NBCOT 2

An adult has been referred to occupational therapy. The individual demonstrates decreased ROM in the dominant hand secondary to a nerve injury. Active thumb ROM for the IP and MP is within normal limits. Active ROM of the IPs of all four fi ngers is 0°-60°. The individual wants to be able to hold a knife, spoon, and fork. Which utensils are best for the therapist to recommend to this person? Answer Choices: A. Utensils with cylindrical foam handles, 1½″ in diameter. B. Standard utensils with no adaptations. C. Utensils with custom-built handles made of low-temperature thermoplastic splinting material. D. Utensils held in a universal cuff.

A. The foam handle accommodates to the 60° ROM of the IPs of the fi ngers to hold the utensils. Without an adapted handle, the person can use only pad-to-pad grasp, which is unstable. A custom handle is most commonly used for someone with spasticity or with more diffi culty holding the utensil than mentioned in the scenario. A universal cuff is used by someone who has no functional grasp.

A college is converting an historical building into wheelchair-accessible dormitory space. To allow for a 360° turning radius, which dimensions are best for the occupational therapist to recommend as the minimum space between the students' desk and bed? Answer Choices: A. Four feet by four feet. B. Five feet by fi ve feet. C. Six feet by six feet.

B. A 360° turning radius requires a minimum clearance of at least fi ve feet by fi ve feet. Four feet by four feet is too small. Six feet by six feet is more than the minimum standard. While exceeding minimal standards is desirable, it is not always attainable, and the question is asking for the minimum.

To develop social interaction skills, an occupational therapist implements a group program for students with autism spectrum disorder (ASD). Which group is best for the therapist to include in this program? Answer Choices: A. A directive group. B. A topical group. C. A developmental group. D. A task-oriented group.

C. A developmental group's focus is to teach the social interaction skills needed for group participation in a sequential manner. It provides relevant group structure and activities along a continuum that is consistent with how interaction skills typically develop. ASD is a pervasive developmental disorder. Individuals with ASD often have normal intelligence but signifi cant defi cits in social interaction skills.

An occupational therapist provides intervention for an individual with a swallowing disorder. To elicit a swallow refl ex, the occupational therapist provides sensory input to the inferior faucial arches. Which should the therapist use to provide this intervention? Answer Choices: A. A tongue depressor. B. A moistened cotton swab. C. A chilled dental exam mirror. D. A warmed metal teaspoon.

C. The use of cold stimulation of the inferior faucial arches via a chilled dental exam mirror will elicit a swallow refl ex. The others will not.

An older adult with Parkinson's disease has a secondary diagnosis of a major depressive disorder. During home-based occupational therapy service provision, the client exhibits increased confusion and disorientation. Which action is best for the home care occupational therapist to advise the client's primary caregiver to take in response to the client's change in status? Answer Choices: A. Schedule a neurological evaluation to rule out a. neurocognitive disorder. B. Seek support from a caregiver's respite program. C. Discuss placement alternatives with the social worker. D. Contact the client's physician to request a medical evaluation.

D. Because confusion and disorientation can be caused by depression and/or physical conditions, contacting the client's physician to request an evaluation is the best action for the therapist to take. If the physician fi nds no physical reason for the client's change in status, the physician can request a neurological and/or psychiatric consult

A person with arthrogryposis undergoes serial casting with weekly cast changes of the right wrist. Upon cast removal during the fourth week, the therapist notes a small open area 0.25 cm by 0.25 cm and a red rash over the ulnar styloid. Which is the therapist's best response to these observations? Answer Choices: A. Pad the area and apply another cast. B. Refer the individual to the wound care team. C. Fabricate a static splint that does not impede on the ulnar styloid. D. Contact the physician and describe the observations.

D. The physician needs to be informed of the therapist's observations. The physician can then make a decision whether to recast, dress the open area, refer to the wound care team, fabricate a new splint, or employ another action.

An occupational therapist provides bed mobility training for an individual recovering from a left CVA. The therapist notes that the person's right calf is swollen and warm. The person complains that it is painful. Which action should the therapist take initially? Answer Choices: A. Elevate the leg and provide retrograde massage. B. Advise the person to tell the physician about the symptoms during the physician's next bedside visit. C. Continue with the training and document the symptoms in the medical record. D. Contact the charge nurse immediately to report symptoms.

D. The signs and symptoms in this scenario are indicative of deep vein thrombosis (DVT). DVT, an infl ammation of a vein in association with the formation of a thrombus, is often a complication of CVAs or the result of prolonged bed rest. DVT is a medical emergency that must be handled immediately by medical staff. While it would be appropriate to elevate the legs, massage is contraindicated. The other answers are inappropriate because they delay the acquisition of needed medical care.

An occupational therapist conducts an on-site accessibility assessment with a building contractor who is remodeling an apartment building. The therapist recommends modifi cations for doorways which do not meet minimum accessibility width standards. The contractor states the building's owner wants to exceed minimum standards without incurring unreasonable costs. Which is the most preferred doorway measurement for the occupational therapist to recommend the contractor use for the remodeling? Answer Choices: A. 36 inches. B. 32 inches. C. 34 inches. D. 38 inches.

A. 36 inches is the preferred doorway measurement for wheelchair accessibility that exceeds the minimum accessibility standard of 32 inches. This allows for adequate hand clearance and is suffi ciently wide enough for nonstandard width chairs. thirty-four inches may not be suffi cient for wider wheelchairs. Although the 36-inch width exceeds minimum accessibility standards, it is a door frame width that is commonly used in commercial and residential construction; therefore, modifi cation can be done in a cost-effi cient manner. A 38-inch door frame width would require costly customized construction that is diffi cult to justify and is likely not necessary.

A seven-year-old child with spina bifi da at the C7 level receives home-based occupational therapy services. Which ability is most relevant for the occupational therapist to focus on during intervention? Answer Choices: A. Dressing the lower body. B. Dressing the upper body. C. Playing tabletop games.

A. An individual with a spinal cord lesion at C7 has diffi culty dressing the lower extremities. At seven, a child is typically independent in dressing; therefore, an intervention to increase the ability to dress the lower body is age appropriate. An individual with a C7 lesion is independent in upper extremity dressing and tabletop activities; thus, no intervention is warranted.

An occupational therapist establishes a program for a new acute psychiatric unit at a community hospital. The therapist designs the physical layout of the occupational therapy department to include storage for arts and crafts materials. Which of the following should the therapist recommend to store these materials? Answer Choices: A. A ventilated locked metal cabinet accessible only to staff. B. Open shelving accessible to staff and patients. C. Shelving next to a sink for easy clean up. D. A locked closet outside of the intervention area to ensure safety.

A. Arts and crafts materials may include fl ammable, hazardous materials such as paint, stain, and thinners. These must be kept in ventilated metal cabinets in accordance with fi re safety guidelines. Since these supplies are also toxic and potentially dangerous, access to them must be controlled by staff; therefore, a locked storage unit is required. The other options do not meet fi re safety needs.

An individual with a spinal cord injury at C7 reports noticeable redness on the ischial tuberosity during selfexam with a mirror. Which action is most effective for the occupational therapist to recommend in response to client's observations? Answer Choices: A. Integrate weight shifting into daily activities. B. Use a tilt-in-space wheelchair. C. Use an angled foam cushion. D. Self-direct caregivers to assist with weight shifting at least once every 30 minutes

A. During rehabilitation, a person with a spinal cord injury must be instructed on the need to relieve pressure on a consistent basis. A person with a spinal cord injury at the level of C7 can perform depression transfers so the ability to perform weight shifting for pressure relief is intact. The person is reporting the early signs of skin breakdown, so it is vital that the person integrates weight shifting into daily activities.

An occupational therapist conducts an in-service at an outpatient wheelchair clinic for individuals with central nervous system dysfunction. According to the principles of wheelchair prescription, which of the following statements is accurate for the therapist to make during the presentation? Answer Choices: A. Firm seats are needed to provide stability. B. Soft seats are needed to prevent decubiti. C. Back heights should be extended to facilitate weight shifting. D. Seat angles should be 45° to prevent falling forward

A. Firm seats provide stability and a solid base for seating systems that can be used to prevent decubiti, contractures, and deformities, and to increase sitting tolerance, proper positioning, and functional abilities. Soft seats are contraindicated as they do not provide suffi cient pressure relief. Soft seats can "collapse" under pressure and can increase the risk of decubiti. Extended back heights increase the diffi culty of weight shifting because the person cannot hook their arm around the push handle. The recommended seat angle ranges from 80° to 110°.

An individual recovering from hepatitis, type C has decreased upper and lower extremity muscle strength and hypertension. Six months ago the client had an angioplasty and is very fearful of having a heart attack. Which should the occupational therapist instruct the client to perform to increase muscle strength? Answer Choices: A. Isotonic exercises. B. Isometric exercises. C. Contract-relax exercise. D. Muscle contractions and holds.

A. Isotonics are the only exercises listed that are not contraindicated for a person with hypertension or heart disease. The other choices describe isometric exercises or activities that include isometric elements and are contraindicated in this case.

In an outpatient rehabilitation clinic, an occupational therapist is developing a fall prevention group for at-risk older adults with Parkinson's disease. The clients live alone and have had at least three falls within the past six months. When presenting strategies to prevent falls, which is the most common risk factor for falls in the older adults that the therapist should review with the clients? Answer Choices: A. Ascending and descending stairs. B. Dressing while seated in a chair. C. Walking with a walker with wheels. D. Transferring out of the shower with grab bars.

A. Most falls occur during normal ADL, including bending, getting up and down from a seated surface, turning, walking, and ascending and descending stairs. Using assistive devices in the correct manner reduces fall risk and completing ADL while seated is a safe modifi cation to the activity of dressing.

An occupational therapist provides caregiver training to the spouse of an individual with cerebellar cortical degeneration. The focus of the session is on community mobility using a wheelchair. The individual is dependent upon the spouse's assistance for mobility. Which of the following is most effective for the therapist to recommend the spouse do when descending a steep grade? Answer Choices: A. Go down backward with all wheelchair wheels maintaining contact with the ground surface. B. Tilt the wheelchair backward to its gravitational balance point and then go down forward. C. Tilt the wheelchair backward to its gravitational balance point and then go down backward. D. Push forward as on fl at surfaces but lean body back for extra drag.

A. Proceeding down a steep grade backward with all wheelchair wheels maintaining contact with the ground enables the spouse to use body weight to slow the chair's momentum. If the spouse tires, they can readily stop and use their body weight to hold the chair in place while putting the wheelchair brakes on

An occupational therapist designs a dining rehabilitation program in a long-term care facility. The occupational therapist instructs paraprofessional staff in proper feeding techniques. Which point is most important for the therapist to include in this staff training? Answer Choices: A. Meals should occur in a homelike environment with staff conversing with the residents being fed. B. Residents with swallowing diffi culties should be fed in a group so that staff can remind them to swallow at the beginning of each meal. C. Placing three fi ngertips on the throat and pressing fi rmly will stimulate a swallow response. D. The head should be tilted slightly backward during feeding to facilitate an assisted swallow.

A. Proper feeding techniques include a facilitative environment. Dining in a homelike setting with staff who are attentive to the residents' needs and interests during feeding/mealtimes will facilitate eating and socialization during the activity. Grouping individuals with swallowing diffi culties diminishes the individualized approach that is essential to quality long-term care

The occupational therapist also advises the direct care staff on proper positioning of the patient's right arm while the patient is seated in a wheelchair. Which is the most appropriate recommendation for the therapist to make for positioning of the patient's right arm? Answer Choices: A. Rest the person's arm on a wheelchair lap board. B. Rest the arm in the person's lap with the hands folded. C. Have the person wear a shoulder sling throughout the day.

A. Proper positioning is important in addressing the patient's shoulder subluxation, which was identifi ed in this scenario's stem. Positioning must avoid shoulder traction, scapular downward rotation and weight on the shoulder. Lap boards are ideal for positioning in a wheelchair. They promote proper shoulder positioning and protect the arm from hanging over the side of the wheelchair and getting caught in the wheel during mobility. Wearing a shoulder sling for prolonged periods is contraindicated as long-term use can result in soft-tissue contractures, edema, and the development of pain syndromes. Shoulder slings can be used to support a fl accid shoulder for short and controlled periods of time

An adult incurred an injury to the anterior spinal artery at the T12 level. The occupational therapist completes a sensory evaluation with this client. Which sensation is most likely for the therapist to document that the individual has retained? Answer Choices: A. Proprioception. B. Pain. C. Crude touch. D. Temperature.

A. Proprioception is maintained with the condition of anterior spinal cord syndrome, which is caused by damage to the anterior spinal artery or anterior spinal cord. Dorsal (posterior) columns transmit proprioceptive information. The others are aspects of sensation that are impaired or absent in anterior spinal cord syndrome.

An occupational therapist designs a qualitative research study to examine the effi cacy of an after-school playbased program for the development of social interaction skills. Which method of data collection is best for the therapist to use? Answer Choices: A. The therapist's observations of the participating children in the classroom and during recess. B. The completion of a social skills Likert-scale questionnaire by the participants' teachers. C. The completion of a social skills Likert-scale questionnaire by the participants' parents. D. The administration of a standardized social skills evaluation pre- and postintervention

A. Qualitative research is a form of descriptive research that studies people individually or collectively in their natural social and cultural contexts. Data collection methods include direct observation in naturalistic settings, such as observing children in their classroom and during recess. The completion of Likert-scale questionnaires and the administration of a standardized evaluation are research methods that are used to collect quantitative data; therefore, they would not be used in a qualitative study.

A client participates in occupational therapy for intervention following a rotator cuff injury. The therapist provides progressive resistive exercises. When grading these exercises, which of the following is best for the therapist to increase? Answer Choices: A. The amount of resistance provided with a stronger level of therapy band. B. The proximal load on the muscles the client uses during the exercises. C. The repetitions of external rotation exercises with less distal weight.

A. Resistive exercises serve to increase strength of muscles from fair plus to normal through adequate ROM. Increasing the resistance level of therapy band is the best method provided to progressively grade the resistive exercises. This approach can increase the person's strength.

A preschool-aged child with recurring headaches and decreased gross and fi ne motor skills is hospitalized on an acute care unit for a diagnostic workup. Just prior to the occupational therapy evaluation, the parents are told that their child has cancer. The parents are upset when they bring their child to the evaluation session. Which are the best actions for the therapist to take in response to this situation? Answer Choices: A. Recommend the parents speak to their spiritual advisor or the social worker and proceed with the OT session. B. Cancel the OT session and recommend the parents speak to their spiritual advisor or the social worker. C. Spend the OT session providing support to the parents and addressing the parents' acceptance of the diagnosis. D. Recommend the parents speak to their spiritual advisor or the social worker and reschedule the OT session for later in the week.

A. The best actions are recommending the parents speak to a source of help and comfort and then proceed with the session. The therapist can provide this recommendation in a supportive and empathetic manner and then complete the scheduled evaluation.

The parents of an 18-month-old bring their child to a free community developmental screening. The child can attend to shapes and use them appropriately. However, the parents are worried because the child cannot match shapes or manipulate differently shaped objects into a shape sorter. Which is the best response for the occupational therapist to make in response to the parents' expressed concern? Answer Choices: A. Advise the parents that the child is showing a typical, age-appropriate skill. B. Complete an occupational therapy evaluation of the child's cognitive skills. C. Refer the child to the early intervention program for developmental delay. D. Provide the parents with activity recommendations to develop shape recognition.

A. The child is showing an age-appropriate skill. According to established developmental milestones, the ability to recognize shapes and manipulate differently shaped objects into a shape sorter does not typically develop until the age of 21-24 months. The ability to attend to the shape of things and use them appropriately is typical of children aged 18-21 months. There is no additional information provided in the scenario to indicate a developmental delay that would warrant further evaluation of cognitive skills or intervention for developmental delay. There is no need to provide activities to reinforce shape recognition since the child is functioning at a developmentally appropriate level and these skills can be expected to develop typically as the child ages.

An adult with amyotrophic lateral sclerosis frequently coughs and chokes when eating fi nely chopped foods and drinking thin liquids. The speech pathologist and occupational therapist collaborate and recommend a videofl uoroscopy procedure. Which behavioral information would be most relevant for the occupational therapist to include on the referral? Answer Choices: A. The client demonstrates minimal limitations in cognitive level. B. The client is able to consume chopped foods and apple juice with no diffi culty. C. The client demonstrates only oral stage problems during eating. D. The client cannot tolerate therapy focused on improving feeding and swallowing skills.

A. The client with minimal cognitive limitations can be a candidate for the procedure. If a person can progress to swallowing thin liquids, a videofl uoroscopy is usually not necessary. The client that shows only oral stage problems also does not need a videofl uoroscope to rule out swallowing diffi culties, which is the goal of the videofl uoroscopy procedure

An occupational therapist plans intervention for an individual with cognitive perceptual defi cits. In deciding whether to use a dynamic interactional approach or a defi cit-specifi c approach, which is most important for the occupational therapist to consider? Answer Choices: A. The client's auditory processing skills. B. The availability of familial support. C. The client's social interaction skills. D. The client's problem-solving skills.

A. The dynamic interactional approach utilizes awareness questioning to help the individual detect errors, estimate task diffi culty, and predict outcomes. Therefore, the therapist must consider the client's level of auditory processing skills to determine if adaptations or modifi cations are needed when implementing this approach. If an individual has severe auditory processing defi cits, it may indicate a need to use a defi citspecifi c approach, for cognitive perceptual remediation.

A teenager with spinal muscle atrophy shows decreased trunk balance and strength. Upper extremity strength and ROM are unchanged from the last evaluation. Which is the best recommendation for the occupational therapist to make? Answer Choices: A. A reevaluation of the client be completed. B. The client be referred to an orthotist for a soft spinal support. C. The client be measured for a power wheelchair. D. A trunk strengthening program be initiated with the client.

A. The most important action to take after noticing a change in the functional status of a person with a progressive condition is to reevaluate. Based on the results of the evaluation, interventions can be planned. These interventions can include orthotics, adaptive equipment, powered mobility, compensation techniques, and/or a strengthening program; only the results of a reevaluation can appropriately determine intervention needs

A young adult with a ten-year history of serious mental illness is being discharged home in two days. The client collaborates with the care coordination team to plan discharge with the client's primary family members. The team consists of a psychiatrist, a registered nurse, a social worker, and an occupational therapist. The team conducts a predischarge family meeting to provide family members with information to assist them in supporting the client's recovery. Which is the most relevant information for the occupational therapist to provide to the client's primary family members at this meeting? Answer Choices: A. Family role activity suggestions and potential adaptations. B. The therapeutic effects and potential side effects of medications. C. Advocacy strategies and consumer/family resources. D. Family dynamics information and family support groups.

A. The occupational therapist is the only one on the identifi ed care coordination team who is qualifi ed to provide information about role activities and potential activity adaptations. The ability of a client to engage in meaningful activities in the home and resume relevant role activities can facilitate positive family functioning and support recovery. The other choices are all relevant but other members of the team can provide this information.

An occupational therapist supervises a Level II Fieldwork student regarding the evaluation procedures of a work hardening program. The therapist explains that some individuals attending the program magnify their symptoms to retain benefi ts; therefore, the validity of some evaluation measures may be compromised. Which assessment tool does the therapist identify as providing the most valid results? Answer Choices: A. A volumeter. B. A dynamometer (all fi ve positions). C. A standardized pegboard test. D. A total active motion (TAM) evaluation.

A. The volumeter is the only true objective assessment tool that occupational therapists utilize for it is based on the displacement law of physics. It is the only tool that a person cannot manipulate.

An adult is referred to occupational therapy for ADL training. The patient incurred a fracture of the right proximal humerus and is using a shoulder immobilizer for the fi rst two weeks to aid healing and help control pain. The patient is right-hand dominant. Which activity will be the most diffi cult for the patient? Answer Choices: A. Putting on a pullover top. B. Taking off a heavy coat. C. Brushing their teeth.

A. Treatment of a proximal fracture of the humerus includes nonoperative treatment using a sling or shoulder immobilizer with no shoulder mobility for the fi rst two weeks followed by exercises to slowly increase the range of motion or surgery. Since there is a period of immobilization, patients need to learn how to complete ADL using modifi ed techniques.

During an intervention session in a school, the occupational therapist observes a young child turn the pages of a book. The therapist identifi es this behavior as an example of an in-hand manipulation task. Which task should the occupational therapist document the child is capable of performing? Answer Choices: A. Shift. B. Simple rotation. C. Translation. D. Translation without stabilization

A. Turning the pages of a book involves a linear movement of each page on the fi nger surface. This allows for repositioning of the page relative to the pads of the fi ngers while the thumb remains opposed. Simple rotation is not correct as this involves a turning/rolling of an object held at the fi nger pads with the fi ngers acting as a unit and the thumb in opposition (e.g., unscrewing a bottle cap)

An adult is hospitalized and diagnosed with mild chronic obstructive pulmonary disease (COPD). During the discharge planning session, the person identifi es a desire to exercise regularly. Which of the following should the occupational therapist recommend the client pursue? Answer Choices: A. The hospital wellness program's yoga group. B. Low-impact aerobics at a local gym. C. Weight-lifting under the direction of a personal trainer. D. Jogging in a local park with friends.

A. Yoga puts the least amount of pressure on the pulmonary and cardiovascular systems. Also, the wellness program is monitored by hospital personnel. All of the other activities can stress the cardiovascular and pulmonary systems too much. Also, they are not monitored by health-care professionals familiar with COPD.

Occupational therapy services are provided to the residents of a psychogeriatric unit in a skilled nursing facility. An occupational therapist presents an inservice on restraint reduction to the unit's direct care staff. Which of the following would the therapist identify as a permissible use of a restraint? Answer Choices: A. A bed guardrail to prevent a confused resident from wandering in the evening. B. A lap board to enhance a resident's engagement in self-determined activities. C. A wheelchair with a lap belt to prevent a resident with ataxic gait from falling.

B. A restraint is defi ned as anything that prevents access to the environment or to one's self. A restraint such as a lap board can enhance activity engagement and functional performance. It is permissible with a resident's informed consent. The correct answer choice states that the individual can self-determine activity engagement. This indicates that the person has the ability to give informed consent and that they can direct the staff on its removal and its desired use.

An individual prepares for discharge home following rehabilitation for a left cerebrovascular accident (CVA). Residual diffi culties include fair dynamic balance and decreased proximal upper extremity (UE) strength. The individual's stated priority is to be able to ambulate safely to the senior center located in the client's apartment building. Which ambulatory aid would be most effective for the occupational therapist to recommend to this client? Answer Choices: A. A hemi-walker. B. A rolling walker. C. A side-stepper walker. D. A standard walker.

B. A rolling walker is indicated for a person who cannot lift a standard walker due to impaired balance or upper extremity weakness. A hemi-walker and side-stepper are indicated for individuals who do not have use of both hands.

A person with a traumatic brain injury (TBI) is assessed to score a 6 on the Glasgow Coma Scale. Which should the occupational therapist use to initiate intervention with this person? Answer Choices: A. Demonstrated directions. B. Sensory stimulation. C. Verbal cues. D. Hand-over-hand assistance.

B. A score of 6 on the Glasgow Coma Scale is just one level above a completely nonresponsive coma. As a result, a person at this level has severe defi cits. The person can open their eyes in response to pain and make incomprehensible sounds; therefore, intervention begins at the sensory stimulation level. The other choices are at levels that are too high for this individual.

The client is now seven weeks postoperation. Which are the most appropriate intervention activities for the occupational therapist to use with this client? Answer Choices: A. Home management activities such as doing laundry. B. Light ADL such as grooming. C. Strengthening exercises using high-resistance TheraBand. D. Passive exercises using a dynamic splint.

B. According to the Kleinert protocol, light ADL are introduced 6-8 weeks postoperation. Strengthening activities and heavier work activities (such as laundry) are introduced 8-12 weeks postoperation. The use of a dynamic splint is indicated immediately and up to 4 weeks postoperation.

An occupational therapist is scheduled to give a one-hour presentation to a support group of parents of infants with a diversity of developmental disabilities. Which of the following is the most important focus of the therapist's presentation? Answer Choices: A. Demonstration of infant positioning techniques. B. Discussion of typical areas of concern addressed by OT practitioners. C. Demonstration of different types of developmental assessments. D. Discussion of the Individual Family Service Plan (IFSP).

B. An overview of the domain of concern addressed by OT for infants with developmental disabilities is the most appropriate topic for a one-hour presentation to an audience with diverse needs.

The occupational therapist plans intervention for a client with a recent diagnosis of complex regional pain syndrome (CRPS) Type I. Which intervention approach is most effective to use to reduce pain and increase function? Answer Choices: A. Hot packs. B. Biofeedback. C. Paraffi n. D. Passive range of motion.

B. CRPS Type I is a vasomotor dysfunction which causes extreme hypersensitivity to touch, edema, intense burning pain, and dramatic temperature and color changes to the affected limb. Goals of treatment include reducing pain and edema, promoting normal positioning, and increasing function. Biofeedback is a technique where electrodes are used to measure muscle responses and stress levels. The goal is to train the individual to release tension, which can reduce pain and prepare the individual for increased tolerance to range of motion

A person fell and sustained bilateral Colles' fractures. The client wore bilateral short-arm casts for six weeks. After cast removal, the client began OT sessions to increase endurance and strength prior to returning to work. The client tends to work hard when performing resistive exercises with both wrists. The therapist monitors the client for overexertion. Which behavior would indicate overexertion? Answer Choices: A. Increased ability to achieve full ROM of the wrist. B. Complaints of pain in the wrist extensors. C. Consistent strength in wrist extension activities

B. Complaints of pain can be a sign of overexertion. The others are signs of adequate performance, not overexertion.

A cooking group meets for 1½ hours each week at a partial hospitalization program. During the group, members do not smoke, they wait for everyone to be served before eating, and they clean up after the meal. When reporting these observations, which of the following is the most accurate statement for the therapist to make? Answer Choices: A. The group protocol is clear. B. Group norms are being followed. C. Group sanctions are effective

B. Group norms are the expected and accepted behaviors in a group. These norms establish an atmosphere of mutual respect, safety, and support. Sanctions are implemented only in a group if members' behaviors fall outside of the group's norms and are considered deviant. A group protocol outlines the group's membership criteria, goals, and activities; it does not describe in vivo group member behaviors.

The client is attending a vocational rehabilitation program three days a week but is frequently late due to diffi culties with getting ready in the morning. The client asks the home care therapist for suggestions to address this problem. Which is the most appropriate action for the occupational therapist to take in response to the client's request? Answer Choices: A. Advocate that the vocational program provide the client with a fl exible start time. B. Develop a visual chart with the client, depicting the necessary sequence of their morning activities. C. Advise the client to call the vocational program to tell staff when they are running late. D. Advise the client to wake up one hour earlier on vocational rehabilitation program days.

B. Individuals at Rancho Los Amigos Level VII have cognitive abilities that are automatic-appropriate. They are able to initiate and attend to highly familiar tasks (e.g., BADL) in a distraction-free environment but have shallow recall of what has been completed. Creating a visual chart of the necessary sequence of routine morning activities will provide the person with a tool that they can use each morning to check off ADL task completion. This visual cueing device can also help the client refocus if they get distracted. Increasing the time available in the morning to do the daily routine is not needed.

A child with developmental delay has mastered the ability to cut simple fi gure shapes with scissors. Which scissor activity is best for the occupational therapist to introduce to the child during their next intervention session? Answer Choices: A. Cutting simple geometric fi gures. B. Cutting complex fi gure shapes. C. Cutting multiple circles.

B. It is typical to use a developmental frame of reference with children with developmental delays. Thus, the therapist should introduce activities that employ the next developmental scissoring skill. The ability to use scissors to cut complex fi gure shapes is the next developmental task after the acquisition of the ability to cut simple fi gure shapes. In typically developing children, these abilities develop between the ages of four and six. The abilities to cut circles and geometric shapes are earlier developmental scissors skill tasks (typically emerging between the ages of three and four).

In an acute inpatient psychiatric facility, an occupational therapist designs a therapeutic activity group for individuals with poor orientation to reality. Which is the best activity choice for the therapist to provide in this group? Answer Choices: A. A discussion of the effects of hospitalization on occupational roles. B. The assembly of wooden toys for a children's unit. C. Guided imagery for stress management. D. Structured verbalizations of personal assets and limitations.

B. On an acute inpatient psychiatric unit, activities should be structured, easily completed in one session, and provide a concrete result to reinforce reality. Wooden toy kits meet these criteria and donating them to the children's unit facilitates Yalom's curative factor of altruism. Discussions and verbal activities are abstract and would be diffi cult for persons with poor orientation to reality.

An occupational therapist employed in a pediatric clinic participates in an initial performance appraisal. The supervisor identifi es an area needing improvement as handling skills in working with children with various types of cerebral palsy. Which is the most effective way for the occupational therapist to improve handling skills? Answer Choices: A. Observe an experienced occupational or physical therapist use handling techniques. B. Participate in an advanced-level experiential course on handling techniques. C. Participate in a teleconference on handling techniques for children with cerebral palsy.

B. Participating in an advanced handling skills course provides opportunities to learn and practice these techniques. It would also provide opportunities to interact with other therapists and benefi t from visual and kinesthetic learning. Observing a skilled therapist is helpful but does not offer the opportunity to develop hands-on skills

The residents of an urban homeless shelter include individuals with histories of chronic alcohol abuse who are at risk for developing peripheral neuropathy. The occupational therapist consulting at this shelter monitors the residents' status to ensure early detection of this problem. Which is the most important observed status change for the therapist to report? Answer Choices: A. Progressive deterioration in visual acuity. B. Progressive deterioration of sensorimotor functions of the lower extremities. C. Rapid onset of intention tremors. D. Rapid loss of sensorimotor functions of the facial and neck muscles.

B. Peripheral neuropathy is a syndrome of sensory, motor, refl ex, and vasomotor symptoms, with symptoms exhibited according to the distribution of the affected nerve. Its etiology includes diabetes, Lyme disease, multiple sclerosis, alcoholism, or metabolic or infectious diseases.

An adult recently diagnosed with scleroderma receives occupational therapy services to deal with the functional changes caused by this disease. Which recommendation is best for the occupational therapist to make to this individual? Answer Choices: A. Dress in lightweight clothing for thermal comfort. B. Dress in layers for neutral warmth. C. Use pull-on clothing to ease donning and doffi ng. D. Use Velcro or a button hook to ease fastening.

B. Scleroderma is a systemic disease of unknown etiology. Symptoms are grouped into the CREST syndrome which includes calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly of fi ngers and toes, and telangiectasis or red spots covering the hands, feet, forearms, face, and hips. The systemic sclerosis of internal organs can be life threatening.

An occupational therapist conducts a sensory evaluation of an individual recovering from a left cerebral vascular accident. The individual has right hemiplegia and expressive aphasia. During the evaluation of stereognosis, which should the therapist have the client use to identify responses to the testing stimuli? Answer Choices: A. Pictures of the objects. B. A set of identical objects. C. Cards with "one" and "two" printed on them. D. Cards with "yes" and "no" printed on them

B. Stereognosis is the ability to identify objects through touch and cognition. Having an identical set of objects from which the individual can select an object that matches the test stimulus will enable a person with expressive aphasia to participate in the evaluation

Ten members of a community reintegration group are not working well together and show decreased levels of trust. The occupational therapist's goal is to enhance the level of cohesiveness in the group. To begin the next group session, which is the best action for the therapist to take? Answer Choices: A. Read inspirational phrases to increase motivation. B. Verbally review the goals and purposes of the group. C. Have each person contribute a line about childhood memories to group poem. D. Ask each person to talk about silly mistakes to provide some levity

B. The best choice is to verbally review the goals and purpose of the group. This helps to direct the focus of the members onto the reason(s) that they are participating in the group. This reinforcement of a shared purpose can help develop cohesion. The therapist can then provide activities that build on this commonality. Inspirational phrases can help instill a positive attitude, but they do not address the need to develop group cohesion.

The occupational therapist meets with the nursing staff that will be providing primary care to the patient at the patient's bedside. The occupational therapist recommends that the direct care staff position the patient in left sidelying. Which is the best bed position for the therapist to recommend for placement of the patient's right arm? Answer Choices: A. In 90° of humeral abduction and internally rotated. B. Protracted with arm forward on a pillow and the elbow extended or slightly fl exed. C. On the person's side, adducted and internally rotated. D. In 90° of abduction of the humerus with neutral rotation.

B. The best position of the upper extremities for sleeping or bed rest is to place the affected arm on a pillow in a position which ensures that the shoulder is approximated and that the extremity is well supported. Excess abduction can cause the joint capsule to loosen and reduce the stability of the humeral head in the glenoid fossa. It is important to avoid traction of the affected arm to ensure adequate positioning of the humerus with the scapula and to prevent subluxation. Correct positioning means putting the involved arm in slight abduction. Ninety degrees of abduction is excessive.

While completing the screening, the occupational therapist observes that the patient uses only their left side to participate in activities. The therapist suspects that the patient has unilateral neglect and diffi culties with body scheme. Which should the therapist have the patient do during the OT evaluation to determine if these defi cits are present? Answer Choices: A. Point to various body parts named by the therapist. B. Complete upper and lower extremity dressing. C. Complete the draw-a-person test.

B. The best way to evaluate for unilateral neglect and body scheme defi cits is to have the person complete a functional activity such as dressing. A body scheme disorder is characterized by a loss of awareness of body parts, as well as the relationship of the body parts to each other and objects. Unilateral neglect (also called unilateral inattention) is a type of body scheme disorder in which the person fails to respond to or report unilateral stimulus presented to the body side contralateral to the lesion.

A toddler with severe congenital anomalies and an irreparable cleft palate has a do not resuscitate (DNR) order. While being fi tted for a molded seat for a wheelchair, the child stops breathing and turns blue. The entry-level occupational therapist determines that the child has a brachial pulse. Which of the following is the fi rst action the therapist should take in response to this situation? Answer Choices: A. Inform the physician about the situation and the child's DNR order. B. Implement the facility's emergency procedure. C. Perform obstructed airway maneuver and monitor heart rate for fi ve minutes.

B. The child is not breathing and the therapist should initiate the facility's plan for medical emergencies and cardiac codes. It is not the decision of the therapist to withhold treatment or to provide intervention. The medical team that responds to emergency procedures must make the decision about the best action to take in a DNR situation.

The family of a two-year-old in a spica cast asks the occupational therapist to modify the child's car seat. The child cannot fi t in the car seat due to the cast. Which action is best for the therapist to take in response to this request? Answer Choices: A. Pad the area between the car seat and the child's back with a pillow to accommodate for the lack of hip fl exion. B. Recommend the family purchase a car seat designed for a child with a spica cast. C. Cut down the sides of the car seat to allow the cast to hang out of the sides of the car seat.

B. The child needs a car seat adapted for a child in a spica cast that has been crash tested. A variety of specialized car seats are available. Therapists and other pediatric care providers can become trained in fi tting specialized car seats. Padding the area between the child and the car seat and cutting the car seat would compromise its integrity and is unsafe

An individual recovering from myasthenia gravis has fair minus (F-) muscle strength in both upper extremities. The occupational therapist develops an intervention plan to include the goal of increasing muscle strength. According to the biomechanical approach, which should the therapist work on with the patient during intervention? Answer Choices: A. Complete active ROM with gravity decreased. B. Complete active ROM against gravity. C. Incomplete active ROM against gravity. D. Complete active ROM against gravity and slight resistance.

B. The next muscle grade after a minus Fair (F-) is fair (F) which indicates the ability of the body part to move through its complete ROM against gravity. An F- muscle grade indicates a body part can move through its incomplete ROM (more than 50%) against gravity. An F+ muscle grade indicates a body part can move through its complete ROM against gravity and slight resistance. The ability to move a body part through complete ROM with gravity decreased is indicative of a poor (P) muscle grade.

An older adult with a diagnosis of osteoarthritis in both knees is referred to inpatient occupational therapy. During screening, the patient expresses a desire to return home to live alone independently. Which should the occupational therapist do fi rst in response to the patient's stated goal? Answer Choices: A. Recommend adaptations to the patient's home environment to increase safety. B. Evaluate the patient's BADL and IADL using a standardized measure. C. Teach the patient energy conservation techniques to use during IADL tasks. D. Train the patient in a home resistive exercise program to build strength and ROM

B. The patient has just been screened for OT services so the next step in the OT process is to evaluate the person's functional abilities. Osteoarthritis is isolated to specifi c joints and is not systemic in nature. By evaluating the patient's BADL and IADL, the occupational therapist can determine the activity demands of the BADL and IADL the patient performs while keeping in mind the specifi c joints that are affected. Once this information is obtained, then the occupational therapist can make informed recommendations based upon their observations and clinical reasoning to decrease excessive loading and repetitive use of these joints. S

An occupational therapist provides home care services to a neonate with signifi cant developmental delays. Two hours before the next scheduled home visit, the child's parent informs the therapist that one of three older children has developed chicken pox. While the other children do not show signs of chicken pox, the parent expresses concern that they are contagious. Which is the therapist's best response to this situation? Answer Choices: A. Cancel the scheduled session and reschedule after two weeks have passed. B. Complete the scheduled session using airborne precautions. C. Complete the scheduled session using standard precautions. D. Complete the scheduled session using droplet precautions.

B. There is no need to cancel the scheduled session. Standard precautions are used in all clinical situations. Chicken pox is a disease transmitted by airborne droplet nuclei that remain suspended in the air; therefore, airborne precautions are warranted

An older client with a diagnosis of major neurocognitive disorder lives with family members. On the last three occasions, the client attended OT sessions with bruises and cuts on both legs. When asked about this, the client replies that a family member caused these injuries. Which is the fi rst action the occupational therapist should take? Answer Choices: A. Confi rm the client's statements with the family. B. Immediately report potential abuse according to the facility policy. C. Call the police to report elder abuse. D. Administer a cognitive evaluation before taking further action.

B. This situation may indicate elder abuse. The therapist must report the fi ndings according to established facility protocols. It is not within the realm of an entry-level therapist's area of expertise to investigate, judge, or confi rm child, adult, and/or elder abuse. The role of the therapist is to report suspected abuse to professionals who are qualifi ed to investigate the incident. Even though the person claimed to have been abused, the therapist should not directly call the police.

An occupational therapy administrator implements a quality improvement program at a large private hand therapy clinic. The administrator determines that the clinic's certifi ed occupational therapy assistants (COTA®s) are not completing their assigned initial screenings in a timely manner. This has resulted in scheduling delays for complete functional evaluations. Which initial action is most effective for the administrator to take in response to this situation? Answer Choices: A. Counsel the COTA®s on the need to adhere to screening schedules. B. Examine the organizational structure of the screening process. C. Assign the occupational therapists to complete all screenings. D. Redesign the screening to simplify the process.

B.A fundamental principle of quality improvement (QI) is to view problems and limitations as opportunities to explore organizational improvement needs. Blame for identifi ed problems is not attributed to any person within the organization

An individual with rheumatoid arthritis has developed several boutonniere deformities. Which of the following is the most accurate description for the occupational therapist to include in documentation of the individual's presenting signs? Answer Choices: A. Hyperextension of the PIP joint and fl exion of the DIP joint. B. Ulnar deviation and subluxation of the MCP joints. C. Flexion of the PIP joint and hyperextension of the DIP joint. D. Heberden's nodes at the DIP joints and Bouchard's nodes at the PIP joints.

C. A boutonniere deformity occurs when there is hyperextension of the DIP joint with fl exion of the PIP joint. A swan neck deformity is evident when there is hyperextension of the PIP joint and fl exion of the DIP joint. Ulnar deviation and subluxation of the MCP joints are additional deformities that can result from rheumatoid arthritis. Heberden's nodes and Bouchard's nodes are types of bone spurs that can result from osteoarthritis.

The administrator of a large rehabilitation hospital reviews the occupational therapy staffi ng schedules. The administrator determines that of the 12 full-time therapists, six work full-time in the inpatient department, two work full-time in the outpatient department, two divide their hours equally between the inpatient and outpatient department, and two divide their hours equally between administrative/managerial work and direct care provision on the inpatient unit. Which is most accurate staffi ng for the administrator to document for the occupational therapy inpatient department in the annual report? Answer Choices: A. Twelve full-time equivalent employees. B. Ten full-time equivalent employees. C. Eight full-time equivalent employees. D. Six full-time equivalent employees.

C. A full-time equivalent (FTE) is the amount of work time assigned to one full-time staff member in a year. In this scenario, two employees have part-time inpatient responsibilities, so they would each be considered 0.5 FTE and two employees only devote half of their hours to direct care, so they would also each be considered 0.5 FTE. Since 0.5 × 4 = 2, and there are six staff members with full-time inpatient responsibilities, the total of FTEs would be eight.

The client responds well to the compensatory approach when performing countertop meal preparation tasks. The therapist decides to use a dynamic interactional approach as the theoretical foundation for cognitive perceptual intervention for other meal preparation activities. During a session to train the client in scanning strategies, the client accurately fi nds two items in a refrigerator. Which is the therapist's most appropriate initial response to the client's task success? Answer Choices: A. Praise the client for successful task completion. B. Ask the client to now fi nd three items in the refrigerator. C. Ask the client how they know that the items are correct. D. Ask the client to now fi nd two items in the pantry.

C. A fundamental technique in the dynamic interactional approach is awareness questioning to help the individual identify successes, detect errors, estimate task diffi culty, and predict outcomes. The person's processing abilities and the use of self-monitoring techniques are used to facilitate learning for different tasks and/ or environments

During a topical work preparation group for individuals recovering from mental illness, a member expresses concern about answering questions related to personal psychiatric history during a job interview. Which action is best for the occupational therapist to take in response to these expressed concerns? Answer Choices: A. Refer the client to a vocational rehabilitation counselor. B. Encourage the other members of the group to share their interview experiences. C. Lead a group discussion on the legal rights afforded in the interview process. D. Support the client in not disclosing past psychiatric history.

C. A primary purpose of a topical group is to develop knowledge about a particular area of performance. Since members of the group may not be aware of all of their legal rights in an interview, it is most important for the occupational therapist to lead a discussion about this issue. The Americans with Disabilities Act (ADA) protections concerning the disclosure of medical histories are invaluable for all members to know.

An occupational therapist is treating an individual with Parkinson's disease in an outpatient setting. The therapist observes that the person attends regularly but has little energy and is diffi cult to engage during intervention. The person reports limited performance of the activities prescribed for their home program. Which is the best action for the therapist to take in response to these observations and the person's self-report? Answer Choices: A. Ask the person's physician to complete a referral for a psychiatric evaluation. B. Tell the person that the completion of the home program is vital to recovery. C. Interview the person and complete a standardized depression scale. D. Defer intervention until the person's depression is treated.

C. A standardized depression scale provides objective data and an interview can obtain the person's subjective experience and viewpoints. Together this information can be used to determine the reasons for the person's limited energy and diffi culty engaging in interventions in the clinic and at home. If the results of this evaluation indicate that the person may be experiencing a depressive episode, a referral for a psychiatric evaluation can be made. However, asking the person's physician to complete a referral for a psychiatric evaluation is premature at this point. The reasons for the person's behavior are not known.

An occupational therapist completes a cognitive screening for a person with chronic schizophrenia, undifferentiated type. The therapist uses Allen's cognitive disabilities model to guide the evaluation process. During the screening, the person is able to imitate the whipstitch but cannot imitate the single cordovan stitch. Based on these results, the occupational therapist determines that further evaluation is indicated. Which ability is most relevant for the therapist to assess? Answer Choices: A. Performance of multistep tasks using overt trial and error problem-solving. B. Performance of multistep tasks using analytical reasoning. C. Performance of simple tasks independently using visual cues. D. Performance of simple tasks with long-term repetitive training.

C. According to the Allen Cognitive Level (ACL) test, a person who is able to imitate a whipstitch but not able to imitate a cordovan stitch is at a cognitive level of 4. According to Allen's cognitive disabilities model, a person at Level 4 is able to complete simple tasks independently. However, the person relies heavily on visual clues. Since the screening indicated that the person is likely at this level, further evaluation is needed to provide more specifics about the person's abilities and limitations. According to Allen's cognitive disabilities model, a person at Level 3 can perform simple tasks with long-term repetitive training

A school-based occupational therapist is teaching orientation and mobility skills to an adolescent with a degenerative visual disorder. Which is the most effective motivational technique for the therapist to use with this student? Answer Choices: A. Provide concrete structure and frequent feedback to ensure accurate orientation and safe functional mobility. B. Keep sessions short to allow time for emotional adjustment to orientation and mobility challenges. C. Treat the student as an adult and incorporate the student's orientation and mobility goals into intervention sessions. D. Limit anxiety by practicing the techniques in a quiet and self-contained environment (e.g., an empty classroom).

C. Adolescents prefer to be treated as adults. The most important (and most effective) motivational technique is to incorporate the student's goals into the intervention sessions. Too much structure will limit the student's trial and error learning which is vital to learning and retaining orientation and functional mobility skills. The length of intervention sessions should be determined by the student's established goals, the methods identifi ed to attain these goals and the student's progress toward goal attainment.

An individual with developmental disabilities scores a Level 3 on the Allen Cognitive Level Test. Which activities should the occupational therapist include in the intervention plan to help meet the client's functional needs? Answer Choices: A. Community mobility activities such as taking a bus. B. Home management activities such as preparing a food shopping list. C. Self-care activities such as brushing teeth. D. Leisure activities such as completing a 50-piece puzzle.

C. An individual who scores a Level 3 on the Allen's Cognitive Level Test can perform basic repetitive tasks. Level 3 is the beginning of using the hands to manipulate objects, but task completion requires proprioceptive cues (e.g., physical prompts to perform the hand to mouth movement needed to brush teeth). The other activities require cognitive skills that are not present at Level 3, according to Allen's model.

A school-based occupational therapist consults with a teacher regarding a nonspeaking student who uses a wheelchair and an augmentative communication device. The teacher reports that the student has been making many errors on the communication device but that no diffi culties had been observed when the student used the device in the past. Which is the most effective initial action for the therapist to take in response to the teacher's report? Answer Choices: A. Advise the teacher to contact the student's parents and recommend that they bring the child to a physician for an exam. B. Reassess the student's motor and communication abilities to determine needed modifi cations. C. Evaluate the position of the student in the wheelchair and the device on the wheelchair. D. Reposition the communication device on the wheelchair to facilitate access and increase accuracy.

C. Even minor changes in a person's positioning can impact on their access to an assistive device; therefore, the therapist's initial action must be to evaluate the position of the student and the device. Based upon the results of this assessment, the therapist may provide recommendations for positioning the student and/or for placement of the device.

The occupational therapist meets with the client to ensure compliance with the prescribed splinting protocol. Which is the most important outcome of this session? Answer Choices: A. The client's adherence to a written splint wearing schedule. B. The client's ability to independently don and doff the splint. C. The client's understanding of the purpose(s) and procedure(s) of the splint protocol. D. The completion of functional training in the use of the splint.

C. If a client understands the purposes and procedures of the splint protocol, they will become a collaborative partner in the intervention programs. The other choices are important components of a splinting intervention program and may be required by accrediting bodies (e.g., documentation of functional training and the individual's ability to don/doff a splint). However, the success of these interventions and the attainment of client compliance rely on the client's understanding of the splint protocol's purpose(s) and procedure(s).

An individual with a spinal cord injury (SCI) at the level of T1 is practicing a stand pivot transfer in the OT department of a rehabilitation center. The patient complains of dizziness and nausea. Which action is most important for the occupational therapist to take fi rst? Answer Choices: A. Call for help according to facility procedures. B. Return the patient to the wheelchair for a fi ve-minute rest break. C. Return the person to the wheelchair and immediately recline it. D. Return the patient to the wheelchair and transport the patient back to rest in bed.

C. Individuals with SCIs are at risk for orthostatic hypotension. Complaints of dizziness and nausea are indications of orthostatic hypotension and require an immediate response. Reclining the individual in their wheelchair will return blood pressure to a normal range. The other choices do not address the need for immediate remediation of this crisis.

Several newly homeless veterans with a variety of mental health diagnoses attend an occupational therapy community reentry group conducted in a community-based shelter. Which should be the primary focus of the initial group session? Answer Choices: A. Development of home management skills such as meal preparation. B. Determination of fi nancial assets and money management skills. C. Identifi cation of local resources such as soup kitchens and thrift stores. D. Exploration of vocational interests and employment possibilities.

C. Locating basic resources is the most essential survival skill listed for people who have recently become homeless. Initial sessions at a homeless shelter would likely focus on basic survival and personal self-care skills prior to focusing on vocational interests, employment opportunities, or IADL (e.g., meal preparation, money management). Subsequent sessions may focus on the development of IADL and vocational skills.

An occupational therapist provides consultation services to a psychogeriatric unit for individuals with moderately severe cognitive decline. In designing the activity program, which groups are best for the occupational therapist to include? Answer Choices: A. Reality orientation. B. Sensory stimulation. C. Reminiscence. D. Coping skills

C. Reminiscence. Reminiscence groups are designed to review past life experiences to promote use of intact long-term memory. Current memory is not required for successful participation in reminiscence groups. Individuals with moderately severe cognitive decline typically have poor recent memory, but long-term memory is often intact.

A Level II fi eldwork student's fi rst assigned case is an individual with right hemiplegia. The supervising therapist reminds the student that primitive refl exes can emerge when someone incurs a CVA. The therapist demonstrates this point by rotating the client's head to the right and stating that the observed response demonstrates a subtle asymmetrical tonic neck refl ex (ATNR). The therapist asks the student to describe the client's reaction that resulted in the therapist's interpretation. Which is most accurate for the student to state the client is exhibiting based on this observation? Answer Choices: A. Increased fl exor tone of the right upper extremity. B. Increased extensor tone of the left upper extremity. C. Increased extensor tone of the right upper extremity. D. Increased extensor tone in both upper extremities.

C. Rotating the head to one side facilitates the ATNR. When observing ATNR, one will see fl exion of the skull side of the body, and extension of the face side. Therefore, when assessing an adult patient with right hemiplegia and rotating the head to the right, one would note an increase in extension tone in the right upper extremity.

A 10-year-old with congenital anomalies wears bilateral ankle-foot orthoses. The parents want the child to be able to don and doff shoes independently, but the child cannot tie shoes. Which is the best footwear recommendation for the therapist to make for the child to wear? Answer Choices: A. Leather slip-on loafers. B. Slip-on tennis shoes with no laces. C. Running shoes with Velcro shoe closures. D. Hi-rise sneakers with sliding adapters on the laces.

C. Running shoes are the best option for use with ankle-foot orthoses (AFOs), and Velcro closures will help the child to be independent until tying is learned. Leather slip-on loafers will not correctly support the AFOs. Slip-on tennis shoes that do not have laces do not have adequate support in the upper part of the foot to maintain the AFOs. The sliding adapters are a good option to replace the laces, but the hi-rise sneakers will not likely allow for placement of the AFOs on the feet.

A young adult with a T9-T10 spinal cord injury wishes to engage in sports activities. Which wheelchair features are best for the occupational therapist to recommend to this client? Answer Choices: A. A heavy-duty foldable frame with a high back. B. An ultra-light foldable frame with a high back. C. An ultra-light rigid frame with a low back. D. A heavy-duty rigid frame with a low back.

C. Sports competition wheelchairs are usually made with rigid construction and very strong lightweight materials. A folding wheelchair does not provide the stability needed for competition sports. A low seat back enhances the user's upper body/arm movements. A higher seat back is indicated for patients with decreased trunk control (not a factor in this example). At T9-T10 this patient has partial innervation of the abdominals (innervated T6-T12) and full innervation of the upper extremities.

The occupational therapist plans the client's early mobilization program. Which is the most appropriate exercise routine for the occupational therapist to use within the limits of a dorsal block splint? Answer Choices: A. Active fl exion/passive extension. B. Active fl exion/active extension. C. Active extension/passive fl exion D. Passive fl exion/passive extension

C. The Kleinert protocol in the early phase (0-4 weeks postsurgery) has the person performing active extension and passive fl exion within the limits of a dorsal block splint. The Duran protocol, which also can be used postsurgery for fl exor tendon repairs, uses passive fl exion and passive extension within the limits of a dorsal block splint.

A child with congenital anomalies has severe developmental delay. The child demonstrates motor and cognitive skills at the nine-month level. Which is the best adaptation for the occupational therapist to use during intervention to develop the child's visual and auditory awareness? Answer Choices: A. A hand-held rattle of the child's favorite cartoon character. B. A wrist bracelet with blinking lights that makes noise when moved. C. A button switch that activates a CD player when the switch is pressed.

C. The button switch encourages the child to develop the developmentally appropriate skill of cause and effect. Visual stimulation is provided when the child focuses on the device to activate it. Activating the CD player provides auditory feedback

An occupational therapist works in a school system with a child with developmental delays. One of the goals of treatment is to develop prewriting skills. The child exhibits the ability to grasp a pencil proximally with crude approximation of the thumb, index, and middle fi ngers and the ring and little fi ngers slightly fl exed. The therapist develops an intervention plan. Which grasp should be the focus for the implementation of intervention? Answer Choices: A. Digital pronate grasp. B. Static tripod posture grasp. C. Dynamic tripod grasp. D. Palmar supinate grasp.

C. The grasp pattern described in the case is static tripod posture grasp. The next grasp pattern to be mastered after this grasp is the dynamic tripod grasp. The other grasp patterns are precursors to the static tripod grasp.

An occupational therapist working in a school system must incorporate the Individuals with Disabilities Education Act (IDEA) in the program. In which location should the therapist provide intervention? Answer Choices: A. Regular classroom while general education classes are not in session. B. Special education classroom while other children with disabilities are present. C. Regular classroom while general education classes are in session. D. Private occupational therapy room designed for children with disabilities.

C. The guidelines from IDEA emphasize that a child's needs be served in an inclusive manner that enables the child to have full access to the general education curriculum, focusing on participation in a general education classroom. The other options are too restrictive and do not facilitate inclusion in general education.

A single parent with rheumatoid arthritis and two school-aged children reports diffi culty completing a home exercise program. The parent states that multiple familial, work, and home management responsibilities fi ll the day and additional activities cannot fi t into the day. Which is the best action for the occupational therapist to take in response to these realities? Answer Choices: A. Explain and reinforce the importance of active range of motion exercises for remediation of dysfunction. B. Provide intervention to develop time management skills and enable temporal adaptation. C. Incorporate the parent's engagement in a diversity of role activities into the home program. D. Increase the frequency of OT sessions to compensate for lack of follow-through with the home program.

C. The performance of role activities requires the individual to actively range joints which is the purpose of an exercise program. Incorporating AROM into one's daily routine can be more easily implemented than adding a specifi c exercise regimen. Some people fi nd pure rote exercise uninteresting. In addition, since activity and the pursuit of occupational roles is the foundation of OT, this choice provides the most theoretically consistent action

An occupational therapist working for a home care agency provides an inservice to new employees on Medicare reimbursement guidelines for durable medical equipment (DME). Which item would the therapist describe as reimbursable by Medicare? Answer Choices: A. A raised toilet seat for a patient after a hip replacement. B. A reacher for a person with arthritis in both hips. C. A walker for a person who cannot ambulate in the home without one. D. Grab bars in the bathroom for a person who cannot bathe or toilet without them.

C. The walker is covered by Medicare. The others are not. The criteria for durable medical equipment to be reimbursable by Medicare are that the item must be necessary and reasonable to treat an illness or incidence of decreased functioning. The item must have a medical purpose, be used repeatedly and not useful in the absence of an illness.

A young adult recently diagnosed with schizophrenia is referred to an occupational therapy day treatment program. Which should the occupational therapist do fi rst with the client? Answer Choices: A. Determine short-term and long-term goals for program participation. B. Model desired behaviors during occupational therapy groups. C. Have the client complete an occupational interest checklist. D. Encourage the client to maintain a daily log of medication intake.

C. Upon referral, the fi rst step in the OT process is screening. Determining the person's occupational interests can help identify areas requiring further evaluation. One cannot establish short-term and long-term goals with the client until an evaluation is completed. It is unknown if the client has defi cits in medication management. Modeling behavior is a component of the intervention process.

An individual is status post carpal tunnel release. When the occupational therapist conducts a sensory test for sharp/dull (pain), the person reports dull as sharp on the palmar surface of the thumb and index fi nger. All other responses were correct. Which is accurate for the therapist to document about the individual's sensation? Answer Choices: A. Impaired for pain along C5 and C6 dermatomes. B. Hypersensitive along the ulnar nerve distribution of the palmar surface of the hand. C. Hypersensitive along the median nerve distribution of the thumb and index fi ngers. D. Absent for pain along the median nerve distribution.

C.The individual is so sensitive that when touched with a dull stimulus they report it as "sharp." Therefore, the sensation is not absent, but rather hypersensitive at the median nerve distribution. Impairment at C5 and C6 would also involve the loss of sensation in the upper arm and forearm. Ulnar nerve distribution involves the ring and little fi ngers

A patient who is status-post left frontal lobe ischemia has diffi culty bearing weight through the right lower extremity during reaching activities (e.g., standing at a sink during morning self-care routine). The occupational therapist implements a Motor Re-Learning Program (MRP). Which is the best intervention for the therapist to provide according to this approach? Answer Choices: A. Therapeutic handling to affect the central nervous system. B. A stool to sit on during reaching activities. C. Joint compression to the right lower extremity during reaching activities. D. Verbal and visual feedback while practicing reaching.

D. A MRP approach provides verbal and visual feedback to give a person the input needed to make postural and limb adjustments. Therapeutic handling to affect the central nervous system is consistent with a neurodevelopmental therapy approach. Providing a stool to sit on during reaching activities can be used for safety purposes

A patient is recovering from a right CVA resulting in severe left hemiplegia and visuospatial defi cits. Their left lower extremity has pitting edema. Which wheelchair would be best for the occupational therapist to recommend for this patient? Answer Choices: A. A powered wheelchair with a joystick control and dual elevating leg rests. B. A lightweight active duty wheelchair with dual elevating leg rests. C. A one-arm drive chair with an elevating leg rest on the left. D. A hemiplegic chair with an elevating leg rest on the left.

D. A hemiplegic chair has a low seat height (17½ inches as compared to the standard seat height of 19½ inches) and is the best choice for this patient. The patient can propel it using both the unaffected hand and leg. An elevating leg rest for the left side is needed to address the edema in the patient's left lower extremity. There is no need for an elevating leg rest for the right lower extremity. A one-arm drive wheelchair has both drive mechanisms located on one wheel. A person can propel this type of wheelchair by using one hand.

An individual cannot independently get from a supine position to a sitting position. The person has good scapular, shoulder, and elbow muscle strength. Which of the following should the occupational therapist recommend as most effective for the client to use to improve bed mobility? Answer Choices: A. A leg lifter. B. A bed rail assist. C. A log roll technique. D. A rope ladder.

D. A rope ladder or bed loops enable the individual to loop the arm(s) into the fi rst "rung"/loop, and then into the next "rung"/loop, and so on until they have achieved a sitting position. The other options do not assist with independently moving from supine to sitting. A leg lifter is used to lift a leg that cannot move independently. A bed rail assist is used to help with rising from sitting to standing.

In an outpatient rehabilitation clinic, an occupational therapist is treating a high school student with spina bifi da resulting in full motor paralysis and sensory defi cits below L1 spinal cord level. The client is a competitive swimmer and is able to transfer independently from the wheelchair to the pool without an assistive device. The client's goal is to learn how to mount and ride a horse. Which is best for the therapist to do initially to help the client attain this goal? Answer Choices: A. Implement a home-based transfer training program for the client's family to learn how to assist with mounting a horse. B. Develop an exercise program for the client to do at home on a daily basis to increase upper extremity strength. C. Encourage the client to extend scheduled swimming sessions and practice mounting large infl atable tubes in the pool. D. Consult with a stable owner to discuss alternative methods of mounting a horse.

D. Consulting with a stable owner would be the best option initially to determine other ways to mount a horse. Based upon this information, the therapist can plan an appropriate intervention. Implementing a homebased transfer training program for the family may be relevant after determining the possible ways the client can safely mount a horse. Since the client is a competitive swimmer and can transfer independently to the fl oor, upper extremity strength is not a problem. The activity demands of mounting large infl atable tubes in a pool are not the same as the activity demands of mounting a horse. The ability to mount tubes in a pool would not generalize to mounting a horse.

A graduate student with an anxiety disorder reports feeling confused about the future. During the OT evaluation, the client relates decreased feelings of competence for their chosen fi eld of study and overall poor personal causation. Which is the best initial action for the therapist to take in response to the client's stated concerns? Answer Choices: A. Administer a vocational interest inventory. B. Provide activities related to the client's chosen fi eld of study. C. Refer the client to the state offi ce of vocational and educational services. D. Establish short-term goals with high potential for attainment.

D. Decreased personal causation and feelings of incompetence are common symptoms of anxiety disorders. The establishment of short-term goals with high potential for attainment can provide the individual with the success experiences needed to develop a sense of competence and improve personal causation. Once these skills are developed, the need for further vocational exploration and/or services can be determined.

A person recovering from a cerebral vascular accident has left-sided weakness and dysphagia. Which of the following is the most effective direct intervention approach to help the person successfully swallow ingested food? Answer Choices: A. Provide pureed, thick liquids. B. Provide thermal stimulation to the inferior faucial arches. C. Tilt the person's head back and toward the left side. D. Provide small, warm boluses.

D. Direct intervention for oral motor control involves techniques that utilize a bolus. These techniques can involve modifi cation of bolus amount, consistency and temperature. Providing thermal stimulation to the inferior faucial arches using a chilled dental exam mirror can elicit a swallow response; however, this is considered an indirect treatment method. Tilting the head back is contraindicated because it increases choking risk

An occupational therapist observes a COTA® having diffi culty transferring a client with athetoid movements from a mat to a wheelchair. Before the therapist can cross the room to help with the transfer, the COTA® slides with the client to the fl oor. The therapist assists the COTA® in safely returning the client to the wheelchair. They assess that the client appears to be unharmed and return the client to the unit for a medical evaluation. Which action should the therapist take next? Answer Choices: A. Counsel the COTA® on the need to ask for assistance with diffi cult transfers. B. Require the COTA® to attend a transfer training inservice. C. Document the COTA®'s unsafe actions in the personnel record. D. Complete an occurrence report according to facility standards.

D. Immediately after an incident occurs, the therapist must complete documentation according to the setting's standards. Counseling a COTA® to ask for assistance and requiring attendance at a workshop can be appropriate aspects of risk management but they are not the fi rst steps. In addition, there is no information provided to clearly identify that the COTA® was acting unsafely. There are transfer situations that unexpectedly become beyond a practitioner's ability to successfully complete. During those situations, the practitioner should guide the patient to the fl oor in a controlled manner. This is often done by using one's own body to support the patient and can give the appearance of "sliding." More information is needed to determine if the COTA®'s actions were actually unsafe.

An occupational therapist provides home-based services to a home maintainer who incurred a right CVA eight months ago. The individual and the therapist have chosen to focus on kitchen activities during the intervention session. The therapist has the client stand in front of the counter with an open dishwasher to the left. The therapist asks the client to put the clean dishes into an overhead cabinet to the right of the client using the affected UE. By setting up the activity in this manner, which proprioceptive neuromuscular facilitation (PNF) technique is the therapist using? Answer Choices: A. Heavy work/mobility superimposed on stability. B. Reciprocal inhibition/innervation. C. Diagonal patterns of D2 fl exion/extension. D. Diagonal patterns of D1 fl exion/extension.

D. In this example, the D1 fl exion pattern moves the person's left upper extremity "up and away" as the person grasps the dishes from the dishwasher on the left and puts them away in the cabinet above the counter to the right. Heavy work and reciprocal inhibition/innervation are techniques used in the Rood approach. In heavy work (also termed "mobility superimposed on stability"), proximal muscles contract and move, and the distal segments are fi xed. According to the Rood approach, reciprocal inhibition/innervation is an early mobility pattern that is primarily a refl ex governed by spinal and supraspinal centers. D2 is the PNF extension diagonal which moves the UE "down and in."

The supervisor of an acute inpatient unit requests that a recently hired entry-level therapist write summaries of several evaluation sessions that were completed by another therapist. The evaluating therapist had to leave work unexpectedly due to a medical emergency and is not expected to return to work. Which is the best response for the therapist to make in response to this request? Answer Choices: A. Comply with the supervisor's request but ask for the supervisor to co-sign the notes. B. Request time to complete an independent evaluation of each individual previously evaluated. C. Report the supervisor's request to the facility's administration. D. Suggest that the therapist's evaluation results be documented by the supervisor.

D. It is not appropriate for a peer to document results of an evaluation session in which they did not participate. It is acceptable for a supervisor to provide documentation based upon staff's input, as long as the documentation reports that it is based upon the work of a given staff member. The supervisor must provide an accurate record of the situation (i.e., evaluation completed by therapist X found that . . .). In an acute inpatient setting, there is insuffi cient time to complete another evaluation. The entry-level therapist should communicate directly with their supervisor. There is nothing to report to the administration at this time.

An individual with obsessive-compulsive personality disorder participates in a vocational program. The client asks the occupational therapist to speak to the supervisor of the transitional employment program (TEP). The client is concerned that compulsive behaviors are interfering with job performance and may result in the loss of a new TEP placement. Which is the therapist's best response to these expressed concerns? Answer Choices: A. Instruct the client to speak directly to the TEP supervisor about the right to receive reasonable accommodations. B. Schedule a reevaluation of the client's work behaviors and skills. C. Assure the client that it is natural to have initial diffi culties at a new job. D. Schedule an appointment with the client and the TEP supervisor.

D. Meeting with the individual and the supervisor will enable the therapist to provide support for the individual's concerns. The therapist can also facilitate a dialogue about the specifi c diffi culties the individual is experiencing from both the employee and employer perspective. This will help the therapist analyze the situation and can provide a basis for making recommendations for accommodations, if needed.

A high school student is referred to occupational therapy for ADL training. The student has nonspastic cerebral palsy resulting in right side hemiparesis and decreased muscle tone. During a transition planning meeting, the student's teacher reports the student has had several accidents during a meal preparation class (i.e., incurring cuts when using a knife and burning hands when taking items out of the oven). As part of the transition plan, the occupational therapist will teach the student adaptive techniques used in a kitchen setting to compensate for right-side weakness. Which of the following adaptations should the therapist recommend to improve the student's independence in preparing meals safely? Answer Choices: A. Prepare foods that do not require cutting. B. Use a microwave oven to cook food. C. Use a weighted knife to cut food. D. Use oven mitts that extend to the elbows.

D. Nonspastic cerebral palsy will exhibit decreased or fl uctuating muscle tone and can include hemiparesis which indicates the arm and leg on one side of the body is weakened. Adaptations to an activity or the environment can prevent injuries in the kitchen and support independence during meal preparation. Using oven mitts that cover the forearms is a practical adaptation that will prevent burns when handling hot baking dishes in both the oven and microwave. The adaptation will allow the student a choice in using an oven or the microwave during meal preparation. Cutting food items regularly occurs when preparing meals.

An older adult recovering from a myocardial infarction is referred to occupational therapy for a home care evaluation. The referral states that the client has high blood pressure and medication-related orthostatic hypotension. Which precaution is most important for the occupational therapist to observe with this client? Answer Choices: A. Adherence to dietary restrictions during meal preparation activities. B. Avoidance of activities that require movement against gravity. C. Delay of the OT evaluation until the client's medications are stabilized. D. Avoidance of activities that require sudden postural changes.

D. Orthostatic hypotension or postural hypotension is an excessive drop in blood pressure that occurs upon assuming an upright position. All functional activities have components that are against gravity so these cannot be avoided during treatment.

A child with a diagnosis of traumatic brain injury (TBI) is evaluated by an occupational therapist. The child presents with extension of both upper extremities and fl exion of both lower extremities following a stimulus of neck extension. When interpreting this observation, which statement is most accurate for the therapist to document? Answer Choices: A. The presence of + ATNR, which is "abnormal" and has reappeared after the TBI. B. The presence of a + STNR, which is "normal" and not affected by the TBI. C. The presence of a + ATNR, which is "normal" and not affected by the TBI. D. The presence of a + STNR, which is "abnormal" and has reappeared after the TBI.

D. STNR is facilitated by fl exion of the neck followed by extension of the neck. The response is that fl exion of the neck results in bilateral UE fl exion with bilateral LE extension. Neck extension results in bilateral UE extension with bilateral LE fl exion. Positive reactions are normal up to four to six months of age. Positive reactions after 12 months of age are indicative of delayed reflexive maturation or pathology.

A rehabilitation hospital is interested in starting a driver rehabilitation program. Which must the occupational therapist hired to develop this program do fi rst? Answer Choices: A. Determine the cost of commercially available driving rehabilitation programs. B. Develop admission criteria for program participants. C. Develop a marketing plan to obtain referrals. D. Learn the state's driving laws and requirements.

D. State laws and regulations regarding the mandatory reporting of driving ability post illness or injury are essential for a therapist developing a driver rehabilitation program. The therapist would need to know state laws and regulations prior to setting admission criteria or a marketing plan. While cost is an important aspect of program development, it is not the greatest priority. Knowledge and adherence to state laws are essential to avoid potential program liability

Upon evaluation, the therapist determines that the patient has right homonymous hemianopsia. The therapist provides recommendations to modify the patient's room to enhance independence. Which are the most appropriate recommendations for the therapist to make for the placement of the patient's call button and cell phone? Answer Choices: A. Call button on the left side and the cell phone on the left side. B. Call button on the right side and the cell phone on the right side. C. Call button on the right side and the cell phone on the left side. D. Call button on the left side and the cell phone on the right side.

D. The call button must be placed within the person's intact visual fi eld (which, in this case, is left) so that the person can readily access it in case of emergency. However, the cell phone can be placed outside of the person's visual fi eld (right, in this case) to encourage the person to scan the environment

The administrator of a home care agency tells the occupational therapist to submit all intervention plans to the client's third-party payers, prior to the implementation of treatment. Which is the most accurate term for the therapist to use when documenting these actions? Answer Choices: A. Concurrent review. B. Peer review. C. Utilization review. D. Prospective review.

D. The evaluation and approval of proposed intervention plans by third-party payers is called prospective review. Concurrent review is the evaluation of ongoing intervention programs. Peer review is a system in which the quality of work by a group of health professionals is reviewed by their peers. Utilization review is a plan to review the use of resources within a facility to determine medical necessity and cost effi ciency.

An occupational therapist works in a program for survivors of domestic violence. The therapist applies a client-centered approach to guide intervention. When using this approach, which is best for the therapist to do? Answer Choices: A. Offer specifi c concrete behavioral suggestions for dealing with confrontations. B. Respond to the participants' self-deprecating comments with positive feedback on personal characteristics. C. Reinforce only the participants' neutral comments about themselves and personal skills. D. Refl ectively paraphrase the participants' statements and ask for their verifi cation.

D. The main principle of client-centered therapy is that it is directed by the person. By refl ectively paraphrasing the participants' statements and asking them to verify the accuracy of the interpretations, the therapist is conveying a message that the participants' thoughts and feelings are important. This validation of participants' worth can provide a foundation for the development of a trusting relationship, which is paramount to recovery. An intervention goal when working with survivors of domestic violence is to empower them to live self-directed lives.

During meal preparation tasks, the client ignores items on the left side of the counter. The therapist decides to use a compensatory functional approach to improve the client's performance. Which is the most appropriate method for the therapist to use during intervention to develop meal preparation skills? Answer Choices: A. Encourage bilateral activities. B. Place all items on the right side of the counter. C. Practice scanning activities. D. Place a brightly colored placemat on the left side of the counter

D. The placemat provides an external cue that the person can be taught to scan for during meal preparation. This anchoring technique is a basic compensatory functional approach. Encouraging bilateral activities and placing all items on the right side of the counter would not address the client's performance defi cit. Using practice of scanning activities is a transfer of training approach which assumes that remediation of the cause of the presenting symptom will result in increased functional skills.

An individual is recovering from deep partial-thickness burns on the upper extremities, chest, and lower neck. The occupational therapist provides equipment to prevent positions that can result in contractures. Which are the most important positions for the therapist to prevent? Answer Choices: A. Positions of comfort. B. Antideformity positions. C. Positions resulting in edema. D. Positions causing pain.

A. The position of comfort is often assumed by individuals recovering from burns. This position occurs when the person assumes the protective postures of adduction and fl exion of the upper extremities, fl exion of the hips and knees, and plantar fl exion of the ankles. This position does decrease discomfort, but it is nonfunctional and can result in contractures.

A middle school student with learning disabilities exhibits no behavioral problems in the classroom. However, whenever the class is in a line waiting to switch classrooms, the student becomes agitated and often pushes classmates. The occupational therapy consultant advises the teacher that this behavior may be indicative of an underlying disorder. Which of the following is most accurate for the therapist to identify as a potential disorder warranting further evaluation? Answer Choices: A. Gravitational insecurity. B. A conduct disorder. C. Antisocial tendencies. D. Tactile defensiveness

D.. The tactile stimuli due to closeness of peers in a line can become overwhelming to an individual with tactile defensiveness. The behavior described in the scenario is not refl ective of behavior indicative of the other disorders listed