Mod 6: Psychosocial Conditions & Interventions Part 4

The daughter of an 82-year-old man who has mild-to-moderate dementia seeks the advice of a home health COTA®, on how to help reduce her father's frustration and agitation when he loses his prescription reading glasses. The daughter with whom her father lives, has tried having a dedicated labelled container for her father's glasses but she needs to redirect him whenever she notices him placing his glasses somewhere else. Recently, he misplaced his glasses and she spent an hour searching for them before locating them between the sofa cushions. This has been burdensome for both daughter and father. What is the BEST recommendation the COTA® could make to prevent this problem from recurring? A. Attach an eyeglass chain to the frames of the glasses for the father to wear around his neck B. Since they live together, have the daughter store the glasses herself after every use C. Ask the optometrist to prescribe bifocal contact lenses in place of framed lenses D. Hang the glasses on an upright stand in plain sight by his toothbrush

A. Attach an eyeglass chain to the frames of the glasses for the father to wear around his neck

What key elements of the therapeutic approach and environment would you include when treating a patient with a diagnosis of depression? Select the best 3 choices. A. Avoid too many choices B. Involve the patient in real life activities C. Increase the opportunity for decision making D. Notify staff of suicidal ideation E. Stay out of the person's reach F. Avoid sudden changes in care or the therapy setting

A. Avoid too many choices C. Increase the opportunity for decision making D. Notify staff of suicidal ideation

Jane, a 35-year-old widow, who has been diagnosed with a dependent personality disorder, has recently joined a community skills group which is focused on assertiveness training. The group is on their first outing, shopping for ingredients at the local grocery store for an upcoming cooking activity. The group members have been given a budget and instructed to buy the ingredients for the activity. Which of the following tasks is the MOST appropriate to request Jane to perform at this stage of her assertiveness training. A. Before buying a product, ask the sales-clerk more information about it B. Ask the sales-clerk if the total amount on the bill is accurate C. Make an exchange of an item using a receipt with the expectation of having some money returned D. Alert a sales associate that the items on the top shelf are stacked dangerously high

A. Before buying a product, ask the sales-clerk more information about it

A homeless veteran suffering from paranoid schizophrenia is referred to an OT for treatment. While being interviewed by the OT, he becomes uncooperative, refuses to answer the OT's questions, and demands a reason for being interrogated. What action should the OT take now? A. Clearly restate the purpose of the interview B. Ask more questions about his childhood C. Elegantly ask the patient to be calm and answer the questions D. Be patient with the patient

A. Clearly restate the purpose of the interview

A patient who has been diagnosed with major depression has been experiencing difficulty participating in a daily OT group, in the in-patient psychiatric department. Recently, the patient has started taking antidepressant medication and she has expressed that although she has more energy, she continues to feel depressed. Based on the patients subjective statement, how should the OTA BEST proceed with the intervention session? A. Continue to observe the patient and provide structured activities B. Avoid daily walks due to medication side effects C. Avoid activities where the patient lies down D. Minimize the use of cooking activities to avoid frustration and incompletion

A. Continue to observe the patient and provide structured activities

A former US marine who is suffering from PTSD from a recent tour in Iraq is experiencing difficulty performing his ADLs due to his overwhelming symptoms of fitful sleep, anxiety, and hypervigilance. What should the OTR®'s FIRST focus of intervention be, in this scenario? A. Facilitate expression of emotion and promote relaxation B. Focus on forming healthy eating habits C. Refer the patient to a psychologist for CBT D. Remind the patient of how hopeful he should be

A. Facilitate expression of emotion and promote relaxation

An OT practitioner is consulting with the adult children of a patient who has been diagnosed with early stage Alzheimer's Disease. At this stage of the patient's disease, which activity is the patient MOST likely going to need assistance performing? A. Paying the bills B. Bathing C. Laundry D. Washing the dishes

A. Paying the bills

A patient with early stage dementia is working with the OTA on grooming. The patient gets confused and does not know what items to pick up and use first. What is the best way to help the patient with selecting ans using the correct items in the appropriate sequence? A. Provide a visual chart B. Provide verbal cues C. Hand the patient the items one at a time D. Work on dynamic standing balance

A. Provide a visual chart

A patient with Germaphobia becomes extremely anxious when asked to participate in a group activity of pizza-making. How should the OTA react in this situation? A. Provide the patient with latex-free gloves B. Explain the benefits of occupational therapy C. Allow the patient to observe the task D. Allow the patient to stay in her room

A. Provide the patient with latex-free gloves

Barry, a veteran, has been admitted to an inpatient mental health hospital for treatment of his depression and obsessive-compulsive disorder. He is participating in an activity group with other patients who have similar diagnoses. The clinician has noticed that Barry's compulsions seem to become more pronounced when he feels pressured to complete tasks within a certain time limit. What is the MOST appropriate type of activity that can be used in this group setting, focussing specifically on Barry's needs? A. Repotting plants in the garden center B. Painting a tile trivet with 2 colors only C. Weaving a placemat D. Wrapping a glass vase with jute rope

A. Repotting plants in the garden center

A 21-year-old woman who works at the coffee shop and attends community college has been diagnosed with bulimia and has recently been having recurrent episodes of binge eating. Her parents have admitted her to the inpatient psychiatric unit, as they are concerned about her "lack of control". What should the first OT intervention focus on when working with this patient? A. The OT can build trust, provide education on nutrition and food management, and help the patient develop healthy use of leisure time B. The OT can provide adaptive and positioning equipment and collaborate with family C. Ask questions about the patients binge eating and provide therapeutic listening D. Help the patient choose a restaurant that would give lots of choices for healthy eating

A. The OT can build trust, provide education on nutrition and food management, and help the patient develop healthy use of leisure time

A 47-year-old woman has been suffering from depression for over 5 years. After evaluating the patient, the OT determines that an appropriate intervention would be for the patient to wake up at 7 am, go to the bathroom, get dressed, groom herself, and then join the other patients for breakfast in the cafe at 7:30 am. What is the reason for this type of intervention? A. To be successful at a routine B. To wake up at a reasonable time of day C. To participate in a social event of breakfast with other members D. To participate in ADLs independently

A. To be successful at a routine

A patient who has been diagnosed with dementia is receiving OT services in an inpatient setting. The OT intervention plan is based on the Allen Cognitive Model with the goal of teaching the patient self-grooming skills. The patient has been assessed and found to be functioning at an ACL 4 (Goal Directed Actions). When planning this patient's OT session, what approach would be the MOST appropriate to use with this patient? A. Top-Down Approach using visual cues to learn self-grooming B. Bottom-Up Approach using verbal instructions to learn self-grooming C. Restorative Approach using written instructions to learn self-grooming D. Top-Down Approach providing opportunities for the patient to learn self-grooming through trial and error

A. Top-Down Approach using visual cues to learn self-grooming

Sue-Anne, a 36-year-old patient who has been diagnosed with OCD, works at a storage facility as an administrative assistant. Her work-related tasks include filing and storing documents. Sue-Anne is currently attending an outpatient adult mental health program as she is having difficulty coping with her current workload. As a result of her OCD, she has started to perform poorly at work, and she is concerned that she may lose her job. It generally takes her 45 minutes to complete a task that would typically take another employee 20 minutes to complete, with the same level of skill. Sue-Anne reports that, "I take extra time because I have to make sure that all the pages are neatly put together before I staple them and file them". Which of the following methods would MOST EFFECTIVELY evaluate Sue-Anne's work performance? A. Use of cognitive-behavioral strategies implemented when most appropriate to reduce anxiety B. A functional assessment of work-related skills, such as carrying boxes of documents C. Evaluation of a task using a quiet activity such as a timed word-finding puzzle D. The patient's self-assessment of her strengths and weaknesses during an interview

B. A functional assessment of work-related skills, such as carrying boxes of documents

A diagnosed alcoholic patient is unable to realize that the source of his problems is drinking. This is an example of what type of thinking? A. Hypocrisy B. Denial C. Split personality D. Regression

B. Denial

A patient refuses to admit that she has anorexia. She believes that she eats a proper amount every day. What type of thinking is this an example of? A. Rejection B. Denial C. Acceptance D. Progress

B. Denial

A patient residing in a long-term care facility has progressed to the mid stage of Dementia. In which activity would this patient have the most difficulty participating? A. Giving a detailed description of their childhood home and favorite family outing B. Describing their daily routine of the past week C. Answering open ended questions about their schooling and work history D. Difficulty dressing, needing maximum assistance

B. Describing their daily routine of the past week

An OTA is working with six patients in the inpatient unit at a local hospital. All six patients have anxiety . Which method represents a cognitive-behavioral therapy (CBT) approach that the patients can use to effectively manage their anxiety in daily living? A. Allow the patients to express themselves through a watercolor painting activity B. Educate the patients on ways to replace distorted thoughts and fears with positive ones C. Take the patients for a walk outside to de-escalate their stress level D. Provide positive reinforcement when each patient remains calm during a stressful situation

B. Educate the patients on ways to replace distorted thoughts and fears with positive ones

For a patient who has been diagnosed with Bipolar disorder what type of job is the most appropriate to recommend for this patient? A. Jobs that entail a stable, well-defined set of duties, calm environment, and night-time hours B. Jobs that entail a stable, well-defined set of duties, calm environment, and daytime hours C. Jobs that entail a stable, well-defined set of duties, and frequent travel D. Jobs that entail a stable, well-defined set of duties, calm environment, and shift work hours

B. Jobs that entail a stable, well-defined set of duties, calm environment, and daytime hours

An OTR® is working with Sylvia, a 77-year-old retired elementary school teacher who has been diagnosed with Stage 4 Alzheimer's disease. Sylvia is currently living with her daughter who has approached the OTR® during a home visit, to request advice on how she can help her mother with dressing in the mornings. Although Sylvia can dress herself, lately her choice of clothing is not appropriate for the weather and she wears her clothing "oddly", often wearing her underwear over her clothing. Sylvia is also very hesitant to wear clean underwear as she insists on wearing the same pair of underwear daily, referring to them as her "favorite underwear". The daughter has tried her best to help Sylvia, but Sylvia does not want to be told what to wear. What is the BEST advice the OTR® can give the daughter to help her with assisting her mother, with dressing? A. Give Sylvia a wide selection of clothing to choose from B. Lay out Sylvia's clothing in the order that each item should be put on C. Do not be flexible, Sylvia needs to understand that she has to dress appropriately D. As long as Sylvia dresses herself in the correct sequence, wearing clean underwear is not a concern

B. Lay out Sylvia's clothing in the order that each item should be put on

Diane is a 45 year old female with a diagnosis of severe, chronic anxiety, admitted to the inpatient psychiatric unit following a "nervous breakdown". What activities should the COTA® introduce to help Diane manage her anxiety levels? Select the best 3 choices. A. Timed cognitive exercises B. Progressive relaxation techniques C. Structured journaling D. Advanced yoga E. Simple yoga poses graded up according to Diane's skill level F. Cooking a full meal

B. Progressive relaxation techniques C. Structured journaling E. Simple yoga poses graded up according to Diane's skill level

An OT is due to meet with a patient who has been diagnosed with paranoid schizophrenia. In preparation for the meeting, what type of environment would be optimal for this patient? A. Brief and loud B. Quiet and structured C. Client-centered and flexible D. Psychoanalytical

B. Quiet and structured

An OTA working at an in-patient psychiatric unit, is planning a topical group for patients with schizophrenia. What type of environment would be optimal for this group? A. Cozy and amiable B. Quiet and structured C. Social and flexible D. Psychoanalytical

B. Quiet and structured

With which mental health illnesses is anosognosia (lack of insight) MOST commonly associated? A. Personality disorder and GAD (generalized anxiety disorder) B. Schizophrenia and Bipolar Disorder C. Stroke and Depression D. Depression and Anxiety

B. Schizophrenia and Bipolar Disorder

A 75-year-old resident at a skilled nursing facility is participating in OT. She has been losing weight at a rate of 2 pounds per week which the dietician is addressing. During the initial OT evaluation, it was determined that the resident has mild dementia and moderate hearing loss. One of the goals of her OT intervention is to improve the resident's engagement in self-feeding. Given her deficits, what is the BEST method for the OTR® to use when providing instructions to this resident during treatment sessions? A. Sit beside the resident and write 3-word instructions on a small wipe-off board B. Use a combination of hand gestures with verbal instructions C. Set up the tray within the patient's line of vision, explain where everything is located and identify foods by name D. Provide hand-over-hand assistance as needed

B. Use a combination of hand gestures with verbal instructions

A patient who was diagnosed with major depression 5 years ago, has recently been admitted to an inpatient mental health facility for treatment of a major depressive episode. As depression is linked to suicidal ideation, all professionals involved in this patient's care have to be aware of any signs indicating that the patient may be planning to attempt suicide. At what stage of this patient's depressive episode is the patient MOST LIKELY to plan and carry out harming themselves? A. When the patient is first admitted to the unit B. When the patient is coming out of the deepest part of their experience C. When the patient is showing signs of loss of appetite and weight D. When the patient has been prescribed ECT

B. When the patient is coming out of the deepest part of their experience

Carol, a 73-year-old resident of an assisted living facility was admitted to an inpatient rehabilitation unit after sustaining a right femoral fracture, 2 weeks ago. Carol has been diagnosed with Dementia and she is currently functioning at an ACL level of 3.8. She is ambulatory, using a FWW, and requires minimal assist with basic routine self-care. In order to alert the nursing staff that she needs to use the bathroom, Carol does not use the call button but instead, yells from her room that she needs to use the toilet. The case manager announces that Carol will be transferred to the next level of care in 2 days' time. Which setting would be the most appropriate in terms of meeting Carol's needs, based on her current level of functioning? A. Assisted living where she has previously lived B. Long-term acute care facility C. An adult group home or board and care D. An Alzheimer's/Memory care facility

C. An adult group home or board and care

A 65-year old widow who has an anxiety disorder and lives alone is showing signs of mild cognitive decline. She currently volunteers at a local community center doing general cleaning. A bake-off at the center is scheduled in a week and the patient decides to volunteer at that event, as well. She is required to attend several planning sessions before the event. She is assigned to work on tasks such as making decorations and posting signs for the event. The patient is feeling anxious as the day of the event approaches. Which strategies can the COTA® teach the patient so that she can manage her anxiety and cope with her assigned tasks? A. Set up alarms on her digital wrist watch to remind her when a task is due B. Hang a calendar on the refrigerator that lists the time and day of the meetings C. Develop an actionable list which she can be checked off as she prepares for each activity D. Create a mnemonic that helps her remember the steps required to prepare for each activity

C. Develop an actionable list which she can be checked off as she prepares for each activity

What treatment strategy would be the MOST effective for a patient who has dementia and is demonstrating signs of auditory defensiveness? A. Therapeutic listening B. Sound bingo C. Ear plugs or headphones D. Passive range of motion to relax the nervous system

C. Ear plugs or headphones

A patient with moderate stage dementia has recently been assigned a new caregiver to assist her with her ADLs and IADLs. What is the MOST important strategy the OT should teach this caregiver, to help equip her for caring for this patient? A. Educate the caregiver about the disease B. Educate the caregiver about hip precautions C. Explain the importance of visual cues D. Provide ways to improve the patient's memory

C. Explain the importance of visual cues

Steven has been admitted to an inpatient mental health facility. He is diagnosed with Schizophrenia with hallucinations following an episode where he strongly believed that he was in a jungle and he was thrashing around to chase away mosquitoes. During a gross motor activity group, Steven starts attempting to frantically remove his clothing. What should the OTR® do NEXT to address this behavior? A. Immediately explain the impact of his behavior on the group members B. Tell the patient to leave the group as he is displaying inappropriate behavior C. Incorporate stimulating his senses other than the tactile system, into the activity. D. Have him work with a small group in front of a mirror

C. Incorporate stimulating his senses other than the tactile system, into the activity.

After a PTSD relapse, a patient has recently been re-admitted to an inpatient psychiatric unit. From an OT point of view, what is the BEST type of intervention the OT should implement? A. Have the patient write his feelings B. Discuss with the patient C. Initiate a schedule of daily meditation and yoga D. Participate in an ADL group

C. Initiate a schedule of daily meditation and yoga

While working with a patient who resides in a SNF and presents with dementia, an OTA asks the patient several questions about his routines and roles. After several questions, the OTA detects that the patient is making up many of the answers and being untruthful. What should the OTA do now? A. Ask only closed questions B. Complete the evaluation during the next session C. Interview the patient's caregiver D. Give the patient a checklist questionnaire

C. Interview the patient's caregiver

A 24-year old patient in an inpatient mental health facility has been displaying negative outbursts and poor self-concept. He appears uninterested in participating in a conflict resolution, social skills training group. The patient states, "this doesn't relate to me. I don't need this". What should the OTR® do NEXT in response to his statement? A. Allow the patient to choose a different activity B. Give the patient a homework assignment regarding the group topic on his own C. Investigate the patient's perception of his self-limiting behavior and encourage participation D. Re-direct the patient and tell him to stop behaving negatively

C. Investigate the patient's perception of his self-limiting behavior and encourage participation

An OT is working with a patient with cognitive deficit in an in-patient rehab. What psychological assessment will provide a quick screening test of cognitive functioning? A. Portable Mental Problem Exam B. Adolescent Sensitive Profile C. Mini-Mental State Examination D. Depression Inventory

C. Mini-Mental State Examination

You are working with a patient with cognitive dysfunction in inpatient rehab. What psychological assessment will provide you with a quick screening test of cognitive functioning? A. Portable Mental Problem Exam B. Adolescent Sensitive Profile C. Mini-Mental State Examination D. Depression Inventory

C. Mini-Mental State Examination

After having a relapse from anorexia a 16 year old female has been admitted to the in-patient psychiatric unit. As part of a multidisciplinary program, the patient has been participating in several groups for treatment of ADL's, social skills, and leisure skills. What would be most beneficial for the OT to document in the "A" of the SOAP note to provide information about the patient's participation and progress? A. Patient's ability to list leisure activities as part of a leisure skills group B. Patient reports feeling tired and restless C. Patient appears to use appropriate judgement when role playing various tasks that involve social skills D. Patient is able to stay in the range of required caloric input

C. Patient appears to use appropriate judgement when role playing various tasks that involve social skills

Diane is a 45-year-old female with a diagnosis of Generalized Anxiety Disorder. She was recently admitted to the inpatient psychiatric unit following an acute exacerbation of her symptoms. What would help Diane the MOST to manage her anxiety levels? A. Timed cognitive exercises, progressive relaxation techniques, advanced yoga B. Advanced yoga, cooking a full meal, structured journaling C. Progressive relaxation techniques, structured journaling, simple yoga poses graded up according to Diane's skill level D. Timed cognitive exercises, structured journaling, simple yoga poses graded up according to Diane's skill level

C. Progressive relaxation techniques, structured journaling, simple yoga poses graded up according to Diane's skill level

In a long term care facility a patient with dementia starts to walk back to her room while in a gardening group with 4 other members. What action should the OT take next? A. Allow the patient to walk back to her room B. Explain why it is important to participate in the group C. Redirect the patient back to the area and activity D. Ask the patient where she is going

C. Redirect the patient back to the area and activity

An OT in a skilled nursing facility has received a physician's order to evaluate and treat a 70 year old man with a diagnosis of schizophrenia. The patient's chart reveals that he has developed parkinsonism as a result of long term use of antipsychotic medication. What symptoms should the OT expect to observe? A. Athetosis, muscle spasticity, and amblyopia B. Grimacing, tongue thrusting, lip smacking C. Shuffle gait, stooped posture, resting hand tremor D. Partial hemiparesis, slurred speech, neglect of one side

C. Shuffle gait, stooped posture, resting hand tremor

Tracy, a 30-year-old woman who was recently diagnosed with post-traumatic stress disorder following a history of domestic violence, is currently residing in a women/family shelter with her 4-year-old daughter. Tracy is attending an OT community re-entry program. The OTR® has assessed Tracy to determine her roles and habits, sense of volition, support in the environment, and specific skills such as task management. Tracy has stated that she wants to be an independent and productive "citizen in society and make my 4-year-old daughter feel safe". What should the PRIMARY focus of Tracy's initial group session be, in this scenario? A. Exploration of leisure opportunities B. Skill training in money management and completing a housing application C. Meal planning and child nutrition D. Assertiveness and advocacy training, and safety planning

D. Assertiveness and advocacy training, and safety planning

Gertrude is an 80-year-old woman with stage 3 Alzheimer's disease. What symptoms would you expect to observe as Gertrude completes daily activities? A. Difficulty finding the right word when speaking, misplacing valuable objects, confusion about the date or location B. Trouble with planning or organizing, confusion about the date or location, personality changes C. Trouble with planning or organizing, confusion about the date or location, requires assistance choosing clothing appropriate for the weather D. Difficulty finding the right word when speaking. misplacing valuable objects, trouble with planning or organizing

D. Difficulty finding the right word when speaking. misplacing valuable objects, trouble with planning or organizing

A veteran who has been diagnosed with PTSD was admitted to an inpatient mental health facility a week ago, for moderate depression. He demonstrates decreased motivation with performing basic self-care. For the week, the OTR® has been focusing on identifying meaningful roles, routines, habits ,and developing strategies to build his self-esteem. What activities would promote carryover of the interventions upon discharge? A. Creating a list of activities with instructions of how to maintain proper nourishment, relaxation, and physical condition B. Teaching the patient on how to incorporate guided imagery and meditation in his daily routines C. Developing written and visual guidelines on how to cope with stress D. Establishing a daily schedule of activities for resuming previous roles

D. Establishing a daily schedule of activities for resuming previous roles

Julia, a grandmother with mild stage dementia, wants to take the bus to her grandson's house, but keeps getting lost. Which of the following actions should the OT take FIRST when evaluating Julia to determine if she can successfully complete this task? A. Ask Julia every day to explain the directions. B. Guide Julia on her route on a regular basis. C. Start following Julia without her consent. D. Evaluate Julia's topographical orientation skills to determine if it is safe for her to ride the bus alone.

D. Evaluate Julia's topographical orientation skills to determine if it is safe for her to ride the bus alone.

An OT is planning on creating a group that addresses ways to help patients achieve restful sleep. It is to be implemented in an acute inpatient unit for patients with a medical history of substance abuse. What is the BEST method the OT can use in order to achieve the goals of this group? A. Identify assertive behaviors B. Identify work abilities and interests C. Visual scanning skills D. Identify leisure pursuits

D. Identify leisure pursuits

An OTR® is planning on working with a group of patients who have been diagnosed with either a major depressive disorder or Schizophrenia. Most of the group members have minimal social interaction, low energy, and present with stooped postures. What is MOST appropriate activity, the OTR® should select for the initial group session? A. An aerobic group exercise syncopated to music B. A car wash involving patients directing staff outdoors to the car wash location C. Create a group collage to be hung in the Activities Room D. Plan a destination for a group walk, a few minutes away

D. Plan a destination for a group walk, a few minutes away

There have been reports that a schizophrenic patient living in a group home does not contribute towards meal preparation when he's supposed to. After evaluating this patient, the OT determines that he has difficulty with initiation of a task. What is the most valuable advise the OT can give the staff, to help them manage this patient's behavior? A. Tell the staff to remind the patient that no one will be allowed to help him B. Tell the staff to provide a specific time to the client for completion of the task C. Tell the staff to let the patient be flexible with his task D. Tell the staff to provide verbal cues to begin the task as needed

D. Tell the staff to provide verbal cues to begin the task as needed

A 40-year-old man diagnosed with Schizophrenia has been admitted to an inpatient facility. He has recently been experiencing visual hallucinations and describes the images as "visions of animals with wings in a black and white movie". The OTR® decides to include the patient in a craft activity group. What is the MOST APPROPRIATE craft activity for this patient? A. Seated outside on the patio while lacing and stamping a leather wallet B. Music activity with a large group involving gross motor movements C. Sanding a birdhouse in a quiet corner of the activity room D. Work with a few, trusted people at a table painting a Paint-by-Numbers poster board with bright colors

D. Work with a few, trusted people at a table painting a Paint-by-Numbers poster board with bright colors