AOTA Hands Questions

An OTR® is providing intervention to a medically stable client who sustained upper-extremity partial-thickness burns of the dominant arm, 5% of the total body surface area, 2 days ago. Which intervention BEST represents a typical ADL intervention? A. Instruct the client in the use of a long-handled spoon and fork and a built-up-handled knife for self-feeding. B. Instruct the caregiver to assist the client in self-feeding and grooming tasks to prevent pain with movement. C. Instruct the client in donning and doffing a pressure garment sleeve after applying lotion to the arm. D. Encourage the client to independently self-feed without the use of adaptive equipment.

A A 5% total body surface area burn in one of the upper extremities means that the client has approximately 50% surface area burns to the dominant upper extremity. Edema and bulky dressings in the early stage may interfere with the motion needed for ADLs, and short-term use of adaptive equipment would be indicated. Adaptation to environment and activity can facilitate the client's achieving goals for independence in ADLs. Scar management techniques such as applying lotion and using a pressure garment will not be needed until a later phase of rehabilitation.

A client with a transfemoral amputation who is being fitted for a prosthesis is reporting severe pain when placing weight on the end of the residual limb. The OTR® examines the limb but does not see any reddened or open areas. What is this pain MOST likely the result of? A. A neuroma B. Phantom sensation C. Phantom limb D. A sebaceous cyst

A A neuroma is a ball of nerve tissue that occurs when axons attempt to grow back in the distal limb. They can be painful when pressed but are not necessarily visible.

An OTR® has just fabricated a dynamic splint for an inpatient who had an MCP joint arthroplasty 4 days ago. The patient is being discharged to home and will have home-health follow-up in several days. What information is MOST IMPORTANT for the OTR® include in the patient's discharge instructions? A. Call the inpatient OTR® with questions about the splint position or fit. B. Contact the home health OT with any questions about the splint. C. Remove the splint for short intervals and elevate the hand if swelling occurs. D. Contact the home health or inpatient OT if there is an increase in redness around the incision.

A Any patient provided with a splint should be given thorough written instructions, which include the contact name and number of the practitioner who fabricated the splint. Explanations of Incorrect Answers B, D. The practitioner who fabricated the splint should be the follow-up contact person because that practitioner will be the one who is familiar with the patient's status and the design and purpose of the splint that was fabricated. C: Splint wear schedules should be communicated clearly in both oral and written format, although with a joint arthroplasty, the patient will require continuous splint wear.

A 5-year-old client has been referred for fabrication of an orthosis after a flexor tendon repair. Which protocol would be MOST appropriate for this client? A. Early active motion B. Duran protocol C. Kleinert protocol D. Immobilization orthosis for 3-4 weeks

D Children who cannot understand or follow a prescribed protocol for motion are best treated initially with an immobilization orthosis to strengthen the repair before movement to reduce the chance of rupture. Explanations of Incorrect Answers A, B, C: These protocols are more appropriate for adults, who are able to follow directions and adhere to instructions.

A construction worker was referred to occupational therapy as part of a work hardening program. During the interview, the OTR® discovers that the client is required to lift construction equipment weighing 20 lb on a frequent basis. At what level of work must the OTR® create work simulation tasks? A. Medium B. Heavy C. Very heavy D. Light

Medium work requires exerting 20-50 lb of force occasionally, 10-25 lb of force frequently, or more than negligible weight to as much as 10 lb of force constantly to move objects.

An OTR is evaluating a client with a brachial plexus injury. When checking upper-extremity movement patterns, what is the GREATEST degree of abduction the OTR should allow on the affected side? A. 25° B. 45° C. 10° D. 90°

The right answer is D Any motion beyond 90° abduction may induce added stress to the brachial plexus and its roots. Explanations of Incorrect Answers B, C, D: Range of motion in shoulder abduction below 90° should not place additional stress on the brachial plexus injury.

An OTR® is treating a client with a boutonniere deformity using conservative splinting. Which statement can the OTR use to educate the client about the proper use of the circumferential proximal interphalangeal (PIP) joint orthosis? A. Wear the orthosis only at night to maintain the PIP joint in extension when at rest. B. Remove the orthosis every hour for passive motion exercises. C. Wear the orthosis continuously up to 6 weeks. D. Wear the orthosis during the day, but remove it at night.

Wear the orthosis continuously up to 6 weeks. Continuous use of the PIP joint extension splint allows the central slip to reestablish tissue continuity and prevents further flexion deformity. Explanations of Incorrect Answers A, D: PIP joint extension must be maintained full time, not only in the daytime or nighttime, to allow central slip reestablishment. B: Passive motion of the PIP joint is contraindicated during the splinting phase of conservative treatment.

An OTR® is working with a client who fractured the distal radius 6 weeks ago. Within what time frame can controlled AROM be initiated if the fracture is healing secondarily? A. 0-3 weeks postinjury B. 3-6 weeks postinjury C. 6-9 weeks postinjury D. 9-12 weeks postinjury

3-6 weeks postinjury Initiation of controlled AROM can begin between 3 and 6 weeks postinjury if the fixation of the fracture is adequate. Explanations of Incorrect Answers A: The fracture may not tolerate AROM this early, and edema and pain will result if AROM is initiated. C, D: These time ranges may be too late to prevent scar adhesions from forming at the fracture site.

Which of the following exercise programs is MOST appropriate for a client with rheumatoid arthritis (RA) during an acute flare-up that involves significant pain and swelling? A. Daily PROM of the joints through full comfortable ROM B. Daily AROM of the joints through full comfortable ROM C. Isotonic progressive resistive exercises of the joints as tolerated 3 times a week D. No exercise program

A Exercise to maintain ROM and strength is important for clients with RA. Although as a general principle AROM is preferred, during a flare-up PROM is indicated if pain makes it difficult for the client to do AROM.

An OTR is providing education to a client who has undergone surgical nerve repair to the median nerve. The client has a medical background, so when the OTR explains nerve regeneration, which sensation should the OTR indicate is likely to return FIRST? A. One-point moving B. One-point discrimination C. Two-point moving D. Two-point discrimination

A In the realm of nerve healing and testing, the order in which recovery occurs is one-point moving, one-point discrimination, two-point moving, and finally two-point discrimination. Explanations of Incorrect Answers B, C, D: In nerve healing and testing, the order in which recovery can be seen is one-point moving, one-point discrimination, two-point moving, and finally two-point discrimination.

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

A Teaching self-cueing is useful in helping clients initiate movement to minimize the effects of bradykinesia.

What is the purpose of the Disciplinary Council as described in the Enforcement Procedures for the Occupational Therapy Code of Ethics and Ethics Standards? A. To give the Respondent an opportunity to present evidence and provide witnesses to answer and refute a charge B. To ensure that no additional ethical issues beyond those described by the Complainant are raised C. To discuss and examine the claim of ethical violation in the absence of the chairperson of the AOTA Ethics Commission D. To gather members of multiple disciplines affiliated with occupational therapy to judge the validity of the claim

A The Disciplinary Council provides a forum for the person against whom the ethical violation charge has been made to respond to the charge. Witnesses and evidence can be presented.

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

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.

For clients who have arthritis, which aspect of an occupational therapy intervention plan is the MOST crucial? A. Self-efficacy B. Splinting C. Compliance with the independent home exercise program D. Instruction in compensatory strategies for ADL management

A Self-efficacy facilitates independent follow-through in the home context. The resulting confidence may ultimately lead to the desired behavior. Explanations of Incorrect Answers B, C, D: Splinting, home exercise compliance, and ADL strategies all are important components of an intervention plan for clients with arthritis. Fostering self-efficacy, however, promotes the client's compliance with all aspects of the plan.

An OTR is working with a client who has decreased nerve function. The client has lost precision pinch, thenar opposition, and the ability to bend the index and long fingers at the proximal and distal interphalangeal joints. What deformity is the client MOST likely to have? A. Ulnar claw B. Boutonniere deformity C. Swan neck deformity D. Ape hand deformity

Ape hand deformity Ape hand deformity is the result of a high median nerve injury at the elbow or proximal forearm. Explanations of Incorrect Answers A: Ulnar claw is a result of an ulnar nerve injury and hyperextension of the metacarpophalangeal joint in the small and ring finger with proximal interphalangeal flexion. B, C: Boutonniere and swan neck are finger deformities and structural ligament injuries.

An OTR® is assessing a new client who has a distal radius fracture. Functional outcome reporting is required by the facility. Which approach to functional outcome measurement is MOST consistent with client-centered care? A. Quantitative range of motion measurements, to ensure that quantitative measures are used to facilitate functional return B. A range of quantitative and qualitative measures, to assess clinical outcomes C. Standardized assessment tools, to ensure payment by third-party payers D. Qualitative assessments such as the Disabilities of the Arm, Shoulder and Hand (DASH), as a disease-specific measure for the upper extremity

A range of quantitative and qualitative measures, to assess clinical outcomes The right answer is B Research on qualitative and quantitative measures suggests that practitioners should assess clinical outcomes from both a qualitative and a quantitative perspective and that subjective information plays a crucial role in maximizing therapeutic outcomes. Explanations of Incorrect Answers A: Quantitative measures such as goniometry have demonstrated poor reliability and decreased responsiveness compared with client self-report measures of function. C: Research has shown a less than optimal relationship between client self-report of quality of life and health care provider ratings from quantitative measures. Third-party payers are increasingly relying on self-reporting from patients in determining coverage. D: The DASH is a region-specific (not disease-specific) measure. Its focus is too narrow to characterize dysfunction; additional assessments are needed.

An OTR is evaluating a client for an injury to the right middle finger. On assessment, the OTR notices that the client is unable to extend the distal interphalangeal (DIP) joint but can move it into extension passively (mallet finger). What treatment plan would the OTR recommend for this injury? A. Electrical stimulation and ultrasound to facilitate extensor tendon gliding B. A hand strengthening program C. Resting of the joint D. A static orthosis holding the DIP joint in slight hyperextension

A static orthosis holding the DIP joint in slight hyperextension An orthosis holding the DIP joint in slight hyperextension places the tendon on slack for optimum healing of the extensor tendon injury. Explanations of Incorrect Answers A: Electrical stimulation and ultrasound are not used on tendon injuries until 6-8 weeks postinjury. B: Gripping activities can damage the tendon further initially. C: The joint does need to rest, but the slight hyperextension position is essential to place the tendon on slack for healing.

An OTR® is working with a client with C5 spinal cord injury. What is the BEST splinting strategy to use to encourage sensory feedback? A. Use of padded splints B. Use of dorsal splints C. Use of hand-based splints D. Use of dynamic splints

B A dorsally based splint will allow for maximal sensory feedback while worn.

An OTR® is fabricating an orthotic for a client with radial nerve palsy. Which orthotic design is appropriate to improve function? A. Forearm-based radial thumb spica that supports the lateral aspect of the wrist and hand B. Forearm-based wrist orthotic that maintains the wrist in 30° of extension C. Anticlaw orthosis D. Hand-based short thumb spica

B A forearm-based wrist orthosis that maintains the wrist in 30° of extension usually allows the client to extend the fingers for object release using the intrinsic hand muscles. It is also less conspicuous and less costly than a dynamic orthosis. Explanations of Incorrect Answers A: A radial thumb spica does not offer full wrist support to prevent overstretch of the forearm extensors. C: An anticlaw orthosis is not appropriate for radial nerve palsy. This orthosis would be used in ulnar nerve palsy to prevent MCP hyperextension. D: Hand-based thumb spica splinting does not support the wrist in a functional position that facilitates extension through the lumbricals.

An OTR® is working with a client with severe kyphosis secondary to osteoporosis. What is the primary cause of kyphosis in osteoporosis? A. Pathological deterioration of the vertebrae of the cervical spine B. Pathological deterioration of the vertebrae of the thoracic spine C. Pathological deterioration of the vertebrae of the lumbar spine D. Pathological deterioration of the neck of the femur

B A kyphosis is an abnormal rounding of the upper back. In the case of osteoporosis, it is caused by compression fractures of the vertebrae weakened by the osteoporotic condition.

An OTR® is treating a client with a cumulative trauma disorder resulting from work in an automotive assembly plant. Acute symptoms have subsided, and the client is preparing to return to work. Which strategies should the OTR® train the client in to prevent symptoms from recurring? A. Deep breathing and relaxation exercises B. Activity modification and proper body mechanics C. Joint protection and pacing techniques D. Energy conservation and work simplification techniques

B Activity modification and proper body mechanics are essential for long-term control of an inflammatory cumulative trauma disorder. Explanations of Incorrect Answers A: Deep breathing and relaxation exercises assist in reducing anxiety but will not prevent cumulative trauma disorder symptoms. C: Joint protection and pacing techniques best address symptoms of arthritis. D: Energy conservation and work simplification techniques are recommended for clients with respiratory and cardiac diagnoses.

A 10-year-old child sustained a Zone 2 flexor digitorum profundus tendon laceration and underwent primary repair. Which flexor tendon repair protocol represents best practice standards? A. Active mobilization approach B. Immobilization approach C. Passive mobilization approach D. Controlled early active mobilization approach

B Children younger than age 12 are usually placed on an immobilization protocol because of their low maturity level and low ability to comply with the exercises and precautions of other protocols. Explanations of Incorrect Answers A, C, D: Immediate or early mobilization protocols involve glide of the tendon in the early phases of postoperative healing. Children under age 12 may not have the maturity level or ability to understand precautions and adhere to exercise guidelines.

An OTR® is training a client with a new transradial amputation to wrap the residual limb with an elastic bandage. What is the PRIMARY reason for wrapping the residual limb? A. To desensitize the residual limb B. To develop a tapered distal end C. To reduce phantom sensations D. To protect the limb during healing

B Elastic bandages and elastic shrinkers are used to optimally shape the residual limb for prosthetic use. Although an elastic bandage may assist with these problems, it is used primarily for shaping.

What advantage does using a functional motion assessment provide an OTR® when evaluating a client? A. The OTR can learn specific information about range of motion (ROM) in multiple joints. B. The OTR can assess range of motion (ROM), strength, and motor control in a natural environment. C. The OTR can assess range of motion (ROM), motor control, and caregiver needs. D. The OTR can use pencil-and-paper tasks to assess sensory function.

B In a functional motion assessment, an OTR observes a client during functional tasks to assess ROM, strength, and motor control in a natural environment. The OTR can also observe cognitive function, awareness, and sensory deficits.

An OTR® is working with a client who recently underwent a radical mastectomy, chemotherapy, and radiation for breast cancer. What specialized skill must the OTR® have to effectively manage this client's occupational therapy treatment? A. AROM techniques to the shoulder B. Manual lymphatic drainage techniques C. Activity analysis D. Energy conservation techniques

B Lymphedema is a primary symptom that interferes with occupational performance after radical mastectomy. Effective treatment of lymphedema requires specialized knowledge of lymphatic drainage techniques.

A client's wrist and thumb joints are limited in range of motion, and the client complains of some mild discomfort that affects the client's caregiving duties at home. The OTR® wants to facilitate movement, increase circulation, and decrease pain. What would be the MOST appropriate use of thermal modalities? A. Use deep heat while stretching the client's stiff joints. B. Use superficial heat before or during a passive stretch. C. Use superficial heat or deep heat without stretching the client's stiff joints. D. Use a different modality for this problem.

B Mild heat before or during a passive stretch will give the best results and increase range of motion and circulation, because the heat will have a soothing effect and decrease discomfort.

What is the primary focus of the Joint Commission? A. Researching new methods of intervention B. Improving health care services C. Relicensing OTR®s and COTA®s D. Identifying an organization's strengths and weaknesses

B The Joint Commission's focus is more on improving health care services by facilitating effective and safe services.

An OTR is working with a client who has a flexor tendon injury. The referring physician prefers patients to follow the flexor tendon protocol using controlled passive motion. Which movement is indicated? A. Active movement of the metacarpal joint only B. Passive extension of the distal interphalangeal joint if the metacarpal and proximal phalangeal joints are flexed C. Active movement of the distal interphalangeal joint only D. Passive flexion of the distal interphalangeal joint if the metacarpal and proximal phalangeal joints are extended

B The distal interphalangeal joint and proximal interphalangeal joint can be passively extended if the other joints of the digit are flexed to initiate tendon glide and prevent scarring of the tendon. Explanations of Incorrect Answers A, C: Joints may only be moved passively in this controlled-movement flexor tendon protocol. D: Because this is a flexor tendon repair, extension needs to closely guarded to prevent flexor tendon rupture.

An OTR® is seeing a client with severe diabetes and obesity in a skilled nursing facility. The client is bedbound and has developed a decubitus ulcer. Where is the decubitus ulcer MOST likely to occur on the client's body? A. Upper back B. Abdomen C. Elbows D. Insulin injection site

C A decubitus ulcer most commonly occurs at a boney prominence that has been compressed against an external surface for a prolonged period.

An OTR is advising a client who has had a flexor tendon repair on the timing for resuming ADLs. During what time period is the flexor tendon repair the weakest and most likely to rupture? A. 1-3 days postsurgery B. 4-9 days postsurgery C. 10-12 days postsurgery D. 4-8 weeks postsurgery

C A tendon repair is typically at its weakest 10-12 days postsurgery during the fibroplasia phase, in which collagen is just beginning to be laid down to strengthen the repair. Explanations of Incorrect Answers A, B: At 1-9 days postsurgery, the tendon is still newly repaired and has the strength of the original suture. D: The period 4-8 weeks postsurgery is considered the intermediate phase, during which the tendon gains strength.

A resident in a long term care facility has a severe elbow contracture. The OTR® has just finished applying a bivalved splint to provide low load prolonged stress to the affected elbow. What MUST the OTR® do as part of the care plan for maximizing the effectiveness of this splinting intervention? A. Supplement the splint wear schedule with high brief-load stretches for 1-2 minutes at least 3 times per day. B. Advise the resident that the stretch will be uncomfortable but needs to be tolerated for at least several hours at a time. C. Provide nursing staff with specific instructions for a graded daily splint-wearing schedule. D. Ensure the evening nursing shift has documented orders to apply the splint just before the resident goes to sleep.

C An extremely tight elbow will require a graded splint wear schedule for maximum comfort, and staff education is essential to ensure compliance with a proper wear schedule.

An OTR® has just instructed a hip replacement client on a proper sit-to-stand technique from the chair. What is the BEST method to record the client's adherence to hip precautions? A. Ask the client to demonstrate the activity in the clinic. B. Ask the client to demonstrate the activity in the client's room. C. Observe the client in the dining room performing the activity. D. Ask the client's caregiver to demonstrate how they are performing transfers.

C By observing the client, a true level of occupational performance can be recorded.

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

C Cross-out assessments are used in visual scanning and can be beneficial in detecting spatial neglect or visual field impairments.

An OTR® is working with a client 8 weeks after a unilateral traumatic transtibial amputation. The client's residual limb is well healed, and the team has identified prosthetic fitting and training as the next step. The client wants to use a prosthesis but indicates that the residual limb is not healed enough and is fearful about wearing it. The client's mother currently performs all limb care, including washing, dressing, and wrapping. What is the BEST strategy to progress the client to prosthetic training? A. Have the prosthetist make the client a prosthesis and implement a wearing schedule. B. Recommend that the client wait another month and then return for prosthetic fitting and training. C. Have the client talk with other clients who have similar amputations. D. Refer the client for psychiatric evaluation and treatment.

C Encouraging the client to talk with others who have experienced similar amputations can help facilitate acceptance.

An OTR® is evaluating a client with multiple sclerosis (MS). What main evaluation finding related to neuromusculoskeletal function can the OTR anticipate? A. Slowed movement of the extremities B. Uniform resistance to passive movement C. Tremor when moving the extremities to reach D. Inability to initiate movement in the extremities

C Intention tremor is commonly seen in people with MS.

An inpatient who has Stage III lung cancer undergoes surgery for removal of axillary lymph nodes of the dominant upper extremity, followed by palliative chemotherapy. The patient is referred to occupational therapy for ROM, edema management, and preparation for hospice care at home. What is the PRIMARY purpose of initiating an exercise program for this patient? A. To increase overall endurance for daily tasks B. To promote normal venous and lymphatic return C. To improve mobility for preferred activities D. To facilitate passive ROM through a full arc of motion

C The goal of therapy is to restore a patient's participation in meaningful goal-directed activities that are preferred by the patient, and engaging in an exercise program that will improve mobility may facilitate improved engagement. Cancer rehabilitation focuses on engaging the patient at whatever level is possible for the patient; the focus is not on increasing endurance at Stage III level of progressive cancer when endurance is likely to not increase.

An OTR® is designing treatment sessions for a client with Type I complex regional pain syndrome (CRPS). Which occupational therapy treatment activities for the affected upper extremity would be MOST appropriate for this client? A. Instruction in PROM and application of joint mobilization techniques B. Use of cold packs followed by application of ultrasound C. Instruction in a stress loading program and incorporation of use of the upper extremity in functional activities D. Serial casting

C The most recognized treatment of complex regional pain syndrome is a stress loading program and use of the upper extremity in functional activities that promote occupational engagement. Explanations of Incorrect Answers A: PROM increases pain and swelling and is often contraindicated. B: People with CRPS are often cold intolerant. D: Serial casting does not increase active ROM and may add to joint stiffness.

An OTR® is working with a client who presents with lateral epicondylitis secondary to the leisure occupation of playing tennis. In the final 2 or 3 OT visits, what treatment intervention would be the most appropriate? A. Application of ice at the end of the treatment session B. Instruction in gentle AROM during functional activities C. Instruction in progressive resistive exercise D. Education to avoid movements that trigger pain

C To prevent future flare-ups, progressive resistive exercise should be initiated at the end of therapy visits when the lateral epicondylitis has subsided. A, B, D: Application of ice, gentle AROM during functional activities, and avoidance of movements that trigger pain are all appropriate treatment interventions in the acute phase of tendinitis.

An OTR® is treating an outpatient client who has sustained burns to the face, neck, and hands. Customized pressure garments are being fitted to reduce hypertrophic scarring. Which item cannot be used under the pressure garments to increase conformity to the skin? A. Silicone gel sheet B. Neoprene sheet C. Silastic elastomer D. Dynamic splint

D Dynamic splinting is primarily used to decrease soft-tissue contractures surrounding joints, not hypertrophic scarring of the skin, and splints are worn over the pressure garment, not under it. Silicone gel sheet, neoprene sheet, and silastic elastomer can be used under pressure garments to increase pressure garment conformity to the skin.

An OTR® is working with a 56-year-old client who has recently undergone a bilateral hip replacement. What musculature is the MOST IMPORTANT to focus on in the client's strength training? A. Shoulder girdle B. Elbow flexors and extensors C. Plantar and dorsiflexors D. Gluteal muscles

D Emphasis in rehabilitation should be on maintaining motion and increasing strength of surrounding musculature. Gluteal muscles are inclusive of this group. Elbow flexors and extensors are important in transfers, but primary emphasis should be placed on musculature surrounding the hip.

A client with a nondisplaced shaft fracture of the right fifth metacarpal has a physician's order for full-time splinting. Which orthosis would the OTR® be MOST likely to fabricate? A. Dorsal hood splint with the wrist in approximately 20° flexion, all metacarpophalangeal (MCP) joints of the affected hand in 70°-90° flexion, and interphalangeal (IP) joints of the affected hand in 0° extension B. Volar-based ulnar gutter with MCP and IP joints of the ring and fifth fingers in 0° extension and the wrist in neutral C. Dorsal-based wrist cockup splint with MCP and IP joints free and the wrist in approximately 20° extension D. Volar-based ulnar gutter with MCP joints of the ring and fifth fingers in 70°-90° flexion, fourth and fifth IP joints in 0° extension, and the wrist in approximately 20° extension

D Holding the MCP joints in flexion helps prevent contracture of the collateral ligaments. Explanations of Incorrect Answers A: A dorsal hood splint does not offer adequate protection for the fractured metacarpal. B: Maintaining the MCP joint in extension may lead to collateral ligament shortening and decreased ability to flex the MCP joint after the fracture is healed. C: Maintaining the MCP joints in extension may lead to shortening of the lateral bands and joint contractures.

A client is being treated for an extensor tendon repair in Zone VI of the middle finger proximal to the juncturae tendinum. Which orthosis would be MOST appropriate? A. Hand based, including only the middle finger B. Forearm based, including only the middle finger C. Hand based, including the middle, ring, and index fingers D. Forearm based, including the middle, ring, and index fingers

D It is important to consider adjacent digits when applying an orthosis. In this example, the injury falls proximal to the juncturae tendinum, which can apply force to the repaired site if the adjacent digits were to flex, thus compromising the repair. Explanations of Incorrect Answers A, C: Hand-based orthoses would not protect the tendon repair unless the wrist were immobile as well. B: Adjacent digits need to be included in the splint because flexion of adjacent digits can apply too much force to the tendon repair, resulting in a possible rupture.

An OTR is working with a child who has an epiphyseal fracture of the proximal interphalangeal bone with slight malalignment. Which intervention is MOST appropriate for a child with this condition? A. Do nothing; the child's fracture will heal and no occupational therapy is required B. Fabricate a serial cast for the child's finger C. Fabricate a dynamic splint for the child's finger D. Buddy tape the finger to an adjacent finger

D The least invasive and most effective treatment for a slight malalignment is buddy taping, and this is the intervention the child would be most likely to tolerate. Explanations of Incorrect Answers A: Because it is an epiphyseal fracture, it is important to realign the bone for future growth. B, C: A serial cast or dynamic splint is generally unnecessary for slight malalignment secondary to fracture and may not be well tolerated by children.

In preparation for an upcoming orchestral performance, an adolescent student has been practicing playing a string musical instrument 5 to 6 hours per day. The student reports hand pain that is causing illegible handwriting and an inability to complete written classwork in a timely manner. What INITIAL action should the OTR® take in this situation? A. Advise the student to take a break from music practice until the pain subsides. B. Arrange for the student to use a computer for written assignments for school. C. Collaborate with the music teacher to determine an appropriate rest/practice schedule. D. Schedule a time to observe the student during a rehearsal set-up and practice.

D The primary goal of intervention for upper-extremity overuse with musicians is to identify and reduce muscle tensions when playing the instrument. Observing the student during a rehearsal and practice would allow the practitioner to gather this information. Explanations of Incorrect Answers A: It may be necessary for the student to decrease practice time or discontinue playing altogether, although this does not have to be the initial action until the practitioner observes the student playing the instrument. B: The increase in practice time is what has caused the hand pain to occur, and changing from writing to computer use will not address the source of the problem. C: Collaborating on accommodations to the practice schedule may be a necessary intervention approach once the practitioner has observed the student playing the instrument.

A high-level ulnar nerve injury may result in which characteristic deformity? A. Flexion of the ring and small finger metacarpophalangeal (MCP) joints because of loss of the extension-controlling forces of the third and fourth lumbricals B. Hyperextension of the index and middle finger MCP joints because of loss of the extension-controlling forces of the first and second lumbricals C. Unchecked abduction of the ring and small finger MCP joints because of lack of motor innervation of the third and fourth lumbricals D. Hyperextension of the ring and small finger MCP joints because of loss of the extension-controlling forces of the third and fourth lumbricals

D The third and fourth lumbricals are innervated by the ulnar nerve. Loss of motor function in these muscles allows the extensor digitorum communis to extend the MCP joints without any opposing controlling forces, also known as "claw hand" deformity. Explanations of Incorrect Answers A, C: The third and fourth lumbricals are prime flexors of the MCP joints. A high ulnar nerve injury would result in the inability to use the lumbricals for flexion. B: The first and second lumbricals are innervated by the median nerve and therefore are not affected in ulnar nerve injuries.

When performing a manual muscle test (MMT) on a client, the OTR® should use standard principles to guide the evaluation of muscle strength. Which statement accurately reflects those principles? A. The OTR can safely perform MMT on a client in acute pain. B. The OTR should apply the same amount of resistance for all muscles tested. C. The OTR should stabilize distally from the joint and apply resistance proximally to the joint. D. The OTR should apply resistance applied gradually and increase it as the client responds.

D To appropriately measure muscle strength, the OTR should apply pressure in a gradual manner, giving the client time to respond to the resistance.

During an assessment, an OTR asks the client to pinch a pinch gauge and notices increased flexion of the thumb interphalangeal joint. What term is used to describe this type of pinch? A. Froment's sign B. Wartenberg's sign C. Jeanne's sign D. Ulnar claw

Froment's sign Froment's sign occurs when the flexor pollicis longus compensates for a weak or paralyzed adductor pollicis and flexor pollicis brevis. When a client attempts to pinch, the interphalangeal joint of the thumb flexes more than usual Explanations of Incorrect Answers B: Wartenberg's sign is the little finger held in abduction. C: Jeanne's sign is hyperextension of the proximal phalanx of the thumb when pinching. D: Ulnar claw refers to hand posture with ulnar nerve injury.

An OTR® in an outpatient setting is treating a client who underwent repair of multiple flexor tendons in Zones 2 and 3 approximately 6 weeks ago. The dorsal blocking splint has been removed, and the client is beginning to actively move the digits. The client is eager to return to work as a carpenter, and the OTR is revising the goals with the client. Which goal for this time period is MOST appropriate? A. Increase passive wrist and digit composite extension to improve flexor tendon length B. Increase digital active range of motion to facilitate holding a washcloth during bathing C. Increase grip strength to maintain grasp on woodworking tools D. String 25 beads of various sizes and shapes to improve fine motor coordination

Increase digital active range of motion to facilitate holding a washcloth during bathing Setting realistic, meaningful goals and revising them as the client progresses is a critical component in treating traumatic injuries. At 6 weeks after operative tendon repair, the client may be ready for light, nonresistive functional activities that promote active flexion. Explanations of Incorrect Answers A: Adding too much force at this stage may result in rupture of the repairs. C: At 6 weeks after repair of flexor tendons, strengthening is contraindicated. D: This goal has no functional component or intrinsic value to the client.

An OTR® is treating a client with decreased digital range of motion and minimal subacute edema of the same hand. After ascertaining that there are no contraindications to modality use, which preparatory method is the BEST choice for before therapeutic activities? A. Pneumatic pump application to the hand and digits B. Contrast bath application to the hand and digits C. Mild cold pack application to the hand and digits D. Mild, superficial heating application to the hand and digits

Mild, superficial heating application to the hand and digits Heating between 71.6°F and 105.8°F increases lymph flow and helps soften tissues to promote increased range of motion. Heating does not exacerbate minimal edema. Explanations of Incorrect Answers A: Pneumatic pumps are rarely used in hand therapy. B: No evidence indicates that contrast baths reduce edema. C: Cold application is usually used to control acute inflammation. Acute edema occurs within the first 24 to 72 hours after injury.

An OTR® is treating a client who sustained dorsal hand burns secondary to a work-related injury. In the intensive care unit phase of treatment, which technique for completing ROM of the hand is safest? A. Passively range all digits and joints at once B. Passively range each digit and joint one at a time C. Instruct the client to actively make a fist, then straighten the fingers completely D. Instruct the client to wear a resting hand splint at all times

Passively range each digit and joint one at a time Ranging each joint separately decreases the chance of rupturing finger extensor tendons with dorsal hand burns. Explanations of Incorrect Answers A, C: AROM or PROM of more than one joint at a time increases the chance of a tendon rupture after a burn to the dorsal hand. D: Wearing a splint inhibits performing ROM of the hand.

An OTR is working with a client who jammed the distal interphalangeal (DIP) joint of the long finger while playing basketball. The terminal tendon was avulsed, so the client was diagnosed with mallet finger. Which occupational therapy intervention is appropriate to use FIRST with this client? A. Show the client DIP flexion and extension exercises to perform daily for 2 weeks. B. Advise the client to limit playing basketball for 3 weeks to give the tendon time to heal. C. Splint the client's DIP joint in full extension continuously for 6 weeks. D. Refer the client to the orthopedic doctor for surgery.

Splint the client's DIP joint in full extension continuously for 6 weeks. The DIP terminal tendon is delicate and requires continuous splinting to prevent extensor lag of the tendon. Explanations of Incorrect Answers A: The client should not move the DIP at all for 6 weeks to protect the tendon. B: The client should not play basketball for 8 weeks to ensure tendon healing. D: Mallet finger is generally not operated on unless a bone fracture also is present.

An OTR® is treating a client with a nondisplaced radial head fracture and is following the referring physician's order for an immediate mobilization protocol. In which position would the client BEST tolerate early elbow flexion and extension? A. Supine with the upper arm supported on a folded towel along the torso B. Seated upright with the affected extremity free to flex and extend alongside the chair C. Standing with the affected extremity close to the torso D. Prone with the upper arm supported on a folded towel along the torso

Supine with the upper arm supported on a folded towel along the torso Positioning in supine with the upper arm supported on a folded towel along the torso facilitates gravity-assisted motion of the elbow with support to the affected extremity. Gravity-assisted motion allows for early, nonresistive motion of a stable fracture, which can promote bone healing. Explanations of Incorrect Answers B, C: Seated upright with the affected extremity free to flex and extend alongside the chair and positioned in standing with the affected extremity close to the torso are positions to which the client may progress after initial gravity-assisted elbow flexion and extension. D: Prone is an inappropriate position for early elbow extension and flexion.

An OTR is working with a client who presents with digital tenosynovitis in the index finger, or "trigger finger." After the OTR fabricates a splint to support the metacarpophalangeal joint in extension, which exercise should the OTR advise the client to perform FIRST? A. Hook fist with splint on B. Hook fist with splint off C. Full fist with splint on D. Full fist with splint off

The right answer is A A: Trigger finger is a condition in which edema in the tendon and synovium of the digit results in lack of smooth flexion or extension of the finger. To rest the tendon and prevent snapping as the tendon pulls through the finger pulleys, the MCP joint is blocked by splinting, then gentle pull through with bending and straightening of the distal and proximal interphalangeal joints is recommended 20 times every 2 hours while the client is awake. Explanations of Incorrect Answers B: The MCP joint is not supported if the hook fist exercise is performed with the splint off, resulting in increased tendon inflammation. C: A client wearing the MCP extension splint will be unable to make a full fist with the splint on. D: Making a full fist without the splint on will increase tendon inflammation and edema.

A large outpatient hand clinic employs certified hand therapists who are either licensed OTR®s or licensed physical therapists. COTA®s are used to efficiently manage caseloads. Which description of the supervision requirement for COTAs working in this environment is MOST accurate? A. Must be supervised by a licensed OTR in accordance with state licensure and scope of practice for COTAs B. Does not require supervision if the COTA has a minimum of 5 years of experience treating clients with upper-extremity conditions C. Can be supervised by a licensed OTR or physical therapist regardless of any other certifications D. Can be supervised by a licensed OTR or physical therapist as long as the supervisor is a certified hand therapist

The right answer is A COTAs typically require supervision by a licensed OTR in accordance with state licensure and scope of practice for COTAs. Explanations of Incorrect Answers B, C, D: COTAs typically require supervision by a licensed OTR, not a physical therapist, regardless of years of experience and other certifications in accordance with state licensure and scope of practice for COTAs.

An OTR® is treating a client with wrist tendinitis secondary to computer use. Before educating the client on wrist positions to avoid, the OTR® has applied iontophoresis to the affected area. Which medication would the OTR® be MOST likely to use with the iontophoresis? A. Dexamethasone B. Acetic acid C. Lidocaine D. Magnesium

The right answer is A Dexamethasone is the most widely used medication by therapists using iontophoresis because of its anti-inflammatory properties. Explanations of Incorrect Answers B: Acetic acid is used for soft-tissue mineralization. C, D: Lidocaine and magnesium are used to reduce pain.

An OTR® has been treating a client with a distal radius fracture. Because normal pain-free range of motion (ROM) may not be possible after this injury, the OTR has refocused efforts on gaining pain-free motion within the client's functional ROM. How would the OTR determine this client's functional ROM? A. Assist the client in identifying activities the client wants or needs to be able to accomplish with the affected extremity and incorporate practice of these specific activities B. Measure passive ROM to determine the available range of the affected extremity and then focus on place and hold exercises within that available range C. Review the evidence to determine specific measurements that correspond to functional ROM and then formulate functional ROM goals for the client D. Use goniometric measurements of the unaffected extremity to create ROM goals for the affected extremity

The right answer is A Identifying activities with meaning for the individual client allows the OTR to measure functional ROM needed for those activities. Explanations of Incorrect Answers B: Passive ROM is not a clear indicator of the client's functional ROM. C: Functional ROM must be determined individually for each client. D: Goniometry of the unaffected extremity does not identify functional ROM for the affected side.

A corporate client has hired an OTR® as an injury prevention consultant. How might the OTR's role BEST be described? A. Educating managers and other employees in ways to control and reduce workplace musculoskeletal injuries and in designing an ergonomic team B. Evaluating employees and treating those with upper-extremity musculoskeletal injuries C. Educating employees to be self-sufficient in ADL management after injury D. Prescribing therapeutic exercise and orthotics for injured employees

The right answer is A In a consultant role, the OTR provides services to the corporate client as whole, not to individual employees of the company. Explanations of Incorrect Answers B, C, D: The OTR playing a consultant role does not provide treatment to individual employees.

An OTR® assigned to the stroke unit of an acute care hospital is prioritizing goals and treatment for a patient with a hemiplegic hand. Based on the expected pattern of progression in the acute phase after a stroke, which areas of focus should the OTR consider to enable the patient to overcome barriers to ADL performance? A. Passive range of motion and positioning of the affected upper extremity, bed mobility B. Visual and cognition issues, upper-extremity orthotic needs C. Transfers, therapeutic exercise for upper-extremity strengthening D. Community mobility, fine motor coordination

The right answer is A In the acute stage of recovery, passive range of motion, positioning of the affected extremity, and bed mobility are critical components in restoring function for ADL performance. Explanations of Incorrect Answers B, C, D: Although visual and cognition issues, upper-extremity orthosis needs, transfers, therapeutic exercise for upper-extremity strengthening, community mobility, and fine motor coordination all are areas of concern, in an acute care setting, passive range of motion, positioning of the affected extremity, and bed mobility are areas of focus critical to overcoming barriers to self-care.

A client with a chronic median nerve compression at the carpal tunnel has severely diminished functional pinch. In what position should the thumb be splinted to facilitate functional pinch? A. The thumb should be splinted in opposition and palmar abduction to facilitate thumb-to-tip prehension. B. The thumb should not be included in a carpal tunnel orthotic to allow for functional prehension. C. The thumb should be splinted in opposition and radial abduction to facilitate thumb-to-tip prehension. D. The thumb should be splinted in extension to limit shortening of the extensor pollicus longus.

The right answer is A Opposition and palmar abduction represent the functional position of the thumb that best allows pinch. Explanations of Incorrect Answers B: Chronic median nerve compression, which affects the thumb, severely limits functional prehension. Splinting should address the thumb to maintain a functional position and maintain the first web space. C: Radial abduction does not position the thumb for thumb-to-tip pinch. D: Positioning the thumb in extension shortens the extensor pollicis longus.

An OTR is working with a client who has undergone a carpal tunnel release. The client describes postoperative pain on either side of the carpal tunnel that makes it difficult to grasp objects. What is the term for this type of pain? A. Pillar pain B. Chronic pain C. Phantom pain D. Complex regional pain

The right answer is A Pillar pain is pain on either side of the carpal tunnel release surgery site. The source of the pain is unknown and may be ligamentous or muscular in origin. Explanations of Incorrect Answers B: Chronic pain is pain that lasts longer than 6 months. C: Phantom pain is usually associated with amputation. D: Complex regional pain is hypersensitivity to pain caused by misfiring synapses of the autonomic nervous system.

State laws vary with regard to use of physical agent modalities (PAMs) by OTR®s. When explaining how PAMs fit within the scope of occupational therapy practice in their state, which description of PAMs should OTRs use, provided in the Occupational Therapy Practice Framework: Domain and Process? A. Preparatory methods used as part of a treatment session in preparation for purposeful or occupation-based activity B. Occupation-based interventions that are systematically applied to modify specific client factors that may be limiting occupational performance C. Activities that support performance skills and patterns D. Preparatory tasks that target specific client factors or performance skills

The right answer is A Preparatory methods are described in the Framework as "modalities, devices, and techniques to prepare the client for occupational performance" (AOTA, 2014, p. S29). They may be used as part of a treatment session or concurrently with occupations and activities that support occupational performance. Explanations of Incorrect Answers B, C, D: PAMs are considered preparatory methods. They are not purposeful activities or occupation-based treatment. Rather, they precede client engagement in purposeful and occupation-based therapy.

A COTA® is treating a client in an upper extremity outpatient clinic. During the first treatment session after the OTR® performed the initial evaluation, the client describes an area extending from the radial head to the proximal aspect of the supinator muscle as having a dull ache and burning sensation. Which syndrome is the client describing? A. Radial tunnel syndrome B. Pronator syndrome C. Carpal tunnel syndrome D. Cubital tunnel syndrome

The right answer is A Radial tunnel syndrome is compression of the radial nerve in the proximal forearm resulting in a dull ache and burning sensation along the lateral forearm. Explanations of Incorrect Answers B: Pronator syndrome is compression of the median nerve and causes diffuse pain along the medial aspect of the forearm. C: Carpal tunnel syndrome is median nerve compression with pain and numbness into the hand and fist through half of the fourth digit. D: Anterior interosseous nerve syndrome is motor loss of function without sensory disturbance.

An OTR is seeing a client in the upper extremity outpatient clinic. During the initial assessment, the client describes an area extending from the radial head to the proximal aspect of the supinator muscle as having a dull ache and burning sensation. Which syndrome is the client describing? A. Radial tunnel syndrome B. Pronator syndrome C. Carpal tunnel syndrome D. Cubital tunnel syndrome

The right answer is A Radial tunnel syndrome is compression of the radial nerve in the proximal forearm resulting in a dull ache and burning sensation along the lateral forearm. Explanations of Incorrect Answers B: Pronator syndrome is compression of the median nerve and causes diffuse pain along the medial aspect of the forearm. C: Carpal tunnel syndrome is median nerve compression with pain and numbness into the hand and fist through half of the fourth digit. D: Anterior interosseous nerve syndrome is motor loss of function without sensory disturbance.

With which type of client would it be best practice to allow the proximal interphalangeal (PIP) joints to develop a contracture to facilitate functional grasp? A. Client with a C6 spinal cord injury B. Client with rheumatoid arthritis C. Client with cerebrovascular accident (CVA) D. Client with cerebral palsy (CP)

The right answer is A Ranging the hand (wrist extension combined with finger flexion and wrist flexion combined with finger extension) of a client with a spinal cord injury preserves a functional tenodesis grasp while encouraging PIP flexion contractures. Explanations of Incorrect Answers B: PIP flexion deformities from rheumatoid arthritis result in decreased hand function. C, D: Allowing PIP flexion contractures in clients with CVA and CP limits hand function.

An OTR® in an outpatient clinic evaluates a client with bilateral primary adhesive capsulitis who is experiencing interrupted sleep patterns and decreased ability to perform ADLs because of pain. Range of motion (ROM) is close to functional but painful throughout the arc. What is the PRIMARY functional focus of occupational therapy intervention? A. ADL modifications and adaptive equipment education for grooming, bathing, and dressing B. Electrotherapeutic modalities followed by stretching exercises to facilitate increased ROM C. Rest, ice, elevation, and compression (RICE) to facilitate functional return D. Intra-articular corticosteroid injections to allow for better tolerance to stretch

The right answer is A The primary role of OTR includes education regarding modifications and meaningful adaptive equipment choices to facilitate ADL performance. Explanations of Incorrect Answers B, C: No evidence at this time supports the efficacy of therapeutic modalities or RICE in enhancing recovery from primary adhesive capsulitis. D: OTRs do not provide corticosteroid injections. Although these injections may be indicated by the treating physician to facilitate ROM, this client is in the freezing phase, indicated by the painful arc of motion. Overstretching in this phase may enhance the inflammatory process and increase the process of capsular fibrosis.

An OTR is working with a client with lateral epicondylitis. What is the BEST client education the OTR can offer in terms of wearing a splint for this condition? A. To wear the splint during any activity that causes pain B. To wear the splint only at night so that it does not interfere with the client's daily activities C. To wear the splint 24 hours a day without removing it for any reason until the next occupational therapy appointment D. To not wear the splint unless the client feels pain

The right answer is A The splint rests the muscle and tendon and protects against pain with activity. Explanations of Incorrect Answers B: Wearing a splint at night is appropriate for carpal tunnel syndrome, not lateral epicondylitis. C: Wearing a splint continuously decreases blood flow and oxygen to tissues. D: The splint is to be worn to prevent pain during activities that have been causing pain, not after the pain begins.

An OTR® is working in an inpatient setting with veterans who have upper-extremity amputations. Each morning the rehabilitation team, consisting of physician, nurse, psychologist, social worker, OTR, physical therapist, and orthotist, come together to discuss their patients' clients' progress toward the goals set within their individual disciplines. What type of team is this? A. Transdisciplinary team B. Multidisciplinary team C. Interdisciplinary team D. Allied health team

The right answer is B A multidisciplinary team is an interprofessional team composed of individuals representing the professional disciplines that serve the client. Explanations of Incorrect Answers A: Transdisciplinary teams function without discipline-centered boundaries. C: Interdisciplinary teams set goals and engage in intervention collaboratively across the disciplines. D: Allied health teams are not a recognized, definable type of team collaboration.

An OTR® is working with clients who have delayed healing of wounds. Which client would be MOST likely to take the longest amount of time to heal? A. A 50-year-old client with hypertension and a finger amputation B. A 77-year-old client with a foot ulcer, diabetes, and shingles C. A 21-year-old client with a radial fracture and a dog bite D. An 18-year-old client with a flexor tendon and median nerve injury

The right answer is B Age, diabetes, and a compromised immune system (indicated by shingles) are all factors that delay the wound healing process. Explanations of Incorrect Answers A, C, D: These clients are younger and do not have systemic diseases that would interfere with the wound healing process.

An OTR has been working with a client diagnosed with carpal tunnel syndrome. The client's symptoms have diminished, but now the client reports more pain at the elbow in the median nerve area. When a client reports dual sites of impingement of a single nerve without a history of trauma, what condition is MOST likely the cause? A. Thoracic outlet syndrome B. Double crush syndrome C. Ulnar tunnel syndrome D. Cubital tunnel syndrome

The right answer is B B: Over time, diminished blood flow to a peripheral nerve can result in serial impingements, called double crush syndrome. Explanations of Incorrect Answers A: Thoracic outlet syndrome involves the shoulder region. C: Ulnar tunnel syndrome involves the ulnar nerve. D: Cubital tunnel syndrome involves the ulnar nerve.

An OTR® is treating a client who sustained second- and third-degree burns on the dorsal forearm and hand. Which splint would be appropriate for this client? A. Resting hand splint B. Intrinsic plus splint C. Cone antispasticity splint D. Dorsal flexor tendon repair splint

The right answer is B Burns to the dorsum of the hand require the metacarpophalangeal joints to be splinted in 70°-90° of flexion to prevent clawing of the fingers and shortening of the tendons and ligaments. This type of splint is also referred to as an antideformity splint or a safe position splint. Explanations of Incorrect Answers A: A resting hand splint is for support or immobilization. C: A cone antispasticity splint is used for clients with cerebrovascular accident, traumatic brain injury, or cerebral palsy. D: A dorsal flexor tendon repair splint is used for clients with flexor tendon repair.

An older adult client complains that objects appear distorted—for example, straight lines look wavy. The client has difficulty reading and makes frequent mistakes when reading but is able to navigate busy and crowded environments using peripheral vision. Which visual deficit would the OTR® suspect? A. Glaucoma B. Macular degeneration C. Cataract D. Diabetic retinopathy

The right answer is B Macular degeneration results in a gradual loss of ability to see objects clearly. Objects appear distorted in shape and straight lines look wavy or crooked, creating difficulty with reading.

An OTR® is working in the burn unit of a hospital. A client has undergone skin grafting to close wounds on the dorsum of the hand. What occupational therapy treatment is MOST appropriate for the 5 to 7 days post skin graft? A. Instruct client in AROM of the wrist and hand but limit PROM until the staples are removed B. Fabricate and fit the client with a safe position splint over the dressings C. Involve the use of the grafted hand in ADLs D. Perform PROM to the wrist and hand but instruct the client to limit use of the hand outside of occupational therapy treatment

The right answer is B Splinting the hand in the safe position allows the graft to take and the wound to heal and prevents deformities. Explanations of Incorrect Answers A, C, D: Once the skin has been grafted, the wrist and hand should be protected for 5 to 7 days until the staples are removed. No AROM, PROM, or functional use of the hand should occur during this time.

A client sustained a nondisplaced humeral neck fracture after a fall. Which course of occupational therapy would be BEST? A. Instruct the client in use of a sling with no ROM for 3 weeks B. Instruct the client in use of a sling with supervised ROM C. Provide no occupational therapy intervention because the client will have a surgical reduction D. Fabricate a removable orthosis

The right answer is B With a nondisplaced fracture of the humeral neck, support from a sling and supervised exercise lead to the most desirable outcome.Instruct the client in use of a sling with supervised ROM Explanations of Incorrect Answers A: A sling without supervised ROM would result in decreased ROM and possible frozen shoulder. C: Nondisplaced fractures do not require surgical intervention. D: Nondisplaced fractures of the humeral neck require a sling, not an orthosis.

An OTR® is treating a client with a proximal interphalangeal (PIP) flexion contracture secondary to a sports injury. To improve extension of the PIP for functional use of the hand, what is the BEST use of limited therapy time? A. Apply paraffin followed by joint mobilization techniques B. Fit the client with a prefabricated dynamic PIP extension assist splint C. Instruct the client in flexion blocking exercises D. Fabricate a customized dynamic PIP extension assist splint

The right answer is B Fit the client with a prefabricated dynamic PIP extension assist splint A prefabricated dynamic PIP extension assist splint will improve PIP extension and takes less therapy time to fit than to custom make this splint. Explanations of Incorrect Answers A: Heat and joint mobilization can increase ROM temporarily, but long-term improvement of the PIP flexion contracture requires dynamic splinting. C: Flexion blocking exercises increase flexion, not extension. D: Fabricating a custom dynamic splint takes longer than fitting a client with a prefabricated splint.

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. Explanations of Incorrect Answers A, B, D: If the angle of pull is greater or less than 90°, the torque is less effective, and skin breakdown may result.

A client fell while skiing downhill and sustained a Type III fracture of the radial head. Which treatment would be MOST appropriate for this type of fracture? A. Long arm cast for 6 weeks B. Therapy alone C. Fragment excision with a long arm cast for 3-4 weeks D. Fragment excision with a long arm splint for 3-4 weeks

The right answer is C A Type III fracture of the radial head requires removal of the fragmented bone and a cast for 3-4 weeks to ensure proper healing and support. Explanations of Incorrect Answers A: A long arm cast for 6 weeks would not be appropriate because that time frame would lead to greater stiffness. B: Therapy alone would not be sufficient for a Type III injury. D: A splint would not stabilize the fracture sufficiently for a Type III injury.

An OTR® fabricated a thermoplastic splint for a client with carpometacarpal (CMC) osteoarthritis to support the CMC joint. The client is unable to wear it during work hours because some movement of the joint is required to complete tasks. Which positioning device would BEST suit this client's needs? A. CMC plaster of Paris cast B. CMC fiberglass cast C. CMC neoprene wrap support D. Thicker CMC thermoplastic splint

The right answer is C A neoprene strap provides less support but allows some movement. Explanations of Incorrect Answers A, B, D: A plaster of Paris or fiberglass cast or thicker splint will limit movement more than the original splint.

An OTR® who is a certified hand therapist is responsible for supervising a new COTA® in an outpatient hand clinic. What is the purpose of the supervisory process, as defined by AOTA? A. To ensure that COTAs treat only clients with diagnoses about which they have extensive knowledge B. To ensure that COTAs practice within their scope of practice with regard to state licensure laws C. To ensure the safe and effective delivery of occupational therapy services and to foster professional competence and development D. To provide evaluative feedback on an ongoing basis to the supervisee

The right answer is C As stated in the Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services (AOTA, 2014), "Within the scope of occupational therapy practice, supervision is a process aimed at ensuring the safe and effective delivery of occupational therapy services and fostering professional competence and development" (p. S16). Explanations of Incorrect Answers A: All practitioners must understand the diagnoses of clients with whom they work; this understanding occurs outside the supervisory process. B: All practitioners must understand scope of practice and state licensure laws; this understanding occurs outside the supervisory process. D: Feedback should be descriptive rather than evaluative. Descriptive feedback clearly states specific information that allows the receiver of the feedback to self-assess. Evaluative feedback is general in nature and does not promote critical reflection.

An adult with posttraumatic stress disorder (PTSD) is admitted to an inpatient psychiatric unit after a suicide attempt. What would be the BEST initial intervention for an OTR® to attempt with this client? A. Individualized assertiveness training B. Reality-orientation group C. Relaxation-focused group D. Daily routine group

The right answer is C Brown and Stoffel (2011) list relaxation as one of the primary interventions for people with PTSD.

An OTR is working with a client who punched a wall after an argument. The client presents with inflammation and pain in the right fourth and fifth metacarpals. What type of fracture does this client have? A. Bennett's fracture B. Colles fracture C. Boxer's fracture D. Kienbock's fracture

The right answer is C C: A boxer's fracture is the result of a clenched fist hitting an object with enough force to break the metacarpophalangeal neck, most commonly seen in the fourth and fifth digits. Explanations of Incorrect Answers A: Bennett's fracture is an intraarticular fracture of the thumb metacarpal bone. B: Colles fracture is a common distal radial fracture. D: Kienbock's disease is associated with lunate fractures.

An OTR® is treating a 77-year-old client who requires a resting hand splint. Which splint characteristics are MOST important in addressing the natural aging process of skin and adipose tissue? A. Use colored splints and no moving parts B. Use D rings and mark where straps go C. Use soft straps and thick padding D. Label the splint with client's name and left-right and top-bottom instructions

The right answer is C C: As a person ages, the skin thins, and adipose tissue is lost. Soft straps and padding add comfort and prevent skin breakdown. Explanations of Incorrect Answers A: Colored splints are easier to locate in white institutional bedding. B: Using D rings and marking straps makes it easier for the client to don and doff the splint independently. D: Labeling the splint can compensate for cognitive deficits.

An OTR is teaching discriminative sensory reeducation techniques to a client who has had a median nerve surgical repair. Which method is BEST for reeducation of discriminative sensibility? A. Educate the client to avoid working around machinery. B. Advise the client to use vision to compensate for sensory loss. C. Educate the client to identify items by touch both with and without vision on a daily basis. D. Educate the client to avoid temperatures below 60°.

The right answer is C C: This visual-tactile matching process is part of a discriminative sensory reeducation program. Explanations of Incorrect Answers A, B, D: Avoiding machinery and low temperatures and using vision to compensate for sensory loss are all approaches for protective, rather than discriminative, sensory reeducation.

An OTR® is assessing a client with a peripheral nerve injury affecting sensation in the nondominant hand. The client is a chef and is eager to return to work. Using monofilament testing, the OTR determines that the client has diminished protective sensation. Which recommendation BEST fits this client's occupational profile? A. Wear a glove to protect the affected hand from cold weather. B. Use equipment with soft, textured grips to maximize gross grasp and in-hand manipulation during kitchen tasks. C. Protect the affected hand from exposure to sharp items and to cold or heat. D. Avoid using sharp tools to prevent injury to the affected hand.

The right answer is C Client education for diminished protective sensation includes information about avoiding extreme temperatures and testing temperature with the affected hand. The client is a chef and therefore is unable to avoid exposure to knives. The client may be educated about specialized steel mesh gloves that can be worn to protect the insensate hand during cutting tasks. Explanations of Incorrect Answers A: A glove would protect the hand from temperature changes but not from sharp objects; both considerations are necessary for the client's work-related goal. B: Enlarged handles would more evenly distribute grip forces for better control of kitchen tools during use, but this recommendation does not address protecting the affected hand secondary to sensory loss. C: Avoiding sharp cutting tools does not address the client's work-related goal.

A blocking splint fabricated to maintain the metacarpophalangeal (MCP) joints in extension can be useful to isolate which joint movements? A. MCP joint flexion and flexor digitorum profundus (FDP) excursion B. Interphalangeal (IP) joint extension and FDP excursion C. IP joint flexion and FDP excursion D. Proximal IP joint extension and FDP excursion

The right answer is C MCP joint extension helps isolate proximal and distal IP joint flexion and allows maximum FDP excursion. Explanations of Incorrect Answers A: This splint holds the MCP joints in extension, not flexion. B: FDP excursion occurs with distal IP joint flexion, not extension. D: Proximal IP joint extension is facilitated when the MCP joints are blocked in flexion, not extension.

A client with an acute mild brachial plexus stretch injury affecting the left side reports limited forward shoulder flexion because of pain; limited cervical mobility; forward head and rounded shoulder posture; and decreased sensation in the thumb, index, and radial side of the long finger. The client has full range of motion in internal and external rotation of the shoulder. The occupational profile reveals that the client is an accountant who enjoys surfing and tennis on the weekends. What instruction should the OTR®provide on the first visit? A. Rotator cuff strengthening exercises for humeral head stability to reduce impingement pain noted with forward flexion B. Forward flexion active-assisted exercises to reduce capsular tightness C. Postural correction exercises, modification of the workstation to promote appropriate posture, and reduction of overhead activities D. Recommendation to maintain normal work activities but avoid tennis and surfing until further notice

The right answer is C Nonoperative treatment of a brachial plexus stretch injury includes education on how to minimize further irritation to the brachial plexus, including postural education and education regarding avoidance of provocative positions (e.g., overhead activities). Explanations of Incorrect Answers A, B: Normal pain-free range of motion in internal and external shoulder rotation indicates no involvement of the rotator cuff. D: Posture is a crucial component of treatment. Forward head posture indicates limited scapular mobility. When scapular mobility is limited, motion at the glenohumeral joint is adversely affected because of an imbalance in scapulohumeral rhythm.

An OTR® is working with a client experiencing a cumulative trauma disorder of the right upper extremity. To document client improvement as a result of therapy, which occupation-based statement would the OTR® be MOST likely to write? A. Client's pain-free AROM of right elbow is now 15° to 110°. B. Client can perform 30 repetitions of elbow flexion-extension using a 1-lb weight. C. Client can brush teeth using the involved upper extremity without pain. D. No progress was noted this week.

The right answer is C Occupation-based practice requires documentation of improvement in occupations such as ADLs. Explanations of Incorrect Answers A, B: Statements about AROM and exercise document progress from a biomechanical frame of reference. D: This statement does not document improvement as a result of therapy.

A therapy group of clients with rheumatoid arthritis is meeting once a week. These clients may benefit from a group education approach to teach which technique? A. Exercises to increase stability of the hands and digits B. Medication management to ensure proper use of prescribed medications C. Joint protection strategies to help prevent further joint stress or injury D. Night splinting in a position of antideformity

The right answer is C Studies have shown a decrease in reported pain and disability after participation in a group program in which joint protection strategies have been taught. Explanations of Incorrect Answers A, B, D: Exercises, medication management, and night splinting are more appropriate as individual rather than group interventions.

Which outpatient treatment intervention is contraindicated for decreasing the arm edema and stiffness associated with complex regional pain syndrome of the upper extremity? A. Instruction in the use of contrast baths several times a day B. Instruction in performing gentle, pain-free AROM movements several times a day C. Provision of an arm sling to wear during the day D. Provision of a compression garment to wear during the day

The right answer is C Wearing an arm sling will increase stiffness and edema because it places the extremity in a dependent and static position for long periods of time. Explanations of Incorrect Answers A, D: Taking contrast baths and using a compression garment are beneficial for edema control of the arm in a client with complex regional pain syndrome. B: Gentle, pain-free AROM encourages circulation, decreases stiffness, and may assist in interrupting the pain cycle.

A student occupational therapist arrives at a facility for Level II fieldwork and discovers that the OTR®; supervisor has to take an unplanned leave for the duration of fieldwork. An entry-level COTA® is present at the facility. What options does the student have for appropriate fieldwork supervision at that facility? A. The student may be supervised by the entry-level COTA as long as the COTA consults with the OTR. B. The student may be supervised by an OTR who works at another facility. C. The student may be supervised by an entry-level COTA who works at another facility. D. The student cannot complete fieldwork at the facility because adequate supervision is not available.

The right answer is D A Level II fieldwork student may be supervised only by an OTR with more than 1 year of experience. Because an OTR with sufficient experience is not available to supervise the fieldwork student onsite, the student cannot complete fieldwork at the facility. Fieldwork supervision must initially be direct line of sight at the facility, and a COTA may not supervise a Level II fieldwork student.

An OTR® is seeing a client in an outpatient clinic. The client is experiencing pain and swelling in the radial wrist extensor muscles. Treatment includes use of phonophoresis using hydrocortisone. For safe treatment of this client, what information is MOST important to be aware of? A. How long the pain and swelling have been present B. What prior surgeries the client has had C. What activities aggravate the pain and swelling D. What the client's medications and medication allergies are

The right answer is D Before applying any medication using phonophoresis, the OTR® needs to be aware of the client's current medication and any medication allergies. Explanations of Incorrect Answers A, C: Knowing the duration of and triggers for pain can influence the choice of settings and the kind of medication used for effective treatment. B: Surgeries (e.g., implantation of a cardiac pacemaker) would not affect treatment of the arm.

An OTR is working with a client who fell on an outstretched hand and broke the distal radius. Which complication from this type of fracture is the MOST severe? A. Limited forearm rotation B. Limited wrist flexion C. Carpal tunnel syndrome D. Complex regional pain syndrome (CRPS)

The right answer is D D: CRPS requires the most intensive intervention of all the complications listed. Explanations of Incorrect Answers A, B, C: Limited forearm rotation and wrist flexion and carpal tunnel syndrome are possible complications from a distal radius fracture, but CRPS is more severe.

An OTR is working with a client with a flexor tendon injury. One week after repair surgery, the OTR removes the cast made postsurgery and fabricates a splint. Which splint is appropriate for this client? A. Active wrist extension splint B. Active wrist, finger, and thumb extension splint C. Resting hand splint D. Dorsal blocking splint

The right answer is D D: The dorsal blocking splint protects the surgery and guards against flexor tendon rupture. Explanations of Incorrect Answers A, B: Active wrist extension and wrist, finger, and thumb extension splints are fabricated for extensor tendon injuries. C: The resting hand splint is made for clients who need positioning to prevent deformities, such as in rheumatoid arthritis.

An OTR® decides to use desensitization techniques in structured practice within the context of daily activities for a client with hypersensitivity secondary to peripheral nerve injury. Which desensitization technique would be the MOST therapeutic initially? A. Begin using desensitization with the texture that is the most irritating to the client B. Begin using desensitization at the most sensitive area to be treated C. Instruct the client to use the desensitization techniques one or two times a day for 30 minutes each as part of a home program D. Instruct the client in use of a transcutaneous electrical nerve stimulation (TENS) unit during desensitization activities

The right answer is D If desensitization is poorly tolerated, the activity can be combined with use of a TENS unit initially to decrease the client's perception of pain. A, B: Desensitization begins with the least irritating texture in the least sensitive area to be treated. C: Desensitization is best used for short periods (3 to 5 minutes five or six times per day).

A student in kindergarten has dyspraxia and frequently falls when playing at recess and during gym class. When completing at-desk art and writing activities, the student often reverses numbers and letters and holds the pencil with an immature grasp. What should be the INITIAL focus of intervention sessions with this student? A. Identifying assistive devices for improving handwriting legibility B. Using parquetry activities for improving visual-spatial and visual-motor skills C. Engaging in fine motor games to increase pinch and grip strength D. Providing a just-right challenge during gross motor play activities

The right answer is D Improving the child's safety during recess and gym class should be the first priority of the intervention plan, so addressing gross motor play skills is most appropriate. Providing the just-right challenge will allow the child to participate in tasks that do not overwhelm yet are also not so simple that the task is routine or uninteresting. This challenge will allow the child to develop praxis with gross motor play.

The occupational profile of a client recently diagnosed with bilateral osteoarthritis of the first carpometacarpal joints of the thumbs reveals that the client is retired and enjoys reading, playing cards with friends, and painting. The client has insurance coverage for only three occupational therapy sessions. What client education topics should the OTR® focus on FIRST? A. Hand strengthening exercises the client can perform independently B. Orthoses that may be fabricated to support and protect affected joints C. Thermal modalities to reduce pain and stiffness D. Joint protection principles

The right answer is D Joint protection principles are ideally taught early in the disease process to decrease joint stress and damage. Explanations of Incorrect Answers A: Exercise programs that use active range of motion have been found to be more effective than strengthening; thus, hand strengthening exercises would not be the first focus for this client. B, C: Although orthotics and thermal modalities may be effective interventions, practitioners must work within time constraints. Joint protection principles would be addressed first because they cover the scope of the client's valued occupations.

An OTR® is describing a client with a hand injury to an occupational therapy student. The OTR® states that the client presents with burning and stabbing pain in the hand, shiny skin, very stiff joints, and abnormal sweating and hair growth. What medical condition does this client MOST likely have? A. Carpal tunnel syndrome B. Fibromyalgia C. Neuroma secondary to index proximal interphalangeal amputation D. Complex regional pain syndrome

The right answer is D Symptoms of complex regional pain syndrome often include pain, swelling, stiffness, and sudomotor and trophic changes. Explanations of Incorrect Answers A: Fibromyalgia presents with pain, fatigue, and tender trigger points. B: Carpal tunnel syndrome presents with numbness and tingling in the thumb and index and middle fingers. C: Neuroma is hypersensitive and painful to touch.

An OTR® is evaluating a client with Parkinson's disease who lives at home but has begun to have mobility challenges. Which intervention is BEST to facilitate lifestyle changes to improve safety? A. Issue a long-handled reacher and teach the client how to use it B. Advise the client to continue to carry items during functional mobility C. Issue a rolling walker and educate the client how to use it D. Introduce use of a rhythmic beat to facilitate mobility

The right answer is D The use of rhythm has been shown to support mobility in people with Parkinson's disease. This approach can minimize the impact of the immobilization that may occur from this disease. A rolling walker may not be effective because the motoric freezing and festinating gait characteristic of this condition cause people to take smaller steps to adjust for postural instability.

When planning a sensory reeducation program for a client with sensory loss associated with peripheral nerve damage, which intervention would the OTR® use FIRST? A. Sensory retraining, but only after signs of nerve regeneration are apparent B. Discriminative sensory reeducation involving graded localization and discrimination tasks C. Noxious sensory input to facilitate reduction of hyperalgesia D. Protective sensory reeducation because the client is at risk for injuring the insensate hand

The right answer is D When protective sensation is diminished or absent, client education is initiated first to prevent potential harm from hot and cold or from sharp edges. Explanations of Incorrect Answers A: Protective sensory reeducation should begin immediately, before nerve regeneration is apparent, to protect the client from further injury. B: Discriminative sensory reeducation should begin soon after nerve injury. However, protection from further harm is addressed first. C: Noxious input does not reduce hyperalgesia.

An OTR is working with a client who has sustained injuries in a knife attack. The injury to the flexor tendon is in what is known as "no man's land." The stitches in the fingers are between the distal palmar crease and the proximal interphalangeal joints. In what flexor tendon zone are the injuries located? A. Zone I B. Zone II C. Zone III D. Zone IV

Zone II Zone II of the flexor tendon system has been called no man's land because excessive scarring makes it difficult to get good results from a repair. Explanations of Incorrect Answers A, C, D: Zones I, III, and IV of the flexor tendon system do not have the overlap of the flexor digitorum profundus and the flexor digitorum superficialis to increase scarring and decrease tendon gliding.

An OTR is working with a client who has been in a motor vehicle accident. The client has sustained flexor tendon injuries to the index and middle fingers and also presents with a median nerve injury. Which flexor tendon zone corresponds to this client's injuries? A. Zone I B. Zone II C. Zone III D. Zones IV and V

Zones IV and V Zone IV consists of the transverse carpal ligament, and the median nerve runs under this ligament; Zone V is distal to this ligament and thus contains the median nerve branch. Explanations of Incorrect Answers A, B, C: Zones I, II, and III do not contain the median nerve branch.