Principle Exam

True or False: If an OTA is working with an individual in cardiac rehab whose heart rate suddenly changes from regular to irregular, the OTA should report this incident directly to the physician. True False

True

When you have completed the MMS or MMT and want to document that your client has returned to a status of "Good" strength but in numeric form, how you document this to represent the strength scale and score appropriately?

4/5

List 3 adaptive equipment items that you were not familiar with before doing your Adaptive Equipment Resource File and describe the purpose they serve.

A dialogue telephone - The phone has a screen on it, and it provides a written dialogue of the conversation. The purpose is for those with auditory deficits and allows the individual to read the conversation as well. "Jon" medication holder - This holder flashes, gives an alarm, and will call when it's time to take medication. It also locks the other compartments. It's useful for individuals that may have cognitive deficits. It gives visual cues, auditory cues, and many reminders. Remembering to take medications in necessary for health maintenance. The Swedish cutting board - Many cutting boards have spikes to hold fruits and vegetables for cutting. This board allowed individuals to cut, but also to put bowls and jars in the jaws for stabilization. I liked how multi-purposful it was for anyone but especially a person with one hand use

Break down the process to assess Manual Muscle strength into 10 steps.

1. Perform a visual check. 2. Position the subject so he or she is comfortable and arrange or remove clothes to see the muscle(s) tested. 3. Examiner positions in relation to the subject. 4. Stabilize the proximal part being tested. 5. Demonstrate or describe the movement while the subject observes then performs. 6. Palpate the prime movers or tendinous insertions. 7. Observe for substitution and ROM completed. 8. Add resistance while the subject holds the contraction. 9. Test weak muscles with gravity-eliminated. 10. Grade the muscle strength.

Which of the following are examples of contextual or environmental factors? • Gender • Completing high school or college • Internet access • Lack of public transportation for a client who is unable to drive • Presence of lead or pesticides in client's home • Income below poverty level

All

How could an OTA use one of the chaining techniques during a treatment session focused on feeding/eating retraining?

An OTA could use forward training during a treatment session focused on feeding/eating retraining. The patient would do the first step. Depending on how the steps were broken down, the patient could first gather the materials needed. The OTA could assist with the rest of the steps which include making or putting together the food, transporting the plate of food to the table, getting the food on the utensil, and bringing the food to the mouth.

When performing the MMS or MMT, and the client is able to demonstrate full AROM against gravity, then you will perform the _________ test.

Break

True or False: Taking a long hot bath is very beneficial for someone with MS. True False

False

When performing the MMS or MMT, and the client is NOT able to demonstrate full AROM against gravity, then you will re-position to eliminate _________.

Gravity

Identify 3 adaptive equipment items that you might recommend for someone recovering from a burn and explain why you think this could be helpful.

I don't recall what it was called, but Ashley demonstrated a little foot tent for bed. The tent allowed for temperature control, but I think it could be helpful to avoid the sheets from rubbing against the skin. I would also recommend various pillows depending on the location of the burn in order to ensure proper positioning. If the person had a burn on their posterior lower extremity, I would recommend a leg lifter. Once again, it would allow the person functional mobility without dragging the wound across the bed which would potential cause more damage.

Identify 3 adaptive equipment items that you might recommend for someone demonstrating UE weakness and limited shoulder flexion and rotation. Explain why/when/how these items would be helpful.

I would recommend a reacher. A reacher would be helpful when the individual wants to grab something especially above their head because of their limited shoulder flexion. I would also recommend an electric can opener. Opening a can manually takes muscle strength and rotation. This would be helpful during meal preparation and would conserve some energy. Another adaptive equipment item I would recommend is a hair dryer holder. The activity demands of holding a hair dryer include holding arms against gravity for a long period of time and rotating the dryer around the head. It would be helpful combined with the long handled hair brush. Then the person wouldn't have to flex their arms as high or held them against gravity.

Identify 3 adaptive equipment items that you might recommend for someone recovering from a lower extremity amputation and explain why you think this could be helpful.

I would recommend a slide board for transfers. Using a slide board is safer when moving from surfaces. Since the person is recovering, their stability and balance is a concern. Working along with PT, I would recommend a wheelchair, walker, or cane. These items provide stability and more safe mobility. I may recommend a reacher. Typically people are used to having both legs to be a support. If a person quickly bends down to reach for something they may become off balance if they're not used to this change yet.

The lowest score achieved from a Manual Muscle test is a 0/5. What is the word associated with level 0 on this scale? What must the person demonstrate or the OTA observe in order for this score to be provided?

The word associated is 'Zero'. The OTA observes that there is no visible muscle contraction, and muscle contraction can't be felt.

In which section of the SOAP note would you document the strength score?

The objective section

What are the two types of chaining methods for teaching? How are they different?

The two types of chaining are forward and backward. With forward, the patient performs the first step and the therapist assists with the rest of the steps. Then the patient performs the first two steps while the therapist assists with the rest of the step and so on. Backward chaining is the other way around. The therapist assists with the steps while the patient does the last step. Then the patient does the last two steps and so on.

The mid-range score achieved from a Manual Muscle test is a 3/5. What is the word associated with level 3 on this scale? What must the person demonstrate or the OTA observe in order for this score to be provided?

The word associated is 'Fair'. Fair minus is given when the part moved through incomplete ROM (but greater than 50%) against gravity. Fair is given when the part moves through complete ROM against gravity. Fair plus is given when the part moves through complete ROM against gravity and slight resistance.

The highest score achieved from a Manual Muscle test is a 5/5. What is the word associated with level 5 on this scale? What must the person demonstrate or the OTA observe in order for this score to be provided?

The word associated is 'Normal'. The person must be able to move the part through complete ROM against gravity and full resistance.

An OTA is working with an individual who has cardiac dysfunction and expresses concern about resuming sexual activity. The OTA should: • Ask the occupational therapist to talk to the individual. • Refer the individual to the physician. • Provide the individual with the necessary information. • Refer the individual to a sex therapist.

• Ask the occupational therapist to talk to the individual.

An OTA is developing an intervention to teach an individual how to maneuver a wheelchair in the hospital cafeteria. Before treatment the occupational therapist should: • Evaluate muscle strength. • Assess CNS function to determine learning tasks and teaching methods. • Review different teaching methods with the OTA and provide supervision. • Evaluate range of motion.

• Assess CNS function to determine learning tasks and teaching methods.

During a cooking activity, the OTA observes that an individual cannot reach into a bag of potato chips without crushing the contents. The OTA should document problems related to: • Athetoid • Familial tremor • Ataxia • Dyssynergia

• Ataxia

An OTA is working with an individual who sustained a burn on the lower extremity. The treatment should focus on: • Co-treatments with the PT during ambulation. • Avoiding activities that require static standing and prolonged dangling of the feet. • Co-treatments with the occupational therapist to ensure close supervision. • Asking the PT to apply elastic wraps in a figure eight pattern before activities that require standing.

• Avoiding activities that require static standing and prolonged dangling of the feet.

An OTA is providing training to an individual, who has a transtibial lower extremity amputation, on proper positioning. The OTA should suggest: • Avoiding placing a pillow under the stump. • Range of motion exercises twice a week while lying in bed. • Avoiding placing a pillow beneath the knee. • Range of motion exercises twice a week in a seated position.

• Avoiding placing a pillow beneath the knee.

An OTA is planning a cooking group for individuals with stroke. The individuals who participate in this parallel group may: • Be at various stages of motor development. • Experience the exact motor deficits. • Be willing to learn new recipes and methods. • Be comfortable interacting with many people.

• Be at various stages of motor development.

An individual, who recently had a CVA, is practicing transfers to a bath bench. The OTA notices that the individual is unable to regain balance after weight shifting. The OTA should: • Be positioned to protect the individual. • Transfer the individual back to the wheelchair. • Report the incident to the occupational therapist. • Call for assistance.

• Be positioned to protect the individual.

An OTA who would like to work with individuals with burn-related injuries should: • Become familiar with local practices and regulations related to the role of the OTA. • Seek one-on-one direct supervision by an occupational therapist who has extensive experience. • Complete specialized training before applying for a position. • Provide intervention that includes only interviewing and documentation.

• Become familiar with local practices and regulations related to the role of the OTA.

An OTA is working with an individual with stroke who attempts to put on a jacket before putting on a blouse or bra. The OTA should plan intervention with a focus on: • Begin activities using simple short steps progressing to multiple steps. • Dressing techniques using the compensatory method. • Start with complex activities with three or more steps and decrease steps. • Dressing techniques using the NDT approach.

• Begin activities using simple short steps progressing to multiple steps.

Which of the following are examples of a performance skill? • Bending far enough to retrieve clothing from dryer • Muscle strength to Good (4/5) for shoulder flexion • Standing for 10 minutes • Reciting a prayer from memory • Normal muscle tone • Gag reflex

• Bending far enough to retrieve clothing from dryer • Standing for 10 minutes • Reciting a prayer from memory

An individual who has unilateral neglect would benefit from activities that incorporate: • Bilateral use of both hands. • Guiding. • Compensatory techniques. • Weight bearing.

• Bilateral use of both hands.

An OTA is working with an individual who sustained a burn injury and is teaching the individual to apply lotion, massage, and vibration. The OTA should explain that the purpose of this particular intervention is to: • Decrease skin breakdown. • Prevent hyperthermia and hypothermia. • Modify burn scars. • Control itching and prevent excoriation of wounds.

• Control itching and prevent excoriation of wounds.

During a hygiene activity, the OTA observes an individual overreaching for the toothpaste and knocking over the mouthwash. The OTA should inform the OT supervisor that the individual may have deficits related to: • Dyssynergia • Ataxia • Dysmetria • Athetoid movements

• Dysmetria

An OTA is working in an outpatient setting with an individual in phase two cardiac rehabilitation. The intervention plan should focus on: • Low-level physical activity. • Exercise that can be advanced when closely monitored. • Interventions to alleviate depression. • Education related to postsurgical procedures.

• Exercise that can be advanced when closely monitored.

An OTA is working with an individual who had an MI and is teaching relaxation and breathing control. The individual does not want to participate, stating that "this doesn't help me." The OTA should: • Explain that skills in relaxing and breathing control will decrease hospitalization and cost less. • Discontinue the treatment and ask the individual to choose another activity. • Ask the occupational therapist to treat the individual. • Document the incident and report the incident at the next team meeting.

• Explain that skills in relaxing and breathing control will decrease hospitalization and cost less.

An OTA is working with an individual who becomes alarmed when her heart rate rises while washing her hair at the sink. The OTA should: • Explain that the heart rate should rise in response to activity. • Ask the individual to sit in a chair and continue the activity. • Explain that it is uncommon and that you will report the incident to the physician. • Ask the individual to sit in a chair and call for help.

• Explain that the heart rate should rise in response to activity.

An OTA is working with a patient and is using a board with buttons and fasteners. The patient asks, "Why am I buttoning a board?" The OTA should: • Explain that this is a preliminary activity and will follow with buttoning a sweater. • Grade the activity and have the patient use smaller buttons so that she feels challenged. • Encourage the patient to participate and explain the benefits. • Explain that you need to observe the patient buttoning to report on coordination skills to the occupational therapist.

• Explain that this is a preliminary activity and will follow with buttoning a sweater.

An individual who has ALS has lost the ability to speak. The OTA should: • Fabricate equipment and a switch so that the individual can summon help. • Refer the individual to the speech pathologist. • Ask family members to answer questions for the individual. • Teach the individual sign language.

• Fabricate equipment and a switch so that the individual can summon help.

An individual who has a burn-related injury is receiving OT in an acute care setting. The OTA should focus the initial treatment on: • ADL training as tolerated. • Family training and home modification. • Desensitizing and massage. • Fabricating splints and edema management.

• Fabricating splints and edema management.

An OTA is providing training to an individual who has a myoelectric prosthesis who is learning how much force to use when gripping objects. The OTA should suggest that the individual pick up objects, such as a (an): • Ballpoint pen. • Hairbrush. • Foam hair curler. • Eating utensil.

• Foam hair curler.

An individual who has PD is taking medications to manage symptoms. An OTA should schedule treatment during periods of optimal and nonoptimal drug response to: • Provide as much therapy as possible to help the individual make gains. • Get a full overview of the individual's functioning throughout the day. • Observe them doing various activities at the time they would usually engage in them. • Accommodate the scheduled physical therapy so there is focus on mobility.

• Get a full overview of the individual's functioning throughout the day.

An OTA is working with a person who was recently admitted to a skilled nursing facility who became upset when asked to prepare a microwave meal. This is an example of: • Personal beliefs. • Habits and internalized roles. • Occupations. • Personal motivation.

• Habits and internalized roles.

An OTA is working with an individual who shares that it is important to him to wake at the same time every day, meet friends for coffee and doughnuts at 10 AM, and watch a favorite TV show at 8 PM. This is an example of: • Habituation • Purposeful Activity • Occupational performance • Volition

• Habituation

An OTA is working with an individual who has difficulty with motor learning. The OTA should plan intervention with a focus on performing motor skills: • In a variety of environments and under a variety of conditions. • That include gross movements. • That are familiar and relate to specific ADL tasks. • In a familiar, quiet environment.

• In a variety of environments and under a variety of conditions.

An OTA is working with an individual who has dyspnea and is unable to speak without gasping for air. When reporting the incident, the OTA should provide information on the: • Individual's breathing pattern. • Length of time the activity lasted. • Environment where the activity took place. • Precipitating factors.

• Individual's breathing pattern.

An individual with multiple sclerosis has difficulty placing a plug into an outlet most likely is experiencing: • Ataxia • Intention Tremor • Dysmetria • Resting Tremor

• Intention Tremor

An OTA is teaching an individual how to come to stand from the floor because the individual has set a goal to play with his grandchildren. This is an example of: • Just right challenge. • Extrinsic motivation. • Forward chaining. • Intrinsic motivation.

• Intrinsic motivation.

An OTA is working with an individual who has CVA. The occupational therapist prefers to use the Brunnstrom approach. The OTA should understand that this approach focuses on using: • Diagonal movement patterns during functional activities. • Motor patterns available at any point in the recovery process. • Bilateral movements during activities. • Weight bearing on the affected side.

• Motor patterns available at any point in the recovery process.

An OTA works in a day treatment setting with individuals with Alzheimer's disease. Activities should focus on: • New activities to evaluate learning ability. • Childish activities to enhance learning. • Music, simple games, and reminiscence. • Community outings involving family members.

• Music, simple games, and reminiscence.

Which of the following are examples of a performance pattern? • Tracing a client's hand during orthotic device fabrication • One's family or work role • Bilateral coordination • A religious ritual • Bedtime routine • Two-point gait

• One's family or work role • A religious ritual • Bedtime routine

Which of the following are examples of prepatory methods (similar to an adjunctive activity)? • Using pulleys to increase range of motion. • Squeezing therapy putty to improve grip strength. • Practicing buttoning a shirt. • Measuring ingredients to make a cake. • Passive range of motion to increase elbow flexion. • Fabricating and issuing an orthotic device

• Passive range of motion to increase elbow flexion. • Fabricating and issuing an orthotic device

A person, who enjoys hand embroidery and fractures both wrists in a fall, is more likely to experience a loss than a person who embroiders using a sewing machine. This is an example of: • Habits performed by reflex. • Interests that are enjoyable. • Performance ability to do things. • Values that are meaningful.

• Performance ability to do things.

An OTA is working with an individual with MS who has visual loss. The individual expresses an interest in using family photographs to make a collage. The OTA should recommend: • Asking a family member to describe the photographs. • Placing the photographs on a contrasting color cloth and using a magnifier. • Participating in the activity only when the disease is in remission. • Exploring another activity that will be successful.

• Placing the photographs on a contrasting color cloth and using a magnifier.

An individual with a TBI becomes frustrated and irritable during OT treatment sessions. The OTA should: • Schedule the session after physical therapy. • Engage the individual in group activities. • Return the individual to his room. • Plan short, relevant, successful activities.

• Plan short, relevant, successful activities.

An OTA is planning a group treatment session for individuals with TBI. Which of the following would meet the goal of improving social behavior? • Playing a board game • Listening to music • Playing a game on the computer • Making microwave popcorn

• Playing a board game

Using the proprioceptive neuromuscular facilitation (PNF) approach to increase speed and accuracy during a functional activity, the OTA should instruct an individual to: • Repeat the steps of an activity aloud. • Practice repeating the movement until it becomes smooth and coordinated. • Use diagonal movements. • Look at visual stimuli to coordinate movements and listen for verbal commands.

• Practice repeating the movement until it becomes smooth and coordinated.

Which of the following are purposeful activities? • Practicing writing one's name in cursive. • Preparing a meal after shopping for ingredients. • Peeling potatoes. • A 50-year-old client stacking cones to improve upper limb function. • Maintaining balance while sitting on a therapy ball. • Completing morning grooming routine.

• Practicing writing one's name in cursive. • Peeling potatoes.

An OTA is working with an individual who extends the affected arm to prevent falling after losing balance when reaching to turn on the water. This is an example of: • Protective reaction. • Automatic movement. • Weight bearing. • Motor performance.

• Protective reaction.

An individual with central nervous system (CNS) dysfunction would like to resume watercolor painting. Using the Rood theory, the OTA should: • Ask the individual to initially paint using finger paints. • Ask the individual to shift weight during the activity. • Provide intervention that initially strengthens heavy-work muscles. • Ask the individual to stand while painting.

• Provide intervention that initially strengthens heavy-work muscles.

An individual with a TBI has difficulty with new learning and carryover. The OTA should INITIALLY: • Provide interventions with low expectations and grade the activity accordingly. • Design a schedule for a period of 1 month. • Provide interventions with high expectations and change and grade the activity accordingly. • Focus only on basic ADL for the first 2 weeks.

• Provide interventions with low expectations and grade the activity accordingly.

An individual with stroke lacks insight related to deficits and poses problems related to safety. The OTA should: • Provide training in the clinical environment in a quiet, isolated area • Provide nonthreatening information and training in real-life situations. • Ask the physician to explain the problems related to stroke. • Refer the individual to home health therapy to identify problems at home.

• Provide nonthreatening information and training in real-life situations.

An individual with stroke has difficulty learning new concepts and is unable to adapt thinking patterns in response to change. The OTA should: • Change activities and environments frequently. • Ask the occupational therapist to reevaluate the individual and change goals. • Provide simple explanations for doing things a certain way. • Provide the individual with information on a local support group

• Provide simple explanations for doing things a certain way.

An OTA with 20 years of experience is asked to use neuromuscular electrical stimulation before having an individual prepare a light meal. The OTA should: • Ask the PT to administer the procedure. • Ask the occupational therapist to observe the treatment. • Provide the procedure and document the results after the intervention. • Provide the procedure only if service competency has been established.

• Provide the procedure only if service competency has been established.

An OTA is working on self-care tasks with an individual with stroke who missed buttoning several buttons when buttoning a shirt and neglects straightening the collar. The OTA should plan further intervention with a focus on: • Activities that the individual finds meaningful. • Providing immediate feedback when an error occurs. • Recognizing and correcting errors and checking quality. • Activities that use a matter-of-fact approach.

• Recognizing and correcting errors and checking quality.

An OTA is working with an individual who has adequate ROM to perform meaningful occupations but has less than normal ROM. The OTA should: • Select intervention to increase ROM to the normal range. • Teach the individual SROM to maximize ROM. • Select intervention that addresses other deficits. • Ask the occupational therapist to reevaluate the ROM weekly.

• Select intervention that addresses other deficits.

An OTA is teaching an individual how to wrap his stump using an elastic bandage. The OTA should teach the individual to apply the bandage: • Smoothly and evenly, not tightly, distal to proximal. • With a circular wrap proximal to distal. • Smoothly and evenly, not tightly, proximal to distal. • With a circular wrap distal to proximal.

• Smoothly and evenly, not tightly, distal to proximal.

Which of the following are considered occupations? • Spirituality • Social participation • Range of motion • Sleep • Rest • Play

• Social participation • Sleep • Rest • Play

An OTA is treating an individual in cardiac rehab who complains of dizziness and that his skin feels cold and clammy. The OTA should INITIALLY: • Monitor the individual for 10 minutes to see if the symptoms subside. • Stop the activity, have the individual rest, and seek medical help if the symptoms do not resolve. • Change the activity to one that is less strenuous. • Transfer the individual to the wheelchair and return him to his room.

• Stop the activity, have the individual rest, and seek medical help if the symptoms do not resolve.

An OTA is working with an individual who has low back pain and works as a taxi driver. Using the biomedical approach the OTA should: • Assess the individual to determine other jobs that may be satisfying. • Suggest proper positioning for sitting while in the work environment. • Ask the occupational therapist to evaluate the person's work tolerance skills. • Suggest that the person work part time until the pain subsides.

• Suggest proper positioning for sitting while in the work environment.

List 3 reasons why taking measurements are important to the OT Process.

• To document quantitative information and create goals • To know the starting point • To see improvement

The occupational therapist asked the OTA to develop intervention using declarative learning for an individual who has deficits with motor learning. The OTA should: • Teach ways to master gross movement. • Ask the individual how he learns best. • Use a story to assist in recalling the steps. • Use repetitive techniques to enhance learning.

• Use a story to assist in recalling the steps.

An individual with a TBI has difficulty processing auditory information. When communicating with the individual, the OTA should: • Speak loud and clear. • Use visual cues. • Speak slow. • Use prerecorded messages.

• Use visual cues.

Which of the following are client factors? • Values • Sleep • Mental functions • Roles • Blood pressure • Age

• Values • Mental functions • Blood pressure *Roles are a performance pattern *Age is context

An individual who has difficulty with light-work muscles would benefit from intervention with a focus on: • Washing the face while standing. • Cleaning a mirror while seated. • Brushing teeth while standing. • Putting on makeup while seated.

• Washing the face while standing.

An OTA is instructing an individual on lower extremity stump care. The OTA should emphasize: • Using alcohol to clean the area. • Washing the stump with warm water and dry with a towel. • That stump care should be done in the morning. • Using lotion on the area.

• Washing the stump with warm water and dry with a towel.

An individual who sustained a burn injury is interested in resuming leisure and recreational activities. The OTA should recommend that the individual: • Choose activities that incorporate range of motion. • Become active in a burn support group. • Wear external vascular supports and splints. • Focus on vocational exploration before leisure activities.

• Wear external vascular supports and splints.