module 6

A Ensure the activity environment provides structure and allows for continuous observation The symptoms the patient reports indicate that the antidepressant is not working in the correct way and may put the patient at an increased risk of suicidal thoughts. All activities should be structured to reduce the patient's frustration level and the patient should be continuously monitored for any indication of suicidal thought

85. Question A patient who has depression has been taking an antidepressant for 3 weeks. The patient has also been participating in a daily OT group. During the most recent group activity, the patient reported having more energy despite still feeling depressed. Based on this report, what precautions should the OT take when preparing intervention session? Ensure the activity environment provides structure and allows for continuous observation Avoid gross motor activities that may exacerbate medication side effects Use sedentary activities to avoid the potential for disruptive hyper-manic outbursts Minimize the use of fine motor activities to avoid frustration due to cogwheel rigidity

D Balance the patient's day with familiar valued routines and activities The patient with cognitive disorder will benefit from familiar routines, tasks and activities. Engaging the patient with activities that he is interested in and enjoys will help him in his recovery.

A 21 year old patient with cognitive disorder was recently discharged after he attempted suicide. After several weeks, the patient is ready to be discharged home. What should the therapist advise the parents of this patient? Ignore the patient's questions Provide round the clock supervision Help the patient with leisurely activities outside the home Balance the patient's day with familiar valued routines and activities

B Tile project During an acute manic episode an important role for the COTA is monitoring behavior changes and providing a structured environment in which behavior can be managed. Setting limits is essential. Of the activities listed, a tile project provides the most structure.

A 25-year-old in-patient in an acute psychiatric unit is exhibiting rapid speech and hyperactive behavior. After beginning a project, he quickly loses interest and fails to complete three separate projects. What activity should the OT use to engage this patient? Sketch Tile project Planning Carving

D

A 29 year old female patient is being seen in a inpatient psychiatric facility to stabilize symptoms associated with the manic phase of bipolar disorder. Part of her goals are to be independent in meal preparation. While in a lunch preparation group, the OT asks the patient to set the table for the meal, however the patient becomes highly distracted and begins chopping vegetables. What would be the BEST course of action the OT should take next to help this patient achieve more independence with her goal of setting the table. The OT can ask the patient what task she would be more interested in and then after that task is completed, the patient can set the table Allow the patient to finish the task of chopping vegetables and then ask the patient to set the table Pull the patient aside from the other group members to discuss the patients goals of setting the table Provide additional structure to continue with the assigned task of setting the table

A Determine the patients typical mealtime routines and habits At Allen Cognitive Level 4, the patient will have difficulty participating in meal planning tasks. Structuring meal planning by using food choices and routines that are familiar to the patient will help facilitate the client's participation in this activity.

A 34 year old male has chronic schizophrenia and is functioning at Allen Cognitive Level 4 (Goal-Directed Actions). The patient lives at a group home with 4 other residents. The patient has a goal of preparing simple meals with other residents in the group home kitchen. What would be best way to prepare in advance in order to support the patients success during this intervention? Determine the patients typical mealtime routines and habits Provide step-by-step verbal cues during the meal time task Provide verbal prompts when needed during the meal time task Limit the number of residents working in the kitchen during this task to 2 or 3 patients

A To be successful at a routine Being successful at a daily routine will help bring confidence and allow the patient some structure during the day.

A 47 year old woman has been suffering from depression for over 5 years. After the evaluation, the OT has determined that an appropriate intervention would be to wake up at 7am, go to the bathroom, get dressed, groom, and then meet up with the other patients for breakfast in the cafe at 7:30am. What is the reason for this? To be successful at a routine To wake up at a reasonable time of day To participate in a social event of breakfast with other members To participate in ADL's independently

B Explore activities that he loves to do Exploring activities that he likes doing is important to talk about during his last therapy session. There is no indication that we need to consider the patients wife, other than the fact that he is married.

A 56 year old married man diagnosed with depression is about to be discharged from in-patient rehab. What should the the therapist include as a topic of conversation for the last session? ADL's Explore activities that he loves to do Explore activities that he likes doing with and without his wife Explore his secret desires

C Post visual reminders on each of the doors of the home to indicate the need to lock the door and put on the alarm The concept of aging-in-place promotes the ability to live in one's own home regardless of age, income or ability level. Due to the patient's dementia, the patient does not have the ability to remember to use a checklist, learn how to use an environmental control device, or remember learning on a short term basis. Visual reminders will help the patient remember to lock the door without requiring him to learn and remember new information.

A 78 year old man diagnosed with early stage dementia lives alone in a 1 bedroom apartment. One of the patient's goals is to remain in his current apartment as long as possible, however he has difficulty remembering the sequence of steps for securing the locks on a door and remembering his alarm password. What would be the best intervention strategy to allow this patient to live at home independently? Engage the patient in repetitive drills to facilitate help with memory of learning Identify a programmable environmental control device that the patient can use in his home Post visual reminders on each of the doors of the home to indicate the need to lock the door and put on the alarm Recommend a home health aid check in on the patient at the end of each day to ensure he locked his door and put on the alarm

C Group collage Cooperative- enable members to change in a group activity, facilitating free expression; develop trust, love, belonging, and cohesion; identify and meet socio-emotional needs (working cooperatively)

A COTA is working with a cooperative group of 10 patients. What would be the BEST intervention? Playing cards Role Play Group collage Unstructured course

A Upgrade skills and establish service competency in physical dysfunction It is the COTA's ethical responsibility to have service competency in the area in which they practice.

A COTA working in adult psychiatry wants to work for a home health agency that provides services to CVA patients. It is the COTA's responsibility to: Upgrade skills and establish service competency in physical dysfunction Treat patients who have cognitive impairments Take education classes Inform patients about unfamiliarity

B

A diagnosed alcoholic patient unable to realize that the source of his/her problems is drinking is an example of: _______ Hypocrisy Denial Split personality Regression

B Parallel group A Parallel Group focuses on developing interaction between people while they work on individual tasks.

A group of patients in a drug rehab program take part in an art class. Each patient works on their own painting or drawing but the group leader may facilitate discussions and interactions between the group members. What type of group is this? Topical group Parallel group Project group Cooperative group

C Mature group Mature group members also participate in various clubs, and groups. These members are of both sexes, come from different backgrounds, and have different interests and skills.

A group where members are able to take on a variety of group roles, including task and group maintenance roles, in response to changing conditions is called a _______ group Active group Ideal group Mature group Review group

A The OT should watch to see if her patient is biting her nails and pulling her hair Anxiety is a feeling of apprehension or worry associated with anticipation of future anger. An example of a client feeling anxiety in a session would be biting their names, pulling their hair, tapping their feet etc.

A middle aged female, who attends a day program for adults with mental disabilities, has difficulty participating in several group activities. What would be the best way for her OT to find out whether her patient is actually showing signs of anxiety during her group sessions? The OT should watch to see if her patient is biting her nails and pulling her hair The OT should ask her patient to complete a questionnaire after each session The OT should ask other group members to provide feedback on the patient's anxiety The OT should create a smaller group for her patient

A Provide the patient with cooking gloves The patient can participate in the activity by wearing cooking gloves.

A patient has severe anxiety about germs and does not want to participate in a group activity of pizza making. What is the best thing the OT should do? Provide the patient with cooking gloves Explain the benefits of Occupational Thearpy Allow the patient to observe the task Allow the patient to stay in her room

A Characterized by movement that is associated with comfort. There is some awareness of large objects in the environment, and the individual may assist caregiver with simple tasks Unable to imitate the running stitch Postural Actions/Gross Body Movement-MAX ASSIST Motor actions: approximate imitations, pacing, bending, stretches Activities: gross motor games, dance Attention Span: minutes

A patient is able to sit down, walk, and perform gross motor exercises. However he may wander off in social situations. What ACL level is this patient at? Level 2 Level 5 Level 4 Level 3

A Reminiscence group Reminiscence therapy is defined as "the use of life histories - written, oral, or both - to improve psychological well-being. The therapy is often used with older people." This form of therapeutic intervention respects the life and experiences of the individual with the aim to help the patient maintain good mental health. The majority of research on reminiscence therapy has been done with the elderly community, especially those suffering from depression, although a few studies have looked at other elderly samples.

A patient is attending a group in which several women share their past experiences, life stories, life challenges with one another in order to gain social support. What is the name of this group? Reminiscence group Behavior alteration MOHO Motivational approach

B ACL level 4 A patient at ACL level 4 is able to follow a picture or diagram to follow an activity.

A patient is given a picture on how to fold paper to make a paper plane. What ACL level is this patient performing at? ACL level 5 ACL level 4 ACL level 3 ACL level 2

C Parallel groups Parallel groups use individual tasks with minimal interaction required Ex: Finger painting next to peer, with possible sharing of supplies, interaction not required for task completion

A patient is painting using water colors independently next to another group member. While they complete their art project they are not interacting or talking. What type of group is this? Egocentric groups Project division group Parallel groups Cooperative manager groups

D ACL level 3 A person at this level will also engage in simple repetitive crafts but is likely to be surprised to see that something has been produced. They will have difficulty understanding cause and effect. They may become easily disoriented and may get lost

A patient with a cognitive disorder enjoys manipulating and touching several therapeutic objects on the table. What ACL level is this patient most likely at? ACL level 6 ACL level 4 ACL level 2 ACL level 3

D Move the patient to a quiet part of the room to complete the task The keyword is first course of action. By moving the patient to a quiet part of the room to bake a cake, the OT can see if the patient can cook independently. The goal is not social skills training.

A patient with schizophrenia has just relapsed and has just been admitted to inpatient rehabilitation. The patient will be discharged in two weeks and has goals to live independently. During a cooking group, the patient states she has difficulty following written instructions to bake a cake. The patient also states, there are too many people and too much noise. What is the first course of action the OT should take based off of the patients subjective statement? Ask the group members to talk quietly when working in the cooking group Document the patient's inability to concentrate long enough to cook independently Evaluate the patient's meal preparation skills at the next therapy session Move the patient to a quiet part of the room to complete the task

A

A schizophrenic begins having hallucinations after picking up a cup of juice? What is the role of COTA at this point? Redirect him to the activity Alter the environment Grab his hand Call the caregiver

B Concreteness Concreteness is an aspect of communication that means being specific, definite, and vivid rather than vague and general. A concrete communication uses specific facts and figures.

A schizophrenic female has been asked to make a grocery list. She grouped all items together and listed eggs separately, explaining that, "Eggs break, they should be on top". This approach to the task is indication of: ______ Anosognosia Concreteness Diminished insight Poor concreteness

B Further evaluation should focus on determining whether the patient can perform simple tasks independently using visual cues If the patient is able to demonstrate the whipstitch, but cannot imitate cordovan stitch then further evaluation should focus on determining whether the patient can perform simple tasks independently using visual cues.

A therapist is screening a patient using the ACL. The patient can complete a whipstitch but is unable to complete the cordovan stitch. Which of the following is most likely indicated? The patient can do mental trial and error Further evaluation should focus on determining whether the patient can perform simple tasks independently using visual cues The patient may assist the caregiver in simple tasks The patient may think of hypothetical situations

A Topical group Topical groups—focus on discussion of activities/issues members are engaged in outside of the group; to enable members to engage in these activities in a more effective, need-satisfying manner (e.g., a parenting skills group for parents of children with disabilities). Members must be at an ego-centric cooperative group skill level

According to Mosey's developmental groups, concentrating on issues where members are engaged in outside of the group such as a parenting skills for parents of children with disabilities would be considered a ________ group. Topical group Control group Practical group Sectional group

C Initiate a schedule of daily meditation and yoga Relaxation is one of the primary interventions for people with PTSD.

After a PTSD relapse a patient has recently been admitted to an inpatient psychiatric unit. What would be the BEST intervention? Have the patient write his feelings Discuss with the patient Initiate a schedule of daily meditation and yoga Participate in a ADL group

D Refer him to a primary therapist If the person after suicide attempts tells you after a group session that you are the only therapist that was ever helpful, and he wants you to meet him privately, don't do it. Refer him to primary therapist.

After a recent suicide attempt, a 27 year old male with borderline personality disorder tells his female OT that he would like to meet with her privately because she is the only therapist that has ever been helpful. What should his OT do now? Schedule an intimate session Immediately contact his family members Ignore the request Refer him to a primary therapist

D Simplify the task and slowly increase duration The goal of treatment is to increase the patient's ability to focus on the task, not to manage the complexity of the task. Therefore the task can be simplified which will typically improve the patient's ability to stay focused.

After attending 3 training sessions, a patient in a cognitive retraining program (where the goal is to be able to attend to a task for 30 minutes) can only remain focused for 10 minutes. What should the OT do at this point? Set goals that can be reached more quickly Arrange small group patients to assist in task completion Use chaining techniques Simplify the task and slowly increase duration

A Baking a cake New learning occurs at this level. This may be the usual level of functioning for 20% of the population. It alters actions with overt trial and error; poor organization, planning, and socialization

After screening a patient with dementia using the Allen Cognitive Level Screening tool, the OT determines that the patient is functioning at a level. 5. What would be the best treatment intervention? Baking a cake Flipping through a magazine Riding a bicycle Performing overall body exercises

D Time management and social skills The OTR will want to evaluate the patients time management and social skills to determine if the patient can handle the work schedule, arrive to work on time, and interact appropriately with the job su pervisor and co-workers. The physical requirements of the job can be assessed after the patients ability to manage the work schedule is determined.

An OT is preparing to complete a vocational-readiness assessment with an 52 year old patient who has chronic schizophrenia. The patients wants to work with a landscaping company that consists of mowing lawns and gardening. What performance skill should the OT INITIALLY evaluate to provide information about the patients current work behaviors? Lifting capacity and endurance Memory and physical stamina Strength and adaptability Time management and social skills

D Administer the lower cognitive test If the patient appears to be confused and disoriented during the ACL test, administer the lower cognitive test. If alertness impaired: increase environmental stimuli, use gross motor activities, and increase sensory stimuli. When working with a patient with Alzheimer's disease = make eye contact and show that you are interested in a person, maintain friendly positive facial expression, don't give orders, use short sentences, use non-verbal communication, and attend to safety (don't make them play child's games ABSc).

An OT is screening a patient with cognitive decline using the Allen Cognitive Level screening tool. When the OT asks the patient to imitate the running stitch, the patient becomes confused and disoriented. What is the next step the OT should take? Ask the patient to imitate the single runstitch Ask the patient to imitate alternatively Administer the cognitive test Administer the lower cognitive test

C Physical exercise When patients have chronic schizophrenia, distraction and compensation from their symptoms will help. When this patient performs jumping jacks, running in place, or other physical exercises, they will increase their sense of personal accomplishment.

An OT is working at a clubhouse and working with patients who have chronic schizophrenia. What type of leisure activity will help these patients cope with their deficits? Table top board games Playing music Physical exercise Watching a movie

D

An OT is working in an assisted living facility with a patient who has schizophrenia. This patient will be discharged next week and will be residing in a group home with 4 other residents. The patient is currently independent with self-care and enjoys cooking, but requires assistance during meal-preparation tasks due to a disregard for safety. The new group home staff is willing to assist the patient during meal preparation activities. What would you recommend the new staff at the group home do to help maximize the patient's independence in meal preparation? The new staff can encourage the patient to prepare familiar meals The new staff can encourage the patient to limit meal preparation to simple cold meals The new staff can encourage the patient to prepare meals while sitting down at a table The new staff can provide step-by-step verbal cues throughout a cooking task

B Educate the patients on ways to replace distorted thoughts and fears with positive ones The cognitive-behavioral approach (CBT) involves the patient consciously replacing incorrect thoughts and fears with positive or correct thoughts, resulting in a change in emotional response.

An OT is working with 6 patients who have anxiety in the inpatient unit at a local hospital. Which method represents a cognitive-behavioral therapy (CBT) approach that the patients can use to effectively manage anxiety in daily living? Allow the patients to express themselves through a water-coloring activity Educate the patients on ways to replace distorted thoughts and fears with positive ones Take the patients for a walk outside to deescalate their stress level Provide positive reinforcement when each patient remains calm during a stressful situation

A To identify goals The purpose of a questionnaire is to engage the patient in identifying their IADL's and what goals they want to work on in OT. Clinical Simulation

An OT is working with 8 women who have been abused by their husbands at a local outpatient clinic. In the beginning of the six week program, the OT provides each patient with a checklist questionnaire for them to fill out about their leisure, communication, and assertiveness. What is the reason the OT hands out this questionnaire? To identify goals To increase socialization among the members To increase assertiveness To identify ADL's

A Locating community resources A therapist will work on getting homeless patients integrated back to the community. This will include resources for food, clothing, and shelter.

An OT is working with several homeless patients at a local church. What should the OT focus on in these sessions in order to help the patients get integrated back to the community? Locating community resources Finance management Social techniques Transportation

A Teach the patients to replace thoughts of anxiety with calm thoughts The cognitive-behavioral approach involves the patient consciously replacing incorrect thoughts and fears with positive or correct thoughts, resulting in a change in emotional response.

An OT is working with several patients in an in-patient psychiatric unit on managing anxiety when it comes to ADL's and IADL's. Which cognitive-behavioral intervention would be best to integrate in the sessions? Teach the patients to replace thoughts of anxiety with calm thoughts Incorporate writing and expressive exercises to release emotions Engage the patients in a physical exercise to release stress Provide the patients with a reward after they complete a task in which thet are calm

A Stress management training As a consultant, the OT can first talk about stress management training and ways to handle care, finances, skills, and interests.

An OT will be proving a consultative session one night a week for 6 weeks at the local hospital for caregivers of patients who have Alzheimer's disease and report symptoms of burnout. What would be the best topic to start out with? Stress management training Community resources Management techniques Relaxation exercises

D What is the name of your first pet? Episodic memory is the memory of autobiographical events (times, places, associated emotions, and other contextual who, what, when, where, why knowledge) that can be explicitly stated. It is the collection of past personal experiences that occurred at a particular time and place. For example, if you remember the party on your 6th birthday, this is an episodic memory. They allow you to figuratively travel back in time to remember the event that took place at that particular time and place

An OT, at a senior nursing facility, is instructed by the physician to evaluate a patients long-term memory. Which type of question will best evaluate this request? Do you use a dishwasher to wash clothes or utensil? What is your favorite game? What did you do for 4th of July? What is the name of your first pet?

B Recommend family members bring pictures to the patient's room Pictures might trigger a memory and lead to less confusion.

An elderly female with a history of Alzheimer's Disease begins showing signs of increased confusion and limited stability while getting admitted to an Alzheimer's unit. Which of the following is the most appropriate course of action for the OT if upon arrival, the patient refuses to use a wheelchair? Recommend the patient remain confined in her room Recommend family members bring pictures to the patient's room Recommend the patient see a speech therapist Recommend the patient use a wheelchair for her own safety

B Stress management A patient diagnosed with substance abuse may have difficulties with stress.Treatment interventions include: -Identify reasons for abuse -Develop coping skills -Develop skills for drug-free lifestyle -Assist with concrete services

An occupational therapist is leading a group and working with 8 patients who have substance abuse. The therapist asks the patient to pass out pencils to all the members. The patient starts screaming and runs out of the room to get a cigarette. What skill would be best to work on with this patient? Eye-hand coordination Stress management Visual perception Fine motor skills

A Orientation activity In the first session, it is best to start off with an orientation to discuss the purpose and goals of the group (max 5 minutes)

An occupational therapist is working with several low cognitive patients in a high structured directive group. What activity would be best to initiate in the beginning of the first session? Orientation activity Help to memorize all the names Warm up session Participate in a pizza making activity

D

As you walk into your patients room who has a mental disorder, you notice your patient looking sad. You ask her how she is doing, and she states that she feels down and depressed. What action should you take? Contact the primary doctor Call 911 immediately for suicide risk Contact the psychiatrist Provide active listening

B Role-play the situation so the patient can receive feedback about how to respond Role playing assertive situations will help decrease the patient's anxiety, and teach methods to confront intimidating social situations in a way that offers more personal control.

During an outpatient assertiveness training group a patient who has generalized anxiety disorder reports being ridiculed by a co-worker because of being obese. The patient has done nothing in response to the co-worker's comments. Which group activity can BEST be used to assist this patient? Educate the patient about their condition Role-play the situation so the patient can receive feedback about how to respond Reinforce the patient's weight loss efforts Model appropriate social behavior

C Further explore the situation since the children may be at risk Gathering specific information about client's comments is critical due to the seriousness of the accusation. Therapists are required by law to report any situation where abuse is suspected. A COTA should not assume an individual expressing increased discipline of her children equates to child abuse, but does need more information.

During treatment for pain at an outpatient facility, a patient tells a COTA that being injured has caused considerable stress at home. The patient also says that she often feels frustrated, angry, and is concerned with disciplining her children. The FIRST action the COTA should take is to: Encourage expression of emotions Document the information Further explore the situation since the children may be at risk Report the information to the child abuse authorities

C

If a patient is able to foresee errors, reason why they may occur and plan how to avoid them, what ACL would they be given? Level 8 Level 4 Level 6 Level 3

A When a patient is having a manic episode, an important role for the occupational therapist is monitoring behavioral changes, and providing a structured environment in which behavior can be managed. Mood lability is a common characteristic during this acute phase. The patient may be expansive and grandiose one minute, angry and hostile the next. The individual may be oblivious to the behavior and totally unaware there is a problem. The patient needs to have the behavior pointed out and limits need to be reinforced.

If an acute mania patient during treatment gets frustrated and becomes verbally abusive toward the COTA , what should the COTA's FIRST response? Remind the patient of the appropriate boundaries in the therapeutic relationship Report the incident immediately to the treatment team Warn the patient that therapy will be discontinued if the behavior is repeated Wait until the patient's condition stabilizes to do anything

D Ask the client if she needs help and put a toothbrush in her hand Your patient may need help initiating the task of brushing their teeth.

If an elderly woman with dementia declines to participate after asking her to brush her teeth, what should an OT do? Ask her to initiate the task again Respect her refusal Assume that she does not want to do the activity and help her complete it Ask the client if she needs help and put a toothbrush in her hand

A A patient may learn interpersonal skills In a task oriented group a patient may learn interpersonal skills, new behaviors, and the ability to explore his thoughts, feelings,and behaviors.

In a task oriented group, patients learn from interactions with others and the activity increases awareness. What is a skill the patient would learn? A patient may learn interpersonal skills Performance expectations Relaxation training Destress exercises

A Photosensitivity A patient on antipsychotic medication needs to be educated about the use of sunblock and protective clothing due to the increased risk of sunburn when taking the medication. This is critical for a patient working for a landscaping company where prolonged sun exposure is inherent in the job.

Precautions against which of the following should be given to a patient who is taking antipsychotic medication who will be starting a vocational retraining program with a landscaping company? Photosensitivity Stereotypic sensitivity Dystonia Dehydration

D

Question 76 of 100 76. Question A patient has mania and is asked to put placemats down on the table for lunch as part of a meal preparation group. The patient starts looking at the mirror, going to the bathroom, and looking through all the drawers. Before completing the task, the patient asked the OT to be assigned a different task. What action should the OT take? Have the patient sit down and have another member complete the task Tell the patient that he can complete a different task after he puts the placemats on the table Ask the patient what he would like to do next Provide additional structure to the assigned task of putting the placemats on the table Clinical Simulation

C

The MOST helpful information after using Allen's Cognitive Disability theory to determine the level of cognitive function in a developmentally disabled adult is: _______ Identifying the client's difficult behaviors Improve prevocational skills To estimating a patients cognitive level Improve social skills

A Anorexia Anorexia is an eating disorder characterized by an abnormally low body weight, intense fear of gaining weight and a distorted perception of body weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with activities in their lives.

The eating disorder characterized by stubborn and willful refusal to eat, a distorted body image, and an intense fear of growing fat is identified as _______? Anorexia Bulilmia Ataxia Zero figure syndrome

A Cognitive behavioral therapy (CBT) CBT can help change a person's thinking to ultimately change their behavior. Some interventions include: • Intervention goals designed to help client monitor negative thoughts • Assist the client in identifying current problems and potential solutions • Help client identify distorted or unhelpful thinking patterns • Facilitating client's role in the therapeutic process by frequently providing homework and structured assignments • Behavioral techniques include: Scheduling activities (increasing mastery; grading tasks to ensure success)

To help develop insight necessary for growth and change, what kind of therapy is especially effective for treating depression, schizophrenia, anxiety, bipolar, OCD, personality, somatoform, and anorexia? Cognitive behavioral therapy (CBT) Sensory therapy Dialetical behavior therapy (DBT) Psychodynamic

C Level 4 Level 4: Goal-directed actions. At this level, the person relies on visible cues that are associated with his or her goal-directed actions. Features of objects with sharp contrast such as color and shape are dealt with successfully, while other details are ignored. Invisible properties of objects (e.g., electricity, heat, and chemical reactions) do not capture the attention; direct supervision (Allen, 1985) is necessary to avoid injuries. Allen (1987) used the term training for persons functioning at Level 4 to describe a limited capacity for learning that is situation-specific. Training does not carry over to other environments or activities. Many day-to-day activities are successfully performed, which may conceal disability, but support is needed to cope successfully with changes in the environment. Monitoring by a support person is recommended for these persons. Patients assessed at Level Four do attempt to complete a project, usually an exact match. of the sample supplied by the therapist. Attention is focused concretely on things that they can see; physical objects that are out of their visual field cause confusion. Level Four the person can follow a checkerboard pattern. o Level 4: able to imitate the whipstitch, three stitches

What ACL is given to a cognitive dysfunction individual that can imitate the whipstitch and three stitches? Level 3 Level 5 Level 4 Level 6

C

What OTR recommendation should be given to the caretaker of an early Stage III Alzheimer's disease patient who is being discharged home from an inpatient facility? Find new leisure skills for her patient Provide full-time supervision for her patient Simplify the home surroundings and reduce stimuli for her patient Encourage the patient to try new activites

B Follow facility procedures for investigating patient safety If your patient with Alzheimer's has bruises, you should follow facility procedures for investigating patient safety. A patient with dementia may not provide accurate information, so we have to contact professionals who are trained in abuse investigation.

What action should you take if you notice bruises on the right arm of an Alzheimer's Disease patient ? Review CCTV where the patient may have gotten the bruises Follow facility procedures for investigating patient safety Ask repeated questions Contact the physician immediately

A Art, poetry, or music group A cooperative group can consist of art, poetry, music, or other creative experiences that will allow patients to share their feelings, and thoughts

What are some interventions that would be used in a cooperative group to help patients with bipolar disorder share their thoughts, feelings, and common interests? Art, poetry, or music group Community transition Communication skills Stress management group

A Photosensitivity, orthostatic hypotension, and amenorrhea Anti-psychotic meds photosensitivity, orthostatic hypotension, and amenorrhe

What are some of the side-effects for a depression patient taking anti-psychotic medication? Photosensitivity, orthostatic hypotension, and amenorrhea, Apraxia, lack of energy Excessive sweating, decreased cardiac output Social phobia, schizophrenia

A Schizophrenia, clinical depression, anxiety disorders, eating disorders Psychoeducation refers to the education offered to individuals with a mental health condition and their families to help empower them and deal with their condition in an optimal way. Frequently psychoeducational training involves individuals with schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, and personality disorders, as well as patient training courses in the context of the treatment of physical illnesses.

What disorders would benefit from the psychoeducation approach? Schizophrenia, clinical depression, anxiety disorders, eating disorders Bipolar, mood disorder, personality disorder Dementia, mania, personality disorder PTSD, apraxia, motor impairment

A "You must miss your mother, tell me about her" "You must miss your mother, tell me about her" = validate person's feelings and allow to reminiscence. ‐ Facilitate memory with familiar objects.

What is an ideal response to a non-Alzheimer's dementia resident who becomes upset and cries for his mother who died years ago? "You must miss your mother, tell me about her" "Let's forget the past" "Tell me something else about your past" "What are the colors in a rainbow"

C Correct Dementia Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer's is the most common type of dementia.

What is the MOST common disorder in a client with multiple cognitive defects and disturbances of memory? Depression Schizophrenia Dementia Delirium

C Learn a new recipe for dinner Level 5: Exploratory Actions: At this level, a patient will be able to learn a new skill, generalize, and practice self control. However this patient does have poor organization, planning, and socialization. The patient is able to imitate the single cordovan stitch

What is the best activity to work on for a patient who is functioning at Allen Cognitive Level 5 (Exploratory Actions)? Get items from store Wash their hair Learn a new recipe for dinner Put cereal into a bowl

B Use techniques to de escalate the situation Diagnoses and Presenting Problems OT-help with the diagnoses of mood, anxiety, substance-related, eating, conduct, oppositional defiant, those living in violent environments, separation anxiety disorder, mental retardation, developmental disorders, ADD Structure and Consistency Help with problems of impulse control and difficulty modulating their emotions. Provide structure by: stating the rules of an activity or group in the beginning, choose someone to be the time keeper, through the activity (jewelry making, CD buring) Redirection-going from one activity to the next

What is the best course of action to be taken if a patient with opposition defiant disorder (ODD) suddenly screams at another patient for not following the directions at the beginning of a mental health 5 person crafting group session? Discard the patient from the group Use techniques to de escalate the situation Wait and watch to see if another outburst occurs Recommend the patient seek councelling

A Visual cue, short verbal cue, touch after you have the person's attention Individuals with dementia have a greater difficulty performing tasks or coming up with the correct word or name. Patients with dementia, especially in early to moderate stage rely on visual cues to help them remember things such as not touching a hot stove

What is the best order of cues to provide while conducting a cooking group with dementia patients? Visual cue, short verbal cue, touch after you have the person's attention Touch after you have the person's attention Verbal cue for social greeting visual cue to show the person what is being asked

C Focus on verbal cues to explain a situation to the client When working with a patient with Alzheimer's it is important to: • Make eye contact and show you are interested in the person • Value and validate what is said by the person • Maintain a positive and friendly facial expression and tone when communicating • Do not give orders • Use short, simple words and sentences • Use non-verbal communication • Create a routine that is familiar and uses enjoyable activities (allow for ample time for completionB

What is the most important topic to include while teaching dementia care techniques to a family caregiver? Explain why communicating with dementia patient can be difficult Describe memory changes in every step of dementia Focus on verbal cues to explain a situation to the client Provide sample questions that a caregiver can ask a patient to improve the memory

D Assists with activity selection, facilitates discussion, and assists members in exploring relationship between thoughts, feelings and actions Task-oriented groups—assist members in becoming aware of their needs, values, ideas and feelings through performance of a shared task • For clients whose primary dysfunction is in the cognition and socioemotional areas due to psychological or physical trauma • Clients with fair verbal skills who can interact with others Role of the therapist: • Initially, very active—assists with activity selection, facilitates discussion; gives feedback and support; assists members in exploring relationship between thoughts, feelings and actions • As group develops the leader is less active

What is the responsibility of a therapist in a task-oriented group? Serves as a role model Provides guidelines and assistance as needed Develop trust, provides structure, and facilitates interaction Assists with activity selection, facilitates discussion, and assists members in exploring relationship between thoughts, feelings and actions

C Advisor In cooperative group therapist act as adviser. Group members are mutually responsive for giving feedback and meeting group needs. The therapist's interventions should facilitate group problem solving rather than direct the course of actions. Waiting until the group is deadlocked wouldn't benefit to group cohesion.

What role does the therapist take on in a cooperative group? Director Caregiver Advisor Pschycotherapist

C Attend to the patient until the treating OTR returns The most important factor for the OTR to consider is that the patient's safety comes first.

What should a COTA do if she sees that a colleague, who works at a long-term care facility, has left a Stage III Alzheimer's patient unattended during a cooking activity? Report the incident Return to the patient immediately Attend to the patient until the treating OTR returns Have the patient return to his room

B Redirect the patient's thoughts to reality based thinking and actions Delusions = false beliefs = I am a king of Spain. An OT should avoid discussions that validate and reinforce delusional material and redirect patient's thought to reality based thinking and actions.

What should an OT do if while in the middle of a scrap book activity her patient, a 40 year old homeless veteran, starts experiencing delusions and believing that the other therapists are scheming against him and his family? Attempt to validate what he is thinking Redirect the patient's thoughts to reality based thinking and actions Ignore the delusional material Restrain the patient

D Give him a visual cue and call the person by their name You do not want to startle the patient, therefore give him a visual cue and call the person by their name to get their attention.

What should be done in order to get the attention of a dementia patient who is just about to touch a hot toaster oven? Grab their hand Slightly push their hand away Say their name in order to get their attention Give him a visual cue and call the person by their name

B Paranoid Schizophrenia Paranoid schizophrenia is a subtype of schizophrenia in which the patient has delusions (false beliefs) that a person or some individuals are plotting against them or members of their family. Paranoid schizophrenia is the most common schizophrenia type.

What type of diagnosis is associated with a patient who believes that people are scheming against him or members of his family? Aphasia Paranoid Schizophrenia Maniac Bipolar Disorder

C Egocentric - cooperative group Egocentric cooperative: The group members must work together to decide on a task to complete while each maintaining their rights as a member. Each group members is expected to provide input on the task - this input should be specific to that member's skill set.

What type of group allows a patient to express his need and address those of others while completing a specific task in a long-term setting? Social group Symbolic group Egocentric - cooperative group Joint group

C roject level group A Project Group is brought together for a short time to complete a small projects while cooperating with group members.

What type of group is brought together for a short time to complete a small project while cooperating with group members? Cooperative group Community group Project level group Social group

D Identify leisure pursuits A topical group is a verbal discussion group focused on a specific activity engaged in outside of the group. Identifying leisure activities that can be pursued in a substance free environment is an important topic to focus on because it will help increase their self-esteem, coping skills, and assertiveness.

What would be discussed in a topical group for 8 patients who suffer from substance abuse? Assertiveness training Stress management Learn meditation exercieses Identify leisure pursuits

C Suggestions for the group to make a decision Egocentric-Cooperative Group: OT Role o Democratic Leader o makes suggestions and allows patients to choose and carry out the task and group plan o Resource for facilitating task completion and a support that promotes an atmosphere of acceptance and safety

What would be the BASIC task of a COTA controlling an egocentric cooperative group of members as part of a community-based mental health program? Assisting the participants in creating a task Control a discussion related to personal issues Suggestions for the group to make a decision Limits for specified short-term projects or activities

A Invite the patient to join in the discussion if he would like to join the conversation By inviting the patient to join in the discussion if he would like to, gives him a choice without pressuring him to speak before he is ready. It takes time for someone to feel comfortable sharing personal thoughts. It's inappropriate to pressure for verbal participation before the person is ready.

What would be the BEST method for an OT to encourage a new group member who listens intently, nods in agreement when other group members speak, but doesn't participate verbally even after attending multiple meetings? Invite the patient to join in the discussion if he would like to join the conversation Ask the patient a question and motivate him open up Provide the patuent with feedback and encourage him to talk Explain the positive points of group discussion to the patient

A Review the treatment goals with the patient In order for the patient to become involved in a group process, the group expectations must first be explained to the client. They may need to be repeated after the initial assessment, especially with a patient who has depression with this set of problems.

What would be the most effective response to a severe depression patient who is sitting alone and avoiding eye contact and attempting to isolate himself from the rest of the group? Review the treatment goals with the patient Encourage the group members to engage the patient Give the patient a project Allow the patient to passively participate

A Keep the patient in her assigned seat Individuals with borderline personality disorder feel something may be all good or all bad. The patient may also show impulsivity, and intense emotions for a short period of time. It is BEST for the OT to understand this condition.

When working with a group of patients in the in-patient psychiatric unit, a female patient with borderline personality says "I don't want to sit next to you because you are not my best friend anymore." Then the patient begins to cry. What should the OT do? Keep the patient in her assigned seat Change the patients assigned seat Explain the benefits of changing seats Do what the patient wants

A Assist the patient in planning and scheduling leisure activities Patients who have a history of substance abuse develop pronounced functional impairments as they give up valued pursuits to devote more time to the acquisition and use of addictive substances. One-to-one assistance to gather resources and schedule activities will most likely facilitate follow through.

Which of the OT duties described below would best serve a patient who has been abusing alcohol and methamphetamine and is working to acquire leisure skills in order to help maintain sobriety? Assist the patient in planning and scheduling leisure activities Have the patient complete a seasonal time log Request the patient to work as a volunteer at the clinic Provide the patient with brochures on entertainment

B Put the scissors away and remind the aide of the policy . The first action must be to eliminate the immediate safety risk, and then provide an effective review of department policies. New employees should be treated in a respectful way that can build a positive team relationship.

Which of the following actions would be most appropriate if a COTA observes that a new aide has left a pair of scissors out on a table, thus violating departmental policy at the acute center? Inform the supervisor immediately Put the scissors away and remind the aide of the policy Document the incident Explain to the aide that leaving scissors out is a safety hazard

D Prioritize short-term goals that will have a high chance of success Developing achievable short-term goals is an effective strategy for an individual who has difficulty with planning. Feelings of competence are enhanced by successful progression toward achievable goals.

Which of the following activities is the best treatment intervention for a generalized anxiety disorder adult who is having difficulty conceptualizing and organizing future events as well as experiencing decreased feelings of competence? Plan social and leisure activities Start new projects at home Freely explore complex tasks Prioritize short-term goals that will have a high chance of success

A Facilitate expression of emotion and promote relaxation Depending on the severity of the disorder function may be minimally or severely impaired. If the trauma occurred in a place that is difficult to avoid, it may become quite disabling. First, an effort should be made to promote relaxation so patients develop the ability to concentrate on functional tasks. Likewise, allowing the patient to express emotion is valuable in reducing anxiety. As anxiety is resolved, attention should shift to restoring participation in valued activities.

Which of the following activities should an OT first focus on when working with a 25 year old girl who after being physically assaulted during a home robbery is diagnosed with post-traumatic stress disorder. She also reports persistent symptoms of anxiety, interrupted sleep and hypervigilance, which impairs function in ADL. Facilitate expression of emotion and promote relaxation Promote behavioural skills Encourage completion of all tasks Require gross motor action

B Quiet and structured Treatment for a patient with schizophrenia Early steps of treatment- one on one to build relationship Groups- builds social skills e. time and cost effective treatment- OTR visiting rooms on an inpatient unit with grooming supplies- brief contact paves way for sustained one on one and group activities. People who display positive symptoms benefit from activities that divert attention away from symptoms. Activities bolster the sense of achievement and mastery are most successful in coping with hallucinations. For people with negative symptoms, specific skill training and psychoeducation are very beneficial. They need highly structured activities. Improving quality of life is main objective. Themes in quality of life: Managing time Connecting and belonging Making choices and maintaining control.

Which of the following environments is best for a schizophrenia patient? Cozy and amiable Quiet and structured Social and flexible Psychoanalytical

B

Which of the following foods would LEAST likely cause choking if served to an 80-year-old man with advanced Alzheimer's disease ? A cup of tea Moderately thick split-pea soup Multigrain bread Any food cooked in white sauce

B Remotivation approach Topic selection is based on clients' interests, age, cultural backgrounds, and personal histories. Usually draws on long term memory, which may remain intact and quite sharp despite deterioration of short-term memory and orientation to the present.

Which of the following techniques in a group discussion are best in helping depressed and confused people organize and verbalize their emotions? Tenodesis (grasp) Remotivation approach Psychomotor retardation Wish Checklist

C Identify purposeful short term goals Occupational therapists need to focus on assisting the patient in finding gratifying activities that improve self-esteem and increase motivation. For this reason it is critical to involve the patient in setting realistic short-term goals. Reengagement in valued activities that allow the patient to experience success and feelings of competence should be the first intervention strategy.

Which of the following would be the best counselling strategy for a patient who reports poor concentration, decreased pleasure in activity, an inability to plan or prioritize tasks, and who has feelings of incompetence? Freely explore all the tasks Participate in social groups Identify purposeful short term goals Engage only in long term group activity Clinical Simulation

A Give positive reinforcement for attending the group without disruptions Patients with anorexia have difficulty with self-regulation and are often obsessed with body image and food due to cognitive impairments. Social functioning tends to be poor and self-esteem low. Behavioral techniques that use positive reinforcement are most helpful in changing negative behaviors.

Which of the following would be the best response to an adolescent anorexia girl who frequently disrupts a social skills group with statements about body image? Give positive reinforcement for attending the group without disruptions Encourage participation in groups Ignore the adolescent's comments Dismiss the adolescent from the group

D Inform the patient's physician These side effects of antipsychotic drugs - known as tardive dyskinesia - are fairly common, vary in intensity, and need to be reported to the treating physician

Which of the following would most help a 30-year old schizophrenia patient who has been exhibiting an increase in lip smacking, tongue protrusion, and facial grimacing? Check whether the patient is aware of facial habits Suggest that the patient different medications Ignore the behavior Inform the patient's physician

C Task group Task oriented group- to increase client's awareness of their needs, values, ideas, feelings, and behaviors as they engage in a group task. To improve intra- and interpsychic functioning by focusing on problems which emerge in the process of choosing, planning, and implementing a group activity. Understand that a task-oriented group uses a psychodynamic frame of reference to increase intra and inter-psychic functioning; activities are selected to help members examine their behaviors to increase self-understanding.

Which of the groups listed below involves the development of daily living skills as well as work skills which focuses on the here-and-now and includes learning through doing, activity, and processing? Rehab group Horizontal group Task group Therapeutic group

C

Which screening tool gives a patient structured tasks that allows the therapist to observe the individual performing 3 increasingly complex stitches and make determinations about that person's cognitive level? Rancho Los Amigos Glasgow Coma Scale Allen Cognitive Level Functional Independence Measure

C

Which setting would be best for a mental patient who needs assistance with employment, community support, and housing programs? Senior Nursing Facility Adult day care Outpatient Inpatient psychiatric uni

D

While demonstrating a bed to wheelchair transfer with a patient, the patient falls down on the floor and hurts her hip. What should the OT do next? Transfer the patient to wheelchair Transfer the patient back to bed Request documentation of the incident Report the incident according to facility guidelines

A Provide a visual chart A patient with early stage dementia will benefit from a visual chart in order to complete grooming activities

Your patient with early stage dementia is working on grooming. Your patient gets confused and does not know what items to pick up and use first. What is the best way to help your patient with sequencing? Provide a visual chart Provide verbal cues Hand your patient the items one at a time Work on dynamic standing balance

A Catharsis Catharsis is the discharge of pent-up emotions so as to result in the alleviation of symptoms or the permanent relief of the condition. Used especially through certain kinds of art, such as tragedy or music

________ is the term used to describe the expelling or relieving of emotional tensions (i.e. punching a pillow to relieve anger). Catharsis Pretention Psychoanatomy Ideation