d3 study guide

An OTR is providing ramp specifications for a client with a disability who uses a power wheelchair for mobility. What is the minimum gradient for the ramp that the OTR should recommend to this client?

A.1:10 B.1:12 C.1:6 Correct Answer: B Rationale: The standard ratio of rise to run for a wheelchair ramp is 1:12.

An OTR is selecting a seat cushion for a client who has tetraplegia. The primary objective is to select a cushion that provides even distribution of pressure relief to the buttocks when the client is seated in a wheelchair. Which type of cushion would be MOST EFFECTIVE for this purpose?

A.Air-filled B.Honeycomb gel C.Soft foam Correct Answer: A Rationale: Air-filled seat cushions are lightweight and provide even distribution of pressure relief.

An OTR working in a pediatric outpatient setting approaches the therapy manager and states, "I believe my colleague is billing for interventions that are not being provided during client sessions." After acknowledging the practitioner's concern, what actions should the manager take NEXT?

A.Ask the OTR to provide supporting proof of the colleague's misconduct. B.Initiate a review of internal clinical service coding and billing practices. C.Develop a remediation program for resolving future billing issues. Correct Answer: B Rationale: The manager is responsible for the oversight of billing practices utilized by the occupational therapy staff.

An OTR is seeking a pressure-relieving seat cushion for a client who uses a wheelchair throughout the day. The primary objective is to select a lightweight, inexpensive cushion that provides even distribution of pressure relief to the buttocks when the client is seated in the wheelchair. What is the MOST EFFECTIVE type of cushion for this purpose?

A.Foam B.Gel C.Air-filled Correct Answer: A Rationale: Foam material is lightweight, inexpensive and provides a stable base of support.

An OTR who works in a school is planning a session for a kindergarten student who has Down syndrome. The student can push down their pants during toileting, but is unable to pull them up. Which technique would be MOST BENEFICAL to include as part of the initial intervention for this student?

A.Assist the student with pulling up their pants. B.Train the staff on methods to support the student. C.Use games and activities that support pinch strength. YOU ARE CORRECT! Your Answer: C Correct Answer: C Rationale: Low tone and reduced strength is associated with Down syndrome. This remediation technique focuses on increasing hand strength to support the goal of being able to pull up pants after toileting.

A 6-year-old child who has mild ataxic cerebral palsy has been referred to OT for handwriting skill development. When implementing treatment, what action should the OTR take FIRST?

A.Attach a wrist cuff weight to promote forearm stability. B.Fabricate a thermoplastic splint for the dominant hand. C.Facilitate letter formation by having the child trace simple lines. D.Position the child`s wrist in slight extension and the forearm in 45° of pronation. Correct Answer: D Rationale: Prior to implementing compensatory and rehabilitative approaches, the OTR should FIRST ensure the child is optimally positioned to support progress toward the handwriting goal

An OTR working in a children's hospital has been providing services on a daily basis for the past several weeks to a school-age child hospitalized for treatment of a systemic congenital condition. When the OTR arrives at the child's room for the next scheduled session, there is a sign posted on the door indicating enteric contact precautions are in place. What action MUST the OTR take based on this observation?

A.Cancel sessions with the child until these precautions are no longer in place. B.Rub hands with an alcohol-based hand sanitizer at the end of sessions with the child. C.Follow transmission precaution procedures when interacting with the child. Correct Answer: C Rationale: To prevent the spread of the infectious agent, the OTR in this circumstance should use transmission precautions procedures when interacting with the child.

A student in the second grade has spastic quadriplegia secondary to cerebral palsy and uses a power wheelchair for mobility. The OTR observes the student throwing and catching a ball with peers during gym class. As the student attempts to throw the ball, the trunk shifts laterally and the student has difficulty moving back to midline to continue the game. What modification to the wheelchair would be MOST EFFECTIVE for promoting postural stability to maintain a proper base of support while this student is throwing and catching the ball?

A.Chest harness B.Thigh and pelvic strap C.Lap tray attachment Correct Answer: A Rationale: Adding a chest strap to the power wheelchair during gym class will allow the student the opportunity to participate in the game using full effort without a fear of falling forward or losing balance.

An OTR is providing supervision to a rehabilitation aide, who assists a patient with bathing. During the initial OT evaluation, the patient identified independence in bathing as a priority goal and was assessed to require 25% assistance. However, the aide tells the OTR that the patient wants total assistance during bathing sessions and frequently asks the aide to complete tasks that the patient can perform. What is the FIRST action the OTR should take to support progress toward the patient's bathing goal?

A.Conduct a joint session with the patient and the aide to review goals for bathing. B.Document the discrepancy in the patient's performance level between the OTR and the aide. C.Plan to re-evaluate the patient's level of assistance for bathing during the next scheduled session. Correct Answer: A Rationale: It is the responsibility of the supervising OTR to provide adequate supervision and training to ensure the effectiveness of the intervention.

A client who has low vision is learning methods for handling money when shopping for personal items in a store. The client is able to identify coins using touch, but wants suggestions for handling paper monetary denominations. Which recommendation should be included as part of the INITIAL intervention with this client?

A.Consistently place money denominations in a specific order in a wallet. B.Pay for purchases using a bank debit card instead of paper money. C.Use a consistent method of folding individual denominations. Correct Answer: C Rationale: An adaptive strategy that will support independence in money management in a client who has low vision is to use a consistent method for folding each individual denomination.

A patient with a borderline personality disorder was admitted to an inpatient facility 4 days ago secondary to an exacerbation of suicidal and self-mutilating behavior. The patient's condition is now stable and the patient is functioning at Allen Cognitive Level 5 (Exploratory Actions). The patient reports being overwhelmed by a new personal relationship, experiencing job dissatisfaction, and feeling a lack of control in most daily situations. Which intervention would be MOST BENEFICIAL for addressing problems in performance skills and patterns secondary to the concurrent symptoms?

A.Coping skills groups that address a variety of adaptive strategies B.One-on-one sessions to encourage the patient to contract for safety C.Structured one-step craft activities to promote successful outcomes D.Daily self-care sessions that focus on structured BADL Correct Answer: A Rationale: Patients functioning at this cognitive level typically are able to use problem solving and inductive reasoning. This type of group provides the patient with opportunities to learn adaptive coping strategies that can be used in a variety of situations relative to the patient's typical performance skills and patterns.

An inpatient had a total hip replacement 2 weeks ago. The OTR is discussing home set-up and seating options with the patient as part of the discharge instructions. What type of seat should the OTR recommend the patient sit on when watching television at home?

A.Cushioned, armless dining chair elevated on one inch (2.54 cm) high blocks B.Firm raised armchair with a wedge pillow roll between the cushion and back of the chair C.Sofa with enough length to allow the patient to elevate both legs on the seat cushions D.Upholstered reclining chair with extra pillows to elevate the affected leg Correct Answer: B Rationale: This allows optimal positioning for designated hip precautions.

A student in the first grade has moderate hypotonicity resulting in poor oral motor control. One of the student's goals is to be able to "eat the same foods as the other kids" at lunchtime in the cafeteria at school. Currently, the student requires moderate assistance when eating and eats a soft diet. What should be the INITIAL focus of intervention for progressing toward this goal?

A.Determining which cafeteria foods have the textures the student can eat B.Asking the student to identify specific food preferences from the cafeteria menu C.Identifying seating and positioning options for the student in the cafeteria D.Providing the student with assistive devices to use when eating in the cafeteria Correct Answer: C Rationale: The first step in supporting this student to achieve the stated goal is to ensure that the student's positioning needs have been met and that the features of the environment are optimal to support the student's success.

A 5-year-old child with Down syndrome and delayed motor skill development is learning to self-toilet. Over the past several months, the child has made significant progress and is now able to complete age-appropriate toileting tasks, with the exception of independently pulling up pants. Based on the child's current abilities, what is the MOST EFFECTIVE technique to include in the intervention plan to support this child's success with toileting?

A.Develop a pictorial reward chart using a system of positive reinforcement. B.Use preferred games to increase upper extremity strength and coordination. C.Read a social story to reinforce successful daily bowel and bladder routines. Correct Answer: B Rationale: Down syndrome is associated with hypotonia and delayed motor development. Using play occupations such as games will support this child in developing the motor skills and strength needed to support progress toward independence in toileting.

A client who is legally blind reports having difficulty locating grooming items in the bathroom every morning, resulting in being late for work. Which recommendation should the OTR suggest for improving the client's occupational performance?

A.Discuss with the employer options for implementing a later start time at work. B.Wake-up at least one hour earlier so that grooming will not be rushed. C.Organize items in the bathroom so that there is a specific place for each item. D.Complete the majority of bathing and grooming tasks the night before. Correct Answer: C Rationale: This option most closely aligns with the client's current habits and routines.

An OTR is developing seating recommendations for a client with cerebral palsy who uses a wheelchair for functional mobility. The client has a fixed hip contracture causing pelvic obliquity with the iliac crest positioned higher on the right. What type of custom seating system should the OTR recommend the client sit on when positioned in the wheelchair?

A.Drop the front part of the seat base downward and build up the posterior part of the cushion to prevent a posterior pelvic tilt. B.Build up the right lateral side of the seat cushion and lower the left side to even out contact area throughout the cushion. C.Provide a pre-ischial shelf on the left, anterior part of the cushion to stop the client from sliding forward. Correct Answer: B Rationale: For a patient who has a fixed hip contracture, an asymmetrical profile in the seat cushion can accommodate for malalignment of the pelvis and evenly distribute the points of contact with the cushion.

A client had an open reduction external fixation of a distal radius fracture several days ago. Evaluation results indicate moderate swelling of the hand, decreased active ROM of the digits, and protective posturing of the involved arm close to the chest at all times. Which intervention would be MOST BENEFICIAL to include in sessions during this initial phase of the client's recovery?

A.Education about proper positioning in a standard pouch sling to minimize swelling B.Exercises to promote capsular gliding and ROM of the shoulder of the affected arm C.Static splinting to prevent MCP joint collateral ligament tightness D.Use of a dry whirlpool modality to manage edema of the affected hand Correct Answer: B Rationale: Insidious onset of shoulder restrictions can occur due to disuse and protective posturing. It is MOST BENEFICIAL to include ROM exercises of the unaffected joints in the intervention plan.

A 6-year-old child, who has immature postural balance and gravitational insecurity, wants to be able to climb a cargo net with peers. To support progress toward this goal, the OTR initially provides physical support as the child plays a board game while sitting on a therapy ball. Once this skill is mastered, what action should the OTR take NEXT to progressively grade the intervention plan?

A.Encourage the child to walk upstairs while holding on to a hand rail. B.Ask the child to play with peers who are sitting on the swings during recess. C.Hold the child's hand when the child is walking on an uneven surface. Correct Answer: C Rationale: To grade this intervention activity, the next level of difficulty for this child is for the OTR to provide physical support when the child is walking on an uneven surface.

An OTR fabricated an immobilization orthosis for a 4-year-old child who had a syndactyly release. The purpose of the orthosis is to protect the skin grafts, maintain the interdigital spaces, and keep the fingers properly positioned. What action should the OTR take as part of the fabrication procedure to proactively support a positive orthotic-wearing experience for this child?

A.Ensure the orthosis is wrapped snuggly on the hand with a brightly colored elasticized wrap. B.Explain the purpose of the orthosis to the child using age-appropriate language. C.Engage the child in an activity to make a sock puppet to wear over the orthosis. Correct Answer: C Rationale: By encouraging the child to make a sock puppet, the OTR is allowing the child to view the orthotic in a playful way and have an increased comfort level in wearing the orthotic.

An OTR is critically reviewing evidence to provide recommendations for a client who has rheumatoid arthritis and who wants to know if attending a water aerobics class would be beneficial. The OTR searches a scholarly database and finds 14 relevant studies. What action should the OTR take to determine the MOST BENEFICIAL evidence to support water aerobics recommendations for this client?

A.Evaluate the studies using an organized methodology designed to appraise the evidence. B.Share the results of the search with the client and ask the client to select their preferred studies. C.Ask experienced practitioners on a social media site to recommend the best study. Correct Answer: A Rationale: Using an organized methodology such as a checklist, structured form, or a critical appraisal scale supports a systematic approach to determining best evidence.

An OTR is employed at a skilled nursing facility on an hourly basis and is typically scheduled to work 2 shifts each month. The facility-specific clinical protocol directs the OTR to use a standardized assessment tool that is unfamiliar to the OTR. What is the FIRST action the OTR should take in this situation?

A.Follow the step-by-step procedural instructions on the test form. B.Alert the therapy supervisor that additional training is needed. C.Request a colleague administer the assessment tool when needed. Correct Answer: B Rationale: It is the responsibility of the OTR to be adequately qualified and prepared to complete all components of the job.

An OTR is preparing to measure the external entrance of a client's home to make recommendations for the design of a ramp. In addition to a measuring tape, which tools are MOST IMPORTANT for the OTR to gather in preparation for this evaluation?

A.Force measure and sidewalk chalk B.Spirit level and string line C.Light meter and safety glasses Correct Answer: B Rationale: As part of the home evaluation, these tools will be used by the OTR to gather information to contribute to the evaluation process and to develop optimal recommendations for the design of the ramp.

An OTR is working with an 8-month-old infant who has severe hypotonia. What is the BEST position to place the infant in for feeding?

A.Forward flexion with the head and neck resting in the caregiver's hand. B.Semi-reclined with the neck in neutral and the head at midline. C.Reclined with the neck in slight extension and the shoulders depressed. Correct Answer: B Rationale: Placing the infant in a semi-reclined position with the neck in neutral and the head at midline is optimal to decrease the risk of aspiration, and to facilitate opportunity for a safe and effective swallow.

An inpatient has a TBI and is functioning at Level V (Confused-inappropriate) on the Rancho Los Amigos scale. Which approach would be MOST EFFECTIVE for facilitating the patient's success with grooming tasks based on the patient's current cognitive level?

A.Give one-step instructions and hand-over-hand cueing throughout the task. B.Provide repeated verbal instructions until the patient completes the task. C.Use forward chaining techniques if the patient is distracted from the task. D.Demonstrate a portion of the activity then ask the patient to return demonstration. Correct Answer: A Rationale: Patients at this level of function have most success during simplified and highly structured tasks. Providing one-step instructions and hand-over-hand assistance supports the patient's participation with the grooming task.

An OTR is completing a feeding evaluation of a 4-year-old child who has mild hypotonia, immature oral motor control, and oral hypersensitivity. The child sits in a standard dining chair during meals and requires moderate to maximum assistance from a caregiver for feeding. When attempting to swallow food the child hyperextends the neck, elevates both shoulders, and has poor lip closure. What information should the OTR include in the INITIAL caregiver instructions based on this observation?

A.Handling techniques for facilitating full forward neck flexion during feeding B.Methods for using cryotherapy to stimulate facial muscles prior to feeding the child C.Neuromuscular facilitation techniques for promoting head and trunk stability D.Adaptive positioning techniques for promoting trunk alignment Correct Answer: D Rationale: Positioning and postural alignment impact oral motor control. The OTR should evaluate the child's sitting position during mealtimes and recommend specific feeding positions and positioning devices.

An outpatient client has increased sensitivity of the residual limb following a transradial amputation of the dominant arm. The incision is fully healed. One of the intervention priorities is to reduce hypersensitivity of the residual limb in preparation for a trial with a prosthetic device. Which intervention activity would be MOST BENEFICIAL to support this objective?

A.Have the client immerse the limb into containers filled with items of various textures. B.Provide a strengthening program for the shoulder girdle and the muscles around the elbow. C.Apply transcutaneous electrical nerve stimulator for 10 minutes before functional activity. Correct Answer: A Rationale: Immersion therapy is a desensitization technique to reduce sensitivity and discomfort of the residual limb in preparation for a for a trial with a prosthetic device.

A client who has generalized anxiety disorder has difficulty conceptualizing and organizing future events, and is experiencing decreased feelings of competence. What method should the OTR include in the INITIAL intervention session?

A.Have the client prioritize short-term goals that will have a high chance of success. B.Assist the client to plan social activities with friends and start new projects at home. C.Encourage the client to freely explore meaningful, multiple-step projects. Correct Answer: A Rationale: Assisting the client to prioritize goals with a high likelihood of success promotes the client's self-efficacy and confidence to support progress toward achieving the goals.

An inpatient had a TBI one month ago and is functioning at Level VII (Automatic-appropriate) on the Rancho Los Amigos scale. Currently, the patient is able to follow two-step instructions and attends to a familiar task for up to 15 minutes at a time. The patient wants to return home to resume homemaking roles. One of the patient's short-term goals is to independently bake cookies for a family member's upcoming birthday. How should the activity be graded to support the patient's successful participation in this task?

A.Have the patient prepare cookies using a boxed cookie mix with pre-measured ingredients. B.Have the patient prepare cookies using slice and bake packaged cookie dough. C.Mix the ingredients together and have the patient drop the cookies onto the cookie sheet. D.Provide the patient with a recipe of ingredients for mixing and baking cookies. Correct Answer: B Rationale: This option aligns with the patient's current functional level and short-term goal to independently bake cookies.

An OTR is selecting a wheelchair for a patient in an acute rehabilitation center who has transhumeral amputation of both arms and a distal transtibial amputation of one leg. The patient plans to alternate between using a manual wheelchair and ambulating with a prosthesis. Which wheelchair feature would be MOST BENEFICIAL for meeting the patient's daily needs?

A.High back height B.Low seat-to-floor height C.Off-set rear axle position Correct Answer: B Rationale: A wheelchair that has a low seat-to-floor height will allow this client to use the unaffected leg to propel the wheelchair.

An OTR is working with a 4-year-old child, who has autism spectrum disorder and oral hypersensitivity. The child's parent is concerned about an upcoming dental appointment, and asks the OTR for strategies that would enable the child to have a positive experience at the dentist. Which of the following is the MOST BENEFICIAL intervention activity to prepare the child for the dental appointment?

A.Identify a meaningful reward to give to the child after the appointment. B.Teach the child to gesture with both arms when experiencing overstimulation. C.Apply vibration to the child's gums and cheeks using an electric toothbrush. Correct Answer: C Rationale: Applying deep oral pressure and vibration to the child's cheeks and gums is a technique used to decrease oral hypersensitivity in preparation for the dental appointment.

An inpatient in a rehabilitation facility recently had transtibial amputations of both legs. The patient is currently scheduled for discharge in 2 weeks. During the weekly interprofessional meeting the OTR reports the patient has met the OT intervention goals. The physical therapist reports the patient will continue to require physical therapy until discharge from the facility. The prosthetist will also be working with the patient during this time, and nursing will continue to perform wound care. What action should the OTR take based on the meeting reports?

A.Identify any other activities in which the patient would like to participate. B.Complete a discharge summary and discontinue the patient from OT services. C.Schedule the patient for at least one hour of OT services per day. Correct Answer: B Rationale: Occupational therapy services must be reasonable and necessary. Intervention goals should result in improvements in the patient's level of performance.

A client is developing pitting edema of the hand secondary to flaccid hemiplegia. What should the OTR teach the client and caregiver as part of the INITIAL intervention for managing this client's edema?

A.Importance of proper upper extremity positioning and elevation B.Procedures for providing retrograde massage of the upper extremity C.Methods for using elasticized compression wraps for the digits and hand D.Techniques for completing passive ROM exercises of the digits Correct Answer: A Rationale: The OTR should teach the client and caregiver to position the distal end of the client's extremity approximately 3.5 inches (9 cm) above the heart. Elevation to this height allows gravity to assist with hemodynamic fluid transport.

An OTR is providing consultative services to develop a wellness program at a community senior center. A needs assessment survey indicates center participants have a fear of falling, feel they are at risk for falls, and want to age in place for as long as possible. In addition to including fall prevention education, which topic should the OTR recommend as part of the educational programming offered at the center?

A.Influence of aging on immediate and delayed memory B.Value of identifying effective home modifications C.Benefits of participating in socially stimulating activities Correct Answer: B Rationale: An effective person-environment fit promotes safe aging-in-place. By including the value of identifying effective home modifications in the educational program, the client will be able to determine if changes will be beneficial in the home.

An adolescent client who has a moderate traumatic brain injury is participating in an initial BADL session. During the session, the client frequently seeks physical contact with the OTR. What action should the OTR take in response to the client's behavior?

A.Inform the client that the behavior is inappropriate and set reasonable limits. B.Advise the client of generally accepted distances for personal space. C.Provide the client with alternate methods for obtaining proprioceptive input. Correct Answer: A Rationale: Establishing clear and reasonable limits is an important part of a behavior management plan.

A client with fibromyalgia reports hand pain and stiffness make it difficult to grasp a standard knife and fork during meals. Which assistive device would be MOST BENEFICIAL for improving the client's functional abilities when eating?

A.Lightweight utensils with non-slip grips B.Utensils with built-up handles C.Rocker knife and plate with raised sides D.Universal cuff with wrist support Correct Answer: B Rationale: This is recommended for clients who have limited motion for gripping small handles.

A client with schizophrenia is being discharged from a long term care facility to a group home. The client is independent with self-care and enjoys cooking, but requires assistance during meal preparation tasks due to a disregard for safety. The group home staff is willing to assist the client during meal preparation activities. What recommendations should the OTR provide the staff to maximize the client's participation in meal preparation?

A.Limit the client's meal preparation activities to pre-made microwaveable meals. B.Provide step-by-step verbal cues throughout a cooking task. C.Allow the client to prepare meals using recipes familiar to the client. Correct Answer: B Rationale: Providing the group home staff with step-by-step verbal cues will promote carryover of the client's skills into everyday meal preparation routines.

An OTR is fabricating a static orthotic for a client who has a partial thickness burn to the dorsum of the hand. The primary purpose of the orthotic is to maintain the length of the MCP joint collateral ligaments. How should the MCP joints, IP joints and wrist be positioned in the orthotic to achieve this goal?

A.MCP joint in 5° extension, IP joint in 45° - 60° flexion and wrist in neutral B.MCP joint in 60° - 70° flexion, IP joint in 0° - 5° flexion and wrist in 25° - 30° extension C.MCP joint in 20° - 30° flexion, IP joint in 20° - 25° flexion and wrist in 25° - 30° extension D.MCP joint in 35° - 45° flexion, IP joint in 30° - 40° flexion and wrist in neutral Correct Answer: B Rationale: Due to the irregular shape of the metacarpal head, the MCP joint collateral ligaments are tight when the MCP joint is in flexion. By positioning the MCP joints between 60°-70° of flexion, the MCP joint collateral ligaments will be taut and the formation of MCP flexion contractures minimized. Positioning the IP joints in 0°- 5° flexion discourages the formation of IP joint flexion contractures caused by shortening of the volar plate, collateral ligaments, and adhesions of the lateral bands.

A client has an upper extremity flexor synergy secondary to a CVA. The client has developed a severe soft-tissue contracture of the affected elbow. Which method would be MOST EFFECTIVE for increasing soft tissue length for improving elbow extension?

A.Provide submaximal stretch to the contracted soft tissue for prolonged periods of time. B.Apply a long-arm cast while the affected elbow is being stretched to the terminal end range. C.Perform passive ROM to the affected elbow with high-load stretch for brief periods of time. Correct Answer: A Rationale: Low load prolonged stretch is an effective technique for increasing the length of contracted soft tissue.

A client sustained a distal radius fracture of the dominant upper extremity 6 weeks ago. A short arm cast was applied on the day of injury and was removed one day ago. The client holds the affected arm close to the chest in a protected position due to pain, which the client rates as 6 out of 10 using a visual analog scale. The hand and forearm are moderately edematous. The client is able to flex the fingers to within one inch (2.54 cm) from each fingertip to the distal palmar crease. The client refused to move the wrist due to pain. Which intervention should be a priority to include as part of the treatment plan during the INITIAL phase of the client's rehabilitation?

A.Manual edema mobilization of the affected extremity B.Passive ROM exercises for the wrist and fingers C.Fabrication of a dynamic finger flexion orthotic D.Gentle stress loading exercises as tolerated Correct Answer: A Rationale: Edema reduction must be a priority of the intervention.

A school-based OTR is selecting seating alternatives for a student who has moderate hypotonia and has just transitioned to a full-day kindergarten program. The student uses a wheelchair for mobility and does not tolerate an upright sitting position throughout the school day. What type of positioning system would be MOST BENEFICIAL for this student?

A.Modular wheelchair with tilt-in-space feature in the mobility base B.Dense foam lateral supports and gel cushion for the current wheelchair C.Lightweight chair with reclining back and reverse wheel configuration D.Corner chair with high lateral supports that can be placed on the floor Correct Answer: B Rationale: This allows positioning of the trunk posterior to the pelvis and accommodates for the forces of gravity against upright positioning.

An OTR is providing recommendations to an outpatient client who has a chronic stage 3 pressure ulcer of the coccyx. One of the client's goals is to learn self-management strategies to promote wound healing. As part of the intervention plan, the OTR provides the client with a recommendation for a new seating system and instructions in pressure relief techniques. What additional topics should the OTR include in the client education to promote effective wound healing?

A.Nutritional intake and adequate hygiene B.Strengthening and therapeutic exercise C.Pain management and desensitization Correct Answer: A Rationale: Good nutrition and adequate hygiene are critical components of a comprehensive plan to facilitate normal wound healing.

An OTR plans to use a sensorimotor approach to improve the handwriting skills of a 6-year-old student who has a mild learning disability. The student maintains a very tight grip on a pencil when writing, consistently uses a palmar grasp when holding the pencil, and has directional confusion when forming letters. Which activity would be effective to include as part of the INITIAL intervention when using this approach?

A.Painting letters using a wide-barrel brush on paper attached to an upright easel B.Using spring-opening blunt-edge scissors to cut out geometric paper shapes C.Rolling out colored modeling dough and making cookie cutter shapes on a tabletop D.Providing hand-over-hand assistance during writing assignments Correct Answer: A Rationale: An upright orientation helps to decrease directional confusion, provides proprioceptive input for proximal control, and promotes a more mature grasp pattern.

An OTR who works in an intensive care unit is selecting a communication system for an inpatient who recently had a C2 spinal cord injury and uses a ventilator to assist with breathing. The patient has intact cognitive function but is unable to communicate verbally. Which option would be MOST BENEFICIAL to support the patient's functional communication needs?

A.Partner-assisted scanning with a picture communication symbol board B.Auditory scanning using a clock face communication device C.Direct selection interfaced with a dynamic display communication system Correct Answer: A Rationale: A low-tech augmentative and alternative communication system to support functional communication is most beneficial at this stage of recovery.

An outpatient had a myocardial infarction two weeks ago. One of the patient's goals is to resume household tasks. The cardiologist is allowing the patient to resume an activity level of no more than 3.0 metabolic equivalent (METs) units. Which activity represents a maximum allowable MET-level activity for this patient?

A.Paying bills electronically with a computer B.Mowing the lawn with a manual push mower C.Washing dishes standing at a kitchen sink Correct Answer: C Rationale: This activity represents a MAXIMUM level of energy expenditure allowable for a 3.0 MET-level.

An OTR is collaborating with a client and a building contractor to have wall-mounted grab bars installed in the client's bathroom. The client lives independently in a mobile home and is at-risk for falls due to cerebellar ataxia. The OTR determines the optimal placement of the grab bars to meet the needs of the client, however the contractor informs the OTR there are no available studs behind the wallboard in the recommended locations. Which alternative option would be MOST BENEFICIAL for the OTR to discuss with the contractor and the client?

A.Place blocks between the wall studs under the wallboard. B.Apply suction cup bathroom safety bars on the wallboard. C.Install 1/2-inch (1.2cm) plywood over existing wallboard. Correct Answer: A Rationale: Having a contractor place blocks between the wall studs provides additional structural support to allow for grab bars to be securely installed.

An OTR is selecting a new seating system for a college student who has cerebral palsy and uses a wheelchair for all functional mobility. The client has flexible asymmetrical postures including scoliosis, kyphosis, and pelvic obliquity. The student wants to be able to sit upright for 12-14 hours per day. Which custom seating system would BEST support progress toward this goal?

A.Planar B.Contoured C.Modular Correct Answer: B Rationale: A contoured cushion is beneficial for this client who is at-risk for skin breakdown and has moderate positioning and seating needs.

A client with a non-operable cerebellum tumor is participating in OT to increase independence with self-feeding. Which assistive devices should the client use to promote progress toward this goal?

A.Plastic cup and lightweight utensils B.Suction plate and cup holder C.Side-cutting fork and rocker knife D.Universal cuff with mobile arm support Correct Answer: B Rationale: Cerebellar lesions result in ataxia and dysmetria. These assistive devices will help the client stabilize the plate and hold the cup during a meal.

A resident recently was admitted to a long term care facility after having an intracerebral hemorrhage secondary to a ruptured aneurysm. Currently, the resident is able to verbalize basic needs, can follow simple one-step directions, and has minimal functional movement of all extremities. The resident wants to be able to change channels on the television independently but is unable to hold the remote control device or apply enough pressure on the buttons to activate the device. The OTR is choosing a switch-activated selection device that will enable the resident to complete this task. Which type of switch is OPTIMAL to use with this device?

A.Plate switch B.Pneumatic switch C.Phonation switch Correct Answer: A Rationale: A plate switch responds to minimal force, so it allows this resident to independently access the channels on the television.

An OTR, who works in an outpatient pediatric clinic, is preparing to fabricate an orthosis for a 4-year-old child who has cerebral palsy and a wrist flexion contracture. The child is crying and is visibly distressed in anticipation of the pending procedure. What action should the OTR take prior to starting the fabrication procedure to provide a positive experience for the child?

A.Play with the child in an adjoining therapy space near the hand therapy room. B.Collaborate with the child to fabricate an orthosis for a doll or stuffed animal. C.Teach the child each step associated with fabricating the forearm-based orthosis. Correct Answer: B Rationale: By engaging with the child in a playful way to fabricate an orthosis for a doll or stuffed animal, the therapist is allowing the child to feel comfortable with the equipment and the therapy environment.

An OTR is teaching stand-pivot transfers to a client who has Stage 2 Parkinson's disease and uses a wheelchair for mobility. After instructing the client to properly position the chair in relation to the transfer surface, and asking the client to lock the wheelchair brakes, what should the OTR ask the client to do NEXT?

A.Position both feet perpendicular to the transfer surface. B.Scoot the hips forward to the edge of the wheelchair. C.Rock forward while reaching toward the transfer surface. D.Come to standing by pushing up on the wheelchair arm rests. Correct Answer: B Rationale: After positioning the wheelchair and locking the brakes, the client should scoot both hips forward to the edge of the chair. Prior to standing, the client's feet should be positioned firmly on the floor and both knees should be flexed to 90°. This position provides a safe base of support to enable the client to come to standing position and then pivot toward the transfer surface.

A patient in a rehabilitation facility has a C6 (ASIA A) spinal cord injury. The patient is learning techniques to maintain forward sitting balance while sitting on the edge of the bed. Which technique is MOST BENEFICIAL for the OTR teach the patient to support progress toward this goal?

A.Position the elbows in slight flexion; use available shoulder movement while maintaining the wrist in neutral B.Lock the elbows in full extension; and use shoulder depression, protraction and external rotation, and full wrist extension C.Alternate between full elbow extension and flexion; use shoulder elevation, retraction and internal rotation Correct Answer: B Rationale: A patient with a complete spinal cord injury at the level of C6 has Gr 0/5 strength in the triceps. The patient will benefit from locking the elbows into extension to maintain balance when sitting upright.

An OTR is providing instruction in lower extremity dressing techniques to a patient who has had a total hip arthroplasty and is following posterior lateral hip precautions. What should the OTR include in the instructions?

A.Position the shoulders over the knees when standing up. B.Use a reacher to put on a pair of pants. C.Sit on a low stool to put on shoes and socks. Correct Answer: B Rationale: Teaching the patient to put on pants using a reacher will ensure the patient does not flex the hip past 90 degrees during lower extremity dressing which is contraindicated when following posterior lateral hip precautions.

An OTR is using universal design for learning (UDL) principles to make recommendations to optimize academic performance for students in a middle school. Using the principles of UDL, what action should the OTR take to meet this objective?

A.Provide environmental design principles to adapt the playground to include students who have a disability. B.Determine the needs of the students and the influence of the educational environment on learning outcomes. C.Recommend desk heights and ergonomic computer workstations that benefit most students in the classroom. Correct Answer: B Rationale: Prior to introducing intervention strategies, the OTR must first understand the needs of the students who attend the middle school and determine the influence the school environment has on learning outcomes.

An OTR is working with a 2-year-old toddler who has a gastrostomy feeding tube for nutritional support. The toddler has made improvement in oral motor function and has medical clearance to transition to oral feeding. During sessions, the toddler engages in oral play activities with a pacifier and blows bubbles. Which intervention technique would be MOST BENEFICIAL to include at this stage of the toddler's oral motor development for supporting successful transition to oral feeding?

A.Provide flavors and tastes by dipping a spoon or chew toy in pureed foods. B.Place a compressed bolus of a sweet-tasting food between the cheek and gums. C.Have the toddler practice dry swallows by pretending to eat from a spoon. Correct Answer: A Rationale: Chewing on toys or tasting preferred flavors on a spoon is motivating for the child and provides an opportunity for oral exploration and to reduce oral hypersensitivity.

An OTR is developing an intervention plan for a 4-year-old child with pervasive developmental delay. The child demonstrates impaired ideation and has limited play skills. A primary goal is for the child to successfully interact with age-appropriate toys. Which strategy would be MOST BENEFICIAL to include in the intervention plan to support progress toward this goal?

A.Provide frequent verbal guidance while the child plays with a preferred toy. B.Encourage the child to select a toy that facilitates pretend play as a favorite superhero. C.Develop a social story with pictures of a peer using appropriate skills to play with the toy. Correct Answer: C Rationale: For a child with pervasive developmental delay who has difficulty knowing how to interact or play with toys using a social story with pictures is an effective intervention strategy.

An adult client with a moderate intellectual disability is beginning a supported employment program. The client typically has a hot lunch each day and wants to continue having hot lunches at work by bringing food from home that can be heated in the workplace microwave. An assessment indicates that the client requires some assistance to complete simple microwave meal preparation. Which strategy should the OTR implement next to MOST EFFECTIVELY achieve the client's goal?

A.Provide the client with sequential picture cards indicating each step of lunch preparation. B.Talk with the client about purchasing a prepared hot meal in the workplace cafeteria. C.Use forward chaining techniques during meal preparation sessions with the client. Correct Answer: C Rationale: Forward chaining is an effective intervention technique that involves progressively teaching the client the steps of task starting with the first step.

An OTR is teaching a client, who has COPD, a breathing technique to use when experiencing shortness of breath during an activity. The OTR instructs the client to place one hand on the stomach, inhale deeply, and allow the stomach to rise. Which breathing technique do these instructions represent?

A.Pursed lip breathing B.Abdominal breathing C.Relaxation breathing Correct Answer: B Rationale: The OTR is teaching the client the technique for abdominal breathing which is typically used to decrease the symptoms associated with dyspnea.

A patient in an acute care setting is undergoing treatment for an exacerbation of cardiomyopathy. The patient reports avoiding most preferred activities because they typically cause shortness of breath and extreme exhaustion. Which self-monitoring assessment should the OTR teach the patient to use for supporting the patient's engagement in these preferred activities?

A.Rating scale of perceived exertion B.Visual analog fatigue scale C.Pulse oximetry measurements Correct Answer: A Rationale: Teaching the patient to use a rating scale of perceived exertion allows the patient to rate how the body feels during physical activities and to use the scores to determine if there is a need to modify the level of physical exertion during an activity.

An OTR is collaborating with a home health client to select a new power wheelchair. The client has morbid obesity, chronic obstructive pulmonary disease, diabetes, and severe edema in both lower extremities. Caregivers assist the client to transfer into the chair with a mechanical lift, and the client uses the wheelchair full time for mobility. Based on this situation, which type of power wheelchair would be MOST BENEFICIAL for the OTR to recommend to this client?

A.Rear-wheel drive with a seat elevator B.Front-wheel drive with power recline C.Mid-wheel drive with elevating leg rests Correct Answer: C Rationale: A mid-wheel drive power wheelchair provides greater stability as the center of gravity is positioned over the drivetrain. Elevated leg rests will provide a positioning option to reduce edema.

An OTR has been asked by the director of nursing in an acute-care hospital to provide an in-service to the nursing staff to describe the role of OT in preventing deep venous thrombosis and pulmonary embolus. Which intervention is MOST IMPORTANT to include as part of this presentation to explain the role of OT in thromboembolic disease prevention?

A.Recommend mechanical interventions such as compression stockings and pumps. B.Support early mobilization to facilitate patient engagement in self-care activities. C.Prescribe anticoagulation therapy to thin the blood and prevent clots from forming. Correct Answer: B Rationale: The MOST IMPORTANT role for OT in thromboembolic disease prevention is to support early mobilization to facilitate patient engagement in self-care activities.

A high school student has spastic diplegia and cognitive delay. The student self-propels a wheelchair and requires moderate assistance for functional transfers. The student has been the target of peer-bullying in school and has been attending OT to help increase social participation. One of the student's goals is to attend a dance being planned by the dance committee of student volunteers. During a role-play session, the student tells the OTR, "I really want to go to the dance, but I am worried that I won't fit in." Which recommendation should the OTR suggest for addressing the student's concern?

A.Require the committee leader to provide inclusion training for all students at a school assembly prior to the dance. B.Have the student partner with the committee to select a music playlist for the dance that includes modified line dances. C.Ask the committee to recruit parent volunteers willing to attend the dance as facilitators of social inclusion. Correct Answer: B Rationale: This activity supports the student in social participation with peers both during the planning phase and at the school dance.

During an OT session a patient stops working on the activity and states, "My grandson would like this activity. What's it costing me to match up these colors and patterns?" What action should the OTR take in this situation?

A.Review costs and insurance coverage with the patient. B.Discuss activities that would be more meaningful to the patient. C.Remind the patient about the importance of the activity. Correct Answer: B Rationale: It is the responsibility of the OTR to establish effective therapeutic rapport and use the principles of client-centered practice to support the client in achieving best possible outcomes.

An OTR is reviewing the clinical record of a client who has a wound on the dorsal surface of the hand that is slow to heal. Which of the following sets of medical conditions are TYPICALLY associated with delayed wound healing?

A.Rheumatoid arthritis and gout B.Peripheral vascular disease and diabetes C.Superficial partial thickness burn with exudate Correct Answer: B Rationale: Chronic diseases that influence vascular circulation such as peripheral vascular disease and diabetes will slow the healing process.

A client with stage 2 Parkinson's disease is preparing to move from sitting on a tub transfer bench in the bathtub to standing up at a walker placed outside the bathtub. Which method would be effective for the client to use at the start of the transfer?

A.Rocking rhythmically back and forth on the bench a few times B.Pulling forward on the grab bar mounted to the bathroom wall C.Bearing weight through both arms by pressing down on the bench D.Using a towel to quickly rub the larger muscles of the thighs Correct Answer: A Rationale: This is a technique used with clients who have difficulty initiating motion due to rigidity associated with this stage of Parkinson's disease.

A rheumatologist has prescribed bilateral nighttime resting hand orthotics for a child who has early stage juvenile rheumatoid arthritis. The parents ask the OTR who works at the child's school to fabricate the orthotics. Despite having this condition, the child is functioning at grade-level and is not on the OT caseload. What action should the OTR take in response to the parents' request?

A.Schedule a time after school hours to fabricate the orthotics for the child. B.Provide the parents with catalog information for ordering pre-fabricated orthotics. C.Inform the parents to schedule an appointment at an outpatient OT clinic. D.Initiate an IEP indicating the child's needs for school-based OT. Correct Answer: C Rationale: School-based OT must relate to curriculum-based activities. These orthotics are typically preventive positioning orthotics for nighttime use. Since this intervention is not directly related to curriculum-based activities and the orthotics will not be worn during the school day, the OTR should refer the child to an outpatient OT clinic for the orthotics.

An inpatient had a TBI 3 weeks ago and is functioning at Level II (Generalized response) on the Rancho Los Amigos scale. Which intervention should be a priority to include in treatment sessions during this phase of the patient's rehabilitation?

A.Self-feeding program using assistive devices and hand-over-hand cues B.Simple life skills tasks using compensatory cognitive strategies C.Sensory stimulation program using graded and consistent stimuli D.Personal hygiene tasks using cueing to minimize outbursts Correct Answer: C Rationale: A patient who is functioning at Level II (Generalized response) on the Rancho Los Amigos scale responds non-purposefully and inconsistently to stimuli. A sensory stimulation program is part of a comprehensive intervention plan during this phase of rehabilitation.

Which method would be MOST EFFECTIVE to use when grading an activity to improve muscular endurance?

A.Shortening the interval of time to complete a controlled set of isotonic exercises B.Maintaining the same resistance and increasing the number of repetitions C.Decreasing repetitions and increasing resistance for short intervals of time D.Increasing resistance to 75% of maximal strength and maintaining repetitions Correct Answer: B Rationale: Progressively increasing the number of repetitions while maintaining the same resistance enhances the muscles ability to sustain activity and resist fatigue.

An inpatient in a rehabilitation facility is preparing for discharge to home. The patient has hemiplegia, uses a wheelchair for mobility and completes self-care independently with assistive devices. The patient's home bathroom has a standard bathtub and a separate walk-in shower with a safety glass door and a 6-inch (15.24 cm) high doorsill. Both the shower and the tub have safety grab bars. Which piece of durable medical equipment would be MOST BENEFICIAL for this patient to use at home?

A.Shower chair that can be used in the shower or bathtub B.Padded transfer bench with swivel seat for the bathtub C.Plastic bath chair with armrests and accessory caddy D.Transfer board and plastic shower stool with a contoured seat Correct Answer: B Rationale: The tub transfer bench provides the patient with the safest method for transferring from/to the wheelchair and bathtub.

A resident of a skilled nursing facility has Wernicke's aphasia secondary to a left CVA and is frustrated during intervention sessions. Which communication techniques should the OTR use to limit the resident's frustration?

A.Sign language and written instructions B.Alphabet and low tech communication boards C.Hand gestures and tactile cues Correct Answer: C Rationale: Using hand gestures and tactile cues will support a resident who has Wernicke's aphasia, difficulty comprehending spoken and written words, to understand the intention of the activity during intervention sessions.

A client has relapsing-remitting multiple sclerosis and recently transitioned from assisted ambulation to using a standard wheelchair for mobility. A recent onset of fatigue, upper extremity weakness, and back and neck discomfort is beginning to interfere with job performance. The client is employed as a magazine editor, and spends much of the day sitting in the wheelchair while working at the computer monitor positioned at eye level. The client wants to continue sitting in a wheelchair to avoid having to complete transfers when moving from the desk to other parts of the work area. Which modification would be MOST BENEFICIAL for this client?

A.Solid seat insert, lumbar support and bilateral forearm supports B.Power scooter with padded seat and electric tilt-in-space control C.Deltoid aid and a split design computer keyboard D.Voice-controlled computer system and telephone headset Correct Answer: A Rationale: Modifying the wheelchair by adding a solid seat insert helps to establish and maintain pelvic alignment for improved postural support. Forearm supports provide external support for the weak upper extremities. These modifications aid in reducing postural discomfort and muscular fatigue.

An OTR is completing home set-up for a client who has a C5 spinal cord injury and is transitioning from an inpatient setting to home. Which type of bed would be MOST BENEFICIAL for this client to use at home?

A.Standard bed that is level to the wheelchair seat height B.Electric hospital bed with adjustable side rails C.Adjustable frame with overhead trapeze and attached rope ladder Correct Answer: B Rationale: A client with a C5 spinal cord injury has active elbow flexion and is able to use the side rails to assist with rolling and bed mobility. The electric hospital bed will decrease risk of injury to a caregiver providing assistance during ADL.

A school-based OTR is making universal design for learning (UDL) recommendations for a student who has difficulty reading printed text because of low vision. Using the principles of UDL, which recommendation would be MOST BENEFICIAL for this student?

A.Suggest the student try a digital version of a novel or a book with enlarged print. B.Recommend the student purchase a text-to-speech reader from the school's library. C.Provide the student with a classroom aide to read assigned materials. Correct Answer: A Rationale: Principles of universal design for learning include ensuring that all students have equal access to course materials to meet individual learning needs such as a digital version of a book for this student with low vision.

For which client condition is the use of a hot, moist pack as a physical agent modality INDICATED?

A.Superficial skin graft 3 days ago with acute pain B.Breast cancer with upper extremity edema C.Spinal cord injury (ASIA B) with painful muscle spasms Correct Answer: C Rationale: Application of a hot pack is safe and effective for use with a client who has a spinal cord injury classified as ASIA B because sensation is intact. Heat is contraindicated during the acute, inflammatory phase of healing and for acute edema.

An inpatient with relapsing-remitting multiple sclerosis has been making steady progress during morning BADL. For the past 3 mornings, the patient reportedly completed the morning self-care routine independently. During a reevaluation of BADL, the patient becomes physically exhausted while dressing after taking a shower and asks to return to bed. In addition to talking with the patient about energy conservation, what action should the OTR take based on the patient's physical response?

A.Teach the patient to monitor symptoms while incorporating appropriate rest-activity ratios into self-care tasks. B.Advise the patient to complete self-care while seated upright in bed in order to reduce energy expenditure. C.Talk with the patient about pacing self-care tasks throughout the day. D.Ask the patient to identify the BADL tasks that typically take the most time to complete. Correct Answer: A Rationale: Monitoring symptoms and using appropriate work-rest ratios will minimize the likelihood of becoming physically exhausted.

A young adult client with high functioning autism attends a community-based day program. The client goes to a restaurant for lunch twice per week with staff and other clients from the program. The client enjoys this activity but becomes extremely anxious and engages in negative self-stimulation behaviors when it is time to transition from center activities to go to the restaurant. One of the intervention goals is to help the client learn to manage these behaviors during this transition time. Which strategy would be MOST EFFECTIVE to include as part of the intervention for supporting this goal?

A.Teach visualization techniques. B.Develop a social story. C.Create a color-coded behavior chart. Correct Answer: B Rationale: A social story is an effective intervention strategy that involves a customized story written to provide guidance to a client with ASD in positive social behaviors during a specific situation, such as during transition from one location to another.

An OTR leads a leisure skills group with young adults who have intellectual and developmental disabilities. The OTR plans to use scaffolding techniques as part of the group process. What is the PRIMARY purpose for using these techniques?

A.To control task elements that exceed the learners' current capabilities B.To provide support to the participants if an error occurs during the group task C.To use directed discussions to ensure each participant engages in the group Correct Answer: A Rationale: Scaffolding is a cognitive technique where the OTR structures an activity to support for components of the task that are too difficult for the client, and provides an opportunity for the client to successfully complete task components within the client's capabilities.

An OTR is fabricating a hand orthosis for a 10-year-old child who has progressive upper extremity symptoms secondary to Charcot-Marie-Tooth disease. What is the PRIMARY purpose for fabricating this orthosis?

A.To improve function for active grasp and release B.To prevent ulnar drift and swan neck deformities C.To rest the hand during periods of acute pain Correct Answer: A Rationale: Charcot-Marie-Tooth disease is a neurological disorder that impacts voluntary muscle control and muscle strength. As the condition progresses, an orthosis may assist to compensate for hand weakness and promote function.

An OTR is working with a client in a home health setting who has a wound on the lateral aspect of the proximal forearm. The wound is 4 cm (1.57 inches) in diameter and is being treated by the wound care nurse with a hydrogel sheet dressing. The wound margins are pink and flat, and the wound is draining a low volume of serosanguinous exudate. What is the PRIMARY reason for using a hydrogel sheet dressing type for this client?

A.To keep bacteria out of the wound while promoting autolytic debridement B.To create a moist healing environment while absorbing discharge from the wound C.To provide hydration to the wound while offering pain relief with a hydrogel sheet Correct Answer: A Rationale: The PRIMARY reason for using a hydrogel dressing with this client is to establish a clean, moist wound healing environment to promote autolytic debridement.

What is the PRIMARY reason for selecting a gel wheelchair cushion to relieve pressure on the sacrum of a client with a C7 spinal cord injury?

A.To offer low daily maintenance needs B.To permit airflow for ventilation C.To provide a stable base of support Correct Answer: C Rationale: A gel cushion provides the pressure relieving qualities and a stable base of support for a client who has a C7 spinal cord injury.

A client has an open wound on the dorsum of the dominant hand. The medical record indicates mechanical debridement to promote wound healing. Which of the following wound management options represents mechanical debridement?

A.Topical enzymes on the wound to selectively remove necrotic tissue and debris. B.Whirlpool as a preparatory activity to remove dead tissue from the wound. C.Wound dressings that keep the wound moist to trap the body's natural enzymes. Correct Answer: B Rationale: Mechanical debridement involves the removal of necrotic tissue using methods such as fluid irrigation and whirlpool.

An 8-year-old student with severe achondroplasia has limited hand function with no isolated finger movements. The student is learning to use an adapted computer to optimize performance during classroom assignments. Which modification would BEST support the student's success to access the computer?

A.Trackball mounted on a stationary base B.Single-switch control interface C.Continuous joystick input device Correct Answer: A Rationale: Using a track ball requires minimal hand function providing the student with the opportunity to be able to move the cursor.

An OTR is teaching medication management strategies to an older adult client who has diabetes and low vision. One of the intervention goals for the client is to increase compliance in adhering to the prescribed medication regimen. In addition to teaching the client to combine the medication schedule with familiar ADL routines, what would be the MOST EFFECTIVE approach in improving medication adherence in this client?

A.Trial several types of adaptive aides for medication management. B.Dedicate set periods of time in the day for taking medication. C.Establish a habit of counting the remaining pills in each bottle. Correct Answer: A Rationale: Trialing several types of adaptive aides for medication management allows for the development of a client-centered recommendation.

An OTR who works in an inpatient rehabilitation unit is completing an evaluation of a patient who had bilateral total knee arthroplasties 3 days ago. The patient is in generally good health, plans to live independently at home, and wants to resume volunteer work in the community. The patient currently requires OT services to increase independence in bathing, dressing, and toileting. What MUST the OTR consider when scheduling the patient for OT?

A.Understand documentation requirements for reimbursement by the third party payer B.Patient's endurance for completing activities according to a clinical pathway C.Availability of caregivers to participate in daily sessions for education and training Correct Answer: A Rationale: The OTR has the responsibility of understanding policies and procedures related to reimbursement when establishing the intervention plan.

An inpatient sustained a complete T5 spinal cord injury one month ago and has been in the intensive care unit on extended bed-rest. The OTR recently initiated a program of graded bed mobility in preparation for beginning transfer training. The patient is now able to sit in bed with the head of the bed elevated to 45° for one-hour intervals without experiencing any dizziness. Which position is safest for the patient to be placed in NEXT?

A.Upright in a standard wheelchair with close monitoring B.Upright on a tilt-table at 90° while wearing an abdominal binder and elastic stockings C.Seated in a semi-reclining wheelchair with legs elevated D.Seated on the edge of the bed with both legs unsupported and knees flexed to 90° Correct Answer: C Rationale: To avoid adverse postural reactions, changes to the patient's position should be incremental and gradual. Positioning the patient's upper body in a more upright position while keeping the legs elevated reduces the risk of orthostatic hypotension.

A client in a home health setting had bilateral lung transplants one month ago and is participating in OT to improve activity tolerance for completing home management tasks. The client is currently able to perform laundry tasks but develops shortness of breath when standing for longer than 2 minutes. The client has a stacked washer and dryer located in the hallway between the kitchen and the main bedroom. Which energy conservation technique should the OTR teach this client to use to MOST EFFECTIVELY improve the client's activity tolerance during this home management task?

A.Use a single basket for weekly laundry to minimize trips to the laundry room. B.Place clothing on a wheeled cart to bring the clothes from the bedroom to the laundry area. C.Transfer clothing from the washer to the dryer all at one time to limit upward reach. Correct Answer: B Rationale: Using a wheeled cart to transport laundry will safely increase the activity demand to improve the client's functional endurance without the heavier demands associated with carrying a full basket or moving wet clothes.

An OTR who works in a school-based setting is planning a session for a fifth-grade student who has autism spectrum disorder. The student has average cognitive ability but poor organization skills. Which support would be most beneficial to include in the INITIAL intervention for improving the student's organization skills?

A.Use visual supports to identify items needed for each class. B.Provide extra supplies for use in all educational environments. C.Develop a behavior management plan to reward the student for planning ahead. Correct Answer: A Rationale: Using a visual support, such as a checklist, is an organizational strategy to assist this child in gathering school supplies needed to participate in classroom activities.

Which of the following environmental adaptations will improve safety during meal preparation for a client who has low vision?

A.Using large-sized bowls and pots for mixing and stove-top cooking B.Placing tactile markings on the operating features of appliances C.Installing a microwave that has preprogrammed cooking options D.Arranging items on the pantry and cabinet shelves in alphabetical order Correct Answer: B Rationale: Tactile markings will enable the client to monitor the settings on appliances. This will improve kitchen safety, especially with meal preparations.

An OTR is fabricating an orthotic for a client who has a claw-hand deformity secondary to an ulnar nerve injury several months ago. Which type of orthotic is indicated for this client?

A.Volar-based forearm and hand static orthotic that blocks MCP joint hyperextension while allowing IP joint motion B.Low-profile dynamic orthotic that blocks hyperextension of the second through fifth digits and has an IP joint extension outrigger C.Dorsal-based MCP joint blocking orthotic with a dynamic component to pull the fourth and fifth digit IP joints into extension D.Hand-based orthotic that positions the fourth and fifth digits in 30° - 40° of MCP joint flexion while allowing IP joint motion Correct Answer: D Rationale: A claw-hand deformity is characterized by hyperextension of the fourth and fifth digits and is typically secondary to an ulnar nerve injury. Blocking the fourth and fifth MCP joints in slight flexion allows the extensor digitorum communis tendon to extend the IP joints in the absence of the ulnar innervated intrinsic muscles. The orthotic will enable the client to have a more functional grasp.

An OTR is providing information about assistive devices to a client who has osteoarthritis of the first CMC joints of both hands. Which devices would be MOST BENEFICIAL for protecting these joints during meal preparation?

A.Washable universal cuff, rocker knife with contoured handle, and wall-mounted jar opener B.Right-angled knife with ergonomic handle, over-stove mirror, and swivel serving utensils C.Mixing bowls with non-slip bottom, scoop dish, and cutting board with slicing guide D.Built-up utensils, adjustable bowl tipper, and mountable electric can opener Correct Answer: D Rationale: These assistive devices will reduce the stress on first CMC joints during meal preparation activities.

A client who works as a hair stylist has cubital tunnel syndrome. The OTR is providing the client with instructions about work modification techniques the client should use to minimize exacerbation of symptoms. What should the OTR include as part of these instructions?

A.Wear a neoprene elbow sleeve on the affected arm as much as possible when cutting and styling hair. B.Use a small handheld vacuum instead of a push broom to remove hair from around the styling chair. C.Avoid holding the affected elbow in 90°of flexion or greater, and actions that require repetitive elbow flexion. Correct Answer: C Rationale: As part of the intervention plan, the client should be instructed to avoid tasks that involve repetitive movements at the elbow and elbow-flexed postures which exacerbate the symptoms of cubital tunnel syndrome.

A client has a one-week history of symptoms consistent with a work-related carpal tunnel syndrome. The client works on an assembly line and is required to stand at a workstation and tighten bolts into sheet metal at waist level using a pneumatic pistol-grip drill. The client uses the drill approximately 6 hours each 8-hour shift. Which ergonomic modification would be MOST BENEFICIAL for reducing symptoms associated with this condition?

A.Wearing anti-vibration gloves B.Adapting the handle of the drill C.Lowering the level of the workstation Correct Answer: A Rationale: Anti-vibration gloves absorb the vibrations emitted by the pneumatic pistol-grip drill to reduce the symptoms of work-related carpal tunnel syndrome.

A home health client had surgery for a total hip arthroplasty 2 weeks ago. During an ADL session, the OTR notes that the area near to the surgical site is warm to the touch and has new erythema. The wound has purulent drainage and a foul odor. Which of the following conditions is TYPICALLY associated with these reported symptoms?

A.Wound infection B.Venous stasis C.Tissue necrosis Correct Answer: A Rationale: Signs and symptoms of infection include red skin and warmth near the wound and purulent exudate with a foul odor.

A client with primary progressive multiple sclerosis has an atonic bladder that causes urinary incontinence. The OTR and the nurse are collaborating to teach the client self-catheterization strategies. The client has poor perineal sensation and wants to be independent in self-catheterization. Which of the following is the MOST BENEFICIAL assistive device to increase self-catherization?

An adjustable handheld mirror B.A no spill urinal C.A built-up handle attached to tubing Correct Answer: A Rationale: This type of assistive device will help the client to use vision to compensate for impaired perineal sensation during self-catheterization.

An adolescent is in an acute setting after sustaining a recent C6 (ASIA B) spinal cord injury. The adolescent underwent surgery 4 days ago for cervical stabilization and is recovering from the surgery as expected. The adolescent has been on bedrest since the surgery, but now has medical clearance to transfer out of bed with assistance. One of the goals for the adolescent is to sit in a bedside chair for BADL. Prior to transferring the adolescent out of bed, what action MUST the OTR take?

Complete a comprehensive manual muscle test. B.Measure the adolescent's resting vital signs. C.Evaluate sensation at key dermatomal segments. Correct Answer: B Rationale: Measuring the adolescent's resting vital signs prior to movement is essential to maintain the patient's safety and to guide the OTR's clinical decisions before and during activity.

A 6-year-old child who has developmental delay is learning to self-dress. Over the past several months, the child has made significant progress and is now able to complete age-appropriate dressing tasks with the exception of independently tying shoe laces. The parent reports the child becomes extremely frustrated with this task and has behavioral outbursts when an adult provides assistance. Which technique should the OTR incorporate into the intervention to MOST EFFECTIVELY support the child's success with shoe-tying?

Gesture prompting B.Forward chaining C.Backward chaining Correct Answer: C Rationale: Backward chaining technique is motivating to the child with a low frustration tolerance because it starts with having the child learn the final step of the task first, providing a rewarding experience.

An OTR is evaluating a client who was recently diagnosed with osteoarthritis of the CMC joint of the dominant hand. The client works as a chef and reports thumb pain and progressive difficulty in using cooking utensils to complete food preparation. The client wants to continue working as a chef. Which intervention should the OTR provide to support INITIAL progress towards this goal?

Initiate a resistive pinch and grip strengthening program. B.Instruction and practice using joint protection strategies. C.Fabricate a forearm-based thumb spica orthosis. Correct Answer: B Rationale: Educating a client in joint protection strategies is effective to reduce the risk of joint damage during routine job tasks.

An OTR is working with a client who has a visual field deficit. Which option represents the BEST type of activity for teaching compensatory scanning techniques?

Pencil and paper tasks, including mazes and crossword puzzles B.Everyday household activities such as paying bills and reading email. C.Visual tracking of a penlight moved slowly by the OTR. Correct Answer: B Rationale: Instruction in the use of visual scanning strategies should be specific to an activity that the client wants to perform independently.

A service competent OTR is completing a feeding reevaluation with an inpatient who has hemiplegia secondary to a CVA 5 days ago. A screening indicates the patient's cognitive and perceptual skills are intact. Observation during mealtime and results of a videofluoroscopy study show the patient has decreased tongue mobility, hypotonicity of the cheek and lips on the affected side, slowed swallow response, and a wet gurgly voice quality after swallowing several bites of food. Which types of food and liquid should the OTR recommend for the patient to reduce risk of aspiration?

Pureed meat and vegetables and honey-thickened liquids B.Moistened soft foods and thin flavored liquids C.Normal foods cut in small pieces and nectar-thickened liquids Correct Answer: A Rationale: The clinical presentation of this client warrants the recommendation of pureed food and honey-thickened liquids.

An OTR working in an adult day care center is preparing activities to use during a gardening group for clients who have moderately severe cognitive decline secondary to dementia. The goal of the group is to increase levels of arousal and engagement. Which activity would provide the BEST opportunity for achieving this goal?

Selecting seeds from an illustrated gardening catalog B.Planting flowers in an indoor raised garden bed C.Assigning clients specific plants to water in the center Correct Answer: B Rationale: At this stage of the disease process, the group members will respond best to an activity that is structured, has immediate gratification and is not complex in the task demands.

An OTR is leading a community-based class for self-referred clients who have rheumatoid arthritis. Through class discussion and observation, the OTR determines that one of the clients in the class would benefit from bilateral hand orthotics. After discussing this observation with the client and determining the client intends to pay for services using insurance benefits, what action should the OTR take NEXT to address the client's needs?

Understand the state regulatory requirements for direct access to OT services. B.Complete a comprehensive evaluation to justify the need for the orthotics to the primary care physician. C.Arrange a clinic appointment time to fabricate the orthotics for the client. D.Contact the insurance company to obtain reimbursement authorization for the orthotics. Correct Answer: A Rationale: The OTR must understand the state regulatory requirements for direct access to OT services within the jurisdiction where services will be provided.