practice

6 month old, 34 week gestation; calculated corrected age

Actual age - weeks premature = corrected age

3. A client has sustained a TBI 3 months ago and is functioning at Level VIII (purposeful appropriate; SBA) on the Ranchos Los Amigos Scale. The client is participating in a meal preparation task. The client is asked to prepare a vegetable soup using a 5 step printed recipe. The client is able to read the recipe steps aloud but does not act on any of them. When the OTR covers over all but the first step of the recipe, the client follows through with the step. What conclusion can the OTR make about the client based on this observation? a. Adaptive strategies compensate for attention deficits b. Anchoring techniques improve visual perception c. Deficits in executive functioning interfere with performance d. Ideational apraxia interferes with task initiation

Deficits in executive functioning interfere with performance

A 3-year-old has spastic cerebral palsy. The child's parents are learning techniques to use when dressing the child. How should the parents position the child to MOST EFFECTIVELY to inhibit muscle tone before putting on the child's shoes and socks? a. Facing upward on the parent's lap with the child's hips and knees in flexion b. Prone on the floor flexing the child's knee to 90o one at a time c. Side-lying on the bed with the child's hips and knees fully extended d. Supine on a firm surface with the child's hips and knees fully extended

Facing upward on the parent's lap with the child's hips and knees in flexion

An OTR is designing a wheelchair seating system for a student who has scoliosis secondary to spina bifida. Which feature should be considered FIRST for achieving optimal functional seating?

Position and stability of pelvis in chair

HS student is a L4-L5 paraplegic. He ambulates with crutches and has normal cognition and does not require OT services. He does however want to use public transportation to go from HS to a class at vocational center across town. what should the OT recommend? A. Request eval according to IFSP B. Refer student for eval on section 504 C. Schedule the student for initial screening as per Americans with disabilities act D. Set up a meeting with the schools special education team to establish an IEP for the student

Refer student for eval on section 504?

A student in kindergarten has cerebral palsy and recently transitioned to a new school. The student is unable to maintain an unsupported standing position and depends on a wheelchair for seating and mobility. An OTR is teaching the classroom aide how to transfer the student to and from a stander for classroom activities. After moving the student from the wheelchair into the stander, what should the OTR teach the aide to do NEXT? a. Adjust lateral trunk supports to snuggly conform to the student's torso b. Fasten the chest strap to prevent the student from slipping downward c. Position the student's feet shoulder width apart to improve weight bearing d. Secure the pelvic band to adequately stabilize the student's pelvis

Secure the pelvic band to adequately stabilize the student's pelvis

6 month old, decreased head control, supine --> sit on ball

support infant shoulders while slowly rocking ball backward and forward

A client just received iontophoresis. Within several minutes of removing the electrodes what should be done to the skin that came in contact with the electrodes? a. Wipe the area with an alcohol pad b. Vigorously massage the area c. Apply a lotion with a neutral pH d. Rub an analgesic lotion into the area

Apply a lotion with a neutral pH

When should the discharge planning process start for a pt. who has been referred to OT in an acute inpatient rehabilitation unit? A. After the intervention plan has been developed B. As soon as the information gathering process begins C. Once the pt's functional improvement plateau D. When progress toward short-term goals is evident

As soon as the information gathering process begins

A 4-year-old child with attention deficit hyperactivity disorder is using a tire swing for vestibular input to feel more organized. After a few minutes, the child appears to have some autonomic reactions to the fast swinging. Which course of action for the OTR® is BEST?

Ask the child to slow down the swinging by pulling a trapeze bar for proprioceptive input

A patient has cerebellar ataxia and will be discharged in 2 days from an inpatient rehabilitation facility to live at home with family. The patient is afraid of falling, especially during BADLs activities in the bathroom. What action is the MOST IMPORTANT for the OTR to take to reduce the patients fear and promote a safe transition to home? a. Assess the home layout to advise the family about modifying potential hazards b. Incorporate dynamic balance exercises into each intervention session c. Provide the family members with handouts about home safety and fall risks d. Recommend the patient and family attend a post-discharge fall prevention class

Assess the home layout to advise the family about modifying potential hazards

An OTR is developing an exercise program for a client who has a moderate hemiplegia. Observation results indicate the client lacks active upward rotation of the scapula and external rotation of the humerus of the involved upper extremity. Which type of exercise is CONTRAINDICATED to include in the client's home program? a. Bearing weight on the affected forearm placed on a table then turning the trunk away from the supported position b. Clasping both hands to reach upward beyond 90° of shoulder flexion c. Cradling both arms at chest level to abduct and adduct the shoulders d. Using a hand-over-hand movement to slide a dust cloth across the tabletop

Bearing weight on the affected forearm placed on a table then turning the trunk away from the supported position

Seriously emotionally disturbed

Behavior modification

A young adult recovering from cardiomyopathy is being evaluated in outpatient cardiac rehabilitation. The client achieved independence with BADL during inpatient cardiac rehabilitation. Since discharge, the client relies on family and friends for assistance with ADL. During the evaluation, the client walked slowly on a treadmill at 2.0 miles per hour for 20 minutes with normal cardiovascular response. What interpretation can the OTR make based on the client's performance during this portion of the evaluation? A. Client is appropriately relying on assistance to help conserve energy during the day. B. Client is demonstrating malingering behaviors with caregivers at home. C. Client is following appropriate guidelines for ADL during this phase of recovery. D. Client may not have a clear understanding of current physical abilities for ADL.

Client may not have a clear understanding of current physical abilities for ADL.

An OTR has completed a developmental assessment of a 6-year-old child who has Down syndrome. Results indicate the child is dependent in all self-care tasks. The parents do not place a high priority on dressing independence, but the OTR does. What action should the OTR take as part of the intervention planning process? a. Ask for the parents' consent to begin working on specific self-care skills with the child b. Collaborate with the parents to identify mutually acceptable treatment goals for the child c. Inform the parents that school-age children are expected to be independent with self-care d. Talk with the parents about establishing independence in self-care skills as a primary goal

Collaborate with the parents to identify mutually acceptable treatment goals for the child

Hearing impairment, normal walk, run, posture, decreased balance on spring

Conflicting sensory input inhibit appropriate vestibular reactions

A client with COPD is doing ADL rehab as part of outpatient pulmonary rehab program. client reports right shoulder discomfort for last several days which is constant during day and worse at night. Over the counter pain meds don't help. Pulse oximetry is 89%. What should OT do? A. Administer physical agent modality to relieve shoulder pain B. Advise client to increase frequency of pursed lips breathing C. Complete sensory and motor assessment to determine shoulder pain D. Contact referring physician to report client symptoms

Contact referring physician to report client symptoms

A client has dysphagia and is beginning an oral motor feeding program. The OTR observes the client has reduced lingual control when swallowing. Which food is SAFEST to include as part of the client's diet? A. Chopped meat with gravy B. Cooked pasta with melted cheese C. Dry oat cereal with milk D. Toasted bread with butter

Cooked pasta with melted cheese http://gicare.com/diets/dysphagia-diet/

A patient who has depression has been taking an antidepressant for 3 weeks. The patient has been participating in a daily OT group. During the most recent group activity, the patient reports having more energy despite still feeling depressed. Based on this report, what precautions should the OTR take? a. Ensure the activity environment provides structure and allows for continuous observation b. Avoid gross motor activities that may exacerbate medication side effects c. Use sedentary tx to avoid the potential for disruptive hyper manic outbursts d. Minimize the use of FM activities to avoid frustration d/t cogwheel rigidity

Ensure the activity environment provides structure and allows for continuous observation

A young adult with a ulnar nerve injury of the dominant extremity has a zero muscle strength of the hand muscles innervated by the ulnar nerve. Which characteristic compensatory posturing of the hand would be most evident when the client attempts a powerful lateral pinch? A. Clawing of the index and middle fingers B. Flexion of the IP joint of the thumb C. Flexion of the thumb mcp joint D. Hyperextension of the thumb IP joint

Flexion of the IP joint of the thumb

An OTR is working on pre-feeding activities with an inpatient who had a recent TBI and is functioning at Level III (localized response) on the Ranchos Los Amigos Scale. What technique would be MOST EFFECTIVE when providing graded stimulation of the patient's cranial nerves? a. Gently rub the patient's tongue using a cotton swab saturated with salty and sweet flavorings b. Hold strong smelling cooking extracts such as artificial vanilla, close to the patients nose for 2-5 seconds c. Place a small piece of the patient's favorite sweet food on the patients tongue d. Use soft candy items as rewards for positive responses to voice commands

Gently rub the patient's tongue using a cotton swab saturated with salty and sweet flavorings

An outpatient client has a seizure disorder secondary to having a TBI 2 months ago. The client is independent with BADL but has some difficulties with problem solving, planning and judgement. The client will be home alone during the day as the spouse has accepted a new job. What info is MOST IMPORTANT to gather when determining the client's safety for being alone when the spouse is at work? A. Ability to prepare nutritious daily meals B. Functional mobility throughout the home C. Info on daily medication routine D. Level of independence using assistive devices

Info on daily medication routine

An OTR works as part of a multidisciplinary team in support of a spina bifida clinic at a university-based orthopedic children's hospital. A 2-year-old child, who lives in a rural community 90 miles (144 km) from the clinic, has a routine appointment with the clinic team every 2 months. During one of the clinic appointments, the OTR completes a developmental screening. Results indicate 2-3 month delay in upper body motor development. What action should the OTR take based on the screening outcomes? a. Advise the child's parents to schedule an appointment with a developmental pediatrician b. Initiate a referral to an early intervention program in the family's community c. Provide a list of interactive websites the parents can use with the child to promote development d. Schedule the child for a comprehensive developmental assessment during the next clinic visit

Initiate a referral to an early intervention program in the family's community

An OTR fabricated a forearm-based thermoplastic thumb spica splint for an outpatient one week ago. On a follow-up visit, the OTR removes the splint and notes small, red, elevated, inflamed papules on the client's forearm. What INITIAL action should the OTR take in response to these findings? A. Change the splint to a prefabricated splint B. Discontinue the use of the splint and contact client's referring physician (a lot of people picked this answer) C. Line the splint with a 1/16 inch (1.5 mm) absorbent padding D. Modify the splint wear times and educate the client about proper hygiene

Line the splint with a 1/16 inch (1.5 mm) absorbent padding ???

10 year old has poor directionality skills secondary to a learning disability. This results in difficulty reading. Which activity would most effectively address this aspect of spatial vision? A. Follow verbal instructions to crawl through a maze while blindfolded B. Locating pictures of specific objects in a hidden pictures coloring book C. Participating in a timed virtual reality memory game on the computer D. Playing computer based games that require scanning objects at various speeds

Locating pictures of specific objects in a hidden pictures coloring book or Playing computer based games that require scanning objects at various speeds

A patient has schizophrenia and is undergoing inpatient treatment. One of the goals is to assess the patient's ability to live independently. During a meal preparation group activity, the patient has difficulty following written instructions for a recipe and indicates that the noise level of the group is too high to complete the assigned tasks. What action should the OTR take based on the patient's responses? a. Ask the group to work more quietly during the remainder of the activity b. Document the patient's inability to concentrate long enough to cook safely c. Evaluate the patient's meal preparation skills individually at another time d. Move the patient apart from the rest of the group to complete assigned tasks

Move the patient apart from the rest of the group to complete assigned tasks??

An OTR is evaluating an adult client who is diagnosed with focal hand dystonia of the non-dominant hand. Symptoms interfere with the client's employment as a professional cellist. What information would be MOST IMPORTANT for the OTR to gather prior to establishing an intervention plan? a. Amount of assistance the client needs during BADLs b. Grip and pinch strength measurements of both hands c. Movement patterns the client uses during work d. Sensory mapping using monofilament instruments

Movement patterns the client uses during work

Client in a work hardening program 8wks with shoulder pain and weakness.What info is most important for the OTR to gather from the client prior to establishing the intervention plan? A. Client's perception of current strengths and abilities B. Complete medical and psychological history. C. Impact of injury on current BADL routines D. Objectives analysis of the client's job demands

Objectives analysis of the client's job demands

An OTR is evaluating a client who is in Stage II of amyotrophic lateral sclerosis. During a mealtime assessment in the client's home, the OTR observes that the client has mild bulbar involvement impacting the ability to swallow and finish eating a meal. What should the OTR advise the caregivers to include as part of the client's mealtime routine? a. Arrange for meals to take place in a relaxed and unhurried atmosphere b. Position the client during meals in a chair that semi-reclines 30-40 degrees c. Prepare the client foods that have a thin liquid consistency d. Provide the client with a nosey cup for drinking liquids

Position the client during meals in a chair that semi-reclines 30-40 degrees

An older adult client has been diagnosed with early stage dementia. The client lives alone in an apartment. One of the client's goals is to remain in the current apartment as long as possible. During an aging-in-place assessment, the OTR determines that the client has difficulty remembering the sequence of steps for securing the locks on a door. Which option would be MOST EFFECTIVE for promoting aging-in-place? a. Engage the client in repetitive drills using blocked practice to facilitate carry-over of learning. b. Identify a programmable environmental control device that can be used in the client's home c. Post visual reminders on each door of the home to indicate the need to lock the door d. Provide a checklist the client can use to check in-home security at the end of each day

Post visual reminders on each door of the home to indicate the need to lock the door

A 2-year-old child has mild oral delay and is participating in an early intervention feeding program. Which option has the MOST impact on the child's tongue control during meals? A. Food consistency B. Jaw movement C. Lip closure D. Postural alignment

Postural alignment

6. An 18 month-old child is hypotonic and cannot fully extend the neck and trunk against gravity. Which position would be MOST EFFECTIVE to place the child in to facilitate antigravity movement and promote hand usage? a. Fully upright in a standing frame b. Prone on a 45 degree wedge positioned on the floor c. Seated upright on a large therapy ball d. Straddle-sit position on a bolster

Prone on a 45 degree wedge positioned on the floor

An OTR working in a skilled nursing facility is beginning an initial patient interview. After providing the patient with a brief introduction to OT service the patient refused to participate in an evaluation, stating "This is childish, I'm here to get stronger. There is an entire staff that can help me get dressed." What action should the OTR take based on the response? a. Provide further discussion about how OT will help improve daily living skills b. Assure the patient that strengthening exercises will be included in the intervention c. Respect the patient's wishes and document the refusal in the medical record d. Advise the patient that an assessment is mandated by the insurance company

Provide further discussion about how OT will help improve daily living skills or assure the patient that strengthening exercises will be included in the intervention

A patient in a rehabilitation facility has a complete C8-T1 spinal cord injury. The patient is learning techniques to maximize independence with dressing. Which technique should the OTR teach the patient to use to support progress toward this goal? a. Put on undergarments and trousers in bed, then transfer to a wheelchair to complete upper body dressing b. Use a universal cuff with a button-hook and zipper-pull to fasten front-opening clothing c. Wear a wrist-driven flexor hinge splint for pulling on and fastening clothing d. While supine in bed, put on socks and shoes; then put on underpants and trousers by rolling side to side in bed

Put on undergarments and trousers in bed, then transfer to a wheelchair to complete upper body dressing

A child diagnosed with DD has been participating in OT in a preschool setting. The child has achieved all STG and LTG and will be discharged from OT. The OTR is concerned about future functional delays. What should the OTR do? a. Recommend a routine assessment schedule for child b. Provide the parents a checklist to track the child's development c. Refer the child to non-school-based agency for routine re-eval d. Request monthly updates from the teacher on the child's progress

Recommend a routine assessment schedule for child

An OTR working in an outpatient setting is completing an initial interview with an older adult who has been recently diagnosed with progressive neurological disease. What message should the OTR use during the course of interview to communicate effective learning and client-centered understanding? a. Discuss intervention based on the diagnosis b. Offer suggestions as client discloses concerns and problems c. Provide examples of how other clients have overcome similar adversity d. Respond by paraphrasing statement the client makes

Respond by paraphrasing statement the client makes

A patient with Parkinson's disease is participating in OT to increase independence with self-feeding. During a session, the OTR notes that the bolus of food becomes pocketed between the patient's teeth and cheek. What does this indicate? a. Necessity to take a drink of water b. Preparation of the oral stage of swallowing c. Risk factor for potential aspiration d. Too large of a piece of food placed in the mouth

Risk factor for potential aspiration

An adolescent had a CVA one week ago and has just transferred to an inpatient rehabilitation facility. The OTR is planning an intervention schedule for the adolescent. Insurance guidelines specify a minimum of 3 hours of therapy per day for reimbursement. Typically, patients in the facility who are referred to OT are scheduled for at least one diagnosis-specific group session per day. Currently, the average age of the patients on the unit who have neurological impairments is 68-years-old. What is the BEST OT option for this newly admitted adolescent? a. Assign the adolescent to a gross motor and self-care group with the other patients who have had a CVA b. Contact the insurance company to explain the situation and ask for an exception to policy c. Provide the patient with individual sessions for 2 hours and then have an OT aide provide therapy for the remaining hour d. Schedule the adolescent for one-on-one sessions to meet the specified time requirements

Schedule the adolescent for one-on-one sessions to meet the specified time requirements

A 7-year-old has severe flexion posturing of bilateral upper extremity secondary to anoxic encephalopathy. The parents have difficulty moving the child's arms for bathing and dressing. They also indicate when the child is sleeping, the muscles become more relaxed and they perform passive range of motion to open the fingers and move the elbows out of the flexed position. When the OTR moves the client's arm, the child winces in pain. Which spasticity management technique for the elbows would be the MOST BENEFICIAL to include as an adjunct to therapy to address the parents' concern? a. Continuous passive range of motion during hours of sleep b. Inhibitory casting in sub-maximal range of extension c. Pressure splints inflated to approximately 30-40 mm Hg d. Serial casting to maximal range of extension

Serial casting to maximal range of extension

15-18 months

Spoon

A 10-year-old child has memory deficits and mild right hemiplegia secondary to an acquired brain injury 2 months ago. The child requires moderate assistance with self-dressing. Which intervention MOST EFFECTIVELY supports the child's independence with self-dressing? a. Establish a consistent routine and location for the child to dress b. Have the child assemble dressing picture cards in sequence prior to dressing c. Provide the child with loose-fitting clothing with few fasteners d. Teach the child to refer to a printed list of sequenced dressing instructions

Teach the child to refer to a printed list of sequenced dressing instructions

A child with myelomeningocele meets the short-term goals of achieving functional gross grasp and lateral pinch. After several additional weeks of OT, the child does not meet the goals of demonstrating pincer grasp and three jaw chuck. The therapist should modify the treatment plan to:

Teach the child to use gross grasp and lateral pinch in functional activities

An OTR is preparing to complete a vocational readiness assessment with an adult client with chronic schizophrenia. The client wants to work with a landscaping company. What performance skills should the OTR initially evaluate about the client's current work behaviors? a. Lifting capacity and endurance b. Memory and physical stamina c. Strength and adaptability d. Time management and social skills

Time management and social skills

An OTR and an entry-level COTA are employed in an outpatient setting. Several clients on the OTR caseload are due for their 90-day plan of care recertification update as required by Medicare. The OTR learns that these clients have been scheduled for reevaluations appointments on a day when the OTR must be on personal leave time and will be away from the facility. How should the OTR respond to this finding? a. Ask the administrator to provide line-of site supervision while the COTA completes the scheduled evaluations b. Continue with the current plan and schedule a comprehensive assessment for a date soon after the scheduled leave time c. Discuss the client's current progress with the COTA and select appropriate evaluations for the COTA to complete d. Use progress notes from the clients previous session to update the plan of care prior to taking the scheduled leave

Use progress notes from the clients previous session to update the plan of care prior to taking the scheduled leave

A 6-year-old child who has Down's syndrome has been participating in OT to promote visual-motor integration. Standardized tests of visual attention indicate the child scored -1.0 standard deviations from the norm. Based on the hierarchy of visual-skills development, which client factors should be addressed NEXT? a. Visual imagery b. Visual discrimination c. Visual cognition d. Visual memory

Visual memory or discrimination.. take your pick

Myasthenia gravis 3-/5, fair minus feeding, has cuff, guard, straw

motor assessment scale