✓NBCOT Questions #7: 311-370 (7/11/19)

An OTR® is working with a client in the active phase of a T2 spinal cord injury. The client reports a terrible headache and is sweating profusely. What is the BEST method to address the client's symptoms? A. Check blood pressure and alert nurse. B. Bring upright and remove restrictive clothing. C. Recline quickly and elevate legs. D. Bring upright and apply abdominal binder.

The client is likely experiencing autonomic dysreflexia, a serious and life-threatening condition. The client should be placed upright, restrictive clothing should be removed, and the bladder should be voided (or catheter tubing checked for obstruction). A: Although the nurse should be alerted and blood pressure checked, it is more important to address the immediate need. C: Reclining and elevating legs will exacerbate the problem because it will increase blood pressure. D: Application of an abdominal binder will increase blood pressure.

An OTR® is using an adaptive approach with a client returning to work after bilateral carpal tunnel release surgery 6 weeks ago. The client works as a supermarket checker. Which job task modification incorporates an adaptive approach? A. Handheld barcode scanner B. Strengthening exercise using 2-pound weight C. Adjustable-height stool at the cash register D. Upper body stretching breaks every hour

The right answer is A An adaptive approach supports functional performance through use of compensatory techniques such as changes in activity demand. B, D: These options are restorative approaches. C: This option is an adaptive approach but is not specific to the client's carpal tunnel condition.

DK- The caregiver of a client with Alzheimer's disease questions the home health OTR® about a recent increase in the client's dosage of donepezil (Aricept) prescribed by the physician. The caregiver is particularly concerned about potential consequences of the increased dosage. What is the OTR®'s most appropriate suggestion for the caregiver? A. Observe the client for signs of dizziness, which increases potential for falls. B. Because the medication can cause photosensitivity, keep the client out of direct sunlight. C. The physician will probably monitor the client closely for potential drug toxicity. D. Monitor the client's hydration carefully because the drug can cause dry mouth and constipation.

The right answer is A Donepezil is a cholinergic-modulating drug that may improve memory and cognition and reduce negative mood, anxiety, and hallucinations; however, dizziness is a side effect. B, C, D: These side effects are not common with donepezil.

Retired- An OTR® is developing a job-finding program to assist clients who have an enduring mental illness. How will research findings about supported employment assist the OTR® in the program development process? A. Enables selection of intervention methods based on objective investigation B. Promotes the core values of occupational therapy and its roots in the behavioral sciences C. Supports practice techniques perceived to be beneficial for clients with a mental illness D. Provides evidence to resolve practice issues with administrators and reimbursement sources

The right answer is A Evidence-based practice is a priority within occupational therapy, and using evidence-based interventions is associated with better outcomes for clients. B: Using evidence to support intervention selections was established in behavioral science research, though the evidence may or may not relate to the core value of occupational therapy. C: Using evidence-based intervention is associated with better outcomes for clients though evidence-based practice techniques are supported with objective information, not perceptions of benefits. D: Research does not necessarily resolve practice issues with administrators and reimbursement sources, though it can be used as evidence to support occupational therapy services.

DK- An OTR® who works with adult clients with mental illness attends an introductory workshop on guided imagery. The OTR® wants to begin applying the skills obtained from the workshop with clients. With which of the following clients would it be MOST appropriate for the OTR® to use guided imagery? A. Clients with generalized stress disorder B. Clients with chronic schizophrenia C. Clients with chronic bipolar disorder with psychotic episodes D. Clients with schizoaffective disorder

The right answer is A Many people respond well to relaxation with guided imagery, but guided imagery alone is contraindicated for people with hallucination potential, such as in schizophrenia, bipolar disorder with psychosis, or schizoaffective disorder. B, C, D: Clients with psychotic disorders will not benefit from imagery techniques because this approach might worsen positive symptoms.

Which occupational therapy intervention strategy is MOST appropriate for use with an older adult with low vision? A. Instruct the client to reduce clutter and improve organization of the home and work environments. B. Instruct the client in the use of bold, colored patterns on tablecloths. C. Teach the client to use a medication chart printed in typical-size print (12-point Times Roman). D. Teach the client how to use the sense of smell to compensate for vision loss.

The right answer is A Reducing visual and physical clutter makes it easier for the client with low vision to find objects and reduces fall risk. B: The use of patterns makes it more difficult for the person with low vision to distinguish an object from the background. The use of contrast makes it easier for the person with low vision to distinguish objects from the background C. This strategy only makes it easier for the person with low vision to manage medications if the chart is large print. D: The sense of smell may help partially compensate for vision loss, but it is helpful to additionally use other senses (such tactile or auditory). This helps supplement the reduced vision and enables participation in tasks and activities.

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

The right answer is A STABLE ANGINA usually resolves with REST, NITROGLYCERIN, or both. B: UNSTABLE ANGINA does NOT resolve with rest or nitroglycerin. It requires emergency treatment. C: Myocardial infarction also requires emergency treatment. D: Atrial flutter is usually treated with other medications, ablation, or cardioversion.

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

The right answer is A Teaching self-cueing is useful in helping clients initiate movement to minimize the effects of bradykinesia. B, C: Use of a walker and lower-extremity strengthening do not address the effects of bradykinesia on mobility. D: Having a caregiver present during mobility provides safety support but does not address the effects of bradykinesia on mobility.

Which occupational therapy assessment tool for motor and sensory function would BEST be used with the population with spinal cord injury in determining baseline performance? A. American Spinal Injury Association (ASIA) Scale B. Canadian Occupational Performance Measure (COPM) C. Modified Ashworth Scale (MAS) D. Manual muscle testing

The right answer is A The ASIA Scale is used to determine baseline sensory and motor control performance for clients with spinal cord injury. B: The COPM provides information about the client's perceived satisfaction with performance of daily occupations. C: The MAS assesses muscle tone and would not provide information about sensory function. D: Manual muscle testing is used to grade muscle strength and would not provide information about sensory function.

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

The right answer is A The distinguishing feature of frontotemporal dementia is behavioral changes with an increase in disinhibited behavior, decreased social tact, lack of empathy, and lack of interest. B, C, D: None of these dementia categories has behavioral changes as a significant symptom.

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

The right answer is A The role of deacon could be perceived as creating situations that make it difficult for the OTR to maintain clear professional boundaries or objectivity. Recruiting parishioners from among the occupational therapy clients suggests a lack of clear professional boundaries. B: Unless the fliers describe controversial or unconventional activities, it is unlikely they would reduce public trust in occupational therapy. C: This statement is not part of the Code of Ethics. D: The right to refuse services does not apply in this scenario.

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

The right answer is A This device will allow the client to continue to drive and to use the left foot to compensate for the right leg hemiparesis. B: The client has no impairment with the right upper extremity and so has no need for a spinner knob. C: The client cannot use the right leg so pedal extenders will provide no benefit. D: The client has no visual field deficits; therefore, additional mirrors are not necessary.

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

The right answer is A This strategy would help the client supplement remaining vision with tactile sensation. B: Because central vision tends to be impaired with this condition, this would not be a suitable option. Teaching the client to use sing peripheral vision would be more beneficial. C. Occupational therapy practitioners are unable to prescribe optical devices; however, they can teach clients how to use these devices after they are prescribed by a physician or optometrist. D: Decreasing the lighting would hinder the client from viewing the microwave controls. Increasing the lighting is more appropriate.

DK, X- An OTR® is working with a client who works on an assembly line. The OTR® suspects compression of the ulnar nerve at the elbow, or cubital tunnel syndrome. Which two nerve-related assessments would be used when cubital tunnel syndrome is suspected? A. Wartenburg's sign and Froment's sign B. Visual analog scale and Kirschner's test C. Tinel's test and Kleinert's rule D. Allen's test and Phalen's test

The right answer is A Wartenburg's sign is the fifth finger held away from the fourth finger, indicating palmar adductor interossei weakness. Froment's sign is flexion of the interphalangeal joint of the thumb when the client performs a lateral pinch. The flexor pollicis longus is compensating for the adductor pollicis and flexor pollicis brevis. indicating weakness of the ulnar nerve. Wartenburg's and Froment's signs are tests of ulnar nerve compression or cubital tunnel syndrome. B: A visual analog scale is a pain assessment. Kirschner's test is a type of wire used in pinning fractures in the fingers. C: In Tinel's test, tapping along a nerve produces numbness and tingling sensations. Kleinert's rule does not exist; Harold Kleinert pioneered microsurgery in the hand and performed one of the first hand transplants in humans. D: Allen's test assesses ulnar and radial artery status of the hand, and Phalen's test checks for median nerve compression at the wrist.

DK, X-An OTR® recently completed a functional capacity evaluation (FCE) on a client who is a piano teacher at a school for the performing arts. The client recently sustained an avulsion injury of the index finger on the client's dominant hand at the level of the distal interphalangeal joint, which resulted in the amputation of the distal phalanx on that finger. What would the results for the FCE completed by the OTR® MOST APPROPRIATELY be used to determine? A. Impairment rating B. Disability rating C. Client's fitness for duty D. Quantifiable physical loss rating

The right answer is B A DISABILITY RATING considers the worker's impairment and the impact of the impairment on the client's ability to perform preinjury for any job and considers the unique characteristics of the job. IMPAIRMENT rating does not take into account the unique factors relating to worker vocation.) In this case, the client's missing joint affects the ability to play the piano, which is one of the primary demands of the client's position. Amputation of the distal phalanx would render the piano teacher disabled from his or her career. A: An IMPAIRMENT rating relates to the PERCENTAGE of whole-body function and translates to a final monetary settlement for an injured worker. IMPAIRMENT rating focuses on permanent QUANTIFIABLE PHYSICAL LOSS related to injury when the client is considered to be at the maximum medical ENDPOINT. Because this client just began the therapy program, the client's medical endpoint has yet to be determined. C: Fitness-for-duty tests are completed by occupational medicine physicians after injury. D: Quantifiable physical loss is NOT a rating used in work rehabilitation.

X- Retired NBCOT® Question An OTR® is reviewing the measurement properties of a new sensory processing assessment. The test manual indicates that when scores from this new measure are compared with scores from another sensory processing test, the correlation coefficient between the two measures is reported as 0.71 (p < .05). What does this finding mean? A. A low score on one test is significantly related to a high score on the other test. B. The score on the new test is significantly related to the score on the other test. C. There is no significant relationship between the two test scores. D. There is a statistically significant difference between the two test scores.

The right answer is B A correlation coefficient compares the variables of one measure to the variables of another measure. Correlation coefficients that are closer to 1.00 or to +1.00 indicate a strong relationship between the variables. The correlation of .71, as indicated by the p value, suggests a strong positive correlation—a high score on one variable is related to a high score on another variable. A: A negative correlation coefficient would suggest relationship between a low score on one test with a high score on another test, and the coefficient of .71 is positive. This suggests a strong positive correlation; a high score on one variable is related to a high score on another variable. C: Correlation coefficients near .00 suggest no relationship exists between two variables. D: Correlation coefficients near .00 suggest that there may be statistically significant differences between the two test scores. A correlation of .71 suggests a positive relationship between test scores.

X- An OTR® is reading a previous initial evaluation report for a child with autism that concluded, on the basis of a sensory processing assessment, that the child shows signs of low registration of sensory information. Which of the child's behavior observed by the OTR® is consistent with low sensory registration? A. Easily gets dizzy with linear swinging B. Shows increased hyperactivity and movement C. Dislikes being touched and hugged D. Shows guarded and cautious movement

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

X- An OTR® is hired as a consultant to design a productive modified-duty program for a small manufacturing plant. Which element should the OTR® NOT incorporate into the program design? A. Focus on maintaining injured employees in a productive work capacity while facilitating progressive recovery. B. Provide opportunities for injured workers to interact with coworkers in the context of the work environment. C. Identify designated staff to be trained to monitor a worker's adjustment and tolerance to work tasks. D. Ensure that the demands of an assignment are within the stated restrictions of the employee's abilities.

The right answer is B Although opportunities to interact with coworkers provide the injured worker the benefit of socialization and exposure to the work environment during recovery, they are not the primary focus of modified duty programs. A, C, D: All these components should serve as guidelines when establishing a productive modified-duty program.

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

The right answer is B Breaking the task into manageable steps allows the OTR® to control the task and provide the "just-right" challenge to the client to maximize attention to the task and to reduce frustration. A: Persisting in a task despite fading attention may lead to increased frustration and anxiety or production of a product that is not of good quality. C: Self-talk is more effective for executive function deficits. D: Increasing visual attention to the environment might be stimulating but would not automatically lead to an increase in attention to task.

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

The right answer is B Evidence has supported the use of constraint-induced movement therapy, or forced-use movement therapy, for children with hemiplegia. This technique involves the therapist restricting the child's ability to use the unaffected arm, thereby forcing the child to use the affected arm during functional tasks. Working on an art project may help encourage the child's participation and make the therapy more enjoyable. A: Tone inhibition would likely result in decreased spasticity but would not increase function of the affected arm. C: The use of a familiar task may be helpful, but it would not directly relate to increasing functional use of the affected extremity. D: Habit training might lead to better performance with the task but would not necessarily lead to increased function of the affected extremity.

A client with multiple sclerosis indicates in the occupational profile that cleaning the home is an important IADL. The client has good balance and fair plus (3+/5) upper-extremity strength, is independent with self-care using adaptive equipment, and needs stand-by assistance for showering due to lack of endurance. The client easily becomes fatigued when cleaning. Which intervention is MOST important to include in the intervention plan? A. Upper-extremity strengthening program B. Energy conservation strategies C. Cognitive rehabilitation techniques D. Workstation modifications

The right answer is B Instruction in energy management strategies and activity techniques is used to address fatigue in clients with multiple sclerosis. A: Strength in the upper extremities is not a significant factor limiting the client's occupational performance. C, D: These approaches are not applicable to the client's goal of being able to clean the home.

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

The right answer is B Issuing advisory opinions is one of several roles the Ethics Commission is charged with. A: Maintaining and reviewing AOTA's governance documents is the role of the AOTA Bylaws, Policies, and Procedures Committee. C: The Ethics Commission informs and educates the AOTA membership. It is not specifically charged with educating all occupational therapy students. D: Determining AOTA's strategic direction is the role of the AOTA Board of Directors.

An OTR® working in a community hospital has been asked to serve on a team assessing the livability of surrounding communities. Which definition BEST describes the concept of livability? A. Provision of sidewalks, crossing signals, and curb cuts to ensure that all citizens of the community can move around the community without an automobile B. Community design that promotes maximum participation of all citizens, regardless of age or ability C. Mix of housing that allows families with and without children and people of all ages and incomes to live in inclusive neighborhoods D. Design of the physical aspects of a community to allow equal access to goods and services for wheelchair users

The right answer is B Livability is a concept that extends beyond specific types of physical access or design to encompass all aspects of community life that may invite participation by all community dwellers, regardless of age or ability. A: Walkability refers only to the built environment. C: Housing policy is not a component of livability. D: Physical accessibility is only one component of livability.

X- A client was recently diagnosed with multiple sclerosis and has been referred to occupational therapy for evaluation. When assessing the client's occupational performance, which information should the OTR® consider? A. ADL assessments completed on the first visit B. Observations of the client's performance over a period of time C. Results of specific measures, such as the manual muscle test D. Observation of the client's routine early in the morning

The right answer is B Observing the client over a period of time allows the OTR® to identify variability in endurance and fatigue a client with MS may experience. A: Assessments completed on the first visit may not accurately reflect a client's current abilities because of the significant impact of decreasing endurance and increasing fatigue on occupational performance. C: Client skills (e.g., motor and praxis skills, sensory-perceptual skills, emotional regulation, and cognition) provide information about factors that may influence occupational performance. However, assessing client skills does not directly assess occupational performance. D: Variability in endurance and fatigue throughout the day means that a client's performance early in the morning may not provide an accurate picture of the client's functioning.

A client working as a transcriptionist for a law firm experiences neck pain. The pain begins on Mondays, increases over the course of the week, and diminishes over the weekend. An OTR® completes an ergonomic evaluation of the client's workstation. Which explanation for the pain is BEST? A. The transcriptionist is using lightweight writing tools. B. The transcriptionist is experiencing glare from overhead lighting. C. The transcriptionist uses an adjustable chair. D. The transcriptionist is using a hands-free headset for the telephone.

The right answer is B Overhead lighting problems can contribute to awkward posturing at workstations. A: Lightweight writing tools should not increase the physical effort for a worker and should not pose an ergonomic risk. C: Workstation chairs should be adjustable to allow customization to the individual worker. D: Hands-free headsets for telephone use should allow for neutral neck alignment.

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

The right answer is B Paraphrasing what a client says is an effective strategy for demonstrating empathy. A, C, D: These options do not acknowledge the client's concern about missing the wedding, a major life event. Although these responses acknowledge that the client is upset, they do not acknowledge why.

An OTR® working in a public school receives a referral for a middle school student with oppositional defiant disorder. Which method to gather reliable information about this student would be MOST effective? A. Interview the student B. Interview the teacher or caregiver C. Read the student's school file D. Observe the child at home

The right answer is B People with oppositional defiant disorder are not always truthful and generally do not have insight into their oppositional behavior. They are unlikely to be able to articulate an accurate picture of their behavior. A: Interviewing the student is an important step in the evaluation process, but the contents of the interview cannot be expected to be reliable. C: Reading the student's file would not provide as much information as talking to the student's teacher or caregiver. D: Although observing the student in his or her natural environment might provide reliable information, home visits are not typical in practice in a public school setting.

X- The OTR® has a client whose job involves typing for 5 hours each day, answering phones, and filing. This client has been referred to occupational therapy because of numbness and tingling in both hands and wrists, primarily the index and middle fingers. The client's hands also fall asleep at night, which causes the client to have diminished sleep. What condition does this client MOST likely have? A. Ulnar nerve injury B. Carpal tunnel syndrome C. Lateral epicondylitis D. Radial nerve injury

The right answer is B Primary symptoms of carpal tunnel syndrome are numbness and tingling in the median nerve distribution (which includes the index and middle fingers). It is common in people who have jobs that involve repetitive movements in the hands and wrists. In addition, especially in early stages, clients will complain that the symptoms wake them at night, most likely because of positioning of the wrist and forearm. A: Clients with ulnar nerve injury will complain of loss of grip function with significant difficulties in fine motor tasks because the ulnar nerve innervates the muscles that allow for STRENGTH in the hand and SIMULTANEOUS MOVEMENTS that require a STRONG GRIP. The arches of the hand will be visibly impaired as well. C: Lateral epicondylitis is commonly caused by repetitive motions with gripping and supination. Clients will likely have pinpoint pain at the lateral epicondyle. D: WRIST DROP is a distinguishing feature of RADIAL NERVE injury because the innervation from the radial nerve supplies the EXTENSORS in the forearm.

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

The right answer is B Pulmonary rehabilitation clients may be instructed to count out loud, sing, or talk to ensure that they are exhaling during the strenuous part of an activity. A: Holding the neck in midline improves swallowing more than breathing. C: Propping elbows on a countertop assists in stabilizing the upper extremities when incoordination interferes with upper-extremity tasks. D: Lifting both arms to 90° of flexion would make breathing more difficult.

A client has C6 complete tetraplegia. Which hand functions would this client be expected to demonstrate? A. Limited grasp to pick up an item with the proximal and distal interphalanges B. Ability to pick up an object by stabilizing it between the palms of both hands C. Inability to use the hands for any functional tasks or object manipulation D. Ability to manipulate the power control of wheelchair using the tips of the fingers

The right answer is B Radial wrist extension allows the client with C6 tetraplegia to stabilize the hands for compensatory grasp activities such as picking up a bottle or sliding an object to the edge of the table. A, D: A client with C8 tetraplegia would be able to demonstrate movement of the extrinsic finger muscles and thumb flexors to flex proximal and distal interphalanges to grasp objects. C: Clients with C1 to C5 spinal cord injury lack the wrist movement and finger innervation to functionally use both hands. Clients with injury at the C5 level are able to use the hands for feeding and other tasks when wrist supports and adaptations for grasp such as universal cuffs are included.

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

The right answer is B Reorganizing a worksheet with clearly defined answer spaces would help the child to attend to relevant information on the worksheet. A: Directional cues can be provided to support visual-motor integration but would not help the child to attend to relevant information on the worksheet. C: Using a game like Bingo would be a good support for kinesthetic learners. D: Color coding would not be appropriate for visual organization.

Which strategy should the occupational therapy practitioner keep in mind when preparing a handout for an older adult with low vision? A. Print the handout in regular-size type on light-colored paper. B. Use a large, dark font on white paper. C. Make sentences short and use a vocabulary appropriate for 8th graders. D. Keep the handout to only one page and place it in a notebook.

The right answer is B This strategy uses the principles of contrast (dark font on white paper) and enlargement and magnification (enlarging font), which makes it easier for the client with low vision to read. A: This strategy makes it difficult for the client to read because the type is not enlarged and the contrast may not be sufficient. C, D: These strategies do not relate to the client's low vision.

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

The right answer is C A 90° angle of pull distributes the pressure most evenly to the proximal phalanx. A, B, D: If the angle of pull is greater or less than 90°, the torque is less effective, and skin breakdown may result.

Retired NBCOT® Question Based on the outcomes of a needs assessment for a retirement community, an OTR® plans to offer a program to promote the residents' adjustment and support participation in the community. What information should the OTR® gather as the FIRST step toward implementing this program? A. Capacity of the community to offer a variety of social and leisure programs B. Public transportation options available to residents of the community C. Performance patterns, skills, and client factors of potential participants D. Volunteer opportunities available in the community for elder residents

The right answer is C A community profile is created to give the practitioner information about the participants, their condition, and the context. The engagement in occupation is understood through performance skills, performance patterns, and client factors. A: The community capacity to offer social and leisure programs is determined through the needs assessment so the OTR® has this information already. B: Public transportation options are determined through the needs assessment so the OTR® has this information already. D: Volunteer opportunities are determined through the needs assessment so the OTR® has this information already.

A 4-year-old child with autism always flushes the toilet before using it and leaves the toilet unflushed after using it. What should the OTR® do to ensure correct toileting habits? A. Give a reward every time the child flushes the toilet after using it B. Suggest a sensor-activated toilet to ensure it is flushed after each use C. Use a visual schedule depicting the correct flow of actions during toileting D. Facilitate memory by prompting the child to flush the toilet after each use

The right answer is C A visual schedule tends to work better than auditory and operant conditioning for children with autism when teaching them the correct steps in using the toilet. A, B, D: Giving a reward, using a sensor-activated toilet, or prompting the child to flush the toilet are behavioral and environmental modifications that do not necessarily ensure transfer of learning in other contexts.

An OTR® is working with a client who is about to undergo a second lower-extremity amputation. The client did not use a wheelchair with the first amputation but wants to purchase one now for occasional mobility if lower-limb prostheses are not available. What is necessary for wheelchair safety for a client with bilateral lower-extremity amputations? A. Reclining back rest B. Elevating leg rests C. Rear antitippers D. Wedge cushion

The right answer is C Because a person who has undergone a bilateral lower-extremity amputation has a different weight distribution when seated, the wheelchair is more likely to tip backward with less weight in the front. Antitippers prevent this. A: Reclining in the chair would further increase the posterior weight distribution and increase the chances of tipping backward in the wheelchair. B: Elevating leg rests are not necessary for someone who has undergone bilateral lower-extremity amputations. A residual limb support may be placed on the wheelchair as needed. D: A wedge cushion would push the client's hips further back in the chair, again increasing the posterior weight distribution.

DK- An OTR® is working with a client who has upper-extremity injuries incurred in a motorcycle accident. The client is being treated using hydrotherapy as a modality for wound debridement. Which tissue needs to be debrided for healing of a wound to occur? A. Red or inflamed tissue B. Hypertrophic scar tissue C. Black or yellow tissue D. Keloid scar tissue

The right answer is C Black, necrotic tissue and yellow, possibly infected tissue need to be removed for healing to occur. A: Red or inflamed tissue is healing appropriately. B, D: Hypertrophic and keloid scar tissue has already healed.

DK, X- An OTR® reviews the cancellation test form in a client's chart. The form indicates that the client crossed out all letter Ms. What does this test assess? A. Visual acuity B. Literacy C. Spatial neglect D. Ocular motor control

The right answer is C Cross-out assessments are used in visual scanning and can be beneficial in detecting spatial neglect or visual field impairments. A: Visual acuity/clarity is more precisely measured with multiple alternate visual tests, such as the Snellen Eye Chart. B: Literacy would best be tested by sample-reading skills, not necessarily with a letter cross-out assessment. D: Ocular motor control is best assessed by observing the client's eyes for movement deficiencies when focused on an object, in light changes, and in tracking.

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

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

X- An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. The daughter has expressed fear that the client might fall down the stairs at the back door while wandering. To prevent the client from using the back door, what would the OTR® MOST likely recommend? A. Painting a big "STOP" sign on the back door B. Painting the door yellow to contrast with the environment C. Using a poster to camouflage the back door and the door knob D. Installing a motion-detecting light at the stairs to the garage

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

X- A client was referred to occupational therapy because of persistent pain in the neck and shoulder and the recent onset of paresthesia (ABNORMAL DERMAL SENSATION: TINGLING, PRICKLING, BURNING, NUMBNESS) in the right index and middle fingers. The OTR® decides that the symptoms may be work related and proceeds with an onsite ergonomic assessment. During the ergonomic assessment, the OTR® observes that the client uses the mouse 80% of the time. What will the OTR® MOST likely recommend? A. Using a vertical mouse and placing it at desktop level B. Changing to a laptop so that the client can use the touchpad instead of a mouse C. Performing full upper body stretches after every 20 minutes of mouse use D. Assigning the client other tasks that require less frequent use of the mouse

The right answer is C Frequent stretches and movements away from the static posture and prolonged use of a mouse is another strategy to prevent repetitions and muscle strain. A: Putting the mouse at regular desktop height is usually too high for most workers and can lead to shoulder tension. B: From an ergonomic standpoint, using a laptop without modifying the level of the monitor screen or the keyboard may lead to other musculoskeletal symptoms. D: Job changes are usually not part of the recommendations after an ergonomic assessment.

DK, X- An OTR® evaluates a client who has just entered the plateau phase of Guillain-Barré syndrome (GBS). When assessing ADLs, what would the OTR® most likely expect to see? A. Bowel and bladder incontinence, which affects skin integrity and toileting routine B. Unilateral sensory impairments, which affect fine motor tasks such as oral care C. Edema and weakness in the lower extremities, which makes bathing and dressing difficult D. Shoulder weakness, which results in decreased independence in upper-body bathing and dressing

The right answer is C In the plateau phase, symptoms are at their most severe: Edema and weakness are common symptoms with GBS. Because symptoms are typically symmetrical and ascend from distal to proximal, bilateral symptoms would likely affect lower-body self-care. A: Bladder incontinence can be a symptom of GBS, but the bowel is not affected. Intervention with bladder incontinence may include creating a toileting schedule and frequent skin checks to avoid breakdown. B: Symptoms are typically bilateral and begin distally; clients with GBS often exhibit mild sensory loss in the feet and hands. D: Shoulder weakness may be an observed symptom; however, the most disabling symptoms are likely to be distal rather than proximal.

Since getting new workstations, clerical workers at a law office are noticing increased neck stiffness and fatigue, and an OTR® and COTA® are preparing a 1-week educational program for them. Which strategy would be MOST likely to reduce neck stiffness and fatigue? A. Require workers to stand and march in place for 5 min every 2 hours. B. Provide neck stretching and strengthening exercises to improve flexibility, decrease stiffness, and strengthen muscles. C. Move computer monitors into alignment with keyboards so workers face the monitor straight on. D. Position workers with forearms resting on the edge of the desk while typing for support.

The right answer is C Maintaining head and neck alignment reduces the risk of strain to the neck. A: Standing during prolonged sitting tasks allows for a change in position but is not the most direct strategy to prevent neck injury. B: The evidence neither supports nor refutes the effectiveness of routine exercise programs in preventing injuries. D: Positioning arms in this way contributes to contact stress injury.

An OTR® is working with an 18-month-old child with bilateral transverse upper-arm deficiency who was recently fitted with myoelectric prosthetics. Which self-care tasks would be appropriate to work on in therapy? A. Donning and doffing prosthetics independently B. Using ties or hook-and-loop fastener to fasten shoes bimanually C. Raising upper extremities to assist with upper-body dressing D. Indicating to a caregiver when more juice is desired

The right answer is C On the basis of the child's condition and age, raising the upper extremities to assist with upper-body dressing is appropriate. A, B: These self-care tasks are appropriate for the condition, but not appropriate given the child's age. D: This self-care task is appropriate for the child's age, but not necessarily related to the child's condition

A client with stroke is demonstrating a 1-finger-width separation of the acromion and the head of the humerus. In the intervention session, what should be the FIRST step of the OTR®;? A. Fit the upper extremity with a sling to minimize its movement B. Recommend that the client not use the upper extremity C. Train the client and caregiver in safe handling of the upper extremity during transfers D. Provide passive range of motion (PROM) exercises to minimize contractures of the upper extremity

The right answer is C Providing training in safe handling techniques to properly position and move the affected upper extremity is the most important approach to addressing shoulder subluxation. A: Further assessment is needed to determine whether the client requires a sling. The client's pain level, functional level during transfers, and awareness of the affected upper extremity, as well as the presence of edema, should be assessed before providing a sling. B: Avoiding use of the upper extremity will lead to further limitations in functional use and contribute to learned nonuse of the extremity. D: PROM is important to minimize the effects of loss of soft-tissue length but does not address the client's subluxation.

A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. What is the OPTIMAL intervention to prevent formation of elbow contracture? A. A dorsal elbow flexion splint to position the elbow at 90° flexion and the forearm in supination. B. A volar elbow flexion splint to position the elbow at 90° flexion and the forearm in neutral. C. A dorsal elbow extension splint to position the elbow at extension and the forearm in neutral. D. A dorsal elbow extension splint to position the elbow at extension and forearm in supination.

The right answer is C The antideformity position for the elbow is elbow extension and forearm in neutral position. Also, because the client has a partial-thickness skin graft at the anterior aspect of the forearm and to maintain maximum surface area of the grafted area, it is better to position the forearm in a neutral position. A, B: Positioning the elbow in 90° flexion will encourage contracture that will prevent elbow extension. Only a dorsal arm splint should be used because the burn area is in the anterior aspect of the arm. D: The forearm should be positioned in neutral to maintain maximum surface area of the grafted area.

A client diagnosed with amyotrophic lateral sclerosis (ALS) 2 years ago is admitted to the hospital because of worsening mobility at home. Before the hospitalization, the client was independent with ADLs but required assistance for IADLs, including cooking, shopping, and home management. Which approach is MOST likely to be the priority for this client in the acute care setting? A. Maximize the client's participation in IADLs B. Identify appropriate positioning for the client in bed C. Guide the caregiver in assisting the client with ADLs D. Facilitate increased strength to maximize abilities

The right answer is C The caregiver should be trained in skills for assisting the client with ADLs because the client will require greater assistance for tasks as symptoms progress. A: Focusing on maintaining the client's participation in ADLs would be more appropriate than promoting independence in IADLs given the progressive nature of ALS. B: Instruction on positioning in bed is not indicated at this time given the client's ability to be mobile and participate in ADLs. D: The client's strength should be optimized to maintain abilities as long as possible, but increasing strength should not be a focus of intervention because of the progressive nature of ALS.

X- An OTR® is treating a client who had a split-thickness skin graft 2 days ago on the left posterior axillary area. What postoperative occupational therapy intervention would be the BEST choice? A. Perform gentle passive left shoulder ROM to pain tolerance twice daily. B. Perform active left shoulder ROM as tolerated, incorporated into daily activities. C. Fabricate an axilla splint with left shoulder in 120° abduction and slight external rotation. D. Occupational therapy is not indicated in the postoperative phase of care.

The right answer is C The postoperative phase of care is 5-10 days post-skin graft operation. During this phase, it is important not to disturb the grafted area so that graft adherence will occur. However, to prevent deformity from scar tightness and shrinkage, it is important to position the arm in antideformity position—that is, 120° abduction and slight external rotation. A, B: Even though ROM exercise and activity are important in postburn rehabilitation, a period of immobilization is enforced immediately after grafting to allow for graft adherence; therefore, no PROM or AROM is allowed during the postoperative phase. D: Occupational therapy is an essential intervention in order to prevent postoperative contracture.

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

The right answer is C The sit-stand stool will allow the client to rest and efficiently unload the joints during the show, and it will allow the client to be at eye level when talking to customers. It will eliminate the client's having to repeatedly stand and sit and reduce fatigue by promoting rest. A, B: These options will reduce forces on the feet but not as efficiently as sitting, and they will not address the client's fatigue issues. C: This option will reduce the client's overall exposure to the forces on the feet but will not eliminate the problem on the days that the client must attend tradeshows.

X- An OTR® is preparing a forearm splint for a client with a high complete spinal cord injury. What surface of the client's forearm should the base of the splint rest upon? (MAIN GOAL IS SENSORY FEEDBACK) A. Ulnar B. Medial C. Dorsal D. Volar

The right answer is C The splint should be dorsal, rather than volar to ENSURE MAXIMAL SENSORY FEEDBACK while the forearm is resting on a surface. A: Placing the base of the splint on the ulnar side of the client's arm reduces leverage and decreases maximal sensory ability. B: Placing the base of the splint on the medial side of the client's arm reduces leverage and decreases maximal sensory ability. D: Placing the base of the splint on the volar side of the client's arm largely blocks all sensory feedback.

An OTR® is working with a child on shoe tying. The OTR® is using backward chaining. Which statement describes this technique? A. The therapist downgrades the activity so that the child is able to complete the task with fewer activity demands. B. The therapist models the task for the child and encourages the child to imitate what he or she observes. C. The therapist performs the first several steps of the task and allows the child to complete the last step of the task. D. The therapist encourages the child to complete the first step of the task, and the therapist then completes the rest of the task.

The right answer is C This option accurately describes backward chaining. A: This option describes grading, which is a way to modify a task and is consistent with adapting a task, or part of a task, to present the next "just-right" challenge. B: This option describes modeling. D: This option describes forward chaining.

Which option can be viewed as a critical comprehensive priority for an OTR® who seeks to optimize community mobility for a client? A. Stay abreast of legislation and policy that influence independence in societal participation, community mobility and alternative transportation options. B. Attend continuing education seminars, and conferences on transportation to ensure up to date knowledge of community mobility practices. C. Include community mobility in the initial evaluation and intervention planning; and include actual or simulated practice in using community mobility options. D. Consult with the driver rehabilitation specialist, transportation providers, and volunteer driver organizations on a regular basis.

The right answer is C This option contains the top two priorities to guide OTR®s in addressing community mobility. A: Having knowledge of legislation and policy will not necessarily optimize the community mobility of a client. B: Obtaining knowledge from conferences is important for professional development but will not, unless it is put into practice, optimize community mobility for a client. D: Consultation with stakeholders is a needed strategy to understand how they operate, but application of that knowledge is necessary to optimize the community mobility of a client.

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The OTR writes the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." What conclusion can you draw about the specific conditions (or S) under which this client is supposed to complete the occupation? A. The client will complete the occupation in the hospital's kitchen with adaptive equipment. B. The client will complete the occupation at home with no adaptive equipment. C. The client will complete the occupation at a community transitional facility using modified techniques. D. The client will complete the occupation in the hospital's kitchen using no adaptive equipment or modified techniques.

The right answer is D Because no specifications are given for adaptive equipment or modified techniques and the client is attending a predischarge hospital cooking group, it is appropriate to assume that the client will not require special conditions for the completion of this goal and that the occupation will be completed in the hospital's kitchen. A, B, C: These statements assume conditions that were not specified in the goal.

An OTR®; is concerned with preventing shoulder pain in a client with hemiparesis in the acute stages of stroke recovery. Which intervention is appropriate to prevent shoulder pain in this client? A. Allow the client to dangle the hemiplegic upper extremity alongside the chair B. Position the client in side lying on the hemiplegic side with internal rotation and scapular retraction C. Use overhead pulleys with prolonged stretch at end range D. Emphasize activities that allow external rotation, shoulder flexion within 90°, and scapular protraction

The right answer is D Clients with hemiparesis should be encouraged to move the upper extremity with external rotation, shoulder flexion within 90°, and scapular protraction to allow for optimal motor recovery by promoting soft-tissue elongation. A. The upper extremity of clients with hemiparesis should be supported at all times by resting it on a surface or using the unaffected upper extremity to position the affected upper extremity. Gravity provides too much force on already weakened muscles and may further the dissociation of the humeral head from the shoulder joint. B: Positioning of the upper extremity in clients with hemiparesis should emphasize external rotation to neutral and scapular protraction. C: Overhead pulley systems should be avoided at all times because of the potential to increase pain in the upper extremity of clients with hemiparesis.

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

The right answer is D The client may need assistance with heavy household maintenance and cleaning. A, B, C: The client should not have difficulty with these IADLs given the level of spinal cord injury.

To prevent skin breakdown in a client with an incomplete spinal cord injury, which method is BEST for preventing pressure sores? A. Remove after-market cushioning from wheelchair. B. Apply moist heating pads to areas of discomfort. C. Encourage the client to remain still in bed. D. Teach the client to inspect the skin on a daily basis.

The right answer is D The client must learn to perform self-inspections regularly. A: Removing wheelchair cushioning can result in further skin breakdown. B: Moisture and heat should be avoided in sensitive areas. C: Lying still in bed increases risk of skin breakdown.

An OTR® is working with a client with a unilateral transradial amputation. The client is switching to a salesperson position from a computer operator position. The client does not wear a prosthesis and is independent in all one-handed skills. The client is concerned that the appearance of a residual limb may put the client at a disadvantage during sales calls and would like to obtain a prosthesis. What is the BEST prosthesis for the client? A. An active realistic myoelectric prosthesis B. An active realistic prosthesis C. An passive hook prosthesis D. A passive realistic cosmetic prosthesis

The right answer is D The client's goal for the prosthesis is cosmetic. The client is a high-functioning one-handed person and does not require an active prosthesis. The additional time and expense needed to develop prosthetic skills is not warranted given the client's current level of functioning. A, B, C: The client does not require an active prosthesis.

X- An OTR® is working in a CLUBHOUSE (MODEL) with a group of clients who have mental health issues. Which leadership style would be MOST effective? A. Director B. Authority figure C. Facilitator D. Advisor

The right answer is D The clubhouse model puts the locus of control on the members. When designing groups, the members formulate the goals, and the OTR® acts as an advisor. A, B: Leading a group as a director or authority figure is not congruent with the clubhouse model, in which the clients direct the program. Although at times the OTR® may need to provide the group with some direction, control of the goals and decision making remain in the hands of group participants. C: A group leader as facilitator maintains control over goals and decision making, so this leadership style would not be best for this group.

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

The right answer is D To administer an assessment, a COTA® must demonstrate to the supervising OTR® competence in administering the specific instrument. The supervising OTR® is responsible for ensuring that the COTA® is competent in each task he or she is directed to carry out. A: The OTR® initiates the evaluation and directs the COTA® to complete components of the evaluation, such as administering an assessment. B: The COTA® is permitted to administer an assessment as long as the OTR® has initiated the evaluation and the COTA® has demonstrated competence in administering the specific assessment. C: Direct, full-time, in-sight supervision is not mandated under AOTA supervisory guidelines.

DK- A client with rheumatoid arthritis (RA) presents with the right index finger in 30° of proximal interphalangeal (PIP) flexion and 20° of distal interphalangeal (DIP) hyperextension. What type of finger deformity does the client have? A. Swan neck deformity B. Mallet finger deformity C. Ulnar drift deformity D. Boutonnière deformity

The right answer is D Boutonnière deformity is defined as PIP flexion combined with DIP hyperextension. A, B, C: Swan neck deformity, mallet finger deformity, and ulnar drift deformity are other common deformities of the hands in RA; however, they do not involve PIP flexion combined with DIP hyperextension.