NBCOT: Miscellaneous practice questions

An OTR® is working in a lower socioeconomic status school district that offers developmental screenings to all 3-year-olds whose parents can prove residency. As part of the process, the OTR® screens for Duchenne's muscular dystrophy (DMD). Which activity would alert the OTR® to the need to refer the child to a specialist? A. A positive Gower's sign B. Abdominal distention C. Excessive bruising D. A positive Trendelenburg's sign

A. A positive Gower's sign

A client who had a total hip replacement 2 days ago with severe kyphosis as a result of osteoporosis is referred to occupational therapy. The chart notes that the client has been demonstrating signs of malnutrition for the past 4 months. What is the FIRST evaluation the OTR® should complete? A. Evaluation of eating B. Evaluation of meal preparation C. Evaluation of knowledge of nutrition D. Evaluation of feeding

A. Evaluation of eating Kyphosis often leads to deficits in eating skills (e.g., the ability to keep and manipulate food or fluid in the mouth and swallow it).

A client with stroke is taught to dress the weaker side first when donning a button-down shirt. The client then initiates putting the weaker lower extremity into the pant leg. What learning has occurred for the client? A. Generalization B. Transfer C. Automaticity D. Acquisition

A. Generalization

An inpatient is in the recovery phase of Guillain-Barré syndrome. Currently, the patient uses a wheelchair for mobility and has Fair Plus (3+/5) strength of the upper and lower extremities, and Good (4/5) trunk control. The patient wants to be able to return home to care for a preschool-age child. What should be the PRIMARY focus of the patient's intervention during this phase of recovery? A. Gross motor movements and energy conservation for completion of PADL B. Fine motor activities and moderate resistance putty exercises to improve BADL C. Functional splinting and caregiver training for participation in routine ADL D. Compensatory strategies and assistive devices for childcare activities

A. Gross motor movements and energy conservation for completion of PADL Addressing gross motor movements and energy conservation will allow the client to meet goals while addressing the primary needs of improving mobility, maximizing energy available for preferred activities, and increasing strength throughout upper and lower extremities. Explanations of Incorrect Answers B: Upper-extremity strengthening may be components of the intervention plan; however, they are not the primary focus, based on the client's current status and the client's goals. C: Splinting is not indicated for this client with Fair Plus upper-extremity strength. D: The expected recovery from Guillain-Barré syndrome is that clients will regain the majority of their previous strength levels; compensatory strategies are not appropriate because the focus should be on remedial intervention strategies.

A client with a disability works through a supported employment agency in a hotel housekeeping department. The client has difficulty staying on task. Which support would be the MOST effective in helping this client stay on task? A. Hold a social event for workers in the housekeeping department. B. Give the client a written reprimand. C. Place the client in another department. D. Add duties to keep the client busy.

A. Hold a social event for workers in the housekeeping department.

A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. When all the wounds are closed and the graft is stable, what is the BEST intervention to prevent hypertrophic scar development? A. Jobst pressure sleeve with inserts B. Elastic bandage wrapping from distal to proximal C. Scar massage 3-5 times per day D. Frequent PROM and AROM

A. Jobst pressure sleeve with inserts

An OTR® chooses to incorporate the use of preparatory activities to modulate muscle tone, promote proximal joint stability, and improve hand function during a handwriting intervention session. Which model of practice is guiding the OTR®'s intervention? A. Neurodevelopmental B. Acquisitional C. Sensorimotor D. Biomechanical

A. Neurodevelopmental

An OTR® is working on sequencing a bedtime routine with a child with autism. Which activities would be supportive of this outcome? A. Providing the child with pictures of the different tasks involved in the routine so that the child may perform them in order. B. Encouraging the child to complete the last task in a series of tasks so that the child is more inclined to want to complete the routine. C. Allowing the child to select which activities to eliminate from the routine. D. Introducing the child to adaptive equipment (e.g., an electric toothbrush) so that the routine takes less time.

A. Providing the child with pictures of the different tasks involved in the routine so that the child may perform them in order.

An OTR is seeing a client in the upper extremity outpatient clinic. During the initial assessment, the client describes an area extending from the radial head to the proximal aspect of the supinator muscle as having a dull ache and burning sensation. Which syndrome is the client describing? A. Radial tunnel syndrome B. Pronator syndrome C. Carpal tunnel syndrome D. Cubital tunnel syndrome

A. Radial tunnel syndrome Radial tunnel syndrome is compression of the radial nerve in the proximal forearm resulting in a dull ache and burning sensation along the lateral forearm.

An OTR® is working on life skills with a teenager who has achondroplasia. Which of the following tasks might pose a challenge for the client? A. Reaching an upper cupboard to obtain a box of cereal B. Transporting silverware from the dishwasher to the silverware drawer C. Sweeping the kitchen floor after a meal D. Making toast using a toaster

A. Reaching an upper cupboard to obtain a box of cereal People with achondroplasia (often referred to as dwarfism) usually grow be to 4 feet tall or less in height. Their limbs have typical width but are usually shorter in length. A client with this condition might have difficulty reaching an upper cupboard to obtain an item.

In a predischarge consultation with a hip fracture client, the client's spouse reports planning to take the client home in a small four-door car and being unsure as to whether the client can get into the car while adhering to hip precautions. Which solution is the BEST solution for the OTR® to recommend? A. Recommend that the client sit in the rear seat of the car for transportation home. B. Recommend that the client take a cab for transportation home. C. Recommend that the client stay at the facility until proper arrangements are made. D. Recommend that the client's spouse rent a car that can accommodate precautions.

A. Recommend that the client sit in the rear seat of the car for transportation home.

An adolescent client who has muscular dystrophy uses a manual wheelchair that has a backrest cushion and a gel seat insert. The client reports a recent onset of shoulder pain while propelling the wheelchair over a carpeted surface. The OTR® observes that the wheelchair has a backrest cushion that positions the client's pelvis beyond the rear wheel axle. Which wheelchair modification should the OTR® recommend to reduce the client's shoulder pain? A. Remove the backrest cushion. B. Change to an air-filled seat cushion. C. Raise the seat height. D. Adjust the axle plate.

A. Remove the backrest cushion. Removing the backrest cushion will position the client's pelvis directly over the rear wheel axle, which will make propulsion easier.

An OTR® is completing a wheelchair assessment for an adult client who has progressive cerebellar degeneration and requires the use of a power wheelchair for mobility. What type of control switch would be MOST BENEFICIAL for enabling this client to independently operate the wheelchair? A. Sip and puff B. Joystick C. Chin-activated toggle D. Proximity-sensing microswitch

A. Sip and puff

Which is the MOST appropriate position for a client with a hip replacement to perform lower-body dressing? A. Sitting on the side of the bed B. Sitting in a low chair without arm rests C. Sitting with the feet on a stool D. Sitting on a tub bench

A. Sitting on the side of the bed For lower-body dressing, the client should be seated on the side of the bed or in a chair with arms.

A patient with deep partial-thickness burns has an extremely edematous right hand. The patient has multiple open wound areas on the dorsum of the hand and between the web spaces. What is the BEST approach for assessing the effectiveness of treatment in reducing swelling? A. Take circumferential measurements of the forearms, wrists, palms, and digits. B. Use a volumeter to measure water displacement of the forearms and hands. C. Ask the patient to elevate the right hand above the level of the heart. D. Compare differences in time in completing the Nine-Hole Peg Test.

A. Take circumferential measurements of the forearms, wrists, palms, and digits. Even though both circumferential and volumeter measurements are appropriate for edema measurement, the patient has multiple open wound areas, and allowing the hand to get wet might not be appropriate. Circumferential measurement is the more appropriate approach. It might be necessary to obtain the doctor's agreement before wetting a hand with open wounds.

A client with multiple sclerosis (MS) presents with balance deficits and impaired lower-body ADL resulting from increased spasticity in the bilateral lower extremities. The OTR® wants to promote safety during bathing tasks, particularly the parts of the task that require standing. What might the OTR® FIRST suggest? A. That the client maintain at least 90° of hip flexion on a shower chair B. That the client use a long-handled bath sponge to reach the lower legs and feet C. That the caregiver be instructed in stretches to the lower extremities D. That the client place one foot at a time on a small stool while washing

A. That the client maintain at least 90° of hip flexion on a shower chair

An OTR® receives evaluation orders for a client who has recently experienced traumatic brain injury. The client's chart lists a Glasgow Coma Scale (GCS) score of 7. What does this score imply? A. The client has experienced a severe head injury and will provide minimal feedback. B. The client has experienced a moderate head injury and may not be able to provide discernible feedback. IncorrectC. The client has experienced a mild head injury and may be confused but able to follow simple commands. D. The client has experienced an extreme head injury and will provide minimal feedback.

A. The client has experienced a severe head injury and will provide minimal feedback.

An inpatient client post-hip fracture also has moderate rheumatoid arthritis (RA; Stage II) with no current signs of inflammation. The client is seen for dressing training first thing in the morning and requires maximum assistance to use the sock aid because of finger and ankle stiffness. The OTR® spends time training the client in using the sock aid. The OTR® plans to have the client practice with the sock aid in the afternoon session but finds that the client is now independent. What is the MOST likely explanation for this improvement? A. The client was experiencing morning stiffness during the initial session. B. The client was experiencing a flare-up during the initial session. C. The client was experiencing depression during the initial session. D. The client's performance was improved through training in use of a sock aid.

A. The client was experiencing morning stiffness during the initial session.

A client with a chronic median nerve compression at the carpal tunnel has severely diminished functional pinch. In what position should the thumb be splinted to facilitate functional pinch? A. The thumb should be splinted in opposition and palmar abduction to facilitate thumb-to-tip prehension. B. The thumb should not be included in a carpal tunnel orthotic to allow for functional prehension. C. The thumb should be splinted in opposition and radial abduction to facilitate thumb-to-tip prehension. D. The thumb should be splinted in extension to limit shortening of the extensor pollicus longus.

A. The thumb should be splinted in opposition and palmar abduction to facilitate thumb-to-tip prehension.

An OTR® is working with a 2½-year-old child on age-appropriate fine motor skills. Which activity would be most appropriate to support development? A. Unbuttoning large buttons B. Lacing a shoe C. Cutting out shapes with scissors D. Drawing shapes

A. Unbuttoning large buttons

An OTR® is working with a client who works on an assembly line. The OTR® suspects compression of the ulnar nerve at the elbow, or cubital tunnel syndrome. Which two nerve-related assessments would be used when cubital tunnel syndrome is suspected? A. Wartenburg's sign and Froment's sign B. Visual analog scale and Kirschner's test C. Tinel's test and Kleinert's rule D. Allen's test and Phalen's test

A. Wartenburg's sign and Froment's sign

A person incurred a rupture of the ulnar collateral ligament of the MCP joint of the thumb 7 weeks ago. Which intervention approach should the OT use with this client? A. splinting B. AROM C. PROM D. strengthening

B. AROM

An OTR® is treating a client with a cumulative trauma disorder resulting from work in an automotive assembly plant. Acute symptoms have subsided, and the client is preparing to return to work. Which strategies should the OTR® train the client in to prevent symptoms from recurring? A. Deep breathing and relaxation exercises B. Activity modification and proper body mechanics C. Joint protection and pacing techniques D. Energy conservation and work simplification techniques

B. Activity modification and proper body mechanics

An OTR® is working with a client with polyarticular juvenile rheumatoid arthritis (JRA). Which biomechanical technique would be appropriate to include in the client's intervention plan during an exacerbation? A. A resistive exercise program B. An AROM program C. A taping program D. A pacing program

B. An AROM program

A 2-year-old client was referred to an outpatient burn clinic for management of developing scar tightness in the left hand and wrist. The client's mother is the primary caregiver and has expressed severe guilt about the child's being burned in a kitchen fire 6 months ago. The mother is feeling very overwhelmed with the postburn management program and has been having difficulty looking at the client's hand during therapy. What should be the INITIAL program for the mother to carry out at home? A. Compression glove worn 24 hours per day with 20 minutes of deep scar massage every 2 hours during waking hours B. Compression glove worn 24 hours per day with silicone gel pads inserted at all the web spaces and regular play time with play dough and toy building blocks C. Coban™ self-adherent wrap on each individual finger during the day, deep scar massage 3 times per day, and antideformity hand splint at night D. Coban™ self-adherent wrapping of each individual finger and elasticated tubular bandage 24 hours per day, regular PROM of left fingers and wrist

B. Compression glove worn 24 hours per day with silicone gel pads inserted at all the web spaces and regular play time with play dough and toy building blocks Although Coban™ self-adherent wrap might be suitable for the initial phase of compression therapy, it does not provide adequate pressure to manage active tight scars 6 months postburn. Deep scar massage, antideformity hand splint, and PROM are all appropriate scar management interventions. However, it might provoke further guilt feelings in the mother. Use of play activity that requires active use of the hand is the best choice.

A 6-year-old student is being evaluated by an OTR® because of difficulty with completing writing tasks and worksheets. The OTR® conducts an observation during class time. Which functional writing activities should a child this age be able to complete without adult assistance? A. Writing the upper- and lowercase letters of the alphabet without a model B. Copying a triangle, printing own name, and copying most letters C. Writing the numerals 1-10 without a model D. Copying a pentagon and an octagon, printing own address, and drawing a house with 12 details

B. Copying a triangle, printing own name, and copying most letters

A student in the third grade with a learning disability has attended school-based occupational therapy for several years to improve visual-perceptual skills for completing curriculum-based school work. The latest update report to the parents indicates the student is not making progress toward the stated Individualized Education Program (IEP) goals. This report is similar to the previous two reports. What action should the OTR® take NEXT to address the lack of progress? A. Continue occupational therapy intervention knowing that developmental progress due to maturity is still possible. B. Discuss alternative classroom modifications and adaptations with the student's teacher. C. Request the special education team schedule an interim meeting to modify the student's IEP. D. Send a letter to the student's parents informing them that occupational therapy is no longer beneficial to their child.

B. Discuss alternative classroom modifications and adaptations with the student's teacher.

An OTR® is treating a client with a proximal interphalangeal (PIP) flexion contracture secondary to a sports injury. To improve extension of the PIP for functional use of the hand, what is the BEST use of limited therapy time? A. Apply paraffin followed by joint mobilization techniques B. Fit the client with a prefabricated dynamic PIP extension assist splint C. Instruct the client in flexion blocking exercises D. Fabricate a customized dynamic PIP extension assist splint

B. Fit the client with a prefabricated dynamic PIP extension assist splint A prefabricated dynamic PIP extension assist splint will improve PIP extension and takes less therapy time to fit than to custom make this splint.

An OTR® is fabricating an orthotic for a client with radial nerve palsy. Which orthotic design is appropriate to improve function? A. Forearm-based radial thumb spica that supports the lateral aspect of the wrist and hand B. Forearm-based wrist orthotic that maintains the wrist in 30° of extension C. Anticlaw orthosis D. Hand-based short thumb spica

B. Forearm-based wrist orthotic that maintains the wrist in 30° of extension

An OTR® receives evaluation orders for a client who has recently experienced a traumatic brain injury. The client is swearing and anxiously looking for something. What Rancho Los Amigos level BEST corresponds with the client's behavior? A. VI B. IV C. V D. II

B. IV

A student in kindergarten is 5 years old and has Asperger syndrome. The student typically avoids classroom activities requiring the use of manipulatives, has occasional verbal outbursts in class, and becomes agitated during physical education class and other group activities. Evaluation results indicate the student has a mild sensory processing deficit. Which school-based occupational therapy service delivery model would be MOST EFFECTIVE to initially use when providing intervention for this student? A. Consultative B. Integrated C. Pull-out D. Prevention

B. Integrated

An OTR® is treating a client who sustained second- and third-degree burns on the dorsal forearm and hand. Which splint would be appropriate for this client? A. Resting hand splint B. Intrinsic plus splint C. Cone antispasticity splint D. Dorsal flexor tendon repair splint

B. Intrinsic plus splint

A client has been referred to occupational therapy after complaining of difficulty with some ADLs. During the range of motion (ROM) assessment, the OTR® notices that the client has more passive ROM (PROM) in bilateral shoulder flexion than active ROM (AROM). What could be the cause of these ROM limitations? A. Muscle tightness B. Muscle weakness C. Joint contractures D. Joint adhesions

B. Muscle weakness

An OTR® is treating a client who sustained dorsal hand burns secondary to a work-related injury. In the intensive care unit phase of treatment, which technique for completing ROM of the hand is safest? A. Passively range all digits and joints at once B. Passively range each digit and joint one at a time C. Instruct the client to actively make a fist, then straighten the fingers completely D. Instruct the client to wear a resting hand splint at all times

B. Passively range each digit and joint one at a time Ranging each joint separately decreases the chance of rupturing finger extensor tendons with dorsal hand burns. AROM or PROM of more than one joint at a time increases the chance of a tendon rupture after a burn to the dorsal hand.

An OTR® is reviewing a chart on an infant who was referred to the developmental follow-up clinic. The OTR® notes that the mother transmitted syphilis to the baby during birth. Which impairments might be seen in the child? A. Poor bladder control B. Poor tolerance of passive range of motion C. Poor balance D. Poor feeding and vomiting

B. Poor tolerance of passive range of motion

Which treatment activity would support a pediatric client's ability to increase visual attention to complete homework tasks? A. Providing directional cues paired with verbal cues B. Reorganizing a worksheet so that the answer spaces are clearly defined C. Using a game like Bingo D. Color-coding folders and notebooks for different subjects

B. Reorganizing a worksheet so that the answer spaces are clearly defined

An OTR® is working in the neonatal intensive care unit with an infant who was born at 26 weeks gestation. The infant's birth history is positive for placental abruption. Given this information, what might the OTR® observe for? A. Signs and symptoms of Marfan's syndrome B. Signs and symptoms of congenital cerebral palsy C. Signs and symptoms of fragile X D. Signs and symptoms of erythrocytosis

B. Signs and symptoms of congenital cerebral palsy

An OTR® is working with a 10-year-old girl with Rett's syndrome. What can the OTR® expect by the time the girl reaches late childhood? A. The child will be able to cook a simple meal. B. The child will not be able to walk or speak. C. The child will not be able to express discomfort. D. The child will be able to put earrings on independently.

B. The child will not be able to walk or speak.

An OTR® is performing a presurgical intervention with a client who will undergo hip replacement surgery in a few days. Which recommendation regarding sleep positioning is MOST appropriate? A. The client should sleep in the most comfortable position that is pain free. B. The client should sleep in supine position with a wedge or pillow in place. C. The client should sleep in prone position with a wedge or pillow in place. D. The client should sleep in side-lying position.

B. The client should sleep in supine position with a wedge or pillow in place.

What would be considered the first line of treatment in the acute setting for the medical management of a cardiovascular accident (CVA)? A. Anticoagulants B. Thrombolytic agents C. Antiplatelet treatments D. Nonsteroidal anti-inflammatory drugs

B. Thrombolytic agents

An OTR® is working with a child who was identified as having sensory integrative dysfunction. What is the typical duration of Ayres Sensory Integration treatment? A. Typically 1 to 2 times per week for 1 year B. Typically 1 to 2 times per week for 2 year C. Typically 3 to 4 times per week for 1 year D. Typically 3 to 4 times per week for 2 year

B. Typically 1 to 2 times per week for 2 year

An OTR is advising a client who has had a flexor tendon repair on the timing for resuming ADLs. During what time period is the flexor tendon repair the weakest and most likely to rupture? A. 1-3 days postsurgery B. 4-9 days postsurgery C. 10-12 days postsurgery D. 4-8 weeks postsurgery

C. 10-12 days postsurgery Explanations of Incorrect Answers A, B: At 1-9 days postsurgery, the tendon is still newly repaired and has the strength of the original suture. D: The period 4-8 weeks postsurgery is considered the intermediate phase, during which the tendon gains strength.

An OTR® is working on exploring the home environment with an infant in early intervention. The child is approximately 3 months behind in gross motor skills. Given this delay, at what age would the OTR® expect the child to crawl? A. <6 months B. 9 months C. 12 months D. 15 months

C. 12 months

An OTR® is working with a child on shoe tying. At around what age can the OTR® expect a typically developing child to master this skill? A. Age 4 B. Age 5 C. Age 6 D. Age 7

C. Age 6

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

C. An ultra-light rigid frame with a low back

An OTR® is working with a client who has upper-extremity injuries incurred in a motorcycle accident. The client is being treated using hydrotherapy as a modality for wound debridement. Which tissue needs to be debrided for healing of a wound to occur? A. Red or inflamed tissue B. Hypertrophic scar tissue C. Black or yellow tissue D. Keloid scar tissue

C. Black or yellow tissue

An OTR® fabricated a thermoplastic splint for a client with carpometacarpal (CMC) osteoarthritis to support the CMC joint. The client is unable to wear it during work hours because some movement of the joint is required to complete tasks. Which positioning device would BEST suit this client's needs? A. CMC plaster of Paris cast B. CMC fiberglass cast C. CMC neoprene wrap support D. Thicker CMC thermoplastic splint

C. CMC neoprene wrap support A neoprene strap provides less support but allows some movement.

An OTR® is working in the neonatal intensive care unit with a 28-week-old infant and the infant's mother. The infant has bronchopulmonary dysplasia (BPD). Which occupation would be affected by this condition? A. Bathing B. Dressing C. Feeding D. Socializing

C. Feeding Infants with BPD may require the use of mechanical ventilation and other traumatic interventions to treat acute respiratory problems. In addition, they may experience excess mucus and airway thickening that may make feeding difficult.

A blocking splint fabricated to maintain the metacarpophalangeal (MCP) joints in extension can be useful to isolate which joint movements? A. MCP joint flexion and flexor digitorum profundus (FDP) excursion B. Interphalangeal (IP) joint extension and FDP excursion C. IP joint flexion and FDP excursion D. Proximal IP joint extension and FDP excursion

C. IP joint flexion and FDP excursion

Which intervention strategy would be appropriate when teaching a compensatory approach for the production of written language to a child who has a diagnosis of developmental coordination disorder? A. Provide the child with a pencil grip. B. Encourage the teacher to provide a copy of the teacher's notes. C. Instruct the child in keyboarding. D. Allow the child to use print instead of cursive writing.

C. Instruct the child in keyboarding.

An outpatient OTR® is assessing a burn survivor, who reports having increasing difficulty in self-feeding because of difficulty in bending the right elbow. During PROM assessment, the client reports localized pain at the elbow when flexed more than 100°. The OTR® feels a hard end feel at the elbow flexion. What is the BEST initial intervention? A. Provide the client with low-load prolonged stretch using an elbow flexion splint. B. Instruct the client in daily aggressive PROM at the elbow. C. Instruct the client in a daily AROM program within the pain-free range. D. Recommend the client use a long-handled swivel spoon for self-feeding.

C. Instruct the client in a daily AROM program within the pain-free range.

An OTR® has completed the Allen Diagnostic Module with a client who has dementia. Results indicate that the client is functioning at a 4.6 level (Goal-Directed Actions). Based on this information, which strategy would MOST effectively promote the client's success during a grooming task? A. Demonstrate and ask the client to imitate the OTR®'s movements. B. Guide the client through the physical movements of the task. C. Lay out the items needed for the task prior to the start of the session. D. Use verbal praise during each task to encourage on-task behavior.

C. Lay out the items needed for the task prior to the start of the session.

An OTR® is evaluating a 7-year-old child with attention deficit hyperactivity disorder who has significant handwriting delays. Which assessment is BEST to use to compare this child's performance with that of same-age peers? A. Beery-Buktenica Developmental Test of Visual Motor Integration B. Print Tool Handwriting Assessment C. Minnesota Handwriting Test D. Peabody Developmental Motor Scales

C. Minnesota Handwriting Test

An OTR® is working with a client who has had a cerebrovascular accident (CVA). One of the client's goals is independence in baking activities. Which modality intervention is BEST used to decrease shoulder subluxation of the nonpainful hemiparetic arm during this task? A. Ultrasound B. Fluidotherapy C. Neuromuscular electrical stimulation (NMES) D. Conventional transcutaneous nerve stimulation (TENS)

C. Neuromuscular electrical stimulation (NMES)

What is the PRIMARY benefit of using the SETT (Student, Environment, Task, Tools) Framework to guide assistive technology (AT) evaluation and service delivery in a school-based setting? A. Helps to reduce the incidence of learned helplessness and low self-esteem among students who have communication deficits B. Meets specific standardized assessment requirements as outlined in the Individuals With Disabilities Education Improvement Act of 2004 C. Promotes educational team collaboration regarding students' AT needs throughout the school day D. Provides a method for prioritizing students' occupational therapy intervention activities based on hierarchy of scores

C. Promotes educational team collaboration regarding students' AT needs throughout the school day

An OTR® working in an acute care hospital has completed the initial self-care evaluation with a patient who has had a recent TBI and is functioning at Level VI (Confused-Appropriate) on the Rancho Los Amigos scale. During grooming and hygiene tasks the patient is able to stand at the sink with stand-by assistance, is easily distracted and consistently requires verbal and tactile prompts. The OTR® observed that the patient put toothpaste on a washcloth when preparing to brush teeth and attempted to brush hair with a toothbrush. Additionally, the OTR® noted that the patient has minimal spontaneous functional movement of the left upper extremity and uses synergistic movements when asked to grasp and hold objects. Which recommendation should the OTR® provide nursing staff to maximize this patient's independence with BADLs? A. Encourage the patient to select items needed for each task. B. Provide multisensory cues for locating self-care items. C. Provide task setup and simple instructions. D. Use hand-over-hand assistance during dressing.

C. Provide task setup and simple instructions.

An OTR® is working on dressing in early intervention with a 2-year-old who has a developmental delay. The child is able to take off socks and put legs through pant holes when pants are held up. What is the next area of dressing the OTR® should address? A. Lace shoes. B. Put on mittens. C. Remove coat. D. Put on socks.

C. Remove coat

An OTR® chooses to incorporate the use of a variety of experiences, different media, and novel instructional materials during a handwriting intervention session. Which model of practice is guiding the OTR®'s intervention? A. Neurodevelopmental B. Acquisitional C. Sensorimotor D. Biomechanical

C. Sensorimotor

An OTR® is working with a client who recently sustained a right-sided cerebrovascular accident with left-sided paresis. The OTR is assisting the client with a wheelchair-to-bed transfer. What instructions would the OTR give the client BEFORE initiating the transfer? A. Shift weight into an anterior pelvic tilt, place the right hand on the wheelchair armrest, and point the heels away from the bed. B. Shift weight into an anterior pelvic tilt, place the right hand on the OTR's back, and point the heels toward the bed. C. Shift weight into an anterior pelvic tilt, place the right hand on the wheelchair armrest, and point the heels toward the bed. D. Shift weight into a posterior pelvic tilt, place the right hand on the wheelchair armrest, and point the heels toward the bed.

C. Shift weight into an anterior pelvic tilt, place the right hand on the wheelchair armrest, and point the heels toward the bed.

An OTR is working with a client who jammed the distal interphalangeal (DIP) joint of the long finger while playing basketball. The terminal tendon was avulsed, so the client was diagnosed with mallet finger. Which occupational therapy intervention is appropriate to use FIRST with this client? A. Show the client DIP flexion and extension exercises to perform daily for 2 weeks. B. Advise the client to limit playing basketball for 3 weeks to give the tendon time to heal. C. Splint the client's DIP joint in full extension continuously for 6 weeks. D. Refer the client to the orthopedic doctor for surgery.

C. Splint the client's DIP joint in full extension continuously for 6 weeks.

An OTR® is considering using an ergonomics rating scale with a worker participating in back training. Which factor is MOST important to consider in selecting an ergonomics rating scale? A. Whether the rating scale can detect subtle change in task performance B. Whether the rating scale provides information on fatigue tolerance C. The extent to which the rating scale is reliable and valid D. The worker's preference for body position when performing tasks

C. The extent to which the rating scale is reliable and valid

An OTR® has been working with a client recently diagnosed with complex regional pain syndrome of the upper extremity secondary to an improperly casted distal radius fracture. Which modality is BEST to reach the treatment goal of pain control for this client? A. Cold spray B. Neuromuscular electrical stimulation (NMES) C. Transcutaneous electrical nerve stimulation (TENS) D. Iontophoresis

C. Transcutaneous electrical nerve stimulation (TENS)

An OTR® is working with a client presenting with a claw hand deformity who has both decreased grip and lateral pinch strength. Before reading the medical notes, what type of injury would the OTR® suspect? A. Low median nerve injury B. High median nerve injury C. Ulnar nerve injury D. Radial nerve injury

C. Ulnar nerve injury A claw hand is the result of an ulnar nerve injury. The fourth and fifth interossei and lumbrical muscles are paralyzed, and the unopposed extensor digitorum musculotendon unit hyperextends the metacarpophalangeal joints. ***NBCOT prep says low median nerve injury can cause claw hand of index and middle fingers

An OTR® is treating a client with a boutonniere deformity using conservative splinting. Which statement can the OTR use to educate the client about the proper use of the circumferential proximal interphalangeal (PIP) joint orthosis? A. Wear the orthosis only at night to maintain the PIP joint in extension when at rest. B. Remove the orthosis every hour for passive motion exercises. C. Wear the orthosis continuously up to 6 weeks. D. Wear the orthosis during the day, but remove it at night.

C. Wear the orthosis continuously up to 6 weeks.

A client with a unilateral transradial amputation is undergoing pre-positioning training for a myoelectric arm. Which of the following is the MOST appropriate goal? A. Within three sessions, the client will independently don the prosthesis and obtain good electrical contacts with the electrode sites 100% of the time. B. Within three sessions, the client will be able to open and close the myoelectric terminal device 100% of the time. C. Within 1 week, the client will be able to accurately identify how to arrange the wrist of the myoelectric terminal device to be able to optimally grasp different objects. D. Within 1 month, the client will be able to use the myoelectric terminal device as a functional assist and stabilizer in 100% of daily activities.

C. Within 1 week, the client will be able to accurately identify how to arrange the wrist of the myoelectric terminal device to be able to optimally grasp different objects.

An OTR is working with a client who has decreased nerve function. The client has lost precision pinch, thenar opposition, and the ability to bend the index and long fingers at the proximal and distal interphalangeal joints. What deformity is the client MOST likely to have? A. Ulnar claw B. Boutonniere deformity C. Swan neck deformity D. Ape hand deformity

D. Ape hand deformity

An OTR® receives a referral to evaluate an older adult client with moderate-stage dementia who resides in a long-term care facility. While the OTR® is conducting the assessment, it becomes apparent that the client is becoming agitated. The client tells the OTR® that she or he is going to make the client late to pick up the client's children from daycare. What is the BEST approach for the OTR® to take in this situation? A. Remind the client that the children are grown adults. B. Attempt to engage the client in an alternative activity. C. Leave the client alone and plan to return later in the day. D. Assure the client that the client will be able to get to the daycare on time.

D. Assure the client that the client will be able to get to the daycare on time.

An OTR® is working with a client diagnosed with fibromyalgia who is experiencing disturbed sleep patterns. Which cognitive areas of functioning are disturbed sleep patterns MOST likely to interfere with? A. Arousal and orientation B. Sequencing and categorization C. Initiation of movement and language D. Attention span and short-term memory

D. Attention span and short-term memory

An OTR®; is completing an intervention to address a client's decreased postural stability when performing tasks in standing. The client has hemiparesis after a stroke. The OTR wants to elicit a postural response at the trunk when completing an intervention activity. Where should the OTR place task objects FIRST to elicit a trunk response? A. Above the client's head B. Within arm's reach C. On a moveable surface D. Beyond arm's reach

D. Beyond arm's reach

An OTR® is performing an initial evaluation of a client with an acute full-thickness burn to the dorsum hand involving all digits. The OTR® is applying Boutonniére precaution and avoiding having the patient form active or passive composite flexion of the fingers. What is the MOST APPROPRIATE clinical reasoning for this approach? A. The tensile strength of the burned skin will not allow for composite flexion of the fingers. B. A bulky dressing on the hand will limit the ability to form composite flexion of the fingers. C. Immobilization is critical for the initial wound healing to avoid wound widening from movement. D. Composite flexion of the fingers increases the risk of extensor dorsal hood disruption.

D. Composite flexion of the fingers increases the risk of extensor dorsal hood disruption. Explanation of Incorrect Answers: A: If the integrity of the dorsal hood has been verified, then it is important to stretch the dorsal burn area by doing active composite flexion of the fingers. B: If the integrity of the dorsal hood has been verified, bulky dressing might limit the composite movement of fingers but should not be preventing active or passive movement to prevent contracture development. C: Unless it is during the initial post-skin graft period, total immobilization is not needed in a postburn management program

A client sustained partial-thickness and deep-thickness burns over a total body surface area of 60%, including the bilateral arms and legs. In the acute phase postburn, on what should the OTR® focus? A. Fluid retention B. Scar management C. Sensory reeducation D. Deformity prevention

D. Deformity prevention

An adolescent with Down syndrome is applying for a part-time job and completing an online job application. Which visual-perceptual skill would this adolescent need to use to locate the appropriate tab to click on to submit the application? A. Form constancy B. Depth perception C. Visual-spatial orientation D. Figure-ground recognition

D. Figure-ground recognition

A client is being treated for an extensor tendon repair in Zone VI of the middle finger proximal to the juncturae tendinum. Which orthosis would be MOST appropriate? A. Hand based, including only the middle finger B. Forearm based, including only the middle finger C. Hand based, including the middle, ring, and index fingers D. Forearm based, including the middle, ring, and index fingers

D. Forearm based, including the middle, ring, and index fingers It is important to consider adjacent digits when applying an orthosis. In this example, the injury falls proximal to the juncturae tendinum, which can apply force to the repaired site if the adjacent digits were to flex, thus compromising the repair. Explanations of Incorrect Answers: A, C: Hand-based orthoses would not protect the tendon repair unless the wrist were immobile as well. B: Adjacent digits need to be included in the splint because flexion of adjacent digits can apply too much force to the tendon repair, resulting in a possible rupture.

A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. To minimize the risk of graft rejection in the initial phase (7 days postinjury), in what should the client be instructed? A. Daily active pronation and supination exercises at least 5 times per day B. Desensitization using ice to gently rub the burned areas from distal to proximal C. Retrograde massage followed by elastic bandage wrapping from distal to proximal D. Immobilization using the elbow extension splint and avoiding forearm movement

D. Immobilization using the elbow extension splint and avoiding forearm movement

An OTR® decides to use desensitization techniques in structured practice within the context of daily activities for a client with hypersensitivity secondary to peripheral nerve injury. Which desensitization technique would be the MOST therapeutic initially? A. Begin using desensitization with the texture that is the most irritating to the client B. Begin using desensitization at the most sensitive area to be treated C. Instruct the client to use the desensitization techniques one or two times a day for 30 minutes each as part of a home program D. Instruct the client in use of a transcutaneous electrical nerve stimulation (TENS) unit during desensitization activities

D. Instruct the client in use of a transcutaneous electrical nerve stimulation (TENS) unit during desensitization activities

An OTR® is working with a child with sickle cell anemia. Which intervention strategy would be appropriate when working with this child? A. Joint protection B. PROM C. Pursed-lip breathing D. Pain management

D. Pain management

An OTR® is working in a pediatric developmental follow-up clinic and learns that a new client has a diagnosis of congenital club hand. When the child and the parent enter the room, the OTR® attempts to gain more information about the client's diagnosis through observation. For what should the OTR® be looking? A. Partial or full absence of the capitates and hamate and muscle hypertrophy B. Dislocation of the humerus and signs of nerve damage C. Bony malformations and underdeveloped musculature D. Partial or full absence of the radius and bowing of the ulnar shaft

D. Partial or full absence of the radius and bowing of the ulnar shaft

An OTR® is a member of an interdisciplinary work hardening program. When completing documentation according to best practice guidelines, which type of documentation should the OTR® NOT use? A. Progress notes that include pain reports, psychosocial complaints, modalities received, job analysis, and plans for next session B. Daily notes that reflect a detailed description of circuit training, including duration, number of repetitions, or both C. Progress notes that reflect the client's attendance, number of sessions, and response to the program D. Progress notes that reflect daily gradations of activities and exercises arranged in a therapeutic hierarchy

D. Progress notes that reflect daily gradations of activities and exercises arranged in a therapeutic hierarchy

A 4-year-old child with bilateral congenital limb deficiencies at the transhumeral level was recently fitted with new prostheses. Which activity should be introduced FIRST as part of the prosthetic program with the child? A. Self-feeding using standard eating utensils B. Coloring pictures in an oversized coloring book C. Stacking 1-inch (2.54-cm) wooden blocks D. Pushing an 18-inch- (45-cm-) diameter exercise ball

D. Pushing an 18-inch- (45-cm-) diameter exercise ball

A client is attending occupational therapy for conservative management of acute carpal tunnel syndrome. What information would be MOST BENEFICIAL to provide the client during the initial stage of the intervention process? A. Methods for immobilizing the hand, importance of taking anti-inflammatory medications, and typical work restrictions B. Handouts illustrating therapy putty exercises, proper wear and care of a resting hand splint, and methods for completing contrast baths C. Instructions for upper-extremity strengthening using therapy bands, fine motor activities, and stress-loading exercises D. Techniques for managing edema, illustrations of tendon glide exercises, and methods for modifying daily activities

D. Techniques for managing edema, illustrations of tendon glide exercises, and methods for modifying daily activities

An OTR® is working with a 4-year-old who was recently diagnosed with Duchenne's muscular dystrophy (DMD). The client's parents are concerned and want to understand how this condition will progress and affect the child's participation in daily life. Which statement describes the progression of DMD? A. The condition progresses slowly, and children often experience difficulty with muscles around their pelvis and shoulder girdle. B. The condition progresses so that the facial muscles have decreased mobility; children eventually have a masklike appearance. C. The condition usually has an onset before adolescence, and it progresses until children cannot raise their arms above their heads. D. The condition progresses quickly, and children often need to use a wheelchair by age 9.

D. The condition progresses quickly, and children often need to use a wheelchair by age 9.

An OTR® has a client who is no longer able to propel a manual wheelchair and is considering a power mobility device. The client asks the therapist's opinion on the advantages of a scooter over a power wheelchair. Which of the following statements about scooters is TRUE? A. They provide for more postural control with seating. B. They require a smaller turning radius to maneuver. C. They involve an easier steering system. D. They are easier to load into the trunk of a car.

D. They are easier to load into the trunk of a car.

An inpatient who has Stage III lung cancer undergoes surgery for removal of axillary lymph nodes of the dominant upper extremity, followed by palliative chemotherapy. The patient is referred to occupational therapy for ROM, edema management, and preparation for hospice care at home. Which intervention modality is CONTRAINDICATED for reducing edema of this patient's affected extremity? A. Gradient compression garments B. Superficial slow-speed vibration C. Manual decongestive therapy D. Transcutaneous electrical nerve stimulation

D. Transcutaneous electrical nerve stimulation Use of modalities may exacerbate edema conditions and are generally contraindicated in situations of cancer.

Which clinical situation would be LEAST amenable to positioning and splinting solutions for decreasing soft-tissue contracture to improve functional use for occupational performance? A. Use of a volar antispasticity hand splint while weight bearing to decrease flexor tone in the wrist and fingers B. Use of a C-bar splint to stretch the first web space of the hand secondary to a medial nerve injury C. Use of a knee extension splint for a client with a below-the-knee amputation while sitting in a wheelchair D. Use of an elbow extension splint post fracture to release a boney block

D. Use of an elbow extension splint post fracture to release a boney block Explanation of incorrect answers: A: A volar antispasticity hand splint can decrease a soft-tissue contracture once minimal or moderate abnormal tone has been inhibited. B: A C bar splint can maintain or improve the first web space affected by a median nerve injury. C: A client with a below-the-knee amputation tends to flex the knee when sitting in a wheelchair. Use of a knee extension splint can decrease the knee flexion contracture.

An OTR® is speaking to a group of nurse aides employed in a skilled nursing facility regarding dressing of residents who have Stage III Alzheimer's disease. What should the OTR® tell the aides about the expected level of dressing performance for these residents? A. Environmental aids should be used to assist the residents with completing dressing tasks. B. One-step commands are needed to start dressing and every few minutes thereafter until the task is complete. C. Total assistance is required for the residents to complete all dressing activities. D. Verbal cueing and physical assistance are needed throughout the dressing task.

D. Verbal cueing and physical assistance are needed throughout the dressing task.

A client with a nondisplaced shaft fracture of the right fifth metacarpal has a physician's order for full-time splinting. Which orthosis would the OTR® be MOST likely to fabricate? A. Dorsal hood splint with the wrist in approximately 20° flexion, all metacarpophalangeal (MCP) joints of the affected hand in 70°-90° flexion, and interphalangeal (IP) joints of the affected hand in 0° extension B. Volar-based ulnar gutter with MCP and IP joints of the ring and fifth fingers in 0° extension and the wrist in neutral C. Dorsal-based wrist cockup splint with MCP and IP joints free and the wrist in approximately 20° extension D. Volar-based ulnar gutter with MCP joints of the ring and fifth fingers in 70°-90° flexion, fourth and fifth IP joints in 0° extension, and the wrist in approximately 20° extension

D. Volar-based ulnar gutter with MCP joints of the ring and fifth fingers in 70°-90° flexion, fourth and fifth IP joints in 0° extension, and the wrist in approximately 20° extension Holding the MCP joints in flexion helps prevent contracture of the collateral ligaments.

An OTR® is seeing a client in an outpatient clinic. The client is experiencing pain and swelling in the radial wrist extensor muscles. Treatment includes use of phonophoresis using hydrocortisone. For safe treatment of this client, what information is MOST important to be aware of? A. How long the pain and swelling have been present B. What prior surgeries the client has had C. What activities aggravate the pain and swelling D. What the client's medications and medication allergies are

D. What the client's medications and medication allergies are

An OTR is working with a client who has been in a motor vehicle accident. The client has sustained flexor tendon injuries to the index and middle fingers and also presents with a median nerve injury. Which flexor tendon zone corresponds to this client's injuries? A. Zone I B. Zone II C. Zone III D. Zones IV and V

D. Zones IV and V

An OTR is working with a client with a flexor tendon injury. One week after repair surgery, the OTR removes the cast made postsurgery and fabricates a splint. Which splint is appropriate for this client? A. Active wrist extension splint B. Active wrist, finger, and thumb extension splint C. Resting hand splint D. Dorsal blocking splint

D. dorsal blocking splint

An OTR® is treating an outpatient client who has sustained burns to the face, neck, and hands. Customized pressure garments are being fitted to reduce hypertrophic scarring. Which item cannot be used under the pressure garments to increase conformity to the skin? A. Silicone gel sheet B. Neoprene sheet C. Silastic elastomer D. Dynamic splint

D. dynamic splint Dynamic splinting is primarily used to decrease soft-tissue contractures surrounding joints, not hypertrophic scarring of the skin, and splints are worn over the pressure garment, not under it.