Module 4

You are reviewing your patient's chart and you come across the abbreviation "AODM", what does this indicate?

The patient has Type II diabetes

A patient has been walking down a familiar street for 30 minutes requires some cuing for stepping off a curb, orientation, and time. At what Rancho level is this patient functioning?

6

A 25-year-old woman who recently sustained a T3 SCI is concerned about being able to live a fulfilling life with her injury. She fears that she will "never be able to be intimate with another person ever again." In this scenario, how should the OT practitioner INITIALLY respond to the patient's concerns?

"It is natural to continue to have physical, emotional, and sexual needs after a SCI"

A patient who underwent an above elbow amputation less than a week ago, is presenting with significant phantom limb pain. To address his pain, mirror box therapy has been incorporated into his OT intervention plan. What is the BEST way to explain this type of therapy to the patient?

"It lets the brain think that the amputated arm is moving normally, helping the brain to reorganize the sensation of movement in the remaining arm"

A patient was recently admitted to acute care after acquiring a full-thickness burn to both upper extremities. How long after having a skin graft, can this patient's AROM be assessed?

7-10 days post-op

A senior has just suffered a right upper extremity amputation and he wants to start dancing again. This patient needs to get an artificial limb. What professional would make this?

A Prosthetist

An OTA is working with a patient in acute care who presents with a burn that has damaged the epidermis and deep layers of the dermis, including the hair follicles and blood vessels located in the dermis. The patient received this injury when taking a cake out from the oven. In the first treatment session, the patient asks the OTA when the wound will heal. How should the OTA best respond?

A deep partial-thickness burn typically resolves in 3-5 weeks

What adaptation is contraindicated for a patient with paraplegia who wants to prevent pressure ulcers?

A donut style cushion

An OTR® and COTA® are conducting a home evaluation for a patient who recently had a total hip replacement. The patient's surgery was performed via a posterior approach and as per protocol, the patient has been advised to take specific precautions. The OT practitioners have identified that as the patient enjoys entertaining guests during poker matches and football games, which involves extended periods of sitting, they need to reinforce sitting precautions with him. What type of chair is the most appropriate to recommend for this patient, to help him adhere to the post-op precautions?

A firm, elevated chair with armrests

Which of the following assistive devices is most effective in helping an elderly woman who is recovering from C1 SCI to breathe?

A mechanical ventilator

Sherry is a 42-year-old woman with a C5 spinal cord injury. What adaptive feeding equipment should the OTA train Sherry to use in order to enable her to be independent in self-feeding?

A mobile arm support

Ella, a 25-year-old college graduate, who has been diagnosed with a borderline personality disorder, recently sustained self-inflicted deep partial thickness burns to both her hands when she submerged them into a pot of boiling water. As both of Ella's hands have been splinted in an anti-deformity position, she is unable to use her hands for function. One of her main goals at this stage of her recovery is to feed herself. What is the MOST practical adaptation you can recommend to enable Ella to be more self-sufficient during meal times?

A spoon can be attached to a universal cuff which is strapped over the splint

A patient with a high level SCI who resides in a nursing home has developed a reddened area on her sacral spine. The area is being monitored by nursing staff and they report that the area remains red for longer than one hour and it does not blanch when touched. What condition does the resident have?

A stage 1 pressure ulcer

Carol, a 58-year-old housewife who recently sustained a mild TBI, has been admitted to a rehabilitation facility. She is currently working with a COTA® and the focus of the session is on identifying the components of ADL tasks using card sorting exercises. Once Carol is able to achieve this, the COTA® asks her to separate clothing into 2 piles of light colors and dark colors, before washing the clothing. What approach is the COTA® using in this scenario?

A transfer-of-training approach working on the skill of categorization

A 26-year-old inpatient who sustained a mild TBI while skateboarding, is displaying decreased attention and disorganization, as well as a low threshold for becoming frustrated. Premorbidly, he was attending community college, pursuing a career in Business Database Development. His goal is to return to school within a month. Which activity should the OTA select in order to improve this patient's attention and organization?

A visual, action-adventure computer game that follows a linear sequence

Tim is a 29-year-old man who is recovering from a traumatic brain injury. His doctor has classified him as a level VIII on the Rancho Los Amigos Scale. What abilities and behaviors would you expect to observe as Tim completes daily activities? Select the best 3 choices.

Able to complete familiar tasks with stand-by assistance Aware of impairments, but may over or underestimate abilities Uses a to-do list to remember schedules or steps of a task

The COTA® is planning on initiating treatment with Celia, a patient in the intensive care unit who has sustained third degree burns on 70% of her body. What treatment techniques should the COTA® plan on using during Celia's first few treatment sessions? Select the best 3 answers.

Active range of motion activities as tolerated Splinting to maintain the involved extremities in an antideformity position Positioning for edema control

Myra is a 61-year-old patient who sustained a third degree burn to her left elbow and forearm 3 months ago. She completed her course of outpatient therapy two weeks ago, but a message from Myra's doctor has been received that she is developing heterotopic ossification at the burn site. What type of OT intervention is indicated to address this condition?

Active range of motion within Myra's pain limits

Proper positioning of the patient's upper limb is crucial in burn management because the position of greatest comfort for the patient is usually the position which results in contracture and deformity. In which position does a patient typically hold their injured upper limb, placing them at risk for developing contractures?

Adduction and flexion

An inpatient who had a posterolateral total hip replacement, 3 days ago, is beginning transfer training with a COTA®. The patient is working on transferring from a wheelchair onto a 3-in-one commode over the toilet. While adhering to the post-operative precautions and techniques, the patient verbalizes having difficulty extending the knee of their operated leg due to arthritic knee pain. As the patient has good standing balance with stand-by to supervised assist, the COTA® decides to modify the environment rather than the method of transfer. Which modification is the MOST EFFECTIVE to ensure a safe transfer while still adhering to the prescribed hip precautions?

Adjust the height and angle of the commode so that the front legs are slightly lower than the back legs

Pete, a 37-year-old professional mechanical engineer sustained an injury to his spinal cord at the level of T1. Pete is currently an inpatient in a rehab facility and is working with the COTA® on adaptive techniques for dressing. He has some limitations in hand dexterity but functions well with orthoses. Pete has informed the COTA® that instead of purchasing adaptive items, he would prefer to be involved in making those adaptations. Which adaptation would be the MOST BENEFICIAL for Pete to be involved in making?

Adjusting the seams of his work shirts to loosen his clothing and adding dressing loops

What would an OTA recommend to a senior male who is chronically ill and lives with family members, but during work hours needs a place to eat meals, relax, receive both mental and social stimulation, and requires an appropriate "aging in place" setting?

Adult day care

A 58-year-old female presents with little or no voluntary control of her bowel & bladder and a bilateral loss of function in her hips and legs. Based on this information, what type of nerve injury did this patient most likely sustain?

An injury to S1-S5 Sacral Nerves

Mary, a 55-year-old self-employed web designer, is receiving occupational therapy in an outpatient stroke rehabilitation program. The focus of intervention is on training Mary in strategies to compensate for her difficulty with saccades, which are the eye movements one uses to rapidly refixate from one object to another. One of Mary's goals is to return to meeting her friends at the local coffee cafe for their weekly board game night. Post CVA, Mary's husband drives her to the café to avoid having her cross any roads. He has however noticed that when she is walking towards the café, she does not notice people crossing in front of her, from her side view. Which activities should the COTA® use to address Mary's deficit so that her participation in her preferred leisure activity can be maximized?

An object-matching activity in which familiar objects are placed in plain sight on multiple shelves

An OTA is working with an overweight patient who appears to be very tired and he has difficulty raising his arms to perform lower body dressing. When asked to sit at the edge of the bed, the patient appears lethargic. What term best describes this patient's behavior?

Anergia

Which example, as listed below, would BEST demonstrate that a patient has astereognosis?

Ask the patient to pick a quarter from a bag while their vision is occluded

Using everyday objects, how would you screen a patient's visual perceptual skills to identify if there are any deficits in this area?

Ask the patient to pick an apple from a fruit basket

A 56-year-old patient who lives with his 28-year-old daughter has recently started to experience difficulty identifying items in his pantry when a different brand is bought or the items are not facing with the label in front. Which of the following adaptations would assist the patient, the most?

Arrange the items in the pantry to be clearly visible and placed upright on the shelf

A COTA® is working with a 36-year-old patient who 8 days ago had skin graft surgery for the treatment of a 3rd degree burn to his right forearm. The COTA® issued the patient with custom-made compression garments and educated him on skin conditioning and self-massage to continue upon discharge from the rehabilitation unit. The patient asks the therapist, "Why do I need to continue this regimen for the next 2 years?" How should the COTA® respond to the patient's question?

As the wound matures, the scar will continue to develop and change

An OTA is treating a patient who recently sustained a C2 SCI injury, and he is therefore dependent on a mechanical ventilator to breathe. In order to perform passive range of motion exercises in the most effective way, the OTA decides to transfer the patient from his bed to a reclining chair. Before transferring this patient, what part of preparing for the transfer is essential for ensuring the patient's safety.

Assemble 3-5 staff members to assist with the transfer

When addressing sexuality with a teenager who has an intellectual disability, on what should the main focus of OT intervention be?

Assertiveness training, training in safe sex, family/caregiver education

Which "aging in place" setting is the MOST appropriate for a senior who is independent in their BADLs but needs maximum assistance with their IADLs?

Assisted living

An OTA is working with a patient with mild vision loss. One of the goals for this patient is to read while sitting in a recliner in their living room. What three interventions would be BEST to introduce with this patient? Select the best 3 choices.

Auditory recordings Enlarged font Magnification

Frank is a 78-year-old man who has undergone a total hip replacement. The surgeon used a posterior approach when completing the surgery. What precautions should the COTA® make sure that Frank follows during ADL retraining? (Select the best 3 choices)

Avoid hip adduction Avoid internal rotation of the hip Avoid bending the hip past 90 degrees of flexion

An OTA must teach hip precautions to a 53-year-old female bus driver who had a hip replacement. Her surgeon used the posterolateral approach. What are the 3 precautions the OTA should teach this patient? Select the best 3 choices.

Avoid hip flexion greater than 90 degrees No hip adduction No hip internal rotation

An athlete who was recently involved in a sports related injury, sustained a TBI and spinal injury. MRI findings revealed a high-grade spondylolisthesis at L4-5. The patient required surgical intervention to stabilize his spine which involved an anterior-posterior fusion at the affected level. Which 3 post-surgical precautions is the patient advised to adhere to, for the first 6 weeks after surgery? Choose the 3 best answers

Avoid lifting, pushing or pulling objects greater than 5 lbs Avoid bending Avoid twisting

An OT practitioner is educating a patient who has recently undergone a total hip arthroplasty how to transfer to and from a chair while adhering to their post-op hip precautions. What is the BEST method to teach the patient to use when sitting down from a standing position?

Back up to the chair, extend the operated leg forward, reach back for the armrests and slowly lower to the sitting position

What is the medical term used to describe a patient's loss of their peripheral vision?

Bitemporal hemianopsia

4 months ago, a 35-year-old patient was involved in a MVA which resulted in his spinal cord being completely severed. The focus of his OT intervention has been on strengthening his wrist so that he can have the opportunity to actively participate in his dressing tasks, at home. The patient however has very weak wrist extensors and requires the assistance of a tenodesis splint. What level of spinal cord injury does this patient most likely have?

C6 SCI

At what SCI level can a patient start doing depression transfers?

C6-7

Edema in an acutely burned hand typically results in the hand being held in a dysfunctional position of wrist flexion, MCP hyperextension, IP flexion, and thumb adduction. If this position of deformity is not prevented during the stage of healing, it can lead to severe dysfunction. What is this dysfunctional hand position hand commonly known as?

Claw hand deformity

Visuospatial deficits are a common and early sign of dementia. As the OT practitioner working with a patient who presents with symptoms of dementia, which tool is the MOST effective for screening for visuospatial deficits?

Clock-Drawing Test

Rancho Los Amigos Levels 1-10 is an evaluation tool used to measure what, in patients with TBI?

Cognitive functioning

An OTA has been working with a patient who sustained a C6 spinal cord injury, in the inpatient rehabilitation department. To help this patient maximize his independence during self-care activities at home with caregiver assistance, what type of adaptive device would be best to recommend to this patient?

Custom-fitted tenodesis splint

Joel, a 37-year-old male who is a construction worker, recently incurred deep partial-thickness burns to both his upper extremities while lighting a barbecue grill with lighter fluid. Joel has stated that he needs to return to work as soon as possible, as his family depends on his income. What is the MOST efficient way to help Joel achieve his goal of returning to work?

Design treatment activities that simulate both functional activities and various work skills

Destruction of nerves is caused by what degree of burn?

Destruction is caused by fourth-degree burns

An OT practitioner is observing a male patient who recently sustained a TBI, shave his face using an electric shaver. The patient is able to operate and control the shaver with skill, but he takes an excessive amount of time to shave his face and repeatedly goes over the areas which have already been shaved. What is this type of behavior MOST likely indicative of?

Difficulty with termination of activity

An OTA is working with an 84-year-old patient who recently had a cerebellar stroke. Upon completing a dressing evaluation, the patient is initially unable to recognize one of her shirts that the OTA selected from the patient's closet. Only when the OTA brings the shirt to the patient, is she able to identify that it is indeed her shirt. What visual deficit does this most likely indicate?

Diminished visual acuity

A 67-year-old man who has recently been diagnosed with glaucoma is receiving OT services. The patient lives independently and he has stated that he wants to continue living an independent life in his own home. In his spare time, he directs a choir at his local church, usually twice a week. His ability to read the music book while on the podium has, however, become very difficult for him due to the reflective glare from the glossy pages of the music book. Which adaptation would be MOST BENEFICIAL for helping him cope with his visual difficulties, while supporting his participation in his preferred leisure activity?

Direct a lamp from behind the patient's shoulders while he is reading the music from matte sheet music paper

Bobby was involved in a MVA 2-months ago which resulted in him sustaining a C3 Spinal Cord Injury. He uses a sip-and-puff power wheelchair and is in the process of adapting his home to his needs. Bobby wants to be able to access the thermostat to adjust the temperature of his single-level condominium. What is the MOST IMPORTANT feature that should be considered when selecting an appropriate control interface?

Ease of the patient's ability to access and operate the device

An OT practitioner is running a Topical Group about the importance of managing one's Diabetes. The focus of the session is on ways to prevent and react to diabetic hypoglycemia. Which of the following statements should be included in the group discussion? Select the best 3 answers.

Eat additional snacks if there is an increase in physical activity Don't skip or delay meals or snacks Blood sugar levels can be quickly raised by eating or drinking a simple sugar source

Marcy is a 75-year-old woman who is recovering from a total hip replacement in the skilled nursing facility. She requires a wheelchair for mobility. What features should her wheelchair include? Select the best 3 choices.

Elevating footrests Reclining back Pommel cushion

What is the BEST intervention for edema control in a patient admitted to acute care, 72 hours after a burn?

Elevation of body part

Ricardo, a 74-year-old patient with a BMI of 30 who has been diagnosed with Diabetes Mellitus Type II had to undergo a transfemoral amputation, a week ago. Ricardo has now been transferred to a post-acute rehabilitation facility, where he is receiving OT. While an COTA® is working with him on lower body dressing techniques, Ricardo states, "This should be a piece of cake. I've put my pants on all my life". What is the MOST important aspect of the education process, that the COTA® should focus on at this point in Ricardo's ADL training?

Energy conservation and work simplification

Diane, a 52-year-old patient, recently sustained a complete C8 SCI from a skiing accident. She has been depressed with the notion that she will not be able to return to the active lifestyle she once led. Diane currently needs minimal assist for bathing and community mobility, and stand-by assist for BADLs and light meal prep. Diane's sister who had a knee replacement a month ago, has agreed to act as her caregiver as they share an apartment. In preparation for Diane's discharge, the OTR® and COTA® will be meeting with Diane and her sister to discuss Diane's discharge plans. What is the MOST IMPORTANT information the clinicians need to obtain during this interview?

Family values and functional capacity of the caregiver and whether independence will be encouraged

Gabriel, a 53-year-old patient who was recently diagnosed with leukemia, has just completed a grueling month of chemotherapy which has had an impact on his muscle strength and stamina. Gabriel is struggling to perform simple motor tasks such as standing during his BADLs and walking around his home. What should the focus of OT intervention be at this stage of his treatment?

Focus on energy conservation

A 42-year-old male songwriter has recently begun to experience difficulty reading what he has typed on his computer due to a visual impairment caused by early-stage cataracts. What is the best computer adaptation to recommend to this patient at this stage of his disease?

Font enlargement

A patient with a C6 spinal cord injury is being educated on how to use a button hook and zipper pull to perform upper body dressing tasks in bed. To provide the patient with some pressure relief while performing the dressing task, what would be the best approach?

Forward weight-shifting or sitting using loops

A patient is functioning at level III (Localized response) according to the Rancho Los Amigos scale, due to a recent TBI. What is the MOST USEFUL pre-feeding technique that can be used for graded stimulation of the patient's cranial nerves?

Gently rub different flavorings of salty and sweet foods on the patient's tongue

When reviewing a patient's medical chart, the OTA reads that the patient has been diagnosed with atrophy of the optic nerve. What is the most likely cause of this?

Glaucoma

If a patient has brief depression periods but can multitask, independently maintain memory, and anticipate consequences, what would his Rancho Los Amigos level be at?

He would be assessed at Rancho level X

For which diagnosis would the Rancho Los Amigos Levels most likely be used as part of the patient's evaluation?

Head injury from MVA

Judyth is a 58-year-old female with a diagnosis of early stage diabetic retinopathy. What home modifications should the COTA® recommend to Judyth during the initial stages of treatment? Select the best 3 choices.

Help Judyth clear the clutter from her main hallway Place strips of black tape on the edges of Judyth's back entry steps which are covered with light tan tile Reposition Judyth's television to reduce glare on the screen

An OTA is working with a 78-year-old male patient, for home health therapy services. The patient states that since he had his recent hip replacement, he is experiencing pain during sexual intercourse. The OTA confirms that the patient is following the prescribed precautions to prevent injury to his hip, during sexual activity. What NEXT should the OTA further explore in order to help the patient with this issue?

His current feelings about sex, sexual preferences, and the role he plays

A man who sustained a second degree deep partial thickness burn to his right thumb, index and middle fingers 2 months prior, receives outpatient hand therapy. As a part of treatment, the OTA provides massage to the affected area. What activity should this man be able to complete if the massage has been effective?

Identify and retrieve loose change from a number of objects located in his coat pocket.

Joanne, a 70-year-old widow who lives alone, is being seen by a COTA® at her home. She enjoys watching her favorite game shows during the day while having her coffee and regularly goes walking with her rolling walker in the afternoon, with her neighborhood friends. Joanne favors aging in place and is seeking recommendations to ensure that she complies with her medication regimen. She reports that every now and then she takes her medication late, but states that she never misses a dose. She has however been prescribed one medication that is time-sensitive. Which steps would be BEST for Joanne to follow in order to integrate good medication habits into her life routines? Choose the best 3 answer choices

Identify the most realistic and simple routine in which the medication could be taken Identify cues that will trigger a medication habit Practice the entire medication habit until it becomes automatic

A patient who has a T10 SCI has developed a Stage 3 decubitus ulcer on his sacrum and has therefore been admitted to an inpatient facility for wound care. The patient is independent in his self-care, only requiring stand-by assist for bathing. Pain and upper body weakness due to deconditioning have been identified as his barriers at this time. The discharge plan for this patient is for him to return home, and for continued wound care management to be implemented through home health care. The patient has stated that when he returns home, he would like to be able to continue using his riding lawn mower. Which aspect of him using his lawn mower could prevent him from achieving his goal?

If the method of transfer produces a shearing effect

An OT practitioner is working with a patient who is recovering from Covid-19 and is currently using supplemental oxygen at home. The focus of the session is on conducting a home safety evaluation. From the options below, which of the following recommendations is NOT an appropriate precaution?

If the patient feels they are not getting enough oxygen, they should change the oxygen flow rate immediately

When should you recommend that a patient move to a long-term care facility?

If the person requires 24-hour personal care and does not require skilled nursing care

A COTA® is working with an elderly patient who has recently undergone a posterior hip replacement. What is the safest positon for this patient when performing lower body dressing?

In a supported chair

Violet is a 93-year-old female with multiple medical diagnoses who lives in a long-term care facility. She has developed a stage 3 pressure ulcer on her right buttock which is being treated by physical therapy. What treatment techniques should the COTA® provide to assist in the healing of this ulcer? Select the 3 best answers.

Incorporate weight-shifting techniques into morning ADLs Work with the activities department to include the woman in Wii© Sports games during the day Issue a gel cushion to the woman for use in her wheelchair

While consulting with an elderly woman at her home, she complains that dressing herself has become very challenging, especially early in the morning. She wears spectacles for low vision but reports that her glasses are not helping her. When working on a home modification for her, what would be the best modification to her bedroom, so that she can independently dress herself ?

Increase lighting

An OT practitioner is working with a patient who recently sustained a crush injury to his right dominant hand which resulted in him undergoing a right wrist disarticulation. The patient is undecided whether he wants a prosthesis, and the focus of OT intervention is therefore on educating him about the care of his residual limb which has partial sensation. What are the MOST important strategies the OT practitioner should teach this patient to help him care for his residual limb? Select the 3 best answer choices.

Inspect the residual limb when removing the wrap and washing the limb Adjust the position of the residual limb when seated for extended periods Visually track the residual limb when completing activities

An OT and OTA are working with an 87-year-old patient who recently had to undergo a below knee amputation as a result of uncontrolled diabetes. What type of screening/assessment should the clinicians implement FIRST with this patient?

Inspection of the patient's skin

A patient has recently been admitted to acute care for second and third-degree burns on the dorsal surface of his forearm and hand. Which splint would be appropriate for this patient?

Intrinsic plus splint

An OTA is working with an elderly patient who has recently relocated to an assisted living facility. While assisting the patient to transfer from a commode to a chair, the patient begins to slip. What action should the OTA take in this scenario?

It would be best to ease the patient to the floor, then get assistance

What adaptation would be MOST BENEFICIAL in enabling an inpatient who has C7 tetraplegia to participate in a game of ping pong?

It would be most beneficial to introduce fasten hook and loop straps to secure the paddle to the hand

At what Rancho Los Amigos level is a patient functioning if they can turn toward sound, respond to family members, and follow an object with their eyes?

Level 3

When working with patients who sustained a TBI, OT practitioners commonly use both the Rancho Los Amigos Scale and Allen Cognitive Levels (ACL) to guide their intervention. If a patient is functioning at RLA 7, which ACL level does this correspond to?

Level 5

Max, a 52-year-old male patient who is recovering from a recent TBI is consistently making progress in his recovery. At this stage of his recovery, he has now developed an interest in watching the morning news, but he has to watch the TV in his room where there is the least amount of distractions. After about 30 minutes however, Max becomes disinterested in watching TV and he starts walking around the facility. Max is aware that he has been injured and that is why he is in this facility, but he has little insight into the extent of his impairments. Max is starting to recognize some of the nursing staff but he is unable to recall their names. In terms of his ADLs, Max has made significant progress as he has re-learnt to brush his teeth independently. Although he is able to follow simple instructions, Max is not yet able to learn new tasks. At what Rancho Los Amigos level is Max functioning?

Level 6

If a patient is able to follow a set schedule and perform a self-care routine independently, at what Rancho level are they functioning?

Level 7: Automatic and Appropriate

An OTA working with a 52-year-old male patient at an assisted living facility documents that the patient regularly watches and concentrate on the evening news for about 30-minutes, as long there are no distractions. If the patient has visitors in the morning, he can recall that he had the visitors but he cannot remember what they spoke about. At what Rancho Los Amigos level is this patient most likely functioning?

Level VI

When working with a patient who has a progressive disease, what will the focus of OT intervention typically be?

Maintaining function

Beverly recently sustained a TBI and she is currently functioning at Rancho Los Amigos 8 (Purposeful Appropriate). OT intervention is focusing on improving her sequencing and problem-solving skills so that she can be discharged to a transitional living program. Beverly is currently participating in a cooking group which is structured to help her work towards achieving her goals . Last week, Beverly was able to successfully mix, dissolve in liquid, and mold Jell-O from a box. Which meal preparation activity should the COTA® work on NEXT?

Make a grilled cheese sandwich following a written recipe

A patient who recently sustained a C8 SCI has just received his first wheelchair from a durable medical equipment company. OT intervention is focusing on training this patient how to use his new wheelchair. What is the FIRST step this patient should be taught?

Lock the brakes

When fitting a pressure garment glove on a patient's right dominant hand, 6 weeks post burn injury, how can you ensure the best fit?

Make sure the compression glove exerts equal pressure, and if necessary, use a silicone gel pad under the garment to distribute the pressure more evenly

What type of wheelchair should be recommended FIRST to a patient who has a C6 spinal cord injury?

Manual wheelchair

In burn management, massage is a recognized modality used to help soften and desensitize healed grafted areas and burn scars. What is the BEST massage technique for treating a burn scar that is hypersensitive?

Massage should be performed in a circular motion, using gentle pressure initially and increasing the pressure gradually as tolerated

Agnes is an 89-year-old woman who lives alone in her single story home. For mobility, Agnes walks with a wheeled walker and she can take care of her basic ADL tasks independently. She, however, has difficulty with her IADLs and is homebound. Agnes has difficulty preparing meals for herself and her family members are unable to cook for her every day. What service should the OTA recommend so that Agnes can get adequate nutrition?

Meals on Wheels

A woman who has a progressive disease has recently been admitted to a long term care facility. When the OTA enters the woman's room to introduce herself, the woman asks the OTA how OT can help her, especially as she has a progressive disease. How should the OTA respond to the woman's question?

Occupational Therapy intervention can help the woman maintain her existing level of function

Willard is an 87-year-old male who suffered a CVA 3 months ago. He previously lived alone in a double-story home but after his Stroke, was transferred to a SNF to receive rehab services. Willard's progress over this time has been limited and he continues to need moderate to maximum assistance with his BADL and IADL tasks. Willard has been informed by Medicare that they will not continue to pay for his to stay in the rehabilitation wing of the skilled nursing facility past 100 days. At Willard's discharge planning meeting, what should the OT practitioner recommend in terms of Willard's living situation?

Move to the long-term care wing of the skilled nursing facility

A 22-year-old male who sustained an injury to his right knee when he fell off his snowboard, has had to have a total knee replacement. Post-op, what are the 3 most important precautions, this patient should adhere to? Select the best 3 answers.

No squatting No kneeling on affected knee No pivoting or twisting on knee

A patient has been referred to OT post bariatric surgery. What should the OT practitioner focus on when working with this patient?

Occupational goals

A 65-year-old male patient is currently in an acute care hospital and recovering from a thoracic spinal surgery. To maintain spinal precautions, while lying supine in bed, what is the BEST location for a patient to place frequently accessed items such as a remote or phone?

On the same side of the arm he is reaching

An OTA is working with a patient who is currently functioning at Level V (Confused-inappropriate) on the Rancho Los Amigos scale. The focus of therapy is on improving this patient's efficiency in self-feeding. The patient has been served a plate of food with a variety of different foods. He however, appears disorganised and takes much longer to finish his meal than is expected. How can the OTA help the patient achieve efficiency in self-feeding?

Only give the patient one food type at a time

A 67-year-old male patient has moderately low vision secondary to macular degeneration. One of the patient's goals is to make a Thanksgiving dinner for his entire family. What is the most important client factor to consider when working with this patient?

Peripheral vision

A patient has diabetes and recently had a lower extremity amputation. After the surgery, the patient reports feeling the presence of the limb and itching of the amputated limb. What is this patient experiencing?

Phantom sensations

Ethel has severe osteoarthritis in her neck and shoulders. She lives alone in her own home and is independent with most activities, but she has trouble reaching into the upper cupboards of her kitchen to retrieve dishes. What adaptation could the OTA recommend to help Ethel access her dishes?

Place frequently used dishes on the countertop

What is the best strategy to help an elderly man who is visually impaired, identify common toiletry items (hairbrush, deodorant, and toothpaste), taking into consideration that these items are colored differently and are not all placed in an upright position?

Place items in labeled open containers in an upright position

A patient who was recently involved in a MVA in which he sustained a TBI, is functioning at a Level II according to the Rancho Los Amigos scale. What is the MOST USEFUL pre-feeding technique that could be used for graded stimulation of the patient's cranial nerves?

Place items with strong smells (i.e. cinnamon, lavender, orange) under the patient's nose for 2-3 seconds

An OTA working with several patients in a senior nursing facility, is making recommendations to for low vision. What are the best ways to modify the environment, to ensure the patients' safety especially at night?

Place night lights in the patients' rooms and along the path to the bathroom

A patient who has low vision is preparing to cook a minestrone soup. Which adaptation is the MOST important to implement in order to ensure that this activity is safe for this patient to perform?

Place tactile labels on knobs of appliances

Elizabeth, a 16-year-old girl, was recently involved in a MVA which resulted in her sustaining an extensive crush injury to her right upper limb. Subsequently, she had to have her right dominant arm amputated, below her elbow. Elizabeth is the lead violin chair in her high school string orchestra, and she wishes to continue playing the violin with dreams of studying at the music conservatory. She has been fitted with a myoelectric body-powered prosthesis which has an accessory grip to hold her bow, a spring for wrist actions, and a mechanism which allows for pronation and supination. Elizabeth has completed practicing grasping and controlling the bow. Which of the following activities should the COTA® work on NEXT during the Functional Training step of the Post-Prosthetic Phase?

Playing simple scales to integrate bilateral use

Martin is a 43 year old man who sustained a C3 spinal cord injury 10 weeks ago. The OTA is assisting with a wheelchair assessment with Martin to improve his independence with mobility. What kind of propulsion should the OTA recommend for Martin?

Power w/c equipped with chin or head controls

A 28-year-old patient sustained a complete, C4 spinal cord injury from a skiing accident. The patient has been recovering in an inpatient wing at the local hospital, receiving rehabilitative services. The patient is being discharged to return home within the next few weeks and requires a customized wheelchair for home use. Considering that his home has no accessibility issues, what type of wheelchair would be the MOST suitable for this patient?

Power wheelchair with chin or pneumatic (sip and puff) controls

An OTA is working with a patient who is recovering from a recent TBI. The focus of the intervention is currently on meal preparation. The patient has successfully prepared cold cereal. In order to appropriately grade this activity, what is the next type of meal the OTA should select, to help this patient progress to the next level?

Prepare a hot beverage, soup, or prepared dish, such as hot chocolate.

An OT practitioner is working with a patient with a C5 SCI who is in the acute stage of their recovery. In what position should the OT practitioner position this patient's forearms to prevent contractures from developing?

Pronation

A professional dancer had to have an emergency amputation of his right dominant upper extremity after sustaining a crush injury to that limb. The patient is keen to resume dancing as soon as possible and has chosen a functional prosthesis to meet his needs. What professional would typically make this prosthesis?

Prosthetist

What is the most appropriate treatment intervention for a patient who is functioning at Rancho Los Amigos Level 1 (No Response)?

Provide PROM and sensory input

A patient who has been diagnosed with low vision, lives alone in a 2-bedroom single story house, is being seen at her home with the purpose of providing her with recommendations to help her compensate for her visual difficulties. What would an appropriate INITIAL recommendation for this patient be?

Provide a dark colored bath mat on a white tiled bath floor

A male patient who recently had a right knee replacement is due to be discharged from OT. Despite teaching him how to use assistive devices for dressing, he continues to have significant difficulty performing his dressing tasks independently. The patient is planning on returning to his home to live with his wife of 50 years. His wife has agreed to assist her husband in his ADLs. What measures should be taken to ensure that this patient's needs can be met by his wife?

Provide caregiver training and evaluate the wife's ability to perform dressing tasks on the patient

A COTA® is meeting a new patient for the first time. The patient recently had a left knee replacement, and her pain has been manageable. The patient immediately identifies that her most important goal at this stage of her recovery, is to be independent in her lower body dressing. However, the patient is reluctant to engage in dressing tasks in front of the clinician as she feels uncomfortable dressing in front of a stranger. How should the COTA® address the patient's apprehension with dressing during therapy so that she can still achieve her goal?

Provide oversized clothing so that the patient can dress over her own clothing

A 2-year-old child is participating in occupational therapy for prosthetic training. The child has absence of his right upper extremity at the proximal forearm level. What would be the most effective activity for the child to participate in FIRST?

Pushing a large therapy ball toward a target with his right upper extremity

At which Rancho level is a patient functioning if they are able to turn towards sound, respond to family members, and follow an object visually?

Rancho level III

An OTA is providing passive range of motion to a patient in the intensive care unit who sustained a severe traumatic brain injury. The patient has been given a rating of 2 on the motor portion (M) of the Glasgow Coma Scale. During range to the left arm, the patient's body suddenly extends, causing the arm to straighten and fall down on the bed. What is the MOST likely cause for this reaction?

Range of motion of the patient's arm is painful for the patient

What type of durable medical equipment is recommended for a patient with a complete C4 spinal cord injury?

Reclining shower chair

For a patient with reduced visual acuity, the OT practitioner's role is to modify activities and the environment so that the patient can compensate for their loss of vision and successfully complete daily activities. Which environmental modifications would be the MOST effective to increase visibility for this patient? Select the 3 best answers.

Reduce background patterns Increase illumination using halogen lighting Increase background contrast

A 93-year-old woman is about to get discharged from the rehabilitation department after a hip replacement. When discussing home discharge and safety, what are the three most important modifications to review with this patient to reduce her fall risk? (Select the best 3 choices).

Reducing clutter in mobility pathways and around sitting areas Removing throw rugs Placing objects at appropriate heights

A young adult who recently sustained a C5 SCI is being discharged from an inpatient rehabilitation facility. What is your INITIAL recommendation for this patient once they have been discharged?

Refer the patient to an outpatient rehabilitation facility

A patient with a C5 spinal cord injury needs to learn pressure relief techniques. What pressure relief method should the OTA teach the patient to relieve pressure in bed?

Relieve pressure using an overhead trapeze and attached rope ladder

Adam, a 52-year-old male who is morbidly obese is having difficulty accessing his bathtub-shower combo as the glass shower door easily becomes dislodged when he is climbing into the shower. He manages to climb into and out of the bathtub with ease, holding onto a grab bar for support but due to his size, his body tends to dislodge the glass door from its frame. What is the BEST modification that can be made in this scenario, so that Adam can safely and independently enter his shower?

Remove the shower door and replace it with a shower curtain or a folding plastic door

Samuel, a high school soccer coach, recently had a below elbow transradial amputation of his right dominant arm due to a gunshot wound. The loss of his arm has caused him great anxiety about dating, fearing rejection "because of my deformity". Samuel is hesitant and fearful to put on his new arm prosthesis. What should the COTA® focus on NEXT during the intervention process, to help Samuel overcome his aversion to wearing his prosthesis?

Repeated donning and doffing, and prosthetic skill training

A patient who sustained a spinal cord injury demonstrates 3+ (Fair plus) muscle strength in both his upper limbs. During a home evaluation, it is identified that the patient is unable to open/close the faucets in his shower and he would like to be independent in this ADL task. The shower has separate hot and cold round-shaped handles which the patient is unable to open/close. What type of adaptation would be appropriate to recommend so that this patient's goal can be accomplished?

Replace the existing round handles with a lever-type handle

A 62-year old patient with a history of diabetic retinopathy and early-stage Parkinson's has been admitted to an inpatient rehab facility due to a ground-level fall resulting in a tibial fracture of the left lower extremity. He now wears a CAM boot with current orders for weight-bearing as tolerated and is participating in a light, cold meal prep activity in the rehab kitchen. The patient suddenly reports feeling "shaky" with a headache increasing in intensity and states, "I wasn't able to eat breakfast and wanted to get here on time". What should the OTA IMMEDIATELY do next?

Report the change in medical condition to the charge nurse who will determine if the patient needs to adjust their blood glucose levels

A COTA® is working with a 72 year-old woman on a self-feeding task with adaptive utensils. The patient has dual diagnoses of diabetes mellitus type II and hypertension. The COTA® notices that the patient's skin becomes pale, her breathing becomes deeper and a "fruity odor" on her breath is evident. The patient suddenly appears very weak and starts to complain of excessive thirst. What should the COTA® do IMMEDIATELY in response to these observations?

Report the symptoms to the patient's charge nurse

A woman on the inpatient unit has a diagnosis of traumatic brain injury to the temporal lobe with auditory agnosia. The woman's daughter has complained to nursing staff that the certified nursing assistants (CNAs) are yelling at her mother when they provide her care. The CNAs report that the woman does not hear the instructions when they provide care. What advice should the OTA give to the CNAs? Select the 3 best choices.

Request training in use of the communication device provided by speech therapy Pair gestures and visual cues with auditory instructions Try giving the patient instructions in writing

A 76-year-old patient has recently been admitted to a rehabilitation facility following a fall at a local grocery store. The patient was diagnosed with Diabetes Mellitus Type II, 15 years ago and her diabetes is being controlled by medication. The patient reports that although her "sugars are good", she sometimes has "problems with her eyes", and this is the reason for her fall. Observing the patient, she demonstrates some difficulty navigating around the facility and she describes seeing floaters, having blurry vison at times and poor night vision. Based on these symptoms, what secondary complication has this patient MOST likely developed from her Diabetes?

Retinopathy

What should an OTA do FIRST if a patient in a rehab clinic experiences lightheadedness and dizziness when standing up from a wheelchair?

Return the patient to the wheelchair and raise legs on elevating footrests

An OT practitioner is working with a female patient who has a history of chronic lower back pain due to a herniated L4-L5 disc. The patient is finding using the toilet very challenging especially when her back pain is severe. What is the BEST way to structure this ADL to help the patient cope with attending to her toileting needs?

Straddle the seat and face the back of the toilet

Jason, a 45-year-old backhoe operator, recently injured his spinal cord at the level of T2. The COTA® has been educating Jason on strategies to compensate for his sensory loss in order to prevent the development of skin breakdown and pressure ulcers. Jason is independent in all his transfers and he tends to spend most of his day in a seated position. He enjoys reading science fiction books and plays Dungeons and Dragons with his friends for 3 hours, once per week. What strategies would the patient be able to perform in order to maintain skin integrity? Choose the best 3 answers.

Rolling side-to-side to monitor and ensure dryness of the skin using touch Lift his body away from the surface to avoid shearing forces Use a long, curved mirror to inspect the bony prominences of the lower body

A 22-year-old male patient who was recently involved in a motorcycle accident, enquires about his prognosis. He is told that he will most likely be able to walk again but that he may have a loss of function in his hips and legs, as well as little or no voluntary control of his bowel and bladder. At which spinal cord level did this patient MOST likely sustain his injury and which nerves have therefore been affected?

S1-S5 Sacral Nerves

When a patient is totally dependent in self-care but can instruct others in preferences for care, what spinal cord injury level did the patient very likely sustain?

SCI C1-C3

Jason is a 20-year-old specialist in the army who underwent an above-the-elbow amputation to his left upper extremity following an injury resulting from an IED explosion. What treatment techniques should the OTA use to help Jason prepare for an upper extremity prosthesis? Select the best 3 choices.

Scar and pain management techniques, including deep heat, tissue massage and tapping to the stump scar Mirror box therapy to reduce phantom limb pain Education in skin inspection and skin care techniques

Oliver is a 13-year-old boy who has been diagnosed with Stargardt disease which causes progressive damage to the macula, resulting in macular degeneration. Oliver is starting to show signs that he is struggling to use a standard computer at school and often reports that he is unable to read the text that is displayed on the computer screen. What type of assistive technology is the MOST appropriate to recommend for Oliver to help him access his school work on the computer?

Screen reading program

An OTA has been assigned to work with a patient who is recovering from a recent TBI. The patient is alert and the plan is for them to be transferred to an outpatient rehab facility. When treating this patient, which deficit would have the MOST impact on the patient's ability to contribute to and participate in their OT intervention plan?

Self-awareness

What level of assistance would you expect to provide to a person with a C5 spinal cord injury? Select the 3 best choices.

Set-up help and use of universal cuff for grooming tasks Minimal to moderate assistance with upper body bathing with use of a sponge mitt Total assist with home management

A COTA® is working with a 73-year-old patient who lives alone in an apartment, on the management of his medication. He has been diagnosed with Diabetes Mellitus II and is therefore at risk for developing a peripheral neuropathy. While observing the patient retrieving his medication from the upper cabinet, the COTA® observes certain actions that may be consistent with early symptoms of a peripheral neuropathy. What observations has the COTA® noted, that would MOST LIKELY require her to report a change in the patient's status? Choose the best 3 answers.

Shaking his hands when trying to open a child-resistant medication bottle Dropping bottles in attempts to transport them to the table Problems with coordination and proprioception while walking

A patient who works as a housekeeper complains of experiencing difficulty locating specific cleaning supplies on the shelves of her local supermarket. She reports that finding the items she needs to purchase is taking significantly more time which suggests that she may be having problems with her visual scanning abilities. The OTA is tasked with screening this patient for specific visual issues and presents the patient with a piece of paper on which several different shapes have been scattered. The patient is asked to circle all the triangles and she successfully completes the task. However, the OTA observes that the patient approached the task in a very haphazard manner. Based on this information, what does this patient's behavior MOST likely indicate?

She is demonstrating decreased visual attention

A patient with bilateral lower extremity amputations demonstrates Fair+ upper body and core strength. The COTA® is teaching the patient how to use a sliding board to transfer from a wheelchair which has removable arm rests to a 3:1 bedside commode. Which instructions should the COTA® use when teaching this type of transfer?

Shift upper body using arms to scoot along the sliding board towards the commode

An OTA is working with a patient who dislocated his hip three days ago. The primary focus of the treatment session is to ensure this patient adheres to precautions during functional mobility tasks and self-care activities to prevent him from re-dislocating his hip. What are the top 3 MOST important types of adaptive equipment to recommend to this patient? Select the best 3 choices.

Shower chair with grab bars Bedside commode Raised toilet seat

Following an above-knee amputation, what should be addressed FIRST when working with a 57-year-old diabetic patient who has impaired sensation in their residual lower limb?

Skin inspection

A COTA® is educating a patient who is due to undergo a total hip arthroplasty about post-op precautions. In terms of sleeping positions, what should the patient be advised to avoid during the initial stage of his recovery?

Sleeping in prone

A patient with fibromyalgia is scheduled to eat lunch as part of an occupational therapy feeding group. As the OTA assists the patient with a wheelchair to chair transfer, the patient's muscles give out and he begins to fall. What is the best action for the OTA to now take?

Slowly lower the patient to the ground and then get help

Maryanne recently had to undergo a posterolateral total hip arthroplasty. She is planning on attending an event on Saturday evening with her sister, who will be picking her up in a standard motor vehicle. As this will be the first-time, post-surgery, for Maryanne to leave the rehab facility, the COTA® begins the process of training her in car transfers. After sliding the passenger seat back, Maryanne ambulates with her front-wheeled walker towards the car. What should the COTA® instruct Maryanne to do NEXT during this transfer?

Slowly turn the walker and back up to the front passenger seat

Michael is a 53-year-old inpatient who was recently involved in a MVA which resulted in him sustaining a TBI and a minor injury to his left non-dominant upper limb. Michael has stated that his main long-term goal is to return to his job, working as a sales assistant in a men's clothing store. On a cognitive level, Michael is functioning at Rancho Los Amigos IX - Purposeful Appropriate. His static hand splint which he has been wearing for the past 6 weeks, has only just been removed and the focus of OT intervention is on facilitating bilateral hand function, and improving his sensory perceptual and attention skills. Which of the following activities would MOST EFFECTIVELY utilize an integrated functional approach involving the use of these skills in order to help Michael achieve his long-term goal?

Sorting through utensils in a drawer and making scrambled eggs on the stove

A patient who sustained a deep partial thickness burn to the radial side of the palm of his right hand is having a thermoplastic splint fabricated for him, in the hand clinic. His burn covers the thenar eminence and extends up to the PIP joints of the index and middle fingers. His wound has closed and is healing with scar tissue developing. How should this patient's hand be splinted?

Splint on the volar surface with MCP joints in full extension, IP joints in full extension, thumb in horizontal abduction

A COTA® is working with an insulin-dependent 58-year-old patient on upper body strengthening exercises using the arm bike. The patient starts to become agitated and begins to complain of shakiness and that his hands are feeling clammy, making it difficult for him to grasp the handlebars tightly. What should the COTA® 's IMMEDIATE response be?

Stop the activity, call for assistance, and provide him fruit juice

What are three compensatory techniques an OTA can teach a patient who recently had a hip replacement? Select the best 3 choices.

Storing frequently used items at eye to waist level Sitting vs. standing when completing dressing and bathing tasks Using adaptive equipment such as a long-handled shoehorn

A patient who sustained a head injury as a result of a sports injury, is currently functioning at Level VI (Confused-Appropriate) on the Rancho Los Amigos Scale. The patient is due to be discharged and the plan is for him to go live with his 44-year-old sister. As she works from home, she has agreed to be available 24/7, to help with her brother's care. Before the patient is discharged, what is the most important information the patient's sister should be given to BEST equip her to take care of her brother?

Strategies to use to reduce or prevent caregiver burnout

An OTA is working with 24-year-old patient who sustained a C5 SCI and has recently been discharged from the inpatient rehab facility in which he was receiving medical care. During a home visit, the patient identifies that accessing the kitchen sink is difficult for him. What is the BEST adaptation/modification to meet this patient's needs?

Take the cupboard doors off under the sink to accommodate the wheelchair footrests

A 78-year-old woman requires maximum assistance with IADLs, but she is able to complete her BADLs independently. Her daughter asks the OTA where the woman should live. What should the OTA recommend?

The OTA should recommend assisted living

A 72-year-old man was admitted to the hospital for a C3 spinal cord injury four days ago. He asks the OTA if he will ever have movement in his legs and his arms again. How should the OTA respond?

The OTA should tell the man that if sensation or motor function does not return within 24 - 48 hours, it is less likely to return.

What is the best adaptation for a patient complaining of a lack of clarity when looking at her kitchen supplies?

The best adaptation would be to increase background contrast

What would be the BEST prosthesis for a patient who has had an above-elbow amputation? Prior to the amputation, the patient was a secretary at a law firm but will be switching jobs and will now be answering phones using a headset. The patient is independent in all one-handed skills and is mainly concerned about the appearance of their residual limb rather than the function of the prosthesis.

The best choice would be a cosmetic prosthesis

What is the best method for an OTA to prevent heterotopic ossification when working with a patient in the active phase of C8 spinal cord injury?

The best method would be maintenance of joint ROM

To prevent falling at home, what should an OTA recommend to a senior female who has just had a hip replacement and is about to be discharged from rehabilitation?

The best recommendation would be removing rugs

A patient has swelling in an upper extremity due to an obstruction in her lymphatic vessels. What is this condition called?

The correct term is lymphedema

Part of the role of the OT practitioner when working with patients who are recovering from burn injuries, is to educate the patient on the aftercare of their burns. Which statements are the MOST accurate in terms of aftercare of burn injuries? Select the 3 best answers.

The graft and donor sites will be sensitive to hot and cold temperatures After skin grafts and donor sites heal it is very important to put on a non-perfumed (unscented) lotion or mineral oil many times a day Wear sunscreen with an SPF of 30 or higher and avoid prolonged sun exposure

When completing a home visit with an 84-year-old woman who is recovering from hip replacement surgery, what is the MOST important aspect of the woman's functioning within her home that should be assessed?

The height of the woman's toilet

An OT practitioner is working with a patient who has a visual impairment. The focus of the session is on helping this patient manage his medication independently. As the patient has difficulty reading standard labels on medicine bottles, the OT practitioner identifies that reprinting the labels in a larger print is necessary. Using a reading acuity test card, how can the OT practitioner determine the minimum size print that should be used for re-labelling this patient's medication?

The last line of print that is easily read on the reading acuity test card indicates the minimum size of the print

What is the most likely reason why a patient who recently had their second digit amputated, would complain of pain and tingling in that missing digit, when there are no signs of swelling or inflammation in the affected hand?

The most likely reason would be phantom pain

A 48-year-old male patient who is a sous-chef by profession, recently had to undergo an above elbow amputation of his right dominant extremity. The focus of OT intervention is on functional training of his myoelectric prosthesis. When addressing bilateral tasks such as cutting vegetables, what role does the patient's myoelectric hand play?

The myoelectric hand acts as the assisting hand and holds the vegetables to stabilize them

A 52-year old man is voluntarily being seen for a driving assessment after recently being diagnosed with Parkinson's disease. The patient presents with no motor control or perceptual difficulties and his ability to alternate his attention between tasks is within the normal functional limits for driving. In terms of his visual acuity, measurements are 20/60 without his corrective lenses, and 20/40 with his corrective lenses, which is the level at which an individual can pass a driver's license test in the United States. How would you interpret the above visual acuity values of 20/40 and 20/60?

The patient is able to see at 20 feet what a person with normal vision could see at 40 feet, and without corrective lenses the patient is able to see at 20 feet what a person with normal vision could see at 60 feet

While fabricating a splint for a patient who has developed carpal tunnel syndrome after giving birth to her daughter 3 weeks ago, the patient starts to complain that her right leg is cramping and becoming sore, and her leg feels warm. Looking at her leg, it appears to be swollen in comparison to her other leg. What is this patient most likely experiencing and what action should the OTA take FIRST?

The patient is experiencing a DVT and the activity should be stopped immediately

A veteran with a spinal cord injury is performing a grooming activity on the inpatient rehabilitation unit. The OTA notices that the patient's right leg appears to becoming swollen, is changing color and is warm to the touch. What does the OTA suspect the patient is experiencing and what action should she take?

The patient is experiencing a deep vein thrombosis (DVT), the activity should be stopped immediately, and the OTA should notify nursing staff

What activity would a patient who is functioning at Rancho Los Amigos 8 (Purposeful and Appropriate) be able to accomplish?

The patient will be able to come up with several solutions to a problem such as being out of milk when trying to cook macaroni and cheese

A OTA® is training a caregiver on how to assist a 27-year-old patient who recently sustained a complete C6 spinal cord injury. The focus of the training is currently on bed to wheelchair transfers, using a sliding board. The OTA® is working with the caregiver and the patient at the patient's home, where the patient has an adjustable bed with bed rails. What part of the transfer sequence will the patient MOST LIKELY have the ability to perform without assistance ?

The patient will be able to lock their elbows while rocking slightly forward and side to side as the caregiver places the board underneath their hips

When working with a patient who is recovering from a 3rd degree burn injury, what phase of OT intervention aims to enhance performance skills, provide adaptive equipment, and teach alternative techniques in self-care as needed?

The phase would be the rehabilitative phase

Using the GCS, if a TBI patient does not respond in any way to being pinched (specific stimulus), what score would you assign him for Motor Response (M)?

The score would be 1

An OTA is establishing a patient's fall risk at home. The patient has fibromyalgia, high blood pressure, diabetes mellitus Type II, and bilateral knee osteoarthritis. The patient is able to transfer in and out of his tub-shower combo but has fallen 3 times, without any major injuries. The OTA has already ruled out unmanaged blood sugar, polypharmacy, and acute illness as contributing factors to the patient's falls. What is the MOST IMPORTANT factor to consider during information gathering?

The status of the patient's current cognitive skills, to be trained in adaptive techniques for safe transfers

What are the symptoms of orthostatic hypotension?

The symptoms would include lightheadedness, pallor, and visual changes

What symptoms would you expect to observe if a patient with a SCI is experiencing orthostatic hypotension?

The symptoms would include lightheadedness, pallor, and visual changes

What type of adaptive equipment would be best to recommend to patients at SCI C1-C4 to promote independence with drinking?

The use of a long bottle or straw

If a patient is due to have a total hip replacement using the posterior surgical approach, what should the focus of preoperative OT intervention be?

The use of equipment and modified techniques to perform transfers and BADLs

A patient in the burn unit has been referred for OT intervention. The patient's chart reveals that the degree of burns they sustained from their injury has resulted in nerve damage. What degree of burn affects nerve endings?

Third-degree burn

A patient who recently had an above knee amputation has confided in you that he is concerned about his relationship with his girlfriend as he is afraid to express himself sexually. What would be the best course of action for you to take?

To ask open-ended questions in order to further explore his concerns

Colin, an inpatient who has a T6 SCI, has been invited by the Activities Director of the rehab facility to join other patients on an outing to the Summer Farmer's Market. The market is in close proximity to the rehab facility and the outing should last an hour. Colin has full use of his upper extremities and he is modified independent in his wheelchair. As this is Colin's first time attending an event outside of the facility since his injury, the COTA® educates both the director and Colin on certain precautions. What would the MOST important points of discussion be, in this scenario? Choose the best 3 answer choices

To be aware of the patient's loss of kinesthesia and proprioception. The patient's lower limbs can therefore knock into or get caught in environmental barriers Maintain fluids to regulate body temperature and observe skin for overheating below the level of injury To watch for any flushing, chills, or abnormal perspiration exhibited by the patient

Gillian, a 27-year-old social worker, recently sustained an injury to her left upper-limb while using a pottery kiln. As a result, she has a third degree burn on her left palm and forearm, and a second degree burn on the dorsal surface of her hand and wrist. During the initial inflammatory phase of healing, the COTA® applied an intrinsic plus splint. As the edema has subsided, the COTA® decides to fit Gillian with a palmar extension splint. What is the PRIMARY biomechanical purpose of applying a palmar extension splint in this scenario?

To increase surface area for maximal tissue lengthening and wound healing

A patient who has glaucoma has significant difficulty walking within her home. She easily becomes disoriented to direction and location and cannot find her way around. She is also constantly tripping and bumping into objects. What technique should this patient be trained in, to assist her with mobility in her home?

Trailing Technique

A COTA® is working with a 32-year-old male patient who recently sustained an injury to his left non-dominant upper limb, which resulted in him having to undergo a below-elbow amputation of that limb. The focus of OT intervention is on tub-shower transfers. The patient is experiencing intense sensitivity and pain in that limb, and he does not want to wear a prosthesis to perform his ADLs. What should the COTA® focus on NEXT during the treatment session?

Training in desensitizing techniques incorporating massage and wrapping of the residual limb.

An inpatient who had an anterolateral right total hip replacement, 10 days ago, is beginning training in IADLs. The patient's session is taking place in the kitchen and he is using a front-wheeled walker, to assist him with his mobility. The patient is preparing to make spaghetti bolognaise, using pasta and a jar of marinara sauce. During the meal preparation , the patient requires moderate verbal cues to ensure that he adheres to his hip precautions, by using proper body mechanics. Which one of the anticipated errors would the COTA® MOST LIKELY prevent by cueing the patient?

Transporting the ingredients from the counter to the kitchen island by lunging and stepping forward onto his left leg

A teenager is recovering from a recent C6 SCI which he sustained while playing rugby. He is an avid gamer and his main goal is to be able to use a computer to resume his preferred leisure activity. What assistive device will enable this teenager to use his PC with ease?

Typing Stick

Analisa, a 22-year-old college student, recently sustained a TBI when she was involved in a MVA. She is currently receiving OT services in an inpatient rehab unit. Analisa's main goal is to return to college, but she is becoming increasingly frustrated with her progress as she is unable to read a book without losing her place, and after a while the print starts to appear blurry. What adaptations should the COTA® introduce to Analisa to help her progress towards her goal of returning to college? Select the 3 best answers.

Use a guide or window to aid in maintaining place and to limit the amount of work presented at one time Break prolonged near work into shorter tasks Focus on auditory skills while building visual skills

Frank, a 74-year-old man who has bilateral cataracts and a mild memory deficit, lives alone in a single-story house. Frank is independent in all his ADLs, but he is finding it increasingly difficult to remember to take his medication on time. What compensatory strategy should the COTA® recommend to promote success with Frank's medication management?

Use a programmable talking medication pill bottle with auto alarm feature

A patient who has been diagnosed with AMD (Age-related Macular Degeneration) is having difficulty applying her make-up in the mornings. She completes her morning ADL routine in her bathroom which is lit by a large central fluorescent light, and when applying her make-up, she uses a standard mirror which hangs on the wall. In terms of lighting, which adaptations are the MOST appropriate to recommend to this patient, to improve her efficiency when applying her make-up? Select the best 3 answers.

Use non-glare bulbs Use lighting on a flexible arm Avoid using fluorescent lighting

A 32-year-old woman was recently involved in a MVA and subsequently sustained a complete SCI at the level of C6. The patient is the mother of 2 children, one of which is 3 months old and whom she is exclusively breastfeeding. As a result of her injury, her milk ejection reflex is absent affecting her milk production, and her ability to handle her infant is impaired due to poor hand function. With the help of medication and visualization, the patient has been able to produce some milk. What should the COTA® recommend for the patient to do, in order to maximize her independence in feeding her child?

Use nursing pillows and wedges to support the mother's arms during breastfeeding

Virginia, a 65-year-old woman who has a history of osteoarthritis, had to have a knee replacement 4 weeks ago due to joint degeneration. Virginia is generally an active person but post-op she has had little interest in pursuing her interests which are swimming, teaching outdoor painting to adults, and playing word games on her smartphone. During a recent home health visit by the COTA®, it was identified that her major barrier to resuming her leisure activities is fatigue. Virginia has already been taught activity pacing strategies to help her conserve her energy, but she has seen minimal improvements and it has therefore been difficult for her to persevere with these strategies. The COTA® decides to introduce a visual feedback strategy to help motivate Virginia to self-manage her symptoms of fatigue while participating in her preferred activities? Which visual feedback strategy would be the MOST EFFECTIVE in helping Virginia manage her fatigue?

Use of a pedometer app to measure movement, and a handwritten journal to log daily activities

Sharon, a 35-year-old patient who recently sustained a coup-contrecoup brain injury, has been assessed to be functioning at Rancho Los Amigos V (confused, inappropriate). As a result of her injury, Sharon's level of alertness is erratic and fluctuates between periods when she has decreased alertness and attention, to periods when she is more alert and responsive. At this stage, Sharon requires maximal assistance for her BADLs. She is generally cooperative when completing these tasks but becomes agitated when confronted with the more challenging ADL tasks, such as brushing her teeth. Taking advantage of those periods when Sharon is more alert and receptive, which strategy would be the MOST effective to incorporate into her treatment plan to help her progress in performing her ADL tasks?

Use of the strategy of guiding the toothbrush followed by a one-step command such as "to mouth" with OT periodically stating, "Let's focus"

A patient was admitted to the surgical ward for an above-knee amputation, one week ago, due to a gunshot wound. While working with the patient, who is seated in a wheelchair, practicing donning his trousers, he suddenly reports feeling light-headed with pain in his left arm. What is the BEST action for the OTA to take, in this scenario?

Use the call button to ask for immediate medical assistance

You have been assigned to work with a patient who is recovering from a recent TBI. The patient's medical records state that he is currently functioning at Rancho Los Amigos Level 5 (Confused, Inappropriate Non-agitated). What specific behaviors would you expect to observe when working this patient? Select the 3 best answers.

Uses objects inappropriately Cannot learn new tasks May be able to complete familiar tasks with structure and cuing

How can a patient with a C7 SCI achieve their goals of maximizing their independence when dressing?

Using a button hook

In which visual perceptual skill is a patient demonstrating an impairment, if they report that they are having difficulty recognizing traffic signs

Visual Closure

When working with a patient who is recovering from a TBI, the OTA observes that the patient seems to be experiencing difficulty seeing objects out of the corners of his eyes and he becomes startled when the OTA moves toward him. What diagnosis does this patient most likely have?

Visual field cut

An OTA is treating a patient with visual perceptual difficulties, secondary to a traumatic brain injury (TBI). During an intervention, the patient is instructed to place pieces of a game onto a picture board in order to construct a design/picture. By using this activity, what three visual perceptual skills does this patient have to use to successfully complete the activity? Select the best 3 choices.

Visual motor integration Figure ground Visual spatial awareness

An OT practitioner is working with a morbidly obese patient in their home. The focus of the session is on assessing whether the patient is able to wash themselves using a bariatric transfer tub bench set-up in the bathtub. Which factor is likely to have the MOST impact on the patient's safety during this task?

Water spillage from the tub

Pre-discharge, a COTA® is educating an obese patient who has multiple physical and mental health diagnoses about ways of how they can manage their GERD at home. What are the MOST beneficial recommendations the COTA® should provide to this patient? Select the 3 best answers.

Ways to manage stress Diet modifications- less spice, less alcohol, small meals more frequently Sleeping with multiple pillows to elevate the head

Ken is a 56-year-old patient who 8 months ago, had to have a left above-knee-amputation due to peripheral vascular disease which developed as a secondary complication to advanced kidney failure. Fitting Ken for a prosthesis has not been possible at this time as he has had recurring infections of his stump which has necessitated frequent hospital admissions for intravenous antibiotic treatment. Ken is receiving dialysis 3 days per week, which has resulted in hemodialysis-related fatigue. Ken's wife is acting as his caregiver and has been assisting him with minimal assistance for stand-pivot transfers. However, she is concerned about keeping Ken safe with transfers, especially on the days he has dialysis due to his fatigue. What should the COTA® do NEXT in response to the wife's concern?

Work on caregiver training with sliding board transfers with emphasis on transferring to both sides of the patient's body

Adeline, a 50-year-old mother of 3 teenagers, is being seen in an oncology rehab unit post having a left mastectomy. Both the surgery and chemotherapy have resulted in Adeline experiencing difficulty performing her ADLs and IADLS due to fatigue and limited AROM of her left shoulder. She reports her overall exertion level with ADLs as being "somewhat hard" which is equivalent to a rate of perceived exertion level 13/20. At this stage, Adeline's main goal is to resume helping her children with making their breakfasts and packing their school lunches. What recommendations will help Adeline achieve her goals? Select the best 3 answers.

Work on seated-level IADLs that facilitates stretching the left upper extremity such as making her favorite pizza dough with a rolling pin Create a calendar of assigned duties for each of her children to do, if they are willing Maintain a journal to track how she is feeling before, during, and after activities

A COTA® is working with a 72-year-old patient who is recovering from a recent total hip replacement. The patient is ambulatory, and her leisure interests include gardening and home crafts. The focus of OT intervention is on training the patient in the use of adaptive equipment for lower body dressing. The patient however refuses to participate in the session and states, "It's boring! I don't like to deal with such nonsense". The COTA® decides to adapt the activity by inviting the patient to join a group of 3 other women, all of whom have the same goal of lower body dressing post hip surgery. Which type of activity would be the MOST APPROPRIATE to work on, that would help the patient develop the necessary skills that would allow her to become proficient in lower body dressing, with the aid of adaptive equipment?

Work together to select and transplant plants from pots into a vertical garden

A patient who recently sustained extensive injuries to both his lower limbs as a result of being shot multiple times, has had to have a bilateral above the knee amputation. After the patient has been medically cleared, what is the first aspect of OT intervention, the OTA should focus on?

Wrapping of the residual limbs for shaping and swelling