NBCOT Exam C

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C155. An occupational therapist working in a hand clinic conducts an evaluation. During the evaluation, the therapist uses the Froment's sign. When documenting the outcome of this evaluation procedure, which is most accurate for the therapist to state was assessed? Sensation of median nerve. Motor function of the median nerve. Sensation of the ulnar nerve. Motor function of the ulnar nerve.

C128. After a work-related injury to the left index finger, an assembly line worker is fit with a buddy strap incorporating the index and middle fingers. In describing the primary purpose of the strap to the client, which of the following explanations is most accurate for the therapist to state? "The strap provides passive range of motion (ROM) to the index finger." "The strap reduces edema in the index finger." "The strap immobilizes the index finger." "The strap provides active ROM to the index finger."

C13. An occupational therapist who is a driver rehabilitation specialist provides on-the-road evaluation for an individual recovering from a right cerebrovascular accident (CVA). The individual is right dominant and has regained sensorimotor functions in the affected extremity. Which is most important for the therapist to assess during the on-the-road evaluation? Tactical aspects of driving. Operational aspects of driving. Ergonomic aspects of driving. Social aspects of driving.

C131. An individual has relocated to a new area and begins treatment at an outpatient OT clinic for follow-up after rotator cuff surgery. It is six weeks' postoperation. Which is the most effective intervention for the occupational therapist to implement at this time? An isometric strengthening program. Passive range of motion (ROM). Active assistive ROM. An isotonic strengthening program.

C2. An occupational therapist works with a survivor of a house fire. The client has burns on both hands that limit thumb mobility. The client identifies a personal goal of being able to pick up and hold cans to enable independent shopping and meal preparation activities. Which movement of the thumb should the goal statement include as the desired functional outcome? a Carpometacarpal (CMC) palmar abduction. b CMC extension. c Metacarpophalangeal (MCP) flexion. d Interphalangeal (IP) flexion.

C21. A fifth-grade student is having difficulty self-feeding and frequently spills beverages. The student has nonspastic cerebral palsy resulting in fluctuating muscle tone and poor motor control. Which is best for the occupational therapist to recommend the student use to improve independence in self-feeding and minimize spillage? A sippy cup. Both hands to hold the cup. A cup with a handle. A straw.

C20. An individual with schizophrenia experiences hallucinations. Which action should the occupational therapist take when the individual begins to actively hallucinate during an occupational therapist project group? Redirect the individual's attention back to the project. Provide tactile reassurance to the individual. Verbally reassure the individual that the hallucination is not real. Use humor to divert the individual's attention away from the hallucination.

C70. A person is five days post coronary artery bypass graft (CABG). The patient expresses anxiety about performing any type of activity and reports chest pain during ambulation. The cardiologist has approved activities at a metabolic equivalent (MET) level of 2-3. Which activity is best for the occupational therapist to use when initiating intervention with this person? Grooming while standing at the sink. Keyboarding while sitting. Performing light housework.

C72. An occupational therapist receives a referral to evaluate an individual's executive functioning following a mild cerebral vascular accident. Which are the most relevant foci for this evaluation? The person's initiation and planning. The person's attention and memory. The person's spatial relations and topographical orientation.

C100. The manager of a large OT department is planning to expand the current inpatient cardiopulmonary rehabilitation program to include outpatient services. Which information is most relevant for the manager to include in the proposal to the hospital's administrative board? Data on the inpatient rehabilitation program's outcomes. Testimonials from patients regarding their satisfaction with the inpatient program. Statistics on physician referrals to the inpatient unit and the average length of stay. Literature on cardiopulmonary rehabilitation across the continuum of care.

C102. An occupational therapist completes a risk management report for the reaccreditation of a rehabilitation facility. In this report, which information is most important for the therapist to include? Procedures for informed consent. Revenue resulting from reimbursement claims. Medical necessity of resources used. The appropriateness of services provided.

C107. A patient with a diagnosis of borderline personality disorder attends a stress management group on an inpatient psychiatric unit. During the group, the patient's roommate states that there is a pocket knife in the patient's backpack. The patient says the roommate is exaggerating and that the item is only a keychain. Which should the occupational therapist do in response to these statements? Immediately inform the charge nurse. Immediately check the patient's backpack. Check the patient's backpack after the group session.

C108. The parents of a school-aged child with Rett syndrome ask the occupational therapist for activities to do at home to help their child regain lost skills. Which of the following should the therapist include in the home program for the parents to do with their child? Encourage the child to use pressure distribution techniques. Use four-step sequencing cards to increase attention. Give positive feedback for active range of motion (ROM) performance. Perform passive ROM to prevent contractures.

C11. An individual with a C3 spinal cord injury is participating in a community mobility group at a shopping mall. The client expresses the desire to return to the rehabilitation center due to a pounding headache. The occupational therapist notices the client is sweating profusely. Which is the best initial action for the therapist to take in response to this observation and request? Check the client's urinary catheter and collecting bag. Call the rehabilitation center's transportation department to relay the client's request. Escort the client to outside of the mall to cool off in the fresh air. Immediately activate the recline feature of the patient's tilt-in-space wheelchair.

C111. The parents of a child referred to OT ask the occupational therapist to treat their child who does not have insurance and bill for services in the name of their older who does have insurance. Which is the therapist's best response to this situation? Deny the request. Report the parents to the insurance company. Refer the parents to the department supervisor. Ask the family to get a referral from a physician.

C117. An occupational therapist conducts a sensory evaluation for an individual with cubital tunnel syndrome. Which of the following is the most accurate location for the therapist to record for this person's presenting sensory symptoms? The ulnar aspect of the forearm and hand. The volar aspect of the forearm and hand. The radial aspect of the forearm and hand.

C134. An individual with peripheral neuropathies due to diabetes is scheduled for a bilateral lower extremity (transfemoral) amputation. During OT intervention sessions to develop upper extremity strength to assist with postamputation transfers and to practice the performance of basic ADL from a seated position, the patient happily chats about plans to go shopping for new clothing to wear to a grandchild's wedding. Which defense mechanism should the occupational therapist consider when working with the person to support their adaptation to disability? Suppression. Regression. Displacement. Projection.

C138. A school-based occupational therapist is providing contracted per diem coverage for an occupational therapist on a disability leave. Upon reviewing the caseload, the therapist notes that 10 students have had evaluations completed during the past month. Five of these students' individualized education plans (IEPs) have also been completed by the team and approved by their families. Which is the best initial action for the therapist to take as a contract practitioner? Consult with the team and family to complete the IEPs for the remaining children. Conduct their own independent evaluations of each child to develop an IEP. Implement the IEPs that have already been established and approved.

C14. An occupational therapist evaluates a person who complains of persistent wrist pain after painting a house three weeks ago. The patient demonstrates signs and symptoms consistent with de Quervain's tenosynovitis. Which assessment measure should the therapist use to confirm the diagnosis? Finkelstein's test. Phalen's test. Froment's sign. Craig's test.

C143. An individual with bilateral knee replacements and cataracts is newly admitted to a skilled nursing facility. The individual retains some residual vision. During the initial evaluation, which is the most effective placement for the occupational therapist to use when presenting materials to the person? To the side of the person, with no direct lighting. Directly in front of the person, at eye level. Directly in front of the person, at tabletop level. To the side of the person, with a strong light shining.

C144. A COTA® provides community mobility training for a resident in a group home for individuals with developmental disabilities. A resident successfully completes the intervention activity the COTA® had designed with the OT supervisor. The COTA® needs to plan the next day's intervention session but the supervising occupational therapist is on a 2-week vacation. Which is the best action for the COTA® to take in response to this situation? Grade the activity that the client successfully completed to its next level of difficulty. Use the same activity that the resident successfully completed during the next session. Delay the next treatment session until the supervisor returns from vacation and is able to provide guidance. Ask the director of the residential program to assign another supervisor for the duration of the current supervisor's vacation.

C145. An individual is recovering from lumbar surgery. The patient must remain flat in bed during the initial recovery stages. The patient expresses an interest in reading from a personal collection of classic comics. Which adaptation is best for the occupational therapist to recommend the client use for reading? Prism glasses. A page magnifier. Audiotapes of books of interest. Large-print books of interest.

C15. During an OT group, a person receiving electroconvulsive therapy (ECT) treatments complains about short-term memory loss. Which should the therapist do in response to the client's stated concerns? Provide cues to facilitate engagement and compensate for memory loss. Immediately contact the psychiatrist to inform them of this symptom development. Advise the person to inform the psychiatrist of this symptom development. Reassure the person that short-term memory loss is a typical response to ECT.

C156. An occupational therapist works with a child who has developmental delay and unintelligible speech to develop the child's functional communication skills using a communication board. The child has attained 100% accuracy in pointing to "yes" and "no" on the communication board in response to questions. The occupational therapist determines that the child should be provided with the opportunity to expand communication skills. Which action should the therapist take to help attain this goal? Add two more choices such as "play" and "snack" to the communication board. Reverse the positions of "yes" and "no" on the communication board to assure competence. Add the options of "play," "thirsty," "hungry" and "TV" to the communication board.

C165. A resident of a skilled nursing facility (SNF) is severely dehydrated after a viral illness. The resident is agitated and confused. The doctor has prescribed intravenous (IV) fluid infusions, but the nursing staff is concerned that the individual will pull out the infusion line. They request that the occupational therapist provide a restraint for this resident. Which is the best action for the therapist to take in response to this request? Provide soft, fleeced mittens for the person's hands. Report the request to the administrator as a violation of restraint-free standards. Decline the referral and explain that restraints are no longer allowed to be used in SNFs. Provide a lap board as this is the least restrictive restraint.

C167. A teenager with Duchenne muscular dystrophy can no longer snap blue jeans or zip zippers. Which recommendation is best for the occupational therapist to make to this client? Replace snaps and zippers with Velcro. Replace snaps and zippers with large buttons. Use a zipper pull to zip jeans and leave the snaps unsnapped. Purchase and wear elastic waist pants.

C168. An occupational therapist evaluates the feeding abilities of a patient who had a cerebrovascular accident two weeks ago. The therapist observes that the patient's dentures seem to slip when attempting to chew food. Which is the best action for the therapist to take in response to this situation? Complete a referral to a dentist. Continue the evaluation using only soft foods. Develop an intervention plan to teach the individual compensation methods. Request that nursing staff reapply denture adhesive prior to all feeding activities.

C18. An occupational therapist accepts a job in an after-school program. The program provides services for adolescents at risk for mental health problems due to their history of being survivors of child abuse. The therapist decides that an activity group to elicit the adolescents' thoughts and feelings in a safe atmosphere would be instrumental to their recovery. Which group would be most relevant for the therapist to design? A task-oriented group. An instrumental group. A topical group. A thematic group.

C30. An older adult is referred to OT for intervention to develop independence in ADL. During a dressing session, the occupational therapist notices a persistent area of redness over the sacrum that is still evident after the patient has been upright for 30 minutes. The client reports the area is itchy. Based on this observation, which of the following is most accurate for the therapist to document as needing attention in a revised intervention plan? A stage I pressure ulcer. A stage II pressure ulcer. A stage III pressure ulcer. A stage IV pressure ulcer.

C33. A COTA® employed in a work-hardening program in a rehabilitation facility demonstrates limited skills when evaluating clients' body mechanics. The COTA® demonstrates excellent skills in other areas of evaluation and intervention. In the COTA®'s initial performance appraisal, which is best for the supervising occupational therapist to suggest to the COTA®? The development of a plan of action to acquire service competence in the evaluation of body mechanics. Assignment to another area of OT service delivery until service competence in the evaluation of body mechanics is established. The completion of evaluations of clients' body mechanics under routine supervision of an occupational therapist experienced in the evaluation of body mechanics. The completion of a continuing education course in body mechanics to increase knowledge about this area of practice.

C36. An occupational therapist works with a patient who incurred a right cerebrovascular accident (CVA). The patient has homonymous hemianopsia. Which is the most effective intervention strategy for the therapist to use initially with this patient? Teach the patient to turn the head to the affected left side. Provide printed notes on the left side telling the patient to look to the left. Place the patient's plate and eating utensils on the left side of the bed tray.

C41. An occupational therapist has scheduled a discharge planning session with an individual recovering from hip replacement surgery. In preparation for this session, the therapist reviews the nursing reports and learns that the person has mycobacterium tuberculosis (TB) which is currently in the dormant phase. Which type of precautions should the therapist use when entering the patient's room? Standard. Airborne. Droplet. Contact.

C44. A client in the descending phase of Guillain-Barré syndrome has bilateral shoulder strength of 2/5. The client fatigues easily. Which equipment should the occupational therapist recommend to enhance the person's performance of activities of daily living? An overhead suspension sling. Angled/curved-handled utensils and tools. An environmental control unit.

C50. A rehabilitation facility is completing a utilization review. The occupational therapist on the utilization review committee contributes to the process by submitting a detailed report about the reasons for, costs of and outcomes of a specific aspect of OT service delivery. Which information is most relevant for the occupational therapist to include in this utilization review report? The therapeutic use of the OT department's ADL apartment. The splinting and adaptive equipment prescribed to clients prior to discharge. The use of personal care aides to provide morning self-care assistance to clients. The craft and art materials used during leisure exploration groups.

C58. An occupational therapist working in a spinal cord injury unit evaluates a client for bowel and bladder training. The client and therapist set a goal of independence in all aspects of bowel and bladder care, including skin inspection. Which of the following is the highest or most severe level of complete spinal cord injury the client can have to be able to achieve this goal? C7-8. C5-6. C4-5.

C60. A six-year-old begins prosthetic training with a right below-elbow myoelectric prosthesis. To learn to operate the terminal device, the occupational therapist implements intervention using age-appropriate play activities. Which activity is best for the therapist to first include during intervention? Assembling building blocks. Squeezing a squeeze toy. Playing board games. Stacking 1-inch blocks.

C62. An occupational therapist designs a research project to study the efficacy of training nursing assistants in feeding techniques for individuals residing in a skilled nursing facility who have neurocognitive disorders. Before implementing the study, from whom must the occupational therapist first obtain consent? The facility's institutional review board. The residents who will be the study's sample. The designated representatives of residents who will be the study's sample. The nursing assistants who will participate in the training.

C66. An occupational therapist reviews the positioning protocol for a premature infant with severe spastic cerebral palsy with the infant's parents. The protocol is in a written format. During the review, the therapist notices that the parents do not seem able to follow along with the protocol's text. Which action is best for the therapist to take initially in response to this observation? Ask the parents if they have any concerns about positioning their infant. Ask the parents if they can read and understand English. Include pictures of proper positioning in the protocol. Demonstrate proper positioning techniques.

C68. An individual is referred to a work-hardening program for evaluation. The referral states that the person had attended another work program for six months but had been discharged due to lack of compliance with treatment recommendations. The physician wants the occupational therapist to determine if the person is applying maximal effort or if the person is magnifying symptoms. When measuring the grip strength of each hand to compare to established norms, which evaluation protocol will be most effective for the therapist to use? One trial on the dynamometer on all five positions. Three trials on the dynamometer at the second position. Five trials on the dynamometer at the first position.

C7. A restaurant employee incurred a fracture to the left humerus. After cast removal, the patient received OT and now demonstrates fair strength (3/5) of the left triceps and full range of motion (ROM) of the left elbow. Which activity is most effective for the occupational therapist to use during intervention to increase elbow function that is needed to perform work-related tasks? Storing glasses on shelves at chest height. Wiping off a table while standing. Carrying a tray of dishes from the table to the sink. Wiping off a counter at chest height.

C162. An older adult with rheumatoid arthritis (RA) is provided with a functional hand splint to help prevent deformity. The occupational therapist also advises the individual about actions that can be taken to help prevent deformity. Which of the following is most important for the therapist to advise the individual to do? Avoid fatigue. Maintain active range of motion (ROM). Increase muscle strength. Do passive ROM exercises.

C79. An adolescent incurred a C4 spinal cord injury. During the initial session, the patient refuses to speak to the occupational therapist. The therapist supportively acknowledges the client's response. Which action should the therapist take next? Set up a chin-operated, bedside environmental control unit (ECU) to enable access to the environment. Provide passive range of motion to prevent contractures. Explain what OT can offer the adolescent to adjust to decreased abilities. Ask the adolescent to tell nursing staff when personally ready for OT.

C80. Several patients in a cardiovascular unit are referred to OT for rehabilitation in areas of occupation. Which diagnosis would be an inclusive criterion for participation in the home management activity group conducted in the department's simulated apartment? Hypotension. Unstable angina. Venous thrombosis. Uncontrolled atrial arrhythmia.

C88. An individual with a complete C5 spinal cord injury (SCI) prepares for discharge. The client plans to return to work as an editor of children's books. Which adaptive equipment is best for the occupational therapist to recommend the client use to access desktop publishing programs? A wrist splint in the functional position with a slot to hold a typing stick. A balanced forearm orthosis with a slot to hold a typing stick. A wrist-driven flexor hinge splint with a slot to hold a typing stick. A universal cuff to hold a typing stick.

C91. An occupational therapist evaluates an individual with a partial tear of the supraspinatus muscle. The therapist documents the results of muscle testing. Which is most accurate for the therapist to state when reporting these results? Strength is fair and the person reports pain. Strength is fair and the person reports no pain. Strength is good and the person reports pain. Strength is good and the person reports no pain.

C93. An occupational therapist provides home-based services to a child with developmental delays. The child picks up and puts away toys when reminded by the parents and mimics the parents when they dry dishes and fold clothes. The family has identified a goal of including the child in home management activities. Which activity should the therapist introduce next during intervention? Wiping tabletops. Sorting laundry. Making a bed.

Questions C146 to C149 are based on the following information. An individual who is scheduled for a right hip total arthroplasty (THA) is referred to OT. A posterolateral surgical approach will be used. The client has expressive aphasia resulting from a cerebral vascular accident incurred four years ago. Medicare is the client's only health care benefit. The client states that private payment for any health care services or equipment is not possible at this time. C149. How can the occupational therapist most reliably determine that hip precautions will be effectively implemented postdischarge? Have the patient demonstrate the techniques that have been taught. Ask the family to observe the patient once home. Ask the patient to point to pictures of the hip precautions being used during activities. Have the patient demonstrate positions that should be avoided.

C1. An occupational therapist conducts a home evaluation for an individual who uses a wheelchair for functional mobility. The only entrance to the home has five steps, a total of 35 inches in height. Which ramp length should the therapist recommend the family have constructed to enable accessibility to the home? a 17.5 feet long. b 35 feet long. c 48 feet long.

C10. An individual is 5'11" and is of average weight for this height. Following a recent traumatic brain injury (TBI), the person has flaccid hemiparesis and demonstrates poor righting and equilibrium responses in standing. Which wheelchair is best for the occupational therapist to recommend for this client? A power wheelchair. A light weight, standard size wheelchair. A reclining, hemi-height wheelchair. A one-arm drive, standard size wheelchair.

C103. An occupational therapist documents an individual's performance during a stress management group. According to established documentation standards, which statement is best for the therapist to include in the daily progress note? The client completed the checklist of stressors in the alloted time. The client was able to identify three current life stressors. The client appeared upset and tense throughout the session. The client stated walking is a relaxing and enjoyable activity.

C104. A school system hires an occupational therapist to implement an after-school sensorimotor integration (SI) program. The occupational therapist plans a staff in-service to explain the indications, contraindications and precautions for the use of a sensory integrative approach. Which precaution is most important for the therapist to review? Self-abusive behavior. Seizures. Somatodyspraxia. Hyperresponsiveness to sensory stimuli.

C105. An individual diagnosed with schizophrenia is referred to a partial hospitalization program. During the initial evaluation interview, the occupational therapist observes that the client answers each question by consistently returning to the focus of the first question. Each time the therapist introduces a new topic to discuss in the interview, the client ignores this topic and returns to the original topical focus. When documenting the client's behavior, which of the following is most accurate for the therapist to report the client is demonstrating? Thought blocking. Perseveration. Obsessive thinking. Poverty of speech.

C118. An occupational therapist designs a quantitative research study to examine the treatment efficacy of a pain-management program. Which method of data collection is best for the therapist to use? A survey with open-ended questions. A survey with Likert-style questions. A discussion with focus groups. Individualized interviews with program participants.

C12. An occupational therapist works with an individual recovering from traumatic brain injury who demonstrates behaviors consistent with Level VII of the Rancho Los Amigos Levels of Cognitive Functioning Scale. The client is a resident in a transitional living program. Which is the most important focus for the therapist to include in the client's intervention plan? The provision of a high degree of environmental structure to decrease confusion and ensure safety. The development of strategies to accurately and safely complete IADL with minimal assistance. The development of adaptive techniques to accurately and safely complete BADL with moderate assistance. The provision of maximum assistance to accurately and safely complete IADL.

C120. A parent admitted to a psychosocial day treatment program has a diagnosis of major depressive disorder. Results of the OT screening process indicate that the person is having difficulty performing home management tasks and caring for two young children. The occupational therapist has determined the need to gather further data regarding past and current performance. The therapist decides that the recently hired, entry-level COTA® will contribute to the evaluation process. Which evaluation is best for the therapist to assign to the COTA® to complete? A cognitive evaluation. An ADL evaluation. A mental status examination. An occupational history interview.

C123. A home care hospice occupational therapist works with a client with end-stage non-Hodgkin's lymphoma. The client is very knowledgeable about this illness and has been active in all aspects of its treatment. The client has requested activity ideas to fill the hours while family members are at work and at school. Which activity is best for the occupational therapist to suggest to this client? Complete a series of progressive resistive exercises to maintain upper extremity strength and endurance. Make personalized memory scrapbooks for each family member. Research alternative and complementary medicine approaches on the Internet. Prepare an entree and dessert for the family's evening meal.

C125. An older adult resident of a skilled nursing facility becomes tearful during an OT session. The resident has a diagnosis of advanced osteoarthritis and relates that pain is causing discomfort during sexual activities. The resident expresses fear about "losing" a valued intimate relationship and asks the occupational therapist for advice. Which is the most beneficial action for the therapist to take in response to the resident's expressed concerns? Refer the resident to social work for individual counseling. Explore the resident's goals for sexual expression. Refer the resident and the resident's significant other to social work for couples counseling. Advise nursing of the resident's statements to ensure that sexual behavior is monitored.

C132. An elementary school student with hypotonic cerebral palsy receives school-based OT to improve fine motor skills. The child holds a thick marker with a static tripod grasp and holds a No. 2 pencil with a gross grasp. The occupational therapist revises the intervention plan based on the child's attained skills. Which grasp would be best for the therapist to address next in the revised OT intervention plan? Dynamic tripod with the thick marker. Static tripod with a pencil. Lateral pinch with a thick marker. Dynamic tripod with a pencil.

C135. An occupational therapist works with an individual recovering from a traumatic brain injury in a rehabilitation hospital. The therapist uses a transfer of training approach to help the patient develop and carry out a daily schedule of activities upon the patient's return home. What is the most effective activity for the therapist to use during an intervention session with this client? Preparation of a simple meal. Organization of a list of daily activities. Composition of a shopping list. Completion of an interest checklist.

C141. An individual is newly admitted to an acute inpatient psychiatric hospital. The occupational therapist observes that the patient is able to follow the unit routines and construct a simple craft project by following written directions with diagrams. However, the patient is not able to complete the project if the directions are missing. According to Allen's Cognitive Disability frame of reference, which level is most accurate for the therapist to document as descriptive of the individual's functional level? Level two. Level four. Level three. Level five.

C142. An occupational therapist is workig with a resident in a long-term care facility to develop swallowing and eating skills. The resident has a history of dysphagia and is taking long periods of time to chew chopped food. The food consistency was prescribed by the speech-language pathologist (SLP). Which action is best for the occupational therapist to take to address the resident's swallowing and eating difficulties? Modify the prescribed food consistency to pureed to prevent aspiration. Collaborate with the SLP to determine the best food consistency for the resident. Train nursing staff to feed the resident slowly and in small amounts. Call the physician to request a fiberoptic endoscopic evaluation of swallowing.

C150. A patient who incurred a right cerebrovascular accident (CVA) asks for a bottle of water to drink. The occupational therapist gives the patient a bottle of water but the patient is unable to open it. The therapist provides instruction on opening the bottle but the patient remains unable to complete the task. After the intervention session, the therapist observes the patient independently open the bottle and drink from it. Which deficit is most relevant for the occupational therapist to further evaluate? Anosognosia. Ideomotor apraxia. Unilateral neglect. Asomatognosia.

C157. An occupational therapist is working in a skilled nursing facility. The therapist is documenting current patient progress for the past 14 days and realizes that a required seven-day progress report to the client's insurance carrier had not been documented. Which should the therapist do in response to this omission? Document the patient's status as of 14 days and backdate the note 1 week. Write a note describing the patient's progress after seven days of treatment and sign with the current date. Call the insurance company to explain the documentation was lost due to a computer failure. Describe the patient's progress after seven days of treatment and backdate the note one week.

C16. An ambulatory older adult with hemiparesis and presbycusis is moving in with their family. The family hires an occupational therapist to provide information to help them maintain the older's functional ability in the home. Which should the occupational therapist recommend? Remove knobs from the stove when the elder is home alone. Speak directly, clearly and slowly to the elder. Add bright color strips to the edge of each stair tread. Provide lists of the sequence of routine tasks.

C163. A carpenter complains of tingling of the left thumb, index and middle finger; weakened grasp; and night pain secondary to carpal tunnel syndrome (CTS). The left thenar eminence appears smaller and more flattened compared to the right thenar eminence. The occupational therapist collaborates with the client to develop an intervention plan. Which recommendation is best to include in this plan? Wrapping wrists with elastic bandages to provide support. Modification of techniques used to hold a hammer. Application of hot packs upon waking to decrease pain. Performance of wrist flexion and extension exercises with progressively increasing repetitions.

C164. A client with chronic schizophrenia attends a transitional employment program. The individual has a secondary diagnosis of Class I heart disease. The occupational therapist meets with the client and the client's work supervisor to discuss the work activities the client can safely complete. Which of the following most accurately describes the client's capacity for work? Work with minimum limitations. Work with no limitations. Work with reasonable accommodation of frequent rest breaks. Work with reasonable accommodation of no heavy lifting.

C166. An occupational therapist works with a person who incurred full thickness burns to both arms. Which intervention approach would be most effective for the therapist to provide to control hypertrophic scar formation? Axillary splints applied in the airplane position. Compression garments. Wound grafting. Elevation of the areas just above heart level.

C17. An occupational therapist provides caregiver education to the spouse of a client with Alzheimer's disease and a secondary diagnosis of left cerebrovascular accident. The client is dependent on a wheelchair for mobility and has been deemed cognitively incompetent. The spouse reports that the client becomes restless at meal times, consistently undoes the lap belt, and tries to get up from the wheelchair. The spouse reports that the need to constantly say "sit down" is personally exhausting and often increases the client's agitation. Frequently, neither one eats dinner. Which is the most effective recommendation for the therapist to make to the spouse? Allow the spouse to get up when restless and provide dinner to the client at a later time. Use a wheelchair lap tray to serve several smaller meals to the client at intervals throughout the day. Hire a home care attendant to assist the client at meal times and provide some respite to the spouse. Use a wheelchair lap tray to serve the client large meals at breakfast, lunch and dinner.

C22. An entry-level occupational therapist implements a therapeutic feeding program in a skilled nursing facility. During a therapeutic feeding session, an older adult with a major neurocognitive disorder becomes upset and cries for their mother. Which should the therapist say in response to the resident's statements? "Remember that you are now in a nursing home and your mother is not here." "You must miss your mother, tell me about her." "Remember your mother passed away years ago." "I will tell the nurse that you want your mother contacted."

C29. An occupational therapist wants to develop an after-school program for obese adolescents who have diabetes or who are at risk for developing diabetes. Which program development action should the therapist take first? Obtain statistical data about adolescent obesity to support the need for the program to the school administrators. Survey the adolescents about their occupational performance to determine program focus. Survey OT practitioners about services they provide to obese adolescents to determine program focus. Review the professional literature to obtain ideas for activities to include in the program.

C32. A patient is recovering from a right total hip replacement (posterolateral incision, cementless fixation). Which is the best type of bed-to-wheelchair transfer for the occupational therapist to teach the patient to use? Stand-pivot transfer to the surgical side. Stand-pivot transfer to the non-surgical side. Lateral slide transfer using a transfer board.

C35. A high school senior with Friedreich's ataxia is working on developing keyboarding skills in a school-to-work transition program. While assessing the student's capabilities for computer keyboarding, the occupational therapist observes signs of dysmetria. Which adaptation is best for the occupational therapist to recommend to increase the effectiveness of the student's keyboarding skills? An eye-gaze input system. A key guard overlay. A voice-activated input system. A reduced size keyboard.

C43. An occupational therapist works on feeding with a toddler who has a hyperactive gag reflex. To decrease the gag reflex, which approach is best for the therapist to use? Have the child suck through straws of progressively longer lengths. Walk a tongue depressor from the front of the tongue to its back. Quickly ice the child's throat laterally. Have the child blow bubbles.

C47. An occupational therapist completes an ergonomic evaluation of a computer programmer and the programmer's workstation. Which is the best recommendation for the therapist to make to ensure the programmer uses ideal wrist and elbow positioning? Elevate the keyboard to increase wrist flexion. Use a keyboard rest to maintain a neutral wrist position. Lower the keyboard to increase wrist extension. Add armrests to keep the elbows away from the body.

C5. An adult diagnosed with multiple sclerosis (MS) over ten years ago experiences an exacerbation of symptoms. The individual's principle complaint is decreased strength and endurance. The person can ambulate short distances with a cane in the home and uses a wheelchair outside of the home. The client asks for suggestions to enable independent performance of instrumental activities of daily living. Which is the best positioning recommendation for the occupational therapist to suggest the person use during meal preparation? Sitting in the wheelchair with a tray table. Sitting at the kitchen table. Leaning against the counter while standing. Leaning against a tall stool while standing.

C52. An adolescent with Duchenne muscular dystrophy refuses to use mobile arm supports (MASs) because "they look so big and stupid." Which action should the occupational therapist take first in response to the client's statement? Collaborate with a rehabilitation engineer to design a more compact device. Explore other options with the client to perform activities that do not use the MASs. Provide several logical reasons for using the MASs to enhance functional performance. Discharge the client and follow up with after one month to reassess interest in the MASs.

C170. A local pharmacy hires an occupational therapist to consult on the redesign of the pharmacy's customer service area. Which height should the therapist recommend for an accessible service counter? 32 inches. 34 inches. 36 inches. 38 inches.

C57. An assisted-living facility has received a grant to purchase capital items that can be used to increase the independence of its residents. Which is best for the OT consultant to recommend for the use of these grant funds? The purchase of adaptive equipment that residents can borrow when needed. The purchase of a computer-based driver rehabilitation program. The hiring of more personal care attendants. The construction of an ADL training apartment.

C59. A person is recovering from a major cardiac infarct. During the initial OT session, the patient loudly and vigorously expresses plans to immediately resume a daily rigorous exercise routine. The occupational therapist reports the individual's plan to the cardiac rehabilitation team and explains that the individual appears to be in which of the following disability adjustment stages? Shock. Denial. Acting out.

C61. An occupational therapist meets with a patient with fibromyalgia who has had difficulty meeting intervention goals. The patient complains of being frustrated in attempts to resolve pain and fatigue issues. Which is the most effective technique for the therapist to use to help the patient increase insight into this situation? Offer a variety of options for pain management. Reflect the patient's verbal expressions back to the patient. Refer the patient to a specialized pain management center. Repeat the patient's exact words back to the patient.

C74. An occupational therapist works in an adult home with a resident who has just been discharged from the hospital. The resident wants to resume participation in the gardening group, physical exercise group, and current events group. The resident takes antipsychotic medications to manage symptoms. Which potential medication side effect should the resident be aware of, and take precautions for, prior to participating in group? Akathisia. Photosensitivity. Akinesia. Tardive dyskinesia.

C76. An occupational therapist observes that a child can open a combination lock, open a lock with a key and turn a pencil over to erase. In documenting the child's in-hand manipulation, which is most accurate for the occupational therapist to report the child can effectively perform? Finger-to-palm translation. Rotation. Palm-to-finger translation. Shift.

C81. An older adult expresses concerns about the ability to perform daily tasks. The occupational therapist assesses that the individual has somatosensory deficits consistent with the normal aging process. The therapist recommends adaptive equipment to assist with task performance. Which adaptive equipment should the therapist recommend the person use during meal preparation and feeding? Utensils with narrow, smooth grips. Utensils with wide, textured grips. A rocker knife and spork

C82. An occupational therapist implements intervention with five patients using a group format. The therapist charges each patient's insurance provider for individual treatments. Which of the following does this action represent? An example of impairment. A violation of procedural justice. An established, accepted practice. A correct action, if group interventions are individualized.

C84. An occupational therapist implements intervention for individuals on an inpatient cardiopulmonary rehabilitation unit. The therapist assesses a patient's heart rate during intervention sessions by palpating a peripheral pulse. Which of the following most accurately describes the timing the therapist should use to complete this assessment? 30 seconds prior to, during and at cessation of the activity. 1-2 minutes prior to, during and at cessation of the activity and 5 minutes' postactivity. 1-2 minutes prior to, during and at cessation of the activity. 30 seconds prior to, during and at cessation of the activity and 5 minutes' postactivity.

C92. An occupational therapist accepts a position at an adult day care and respite program for older adults with a variety of cognitive disabilities. The therapist only has clinical experience in school-based practice. Which is the most effective way for the therapist to prepare for the professional responsibilities this new position will entail? Attend caregiver support group meetings. Review current literature on evidence-based older adult care. Review area demographic information on older adults with disabilities. Confer with the program's administrative director.

C94. A client is being discharged after recovery from hip replacement surgery to live at home alone. Which is the most important equipment for the therapist to review with the client prior to discharge? A rolling walker. A long-handled reacher. A bedside commode.

C96. An individual recovering from a head trauma exhibits a motor pattern indicative of being influenced by the symmetrical tonic neck reflex (STNR). Which is most likely for the occupational therapist to observe the client having difficulty with during functional mobility? Moving both arms to midline when supine. Moving from lying supine to sitting. Flexing the head from the supine position. Extending the head from the prone position.

C98. An experienced occupational therapist assumes a new position as the director of a department of ten therapists, four COTA®s, three aides, and a secretary. The department is not functioning effectively. The therapists, COTA®s, and staff members voice numerous complaints about caseloads and poor support from the hospital administration. Which action is most important for the new director to take first in response to this situation? Request that the director of human resources complete performance appraisals on all department employees. Determine the basis of the complaints to design targeted conflict-resolution strategies. Request that the director of human resources complete performance appraisals on the hospital administrators. Offer positive feedback to all staff on performance and attitude as merited.

C153. A client with Charcot-Marie-Tooth disease participates in a reevaluation session at a wheelchair clinic. The client reports difficulty keeping both feet on the wheelchair's footrests. Which is the most effective action for the occupational therapist to take to address the client's stated concerns? Implement an exercise routine to strengthen lower extremities. Elevate the footrests. Provide heel loops on the footrests. Provide ankle straps on the footrests.

Questions C146 to C149 are based on the following information. An individual who is scheduled for a right hip total arthroplasty (THA) is referred to OT. A posterolateral surgical approach will be used. The client has expressive aphasia resulting from a cerebral vascular accident incurred four years ago. Medicare is the client's only health care benefit. The client states that private payment for any health care services or equipment is not possible at this time. C147. Following surgery, which is the most appropriate bed-positioning intervention for the occupational therapist to recommend? Sidelying with the lower extremities adducted. Use of an abductor pillow between the lower extremities. Use of a hospital bed to elevate the lower extremities to 90°. Change of position from supine to prone every two hours.

C109. A child with short attention span and processing difficulties is referred to OT. Based on the results of a screening, the therapist decides to focus the evaluation on sensory processing performance skills. Which should the therapist evaluate? Form-constancy. Right-left discrimination. Proprioception. Spatial relations.

C122. An individual with complex regional pain syndrome (CRPS), Type I, presents with severe pain and pitting edema in the right hand. The individual has a secondary diagnosis of degenerative joint disease (DJD). Which should the occupational therapist initially recommend to the person to address these concerns? Passive range of motion of wrist and fingers. Retrograde massage from distal to proximal. Elevation of the affected hand above the heart. Retrograde massage from proximal to distal.

C124. An occupational therapist provides consultation services to a nursing home and is developing a restraint reduction program. The therapist is also a faculty member in an OT professional education program. The therapist uses this consultation experience to explain to the students the role of OT. Which of the following is most accurate for the therapist to state this consultation experience represents? Direct service. Primary prevention. Secondary prevention. Needs assessment.

C130. An occupational therapist steps in, at the last minute, to assist another therapist with a problem-solving skills group. Which is the most helpful action for the occupational therapist to take? Split the group in two and have each therapist work with their own group. Participate as a member of the group and supply the desired responses. Support the leader with comments and questions that keep the group on focus. Act as an observer and take notes for documentation.

C139. An individual with cyclothymic disorder has successfully completed a transitional employment program (TEP) and is competitively employed in a busy real estate office as an administrative assistant. The person reports feeling overwhelmed by the number of part-time real estate agents who drop off work late in the afternoon to be completed within one to two days. The individual contacts the TEP occupational therapist for suggestions on dealing with this work stress. Which action is most effective for the therapist to recommend the person take in response to this situation? Make an appointment for a vocational skills reevaluation to determine an intervention plan to develop needed skills. Make an appointment with the psychiatrist for a medication evaluation to manage anxiety. Meet with the work site's direct supervisor at the end of each day to prioritize the next day's workload. Organize the next day's workload at the end of each day according to the deadlines set by each agent.

C151. A preschool-aged child is hypersensitive to touch. The therapist decides to use the SI frame of reference to help the child develop the ability to adequately modulate sensory stimuli. Which technique is best for the therapist to use initially with this child? Fast brushing to the child's arms in a direction opposite of hair growth. Lightly moving touch to the child's abdomen and the extremities. Firm pressure where the child can see the source of the stimuli. Quick icing where the child cannot see the source of the stimuli.

C158. An occupational therapist working in a school system conducts a series of educational workshops for parents of children with attention deficit disorders and sensory processing disorders. The series focuses on principles of sensory integration (SI). Which of the following is most benefi cial for the therapist to recommend the parents provide in the home environment? A wide range of sensory stimuli including auditory, visual and tactile to increase awareness and responsivity. Minimal auditory, visual and tactile sensory stimuli to decrease distractibility and responsivity. A balance between structure and freedom so the child can direct their own actions. Clear directions and structured limits to organize behavior and promote adaptive responses.

C159. An individual with left hemiplegia who is right-hand dominant receives training to resume independent driving. Which adaptation is best for the occupational therapist to recommend the client use? 'Palming' the steering wheel. Hand controls for brake and gas pedals. A spinner knob on the steering wheel. Left-sided accelerator pedal.

C160. A child with moderate arthrogryposis complains of profuse sweating when wearing bilateral night resting splints. When discussing this issue with the child's parents, which of the following should the occupational therapist recommend the child wear? Only one splint each night, rotating from left to right. Bilateral volar cock-up splints. A cotton stockinet liner under the splints. A splint with several one-centimeter perforations in the splinting material.

C161. A hospital-based occupational therapist is committed to promoting the profession to hospital staff, patients, family members, and the general public. Which is the most effective action for the therapist to take to accomplish this goal? Write an article about recent accomplishments of new OT staff members in the hospital's employeenewsletter. Include photos of patients participating in the new driver rehabilitation clinic in the hospital's annual report. Display information sheets about major areas of OT practice on the hospital's cafeteria bulletin board. Write a monthly column in a local newspaper about OT approaches for a diversity of clinical conditions.

C169. An occupational therapist conducts the preadmission screening for a supported housing program with several levels of care. The therapist receives a referral for an individual with schizophrenia who has residual symptoms of circumstantiality, flat affect, and decreased attention. Which screening tool is best for the therapist to use with this client? A semistructured interview. A basic ADL checklist. A structured cooking task. A weekly activity schedule.

C19. A carpenter incurred a short below-elbow amputation. The client plans to return to work. Which components would be most important for the occupational therapist to recommend for the client's prosthesis? A fixed-elbow socket and a lightweight Teflon-coated terminal device. A cable-driven elbow socket and a heavy-duty serrated grid terminal device. A fixed-elbow socket and a heavy-duty serrated grip terminal device. A cable-driven elbow socket and lightweight Teflon-coated terminal device.

C3. A person diagnosed with a mild neurocognitive disorder is evaluated by an occupational therapist. The person demonstrates diminished memory skills, and the therapist determines that the individual is able to live at home with supportive structure. The therapist collaborates with the person to identify activities to include in a structured routine that enables their continued occupational performance. Which activity is best for the occupational therapist to recommend to this individual? a Cooking dinner. b Doing laundry. c Walking with a neighbor. d Watching television.

C31. An occupational therapist conducts a caregiver education workshop on positioning techniques for family caregivers. At the conclusion of the class, the caregivers will be expected to utilize the skills taught. Which is the most effective method for the therapist to use when teaching these techniques? Therapist demonstration of general techniques followed by individualized discussion with each caregiver. An oral multimedia presentation including PowerPoint slides and handouts of positioning techniques for diverse disorders. Therapist demonstration of techniques followed by a lab with caregivers practicing positioning on each other. A question and answer session to address the specific individual positioning concerns of the caregivers.

C34. An occupational therapist leads an outpatient wellness program. An individual with obsessive-compulsive disorder asks for suggestions to manage symptoms that are interfering with life satisfaction. Which is the best recommendation for the therapist to make to the individual? Approach activities in a nonchalant manner without high expectations. Engage in concrete activities that can be broken down into simple steps. Redirect thoughts and energies into meaningful activities. Set limits on the number of activities done in a day.

C37. An individual recently had a left transfemoral amputation as a result of the complications of diabetes. The client is 2 years' status-post a right transtibial amputation as a result of the same precipitant. The client has a right prosthesis. The client is referred to OT for preprosthetic interventions for the left residual limb. The referral notes that the complications of neuromas and phantom limb pain are present in this limb. Which intervention is best for the occupational therapist to implement during the first session? Upper extremity strengthening with emphasis on the biceps. Percussion to the left lower extremity's residual limb. Upper extremity strengthening with emphasis on the triceps. Lower extremity dressing with emphasis on donning and doffing prostheses.

C39. An adult with a right cerebrovascular accident (CVA) begins OT to improve grooming and dressing skills. The client refuses to work with a female therapist and insists on working with a male therapist. The OT supervisor reviews the department's case load and finds that the department's sole male therapist has limited experience working with individuals with CVA. Which action is best for the supervisor to take next in response to this situation? Encourage the individual to work with the female therapist currently assigned and assure the client of the therapist's skill and competence. Contract with a per diem male therapist to work with the client and provide the needed interventions. Assign the male therapist to work with the individual and provide supervision for the therapist. Modify the intervention plan to include activities that are more comfortable for the client when working with a female therapist.

C42. An individual hospitalized for the first time due to a brief psychotic episode attends an OT group. During task performance, the occupational therapist notices that the person is restless with hand tremors and shaking legs. Which of the following should the therapist document that the person seems to be exhibiting? Akinesia. Pseudo-parkinsonism. Akathisia. Tardive dyskinesia.

C45. An occupational therapist working in an outpatient pediatric clinic has been working with a child to address sensory processing deficits. After 12 treatment sessions, a denial letter for services has been received. The letter states that the diagnosis and the treatment do not meet the policy's coverage requirements. The parents ask the therapist to change the child's diagnosis code in order to receive reimbursement for the billed services. Which is the therapist's best responce? Discharge the child from OT and provide a home sensory program for follow-up by the parents. Encourage the parents to seek an alternate insurance carrier to receive improved coverage for services. Explain to the parents that the current diagnosis cannot be changed in order to receive reimbursement. Encourage the parents to set up a payment plan with the clinic's accounting department.

C46. An intervention plan for a person with a complete lesion of the spinal cord at the C6 level has been developed by the client and occupational therapist. Which activity should be included in this plan as a goal for the client to develop the ability to independently perform? Typing with a mouth stick. Transferring using depression transfers. Donning pants while in bed. Feeding using a suspension sling or mobile arm support.

C48. A therapist in a rehabilitation hospital receives a physician's order to evaluate a patient who has metastatic bone cancer with pathologic fracture of the ribs. The physician requests information about the patient's ability to tolerate resistive activities of the upper extremities. Which action is best for the occupational therapist to take in response to this request? Complete a manual muscle test with less than full resistance. Provide isometric strengthening exercises for the upper extremities. Evaluate tolerance during functional activities of daily living. Initiate TheraBand stretches and report tolerance to physician.

C56. A person is diagnosed with chronic obstructive pulmonary disease (COPD). The occupational therapist instructs the individual on breathing exercises to use to control respiration rate during activities. The therapist tells the person to inhale as if smelling roses. How should the therapist tell the person to exhale? As if blowing out 20 lit candles on a birthday cake. As if blowing forcibly to relight a dying campfire. As if flickering a lit candle. In quick short, multiple breaths.

C6. An occupational therapist working in an acute care hospital provides OT services in a patient's room. The patient has left hemiplegia and is unable to recognize the faces of family members when they enter the room to visit or the items the family members bring for the patient. The family members become upset by this behavior. Which deficit should the therapist explain to the family members as the most likely reason for the patient's behavior? Ideational apraxia. Anosognosia. Visual agnosia. Asomatognosia.

C63. An occupational therapist leads a community integration group for individuals with mild intellectual disabilities who reside in a group home. During a travel training session, a member of the group slips while going up the stairs of a bus. The client quickly gets up, pays the fare, sits down and jokingly states, "Good thing I bounce well." Which action should the occupational therapist take after assessing that the person is not injured? Cancel the planned activity and return to the group home to file an occurrence report. Ask the bus driver to radio for an ambulance to obtain a medical assessment to validate that the client was not injured. Continue with the planned activity and file an occurrence report upon return to the group home.

C64. An older adult is referred to OT with a diagnosis of osteoarthritis in both knees and elbows. The occupational therapist interviews the patient and learns that the patient desires to return home to live alone independently in a bi-level home. Which should the therapist do next? Provide suggestions for adaptations to the patient's bathroom to increase safety. Train the patient in energy conservation techniques to use during instrumental ADL. Evaluate the patient's performance of daily activities in a simulated setting. Provide the patient with a home exercise program to build strength and ROM.

C65. An occupational therapist uses a motor learning intervention approach to develop grasp patterns with a child recovering from a brain tumor. The therapist places small toys on a table and asks the child to pick up the toys and put them into a storage box that is also on the table. The therapist uses random practice during this activity. Which types and arrangement of toys are best for the therapist to provide according to the motor learning approach? Toys that are exactly the same shape, size and weight in a mixed arrangement on the table. Toys that are exactly the same shape, size and weight placed in a straight line on the table. Toys of different shapes, sizes and weights in a mixed arrangement on the table. Toys of different shapes, sizes and weights placed in a straight line on the table.

C73. During a parallel task group, one of the members appears agitated and fidgety. The member gets up and looks out the window for a few minutes and then sits back down and quietly returns to the task. This behavior continues throughout the group. Which is the occupational therapist's best response when the group member stands again? Tell the group member to remain seated or leave the group. Ask the other members if the group member is bothering them. Say nothing to the group member and proceed with the group. Inform the group member that the observed behaviors indicate a lack of readiness for this group.

C77. An individual with mild cognitive deficits takes medications for multiple medical conditions. The occupational therapist works with the individual to develop the ability to safely self-administer medications. Which equipment and/or strategy should the therapist train the client to use? Easy-open caps on the medication bottles. A chart listing medication dosages and administration times on the refrigerator. A daily pill holder with time-labeled slots for each dosage. Family caregiver supervision of medication administration.

C8. A home care occupational therapist seeks to enhance an older adult's compliance with the OT intervention program. After discussing the goals of the program with the person, which intervention is most effective for the therapist to use? Provide the individual with limited opportunities for practice of skills to decrease boredom. Use multiple, variable instructions to ensure retention of new learning. Integrate previously learned strategies into new activities to facilitate generalization. Teach family members positive techniques to reinforce activity performance in the home.

C85. A person with recently diagnosed multiple sclerosis begins an outpatient program. During the initial intervention session, the client expresses difficulty concentrating on daily tasks due to chronic fatigue. Which should the occupational therapist do in response to the client's stated concerns? Reassure the client that these are typical symptoms of this diagnosis. Reassure the client that medications will ease these symptoms. Inquire about the client's fatigue level during different tasks. Evaluate the client's endurance and cognition.

C90. A four-year-old child with a complete myelomeningocele at the T12 level is referred for outpatient occupational and physical therapy. In setting goals with the family, the occupational therapist suggests increasing independence in dressing skills and the physical therapist recommends improving ambulation. The family wants to work on ambulation but refuse interventions to develop dressing skills. Which action is best for the occupational therapist to take first to address the family's stated preference? Concur with the family that the child does not need to receive OT services. Refer the family to counseling to assist them in accepting the child's functional limitations. Work with the family to determine a different focus for OT intervention. Reinforce the importance of independence in dressing for the child to the family.

Questions C113 to C116 are based on the following information. An occupational therapist working in a private clinic receives a referral for a client who incurred a nerve laceration while working as a cable installer and repair person. Upon evaluation, the therapist determines that the client exhibits maximum motor and sensory losses consistent with a radial nerve laceration below the supinator. C116. The client successfully completes the work-hardening program. However, the client has residual moderate impairment in temperature perception. During the discharge planning session, the therapist discusses how this impairment may impact areas of occupation and suggests activity modifications to facilitate the client's occupational performance. What is the most appropriate recommendation for the therapist to make to the client? Request reassignment to work activities that do not involve exposure to extreme temperatures. Mark all potentially hot objects at home and at work with bright stickers. Wear work gloves for activities involving extremes or variations in temperature. Wear a protective splint during the work day and at home during home maintenance tasks.

Questions C146 to C149 are based on the following information. An individual who is scheduled for a right hip total arthroplasty (THA) is referred to OT. A posterolateral surgical approach will be used. The client has expressive aphasia resulting from a cerebral vascular accident incurred four years ago. Medicare is the client's only health care benefit. The client states that private payment for any health care services or equipment is not possible at this time. C148. The client is being discharged home. Which equipment should the occupational therapist recommend to ensure safety and independence in toileting? A raised toilet seat. Grab bars. A three-in-one commode. Non-skid mats.

Questions C24 to C28 are based on the following information. A young adult recently diagnosed with depression and anorexia nervosa is a consumer of services at a psychosocial clubhouse. The client attends individual OT sessions once a week and several evening and weekend groups. When completing an activities schedule and questionnaire, the client identifies the clubhouse groups and part-time work as an editorial assistant as the only activities completed each week. In high school the client was captain of the swim team, played tennis and worked in an after-school activities program for young children. C25. During an individual session with the occupational therapist, the client states, "I don't know what I want to work on. I don't really know what my goals are." Which is the most appropriate action for the occupational therapist to take? Defer the development of an intervention plan until the individual has determined personal goals. Establish a short-term goal related to improving the individual's goal-setting skills. Initiate a discussion with the individual about what is personally important. Contact the individual's psychiatrist to request a medication evaluation.

Questions C24 to C28 are based on the following information. A young adult recently diagnosed with depression and anorexia nervosa is a consumer of services at a psychosocial clubhouse. The client attends individual OT sessions once a week and several evening and weekend groups. When completing an activities schedule and questionnaire, the client identifies the clubhouse groups and part-time work as an editorial assistant as the only activities completed each week. In high school the client was captain of the swim team, played tennis and worked in an after-school activities program for young children. C27. During the clubhouse vocational support group, the client reports difficulty keeping track of the job tasks that need to be completed each day. Which recommendation is best for the occupational therapist to make to the client? Write down directions for each task that needs to be completed. Record all completed work tasks in a daily log. Develop and use a checklist of tasks to be completed each day. Ask the work supervisor to provide verbal cues through the workday.

87. An older adult who incurred a hip fracture resides with a family caregiver. The person is referred to home-based OT services. During the initial home visit, the occupational therapist observes that the individual demonstrates impaired short-term memory, disorientation to time and situation and difficulty engaging in activities. The family caregiver expresses many concerns about the client's decreased functional capacity and reports feeling stressed. Which recommendation is best for the therapist to make first to the family caregiver? Explore residential placement to ensure the client's safety. Contact the local Alzheimer's Association to attain caregiver support. Contact the local adult day treatment center to explore respite programs. Contact the client's physician to request a complete medical evaluation.

C101. An adult with arthritis of both hands has myofascial pain syndrome (MPS). The patient exhibits ulnar drift during finger extension and flexion and at rest. The patient also has a lengthening of the central slips of the extensor digitorum communis tendons of the right index and middle fingers. Which of the following should the occupational therapist report the person is exhibiting? Swan-neck deformities. Trigger-finger deformities. MP palmar subluxation-dislocations. Boutonniere deformities.

C106. A teenager with congenital bilateral above-elbow amputations is referred to OT to increase independence in ADL. The adolescent wants to be independent in donning and doffing shirts. Which action is best for the therapist to take first? Refer the patient to a prosthetist. Evaluate abdominal strength. Evaluate the use of adapted equipment in dressing. Evaluate trunk and lower extremity range of motion (ROM).

C110. Following an exacerbation of postpolio syndrome, a client is referred to OT for a wheelchair evaluation to enable independent mobility. The client wears bilateral hip-knee-ankle-foot orthoses (HKAFOs) to provide support during independent transfers and brief standing periods throughout the workday. The client's insurance is Medicare. Which is the best seat-width measurement for the occupational therapist to recommend for the client's wheelchair prescription? Two inches wider than the widest point across the individual's hips or thighs. Four inches wider than the widest point across the individual's hips or thighs while wearing orthoses. A standard adult seat width to ensure Medicare reimbursement. Two inches wider than the point across the individual's hips or thighs while wearing orthoses.

C112. A two-month-old infant with bilateral hip dislocation is being discharged home from an acute pediatric facility. The occupational therapist has developed a home program for the parents of this firstborn child. Which is most important for the occupational therapist to determine before instructing the parents in the details of this home program? The child's insurance reimbursement plan. The parents' level of formal education. The family's home environment. The parents' degree of anxiety.

C119. A patient with fibromyalgia is receiving OT to reduce pain and promote flexibility during ADL. The patient expresses the intent to discontinue treatment based on information obtained during an online search which questioned the value of therapy for fibromyalgia. Which of the following actions should the occupational therapist take first in response to the patient's statements? Confront the inaccuracy of these statements and provide current evidence-based research about the benefits of therapy for persons with fibromyalgia. Reassure the patient that the physician has ordered therapy; therefore, it will be beneficial. Respect the patient's wishes and discontinue OT, offering to provide therapy in the future if symptoms exacerbate. Inform the patient that online information can be inaccurate and provide literature about the benefits of therapy for fibromyalgia.

C121. An occupational therapist works in a school setting with adolescents with autism spectrum disorder. The need for a social skills training group is identified. One activity that the therapist plans to use in the group is roleplaying. Which is the most effective way for the therapist to determine relevant scenarios for the role-play activities? Survey the teachers on social difficulties the adolescents display in class. Survey parents on social difficulties they have observed in their adolescent children. Review literature on adolescent social skill development and typical areas of concern.. Ask the group members to reflect on their social interactions and identify concerns.

C126. An adolescent with a complete myelomeningocele at the T9 level is diagnosed with diabetes. The occupational therapist meets with the adolescent and a nurse practitioner to review the impact of this new diagnosis on the teen's health and daily routines. Which is most important for the therapist to emphasize during this discussion? Skin inspection performed by a parent. Upper extremity strengthening. Self-directed pressure relief. Self-initiated pressure relief.

C127. An adult with hereditary ataxia receives home care OT services. Recently, the client has become more withdrawn and the client's spouse has become more verbal about caregiver strain. During an intervention session, the occupational therapist works with the client on attaining the goal of dressing independently. The therapist notices and comments on several large bruises on the middle section of the client's back. The client tearfully states that a bad fall that morning had caused these and that the progression of the ataxia is becoming too difficult to handle. Which action is best for the therapist to take in response to the observed bruises and the client's statements? Provide reassurance and support of the client's legitimate feelings of loss. Conduct an evaluation of the home to remove items that can contribute to falls. Report the incident to the local domestic violence hotline. Supportively question the client about the incident.

C129. An occupational therapist completes the discharge plan for an individual with a right cerebrovascular accident (CVA) who has completed a three-week inpatient rehabilitation program. The person is right-hand dominant. The patient exhibits residual cognitive perceptual deficits but seems unaware of these problems. Which discharge recommendation is best for the therapist to discuss with the patient and the patient's family? An extension of length of stay. A full-time home health aide. Assistance with personal care. Supervision for cooking.

C133. An elementary school student is referred to OT to improve fine motor skills. The student is having difficulty drawing simple shapes (i.e., circle, square, and triangle) and cutting a straight line with scissors. Which of the following activities is best to help develop the arches of the hand and increase hand strength to improve the student's ability to grasp a writing utensil or scissors? Spell vocabulary words using three-dimensional letter shapes. Identify simple shapes with vision occluded. Complete a puzzle lying prone on the floor. Chair push-ups before tabletop activities.

C136. A person experiencing an acute manic episode is completing the admission process to an inpatient psychiatric unit. The intake coordinator has to unexpectedly complete an emergency admission. The admissions coordinator asks the occupational therapist to spend some one-to-one time with this individual until the coordinator can return to complete the intake process. Which is the best way for the occupational therapist to use this time with the client? Discuss the precipitants to the hospitalization with the person. Ask the person to make positive statements about themselves. Have the person do a craft activity requiring attention to detail. Take a walk around the unit to orient the person.

C137. An adult with right hemisphere damage from a CVA is referred to OT. Which deficits will the patient most likely demonstrate upon evaluation? Negative, self-deprecating comments and depression. Difficulty receiving and processing verbal auditory information. Hesitancy and cautiousness during activity performance. Difficulty attending to incoming stimuli and interpreting abstract information.

C140. A middle school-aged child with a sensory processing disorder participates in weekly OT sessions in a pediatric private practice. Initial evaluation had identified the presence of symptoms consistent with a sensory-based motor disorder. The child has shown no improvement in coordination, equilibrium and motor planning for the past two months. The parent reports that the child continues to exhibit difficulties with play, learning, and social participation. Which action is best for the therapist to take in response to these observations and parental report? Provide the parent with a home program and discharge the child from therapy. Refer the child to a pediatric social worker to explore potential resistance to therapy. Increase the frequency of therapy to two sessions per week to increase the child's engagement. Reevaluate the child to determine deficit areas that are contributing to dysfunction.

C152. An occupational therapist provides a wellness and prevention education series to a community senior center. The topic of the week is joint protection. Which joint protection principle should the therapist include in the presentation? Stand diagonally to the side of containers to be opened or closed to maximize torque. Work through the pain experienced during activities by performing stretching exercises. Preserve joint range of motion (ROM) and muscle strength by using the minimal effort required to perform an activity. Start an activity only if it can be immediately stopped when it requires capacities beyond existing capabilities.

C154. An occupational therapist provides consultation services to a day treatment program for individuals with neurocognitive disorders. Which groups are best for the therapist to recommend the program include? Reality orientation groups. Cognitive-behavioral groups. Parallel groups. Instrumental groups.

C23. A client has a 3-year history of multiple sclerosis. One of the client's disabling symptoms is a persistent and severe diplopia, which leaves the client frequently nauseated and unable to complete desired activities. Which adaptive strategy is most effective for the occupational therapist to recommend the client use during basic and instrumental activities of daily living? Wear magnifying glasses. Wear prism glasses. Wear shaded glasses. Wear an eye patch on one eye.

C38. A person blinded in an accident begins an OT program for persons with vision loss. The occupational therapist collaborates with the individual to develop an intervention plan. Which should be included in the plan as an initial focus of intervention? Developing the client's computer skills. Adapting meal preparation techniques. Exploring potential vocational opportunities. Organizing the client's morning routine.

C4. During an intervention session, a client complains of dry mouth due to prescribed medications. What is the most effective strategy for the occupational therapist to suggest to the client to manage this side effect? Suck on ice. Suck on hard candies. Drink iced tea. Sip water.

C40. An occupational therapist provides intervention for a four-year-old with developmental delays characterized by the persistence of primitive postural reflexes. The child demonstrates age-appropriate cognitive skills. Which is the best play activity for the therapist to incorporate into the child's intervention? Spinning on a swing. Putting a puzzle together. Lying on the floor and playing a game of marbles. Pretending to be an explorer crawling through caves.

C49. An older adult with persistent balance difficulty and a history of recent falls (two in the last three months) receives home care OT services. During the initial session, which client factors should the occupational therapist first address? Spinal musculoskeletal changes secondary to degenerative joint disease. Cardiovascular endurance and level of dyspnea during instrumental activities of daily living. Mental functions of attention and orientation during functional mobility. Sensory functions and sensory organization of balance.

C51. An occupational therapist provides services to a psychosocial clubhouse. The therapist leads a closed group on stress management that has been meeting for several months. One of the members shares some concerns about personal safety at home. Which is the therapist's best response to the member's expressed concerns? Tell the individual you will privately talk about the concerns after the group. Immediately send the individual to see the clubhouse's social worker. Assure the individual that the concerns reflect normal anxieties. Invite the individual to share more details about the concerns.

C53. Two weeks after beginning kindergarten, a five-year-old with myelomeningocele develops sudden onset of headaches, vomiting, irritability and 'sunken' appearance of eyes without signs of a fever. Which action is best for the occupational therapist to take in response to the child's presenting symptoms? Bring the child to the school nurse to determine if the observed changes in the child are indicative ofstomach flu. Inform the parents that they should immediately have a physician examine the child for tethered cord. Refer the child to the school psychologist for an assessment of school anxiety. Inform the parents that they should immediately have a physician examine the child for shunt malfunction.

C54. A five-year-old child with autism spectrum disorder receives home care OT intervention services. The parent identifies a primary goal of developing the child's independent toileting skills. The child is completely dependent and the parent reports not attempting toilet training for several years. The therapist collaborates with the parent to establish the first intervention goal for the child. Which behavior should this goal address? The child's ability to verbally tell someone of the need to go to the bathroom. The child's ability to non-verbally indicate the need to go to the bathroom. The child's ability to indicate when the diaper is wet or soiled.

C55. An occupational therapist is providing intervention for an individual recovering from a cerebrovascular accident (CVA) who has residual body neglect. The therapist is using a deficit-specific approach to intervention. Which type of activities is best for the therapist to use with this client? Unilateral using the affected upper extremity. Unilateral using the non-affected upper extremity. Tasks that require right/left discrimination. Bilateral using both upper extremities.

C67. An occupational therapist conducts a group for long-term inmates in a forensic facility. Which of the following would be best for the therapist to focus on during the group? Vocational planning strategies. Remedial educational activities. Money management skills. Leisure management techniques.

C69. A parent receiving OT in a hand clinic asks the occupational therapist to adjust their child's hand splint. The parent reports that the splint leaves red marks after being removed for 20 minutes. The child received the splint from a school therapist. Which is the best action for the therapist to take in response to this request? Modify the splint using a heat gun. Suggest that the parent have the child refrain from wearing the splint. Have the pediatric therapist in the department modify the splint. Call the child's therapist and have the parent express the concern.

C71. A child with mild cerebral palsy (CP) receives OT intervention in a preschool setting. Which intervention approach should the therapist employ to facilitate development of typical grasp patterns? Place soft foam tubing around objects to be grasped. Analyze the present components of the child's grasp. Analyze the missing components of the child's grasp. Grade the sizes and shapes of objects to be grasped.

C75. An occupational therapist working in early intervention meets with the parents of an infant who cries a lot and has difficulty being soothed. The parents are concerned that they are unable to comfort their child. Which is the most effective strategy for the therapist to recommend to the parents? Loosely wrap the infant in a blanket. Provide frequent and rapid changes in movement. Do nothing, as the infant's behavior is typical. Tightly wrap the infant in a blanket.

C78. An occupational therapist has been counseled twice by the director of the OT department for overcharging patients for services rendered. The behavior continues despite repeated verbal and written reprimands from the director. Which action is best for the director to take next? Report the therapist's behavior to the NBCOT®. Formulate a plan of action to modify the therapist's behaviors. Terminate the employee according to facility procedures. Follow facility procedures for reporting employee misconduct.

C83. An occupational therapist implements an activity program at a hospital that provides long-term care to older adults with serious mental illnesses (SMI). The occupational therapist uses a sensorimotor approach to guide the program design. Which activity is best for the therapist to incorporate into a group? Line dancing using pictures of feet on the floor as visual cues for dance steps. Exercising along with a video routine. A sing-along using songbooks and recorded music. Keeping balloons afloat while music plays.

C86. An elementary school student with autism spectrum disorder (ADS) is referred to OT. One of the student's goals is to self-initiate goal-directed play to decrease the frequency of self-stimulating behaviors of hand waving and rocking. The student's verbal communication is impaired but the student compensates by using picture cards to let others know what is wanted or needed. Which of the following approaches to initiate self-play in the home environment is best for the occupational therapist to suggest to the student's parents? Allow the child time to choose a play activity from several options and do not provide guidance to ensure self-directed decision making. Provide limited choices using picture cards and give verbal praise when the child participates in the chosen play activity. Include the child in after-school programs to socialize with other children and provide role-modeling opportunities for typical play behaviors. Provide limited play choices using picture cards, encourage choosing, and give verbal praise when the child chooses an activity.

C89. An adolescent incurred a spinal cord injury at the C6 level. During a family caregiver education session, the occupational therapist instructs family members in the provision of passive range of motion (PROM) to the patient's wrist and fingers. Which method of PROM should the therapist teach the family members to perform? Extend the fingers with the wrist extended. Flex the fingers with the wrist flexed. Flex and extend the fingers with the wrist in a neutral position. Flex the fingers with wrist extension and extend the fingers with wrist flexion.

C9. In measuring the range of motion (ROM) of a client's elbow, the occupational therapist records a flexion measurement of 145°. Which is most accurate for the therapist to document based on this measurement? Hypomobility. Dysfunctional elbow ROM. Hypermobility. Normal elbow ROM.

C95. During an accreditation self-study, the OT department personnel review all charts. An occupational therapist notices that a colleague fills out the review forms without reading the charts. Which action is best for the therapist to take in response to this observation? Talk to the colleague directly. Report the incident to the director of medical records. Report the colleague to the accrediting agency. Report the observation to the OT supervisor.

C97. An occupational therapist provides caregiver education to the family of an individual who is dependent in all self-care. During instruction on proper wheelchair positioning, where should the therapist advise the family to place the wheelchair seatbelt? At waist level. Midway between waist and trunk. At the widest point of the individual's midsection. At hip level.

C99. An individual with a traumatic above-elbow (transhumeral) amputation has received a body-powered prosthesis. To train the person in the operation of the terminal device (TD), which of the following should the occupational therapist do initially during intervention? Teach the person how to control the elbow joint. Combine training of TD use with training for elbow joint movement. Lock the elbow in full extension and teach only TD control. Lock the elbow in 90° of flexion and teach only TD control.

Questions C113 to C116 are based on the following information. An occupational therapist working in a private clinic receives a referral for a client who incurred a nerve laceration while working as a cable installer and repair person. Upon evaluation, the therapist determines that the client exhibits maximum motor and sensory losses consistent with a radial nerve laceration below the supinator. C115. Through active participation in individual OT sessions, the client regains functional motor skills. To facilitate return to work, the occupational therapist refers the client to a local work-hardening program. This program does not have the exact equipment that the client uses in the job setting. Which action is best for the therapist at the work-hardening program to take in response to this situation? Refer the client to another work-hardening program that has the equipment. Order and install the equipment necessary to duplicate the work setting. Perform some necessary aspects of rehabilitation in the client's work setting. Duplicate the job task components as closely as possible.

Questions C146 to C149 are based on the following information. An individual who is scheduled for a right hip total arthroplasty (THA) is referred to OT. A posterolateral surgical approach will be used. The client has expressive aphasia resulting from a cerebral vascular accident incurred four years ago. Medicare is the client's only health-care benefit. The client states that private payment for any health care services or equipment is not possible at this time. C146. What should the occupational therapist focus on during preoperative OT interventions? The performance of upper and lower extremity strengthening exercises. The performance of IADL in a sitting rather than standing position. The practice of non-weightbearing crutch walking. The use of modified techniques to perform transfers and BADL.

Questions C24 to C28 are based on the following information. A young adult recently diagnosed with depression and anorexia nervosa is a consumer of services at a psychosocial clubhouse. The client attends individual OT sessions once a week and several evening and weekend groups. When completing an activities schedule and questionnaire, the client identifies the clubhouse groups and part-time work as an editorial assistant as the only activities completed each week. In high school the client was captain of the swim team, played tennis and worked in an after-school activities program for young children. C24. The client attends a goal-setting group for persons with depression. Which is the most helpful approach for the occupational therapist leading this group to use with the group members? Encourage the members to discuss long-range planning to attain desired goals. Say as little as possible to allow the members to independently share desired goals. Remain cheerful and upbeat to alleviate the members' pessimistic views of future prospects. Facilitate reality-testing of the members' negative thinking which can constrain goal-setting.

Questions C24 to C28 are based on the following information. A young adult recently diagnosed with depression and anorexia nervosa is a consumer of services at a psychosocial clubhouse. The client attends individual OT sessions once a week and several evening and weekend groups. When completing an activities schedule and questionnaire, the client identifies the clubhouse groups and part-time work as an editorial assistant as the only activities completed each week. In high school the client was captain of the swim team, played tennis and worked in an after-school activities program for young children. C26. The client expresses interest in the pursuit of additional activities outside of the clubhouse and work. Which is the best avocational resource for the therapist to recommend that the client explore? A local fitness center for exercise classes. The town swimming pool for open swimming sessions. The area soup kitchen for volunteer opportunities. A local community center for volunteer opportunities.

Questions C24 to C28 are based on the following information. A young adult recently diagnosed with depression and anorexia nervosa is a consumer of services at a psychosocial clubhouse. The client attends individual OT sessions once a week and several evening and weekend groups. When completing an activities schedule and questionnaire, the client identifies the clubhouse groups and part-time work as an editorial assistant as the only activities completed each week. In high school the client was captain of the swim team, played tennis and worked in an after-school activities program for young children. C28. The clubhouse members attain a level of cohesion which enables them to perform at a cooperative level. Two members of a community integration group disagree with the others on the details of a group project. How should the occupational therapist leading this group respond to this conflict? Clarify all viewpoints and facilitate the members in decision-making. Listen to all viewpoints and suggest that members vote to determine the project details. Mediate only when the members have reached a deadlocked situation. Encourage the members to explore alternative methods to resolve the conflict.

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