Practice Questions

Which of the following is the most appropriate strategy for the OT who is working with persons with psychotic disorders and associated disordered thinking? a. Confront the inappropriate behaviors to facilitate more adaptive behavioral responses. b. Communicate simply, clearly, and concretely with the client. c. Attempt to limit any external triggers d. Try to distract the client to gradually minimize the episodes of disordered thinking.

A - Incorrect. Thinking about this answer, the patient could be having a hallucination (perceived, involuntary experiences) or delusion (false, fixed beliefs). As we learned in mental health, patients with this diagnosis do not perceive reality accurately and may have trust concerns with you as a therapist in general. Criticizing their behavior as inappropriate may cause a spiral in behavior. It will also not help build rapport to meet common goals. B - Correct. Families, caregivers and individuals communicating with a psychotic patient must interact with them in a 'calm, clear, and empathetic manner'. If agitation arises with the patient, aggression to themselves or someone else could occur. For safety concerns, one should speak simply, clearly and calmly with the patient C - This is also needed when working with any client, but without more detail in the question, it is unlikely if this is an eval (first time meeting the patient) or if this is 12 weeks down the line when you know them & possible triggers. D - Not an appropriate choice and may increase the thoughts of paranoia or suspicion.

A 2 year 6 month old child is referred to OT because of eating/ feeding concerns. After interviewing the child's mother and observing a typical lunch, the OT suspects the child's issues may be sensory. What should the next step in the evaluation process be? a. Have the mother keep a food journal for a week to look at trends in oral motor sensory processing b. Discuss treatment options and the theory of sensory integration c. Eliminate all milk products from the diet d. Get a barium swallow study to rule out aspiration

A. The next step would be for the mother to keep a food journal. Journaling can often be a helpful diagnostic tool, shedding light onto patterns and trends both for the client or caregiver to see, as well as the practitioner.

Which dressing task requires the most challenging integration of performance skills and patterns for a typically developing 3-year-old child? a. finding armholes in a pullover shirt b. unfastening the zipper of a front opening jacket c. pulling down a pair of elastic waist pants d. taking off a pair of ankle-high socks

According to sequences of typical development, the most challenging integration of performance skills and patterns for a 3 year old child with no developmental delays would be (B) in this list of options.

OT is working with a child who is very gravitationally insecure. The child has finally met the challenge of walking up and down a gently inclined ramp. The OT has decided to introduce a movement activity involving suspended equipment. What is the best next activity for this child? a. Jumping into the ball pit b. Sitting on a rectangular platform glider six inches from the ground c. The hammock swing in the prone position to eliminate backward space d. Sitting on a square platform swing hung from a rotational device

Answer A: Incorrect, as the question specifically asks for a response with suspended equipment. This would also be movement into phase 5, and the client is currently in phase 1. This would be too quick of a progression. Answer B: Correct! This would be the next natural progression. A child in phase two should be introduced to the suspended equipment in a linear direction with feet close to the floor. Answer C: Incorrect. This is a good choice, as the prone position does eliminate backward space, which is good for a child with gravitational insecurity, however, this would not be the next step in the natural progression of treatment. This would be a step into phase four of GI treatment. The hammock would provide large disturbances in the base of support, which would cause fear in this child; this would also be a change in head movement to the prone position. Answer D: Incorrect. A child should not begin their suspended equipment journey of overcoming gravitational insecurity with a rotational device. This would be too much too soon.

The OT receives orders to evaluate and treat a client who is having difficulty with basic abilities as they relate to instrumental activities of daily living, specifically money management, grocery shopping, and transportation. What is the best tool for the OT who has no specialized training to administer to further assess these issues? a. KTA b. AMPS c. KELS d. SAFER

C. The Kohlman Evaluation of Living Skills (KELS) assesses a patient's independence in the most basic necessary living skills, particularly in five categories: self-care, safety/health, money management, transportation/telephone, and work/leisure. This is the correct answer because the outcome measures of the assessment are most accurate to the target outcome measures of the question. The Kitchen Task Assessment (KTA) is used to measure the level of assistance needed by a patient with Alzheimer's/dementia to successfully complete a cooking task. This answer is incorrect based on the target outcome measures in the question. The Assessment of Motor and Process Skills (AMPS) is incorrect automatically because it requires training. The AMPS assesses performance quality of specific skills necessary to carry out functional tasks to assess a patient's need for assistance in the community. For example, processing skills, memory, problem solving, etc. all of which are relevant to the target outcome measures of the patient in the question, however is not the most appropriate assessment for this patient. The Safety Assessment of Function and the Environment for Rehabilitation (SAFER) assessment was created to assess a patient's ability to carry out functional tasks safely within their home. This answer choice is incorrect because the goals of the patient in the question are for functional independence out in the community.

OT has received a referral for a new client with amyotrophic lateral sclerosis to assist the client to be as independent as possible. Which of the following is the most appropriate intervention approach for the OT to primarily use? a. biomechanical approach, with focus on improving strength and endurance b. neurorehabilitation approach, with focus on improving cognition and upper-extremity function c. compensatory approach, with focus on maintaining occupational performance d. remedial approach, with focus on improving positioning

C. "ALS is a rapidly progressing, fatal condition of unknown etiology. OT aims to maximize the client's function by providing interventions and periodic reassessment to compensate for declining motor function through modification of the environment, roles, and tasks and by helping the client and family achieve self-identified goals." (2017, 0.921). This would indicate the need for compensatory approaches.

OTR is working with a client who has been diagnosed with strabismus and reports difficulties with headaches and double vision that interfere with daily activities. Which of the following is the most appropriate treatment for the OTR to begin with? a. Magnification devices b. Adjusted lighting to reduce glare c. Eye exercises to facilitate focus d. Visual scanning activities

C. Strabismus is a result of weakness and/or lack of coordination in the muscles that aid in focusing the eye, and thus can be addressed with eye exercises to facilitate focus.

OT is working with a child who has a sensory processing disorder. The child's mother reports that the child gets sick in the car on the way home from therapy. This has happened three weeks in a row. When they arrive home the child goes right to bed and sleeps soundly until the next morning. What change should the OT make to the treatment plan? a. No change is necessary. b. Increase the amount of vestibular input. c. Decrease the amount of vestibular input. d. Increase the amount of tactile input.

C. The child demonstrates a sensitivity to vestibular input; therefore a decrease in vestibular input is in order.

OTR is working with the parents of an 18 month old child with developmental delays to facilitate feeding skills. The child was noted to have a reflexive bite. Which of the following adaptive feeding devices is most appropriate to recommend to the parents for use with the child? a. deep-bowled soup spoon b. plastic spoon c. swivel spork d. narrow shallow coated spoon

D. The narrow coated shallow spoon is safest for the child with a reflexive bite.

An OT has accepted a position at an adult day care and respite program. The clients in this facility have a variety of physical and cognitive impairments. Prior to this hire, the OT only had school system based practice experience. What is the most appropriate action for this OT to do in terms of preparing for this new population? a. Attend caregiver education programs. b. Notify the administrator after the hire of the limitations in older adult experience. c. Review the demographics and public health needs of older adults with impairments/disabilities. d. Seek training and elder care professional development prior to starting the job.

D. The most appropriate action for an OT to take in preparing for a new settings is to seek training and professional development opportunities specific to the new setting prior to starting the job.

What is the MOST important aspect of administering and scoring a standardized test? a. Judgment to determine how to best administer the test b. Previous experience as a way to gauge test results c. Adherence to specific instructions for administration and scoring d. Practice in administering the test items

In order for it to be considered a standardized assessment, it MUST be administered & scored in a consistent manner, under the same conditions & utilizing the same test directions.

The COTA documented 7 hours of care each day of the week. The supervising OTR notes the COTA only worked 6 hours on Wednesday. There is no previous history of this type of issue with the COTA. What is the most appropriate way for the supervising OTR to respond? a. Assume this was a onetime event and forget about the discrepancy. b. Sit down with the COTA, discuss the discrepancy, and correct the billing log together. c. Correct the billing log then inform the COTA about the concern. d. Deduct one hour of care on the COTA's billing log for the next day of care

Option B is the most appropriate response for a supervising OTR. It upholds the tenet of Supervision standards calling for open communication between the practitioners, and reduces the likelihood of a pattern forming.

OT is working with an adult client with a neurological condition who has difficulty swallowing. OT is using postural interventions to increase the client's swallowing efficiency during meals. Which of the following is the most appropriate approaches for the OT to take with this client? a. Elongate the trunk and extend the head/neck. b. Position the client with a chin tuck and the head tilted and turned. c. Head/neck positioned in neutral with slow stroking on the weak throat musculature. d. Place the trunk in oblique flexion with the head tilted toward the same side prior to placing food in the client's mouth.

Option B would be known as the "chin tuck or chin down posture. Which is an intervention strategy where the head is flexed during swallowing allowing the anterior structures of the pharynx posteriorly resulting in a smaller entrance to the larynx; this strategy reduces the chance of food or liquid to fall into the airway. This swallowing technique is helpful for patients with reduced closure of the airway or with bolus management. Patients with neurological deficits often present with muscular damage effecting closure of the airway which is the pharyngeal phase of swallowing. All other options are not appropriate positioning for swallowing and managing a bolus and could potentially lead to aspiration.

An OTR is a contributing investigator for a unit-wide research project. The focus of the project is to determine if participation in rehabilitation is beneficial to a client's health, well-being, and general quality of life. Which standardized assessment should the OTR use for gathering the most reliable evidence for this study? a. Short Form-36 Health Survey (SF-36) b. Kohlman Evaluation of Living Skills (KELS) c. Functional Independence Measure (FIM) d. Barthel Index of ADL (BI)

The SF-36 is the only assessment listed that falls under the criteria of the study of addressing a client's general health and well-being while the other 3 assessments focus on a client's functional status. A scoping review by Lins and Carvalho (2016) that reviewed the SF-36 and stated that is widely used to assess a client's health-related quality of life. Therefore, the SF-36 meets all the criteria for the needed assessment for the study stated in the question.

OTR is working to sit a client with a SCI upright in bed for the first time since injury. OTR monitored blood pressure while client was in supine. Upon sitting upright, the client reports feeling dizzy and nauseous. The client also reports feeling like she is going to pass out. What should the first response of the OTR be? a. Monitor client's blood pressure again in sitting b. Quickly return the client to supine position c. Tell the client that the dizziness and other symptoms will go away soon; continue to sit the client up. d. Educate the client that abdominal binders, leg wraps & TEDS stockings will reduce these symptoms and place an order for the needed supplies

The first response of the OTR should be to quickly return the client to supine position. Education, compression garments, and exercise can be incorporated into intervention outside of an acute episode of orthostatic hypotension.

OTR working in an inpatient psychiatric program is running a group. One of the participants is a client with schizophrenia who is having hallucinations during the group session. What is the best response for the OTR to take? a. Explain to the client the hallucinations are not real. b. Guide the client out of the group until the hallucination ceases. c. Use maintained touch to calm the client during the hallucination. d. Redirect the client's attention and attempt to engage the client back to the group activity.

The primary focus in option D is to re-engage the client in the purposeful OT activity. The client needs assistance redirecting away from their perceived sensory reality to re-engage with current reality and meaningful occupations. Intervening when the patient experiences these hallucinations means that the OT must focus on what is real and help shift the patient's mindset to the present reality.

OT is evaluating a 58 year old client who experienced a CVA 8 months ago. The client now reports difficulty with mobility tasks, particularly in crowded areas, reading small print, paying bills, meal preparation, and grocery shopping. The OT evaluation identifies deficits in visual memory, visual field, visual closure, visual attention, figure ground, and visual scanning. Which simple functional activity should be chosen to begin to address a deficit in visual field? A. Locating items on the refrigerator shelf B. Locating objects on a scan course while walking. C. Grocery shopping using a motorized cart. D. Batting a balloon with the therapist while standing.

The question asks for a simple functional activity to begin to address a deficit in visual field. Batting a balloon is a preparatory activity, not a functional activity. Adding mobility to a visual activity increases complexity, so both B and C don't match the requested "simple" functional activity, leaving A as the correct response

A newly hired OTA is instructed by the DOR to supervise two hospital volunteers as they learn how to assist patient in safely completing bed to w/c transfers. The OTA informs the supervising OT of the director's request. Which is the first action the OT should take in response to this request? a. Advise the OTA to comply with the request b. Advise the OTA to refuse the request c. Observe the OTA while providing supervision to assess service competence in transfer training d. Explain to the Director of Rehabilitation why the request is inappropriate.

Volunteers are not trained healthcare professionals and they cannot perform transfers with patients. Therefore, the OTA cannot comply with the director's request. Sine the OTR is responsible for the practice of the OTA, he/she must inform the DOR of the inappropriateness of the request. While having the OTA deny the request is appropriate, the reasoning behind this must be explained to the DOR to prevent future inappropriate requests.

OT is conducting an evaluation of a client who has been terminated from the last three jobs. The client reports that at each job the supervisor was unethical and these experiences are the reason the client has had limited career success. This is an example of what type of defense mechanism? a. Denial b. Narcissism c. Passive Aggression d. Regression

a. Denial

OT is working with a client who has a mental health condition to promote dynamic performance of context dependent occupations. The current focus is on the physical and social components of the client's personal environment and analyzing the influence of the client's Cuban culture. The OT is using the MOHO approach. Which of the following assessment strategies would be most appropriate to use in this scenario? a. Examine occupational roles within the client's cultural context and the client's self assessment of ability to effectively engage in valued occupations. b. Conduct a Lifestyle Performance assessment to match environmental and individual needs. c. Analyze the client's ability to adapt and transition to major roles in preparation for discharge. d. Address the function/dysfunction continuum and the client's temporal adaptation to presenting psychosocial behaviors.

a. Examine occupational roles within the client's cultural context and the client's self assessment of ability to effectively engage in valued occupations. Applying the MOHO approach will mean focusing on intrinsic motivation and the client's self-determined roles.

AUHealth has initiated a Continuous Quality Improvement (CQI) process and the Department of OT has been included. What does this process primarily allow the OTs the opportunity to do? a. Improve overall service delivery. b. Develop personal development skills. c. Enhance leadership skills. d. Promote the OT profession

a. Improve overall service delivery in healthcare organizations

OT is working with a client who has rheumatoid arthritis and resulting hand atrophy, thumb subluxation, and ulnar deviation with hyperextension. The client is taking NSAIDs, corticosteroids, and disease modifying anti-rheumatic medications. OT notes presence of soft tissue lesions, rheumatoid nodules, and tenosynovitis. Client reports morning stiffness and pain assessed as 8/10 on a pain scale. What is the most appropriate area to initially address with this client? a. Reduce the pain and swelling, improve joint function, and provide with an ulnar drift splint. b. Discharge the client as the condition has progressed to a poor rehabilitation prognosis. c. Teach the client to perform morning routines while working through the pain and then take medications to reduce pain after therapy. d. Use e-stim prior to therapy so the patient can move more without pain.

a. Reduce the pain and swelling, improve joint function, and provide with an ulnar drift splint.

A preteen with spastic cerebral palsy wants to use a computer. Prior to evaluating computer needs, what should the OT learn about FIRST? a. The student's and family's goals for the device use b. The family's ability to afford a computer and its upgrades c. Computer learning programs to facilitate student's participation in the classroom d. The student's physical and cognitive capacities to determine appropriate keyboard and screen options

a. The student's and family's goals for the device use

An OTR is treating a client who works on an assembly line and sustained a work related injury to the left index finger. The OTR provides the client with a buddy strap for the left index and middle fingers. What is the purpose of this buddy strap? a. Prevent over-stretching of the injured finger b. Allow PROM of the injured finger c. Keep the index finger from further damage on the assembly line d. Provide finger traction

b. Allow PROM of the injured finger. Buddy straps function to provide passive motion to the injured finger as the un-injured finger is used normally.

A client with chronic low back pain is scheduled to return to work in 2 weeks. The client now describes pain as more intense and lasting for longer periods of time than previously. There is no evidence of new injury. How should the OT respond? a. Request to use physical agent modalities to decrease pain during therapy. b. Discuss this change with the treatment team. c. Consult with the physician about the possible need for additional medication d. Emphasize endurance rather than strength in activitie

b. Discuss this change with the treatment team.

An OTR is interpreting scores of a developmental test that was administered to a 3-year-old child. The child scored at the 89th percentile for the child's age and gender group. What can the OTR conclude based on this score? a. The child has minor developmental deficits compared to the normative sample group b. Eleven percent of children in the sample group scored higher than this child c. This child displays above-average developmental skills compared to similar children d. These scores are sensitive for measuring small changes in the child's overall development

b. Eleven percent of children in the sample group scored higher than this child

OT is working with a client who experienced a R CVA 4 weeks ago. The client is not spontaneously using the affected upper limb during ADLs, does not display an awareness of food on the left side of the plate, and does not display awareness of environmental objects on the left. The client has Stage 2 synergy with less than 50% of functional mobility. Past medical history includes a myocardial infarction with a Medtronic pacemaker device in place. What is the most appropriate assessment to measure spasticity and functional movement for this client? a. Barthel Index b. Motor Assessment Scale c. Tinetti POMA Balance Scale d. Kohlman Evaluation of Living Skills (KELS)

b. Motor Assessment Scale. Options A & D assess functional independence, C assesses balance, and B (MAS) is the only assessment that looks at motor function, spasticity, and impairment of movement.

OT is using a cognitive behavioral intervention approach when working with a home based client who has agoraphobia and associated panic attacks. Which of the following is the most appropriate intervention strategy to use in this scenario? a. Using a reward system to guide the client out of her home. b. Progressive use of a graded desensitization program. c. Use of behavioral extinction methods by ignoring undesired behaviors and recognizing desired behaviors. d. Use of sensorimotor tasks that are best performed outdoors

b. Progressive use of a graded desensitization program.

OT is out of work due to illness when a new client was admitted into the facility. The setting has a requirement that all new referrals are seen within 24 hours of admission. Which of the following options is most appropriate to meet the need for evaluation? a. The COTA can do the initial evaluation and the OT can co-sign the documentation upon return to work. b. The client can go unseen by OT; document the reason for the delay upon the OT's return to work. c. The COTA may do standard portions of the evaluation that she/he has been determined competent to perform and document the client was seen and the completed evaluation results will follow. d. OT will need to report to work to complete this evaluation to ensure compliance with the facility's policy and procedures regarding referrals.

b. The client can go unseen by OT; document the reason for the delay upon the OT's return to work. COTAs may do standard portions of the evaluation in which the COTA has been determined to be competent. However, the OTR must initiate and lead the evaluation, which would include the selection of which standardized portions of the evaluation the OTR is to perform. With proper documentation, it is better to have an unmet time requirement than a practitioner operating outside of his/her scope.

An OTR is evaluating a client who has an ulnar nerve injury at the wrist level of the right dominant extremity. During which task would this injury be MOST evident? a. carrying a briefcase b. turning a key in a car ignition c. operating a desktop calculator d. holding coins in the palm of the hand

b. Turning a key in a car ignition. In the case of an ulnar nerve injury at the wrist level, motor impairments would be present in the hypothenar muscles and the first dorsal interosseous muscle. This would result in difficulty with lateral pinch.

An OT manager is preparing the outpatient OT staff for a visit from an accrediting agency. The accrediting agency that surveys inpatient and comprehensive outpatient rehabilitation programs is BEST represented by the following? a. AOTA b. JCAHO c. CARF d. NBCOT

c. CARF

OTR is working with a COTA who recently attended a PAMs workshop. Upon return the COTA asked for more clients that required the use of PAMs. What is the most appropriate action for the supervising OTR to take? a. Decline the request since the use of PAMS is an advanced skill. b. Collaborate with others to allow the COTA more cases that require PAMs interventions. c. Determine the COTA's competency and check licensure requirements for PAMs before making any changes. d. Ask the COTA to give an in-service on PAMs to determine knowledge.

c. Determine the COTA's competency and check licensure requirements for PAMs before making any changes.

OT is working with a client who experienced a C5 ASIA A SCI during a motor vehicle accident. The client has identified independence in grooming & hygiene as a personal goal. Which of the following is the most appropriate ADL goal? a. Independent showering with a tub/shower chair b. Independent performance in all areas c. Independent sink level hygiene with the use of adaptive equipment d. Stand by assistance for upper body and face grooming/hygiene tasks.

c. Independent sink level hygiene with the use of adaptive equipment

OT is working with a client who has sustained a TBI. The client is currently functioning at Rancho Los Amigos Level of Cognitive Scale Level VI. Which of the following is the most appropriate intervention to use with this client at this time? a. Attempt community travel using public transportation. b. Use repetition for simple ADLs such as face washing, brushing teeth and washing/shaving the face. c. Prepare a sandwich and a drink for lunch d. Encourage client to do independent banking

c. Prepare a sandwich and a drink for lunch

OT is working with a client who was diagnosed with Guillain-Barre Syndrome 3 weeks ago. The client is currently in the ICU with generalized weakness of the trunk and diaphragm, complete dependence in ADLS and requires a ventilator to breathe. What is/are the most realistic goal(s) for this client at this time? a. PROM WNL b. Use bilateral slings to avoid overstretching weak shoulder musculature c. Bed Positioning d. Client/family education for positioning, PROM, and use of a control switch to operate the call button

d. Client/family education for positioning, PROM, and use of a control switch to operate the call button

A parent refuses to allow a level II fieldwork student to lead his son's therapy session, stating he only wants "someone who's qualified". He insists the OT student must observe the OT lead the session. What action should the OT take FIRST under these circumstances? a. Attempt to persuade the parent to allow the OT student to lead the session b. Advise the parent that the OT student is finishing her FW next week c. Cancel the session for that day and document that the parent refused occupational therapy d. Comply with the parent's request and allow the OT student to observe the treatment session.

d. Comply with the parent's request and allow the OT student to observe the treatment session.

The OTR has received a referral for a client in which the physician outlined a specific course of intervention. Following the evaluation, the OTR determines a different course of intervention is indicated. What is the best course of action for the OTR to take? a. Provide the physician's prescribed treatment plan for 2-3 weeks. b. Combine the physician's recommendation with the OTR's chosen course of action. c. Proceed with the intervention the OTR believes is the best for the client. d. Contact the physician and discuss alternative intervention ideas.

d. Contact the physician and discuss alternative intervention ideas.

OT has been treating a child to address deficits with completion of activities of daily living. The focus this week is on feeding. During a feeding activity, the OT realizes the child is frequently refusing food as well as displaying a wet vocal quality when talking after eating. Which of the following is the most appropriate response for the OT to take? a. Continue feeding and instruct the child to take smaller bites and chew very carefully between each one. Only continue with solid food items. b. Continue feeding and instruct the parents to make sure the child is at 90/90/90 positioning when feeding at home. c. Discontinue feeding and initiate oral motor and sensory exercises to ensure the child is able to manage food and to address any oral defensiveness the child has. d. Discontinue feeding and refer the child for a modified swallow study to ensure safety with the pharyngeal phase

d. Discontinue feeding and refer the child for a modified swallow study to ensure safety with the pharyngeal phase. The wet vocal quality when talking after eating is an indication that there is some sort of swallowing dysfunction. Further assessment is essential at this point.

An OT is working in a day treatment center for older adults. One of the OT's clients is an older adult with episodic confusion who lives with an adult child. The client came into the center this week with significant cuts and bruises. The client reports being hit by the adult child several times. What is the best course of action for the OT to take in this instance? a. Confirm the statements with the adult child. b. Call the police and report elder abuse. c. Administer a cognitive evaluation and continue to question the client. d. Report the situation according to facility policy.

d. Report the situation according to facility policy.

OT is attempting to structure activities within a treatment session to decrease a child's arousal. Which of the following is the most appropriate activity to incorporate? a. Use of the child's favorite sing-along songs cd with dancing components. b. Use of suspended equipment with child directed movement via rotary suspension point. c. Use of ball pit activity to have child move around and find various objects. d. Use of physio-ball in prone with deep input and slow rocking

d. Use of physio-ball in prone with deep input and slow rocking