NBCOT Musculoskeletal Impairments Exam Prep

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

Which recommendation is appropriate for a client with arthritis who presents with a boutonniere deformity? A. A splint that blocks the proximal interphalangeal (PIP) joint in extension while leaving the distal interphalangeal (DIP) joint free to flex B. A splint to restrict unwanted PIP hyperextension motions during functional activities C. A splint that provides immobilization of the metacarpophalangeal (MCP) joints out of ulnar deviation D. A dynamic splint to facilitate finger flexion in daily functional activities

A. A splint that blocks the proximal interphalangeal (PIP) joint in extension while leaving the distal interphalangeal (DIP) joint free to flex

A client has just undergone hip replacement surgery. Within what time period should a COTA® generally begin performing out-of-bed activities with the client? A. 1-3 days B. 12 hours C. 5-10 days D. 96 hours

A. 1-3 days

A client with a transfemoral amputation who is being fitted for a prosthesis is reporting severe pain when placing weight on the end of the residual limb. The OTR® and COTA® examine the limb but do not see any reddened or open areas. What is this pain MOST likely the result of? A. A neuroma B. Phantom sensation C. Phantom limb D. A sebaceous cyst

A. A neuroma

A client with a hip replacement has been referred to a COTA® for a wheelchair evaluation. What type of wheelchair is the MOST appropriate to maintain hip precautions and preserve mobility? A. A reclining manual wheelchair B. A standard manual wheelchair C. A hemi-height wheelchair D. A lightweight folding wheelchair

A. A reclining manual wheelchair

What piece of adaptive equipment is MOST IMPORTANT to address bathing needs for a hip replacement client with poor balance and weight-bearing restrictions? A. A shower chair B. Nonskid strips C. A long-handled sponge D. A shower caddy

A. A shower chair

A COTA® working at a rehabilitation hospital is given orders for a client who recently underwent a right hip replacement. The COTA® notices a foam wedge between the client's legs. What is the wedge meant to prevent? A. Adduction of the client's lower extremities B. Abduction of the client's lower extremities C. Internal rotation of the client's lower extremities D. External rotation of the client's lower extremities

A. Adduction of the client's lower extremities

A COTA® who has been certified to use physical agent modalities is treating a client with wrist tendinitis secondary to computer use. Before educating the client on wrist positions to avoid, the COTA® has applied iontophoresis to the affected area. Which medication would the COTA® be MOST likely to use with the iontophoresis? A. Dexamethasone B. Acetic acid C. Lidocaine D. Magnesium

A. Dexamethasone

A COTA® is working with a young adult experiencing acute lower back pain. What is the FIRST action the COTA® should take? A. Educate the client in basic body mechanics. B. Provide long-duration, low-intensity back exercises. C. Recommend short-duration, high-intensity back exercises. D. Refer the client for vocational counseling and planning.

A. Educate the client in basic body mechanics.

A client presents with osteoarthritis of the thumb carpometacarpal (CMC) joint. The client reports moderate pain and weakness and experiences triggering during pinching tasks. Which occupational therapy interventions are likely to improve functional hand use? Select the 3 BEST choices. A. Educate to avoid pinching activities B. Teach joint protection techniques C. Fabricate a hand-based thumb spica splint D. Apply heat to the affected area E. Instruct in a home program of resistive pinching exercises F. Provide AROM exercises for the thumb

A. Educate to avoid pinching activities B. Teach joint protection techniques C. Fabricate a hand-based thumb spica splint

A COTA® is working with a client who is concerned about resuming sexual activity after an amputation. What education strategy would be appropriate for the COTA to use with this client? A. Encourage the client's exploration of his or her "new" body. B. Suggest that the client speak with a psychiatrist. C. Provide educational materials in a group setting. D. Discuss the use of a sex surrogate.

A. Encourage the client's exploration of his or her "new" body.

A COTA® is working with a client who was recently diagnosed with De Quervain's tenosynovitis. In addition to the medical treatment of corticosteroid injection, what nonoperative treatment is MOST appropriate for this condition? A. Forearm-based thumb spica splint B. Hand-based thumb spica splint C. Wrist cock-up splint to 10° extension D. Wrist cock-up splint with dynamic extension assist

A. Forearm-based thumb spica splint

A client with breast cancer had surgery including removal of the lymph nodes of the dominant upper extremity. The client was referred to outpatient occupational therapy for ROM, lymphedema management, and education to prevent infection and further lymphedema. Which educational and adjunctive intervention strategies are indicated for the affected upper extremity before the client engages in purposeful and occupational activities? Select the 3 BEST choices. A. Gradient compression garments B. Transcutaneous electrical nerve stimulation C. Resistive shoulder exercises D. Manual decongestive therapy E. Referral for antibiotics for cellulitis F. Education to avoid bug bites and burns to the affected extremity

A. Gradient compression garments D. Manual decongestive therapy F. Education to avoid bug bites and burns to the affected extremity

A COTA® is seeing a client with severe diabetes and obesity in a skilled nursing facility. The client is bedbound and has developed decubitus ulcers. Where are decubitus ulcers likely to be found on the client's body? Select the 3 BEST choices. A. Heels B. Abdomen C. Elbows D. Insulin injection site E. Upper back F. Ischial tuberosities

A. Heels C. Elbows F. Ischial tuberosities

A COTA® is educating a client about what to expect in the process of wound healing after surgery. What are the expected phases of wound healing in the order they occur? A. Inflammation, proliferation, and remodeling B. Coagulation, tension, and scar formation C. Proliferation, inflammation, and remodeling D. Tension, coagulation, and scar formation

A. Inflammation, proliferation, and remodeling

For which condition is a custom wheelchair seating system MOST appropriate? A. Multiple sclerosis (MS) B. Recent total hip replacement C. Guillain-Barré syndrome D. Acute traumatic brain injury (TBI)

A. Multiple sclerosis (MS)

A COTA® is working with a client who has cervical osteoarthritis. The client is currently working as a computer programmer. Which strategy would be contraindicated by the client's condition? A. Putting the computer monitor as low as possible to stretch the neck into flexion while working. B. Taking frequent breaks during work to move the head. C. Performing AROM exercises to maintain ROM. D. Providing a headrest for the work chair to support the head while sitting.

A. Putting the computer monitor as low as possible to stretch the neck into flexion while working.

The client has fair minus (3−) strength in the bilateral shoulder muscles and fair plus (3+) strength in the elbow, forearm, and wrist joint motions. The client's grip strength bilaterally is just below the norm for the client's age and sex, and the client's pinch strength is normal in both hands. With which functional activity will the client have the MOST difficulty? A. Reaching into the closet above shoulder level for a pair of pants B. Using a fork and knife while sitting at the kitchen table C. Using a toothbrush and dental floss while standing at the sink D. Reaching for salt and pepper shakers on the table directly in front of the plate

A. Reaching into the closet above shoulder level for a pair of pants

A client has fair (3/5) muscle strength of the shoulder flexors and is participating in a strengthening program. Which position and movement pattern would be MOST EFFECTIVE for initially increasing strength of the client's shoulder flexors? A. Seated, moving the arm in a sagittal plane B. Seated, moving the arm on a skateboard C. Side lying, moving the arm in a horizontal plane D. Supine, moving the arm in a non-resisted plane

A. Seated, moving the arm in a sagittal plane

A COTA® is working with a client with fibromyalgia who is experiencing disturbed sleep patterns. When a client is chronically sleep deprived, which areas of cognitive functioning are likely to be affected during the day? Select the 3 BEST choices. A. Selective attention B. Sequencing and categorization C. Initiation of movement D. Attention span E. Short-term memory F. Orientation

A. Selective attention D. Attention span E. Short-term memory

What piece of adaptive equipment is MOST IMPORTANT to address bathing needs for a client with a hip replacement who has poor balance and weight-bearing restrictions? A. Shower chair B. Nonskid strips C. Long-handled sponge D. Shower caddy

A. Shower chair

A COTA® is working with a client experiencing lower back pain, particularly after waking in the morning. What is the MOST APPROPRIATE recommendation that addresses the client's sleeping habits? A. Sleep on back with pillow under knees. B. Purchase a thick, cotton pillow. C. Sleep on stomach with pillow under knees. D. Purchase a soft pillowtop mattress.

A. Sleep on back with pillow under knees.

A COTA® wants to use a cognitive strategy to address a motor learning deficit with a client. The client is having difficulty with lower body dressing after hip replacement. Which is the BEST example of a cognitive strategy to use with this client? A. The client imagines using a dressing stick while the COTA describes the process of lower body dressing as the client visualizes completing the activity. B. The client completes and repeats one step of the dressing task until the client can do it independently (e.g., putting the affected leg into the pant opening). C. The client uses various garments to practice lower-extremity dressing (e.g., shorts, sweatpants). D. The client practices dressing while on the edge of the bed, on a mat table, or on a chair until the client is comfortable getting dressed from a variety of surfaces.

A. The client imagines using a dressing stick while the COTA describes the process of lower body dressing as the client visualizes completing the activity.

A client who has rheumatoid arthritis (RA) has difficulty with ADL tasks and has been referred to occupational therapy. Which statement does reflects a principle of joint protection? A. The client should use an alternate grip on a walker, to provide more stability during ambulation. B. The client should lift items on the kitchen countertop instead of sliding them. C. The client should use a handheld purse instead of a backpack, to reduce stress on joints. D. The client should modify daily tasks, such as replacing elastic shoelaces with regular shoelaces, to reduce stress on joints.

A. The client should use an alternate grip on a walker, to provide more stability during ambulation.

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 COTA®spends time training the client in using the sock aid. During an afternoon session, the COTA® has the client practice with the sock aid 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 had a flare-up during the initial treatment session. C. During the initial treatment session, the client was depressed. D. The client's performance improved through training in use of a sock aid.

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

A COTA®, in conjunction with an OTR®, is developing a fall prevention program for an assisted living facility. Which environmental characteristic is MOST often associated with falls? A. Throw rugs B. Tile flooring C. Low furniture D. Pets

A. Throw rugs

A COTA®, in collaboration with an OTR®, is developing a fall prevention program for an assisted living facility. Which environmental factors often associated with falls should they educate participants about? Select the 3 BEST choices. A. Throw rugs B. Tile flooring C. Familiar furniture D. Vestibular dysfunction E. Clutter on the floor F. Poor lighting

A. Throw rugs E. Clutter on the floor F. Poor lighting

A COTA® is explaining the purposes of therapeutic exercise and therapeutic activity to a physician. What are the PRIMARY reasons that these interventions are used for musculoskeletal conditions? A. To improve function, increase strength, and prevent muscle imbalances B. To improve function, maintain joint range of motion, and maintain strength C. To improve coordination, maintain joint range of motion, and increase billable time in therapy D. To maintain strength and teach compensatory movement patterns for weak muscle groups

A. To improve function, increase strength, and prevent muscle imbalances

A client has undergone an open reduction and internal fixation to the left radius and wants to prepare and cook meals while healing. Because of the injury's severity, the doctors do not think that the client will achieve full range of motion and strength. The client is cost conscious and buys fresh fruits and vegetables whenever possible. Which suggestion would be acceptable for the client and offer a low-tech solution? A. Use a cutting board with side rails, suction cups, and food stabilizers. B. Use a food processor with vegetable- and fruit-cutting blades. C. Buy convenience and precut food so that the client can avoid cutting. D. Purchase canned fruits and vegetables during the healing process.

A. Use a cutting board with side rails, suction cups, and food stabilizers.

Which of the following exercise programs is MOST appropriate for a client with rheumatoid arthritis (RA) during an acute flare-up that involves significant pain and swelling? A.Daily PROM of the joints through full comfortable ROM B. Daily AROM of the joints through full comfortable ROM C. Isotonic progressive resistive exercises of the joints as tolerated D. Isometric, alternating resistance, exercises of the joints as tolerated

A.Daily PROM of the joints through full comfortable ROM

A COTA® 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 COTA® 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

A COTA® is working with a client who has just had a total hip replacement using an anterolateral approach. Which type of equipment is MOST important for maintaining appropriate hip precautions? A. A reacher B. An abductor wedge C. A sock aid D. A tub bench

B. An abductor wedge

A COTA® and OTR® are working with a client with severe kyphosis secondary to osteoporosis. What is the primary cause of kyphosis in osteoporosis? A. Pathological deterioration of the vertebrae of the cervical spine B. Pathological deterioration of the vertebrae of the thoracic spine C. Pathological deterioration of the vertebrae of the lumbar spine D. Pathological deterioration of the neck of the femur

B. Pathological deterioration of the vertebrae of the thoracic spine

A COTA®, in conjunction with an OTR®, is preparing a presentation on ergonomics to the local carpenters union. What factor is MOST associated with the onset of lower back pain? A. Low job satisfaction B. Poor physical fitness C. High anxiety behaviors D. High socioeconomic status

B. Poor physical fitness

Which adult is MOST LIKELY to experience a hip fracture? A. A 40-year-old with diabetes B. A 55-year-old with osteoporosis C. A 60-year-old with early stages of glaucoma D. A 75-year-old with early stages of dementia

B. A 55-year-old with osteoporosis

Which client is MOST LIKELY to experience a hip fracture? A. A 40-year-old man with diabetes B. A 55-year-old woman with osteoporosis C. A 17-year-old athletic girl D. A 55-year-old man with dementia

B. A 55-year-old woman with osteoporosis

A COTA® is working in an outpatient orthopedic facility. Which of the COTA's clients have characteristics indicating they are likely to have experienced a hip fracture? Select the 3 BEST choices. A. A 40-year-old man with diabetes and erectile dysfunction B. A 55-year-old woman with osteoporosis and heart disease C. An 80-year-old woman with a history of vertebral fractures D. A 75-year-old man with a recent sharp decline in physical activity level E. A 17-year-old athletic girl who runs track and has a tibia fracture F. A 55-year-old man with early signs of dementia and presbyopia

B. A 55-year-old woman with osteoporosis and heart disease C. An 80-year-old woman with a history of vertebral fractures D. A 75-year-old man with a recent sharp decline in physical activity level

A COTA® is working with clients who have delayed healing of wounds. Which client would be MOST likely to take the longest amount of time to heal? A. A 50-year-old client with hypertension and a finger amputation B. A 77-year-old client with a foot ulcer, diabetes, and shingles C. A 21-year-old client with a radial fracture and a dog bite D. An 18-year-old client with a flexor tendon and median nerve injury

B. A 77-year-old client with a foot ulcer, diabetes, and shingles

A COTA® is conducting a treatment session with a client with chronic obstructive pulmonary disease. While engaging in a light work task from a seated position, the client suddenly experiences extreme shortness of breath, and panics. Which response by the COTA® would be MOST appropriate? A. Ask the client to lean backward and rest the arms on the chair arms, then practice pursed-lip breathing B. Ask the client to lean forward and place the forearms on the thighs, then practice pursed-lip breathing C. Ask the client to sit upright and allow the arms to dangle and guide the client to use visual imagery D. Ask the client to sit upright, use one arm for the work task, and use the other arm to bear weight and support the trunk

B. Ask the client to lean forward and place the forearms on the thighs, then practice pursed-lip breathing

During a seated lower-extremity screening, a client can flex the hips and knees bilaterally and demonstrates good plantar and dorsiflexion at the ankles. After manual muscle testing, the client's hips and knees are able to tolerate moderate resistance bilaterally. Given this information, what could the COTA® safely do with this client next? A. Ask the client to complete some light housekeeping tasks so that the COTA can assess IADL skills. B. Ask the client to stand up so that the COTA can assess the client's balance and ability to ambulate. C. Ask the client to do light hygiene tasks while seated at the edge of the chair. D. Ask the client to perform high-level balance tasks, such as standing on one foot while catching a ball.

B. Ask the client to stand up so that the COTA can assess the client's balance and ability to ambulate.

A client had surgery 6 weeks ago. The surgeon used a plate to fix a metacarpal shaft fracture. The client is experiencing moderate edema that makes it difficult to make a fist. Grasping containers and manipulating clothing fasteners are the most difficult tasks. What is the BEST approach for the COTA® to take to address the client's edema? A. Pneumatic pump and cold packs B. Cold packs and compression glove C. Deep retrograde massage and elevation D. A bulky dressing for the arm

B. Cold packs and compression glove

A COTA® is seeing a client who sustained a severe wound to the right forearm 4 days ago. Given that the client is in the inflammatory stage of wound healing, what would the goal for therapy be with this client? A. Perform aggressive scar management to eliminate adhesions. B. Control excessive edema and inflammation. C. Ensure that no bleeding of the wound is occurring. D. Educate the client to move the involved limb as little as possible.

B. Control excessive edema and inflammation.

A COTA® 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 client is scheduled for hip replacement surgery and the COTA® is educating the client and his family on important information. What is MOST IMPORTANT for the client to learn before returning home? A. Identification of home hazards associated with falls B. Hip precautions and proper transfer techniques C. Proper use of prescribed adaptive equipment D. Community mobility options and public transportation support

B. Hip precautions and proper transfer techniques

A client has been diagnosed with lateral epicondylitis (tennis elbow). The client works in the maintenance department of a large factory and has been unable to complete some work tasks because of pain. The client fears losing this job if the pain does not improve quickly. What is the BEST strategy to assist the client with work tasks while providing relief from pain? A. Ask the client for permission to call his boss and request 3 to 4 weeks off for his arm to heal. B. Identify environmental modifications to help the client complete work tasks without aggravating symptoms. C. Give the client a tennis elbow strap and a stretching home exercise program and follow up in 1 week. D. Suggest the client keep an ice pack at work, and instruct the client to ice the arm on breaks.

B. Identify environmental modifications to help the client complete work tasks without aggravating symptoms.

Which type of splint should be used with a client who has a recent diagnosis of carpal tunnel syndrome? A. Restriction splint B. Immobilization splint C. Mobilization splint D. Ulnar gutter splint

B. Immobilization splint

A COTA® is instructing a client post-hip surgery on after-toileting cleansing while adhering to appropriate hip precautions. What method is the BEST to prevent further injury? A. Advise the client to wipe between the legs in a standing position over the commode. B. Instruct the client to wipe between the legs while seated on an elevated toilet seat. C. Advise the client to wipe from behind the legs in a standing position over the commode. D. Instruct the client to wipe from behind the legs while seated on an elevated toilet seat.

B. Instruct the client to wipe between the legs while seated on an elevated toilet seat.

What intervention technique is MOST commonly used with clients in acute care who have recently received a hip replacement? A. Strengthening of hip flexors for improved ambulation B. Instruction in the use of adaptive equipment for dressing C. Instruction in energy conservation for home management D. Coordination of community resources for safe discharge

B. Instruction in the use of adaptive equipment for dressing

A COTA® observes a client who is able to complete a toileting routine with light hands-on support of the caregiver for safety and balance and manipulating fasteners, but the client is independent with all other steps of the task. What would the COTA report to the OTR® as the client's assistance level? A. Standby assistance or contact guard assistance B. Minimal assistance C. Moderate assistance D. Maximum assistance

B. Minimal assistance

An OTR® and a COTA® work in a clinic for clients with low back pain. What is the BEST way for the COTA® to identify the client's spinal postures? A. Have the client complete a questionnaire identifying preferred postures B. Observe the client performing ADLs, IADLs, and work-related tasks C. Take AROM, PROM, and manual muscle testing measurements of the trunk D. Send a questionnaire to the client's employer to complete while observing the client working

B. Observe the client performing ADLs, IADLs, and work-related tasks

A COTA® is working with a client who underwent a total hip replacement with a posterolateral approach 2 weeks ago. Which activities put the client at risk for hip dislocation if compensatory methods are not used? Select the 3 BEST choices. A. Preparing a stovetop meal B. Putting on socks C. Showering in standing position D. Putting on shoes E. Shopping at a grocery store F. Performing toileting hygiene tasks

B. Putting on socks D. Putting on shoes F. Performing toileting hygiene tasks

A patient underwent a total hip replacement, posterior approach, 2 weeks ago. Which activity puts the patient MOST at risk for hip dislocation if compensatory methods are not used? A. Preparing a stovetop meal B. Putting on socks and shoe C. Showering in standing position D. Shopping at a grocery store

B. Putting on socks and shoe

A client with bilateral transtibial amputation is being fitted for a wheelchair. Which of the following adaptations is MOST important? A. Swing-away elevating footrests B. Rear antitipping devices C. Padded swing-away arm rests D. Wheel-lock extensions

B. Rear antitipping devices

Which adaptation might a COTA® suggest to improve mobility within the home for a client who uses a wheelchair because of a progressive condition? A. Add extra height to the wheelchair cushion to allow for easy access to countertops. B. Remove strips along doorjambs and install offset hinges. C. Use a front-loading washer and dryer with a table nearby for folding. D. Use long-handled reachers and dressing aids.

B. Remove strips along doorjambs and install offset hinges.

A COTA® is working with a client who uses a wheelchair because of a progressive condition. Which adaptations might the COTA suggest to improve client mobility within the home? Select the 3 BEST choices. A. Add extra height to the wheelchair cushion to allow for easy access to countertops B. Remove strips along doorjambs to allow greater pass through for the wheelchair C. Use a front-loading washer and dryer with a table nearby for folding laundry D. Remove carpeting and throw rugs so the wheelchair will be easier to navigate E. Use a long-handled reacher and dressing aid to dress more independently F. Install offset hinges to doorways to provide wider access from room to room

B. Remove strips along doorjambs to allow greater pass through for the wheelchair D. Remove carpeting and throw rugs so the wheelchair will be easier to navigate F. Install offset hinges to doorways to provide wider access from room to room

A COTA® is treating a client who works on an assembly line. The client presents with symptoms of cubital tunnel syndrome. In educating the client, what position does the COTA® advise the client to avoid? A. Sustained elbow extension B. Sustained elbow flexion C. Sustained wrist extension while making a fist D. Sustained wrist flexion while making a fist

B. Sustained elbow flexion

A COTA® is working with a client who has cervical osteoarthritis. The client is currently working as a computer programmer. Which strategies are appropriate to recommend for this client's condition and occupation? Select the 3 BEST choices. A. Placing the computer monitor as low as possible to stretch the neck into flexion while working B. Taking frequent breaks during work to move the head C. Working in 4-hour intervals without neck stretching breaks D. Performing AROM exercises to maintain ROM E. Installing a headrest on the work chair to support the head while sitting F. Placing materials flat on the desk to encourage neck cervical flexion and downward eye gaze

B. Taking frequent breaks during work to move the head D. Performing AROM exercises to maintain ROM E. Installing a headrest on the work chair to support the head while sitting

A client with recent hip replacement surgery is concerned about how to shampoo hair while not able to use the shower at home. What recommendation from the COTA® will most appropriately address the client's concern? A. The client may shampoo the hair while standing in the shower, covering the hip with a plastic bag. B. The client may shampoo the hair while sitting on a stool or standing at the kitchen sink. C. The client may shampoo the hair while in a wheelchair at the bathroom sink. D. The client may shampoo the hair while standing at the bathroom sink.

B. The client may shampoo the hair while sitting on a stool or standing at the kitchen sink.

A COTA® 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.

Which consideration is MOST important for a safe transfer? A. The client's ability to complete upper-extremity ADL tasks B. The client's medical condition—both physical and cognitive status C. The type of surface on which the client will be transferring D. The amount of space between transfer surfaces

B. The client's medical condition—both physical and cognitive status

A 75-year-old client presents to a COTA® after a distal radius fracture 2 weeks earlier. The client's goals, as reported by the OTR®, are to increase range of motion (ROM) and return to the client's favorite activity of gardening. Because the surgeon used a primary healing technique, what must therapy focus on FIRST? A. Therapy must focus on edema reduction, because the client is still in a cast. B. Therapy can begin with passive and active range of motion (PROM and AROM), because the client's bone is fixed with a plate. C. Therapy should not begin for another 2 weeks because the client is elderly and the client's bones are probably brittle. D. Therapy can be aggressive and include strengthening from the first day of therapy.

B. Therapy can begin with passive and active range of motion (PROM and AROM), because the client's bone is fixed with a plate.

An OTR® and COTA® are training a client with a new transradial amputation to wrap the residual limb with an elastic bandage. What is the PRIMARY reason for wrapping the residual limb? A. To desensitize the residual limb B. To develop a tapered distal end C. To reduce phantom sensations D. To protect the limb during healing

B. To develop a tapered distal end

A client is currently under partial weight-bearing (PWB) status after a recent hip fracture. How is this weight-bearing restriction BEST described? A. The client may judge how much weight to put on the affected leg. B. The client's affected toe may touch the ground for balance purposes. C. Only 10% of the client's weight should be placed on the affected leg. D. Only 50% of the client's weight should be placed on the affected leg.

D. Only 50% of the client's weight should be placed on the affected leg.

A COTA® is working with a client with chronic obstructive pulmonary disease (COPD) on a morning ADL routine. Which treatment strategy BEST describes how this client can be independent in showering? A. Use a shower chair, bathe with hot water from a handheld shower, use relaxation breathing, and inhale on exertion B. Use a shower chair, bathe with warm water from a handheld shower, use pursed-lip breathing, and exhale on exertion C. Sit in the tub for support, bathe with hot water from the tub spout, pace by washing one extremity at a time and then resting, and lean backward in the tub D. Sit in the tub for support, bathe with cool water from the tub spout, use a fan to decrease humidity, and rest arms on the sides of the tub

B. Use a shower chair, bathe with warm water from a handheld shower, use pursed-lip breathing, and exhale on exertion

A client's wrist and thumb joints are limited in range of motion, and the client complains of some mild discomfort that affects the client's caregiving duties at home. The OTR® wants to facilitate movement, increase circulation, and decrease pain. What would be the MOST appropriate use of thermal modalities? A. Use deep heat while stretching the client's stiff joints. B. Use superficial heat before or during a passive stretch. C. Use superficial heat or deep heat without stretching the client's stiff joints. D. Use a different modality for this problem.

B. Use superficial heat before or during a passive stretch.

A COTA® is educating a client who recently underwent hip surgery and his family how to enter and exit a car while observing hip precautions. The client owns a very small car with bucket seats. What is the BEST recommendation the COTA® can make for the client's circumstances? A. Sit in the back with the affected leg elevated. B. Use temporary alternative transportation to limit stress on the hip. C. Use a swivel disk for ease of sliding and to face forward. D. Fold the seat back entirely down to increase client mobility.

B. Use temporary alternative transportation to limit stress on the hip.

Which of the following tasks would be MOST appropriate to use during the functional training phase for a client learning to use a unilateral myoelectric terminal device (TD)? A. Grasping and releasing different-sized blocks B. Using scissors to cut paper C. Typing on a computer keyboard D. Brushing teeth

B. Using scissors to cut paper

A client presents with osteoarthritis of the thumb carpometacarpal (CMC) joint. The client reports moderate pain and weakness and experiences triggering during pinching tasks. What is the BEST treatment to improve functional hand use? A. Application of heat to the affected area B. A home program of resistive pinching exercises C. A hand-based thumb spica splint D. An AROM stretching program

C. A hand-based thumb spica splint

A COTA® is working with a client experiencing a cumulative trauma disorder of the right upper extremity. To document client improvement as a result of therapy, which occupation-based statement would the COTA® be MOST likely to write? A. Client's pain-free AROM of right elbow is now 15° to 110°. B. Client can perform 30 repetitions of elbow flexion-extension using a 1-lb weight. C. Client can brush teeth using the involved upper extremity without pain. D. Client demonstrates grip strength to maintain grasp for 15 seconds.

C. Client can brush teeth using the involved upper extremity without pain.

An OTR® and COTA® are working with a client with a transtibial lower limb amputation to develop a prosthetic wearing schedule. The client has been gradually increasing wear time from 15 minutes to 1 hour in 15-minute increments. However, after 1 hour of wear, they notice a reddened area on the residual limb that remains for 45 minutes after removing the device. What is the BEST course of action to take? A. Cut the wear time back to 30 minutes and gradually increase it, using 10-minute increments. B. Add additional socks to better pad the prosthetic device. C. Contact the prosthetist to adjust the device to improve the fit. D. Educate the client on proper residual limb care to prevent skin breakdown.

C. Contact the prosthetist to adjust the device to improve the fit.

A COTA® is seeing a client with severe diabetes and obesity in a skilled nursing facility. The client is bedbound and has developed a decubitus ulcer. Where is the decubitus ulcer MOST likely to occur on the client's body? A. Upper back B. Abdomen C. Elbows D. Insulin injection site

C. Elbows

An OTR® and COTA® are working with a client 8 weeks after a unilateral traumatic transtibial amputation. The client's residual limb is well healed, and the team has identified prosthetic fitting and training as the next step. The client wants to use a prosthesis but indicates that the residual limb is not healed enough and is fearful about wearing it. The client's mother currently performs all limb care, including washing, dressing, and wrapping. What is the BEST strategy to progress the client to prosthetic training? A. Have the prosthetist make the client a prosthesis and implement a wearing schedule. B. Recommend that the client wait another month and then return for prosthetic fitting and training. C. Have the client talk with other clients who have similar amputations. D. Refer the client for psychiatric evaluation and treatment.

C. Have the client talk with other clients who have similar amputations.

A COTA® is working with a client who has sustained a low ulnar nerve injury to the hand. The client has been instructed in visual protection of the hand. Over the weekend, the client experiences burns to the injured hand. What area of the hand would have been burned? A. Thenar side of the hand B. Thumb and index fingers C. Hypothenar side of the hand D. Index and middle fingers

C. Hypothenar side of the hand

A client with rheumatoid arthritis (RA) is beginning to experience ulnar drift. The client enjoys cooking but is finding it increasingly difficult to use a knife to chop food. Which is the BEST intervention for this problem? A. Instruct the client to use a knife with a built-up handle. B. Instruct the client to raise the kitchen counters to place the food to be chopped closer to the shoulder. C. Instruct the client to use a knife with a bent handle. D. Instruct the client to have the spouse do all the food chopping.

C. Instruct the client to use a knife with a bent handle.

A COTA® is working with a client who presents with lateral epicondylitis secondary to the leisure occupation of playing tennis. In the final 2 or 3 OT visits, what treatment intervention would be the most appropriate? A. Application of ice at the end of the treatment session B. Instruction in gentle AROM during functional activities C. Instruction in progressive resistive exercise D. Education to avoid movements that trigger pain

C. Instruction in progressive resistive exercise

A client has Parkinson's disease and lives alone. The client had been in very good health until a neighbor discovered the client lying on the floor after a fall. Which recommendation is MOST appropriate for this client to return home? A. Meals on Wheels B. City-sponsored companion services C. Lifeline-type phone system D. Transport to the grocery store

C. Lifeline-type phone system

A COTA® working in an acute care setting has just instructed a client with a hip replacement on a proper sit-to-stand technique from the chair. What is the BEST method to record the client's adherence to hip precautions? A. Ask the client to demonstrate the activity in the clinic. B. Have the client demonstrate the activity in the room. C. Observe the client in the dining room performing the activity. D. Require the caregiver to demonstrate how they are performing transfers.

C. Observe the client in the dining room performing the activity.

A COTA® in a subacute care setting is working on independent bathing activities with a client who had a recent hip replacement. The client reports having a high-step tub with a shower door at home and no money to buy additional equipment. The COTA® shares this information with the OTR®. Which recommendation is MOST appropriate for bathing? A. Recommend the client substitute a plastic lawn chair for a shower chair. B. Recommend the client place nonskid strips on the floor of the stall. C. Recommend the client sponge-bathe at the sink until equipment can be purchased. D. Recommend the client stay at the facility until equipment can be purchased.

C. Recommend the client sponge-bathe at the sink until equipment can be purchased.

To facilitate more independence in kitchen mobility and meal preparation, which recommendation would be appropriate for a client with bilateral upper-extremity weakness resulting from arthritis? A. Use mops, brooms, and dustpans with extended handles to do cleaning tasks. B. Use pull-out shelves to organize cupboards. C. Store frequently used items on the first shelves of cabinets and on counters where possible. D. Use a wheelchair during kitchen tasks to promote safe mobility.

C. Store frequently used items on the first shelves of cabinets and on counters where possible.

A COTA® is intervening with a client who is "standby assist or contact guard assist for dressing tasks but minimal assistance for bathing tasks." What do these levels of assistance mean? A. The client can dress with someone within eyesight but needs someone within arm's reach for bathing. B. The client can dress with adaptive equipment but needs someone within arm's reach for bathing. C. The client can dress with someone within arm's reach but needs physical assistance for bathing. D. The client can dress with adaptive equipment but needs physical assistance for bathing.

C. The client can dress with someone within arm's reach but needs physical assistance for bathing.

A client with rheumatoid arthritis (RA) is a salesman for a computer company. Part of the client's job is to work in a trade exhibition booth at conferences (10-15 times a month). This task requires the client to stand continuously for 2-4 hours talking with potential buyers. The client reports that at the end of this time, the client's feet, knees, hips, and back are in severe pain, and the client is so fatigued that the client has to go straight home to bed. What is the BEST reasonable accommodation for this job task? A. The client should obtain proper footwear (e.g., orthotic shoes) and wear them while at tradeshows. B. The client should bring antifatigue matting to stand on when talking to customers at tradeshows. C. The client should bring a tall, adjustable sit-stand stool and sit on it throughout tradeshows. D. The client should request that this task be shared with another worker so the client attends fewer tradeshows.

C. The client should bring a tall, adjustable sit-stand stool and sit on it throughout tradeshows.

A COTA® is working with a client who experienced a radial head fracture 6 weeks ago. The COTA is concerned because the client has multiple complaints about pain and range of motion (ROM). Which statement about this client is TRUE? A. This client will need additional education in pain management because pain is the most common complication after elbow injury. B. This client will regain elbow ROM before wrist ROM, because wrist stiffness is the most common complication after elbow injury. C. This client will regain wrist ROM before elbow ROM, because elbow stiffness is the most common complication after elbow injury. D. This client will require only one visit for home exercise program (HEP) instructions, and the OTR can then discharge the client from therapy.

C. This client will regain wrist ROM before elbow ROM, because elbow stiffness is the most common complication after elbow injury.

A COTA® 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 COTA®suspect? A. Low median nerve injury B. High median nerve injury C. Ulnar nerve injury D. Radial nerve injury

C. Ulnar nerve injury

A client with osteoarthritis is independent with ADLs using compensatory strategies. The client wants to participate in a fitness program at a community wellness center. Which activity would be MOST BENEFICIAL to recommend for this client? A. Progressive resistive weight activity B. Low-resistance circuit program C. Water aerobics exercise group D. Step aerobics and stretching class

C. Water aerobics exercise group

A COTA® is providing information on how to safely complete job tasks to nursing staff at a nursing home. Which instruction should be included in the training? A. "Keep feet close together for stability during client transfers." B. "Bend at the waist when performing dressing changes." C. "Arms should be at full length when transferring patients." D. "Bend at the knees, and keep shoulders and hips parallel."

D. "Bend at the knees, and keep shoulders and hips parallel."

Which type of chair is MOST appropriate for a client with hip replacement? A. A sturdy, wheeled secretary office chair B. A traditional recliner with raised footrests C. A wooden, high-back rocking chair D. A firm-based chair with armrests

D. A firm-based chair with armrests

An OTR® and COTA® are working with a client with a unilateral transradial amputation. The client is switching to a salesperson position from a computer operator position. The client does not wear a prosthesis and is independent in all one-handed skills. The client is concerned that the appearance of a residual limb may put the client at a disadvantage during sales calls and would like to obtain a prosthesis. What is the BEST prosthesis for the client? A. An active realistic myoelectric prosthesis B. An active realistic prosthesis C. An passive hook prosthesis D. A passive realistic cosmetic prosthesis

D. A passive realistic cosmetic prosthesis

A client with chronic inactive rheumatoid arthritis (RA) has been referred for occupational therapy. All the joints in the client's wrists and hands are affected by the RA, but the only visible sign is the beginning of ulnar drift. What type of splint is BEST to prescribe for this client with the goal of reducing pain at night? A. A rigid, prefabricated metacarpophalangeal (MCP) joint ulnar deviation splint B. A prefabricated thermoplastic resting hand splint C. A custom-fabricated wrist cock-up splint D. A soft, prefabricated wrist, thumb, and MCP joint support

D. A soft, prefabricated wrist, thumb, and MCP joint support

A COTA® is working with a client who had hip replacement surgery and will be returning home alone upon discharge. What is the BEST recommendation that the COTA® should make regarding kitchen modifications? A. Keep items in current placements to encourage movement. B. Use only the microwave to prepare weekly meals. C. Order delivered, premade food to be brought in for all meals. D. Arrange for commonly used items to be located at counter level.

D. Arrange for commonly used items to be located at counter level.

A COTA® 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

A client with rheumatoid arthritis (RA) presents with the right index finger in 30° of proximal interphalangeal (PIP) flexion and 20° of distal interphalangeal (DIP) hyperextension. What type of finger deformity does the client have? A. Swan neck deformity B. Mallet finger deformity C. Ulnar drift deformity D. Boutonnière deformity

D. Boutonnière deformity

A COTA® 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

According to the Americans With Disabilities Act of 1990 (ADA), what is the definition of essential job functions when considering employment of a person with a disability? A. Functions that an employer determines are to be completed by each employee B. The physical functions of a job task, such as hand manipulation skills for writing C. The speed with which each task must be performed on the job to meet productivity standards D. Functions that an employee must be able to complete, with or without a reasonable accommodation

D. Functions that an employee must be able to complete, with or without a reasonable accommodation

A COTA®, in conjunction with an OTR®, has been asked to provide an inservice for a facility's nursing assistants to prevent back pain or on-the-job injury. What principle BEST reflects safe patient lifting? A. Keep feet together to maintain a high center of gravity. B. Place foot on stool for ease of weight shifting. C. Use a stoop lift to assist clients in tub transfers. D. Maintain the client's body as close as possible while transferring.

D. Maintain the client's body as close as possible while transferring.

A client is currently under partial weight-bearing (PWB) status after a recent hip fracture. How is this weight-bearing restriction BEST described? A. The client may judge how much weight to put on the affected leg. B. The client's affected large toe may touch the ground for balance purposes only. C. Only 10% of the client's weight should be placed on the affected leg. D. Only 50% of the client's weight should be placed on the affected leg.

D. Only 50% of the client's weight should be placed on the affected leg.

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

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

A COTA® is working with a client who received significant burns to the elbow. The client presents with a soft-tissue contracture at the elbow and is noncompliant with wearing an anterior elbow extension splint. What alternative would be BEST for effective treatment of the soft-tissue elbow contracture? A. Ace wrap the splint to hold it in place instead of using straps B. Talk to the OTR® about discharging the client from secondary to noncompliance C. Refer the client back to the plastic surgeon for surgery D. Use serial casting to gradually and slowly stretch the tissue

D. Use serial casting to gradually and slowly stretch the tissue

A client with osteoarthritis is independent with ADLs using compensatory strategies. The client wants to participate in a fitness program at a community wellness center. Which activities would be beneficial to recommend for this client? Select the 3 BEST choices. A. Progressive resistive weight activity B. Low-resistance circuit program C. Step aerobics and stretching class D. Water aerobics exercise group E. Stationary bike use F. Isometric exercises in a small group

D. Water aerobics exercise group E. Stationary bike use F. Isometric exercises in a small group

What is the MOST effective method that an OTR® and COTA® team can use to prevent osteoporosis in community-dwelling adults? A. Distribute a pamphlet on the risk factors and preventive strategies for osteoporosis. B. Work with the community to provide vitamin D and calcium supplements to adults. C. Work in the community to evaluate all adults older than age 50 for symptoms of osteoporosis. D. Work with community leaders to develop a walking and education program for women older than age 50.

D. Work with community leaders to develop a walking and education program for women older than age 50.