d2 study guide

A client, who has depression, has accomplished the stated goal of completing ADL by 9 a.m. daily for one week. After a medication adjustment, the client has difficulty waking in the morning and ADL performance has decreased. What is the FIRST action the OTR should take in response to the client's change in function?

A.Advise the client to take the medication earlier in the evening. B.Discontinue intervention until the client adjusts to the medication change. C.Discuss the effects of the medication change with the interprofessional team. Correct Answer: C Rationale: The OTR should first discuss the potential medication side effect and the behavior change with the interprofessional team.

A client in an outpatient setting has hemiplegia secondary to a CVA. Over the past several weeks, there has been a decline in the client's energy level, ability to concentrate, and interest in intervention activities. When asked about the change, the client replies: "I just can't sleep at night thinking about the burden I am to my family." What INITIAL action should the OTR take based on this observed change?

A.Advise the client to consult with a psychiatrist B.Consult with the client's primary physician C.Adjust the timeframes for achieving short term goals Correct Answer: B Rationale: The client is demonstrating signs and symptoms typically associated with depression that warrant a consultation with the client's primary care physician.

An OTR is completing a functional visual screening of a client who has macular degeneration. The OTR asks the client to read a passage from a magazine. The client misses several letters and words, and has difficulty finding their place in the text when scanning. What aspect of visual function should the OTR investigate further based on the client's performance?

A. Central visual field B.Contrast sensitivity C.Visual acuity Correct Answer: A Rationale: The performance errors made by the client during the reading task is consistent with central visual field impairment.

An OTR is preparing for an INITIAL intervention session with an inpatient who is in the acute manic phase of bipolar disorder. Which general strategy should the OTR include as part of this session?

A. Minimize distractions in the environment during task performance. B.Provide the patient with an opportunity to select an activity of interest. C.Ensure the patient is aware of the influence of mania on participation. D.Structure the environment to encourage creativity and self-expression. Correct Answer: A Rationale: It is important to provide a structured environment with minimal distractions during the initial phase of intervention.

Which situation listed below warrants a referral to a gastroenterologist?

A.A resident who recently started only eating the food placed on the right side of the plate. B.A client who has diabetes and is experiencing more frequent episodes of hyperglycemia. C.An adolescent who has cerebral palsy who refuses to eat and reports frequent episodes of reflux. Correct Answer: C Rationale: Gastroenterology is a specialty of medicine that address conditions in the gastrointestinal tract and the digestive system.

A client who has chronic low back pain is participating in an interprofessional pain management program. The focus of the program is for the client to learn mechanisms for coping with pain and reducing injury risk during work-related tasks as a manual laborer. The client has been making progress since starting the program 3 weeks ago. What information is MOST IMPORTANT for the OTR to report about the client's progress at the next weekly team meeting?

A.Amount of weight the client is able to lift and carry during sessions B.Length of time the client engages in specific work tasks in the clinic C.Ability to correctly perform stretching and strengthening exercises D.Spontaneous use of self-management strategies during activities Correct Answer: D Rationale: The client's spontaneous use of self-management strategies indicates progress toward the program goals of helping the client learn ways to cope with pain and reduce injury risk during work tasks.

A client sustained a TBI 3 months ago and is functioning at Level VIII (Purposeful, Appropriate, Stand-by Assist) on the Rancho Los Amigos scale. The client is participating in a meal preparation task. As part of the task, the client is asked to prepare vegetable soup using a five-step printed recipe. The client is able to read the recipe steps aloud but does not act on any of them. When the OTR covers over all but the first step of the recipe, the client follows through with the step. What conclusion can the OTR make about the client based on this observation?

A.Anchoring techniques improve visual perception. B.Adaptive strategies compensate for attention deficits. C.Ideational apraxia interferes with task initiation. Correct Answer: B Rationale: A client at this level of functioning has improved to being able to attend to a familiar task for up to an hour but still has residual deficits in attention. This client's performance is enhanced when an OTR provides instruction to use an adaptive strategy.

A family practice physician referred a client to outpatient OT for conservative treatment of carpal tunnel syndrome of the dominant hand. The client reports a 3 month history of numbness and difficulty manipulating objects. Symptoms interfere with work as a jack-hammer operator for a road works department. Evaluation results indicate loss of protective sensation, 11 mm two-point discrimination, and thenar muscle atrophy. Active ROM of the affected hand is within normal limits. What INITIAL actions should the OTR take in addition to fabricating a volar wrist orthosis?

A.Arrange an appointment with an orthopedic surgeon and begin a sensory reeducation program. B.Conduct Phalen's test and report findings of the overall evaluation process to the physician. C.Advise the client to wear the orthosis when sleeping and a padded glove when at work. Correct Answer: B Rationale: Phalen's test is a clinical test used to determine the involvement of the median nerve. The OTR should report the evaluation results to the physician and collaborate with the physician on the overall intervention plan.

An outpatient OTR is working with an adult client who has spastic diplegia. One of the client's goals is to drive a car. The client has the necessary process skills to drive but requires adapted driving controls to access the gas and brake pedals. What is the FIRST action the OTR should take in this situation?

A.Arrange for a trial of specialized equipment from a reputable vendor. B.Refer the client to a driving rehabilitation specialist. C.Research funding options to pay for vehicle adaptations. Correct Answer: B Rationale: A referral to a driving rehabilitation specialist is warranted to evaluate the specialized needs for this client and to provide recommendations for vehicle modifications.

A resident of a skilled nursing facility, who has moderately severe cognitive decline, becomes increasingly agitated during mealtime. What is the FIRST action the OTR should take based on this observation?

A.Arrange for the resident to eat meals in a calm, quiet location. B.Instruct the resident in relaxation exercises to use at mealtime. C.Observe the resident at mealtime to identify behavioral triggers. Correct Answer: C Rationale: In order to provide the most effective intervention strategy, the OTR would first need to identify the stimuli that triggered the behavior during mealtime.

A client who has moderate cognitive decline lives in a skilled nursing facility. The client's spouse visits every morning after breakfast. The spouse informs the OTR that the client's frequency of interacting during the visits has decreased over the past few weeks, and the client now has intermittent verbal outbursts that disrupt the social interaction. In addition to informing the care team, what action should the OTR take based on this observation?

A.Ask the spouse open-ended questions about the situation, and identify possible triggers for the change in level of interaction. B.Provide the spouse with information about providing immediate feedback to the client when there are signs of agitation. C.Sit with client and the spouse during a visit, and ask the client direct questions to facilitate appropriate communication. Correct Answer: A Rationale: Prior to initiating intervention, the OTR first acquires additional information to understand possible triggers for the change in behavior.

An OTR is planning intervention for an outpatient client who had a CMC thumb arthroplasty 1 week ago. What should the OTR include as part of the INITIAL intervention plan at this stage of recovery?

A.Begin gentle passive range of motion at the wrist and thumb CMC. B.Encourage active range of motion of the affected hand within tolerance of pain. C.Immobilize the wrist and thumb CMC and MCP joints while allowing AROM of the IP joint. Correct Answer: C Rationale: At this stage of recovery, the initial intervention plan one week after surgery for a CMC thumb arthroplasty includes immobilizing the wrist and thumb CMC while allowing AROM at the IP joint.

An OTR administered a standardized tool to screen the gross and fine motor skills of a student in the fourth grade. The student's total motor composite scores are listed in the table below: Point score: 85 Standard score: 75 Percentile rank: 99 Stanine: 9 What conclusion can the OTR make about the student's motor skills based on these results?

A.Below average performance B.Commensurate with peers C.Proficient level of function Correct Answer: C Rationale: These results indicate the student is functioning at a proficient level.

An OTR has completed an evaluation of a client who has amyotrophic lateral sclerosis. When reviewing the results of upper extremity goniometric measurements, the OTR notes that the client's active ROM is significantly less than passive ROM. What should the OTR conclude is the PRIMARY cause for this discrepancy?

A.Bony ankylosis B.Muscular weakness C.Soft-tissue shortening Correct Answer: B Rationale: Limitations in active ROM in the presence of full passive ROM indicate weakness or a lack of power generated by the muscle or muscle group.

Which action is MOST IMPORTANT for the OTR to take when recommending driving cessation for a client who is assessed to be unsafe to drive a motor vehicle?

A.Collaborate with the client and family members to determine best plan of action and develop goals for community mobility alternatives. B.Inform the client and the referring physician about safety concerns and know state laws about legal obligation for reporting. C.Report the safety risk associated with fitness to drive to state licensing authorities and educate the family on strategies to prevent the client from driving. Correct Answer: B Rationale: An important step when recommending that a client stop driving is to inform the client and the referring physician about safety concerns, and to know state laws about legal obligation for reporting.

A client who has severe depression has been participating in a partial hospitalization program. The client has made some improvements, but continues to have difficulties concentrating on tasks and coping with day-to-day stressors. The interprofessional team agrees that the client has made sufficient progress to transition to the next level of care. Which type of program would BEST assist the client toward the goal of returning to work as a healthcare provider?

A.Community mental health program B.Support group for working professionals C.Impaired provider program Correct Answer: A Rationale: A referral to a community mental health program is the best option for this client who continues to make progress toward return-to-work goals but has persisting difficulties with process skills and mood.

A young adult client is participating in a community-based OT program after completing inpatient treatment for an acute episode of major depression. Evaluation results indicate the client has difficulty concentrating on simple tasks, has poor personal hygiene, and has limited insight about the impact of the depression on areas of occupation. The client states the primary goal for attending OT is "to get a job". What should be the INITIAL focus of sessions with this client?

A.Determining the client's work habits and current abilities for job readiness B.Finding the client a transitional job involving routine and repetitive work tasks C.Teaching the client how to locate job opportunities and submit job applications D.Assigning the client to a job in a highly supervised sheltered work environment Correct Answer: A Rationale: Prior to selecting a specific employment placement, the initial step in the intervention planning process is to understand the client's work habits and current abilities.

An OTR is interpreting the results of a standardized test on visual perceptual skills administered to a student in second grade who has a developmental delay. The student scored within the average range for all subtests but scored below the norm on the visual closure subtest. Based on these results, which activity would be MOST DIFFICULT for this student?

A.Determining the difference between a crayon and a marker when both are partially covered by a book B.Locating coat and hat hanging on a hook in the hallway before going outside to play on the playground C.Recognizing the similarities between a picture of a mouse in a storybook and the class pet mouse in a cage Correct Answer: A Rationale: A student with impaired visual closure skills would have difficulty identifying an object when there is an inability to visually see the object in its entirety.

An OTR is working in the school system. A second-grade student is referred for an OT evaluation because of an awkward pencil grasp. Results of the evaluation indicate writing skills are at grade level and a 10% delay in fine motor skills. What action should the OTR take in this situation?

A.Develop IEP goals to improve the student's fine motor skill development B.Recommend the student use keyboarding as primary means of written assignments C.Inform the teacher and parents that the student does not qualify for OT services Correct Answer: C Rationale: This student does not meet eligibility criteria under IDEA because the student is meeting grade-level expectations for handwriting.

An inpatient is recovering from a second major depressive episode. The patient plans to resume family and homemaking responsibilities after discharge from the hospital. Which INITIAL action should the OTR take as part of the intervention for promoting progress toward this goal?

A.Develop a program that promotes gradual integration into family routines. B.Recommend family share responsibilities based on typical home routines. C.Educate the patient and family about pacing typical daily tasks. D.Determine the patient and family priorities for role resumption. Correct Answer: D Rationale: The INITIAL action the OTR prior to developing the intervention plan is to determine the patient and family priorities for role resumption.

A patient in an inpatient rehabilitation setting is in the recovery phase of intervention after an acute onset of Guillain-Barré syndrome one month ago. The OTR advises the patient that using assistive devices will improve independence, but the patient refuses to use the devices stating: "My wife is happy to help me whenever I need it." How should the OTR respond to the patient's comment?

A.Discuss the patient's comment with family members. B.Convince the patient to try the devices at least once. C.Focus intervention sessions on strengthening and ROM activities. D.Identify other strategies for improving occupational performance. Correct Answer: D Rationale: Use of assistive devices should be determined based on the patient's needs and priorities. If the patient does not want to use assistive devices, the OTR can work with the patient to teach energy conservation and other compensatory strategies tailored to predetermined needs and priorities.

An OTR, who works in a large, urban hospital, is providing intervention to an inpatient who is preparing for discharge and has COPD, diabetes mellitus, and morbid obesity. The patient lives alone in a rural community and has been readmitted to the hospital for recurrent exacerbation of respiratory distress and poor glycemic control 3 times over the past year. What is the FIRST intervention priority the OTR should address to positively influence the risk of a future readmission?

A.Discuss with the patient the option of moving to the home of a family member. B.Ensure the patient can pay for prescription medications ordered by the physician. C.Recommend durable medical equipment for the patient to use during ADL. Correct Answer: C Rationale: Recommending DME for use during ADL is within the scope of practice for occupational therapy and is associated with reducing the risk of a future readmission to an acute care hospital

Which of the following options represent a modifiable risk factor for readmission that an OTR working in an acute care setting should include in the discharge planning process for an inpatient who is returning home?

A.Poor living situation B.Low health literacy C.High risk for co-morbid conditions Correct Answer: B Rationale: Low health literacy is considered a modifiable risk factor for readmission to the hospital.

An OTR is planning intervention for an outpatient client who had a CMC thumb arthroplasty one week ago. What should the OTR include as part of the INITIAL intervention plan at this stage of recovery?

A.Educate the client to complete a progressive strengthening program of the affected hand. B.Teach the client one-handed techniques using the non-affected hand for ADL. C.Provide the client with a ROM program for the shoulder, elbow, fingers and thumb IP joints. Correct Answer: C Rationale: At this stage of recovery, the initial intervention plan for a CMC thumb arthroplasty one week after surgery includes immobilizing the wrist and thumb CMC while allowing AROM at the IP joint and providing the client with a ROM program for the shoulder, elbow, fingers, and thumb IP joints.

An OTR is preparing discharge recommendations for an inpatient who recently has been diagnosed with relapsing-remitting multiple sclerosis. The patient is an executive chef at a restaurant and wants to resume work as soon as possible after discharge. What would be MOST BENEFICIAL for the OTR to include as part of the discharge planning process for supporting this goal?

A.Education about wearing a cooling vest to regulate body temperature B.Instructions on using pursed lip breathing techniques to regulate dyspnea C.Handouts outlining the general purpose and principles of energy conservation Correct Answer: A Rationale: Heat intolerance is a symptom of multiple sclerosis that may be exacerbated in a client who works in a kitchen. Recommending a cooling vest is a solution to decrease this risk of overheating.

A young adult client who has a substance use disorder has been referred to community-based OT. Although the client has maintained sobriety for the past 6 months, evaluation results indicate the client has an unrealistic self-concept, poor social skills and inadequate independent living skills. Which objective would be MOST BENEFICIAL to include as part of the initial intervention plan for supporting the client's participation in occupations?

A.Education about work stressors that contribute to relapse B.Transition to independent living with a supportive friend C.Acquisition of practical skills for basic life management D.Engagement in leisure activities with social acquaintances Correct Answer: C Rationale: The acquisition of practical life management skills is essential for enabling the client to develop a sense of control and autonomy that will support participation in meaningful occupations.

An OTR who works in an outpatient hand therapy clinic fabricated a forearm orthosis for a client. The OTR is providing instructions to the client on the wearing schedule and care of the orthosis. Which is the MOST EFFECTIVE method for the OTR to use in the education session to promote the client's understanding of the information presented?

A.Encourage the client to independently place the orthosis on and off during the session. B.Provide a detailed written handout with illustrations to reinforce key points. C.Ask the patient an open-ended question that invites a descriptive response. Correct Answer: B Rationale: Written documentation allows the patient to review the instructions after the session and refer to the handout when needed.

An inpatient is preparing for discharge to home after completing 3 months of inpatient rehabilitation. The OTR is reviewing documentation in the patient's contact notes and determines the patient is still working to achieve several short-term goals related to the current treatment plan. What INITIAL action should the OTR take based on this finding?

A.Ensure durable medical equipment delivery and home health visits are scheduled in preparation for the patient's discharge. B.Complete a comprehensive re-evaluation to identify current function in relation to the discharge plan. C.Prepare a discharge summary providing a rationale for the goal shortcomings noted in the contact notes. D.Discuss options with the interprofessional team for extending inpatient rehabilitation until goals are achieved. Correct Answer: B Rationale: The OTR should complete a re-evaluation prior to discussing other options with the interprofessional team or writing the discharge summary.

An inpatient is undergoing treatment in an acute rehabilitation facility after sustaining bilateral ankle fractures one week ago. Medical records indicate the patient will be non-weight-bearing for at least 6 weeks. Currently, the patient is independent with upper body dressing; requires moderate assistance with lower body dressing, bathing, and transfers; and independently propels a standard wheelchair. One of the intervention priorities is for the patient to be independent with IADL prior to discharge. Which action is MOST IMPORTANT for the OTR to take in advance of scheduling intervention activities for this patient?

A.Ensure the hospital bathroom is equipped with durable medical equipment. B.Discuss the projected timeline for recovery with the interprofessional team. C.Identify the patient's expected discharge context and available resources. Correct Answer: C Rationale: A key feature of client-centered care is to select and implement interventions that align with the available resources and the patient's expected discharge site.

An OTR is establishing therapeutic rapport with a young adult client who has a personality disorder and struggles with relationships. As a child, the client lived in several foster homes and briefly attended college before dropping out to live with a partner. Currently, the client is not working and the partner has ended the relationship. What action is MOST IMPORTANT for the OTR to take when establishing rapport with this client?

A.Establish flexible rules of conduct during intervention. B.Support motivation to make changes to personal behaviors. C.Focus on developing an external locus of control. Correct Answer: B Rationale: This client's metacognition and internal motivation to make behavioral change is directly correlated to the success of the intervention.

An OTR who works in an outpatient setting is trying to obtain consent from an older adult client who reports occasional forgetfulness. What action should the OTR take before asking the client to sign the consent form?

A.Explain details of the planned intervention to a family member. B.Ensure the client understands the recommended plan of care. C.Print the written plan of care and allow time for the client to review. Correct Answer: B Rationale: Ensuring that the client is able to understand the plan of care is an important aspect of obtaining informed consent.

An OTR who works in a rehabilitation hospital is providing assistive technology recommendations to a patient who has relapsing-remitting multiple sclerosis. Which is the MOST EFFECTIVE method for the OTR use during the intervention session to evaluate the patient's understanding of the information presented?

A.Explain to the patient evidence that supports the positive outcome associated with each device. B.Engage the patient in conversation to allow the opportunity for questions to be answered. C.Provide the patient with the written instruction manuals from the device manufacturer. Correct Answer: B Rationale: An OTR may use a variety of methods to provide information to the patient, but a critical step to evaluate if the patient has understood the information is to discuss the recommendations with the patient and ensure all questions are answered.

An inpatient had a total hip replacement 3 days ago. During an intervention session, neither the patient nor the spouse appear interested in learning about the assistive devices for improving the patient's independence with BADL. What INITIAL action should the OTR take based on this observation?

A.Explore the couple's feelings about using the equipment. B.Document the reactions in the client's record and inform the care coordinator. C.Explain that assistive devices are essential to the patient's recovery. Correct Answer: A Rationale: One of the key features of client-centered practice is to collaborate with the client to establish a meaningful intervention plan.

A private practice OTR is developing goals for a 4-year-old child with autism spectrum disorder who has difficulty with emotional regulation, impulse control, and problem-solving skills. The child attends preschool, and academically is meeting expectations. Socially, the child has not developed friendships at school or within the neighborhood. Which task should be included as a short-term goal in the intervention plan for this child?

A.Follow rules while playing an age-appropriate board game. B.Play at the sand table without acquiring an injury. C.Interact with peers during a structured play group. Correct Answer: C Rationale: This is a developmentally appropriate goal for a 4-year-old child who has difficulty developing friendships.

A 6-year-old child has developmental delay associated with multiple hospitalizations for a congenital heart defect. The parents currently provide in-home care to meet the child's ongoing medical needs and daily BADL. One of the intervention goals is to teach the parents methods for including in-home playtime into daily routines. What information would be MOST BENEFICIAL for the OTR to provide the parents for supporting this goal?

A.Guidance on directing specific play sequences for age-appropriate activities B.Strategies for developing accessible play spaces the child can access independently C.Explanation about the benefits of playtime for the typically developing child Correct Answer: B Rationale: In a situation where there are highly complex caregiving responsibilities and high care needs, the opportunity for spontaneous play may be reduced. Providing the parents with strategies for developing accessible play spaces will support the child in having the opportunity to choose to play independently.

An OTR is providing intervention for an infant who has lower extremity spasticity secondary to cerebral palsy. The OTR is teaching the caregiver, who is a kinesthetic learner, handling techniques to inhibit the lower extremity spasticity while changing the infant's diaper. Which is the MOST EFFECTIVE method for the OTR to promote the caregiver's understanding of the information presented?

A.Have the caregiver demonstrate the inhibition method used during diaper change. B.Offer to demonstrate the techniques at the contextually appropriate time when the diaper is soiled. C.Provide the instruction in the natural setting where diapers are typically changed. Correct Answer: A Rationale: A kinesthetic learner will learn best by performing the activity, rather than listening to the instructions or watching a demonstration.

An OTR is developing an intervention plan for an inpatient who has major depressive disorder. The patient reports poor concentration, decreased pleasure in activity, inability to plan or prioritize tasks, and feelings of incompetence. What would be the BEST action for the OTR to take during the intervention planning process?

A.Have the client identify meaningful short-term goals. B.Have the client participate in social and leisure groups. C.Have the client engage in a multistep project. Correct Answer: A Rationale: Engagement in the occupational therapy process and progress toward a positive intervention outcome will be enhanced by assisting the client to develop meaningful goals.

A client has moderately severe cognitive decline secondary to Alzheimer's disease. The caregiver reports that the client becomes agitated when hand-over-hand assistance and setup support are provided during routine ADL in the home bathroom. Which recommendation would be MOST BENEFICIAL to include as part of caregiver training for reducing the occurrence of these behavioral responses?

A.Have the client use a checklist to mark off each step of a self-care activity as it is completed. B.Program an auditory timer and an electronic day planner to prompt the client to initiate self-care activities. C.Provide the client environmental cues by labeling drawers and posting pictures of tasks in the bathroom. Correct Answer: C Rationale: A client who has moderately severe cognitive decline secondary to Alzheimer's disease does not have the ability to use cognitive compensatory strategies but would benefit from environmental cues and modifications.

An OTR is preparing an intervention plan for a student in second grade who has attention deficit hyperactivity disorder. The student has difficulties getting ready for school, often misplaces homework assignments, and forgets to bring assignments from home to school. The OTR plans to help the student learn strategies to use in preparation for going to school each day. Which activity would be MOST EFFECTIVE for supporting initial progress toward this objective?

A.Help the student develop an organizational checklist to use as part of a treasure hunt game. B.Have the student follow a step-by-step instruction sheet during a class art project. C.Ask the student's parents to assist the student in completing a school needs checklist each morning. Correct Answer: A Rationale: Assisting the student to develop a checklist for a play-based activity is intrinsically motivating. It will teach the student the skill associated with developing a checklist that can then be transferred to developing a checklist to support the morning routine.

An inpatient recovering from pneumonia has decreased strength and endurance, and functional active ROM. The patient ambulates independently for short distances with the use of a walker. Medical history indicates the patient has recently been diagnosed with moderate macular degeneration. The patient will be discharged in one day to live alone in a single-story home. Which service should the OTR recommend as part of the patient's discharge plans?

A.Home health services to assess ADL needs and teach compensatory strategies B.Extension of current hospital stay for comprehensive rehabilitation services C.Short-term placement in a skilled facility to maximize independence in ADL Correct Answer: A Rationale: Since the patient can ambulate independently for short distances with the use of a walker, the patient will benefit from home health services in the natural environment of the home to further assess needs and teach compensatory strategies.

An OTR working in a community hospital is contributing discharge recommendations for a patient who is generally deconditioned secondary to complications from a septic episode. The patient has been participating in OT for the past 3 weeks. Currently, the patient requires moderate assistance with transfers and tolerates up to 10 minutes of seated ADL activity prior to needing a rest break. The patient's goal is to return home to live independently. Which discharge setting would be MOST BENEFICIAL for the OTR to recommend for the patient's next level of care?

A.Home health with skilled services B.Inpatient rehabilitation hospital C.Subacute rehabilitation facility Correct Answer: C Rationale: The MOST BENEFICIAL discharge recommendation based on the patient's current level of function and rate of recovery is a subacute rehabilitation facility.

To influence modifiable risk factors for readmission, which action should be a priority for an OTR working in an acute care hospital to complete prior to a patient's discharge home?

A.Identify an adequate support network. B.Discuss chronic disease and co-morbidities. C.Address unmet IADL and ADL needs. Correct Answer: C Rationale: ADL and IADL needs are considered modifiable risk factors that the OTR can address to positively influence the risk for readmission.

An OTR working in an acute rehabilitation facility is planning intervention for an adolescent who sustained bilateral femur fractures one week ago. The adolescent is restricted to non-weight-bearing status for at least 6 weeks. Currently, the adolescent is independent with grooming while seated and requires moderate assistance with lower body dressing, bathing and transfers. One of the goals is for the adolescent to be independent with ADL prior to discharge. What action is MOST IMPORTANT for the OTR to take prior to selecting intervention activities for this adolescent?

A.Identify barriers in the expected discharge context. B.Complete a wheelchair seating and mobility assessment. C.Determine a projected timeline for full recovery. Correct Answer: A Rationale: In order to ensure a safe and effective discharge, the MOST IMPORTANT action the OTR should take prior to discharge is to identify barriers and determine best solutions at the discharge site.

A student, who has autism spectrum disorder, becomes increasingly agitated during the school's holiday program. What is the FIRST action the OTR should take based on this observation?

A.Identify the behavioral trigger to develop a solution. B.Instruct the student in visual imagery relaxation exercises. C.Provide a visual timer to cue the student when the program is over. Correct Answer: A Rationale: In order to provide the most effective intervention strategy, the OTR would first need to identify the stimuli that triggered the behavior during the play and then introduce an appropriate strategy to address this trigger.

An OTR administered a criterion-referenced standardized developmental checklist to a 3 year-old-child who has mild developmental delay. The child did not meet the standard for snipping with scissors. For what purpose would these results be MOST USEFUL?

A.Identifying functional tasks that would be most difficult for the student B.Linking outcome measures to other typically developing children C.Comparing the child's performance to that of an age-equivalent population D.Determining developmentally appropriate activities to use in therapy Correct Answer: D Rationale: The purpose of a criterion-referenced test is to assess the child's performance against a specific criterion or measure rather than comparing performance to same-age peers. The OTR can use results of criterion-referenced tests to identify specific tasks to use as the focus of intervention.

An OTR working in a community mental health setting is using dialectical behavior therapy to guide intervention planning for a client who has a borderline personality disorder. The client works in a university setting and is at risk of losing the job due to verbal outbursts and erratic mood swings. The client is aware that behavioral changes are needed and reports a willingness to work toward these changes. Which type of intervention would be MOST BENEFICIAL for supporting progress toward this objective when using this approach?

A.Individual sessions focusing on Socratic questioning and guided discovery for addressing problematic situations and emotions B.Group skills training modules in mindfulness, interpersonal effectiveness, emotion modulation, and distress tolerance C.Role-play sessions using prepared scripts for practicing problem-solving and decision-making related to workplace situations Correct Answer: B Rationale: These interventions should be prioritized when an OTR is using the dialectical behavior treatment protocol to guide the therapeutic process.

What is the FIRST action an OTR should take if a client who has paranoid personality disorder becomes suspicious and reports feeling exploited during an intervention session?

A.Inform the client that therapy will be most effective through maintaining a positive attitude. B.Avoid confrontation and remind the client of the intentions of the therapeutic relationship. C.Report the behavior immediately to the referring physician and interprofessional team. Correct Answer: B Rationale: The general approach with a client who has a paranoid personality disorder is to avoid confrontation, and progressively engage the client to develop a trusting and effective therapeutic relationship.

An OTR working in a pediatric acute care setting is contributing to the discharge recommendations for a patient who was admitted to the hospital due to a pulmonary exacerbation of cystic fibrosis. Current medical interventions include mechanical ventilation support for breathing and multiple intravenous medications. The patient is weaning from the ventilator and long-term therapy goals include optimizing the patient's performance in ADL and IADL. Which discharge setting would be MOST BENEFICIAL for the OTR to recommend for the patient's next level of care?

A.Inpatient rehabilitation B.Subacute rehabilitation C.Long-term acute care Correct Answer: C Rationale: A long-term acute care setting is the most beneficial discharge disposition for this patient due to the high level of medical complexity including the need for a ventilator for respiratory support.

In addition to achieving client-centered short- and long-term goals, which of the following is the BEST example of an optimal overall outcome for a home health client who has multiple chronic conditions?

A.Integration of self-management strategies to positively influence symptoms associated with the health conditions B.Understanding the role of various payer sources to successfully navigate reimbursement systems C.Knowledge of the trajectory of disease processes to identify needed pharmaceuticals and medical interventions Correct Answer: A Rationale: The optimal outcome for a home health client with chronic conditions is to independently integrate self-management strategies to allow for maximum participation in everyday life after discharge from OT.

An inpatient who has pneumonia and mild cognitive decline has been stabilized in the hospital and is medically ready for discharge. Currently, the patient requires constant supervision for ADL and IADL due to safety concerns and impulsive behavior. The patient and family have declined the treatment team recommendation that the patient move into an assistive living facility. Which option represents the MOST IMPORTANT discharge recommendation the OTR should provide the family?

A.Involve the patient in a structured adult day program. B.Modify the home environment prior to discharge. C.Provide the patient with 24-hour supervision. Correct Answer: C Rationale: The patient requires 24-hour supervision to ensure safety due to mild cognitive decline and impulsive behaviors.

An inpatient had a CVA with flaccid hemiplegia 8 days ago. When the OTR arrives for the scheduled session, the patient reports pain in the axillary region of the affected upper extremity. The OTR notes significant edema in the arm and that the arm is warm to the touch. Which of the following is the BEST option for why the OTR should alert the physician about these observations?

A.Late effect of cerebrovascular disease B.Subluxation of the shoulder C.Deep vein thrombosis Correct Answer: C Rationale: Symptoms of edema, pain, and localized warmth in a flaccid extremity could indicate possible presence of a deep vein thrombosis.

An OTR is providing consultation to an early intervention program. The OTR has developed a weekly parenting skills group that is being facilitated by a COTA. After 3 weeks, the COTA reports that group attendance is poor. What action should the OTR take FIRST?

A.Observe and provide feedback on the COTA's leadership skills. B.Suggest that the COTA advertise the group in the community C.Explore possible reasons for low attendance with the COTA. Correct Answer: C Rationale: Prior to providing solutions to solve the attendance problem, the initial action the OTR should take is to discuss with the COTA possible reasons why parents have been unable to attend the group.

A 16-month-old child who has severe spasticity is receiving OT in the home. The parents, who both have intellectual disabilities, have been trained in a stretching program for the child. Which option represents the BEST method to assess the parent's understanding of the program?

A.Observe the parents demonstrate the stretching regimen. B.Request a home health aide perform routine monitoring. C.Have the parents complete an exercise log. Correct Answer: A

An OTR completed an initial assessment of a second-grade student with a learning disability. Results indicate the student has average fine motor skills, but test scores on a standardized test of visual perceptual skills are well below normal. Which of the following activities would be MOST challenging for the student based on the outcomes of the evaluation?

A.Opening lunch containers B.Cutting on a bold, thick line C.Organizing school supplies Correct Answer: B Rationale: Visual perceptual skills are required to attend to a line while cutting.

An OTR is developing an intervention plan for a child who has multiple physical disabilities. Which contextual factors are MOST IMPORTANT for the OTR to consider as part of this decision making process?

A.Parent goals and research studies supporting the proposed intervention B.Number of intervention sessions approved by the child's health care plan C.Techniques and equipment needed to implement the intervention plan Correct Answer: A Rationale: Although all options represent considerations when developing an intervention plan, using the principles of evidence-based and client-centered practice are most important.

An OTR who works in a home health setting is developing educational handouts for clients who have low vision. Which guidelines are MOST BENEFICIAL for the OTR to use when developing educational handouts for this population?

A.Pictorial illustrations and written information placed in columns on the page B.Many different colors to highlight important information printed on high-gloss paper C.Large print with a minimum of 16-point font with high contrast between the text and the paper Correct Answer: C Rationale: These features will increase the readability of educational materials for clients who have low vision.

An OTR working in an outpatient setting is planning intervention for a client who has a trigger finger of the third digit on the dominant hand and wants to avoid surgical intervention. The client reports symptoms associated with this condition are limiting the ability to participate in everyday activities. What should the OTR include as part of the INITIAL intervention with this client?

A.Place the hand in an intrinsic plus position and provide education on how to perform a PROM and AROM program 3 times per day. B.Prescribe a static immobilization orthosis to position the affected MCP joint at 0° and instructions to avoid MCP flexion. C.Support the MCP, DIP, and PIP in maximal extension and provide a list of activities that encourage MCP flexion. Correct Answer: B Rationale: For a diagnosis of trigger finger, the optimal position includes maintaining the MCP joint at 0° while allowing the DIP and PIP full AROM, and instructions to avoid MCP flexion.

An older adult client, who is recovering from pneumonia and sepsis, has been participating in home health OT since being discharged from an acute care hospital 3 weeks ago. During a transfer training session in the client's bedroom, the OTR notes the smell of urine and evidence of incontinence. What is the FIRST action the OTR should take based on this observation?

A.Plan to discretely discuss the findings with the client's spouse. B.Establish a new short-term goal for independence in toileting. C.Ask the client if it is difficult to get to the bathroom in time. Correct Answer: C Rationale: Prior to establishing a new goal or collaborating with the client's spouse, it is important to for the OTR to gather information and evaluate contributing factors associated with this observation.

A patient has flaccid hemiplegia and dysphagia secondary to a CVA one month ago. The patient is participating in an interprofessional rehabilitation program. One of the intervention goals is for the patient to regain independence with self-feeding and become safe when eating. What information about the patient is MOST IMPORTANT for the OTR to present to the interprofessional team during each care coordination meeting?

A.Positioning, adaptive devices and caregiver assistance needed during mealtimes B.Specific evidence-based techniques that are being used during intervention sessions C.Improvements in upper extremity movement patterns used for self-feeding D.Ability to select nutritious foods from the hospital dining menu that are safe to swallow Correct Answer: A Rationale: The primary purpose for an interprofessional team approach is to make collaborative decisions and coordinate patient care. Presenting information about the patient's current abilities enables other team members to reinforce these skills during functional tasks (e.g., properly positioning the patient and providing appropriate assistive devices during meals).

An OTR is using the Modified Ashworth Scale (MAS) to monitor a client's degree of spasticity in response to a newly implemented medication regimen. At the start of the regimen, the OTR rated the client's wrist and finger spasticity on the MAS as grade 3. Two weeks after the regimen, the rating changed to grade 1. What does this change represent?

A.Positive change in muscle tone resulting in increased functional use of the affected upper extremity B.Decrease in overall muscle tone when the affected wrist and digits are passively moved into flexion and extension C.Slight change in muscle tone through most of the ROM, but negligible change in active use of the wrist or hand Correct Answer: B Rationale: The scores in the Modified Ashworth Scale (MAS) range from (0) - No increase in muscle tone to (4) - Affected part(s) rigid in flexion or extension. A lower score after two weeks, indicates a decrease in overall muscle tone.

An OTR is working with a client who has Stage 5 Alzheimer's disease and lives with a full-time caregiver. Based on this stage of the disease process, which option would be the MOST BENEFICIAL recommendation for the OTR to make to the caregiver?

A.Post an illustrated daily schedule for the client to follow. B.Encourage the client to participate in a new hobby. C.Provide assistance for dressing and grooming activities. Correct Answer: C Rationale: A client with stage 5 Alzheimer's disease has moderately severe cognitive decline and would benefit from assistance for ADL such as dressing and grooming.

A client in the outpatient setting recently underwent plastic surgery to correct facial disfigurement. During a grooming session, the client states, "I will never look in the mirror again." What action should the OTR take in response to the client's concern?

A.Provide positive affirmations and encourage the client to seek reassurance from close friends. B.Validate the client's concerns and transition to the next intervention that does not require a mirror. C.Provide support and ask open-ended questions to gain insight into the client's view on their body image. Correct Answer: C Rationale: The client is expressing concerns regarding body image that warrants further assessment by the OTR prior to determining the need for consultation with the physician or modifying the intervention plan.

An 8-year-old child sustained second-degree burns to the first web space of both hands one month ago. Results of a reevaluation indicate the child's web space is contracting despite wearing pressure garments, using night orthotics and completing home program activities. What additional action should the OTR take based on these findings?

A.Provide the caregiver with a list of age-appropriate games that will promote hand use. B.Begin serial splinting that incorporates a polymer gel sheet over the affected areas. C.Advise the caregiver to increase the intensity and frequency of passive ROM exercises. D.Use a paraffin modality during OT sessions to soften the scar prior to functional activity. Correct Answer: B Rationale: Intervention that includes serial static orthoses and polymer gel sheeting is effective for contractures of the thumb web space.

An inpatient in the cardiac intensive care unit had a myocardial infarction 3 days ago. The patient is overwhelmed and shocked by the unexpected change in functional abilities. To facilitate a positive adaptive response to this medical situation, what action would be MOST BENEFICIAL for the OTR to take?

A.Provide the patient with information on current abilities and limitations. B.Provide support and empathy while the patient expresses feelings. C.Teach the patient that feelings of grief and depression are to be expected. Correct Answer: B Rationale: Allowing the patient to express feelings of shock and disbelief during this phase of rehabilitation will facilitate a positive adaptive response.

An adolescent was recently admitted to an inpatient psychiatric unit due to symptoms associated with a conduct disorder. Evaluation results indicate the adolescent has a poor self-concept, decreased fine and gross motor coordination, and is socially aggressive. What should be the focus of the INITIAL sessions with this adolescent?

A.Providing opportunities for success in a consistent structured environment B.Enhancing physical abilities for completing responsibilities at home C.Encouraging participation in self-expression group activities D.Presenting options for pre-vocational exploration and practice Correct Answer: A Rationale: Since a symptom of this disorder includes poor impulse control, providing structure and consistency should be inherent in each treatment session with this adolescent. Additionally, successful experiences help to build self-concept.

An OTR wants to measure the effectiveness of a pre-vocational group at a mental health day program. What data is MOST IMPORTANT to collect for this purpose?

A.Quality of the client's interview responses during role-play activities with peers B.Attendance levels and completion rate of homework assignments C.Number of clients who successfully enter employment positions following the group D.Client satisfaction ratings completed by participants after discharge Correct Answer: C Rationale: Quantitative data, such as measuring the number of clients who successfully enter employment positions after participating in the group, is MOST IMPORTANT to contribute to the understanding about the effectiveness of the group.

Which intervention activity would be MOST BENEFICIAL to use with an inpatient who has depression and poor initiation?

A.Recommend that the patient attend a planned exercise program with peers. B.Have the patient independently navigate the facility to locate spaces used for social activities. C.Engage the patient in a 1:1 intervention activity involving a previously enjoyed leisure activity. Correct Answer: C Rationale: A patient with poor initiation will benefit from a structured 1:1 intervention session that involves a client-centered and motivating activity.

An OTR working in an outpatient setting is planning intervention for a client who has a 12-month history of fibromyalgia. The client reports symptoms associated with this condition are limiting the ability to participate in social activities. This has led to significant frustration and progressive social isolation over the past few months. The client wants to reverse this trend. What should the OTR include as part of the INITIAL intervention planning process with this client?

A.Recommend the client maintain a journal as a means of venting frustration. B.Explore hobbies the client can try at home that do not exacerbate pain. C.Identify options for modifying the client's preferred community activities. Correct Answer: C Rationale: This option is an effective client-centered intervention to address the client's goal and allow for participation in activities outside the home.

An OTR is evaluating an older adult in patient who has had a rapid decline in self-feeding and dressing skills. The patient was confused and unable to respond to verbal instructions. Before the OT intervention plan was implemented, medications were adjusted and the patient's mental status improved. What action should the OTR take FIRST in this situation?

A.Reevaluate the patient B.Follow the established plan C.Write new short-term goals Correct Answer: A Rationale: From the time of the initial evaluation to the first treatment session, this patient had a significant change in function associated with a change in the medication regimen. A reevaluation is warranted to establish current level of function, and to update the intervention plan.

An OTR is working with a client who has post-traumatic stress disorder and reports persistent symptoms of anxiety and interrupted sleep, which impairs function in ADL. Which intervention method should the OTR focus on FIRST?

A.Relaxation techniques B.Cognitive retraining C.Routine physical activity Correct Answer: A Rationale: Although all options represent effective intervention methods for PTSD, relaxation techniques provide the client with a specific strategy to address the symptom of anxiety associated with poor sleep.

An OTR is providing home health services to a 9-month-old infant who underwent surgery for a Type I Chiari malformation one month ago. The infant has been progressing without complication since the date of surgery. During a follow-up home visit, the infant's parent reports lack of progress with the home program because the infant has been extremely lethargic for the past few days and has had several episodes of vomiting within the past 12 hours. What should the OTR advise the parent to do based on the infant's current condition?

A.Report the infant's symptoms as soon as possible to the primary care physician. B.Reschedule the appointment for the next week when symptoms should be resolved. C.Monitor the infant's flu-like symptoms for the next 24 hours and ensure fluid intake. Correct Answer: A Rationale: Possible complications associated with the surgical procedure for Chiari malformation that warrant immediate contact with the physician include decreased alertness, increased drowsiness, and vomiting.

An OTR working in a home health setting is collaborating with a client who has mild dementia to establish client-centered goals and to obtain informed consent for the intervention plan. Which action should the OTR complete NEXT as part of the informed consent process for this client?

A.Request that the client's caregiver review the care plan. B.Assess the client's decision-making skills. C.Interview the client to determine cognitive capacity. Correct Answer: B Rationale: The OTR needs to assess the client's decision-making skills in order to determine if the client has the cognitive ability to provide consent for treatment.

A client who has substance use disorder is referred to OT for assistance with leisure skill acquisition to help maintain sobriety. Which intervention priority is MOST IMPORTANT for the OTR to include in the intervention plan?

A.Schedule the client to work as a volunteer at the clinic B.Provide the client with a list of nearby recreational facilities C.Assist the client to identify activities that are of interest Correct Answer: C Rationale: Having the client identify meaningful and motivating leisure activities is the MOST IMPORTANT intervention priority to support progress toward a leisure skill acquisition goal.

An inpatient had a L5 spinal cord injury one week ago. Results of the American Spinal Injury Association (ASIA) Impairment Scale (AIS) indicate the classification of the patient's injury is ASIA B. What do the results of this scale suggest?

A.Sensory incomplete impairment below the level of the lesion B.Motor incomplete impairment below the level of the lesion C.Complete motor and sensory impairment below the level of the lesion Correct Answer: A Rationale: ASIA B classification indicates an incomplete spinal cord injury where sensory function is preserved below the level of the lesion but not motor function.

A patient who has early Stage III Alzheimer's disease is being discharged home from an inpatient facility under the supervision of a caregiver. What recommendations should the OTR provide to the caregiver as part of the discharge instructions?

A.Simplify the home surroundings and reduce stimuli B.Assist the patient in developing leisure and social skills C.Encourage the patient to explore new environments Correct Answer: A Rationale: A patient at this stage of Alzheimer's disease would benefit from contextual recommendations such as simplifying the home environment and reducing stimuli.

An OTR working in an acute care setting is contributing to the discharge recommendations for an older adult inpatient. The patient has mild cognitive impairment and was admitted to the hospital 4 days ago due to a syncopal event with a diagnosis of atrial fibrillation and hypertension. The patient lives with family who are available to provide care as needed, but the patient wants to be independent in ADL. Currently, the patient completes BADL with supervision, but occasionally relies on physical assistance from a caregiver to stand up from the toilet. Which discharge setting would be MOST BENEFICIAL for the OTR to recommend for the patient's next level of care?

A.Skilled nursing facility B.Home with home health services C.Inpatient rehabilitation Correct Answer: B Rationale: This patient does not meet criteria for inpatient rehabilitation. The discharge recommendation for this patient is home with OT through home health services because the family are able to provide periodic assistance when needed as the patient makes progress towards independence in ADL.

An OTR has completed an evaluation of a patient who is experiencing complications from pneumonia and was recently admitted to a Medicare funded skilled nursing facility. The patient was living independently prior to hospitalization and wants to return home. Evaluation results indicate the patient is generally deconditioned and fatigues quickly during activity. The patient ambulates slowly using a walker, and requires frequent verbal and physical cueing for safety when using the walker during ADL. What criteria should the OTR use to prioritize the goals for this patient's intervention plan?

A.Skilled services the patient currently requires for completion of basic functional tasks. B.Amount of assistance that will be available to the patient to maintain progress after discharge. C.Amount of time the patient will need to maximize strength and endurance prior to returning to independent living. D.Patient's desire to improve strength, ROM, and endurance prior to discharge from the facility. Correct Answer: A Rationale: In a Medicare funded facility, the OTR must prioritize goals based on medical necessity and skilled services needed for function.

Which interprofessional team member would be MOST BENEFICIAL for an OTR to refer a middle-school student who has expressed suicidal ideation?

A.Social worker B.Physician C.Psychologist Correct Answer: B Rationale: Expression of suicidal ideation by a student warrants immediate contact with the interprofessional team and a referral to the student's primary care physician.

An inpatient who had a left CVA one week ago is participating in a dressing session. After putting on a sock during lower body dressing, the patient repeatedly attempts to pull the sock up even though it is already in place. What neurobehavioral deficit is MOST CONSISTENT with these actions?

A.Spatial inattention B.Premotor perseveration C.Somatagnosia D.Dressing apraxia Correct Answer: B Rationale: Premotor perseveration results in repetition of movements and difficulty transitioning from one aspect of an activity to another.

An inpatient had a right CVA one week ago. Prior to the CVA, the patient was relatively healthy and worked a full-time job. During a dressing assessment, the patient puts on a pull-over sweater and then realizes the need to put on a T-shirt underneath the sweater. To do this, the patient attempts to insert the T-shirt down the neckhole of the sweater, instead of removing the sweater to put on the T-shirt. Which statement MOST ACCURATELY describes the reason for the patient's action?

A.Spatial integration deficits may be affecting the ability to recognize items. B.The central nervous system is not receiving complete visual information. C.The patient is not able to conceptualize steps of a task due to ideational apraxia. D.Right hemispheric damage appears to have resulted in perseverative behaviors. Correct Answer: C Rationale: The patient is exhibiting ideational apraxia which involves difficulty conceptualizing, sequencing, and executing a plan using ADL items or objects.

An OTR is formulating a discharge plan for an inpatient who has dementia and is functioning at Allen Cognitive Level 4 (Goal-Directed Actions). The patient will be living at home with assistance from family. What type of caregiver education is MOST IMPORTANT for the OTR to provide prior to the patient's discharge from the inpatient facility?

A.Strategies for providing visual cues that will help the patient complete daily routines B.Methods for promoting the patient's problem solving for independence during ADL C.Techniques for establishing and posting a written emergency plan in the home environment D.Suggestions for modifying the environment to eliminate unnecessary household items Correct Answer: A Rationale: A person who is functioning at Allen Cognitive Level 4 (Goal-Directed Actions) is able to complete basic ADL with visual cues.

A client sustained a severe hand injury 5 weeks ago. During an OT session, the client reports that family responsibilities make it impossible to complete the prescribed exercise and splinting program. What action should the OTR take in response to this comment in order to promote the client's successful participation in the home program?

A.Suggest transition to a compensatory approach for dealing with residual deficits. B.Advise the client to make the home program the highest priority for the short term. C.Analyze a 24-hour log to determine time management issues the client is experiencing. D.Determine a home program that closely aligns with typical performance patterns. Correct Answer: D Rationale: Incorporating the home program into the client's existing performance routines will enhance the opportunities for successful completion within a busy schedule.

Which option represents the final phase of the occupational therapy process?

A.Supporting the transfer of newly acquired skills to the environments and contexts that are important to the client B.Measuring outcome through assessment of participation, quality of life, performance, and / or satisfaction C.Providing community-based resources to promote carry-over of abilities into everyday habits and routines Correct Answer: B Rationale: The final step in the occupational therapy process is to administer a performance-based outcome measure to evaluate the overall effectiveness of the intervention.

An OTR has completed a developmental assessment of a 6-year-old child who has Down syndrome. Results indicate the child is dependent in all self-care tasks. The parents do not place a high priority on dressing independence, but the OTR does. What action should the OTR take as part of the intervention planning process?

A.Talk with the parents about establishing independence in self-care skills as a primary goal. B.Collaborate with the parents to identify mutually acceptable treatment goals for the child. C.Inform the parents that school-age children are expected to be independent with self-care. D.Ask for the parents' consent to begin working on specific self-care skills with the child. Correct Answer: B Rationale: Understanding and integrating cultural values is integral to the client-centered intervention planning process.

An outpatient client is undergoing medical treatment for breast cancer and has debilitating chemotherapy-induced peripheral neuropathy of the hands and feet. The client wants to attend social events with friends, but feels distressed over a fear of falling and frequently dropping objects. In addition to providing fall prevention strategies and recommending adaptive equipment, which intervention priority would be MOST BENEFICIAL for the OTR to include in sessions to support progress toward this goal?

A.Teach the client to manage symptoms of neurological pain. B.Recommend a yoga class at a community center. C.Address the client's psychosocial well-being. Correct Answer: C Rationale: Fear of falling is a health problem that can be addressed by providing specific interventions for the client's psychosocial well-being.

An outpatient client has an acute flare-up of stage I rheumatoid arthritis. Initial evaluation results indicate the client's MCP joints bilaterally are red and swollen. The client lacks 10° active extension of the MCP joints on the second through fifth digits bilaterally. The client works as a florist and reports pain as 9 out of 10 on a visual analog scale when completing activities requiring grasp and prehensile patterns. The client will be participating in OT twice weekly. Which therapeutic exercise should be included as part of the intervention plan for the client to complete by the end of the first week of therapy?

A.Tendon gliding exercises of the fingers against light resistance therapy putty B.Pinching and gripping a soft sponge in warm water within pain tolerance C.Passive motion and stretch of the MCP joints through the full arc of motion D.Isotonic and isometric exercises of both hands within pain-free ranges of motion Correct Answer: D Rationale: During an acute flare up, exercises are important for preserving joint mobility and preventing deformities. Exercises should be completed with caution especially in the presence of painful and swollen joints.

An OTR who works in an inpatient rehabilitation setting is using the FIM™ as a clinical measurement tool to evaluate and monitor the progress of a patient who had a stroke. What additional information can the OTR obtain from interpreting the results of the FIM™ with this patient?

A.The future discharge status of the patient related to level of assistance required for the patient to perform self-care tasks B.The health outcomes for the patient related to stroke, including ADL, IADL, and participation levels C.The patient's potential to return to daily activities at home and in the community Correct Answer: A Rationale: The FIM™ is a measurement tool that has been shown to predict the discharge disposition for patients who have had a stroke.

An inpatient had a CVA several days ago and requires moderate physical assistance for ADL and mobility. An initial screening indicates the patient has intact anticipatory awareness. Based on this finding, the OTR reports the patient is an excellent candidate for rehabilitation. Which statement represents a rationale for this decision?

A.The patient will have fewer neurobehavioral deficits and will have better carry-over of learning. B.The patient will recognize tasks that have inherent risk and will be able to self-monitor task performance. C.The patient will be more motivated to follow-through on recommendations made during therapy. Correct Answer: B Rationale: Anticipatory awareness refers to a patient's ability to accurately complete a self-assessment and predict performance errors based on current strengths and weaknesses.

An OTR is evaluating the biceps strength of a client recovering from a musculocutaneous nerve injury. The OTR asks the client to fully flex the elbow while the client is seated upright with the shoulder adducted, the elbow fully extended, and the forearm in supination. The OTR observes that the client's forearm consistently moves into midposition on each attempt to flex the elbow despite prompting the client to maintain the forearm in supination. What conclusion can the OTR make based on this observation?

A.The pronator teres muscle should be blocked on future testing. B.The movement should be retested with the client positioned in prone. C.The brachioradialis muscle is substituting for the weaker prime mover. D.The muscle strength of the biceps should be graded as Poor (2/5). Correct Answer: C Rationale: The brachioradialis is innervated by the radial nerve and is substituting for weak biceps. This results in movement of the forearm into midposition when attempting to actively flex the elbow against gravity.

A school-based OTR is establishing a new goal for a student in middle school who has poor handwriting legibility secondary to delayed fine motor and visual motor skills. The student reports frustration with inability to complete written assignments on time, and the teacher reports that poor legibility impacts ability to grade the assignments. Which of the following is the BEST goal to meet the student's needs in the classroom by the end of the IEP cycle?

A.The student will rotate pencil from tip to eraser 10 times without dropping on 2 consecutive data days while completing dexterity activities. B.The student will write a 5-sentence paragraph with 80% legibility when provided with a visual model and paper with a highlighted baseline. C.The student will type a 5-sentence paragraph in 20 minutes when provided with word prediction software and keyboarding device. Correct Answer: C Rationale: Recommendations for assistive technology to accommodate for poor handwriting legibility is warranted to support this middle school student to progress toward achieving full academic potential.

An inpatient in an intensive care unit is in the initial acute phase of Guillain-Barré syndrome. The OTR modified the nurse call bell to allow the patient to use available neck movement to push against a switch attached to the pillow. What additional interventions would be MOST BENEFICIAL for the patient during this phase of the disease process?

A.Therapeutic exercise program for strengthening B.Balance and vestibular training for self-care activities C.Positioning and PROM to minimize contractures Correct Answer: C Rationale: During the initial acute phase of Guillain-Barré syndrome, intervention methods to prevent complications such as positioning and PROM are recommended.

An OTR is interpreting scores of a developmental test that was administered to a 3-year-old child. The child scored at the 89th percentile for the child's age and gender group. What can the OTR conclude based on this score?

A.These scores are sensitive for measuring small changes in the child's overall development. B.The child has minor developmental deficits compared to the normative sample group. C.Eleven per cent of the children in the sample group scored higher than this child. D.This child displays above-average developmental skills compared to similar children. Correct Answer: C Rationale: The percentile score is the percentage of subjects that score at or below a particular raw score.

An OTR is planning an intervention session for a 6-year-old child who has fetal alcohol syndrome. The child has difficulty coping when frustrated and frequently refuses to speak in social situations and during therapy. The OTR has attempted to engage the child using play therapy and sensory-based approaches, but the child refuses to participate. How should the OTR modify the intervention approach based on the child's responses during previous interventions?

A.Use role-play scenarios about interacting with super heroes. B.Engage the child in computer games that promote positive feedback. C.Include expressive media using cartoon character puppetry. Correct Answer: C Rationale: Expressive media such as puppetry is an effective intervention approach to support the child's engagement in the therapeutic process.

A young adult client was diagnosed with axonotmesis of the ulnar nerve secondary to a crush injury of the forearm 2 weeks ago. After obtaining baseline assessment information, which technique would be MOST IMPORTANT for the OTR to teach to the client as part of the intervention during the initial phase of the client's rehabilitation?

A.Visual compensation B.Hand-dominance retraining C.Sensory re-education D.Isometric strengthening Correct Answer: A Rationale: Axonotmesis results in loss of protective sensation to the affected nerve distribution. This injury does not require surgical intervention and typically resolves within 6 months from initial injury. Since sensation is impaired in the ulnar distribution, it is MOST IMPORTANT to teach the client to use visual skills as a compensatory means for protecting the hand from further injury.

An inpatient has been participating in rehabilitation since having bilateral transfemoral amputations 2 months ago. The patient has good balance and Fair plus (3+/5) upper extremity strength, is independent with bed mobility and self-care using adaptive equipment, and requires stand-by assistance during wheelchair transfers and with wheelchair management. The patient is preparing for discharge to live at home with the spouse and an adult son. Modifications have been made to the main entrance of the home and the bathroom. The OTR plans to provide family education for promoting the patient's safe transition to the home environment. What information would be MOST BENEFICIAL to include as part of this process?

A.Wrapping techniques for shaping and protecting the residual limb B.Methods for improving the patient's independence with transfers C.Energy conservation techniques for the patient to use during ADL D.Techniques the patient uses to transfer to a variety of surfaces Correct Answer: D Rationale: To provide safe transition to the home environment, it is important for the OTR to provide 1:1 instruction based on the needs of both the patient and the caregiver. In this case, the caregivers need to be competent in techniques the patient uses to transfer to a variety of surfaces prior to discharge.

A patient who has hemiplegia and cognitive-perceptual deficits has been transferred from an acute care facility to a skilled nursing rehabilitation unit. When should discharge planning for this patient take place?

Correct Answer: A Rationale: The OTR should formulate the intervention plan based on the outcomes of the initial assessment and in relation to the intended discharge environment. The discharge plans should be reassessed, as needed, based on the functional progress the patient demonstrates throughout the rehabilitation process.

An OTR, who works in medical oncology, plans to have an inpatient walk to the bathroom and complete all steps for showering. Prior to the session, the OTR reviewed the medical record and noted that the international normalized ratio (INR) value for the patient is greater than 5.0. What action should the OTR take based on this INR value?

Have the patient walk to the sink for a sponge bath. B.Cancel the intervention session planned for the day. C.Proceed with the showering activity as planned. Correct Answer: B Rationale: A patient with an INR > 5 is at risk for bleeding and is typically placed on bedrest or activity restrictions.

An 8-year-old student who has an autism spectrum disorder shows signs of distress during routine planned fire drills conducted at the school. This interferes with the teacher's ability to evacuate the students from the classroom. Which approach should the OTR recommend to the teacher for reducing the student's stress level during these fire drills?

Provide the student with headphones to put on whenever the fire drill alarm begins to sound. B.Provide the student with a picture board illustrating the sequence of steps the class will use during the fire drill. C.Ensure an aide is in the classroom to calm and escort the student during planned fire drills. Correct Answer: B Rationale: Providing the student a picture board will support the student in learning the steps associated with a fire drill, and allow for greater preparedness in the event an actual emergency.

Which interprofessional team member would be MOST BENEFICIAL for an OTR to refer an elementary student who may need modification to the academic curriculum to achieve grade level success in reading and writing?

Speech language pathologist B.Special education teacher C.Pediatric ophthalmologist Correct Answer: B Rationale: A special education teacher is a member of the interprofessional team who works to modify academic curriculum to support the student in achieving grade level expectations.