Wrong Set 2
A worker participating in back-neck rehabilitation is receiving education on proper standing workstations. The worker is required to move 10-lb discs onto a dowel. Which design element should be considered for the client's workstation? A. Workstation height should allow some elbow extension during the task. B. The workstation should enable the worker to sit or stand during the task. C. The workstation should enable the worker to reach overhead during the task. D. Workstation tools should be placed beyond arm's reach during the task.
The right answer is A A standing workstation is ideal for tasks requiring downward force; heavier tasks should be done with some elbow extension to minimize forces applied to the elbow musculature Explanations of Incorrect Answers B: Sitting is not recommended during heavy lifting tasks. C: Repetitive heavy lifting overhead is not recommended. D: Tools used during tasks should be kept within arm's reach for ease of access.
An OTR® in an outpatient center is working with a client who has rheumatoid arthritis. The client, who is the parent of two children, has worked with a driver rehabilitation specialist on vehicle modifications that allow safer and more comfortable operation of the client's car. Which other aspect of community mobility might a generalist OTR® address? A. Securing the client's children safely in their car seats, including handling the car seats and positioning the children B. Training the client in adapted techniques for dressing and bathing the children with hand deformities C. Adjusting the foot pedals of the car to allow the client to minimize stress to the foot and ankle joints D. Recommending enhanced vehicle mirrors and techniques to accommodate for the client's reduced neck range of motion
The right answer is A AOTA's (2010) "Statement on Driving and Community Mobility" addresses the issue of assisting parents with disabilities in managing passenger safety for their children. Explanations of Incorrect Answers B: Training in techniques for bathing and dressing children is not in the domain of community mobility interventions. C, D: Alterations to the client's vehicle require the skills of a specialist trained in driver rehabilitation or vehicle modifications as opposed to a generalist OTR® addressing an IADL.
Which of the following statements about occupational therapy fieldwork is accurate? A. A health care professional other than an OTR® can supervise occupational therapy students on Level I fieldwork. B. Payers are not able to regulate the supervision of occupational therapy students. C. Initial suggested supervision for Level II occupational therapy students is indirect. D. An OTR® or COTA® can supervise an occupational therapy Level II fieldwork student.
The right answer is A According to the ACOTE® guidelines, other health care professionals can supervise Level I occupational therapy students. Explanations of Incorrect Answers B: Payer sources are able to regulate supervision of occupational therapy students. C: The initial suggested requirements for supervision for Level II occupational therapy students is direct and line of sight. D: A Level II occupational therapy student cannot be supervised by a COTA®.
An older adult client with age-related macular degeneration presents for evaluation and demonstrates difficulty reading and signing consent forms. What visual function should the OTR® evaluate first? A. Visual acuity B. Tolerance to glare C. Visual field D. Visual scanning
The right answer is A Age-related macular degeneration causes loss of central visual acuity, resulting in difficulty discriminating small visual details required for reading and writing. Explanations of Incorrect Answers B, C, D: Tolerance to glare and visual field and visual scanning are not characteristic of age-related macular degeneration.
An 18-year-old client is admitted to an inpatient psychiatric hospital. The psychiatrist describes an uninterrupted 18-month period of illness that includes visual and auditory hallucinations. What type of issues would the OTR® expect to see when the client attempts to do a task? A. Aggressive outbursts of behaviors when frustrated with a project B. Overassertive, controlling behaviors during group activities C. Difficulty engaging in problem solving D. Panic over task choices
The right answer is A During task performance, clients with symptoms of schizophrenia can show elevated levels of frustration and aggression during challenging tasks. Explanations of Incorrect Answers B, C, D: These behaviors are more indicative of Bipolar I disorder. Bipolar I disorder typically consists of more than one combined depressive and manic episode. Schizophrenia includes symptoms such as hallucinations, delusions, and disorganized speech.
A patient with deep partial-thickness burns has an extremely edematous right hand. The patient has multiple open wound areas on the dorsum of the hand and between the web spaces. What is the BEST approach for assessing the effectiveness of treatment in reducing swelling? A. Take circumferential measurements of the forearms, wrists, palms, and digits. B. Use a volumeter to measure water displacement of the forearms and hands. C. Ask the patient to elevate the right hand above the level of the heart. D. Compare differences in time in completing the Nine-Hole Peg Test.
The right answer is A Even though both circumferential and volumeter measurements are appropriate for edema measurement, the patient has multiple open wound areas, and allowing the hand to get wet might not be appropriate. Circumferential measurement is the more appropriate approach. It might be necessary to obtain the doctor's agreement before wetting a hand with open wounds. Explanations of Incorrect Answers B: It is not appropriate to wet the open wounds at this stage. C: Elevation of the edematous hand above the level of the heart is a method of intervention to decrease edema; it is not an approach for measuring edema. D: The Nine-Hole Peg Test is a test of coordination and does not directly measure the amount of edema.
An older adult client who lives independently and has age-related macular degeneration reports difficulty reading small print. The OTR® completes acuity testing and determines that the client has visual acuity of 20/200. What recommendation should the OTR make? A. Increase illumination and enlarge print B. Reduce background contrast when reading C. See an eye care specialist for visual field testing D. Use occlusion to facilitate reading
The right answer is A For clients with visual acuity loss, increased illumination and enlarged print facilitate reading. Explanations of Incorrect Answers B: Background contrast should be increased, not reduced, to promote visibility. C, D: Age-related macular degeneration does not result in changes in visual field or oculomotor function, so visual field testing and occlusion would not be recommended.
According the ethical principle of Justice, an OTR® is obliged to be aware of certain laws such as the Americans With Disabilities Act (ADA). An OTR 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 OTR respond to the request? A. Work with administration 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.
The right 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. Explanations of Incorrect Answers 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 OTR's. D: This option is not the best because the OTR should work collaboratively with management rather than abdicate all responsibility for the situation.
An OTR® is instructing a client post-hip surgery on after-toileting cleansing while adhering to appropriate hip precautions. What method is the BEST to prevent further injury? A. Advise the client to wipe between the legs in a standing position over the commode. B. Instruct the client to wipe between the legs in a sitting position on an elevated toilet seat. C. Advise the client to wipe from behind the legs in a standing position over the commode. D. Instruct the client to wipe from behind the legs in a sitting position on an elevated toilet seat.
The right answer is B All hip replacement clients should wipe between their legs in a sitting position. Explanations of Incorrect Answers A, C, D: These methods may violate hip precautions as well as increase fall risk.
A student in the first grade has illegible handwriting. Results of a standardized assessment indicate the student scored 0.5 standard deviations from the mean on a gross motor subtest and 2.0 standard deviations from the mean on a fine motor subtest. What do these results indicate? A. Activities to improve handwriting should be included as part of the intervention. B. Ninety-eight percent of the student's peers would score better on the fine motor test. C. Fine and gross motor skills are within an acceptable range from the norm. D. Fine motor and gross motor skills are moderately delayed compared to the norm.
The right answer is A Standard deviations less than 1.5 suggest a need for occupational therapy services; in this case, the gross motor standard deviation does not suggest a delay, whereas the fine motor standard deviation should be addressed through an intervention plan that addresses the student's handwriting. Explanations of Incorrect Answers B: Percentile score is not derived or related to the standard deviation; rather, it is derived from the raw scores. The percentile score is what suggests the number of peers that would score better than the client. C: Gross motor skills are within an acceptable range from the norm, but fine motor skills suggest a delay. D: Gross motor skills are within an acceptable range from the norm, but fine motor skills suggest a delay.
A grocery store company hires an OTR® to complete work tolerance screenings for potential employees. The company has no written policies regarding work screening processes. What should the OTR®'s FIRST step be? A. Assess whether work tolerance screenings can be completed in the absence of written policies B. Provide a written statement indicating that the organization is required to provide written policies for work screenings C. Complete the work tolerance screenings as the OTR® would for any organization D. Offer to write policies for the work tolerance screening process for the organization
The right answer is A The OTR® must consider the potential ethical dilemmas that may arise in the absence of written policies, particularly for applicants who fail the screening. Explanations of Incorrect Answers B, C: Employers are not required to have policies for work tolerance screening processes but should be encouraged to establish such policies to ensure fair and objective consideration of job applicants. D: The OTR® should remain separate from the hiring process, including related policy development, to maintain objectivity and third-party distance.
A client with stroke is taught to dress the weaker side first when donning a button-down shirt. The client then initiates putting the weaker lower extremity into the pant leg. What learning has occurred for the client? A. Generalization B. Transfer C. Automaticity D. Acquisition
The right answer is A The client demonstrates generalization, which is the ability to take a strategy used with one task and apply that strategy to a new task. Explanations of Incorrect Answers B: Transfer occurs when clients dress themselves at home in the same way they did in their hospital room. C: Automaticity is the ability to perform tasks with little or no contribution of consciousness; this client has not yet demonstrated automaticity. D: Acquisition is a training strategy that relies on conscious control and requires practice and drill exercises. Acquisition is a cognitive strategy, not a method of learning.
When evaluating a client in a skilled nursing facility, the OTR® notes that the client's skin has a yellowish cast, the fingernail beds are bluish in color, and the client has noticeable edema in both lower extremities. What condition would MOST likely cause these symptoms? A. Right-sided congestive heart failure B. Left-sided congestive heart failure C. Aortic stenosis D. Aortic insufficiency
The right answer is A When the right side of the heart fails, blood flows back into the venous system. Symptoms of right-sided heart failure include cyanotic nail beds, jaundice, and lower-extremity edema. Explanations of Incorrect Answers B: When the left side of the heart fails, blood flows back into the lungs, causing difficulty breathing, anxiety, and cerebral hypoxia. C, D: Aortic stenosis and aortic insufficiency have symptoms similar to those of left-sided heart failure.
An OTR® is evaluating a new client and notes that the client has a bluish tinge to the skin and lips. The client also presents with significant edema. Which medical condition is this client MOST likely to have? A. Emphysema B. Chronic bronchitis C. Cystic fibrosis D. Cirrhosis of the liver
The right answer is B A client with chronic bronchitis has poor oxygenation, resulting in a bluish tinge to skin and lips, along with edema. Explanations of Incorrect Answers A: A client with emphysema is most likely to have pinkish skin. C: A client with cystic fibrosis may have yellowing of the skin. D: A client with cirrhosis of the liver will tend to have an orange tint to the skin.
According to AOTA and the Occupational Therapy Practice Framework: Domain and Process, which clinical occupational engagement treatment session would be considered to include an inappropriate use of physical agent modalities? A. Application of a hot pack to the hand followed by an activity that involves making a cord bracelet B. Use of fluidotherapy for the upper extremity followed by passive stretch C. Use of a transcutaneous electrical nerve stimulation unit for the back during homemaking activities D. Use of a cold pack to the elbow after a game of checkers
The right answer is B A treatment session consisting of fluidotherapy followed by passive stretch does not include occupational engagement as part of the session. Explanations of Incorrect Answers A, C, D: The use of each modality is combined with some form of occupational engagement
According to AOTA's (2010) "Statement on Driving and Community Mobility," what training must an occupational therapy practitioner have to address the IADL of community mobility? A. Advanced training as a driver rehabilitation specialist B. Successful completion of training as an OTR® or COTA® C. Specialized training with transportation systems and departments D. A specific number of courses that address driving and community mobility
The right answer is B AOTA's (2010) "Statement on Driving and Community Mobility" states that all OTR®s and COTA®s possess the training and education necessary to address driving and community mobility as an IADL. Explanations of Incorrect Answers A: Although advanced training is necessary to become a specialist in driving and community mobility, every occupational therapy practitioner can address driving and community mobility from a general IADL perspective. C: Specialized training with transportation systems and departments is not necessary to address a client's community mobility. D: Occupational therapy educational standards do not mandate specific hours or credit in coursework addressing driving and community mobility.
A client who has schizophrenia is attending an adult mental health day treatment program. During a task-oriented group the OTR® observes that the client has difficulty understanding the concept of completing the multiple steps involved with developing a monthly personal budget plan. Which Allen Cognitive Level BEST describes this client's level of function based on this observation? A. 3 (Manual Actions) B. 4 (Goal-Directed Actions) C. 5 (Exploratory Actions) D. 6 (Planned Actions)
The right answer is B At Level 4, the client would be able to complete quick tasks and model single-step completion. Routine tasks would be independent for a client. Explanations of Incorrect Answers A: At Level 3, clients are able to engage in simple tasks that have repetitive actions with limited choices, and a client at Level 3 would require assistance for personal budget planning. C: At Level 5, clients are able to improve actions through trial and error and are able to complete several steps at a time, whereas the client in this scenario is having difficulty completing multiple-step tasks. D: At Level 6, a client would handle unlimited steps in an activity including diagrams and written directions and would be independent with personal budget planning.
An OTR® continues to work with and charge for services with a client after all goals are met and there is no further need for occupational therapy services. This behavior is unethical. Which Occupational Therapy Code of Ethics (2015) principle best describes this situation? A. Nonmaleficence B. Beneficence C. Justice D. Veracity
The right answer is B Beneficence is the principle that occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services. Beneficence hold personnel accountable to integrity for goals related to treatment. Principle 1H of the Occupational Therapy Code of Ethics states, "Occupational therapy personnel shall terminate occupational therapy services in collaboration with the service recipient or responsible party when the services are no longer beneficial." Explanations of Incorrect Answers A: The ethical principle of Nonmaleficence states that occupational therapy personnel shall intentionally refrain from actions that cause harm. This item is unrelated to causing direct harm (although unneeded services do have the potential to cause harm). C: The ethical principle of Justice is about promoting fairness and objectivity in providing occupational therapy services. D: The ethical principle of Veracity is the principle that occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession. Principle 6D states that personnel shall ensure that documentation for reimbursement purposes is done in accordance with applicable laws, guidelines, and regulations.
An OTR® is working with a child with juvenile rheumatoid arthritis (JRA). The child is having difficulty carrying the therapist's recommendations over to school. Which strategy would help the child to carry the recommendations over to school? A. Provide training to the child's sibling related to the ROM program. B. Provide the child with a second set of textbooks to keep at home. C. Provide training to the school nurse on how to assist the child with managing pain. D. Provide the child with a color-coded folder to put homework in.
The right answer is B Children with JRA benefit from energy conservation techniques that put less stress on their joints. Allowing the child to have a second set of textbooks would mean that the child would not need to transport heavy books to and from school, thus protecting the joints. Explanations of Incorrect Answers A: Training the child's sibling on a ROM program does not relate to carryover at school, although this recommendation might be appropriate for carryover at home. C, D: Both options are related to school; however, the child would be passive in C, and D would not address the child's challenges related specifically to JRA.
An occupational therapist is working with a child with dysgraphia on school work. Which intervention strategy might the OTR® use? A. Provide the child with a magazine that is of high interest and at his reading level B. Provide the child with a copy of partially completed notes so that he only has to fill in key words C. Provide the child with a lab partner during science experiments D. Provide the child with a calculator
The right answer is B Dysgraphia is a learning disability associated with difficulty producing written language. This option is correct because it requires that the child focus on writing less during instruction. Explanations of Incorrect Answers A: Providing high-interest reading material might be appropriate if the child had a reading disability. A reading-related learning disability is called dyslexia. C: Providing the child with a lab partner would not be necessary and would not address the needs of the child's condition. Difficulty with learning science has no specific name. D: Providing the child with a calculator would be appropriate if the child had difficulty in math. A math-related learning disability is called dyscalculia.
An OTR® has been working on increasing the concentration and attention span of an 8-year-old child with autism who is distractible during handwriting activities in the classroom. Using a sensory integration approach, which environment is the BEST to address concentration and attention skills? A. An isolated room free from any kind of distraction B. A small classroom with two other children and soothing music C. A small corner of a sensory gym where two other children are swinging D. A quiet corner in the child's classroom with a chalkboard divider
The right answer is B Sensory integration techniques emphasize the use of naturalistic environments for intervention. Using a small classroom where two other children are doing handwriting tasks is the most naturalistic environment similar to an actual classroom without unnecessary sensory stimulation. Explanations of Incorrect Answers A: A distraction-free room is not a naturalistic environment. C, D: These environments provide more stimulation than necessary for the client to focus on handwriting tasks.
A client with stroke is receiving occupational therapy services to increase independence with feeding, grooming, hygiene, and toileting. What should the OTR®; FIRST consider in determining the client's needs? A. The client's safety in doing independent transfers B. The client's swallowing ability C. The client's base of support for upright postural ability D. The client's upper-extremity mobility
The right answer is C Clients with stroke often experience postural imbalance and difficulty making postural adjustments during activities. Assessing the client's base of support is the first consideration in determining sitting and standing ability for ADLs. Explanations of Incorrect Answers A: Transfers are essential to the client's ability to complete ADLs; however, postural ability in sitting and standing must be assessed before initiating these transfers. B: Determining swallowing ability is part of assessing the client's feeding skills, but seated posture is the first area to assess in feeding. D: Although upper-extremity mobility is an important factor in determining ADL ability, postural stability provides the basis for a client's ability to move the extremities for ADLs.
The owner of a construction company asks an OTR® completing work tolerance screenings to notify applicants whether they have been hired on the basis of their screening results. What should the OTR® do? A. Suggest that the owner revise the written policies for work tolerance screenings to reflect this change in the process B. Inform the owner that the OTR® will review the results of the completed work tolerance screenings with the owner so the owner can summarize the results with applicants and notify them of the hiring decision. C. Keep good documentation of the agreement to support the need for this change in the work tolerance screening process. D. Implement a quality assurance monitoring system to determine reasonable outcomes for this revised process.
The right answer is B The OTR® should remain separate from the hiring process, including notification of hiring decisions, to maintain objectivity and third-party distance. Explanations of Incorrect Answers A: The OTR® should remain separate from the hiring process, including related policy development, to maintain objectivity and third-party distance. C: Documentation is essential for follow-up support, but the OTR® should consider the ethical implications before agreeing to the change. D: Quality assurance measures are important in consultation services; however, the OTR® must consider the ethical implications of implementing the revised process.
A client will initiate dressing at the appropriate time of the day but will not attend to the day, temperature, or season. The client is able to don clothing slowly but has difficulty with fasteners or fails to see errors in the back (i.e., not tucking in the shirt). At what stage of the Allen Cognitive Level Screen is this client? A. 4.4 B. 4.0 C. 3.6 D. 3.2
The right answer is B The question describes typical dressing behaviors of clients at Mode 4.0; a client would attend to visible sensory cues and ignore what is not in plain sight (e.g., not tucking in the back of the shirt). Explanations of Incorrect Answers A: Clients at Mode 4.4 will be able to locate clothing and initiate dressing at a customary time of the day and dress in sequence. Clients may wear the same clothing over and over again because they like it and have worn it before. C: At Mode 3.6, clients must be trained to initiate dressing at the customary time of day. D: At Mode 3.2, clients will need cues to sequence through a dressing routine.
How does the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; AOTA, 2008) define community mobility? A. As a variety of ways to move about the world and the fit between these means and the client's abilities B. As moving around in the community or using public or private transportation, such as driving, walking, bicycling, and using buses, taxicabs, or other transportation systems C. As selecting, testing, or adopting with the client and the client's family or support system the most appropriate transportation options D. As opportunities for occupational therapists to be involved in broader dialogue with transportation providers, health and human service agencies, and policymakers
The right answer is B This definition is the exact one provided in the Framework. Explanations of Incorrect Answers A, C, D: These options are implications of the definition, but not the definition itself.
An OTR® is working on toileting with a 3-year-old child with autism. The child is delayed approximately 1 year with toileting skills. When is it likely that this child can be expected to completely master this skill? A. Ages 4-5 B. Ages 6-7 C. Ages 8-9 D. Ages 9-10
The right answer is B Typically, children are able to be independent with toileting, including washing hands and completing clothing management, between the ages of 4 and 5. If the child is a year behind, he will likely master the skill between age 6 and 7. Explanations of Incorrect Answers A, C, D: Although some children may completely master toileting before or after the ages of 4-5, this range is typical for skill development.
An OTR is advising a client who has had a flexor tendon repair on the timing for resuming ADLs. During what time period is the flexor tendon repair the weakest and most likely to rupture? A. 1-3 days postsurgery B. 4-9 days postsurgery C. 10-12 days postsurgery D. 4-8 weeks postsurgery
The right answer is C A tendon repair is typically at its weakest 10-12 days postsurgery during the fibroplasia phase, in which collagen is just beginning to be laid down to strengthen the repair. The right answer is C A tendon repair is typically at its weakest 10-12 days postsurgery during the fibroplasia phase, in which collagen is just beginning to be laid down to strengthen the repair.
An OTR® is working with a client population with severe intellectual disabilities. What risk factor MOST predisposes this client population to pneumonia? A. History of smoking B. Antibiotic overuse C. Aspiration of food D. Chest surgery
The right answer is C Among people with severe intellectual disabilities, the most frequent cause of pneumonia is aspiration of food or liquids. Explanations of Incorrect Answers A, B, D: Smoking, antibiotic use, and chest surgery are all risk factors for pneumonia in the the general population.
A client with morbid obesity and obstructive sleep apnea is collaborating with an OTR® on improved sleep routines and positioning. What sleep position is optimal for this client? A. Supine position with head of the bed elevated B. Supine position with only the client's head elevated C. Side-lying position with head of the bed elevated D. Side-lying position with only the client's head elevated
The right answer is C Because of the obesity, the client will be able to breathe better in a side-lying position with the entire upper trunk elevated. Explanations of Incorrect Answers A, B, D: The supine postion is not preferred because the weight of the body makes breathing more difficult. Elevation of the entire upper body improves breathing more than elevation of the head only.
An OTR® receives evaluation orders for a client who has recently experienced traumatic brain injury. The client displays severe memory impairment and can only respond to simple commands without being distracted. What Rancho Los Amigos level BEST corresponds with the client's behavior? A. VII B. III C. V D. II
The right answer is C Because the client is highly distractible and displays severe memory impairment but can respond to simple commands, the client most closely resembles Level V. Explanations of Incorrect Answers A: A Level VII client has limited distractibility and is capable of carrying out a intelligible conversation despite minimal confusion. B: A Level III client inconsistently responds to stimuli and would not be capable of intelligibly responding to simple commands. D: A Level II client responds to stimuli only through physiological changes, gross body movement, or vocalization.
An OTR® is treating a client with a boutonniere deformity using conservative splinting. Which statement can the OTR use to educate the client about the proper use of the circumferential proximal interphalangeal (PIP) joint orthosis? A. Wear the orthosis only at night to maintain the PIP joint in extension when at rest. B. Remove the orthosis every hour for passive motion exercises. C. Wear the orthosis continuously up to 6 weeks. D. Wear the orthosis during the day, but remove it at night.
The right answer is C Continuous use of the PIP joint extension splint allows the central slip to reestablish tissue continuity and prevents further flexion deformity. Explanations of Incorrect Answers A, D: PIP joint extension must be maintained full time, not only in the daytime or nighttime, to allow central slip reestablishment. B: Passive motion of the PIP joint is contraindicated during the splinting phase of conservative treatment.
Which statement BEST describes an important consideration for OTR®s working with clients with dementia and their caregivers? A. Providing a variety of new occupations creates a sense of well-being for the caregiver and care recipient. B. A brief respite from caregiving benefits the caregiver but is detrimental to the care recipient. C. Everyday occupation is central to a caregiver's sense of well-being. D. Psychologically resisting the inevitability of chronic illness improves satisfaction with caregiving.
The right answer is C Embracing everyday occupation has been shown to improve a sense of well-being in the caregiver and offers a suitable context for caregiving. Explanations of Incorrect Answers A, B, D: These choices do not support the principle of use of occupations and activities that are meaningful to the client during occupational therapy intervention.
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.
The right answer is C Hand-over-hand guidance is an effective strategy to encourage maximal independence through participation in daily living tasks, including self-feeding. Explanations of Incorrect Answers 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 with middle-stage dementia has maintained the ability to complete repetitive tasks common in middle adulthood. For example, if given a basket of socks, the client will reflexively fold them until the task is complete. Given this information, what recommendation would be appropriate for the OTR® to give caregivers? A. Provide challenge to the client by placing the laundry basket at various heights to improve trunk stability and balance. B. Provide challenge to the client by putting various types of clothing into the laundry basket, which will aid in maintaining this skill. C. Provide the client with a basket of socks at a set time each day, determined by the client's arousal level, to give structure to the client's day. D. Provide the caregivers with information about how they can use a basket of socks to decrease agitation in the client.
The right answer is C Interventions to control the daily structure of a person with dementia have been documented to provide balance between the times the person is in high arousal versus low arousal. Explanations of Incorrect Answers A, B: Providing too much challenge to a client with dementia might increase agitation; providing structure to the client's day is the best option to decrease agitation and promote better balance. D: Engaging a client in a task once the client is agitated might be difficult; providing structure to the client's day is the best option to decrease overall agitation and promote better balance.
An OTR®; is providing dressing skills training for a client with traumatic brain injury (TBI). The client has a sequencing deficit and continually places underwear over pants and socks over shoes. What strategy is appropriate for the OTR 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
The right answer is C Minimizing environmental distractions and decreasing the complexity of the task will allow the client to experience success in completing one step of the task at a time. Explanations of Incorrect Answers 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.
An OTR® notes that a client with a left stroke makes many errors when reading and is required to stop and reread sentences frequently. The OTR suspects left hemianopia. Which action should the OTR take? A. Provide task lighting to promote the client's vision B. Complete acuity testing to determine whether the client needs glasses C. Refer the client to an optometrist or ophthalmologist for automated perimetry testing D. Provide client education materials in large print
The right answer is C Referral of the client to an optometrist or ophthalmologist for perimetry testing is necessary to confirm hemianopia before recommending specific intervention strategies. Explanations of Incorrect Answers A, B, D: Hemianopia is a visual field deficit and must be confirmed before making specific recommendations; therefore, recommendations for task lighting, acuity testing, and large-print materials are not appropriate at this time.
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
The right 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. Explanations of Incorrect Answers 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.
An OTR® is preparing to assess a student who is 17 years old and has moderate symptoms associated with Asperger's syndrome. The purpose of the assessment is to determine the student's strengths and needs for a work-study experience as part of a transition services program. What type of assessment would be MOST BENEFICIAL to administer when gathering information to achieve this goal? A. Self-administered occupational performance checklists B. Self-perception questionnaire related to occupational performance C. Social interactions and social adjustment inventory D. Functional capacities and work readiness evaluation
The right answer is C Social skills such as getting along with others and functioning socially in a group situation have been found to be significant predictors of employment for individuals with mental illness. This would be the most beneficial information to gather in this assessment. Explanations of Incorrect Answers A, B: Assessment of vocational potential to prepare for transition services should focus on social and vocational functioning for individuals with mental illness; occupational performance areas that relate to work, leisure, and social skills should be the focus, not personal ADL. Assessments addressing prevocational skills should be brief and focused on work-related skills to avoid discouraging the student. D: Functional capacities and work readiness evaluation are appropriate in situations when a work injury has occurred; these services are not used in transition services planning.
An OTR® is assessing a client with bulimia. The client has become preoccupied with hiding purging behaviors from friends and family. While developing an occupational profile with the client, the OTR notices that as the client's bulimia has evolved, the client has replaced many valued activities with the bulimia. The client has severe occupational imbalance, with no participation in anything but binging and purging behaviors. Which strategy would be MOST successful with this client? A. Teach the client relaxation strategies to provide relief from the stress caused by the bulimia. B. Recommend social activities to encourage the client to interact with friends and family in a more positive way. C. Provide the client with leisure activities that will create more balance and offer the client more control over the client's life. D. Assign the client small-group activities with other clients to provide the client with information about the health impact of bulimia.
The right answer is C The client is demonstrating occupational imbalance, so exploring new leisure activities would be important to help the client create a more balanced life. Learning a new skill would also allow the client to feel more control over his or her life. Explanations of Incorrect Answers A: Although relaxation strategies might be an acceptable intervention, there is no indication that the bulimia is causing the client distress. B: Social activities would be important because social relationships and social participation are most likely strained because of the client's preoccupation with hiding the purging. However, the primary concern is the client's occupational imbalance. D: Education is a good intervention idea, but it does not address the immediate concern, which is the client's occupational imbalance.
An outpatient OTR® is assessing a burn survivor, who reports having increasing difficulty in self-feeding because of difficulty in bending the right elbow. During PROM assessment, the client reports localized pain at the elbow when flexed more than 100°. The OTR® feels a hard end feel at the elbow flexion. What is the BEST initial intervention? A. Provide the client with low-load prolonged stretch using an elbow flexion splint. B. Instruct the client in daily aggressive PROM at the elbow. C. Instruct the client in a daily AROM program within the pain-free range. D. Recommend the client use a long-handled swivel spoon for self-feeding.
The right answer is C The client is developing heterotopic ossification at the right elbow. The best intervention is to preserve AROM. Explanations of Incorrect Answers A, B: The client is developing heterotopic ossification at the right elbow. Use of a splint for sustained stretches and aggressive PROM are contraindicated for this condition. D: The client is developing heterotopic ossification at the right elbow. The client may need adaptive equipment for self-feeding, but maintaining AROM should be the highest priority in the initial intervention.
An inpatient who has Stage III lung cancer undergoes surgery for removal of axillary lymph nodes of the dominant upper extremity, followed by palliative chemotherapy. The patient is referred to occupational therapy for ROM, edema management, and preparation for hospice care at home. What is the PRIMARY purpose of initiating an exercise program for this patient? A. To increase overall endurance for daily tasks B. To promote normal venous and lymphatic return C. To improve mobility for preferred activities D. To facilitate passive ROM through a full arc of motion
The right answer is C The goal of therapy is to restore a patient's participation in meaningful goal-directed activities that are preferred by the patient, and engaging in an exercise program that will improve mobility may facilitate improved engagement. Explanations of Incorrect Answers A: Cancer rehabilitation focuses on engaging the patient at whatever level is possible for the patient; the focus is not on increasing endurance at Stage III level of progressive cancer when endurance is likely to not increase. B: Promoting venous and lymphatic return is a primary purpose of lymphedema therapy and would not be the primary purpose of an exercise program. D: Facilitating PROM through a full arc of motion is not a functional outcome of therapy and will not result in improved engagement in activity by the patient.
A client with Alzheimer's disease (AD) perseverates on having to pick up children from daycare. At which stage of the disease process is this client likely at? A. Mild cognitive impairment B. Early C. Middle D. Late
The right answer is C The middle stage of AD is characterized by clients' thinking that they are back in an earlier stage of life. Explanations of Incorrect Answers A: People with mild cognitive impairment will have less consistent patterns of loss than what is found in AD. They will be able to carry on conversation and will not have difficulty with bladder or bowel function related to the impairment. B: People in early-stage dementia are likely to begin having difficulty within the community and with IADLs but have intact ADL performance. Their short-term memory loss becomes an issue that affects their safety in the community. D. People in late-stage dementia need assistance for all areas of function, both ADLs and IADLs. They would not have the conversational skills to perseverate on a topic.
An OTR® receives a referral to evaluate a client with dementia. What type of assessment would the OTR® likely use to evaluate this client? A. Nonstandardized assessment tool that assesses memory B. Standardized assessment tool that assesses executive function C. Observation of client and interview with caregivers D. Assessment tool that examines occupational performance and performance skills in detail
The right answer is C When assessing clients with dementia, observation and interview of caregivers are the primary method of assessment. Explanations of Incorrect Answers A, B, D: Although having information about executive function and memory would be helpful, observation will yield more information about how these performance skills affect the client's daily life. The comprehensive assessment might not be possible with a client who has dementia; it might lead to fatigue and frustration and limit the OTR®'s ability to establish rapport.
Many occupational therapy clients who can no longer drive are referred to public transportation programs. Clients from rural areas, however, may not be served by public transportation of any form. Approximately what percentage of the U.S. rural population does NOT have access to public transportation? A. 5% B. 25% C. 50% D. 75%
The right answer is D According to Eby, Molnar, and Pellerito (2006), about 75% of the rural population in the United States does not have access to public transportation. Explanations of Incorrect Answers A, B, C: These percentages differ from reports in the literature.
An OTR® working in a neurology unit was referred a client with low back pain. During the interview, the client confides that stressful life events have recently been prominent in the client's life. The client added that the low back pain started after the stressful life events. Malingering and fear of illness do not seem to be a part of this scenario. What is the client's likely diagnosis? A. Low back pain B. Factitious disorder C. Histrionic personality disorder D. Conversion disorder
The right answer is D All symptoms point to conversion disorder. Explanations of Incorrect Answers A: Organic low back pain is caused by traumatic or repetitive musculoskeletal injuries. B, C: The case as described includes no signs of factitious disorder or histrionic personality disorder.
According to the Americans With Disabilities Act of 1990 (ADA), what is the definition of essential job functions when considering employment of a person with a disability? A. Functions that an employer determines are to be completed by each employee B. The physical functions of a job task, such as hand manipulation skills for writing C. The speed with which each task must be performed on the job to meet productivity standards D. Functions that an employee must be able to complete, with or without a reasonable accommodation
The right answer is D Essential job functions, as defined by the ADA, are those that the employee must be able to complete, with or without accommodation. The ADA distinguishes between job functions that are essential—that is, those that must be completed by the employee—and functions that can be carried out by other employees in the same environment when an employer is making decisions about hiring and accommodating someone with a disability in the workplace. Explanations of Incorrect Answers A: An employer provides judgment as to what each employee's essential job functions are, but the employer's judgment in determining essential job functions is not all encompassing. B: The physical functions of a job are not considered, only the outcome of the work task. The ADA distinguishes between what needs to be done and how it should be done. C: Speed is a determinant of essential job functions, along with other factors, but it does not define them.
An OTR® working in an outpatient mental health setting meets with a client with depression 3 weeks after the client's discharge from the hospital. The client expresses concern about phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI) the client has been prescribed, saying that the drug's negative side effects deplete the client's ability to function. The client plans to stop taking the medication. What is the OTR®'s MOST appropriate response? A. "Discontinue use of the medication until you see your doctor." B. "Remember the dietary restrictions related to MAOIs." C. "Side effects are present in all medications. You just have to get used to them." D. "Let's get your psychiatrist or a nurse on the phone now so you can discuss your concerns."
The right answer is D Psychiatrists are responsible for medication management for clients with mental illness. Therefore, providing the client the opportunity to inquire about the medication directly would be the most appropriate recommendation. If contacting the psychiatrist right at the moment is impossible, leaving a message with contact information for the client would be the next best alternative. Explanations of Incorrect Answers A, B, C: These responses do not address the client's concern about side effects of the medication.
An OTR® is working in an inpatient psychiatric setting where the average length of stay is 5 days. Which group activity would be MOST appropriate for patients with depression? 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 on a blank canvas D. A parallel group in which each participant completes his or her own solid-color ceramic tile trivet
The right answer is 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. Participation in a parallel group minimizes the need for social interaction but allows physical proximity to others. Explanations of Incorrect Answers A: Working on a free-form clay project of their choice would be too overwhelming for most patients hospitalized with 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 the individuals to interact and problem solve with each other, which can be difficult. Planting a garden would be a poor choice for a 5-day hospitalization because the results would not be visible before patients are discharged. C: Painting a watercolor would not provide enough structure and might overwhelm patients with severe depression.
A client recovering from substance abuse disorder is referred for occupational therapy services. What intervention is the OTR® MOST likely to provide? A. Group psychotherapy B. Medication management C. Assistance with locating a new apartment D. Assistance with finding meaningful ways to spend free time
The right answer is D Substance abuse becomes the primary activity of people with this disorder. Education about and experimentation with alternative uses of time should be a primary focus of intervention. Explanations of Incorrect Answers A, B, C: These interventions are typically provided by other disciplines. OTR®s may assist with psychotherapeutic intervention (e.g., group therapy), medication management, or housing acquisition through behavioral training with the client. However, the OTR® rarely has primary responsibility for these interventions.
Which setting is MOST effective for job coaching with an adult client with mental illness? A. Sheltered workshop environment B. Outpatient rehabilitation setting C. Program offering simulated work D. Workplace with assigned job duties
The right answer is D Support approaches with on-site training are recommended as the most effective setting for job coaching. Explanations of Incorrect Answers A, B, C: Training for job placement in settings outside the workplace does not support generalization of skills to the workplace.
