improving strength and function while preventing further complications, including muscle imbalances. B: Skilled services do not include maintenance; an alternative intervention for someone who is unlikely to improve motion would be prevention of future complications. C: Reasons for therapy should never include increasing time in therapy; occupational therapy practitioners should strive to provide efficient care. D: Skilled services such as therapeutic exercise and activity do not include maintenance; in addition, most clients should not be taught compensatory movement patterns for weak muscle groups unless it is indicated (i.e., in the case of amputation) or a plateau in progress has been achieved.

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 daytime information listed. B. Provide auditory reminders throughout the day that provide basic personal and daytime 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.

Solution: The correct answer is A. Visual reminders are an effective strategy for deficits in orientation. Posting a client's name or picture outside of their room is not a HIPAA violation if the patient or guardian consents. B, C, D: Auditory reminders may be effective, but visual reminders that can be referred to throughout the day are more effective.

A COTA® is working with a client with C5 spinal cord injury. What is the BEST splinting strategy to use to encourage sensory feedback? A. Use of padded splints B. Use of dorsal splints C. Use of hand-based splints D. Use of dynamic splints

Solution: The correct answer is B. A dorsally based splint will allow for maximal sensory feedback while worn. A: Padded splints limit sensory feedback. C: Although hand-based splints may improve sensory feedback, by removing volar obstruction, the client will be more equipped to experience sensory feedback. D: Dynamic splints prescribe a low-load resistance and generally cover a large surface of the hand and arm.

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.

Solution: The correct answer is B. A: Driving assessment and intervention are within the occupational therapy scope of practice, it is an IADL, not an ADL. C: The occupational therapy practitioner should be using clinical reasoning, critical thinking, and best evidence to problem solve whether a client is fit to drive, not just clinical reasoning. D: A comprehensive evaluation, not just assessment of functional performance components, is necessary. A, C, D: These answers are partly true, but not the best answers.

A COTA® is reading an initial occupational evaluation report for a child with autism that concluded, on the basis of a sensory processing assessment, that the child shows signs of low registration of sensory information. Which of the child's behaviors observed by the COTA® during an intervention session is consistent with low sensory registration? A. Easily gets dizzy with linear swinging B. Shows increased hyperactive movements C. Dislikes being touched, kissed, and hugged D. Demonstrates guarded, cautious movements

Solution: The correct answer is B. According to Dunn's model, low registration of stimuli is demonstrated by sensory seeking. A, C, D: These behaviors indicate sensory avoiding or sensitivity, signs of high registration of stimuli.

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

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

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

Solution: The correct answer is B. 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, C, D: Socializing, attending conferences, and meeting with other COTA®'s are activities that fulfill professional behavior and development guidelines but do nothing to prevent career burnout.

The caregiver of a client with middle-stage dementiarequests 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.

Solution: The correct answer is B. Labeling physical structures with symbols, such as arrows for direction, is helpful to people with dementia. A: Bright colors are not recommended, because they might be overly stimulating for people with dementia. C: Low lighting would not be beneficial, because it might not be adequate for a person to identify items, leading to confusion. D: Leaving items out and visible might create too much visual clutter, which can increase confusion in people with dementia.

Which treatment activity would support a pediatric client's ability to increase visual attention to complete homework tasks? A. Providing directional cues paired with verbal cues B. Reorganizing a worksheet so that the answer spaces are clearly defined C. Using raised-line paper to complete assignments D. Color-coding folders and notebooks for different subjects

Solution: The correct answer is B. Reorganizing a worksheet with clearly defined answer spaces would help the child attend to relevant information on the worksheet. A: Directional cues can be provided to support visualmotor integration but would not help the child attend to relevant information on the worksheet. C: Using raised-line paper could be a good support for kinesthetic learners. D: Color coding would not be appropriate for visual organization.

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

Solution: The correct answer is B. 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: Quantitative measures such as goniometry have demonstrated poor reliability and decreased responsiveness compared with client self-report measures of function. C: Research has shown a less than optimal relationship between client self-report of quality of life and health care provider ratings from quantitative measures. Third-party payers are increasingly relying on self-reporting from patients in determining coverage. D: The DASH is a region-specific (not disease-specific) measure. Its focus is too narrow to characterize dysfunction; additional assessments are needed.

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

Solution: The correct answer is B. 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, C: 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. An adjustable-tension back support will further complicate the client's poor positioning, and replacing the foam cushion with a gel cushion will not address the postural problem or the pain resulting from pressure on the coccyx. D: Pressure mapping is an assessment, not an intervention; it illustrates how pressure is distributed across the sitting surface.

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

Solution: The correct answer is B. 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. A: The ability to complete ADLs would be an indicator of transfer ability, but it would not be a decisive factor. C: The surface is important to consider while transferring but should not directly affect the safety of the transfer. D: The amount of space between surfaces is important to consider while transferring, but it will not directly affect the safety of the transfer.

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 110 without a model D. Copying a pentagon and an octagon, printing own address, and drawing a house with 12 details

Solution: The correct answer is B. 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, C, D: These options represent more advanced skills that a 6-year-old would not typically be expected to have mastered.

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.

Solution: The correct answer is B. A contract for safety is the client's written agreement that he or she will tell an appropriate person if he or she is having thoughts of suicide. Preventive measures are the MOST urgent and important part of the discharge plan for clients with suicidal tendencies. A, C, D: These options are important parts of discharge planning, but suicide prevention is the most urgent concern for this client.

The COTA® is treating a client who presents with hemiplegia from a cardiovascular accident. The client's hand is flaccid. To fabricate a custom resting hand orthosis, in what position should the COTA® place the wrist and metacarpophalangeals (MCPs)? A. Wrist at 10 flexion and MCPs at 0 flexion B. Wrist at 25 extension and MCPs at 55 flexion C. Wrist at 45 flexion and MCPs at 10 flexion D. Wrist at 60 flexion and MCPs at 0 flexion

Solution: The correct answer is B. A resting hand orthosis keeps soft tissue positioned in optimal mobility with flexion of the MCPs at 45 to 60; 55 would accomplish this, and 25 of slight extension would maintain the wrist in a position that would not compromise the median nerve. A, C, D: MCPs at 0 of flexion would shorten the collateral ligaments and increase potential for flexion stiffness and wrist positioned in flexion would compromise the median nerve.

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

Solution: The correct answer is B. Activities for clients with major depression should be able to be completed easily to provide a sense of success and competence. A: Clients with major depression may be reluctant to participate in activities that are difficult to accomplish. C: Clients with major depression are best engaged in activities that provide a sense of immediate success. D: Activities for clients with major depression should require active participation.

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? 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

Solution: The correct answer is B. 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, C, D: A client with multiple sclerosis will continue to have progressive decline in function, so restorative strategies such as improving fine motor skill, increasing hand strength, and training in use of clothing fasteners are not appropriate interventions.

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.

Solution: The correct answer is B. 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, C: Reporting to the state regulatory board or to the OTR's supervisor is premature. The Enforcement Procedures for the Occupational Therapy Code of Ethics and Ethics Standards (2010) state that practitioners "should first pursue other corrective steps within the relevant institution or setting and discuss ethical concerns directly with the potential Respondent before resorting to AOTA's ethics complaint process" (p. S3). D: Human resources personnel are not responsible for handling ethical breaches, although if the appropriate investigation affirms that the colleague is falsifying documentation, there would be grounds for terminating the employee.

A COTA® is working on postoperative discharge plan for a school-age child with neurofibromatosis. The COTA® recommends that the parents move the child's clothes from the top drawer so that the child can access them independently. Why might the COTA® make this recommendation? A. Children with neurofibromatosis have weakened shoulder girdles and reduced upper-extremity strength. B. Children with neurofibromatosis are of short stature and have skeletal anomalies. C. Children with neurofibromatosis have decreased sensation and often drop things. D. Children with neurofibromatosis have difficulty initiating routines.

Solution: The correct answer is B. Children with neurofibromatosis are of short stature and have skeletal anomalies. Because of their reduced height, they may benefit from environmental modifications that allow them to reach objects independently. A: Children with neurofibromatosis may have strong shoulder girdles and functional shoulder strength. C: Children with neurofibromatosis may not have decreased sensation, unless they have a comorbid condition. D: Children with neurofibromatosis may not have difficulty initiating routines, unless they have a comorbid condition.

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.

Solution: The correct answer is B. 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: Modified-handle tools would be appropriate if the client had arthritis of the hands. C: Ensuring materials are within reach at all times may not be feasible because plumbers must access pipes in hard-to-reach areas. D: A wheeled cart may not permit the client access to all locations and may add to lifting requirements.

Evaluation results indicate a client who has frozen shoulders has 85° shoulder flexion and abduction bilaterally. The client wants to increase ROM for completing homemaking tasks. Which activity would be MOST EFFECTIVE for promoting progress toward this goal? A. Vacuuming carpets B. Folding bed sheets C. Wiping a countertop D. Ironing long pants

Solution: The correct answer is B. Folding bed sheets would facilitate shoulder flexion beyond 85 while completing the task and work toward increasing ROM. A, C, D: Vacuuming, wiping counters, and ironing would not facilitate shoulder flexion beyond 85 and would not work to increase ROM for the client.

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

Solution: The correct answer is B. Intention tremors occur during voluntary movement, and providing proximal stabilization may be effective in decreasing the intensity of the tremor with eating. A: A universal cuff is used when grasp ability is diminished and would not be beneficial to decrease tremor. C: Mobile arm supports or slings are used to improve mobility of the upper extremity during activities and would not be beneficial to decrease tremor. D: Use of weighted utensils may lessen tremors, but the added weight of the utensil may contribute to a person's fatigue.

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? Close supervision on an ongoing basis to ensure maintenance of service competency Minimal supervision to periodically recheck that service competency is maintained Supervision on an as-needed basis per the COTA®'s request to fine-tune service competency None, unless otherwise indicated by the facility, state law, or licensing changes

Solution: The correct answer is B. Once service competency is established, the supervising OTR® should periodically recheck to ensure maintenance. A: This approach provides too much supervision. C: This supervision is not structured or deemed appropriate by the supervising OTR®. D: Periodic check-ins are warranted.

A student in the second grade has sensory modulation disorder. When handwriting in class the student consistently places excessive force on the pencil, causing the pencil point to break. Which activity would provide the child with proprioceptive input for regulating the amount of pressure applied to the pencil during handwriting? A. Tracing the letters of the alphabet with fingertips B. Kneading modeling clay with both hands on a desktop C. Cutting firm resistance therapy putty with scissors D. Drawing shapes and letters on a chalk board with jumbo chalk

Solution: The correct answer is B. Proprioceptive input is provided through firm pressure to skin or joints, which the student would receive from kneading modeling clay. A: Tracing letters with fingertips provides light tactile input and would not provide the deep, firm pressure needed for proprioceptive input. C: Cutting firm therapy putty with scissors would address hand strengthening and not directly provide proprioceptive input. D: Drawing shapes on a chalk board provides practice in writing but does not provide the proprioceptive input needed.

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

Solution: The correct answer is B. Research indicates that proprioceptive input inhibits vestibular stimulation. A, C, D: No evidence exists that stopping or slowing the activity or continuing autonomic activation inhibits the vestibular response.

A client with stroke demonstrates deficits in visual-perceptual skills. One of the client's goals is to be more independent with dressing. What activity would be appropriate for the intervention session? A. Drawing a clock diagram on paper B. Putting on a button-front shirt C. Copying a pegboard design from a pattern D. Completing a bed-to-chair transfer

Solution: The correct answer is B. The client can remediate visual-perceptual skills through task-specific practice in choosing a shirt from the closet, identifying the top and bottom of the shirt, and locating the sleeve. A: Use of paper-and-pencil tasks does not generalize to functional task performance. C: Bottom-up approaches based on purposeful activities do not generalize to functional task performance. D: Transfers may not allow the client to use visual-perceptual skills at the level required for a dressing activity.

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

Solution: The correct answer is B. This example describes minimal assistance, which is when a client is able to complete at least 75% of a task. A: Standby assistance and contact guard assistance indicate that the client needs the caregiver only for safety and balance during the task. C: Moderate assistance indicates that a client needs at least 25% support from a caregiver. This example would have been considered moderate assistance if the client had also needed additional support to pull up and adjust lower-extremity garments. D: Maximal assistance indicates that a client needs at least 51% to 75% assistance. A client at this level also would have needed assistance with pulling down undergarments, manipulating toilet paper, wiping, and adjusting and pulling up lower-extremity garments.

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."

Solution: The correct answer is B. 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. A: This statement is an example of P (plan); it states the priorities regarding intervention strategy. C: This statement is an example of O (objective); it is an observed and measurable statement that presents a picture of the intervention session. D: This statement is an example of S (subjective); it is information obtained from the client.

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

Solution: The correct answer is C. A TENS unit will best aid the client in reaching the treatment goal of pain control. A: Cold spray is used to treat trigger points and increase passive stretch of a muscle tendon unit. B: NMES is best used to facilitate muscle contraction. D: Iontophoresis is used to control inflammatory conditions.

A COTA® is working with an adolescent with traumatic brain injury on cooking skills. While completing an activity analysis of making simple meals on the stovetop, the COTA® notes that the client must be able to judge therelative distance between self and the stove to safely complete a cooking task. Which visual-perceptual skill does the client need to be able to judge this distance? A. Visual closure B. Position in space C. Depth perception D. Visual memory

Solution: The correct answer is C. Depth perception is a person's ability to judge the relative distance between self and another object in space. A, B, D: Visual closure, position in space, and visual memory are other very important visual and perceptual skills, but not the one highlighted in this activity analysis.

During a commode-to-bed transfer, the client begins to slip from the COTA®'s grasp. What action is best for the COTA® to take? A. Continue with the transfer, and try to get the client to the bed as quickly as possible. B. Have the client return to the commode. C. Ease the client to the floor, then get assistance. D. Call for help, and get the attention of the client's nurse.

Solution: The correct answer is C. Easing the client to the floor protects both the client and the therapist from injury. A, B: Trying to move the client too quickly or reverse the transfer can result in injuries to both the client and the COTA®. D: Help may not arrive in time to assist, resulting in the COTA®'s dropping or injuring the client.

A COTA® is discussing with a set of parents different types of technology to improve the handwriting skills of their 8-year-old child with autism. Which approach is the BEST example of a basic technology that can improve handwriting skills? A. An iPad tracing application for correct letter formation. B. Computer software that prompts the child to copy sentences. C. A pencil grip to facilitate pencil grasp during writing. D. Dot-to-dot tracing of correct letter formation.

Solution: The correct answer is C. Of the options, only a pencil grip is considered a basic technology. A, B, D: These options are considered educational and electronic technologies.

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

Solution: The correct answer is C. 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, B, D: Deciding whether an intervention is within the scope of occupational therapy practice, describing progress by recipients of service when little change has occurred, and extending work hours to treat more clients, although potentially distressing, were not commonly identified by occupational therapy practitioners.

The mother of a 7-year-old boy with autism asks the COTA® to teach her child to urinate in the toilet bowl. Which method is BEST to teach this skill? A. Use a water gun to squirt water inside the toilet bowl to teach the concept of toileting. B. Ask the child to sit, keep deflecting the urine stream inside the bowl, and then slowly stand. C. Place a piece of cereal inside the bowl to serve as a target during the treatment session. D. Use a piece of cardboard to elevate the rim of the bowl for a visual cue.

Solution: The correct answer is C. Using a target such as a piece of cereal can help increase a child's attention to accuracy when learning to urinate while standing. A: This activity will not ensure transfer of the skill to urination. B: This activity will not teach proper orientation when urinating while standing. D: This activity does not facilitate accuracy when urinating.

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.

Solution: The correct answer is C. 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: This viewer has 20/20 visual acuity. B: This viewer has 20/100 visual acuity. D: This viewer has 20/10—better than normal—visual acuity.

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

Solution: The correct answer is C. 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, D: Taking contrast baths and using a compression garment are beneficial for edema control of the arm in a client with complex regional pain syndrome. B: Gentle, pain-free AROM encourages circulation, decreases stiffness, and may assist in interrupting the pain cycle.

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

Solution: The correct answer is C. When beginning to teach dressing skills, the COTA®begins with basic, simple articles of clothing, such as loose-fitting pants and over-the-head, slightly large shirts, to allow for success. A, B: These are more advanced dressing skills. D: Because the case description did not indicate any tactile issues with dressing, there is no basis for selecting this activity.

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

Solution: The correct answer is C. A client with end-stage ALS would likely be totally dependent for all ADL and mobility, thus requiring major caregiver assistance for bed mobility and transfers. A COTA® instructing family members in these techniques would educate them on body mechanics. Positioning and ROM at this stage are important to prevent discomfort, contractures, and skin breakdown. A: A client with end-stage ALS would likely require total care for ADLs. B: Energy conservation is not appropriate because at this stage, the client would likely not be exerting extraneous amounts of energy. D: Therapeutic exercises are just one component of a home program.

A client with multiple sclerosis is experiencing difficulty remembering to complete all of her weekly homemaking tasks. Which of the following cognitive modifications can the COTA® instruct the client in to improve completion of tasks? A. Decrease time spent on an activity to conserve cognitive focus. B. Use an adaptive bath bench to conserve energy during bathing. C. Keep a laminated list of in an easily seen location to keep track. D. Use cognitive strategies to cope with changes in daily activities and routines.

Solution: The correct answer is C. C: Keeping a list is a cognitive strategy that aids memory A: Increasing the time spent on activities improves attention and task completion. B: Use of a bath bench is not a cognitive compensation strategy but an adaptive equipment intervention. D: Emotion-focused strategies best address coping skills to decrease the client's stress and are not as beneficial as problem-solving techniques in compensating for cognitive deficits.

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

Solution: The correct answer is C. Evidence has shown that camouflaging a door and its doorknob can decrease way-finding behavior when a client with Alzheimer's disease wanders. A: A big "STOP" sign requires that the client be able to recognize and understand it. This ability will not be preserved in a client with Stage III Alzheimer's disease; therefore, this option will not be useful in deterring the client from using the back door. B: Making the door contrast with the environment enhances visual/perceptual acuity and might actually increase the possibility of the client's opening and using the back door. D: A motion-detector light can light up the stairs at the garage but cannot prevent the client from wandering out and using them.

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.

Solution: The correct answer is C. Hand-over-hand guidance is an effective strategy to encourage maximal independence through participation in daily living tasks, including self-feeding. A, B: Changing the diet and changing the consistency of foods might encourage the client to eat more but will not specifically address maximal independence in self-feeding. D: Although structured prompting is effective in assisting clients with dementia, continual verbal cues might be overwhelming.

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

Solution: The correct answer is C. 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. A, B: The client's typical routine for setting the table may involve putting the utensils to the right of the plate, so this performance may not be related to a deficit in other tasks or related to figure ground deficits. D: If setting the utensils to the right of the plate during meals is the client's typical routine, it is not necessary for the client to learn a proper technique for setting the table.

Which intervention strategy would be appropriate when teaching a compensatory approach for the production of written language to a child who has a diagnosis of developmental coordination disorder? A. Provide the child with a pencil grip. B. Encourage the teacher to provide a copy of his or her notes. C. Instruct the child in keyboarding. D. Allow the child to use print instead of cursive writing.

Solution: The correct answer is C. Instructing the child in keyboarding would provide the child with a compensatory way to produce written language instead of handwriting. A: The pencil grip would adapt the writing instrument but is not a compensatory approach. B: This option suggests a modification to task demands but does not include a compensatory approach. D: Allowing the child to print still requires the child to use handwriting, and printing may be as difficult as cursive.

A COTA is providing dressing skills training for a client with traumatic brain injury (TBI). The client has a sequencing deficit. What strategy is appropriate for the COTA to use with this client? A. Use picture cards of dressing and have the client put the steps of dressing in order B. Have the client write out the steps in dressing using paper and pencil C. Hand the client each item of clothing and provide assistance in donning the item D. Ask the client which clothing item should be selected next

Solution: The correct answer is C. Minimizing environmental distractions and decreasing the complexity of the task allows the client with TBI to experience success with completion of one step of the task at a time. A, B: Tabletop activities will not generalize or transfer to the client's ability to dress successfully. D: Asking the client questions about which step of the task comes next may present too great a challenge and increase the client's frustration.

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.

Solution: The correct answer is C. Service competency is defined as "the process of teaching, training, and evaluating in which the OTR® determines that the COTA® performs tasks in the same way that the OTR would and achieves the same outcomes" (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, D: These are indirect approaches to determining the COTA's skill, which are insufficient to establish service competency. B: The tasks do not need to be performed in exactly the same way, but the outcomes must be similar.

A COTA® is using groups in a residential rehabilitation facility for people with substance abuse. The COTA has identified a group of clients who have difficulty with assertiveness during encounters with significant others. The COTA decides to use role playing with the group members to help them improve their response in such events. What frame of reference does this intervention choice suggest? A. Psychodynamic B. Sensorimotor C. Behavioral D. Developmental

Solution: The correct answer is C. The behavioral frame of reference uses repetition to shape a client's behaviors in a safe environment in order to reduce negative thoughts and emotions associated with the stressful event. In this example, the COTA wants the clients to practice assertiveness in their interactions so that they can feel prepared and confident in future interactions outside the therapy setting. A: A psychodynamic frame of reference is mostly discussion based and individualized. B: A sensorimotor frame of reference uses sensory experiences to assist in regulation of responses. D: A developmental frame of reference examines the client's age and expectations of the environment and uses activities that facilitate successful completion in this context.

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

Solution: The correct answer is C. 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: The client will gain functional skill through using real objects in a natural environment rather than through rote exercise. B: Assistive technology may or may not be required for the client to use in the home and is not the most important area of education prior to discharge. D: Transfer training should have been part of the inpatient rehabilitation intervention plan, and family should have been educated on these skills prior to discharge.

The initial evaluation documentation for a client with Parkinson's disease indicates that the OTR asked 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

Solution: The correct answer is C. 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. A: If the client is unable to initiate movement of the dominant arm during simulated teeth brushing, it is unlikely that adding weight would facilitate movement. B: Suggesting the assistance of a caregiver for brushing teeth may entail a greater level of assistance than the client actually requires. The client should be provided opportunity to complete ADLs at the highest level of independence desired. D: Clients with Parkinson's disease may have difficulty initiating or limitations in movement because of rigidity. Use of a mobile arm support would not be appropriate without further evaluation of the client's needs.

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.

Solution: The correct answer is C. 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). A: This goal is missing the measurement aspect of the objective. B: This item would be part of the intervention plan rather than a goal. D: This goal is missing the assistance level and the estimated time it will take for client to achieve the goal.

A COTA® is working with a 2-year-old child in early intervention and suspects that the child may have an underlying hearing impairment. The COTA® reports this information to the OTR®. To whom should the COTA®, in conjunction with the OTR®, refer the client? A. The nurse assigned to the case B. The primary care physician C. A speechlanguage pathologist D. An audiologist

Solution: The correct answer is D. An audiologist is the appropriate team member to assess a child's hearing. A, B, C: The other professionals are valuable members of the team, but they do not evaluate a child's hearing.

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

Solution: The correct answer is D. 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: Blurriness of visual details is caused by cataracts. B: Spotty areas of vision are caused by diabetic retinopathy. C: Loss of ability to see details is caused by age-related macular degeneration.

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.

Solution: The correct answer is D. 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: Arguing with a client with dementia is never a good idea; people with dementia lack insight into their condition, and an argument is likely to increase agitation. B: Asking a client with dementia who is agitated to complete any new task would not be wise; it might increase the client's agitation. C: Abandoning a client with dementia would not be wise because the COTA® might be able to calm the client with therapeutic use of self.

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

Solution: The correct answer is D. Upper extremities in decorticate rigidity are spastic and flexed, with internal rotation and adduction. A, B, C: These answers do not describe decorticate rigidity

A COTA® in an inpatient facility is conducting a cooking activity to teach effective coping skills to a small group of adolescents. A group member becomes frustrated with a teammate and is verbally threatening. What is the BEST response for the COTA® to say in this situation? A. "I see that you're upset by your teammate. Let's calm down and take a deep breath." B. "You seem upset by your teammate. Verbally threatening is not a good behavior to show others." C. "I need you to calm down and reflect for a while. We can discuss this later." D. "Do you want to take a minute to calm down, or go back to your room?"

Solution: The correct answer is D. When a potentially dangerous situation commences, such as a threat of assault, the COTA® should offer the adolescent choices for effective coping strategies to deal with emotional outbursts. A, B, C: These options do not offer the client good choices of behaviors and may deter participation.

A client scores a Allen Cognitive Level (ACL) of 4.0 with the Allen Cognitive Disability Framework. Given this score, what discharge arrangement would the COTA®, in consultation with the OTR®, likely recommend for this client? A. This client could be discharged home alone with weekly checks for novel safety issues and health maintenance needs and reminders. B. This client could be discharged home with family for support in all areas of IADLs and personal care, including bathing, dressing, and hygiene. C. This client should remain in the psychiatric facility under close 24-hour supervision for safety and personal care needs. D. This client could be discharged to a supported living arrangement with the expectation that the client can independently complete the morning self-care routine.

Solution: The correct answer is D. A client with an ACL of 4.0 should be in a supported living arrangement but would be expected to complete habitual routines independently (e.g., morning self-care). A: This response indicates a person functioning at an ACL of 5.2. B, C: These responses indicate a person with an ACL of less than 4.0, because a person at such a level will require close supervision and support for all needs.

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

Solution: The correct answer is D. Ape hand deformity is the result of median nerve injury at the elbow or proximal forearm. A: Ulnar claw is a result of an ulnar nerve injury and hyperextension of the metacarpophalangeal joint in the small and ring finger with proximal interphalangeal flexion. B, C: Boutonniere and swan neck are finger deformities and structural ligament injuries.

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

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

An OTR® 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

Solution: The correct answer is D. 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, B, C: Although these sources provide important information, this information is not critical in devising an intervention plan for the client.

A child with Down syndrome has a goal of learning to don socks independently. Which adaptation would be MOST appropriate to facilitate this task? A. Long socks over the calf B. Smaller socks C. Sock aide or donner D. Loops sewn in socks

Solution: The correct answer is D. Loops sewn in socks would be appropriate for a child with Down syndrome to compensate for decreased fine motor skills. A: Socks that go over the calf are more difficult to don than ankle socks and socks that approach the calf. B: Smaller socks are contraindicated for clients who have difficulty donning socks. C: A sock aide or donner is recommended for clients who have difficulty with bending.

A COTA® has recommended that a student with a learning disability use an assignment notebook to write down homework assignments for each class. Which factor related to learning disabilities does this compensatory strategy address? A. Disorders of sequencing and adapting prioritization and problem solving B. Disorders of social skills and concentration C. Disorders of sensory integration and perception D. Disorders of thinking and memory

Solution: The correct answer is D. People with learning disabilities often have difficulty with short- and long-term memory. Using an assignment notebook would mean that the student would not have to recall the assignments after leaving the class. A, B, C: These options are not specifically related to the underlying reason why the student would need to bring an assignment notebook to class.

A client is 2 days post-stroke in acute care with right hemiparesis and requires moderate to total assistance for basic ADLs. The client's FIM™ scores on admission to occupational therapy are 2 for dressing, 1 for bathing, and 3 for feeding. Which intervention is MOST appropriate to provide first? A. Refer the client for a driving evaluation in preparation for community reentry B. Educate the client and caregiver about a home program addressing right-side awareness C. Supervise the client in completing hygiene tasks standing at the sink while emphasizing use of the right arm D. Train the client in postural activity at the edge of the bed to increase supported sitting

Solution: The correct answer is D. Postural stability is essential to performing many ADLs, and hemiparesis influences the client's ability to maintain postural stability at the edge of the bed. A: Driving evaluations are not appropriate for clients in acute care stroke rehabilitation. B: Home program training will be important as the client prepares to transition from the acute care and inpatient rehabilitation environments. However, this intervention should not be the first approach. C: The client's FIM levels indicate that standing at the sink for hygiene tasks is too difficult for the client's current status.

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

Solution: The correct answer is D. Somatosensory dyspraxia occurs when a person is unable to process tactile-kinesthetic or proprioceptive input to complete a motor plan. This child is able to coordinate the movements for kicking the ball but is unable to adequately calibrate the force with which to kick the ball and send it into the goal. A: Visual dyspraxia is the inability to complete visual construction tasks, such as drawing patterns or building with blocks. B: Ideational dyspraxia involves the ability to conceptualize a set of actions through internal visualizations; this is not the impairment demonstrated with this child. D: Verbal dyspraxia involves difficulty making a motor plan after receiving verbal instructions. the child is able to take action to kick the ball toward the goal, so this type of dyspraxia is not the problem.

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.

Solution: The correct answer is D. Supervision that is more frequent may be necessary when the OTR®, COTA®, or both determine that additional supervision is needed to ensure safe and effective delivery of occupational therapy services. In this case, safety is a major concern, and therefore additional supervision may be necessary. A: This unnecessary step would put the COTA®'s job at risk; more appropriate solutions exist before going to this type of extreme measure. B, C: These approaches offer more indirect supervision; moreover, C is not appropriate because whether the COTA® says yes or no, more supervision is warranted because of the OTR®'s safety concerns.

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.

Solution: The correct answer is D. 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: Skipping the treatment session could affect billing or reimbursement for the site and is unfair to the patient, who is expecting treatment. B, C: The COTA® must have specific supervision from the evaluating OTR® before proceeding with treatment.

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.

Solution: The correct answer is D. 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. A: The client's sliding out of the chair indicates that it has poor back support. B: Pain in the ischial tuberosity indicates that the footrests are too short, placing increased pressure on the ischial tuberosity. C: When a client needs to lean out of the chair to propel it, the wheelchair is too wide for the client to sit upright and reach the wheels.

An OTR® is creating an intervention plan for a client who was recently in a car accident and has multiple fractures. The client is currently not driving but has verbalized the desire to drive again in the future. What is the appropriate hierarchy of skill building to restore competence in mobility for this client? A. Start with car transfers, then move to functional ambulation for ADLs, then to functional ambulation for community mobility, and end with driving. B. Start with functional ambulation for ADLs, then to functional ambulation for community mobility, then move to car transfers, and end with driving. C. Start with functional ambulation for community mobility, then move to car transfers, then to functional ambulation for ADLs, and end with driving. D. Start with functional ambulation for ADLs, then move to car transfers, then to functional ambulation for community mobility, and end with driving.

Solution: The correct answer is D. The intervention plan must be developed in sequence with the hierarchy of skills of each mobility task and their increasing complexity. Functional ambulation for ADLs is the least complex, followed by car transfers, functional ambulation for community mobility, and finally driving. A: Considering the hierarchy of skills for each mobility task and their demands, car transfers are considered to be more complex than functional ambulation for ADLs and therefore should not be addressed first. B: Considering the hierarchy of skills for each mobility task and their demands, functional ambulation for community mobility is considered to be more complex than car transfers and therefore should not be addressed before car transfers. C: Considering the hierarchy of skills for each mobility task and their demands, functional ambulation for community mobility is considered to be more complex than both functional ambulation for ADLs and car transfers and therefore should not be addressed before them.

A COTA has recently had a conflict with a physical therapist who works at the same treatment facility. During a team meeting that includes the client, the COTA says that the physical therapist is using outdated approaches that are ineffective. One of the other team members feels that the COTA has violated an ethical principle and wants to discuss the matter with the COTA after the meeting concludes. Which principle will the team member discuss with the COTA in relation to the COTA's comment? A. Beneficence B. Autonomy C. Justice D. Fidelity

Solution: The correct answer is D. The principle of fidelity requires that a COTA treat other professionals with respect, discretion, and integrity. By allowing the interpersonal conflict to affect comments during a team meeting, the COTA has not been respectful of the physical therapist's practice choices and has not used appropriate conflict resolution strategies. Principle 6I of the Occupational Therapy Code of Ethics (2015) states that occupational therapy practitioners "shall respect the practices, competencies, roles, and responsibilities of their own and other professions to promote a collaborative environment reflective of interprofessional teams." A: Beneficence refers to the demonstration of concern for others' safety and well-being. B: Autonomy is the concept that practitioners have a duty to treat the client according to the client's desires, within the bounds of accepted standards of care, and to protect the client's confidential information. C: Justice refers to the fair, equitable, and appropriate treatment of persons and access to occupational engagement.

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. Non-maleficence

Solution: The correct answer is D. 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: Beneficence refers to the demonstration of concern for others' safety and well-being. B: Autonomy is the concept that practitioners have a duty to treat the client according to the client's desires, within the bounds of accepted standards of care, and to protect the client's confidential information. C: Justice refers to the fair, equitable, and appropriate treatment of persons and access to occupational engagement.

A supervising OTR® hires two newly graduated COTA®s 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 and 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 while the other observes.

Solution: The correct answer is D. 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, B: These approaches involve more visual learning techniques, which would be tailored only to the COTA who prefers this style of learning. C: This style is more interactive and kinesthetic and may not be as meaningful for the visual learner.

A COTA® is working with the caregiver of a person with Alzheimer's disease (AD) to provide strategies to reduce the burden of caregiving. What strategies might the COTA suggest? Select the 3 BEST choices. A. Engage the client in appropriate activities during unoccupied time to improve daily structure B. Avoid overstimulation in the environment to reduce behavioral symptoms C. Compensate for declining function in the least restrictive environment D. Allow the client to continue cooking independently with adapted cooking utensils to improve safety E. Challenge the client's daily routine by maintaining moderate distance during routine tasks F. Take a short break outside the home each morning after the client has taken medication to avoid burnout

Solution: The correct answers are A, B, and C. A: Providing structure for unoccupied time is an important consideration to prevent behavior problems and maintain quality of life for clients with AD. In addition, structure promotes an increase in goal-directed activity and may aid in more regular sleep patterns. B: Overstimulation can lead to behavioral issues, so avoiding overstimulation in the environment can improve optimal functioning. C: Intervention should support and maintain capabilities or compensate for a decline in function. D: Providing education to the caregiver about potentially dangerous tasks is important; cooking is best done with supervision. E: Providing challenge to a client with AD can be frustrating and lead to an increase in confusion or agitation. F: People with AD should be supervised at all times because of the tendency to wander or become disoriented, impaired judgment, and increased fall risk. Dooley, N. R., & Hinojosa, J. (2004). Improving quality o

A child in elementary school has difficulty attending to homework tasks because of symptoms associated with attention deficit hyperactivity disorder. The parents want recommendations for improving their child's on-task behavior. Which recommendations should the COTA® provide to the parents to support their child's participation during homework? Select the 3 BEST choices. A. Establish a routine schedule and location for completing assignments B. Allow the child to listen to calming music while completing assignments C. Use a timer so the child knows how many minutes are left to complete an assignment D. Purchase a beanbag chair for the child to sit in when working on assignments E. Prioritize the child's work so that the assignment that requires the most concentration is completed first F. Read homework out loud to the student and write down the child's answers

Solution: The correct answers are A, C, and E. A: Structuring the environment by establishing a schedule and location for completing homework can provide organization for a child having difficulty attending. C: Structuring the work task by establishing time parameters can provide organization for a child having difficulty attending. E: Structuring the work task by prioritizing which assignment or aspect of the assignment is completed first can provide organization for a child having difficulty attending. B: Music may be a distraction to a child completing homework. D: Sitting in a beanbag chair to complete homework may be more distracting for the child, who may have difficulty reaching required materials to complete homework. F: Reading the homework to the child and completing the homework by writing down the answers for the child do not facilitate the child's independence in school performance tasks.

A COTA® is working with a 4-year-old 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 statements describe the progression of DMD? Select the 3 BEST choices. A. The condition progresses slowly. B. The condition progresses quickly. C. Facial muscles will be affected; the child will eventually have a mask-like appearance. D. Pelvic muscles weaken, and positive Gower's sign is present. E. The child may need to use a wheelchair before age 9. F. The condition usually has an onset before adolescence, and it progresses until the child cannot raise the arms above the head.

Solution: The correct answers are B, D, and E. B, D, E: Duchenne's muscular dystrophy progresses quickly and is characterized by weakened pelvic muscles and positive Gower's sign. Children with DMD often need to use a wheelchair before age 9. A: Duchenne's muscular dystrophy progresses quickly. C: A masklike appearance is related to facioscapulohumeral muscular dystrophy, not DMD. F: Inability to raise the arms above the head is related to limb-girdle muscular dystrophy, not DMD.

A client sustained a deep partial-thickness burn to the anterior aspect of the right arm from the hand to the mid-upper arm. A split-thickness skin graft taken from the thigh was placed on the mid-forearm 3 days postinjury. The COTA® wants to minimize the risk of graft rejection in the surgical phase, which is up to 7 days post-surgery. What strategies should the client be instructed to perform? Select the 3 BEST choices. A. Daily active pronation and supination exercises at least 5 times per day B. Desensitization using ice to gently rub the burned areas from distal to proximal C. Adaptations to allow ADLs using the left hand for eating and grooming D. Retrograde massage followed by wrapping with elastic bandage E. Immobilization using a wrist splint and avoidance of wrist and forearm movement F. Immobilization using the elbow extension splint to avoid elbow and forearm movement

Solution: The correct answers are C, E, and F. C: ADL independence can improve confidence and promote the client's feelings of control over the environment. E, F: During the surgical phase after a skin graft operation, it is important to maintain immobilization for 2-7 days or per the physician's specific instruction. The antideformity position for the elbow is elbow extension and forearm in neutral position. A, B, D: Risk of graft rejection as a result of shear friction, movement, and excessive pressure should be avoided.